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CardioPulm Midterm Review Name the 3 normal breath sounds
& corresponding location. If they are present in different
areas than expected, it is
suggestive of certain pathologies – know them. escribe
adventitious sounds.
!rachea normally midline " contra#shift for $!% " ipsi#shift for
atelectasis
reath sounds ↓ with ↓ or ∅ air flow
reath sounds ↑ with consolidation or fluid
Normal breath sounds
!racheobronchial – high pitch, harsh, exhale loud & long vs.
inhale – heard over manubrium'lsewhere consolidation
onchovesicular – hollow, moderate intensity ( pitch, inhale )
exhale – heard over central airways *rib+, between scapulae
'lsewhere early ( partial consolidation or compression
-esicular – soft, low pitch, gentle rustling, inhale loud &
long vs. exhale – heard peripherally *most ofnormal chest
dventitious sounds
/rackles ( 0ales – atelectasis, fibrosis, pulmonary edema,
pneumonia – during inhale
1hee2es – high pitch, musical – partially obstructed airway,
asthma – during exhale0honchi – low pitch, musical, snoring –
centrally obstructed airway
$leural sounds – grating, creaking, scratching – pleural
inflammation & friction – during end of inhale,
beginning of exhale
tridor – high pitch – inhale or exhale – proximal airflow
obstruction
Review both your assessment & pharmacology charts. 4ou
will be given brief case studies. e able to determine thelikely
diagnosis or treatment based on the assessment techni5ues you
learned.
1hat are the causes of dyspnea6
↑ 7+ demand *exercise, sepsis, fever
♥ dysfunction
/7$ 8usculoskeletal restrictions Neurological impairments
9luid imbalance
nemia nxiety
8etabolic acidosis econditioning
/alculate pack years
*: of pack per day x *years smoking
Review postural drainage position pictures. ;ow & when do
you use percussion or vibration6$ostural drainage to mobili2e or
prevent accumulations of secretions
1atch out for< $!%, hemoptysis, unstable ♥, post#op, /;9, $',
pleural effusion, feeding tube, trauma
nausea(vomiting
$ercussion *whole cycle or vibration *exhale only to loosen
retained secretionsecreases time in postural drainage position
Normal & abnormal breathing patterns
Normal – diaphragm upper abdomen rises lateral
rib expansion upper chest expansion
bdominal paradoxical – abs get sucked in during inhale *opposite
of expected ==severe /7$==
/hest paradoxical – intercostals sucked in during inhale, while
belly bulges ==/I==
7thers< accessory muscle overuse, asymmetrical breathing,
shallow breathing, ∆ speech, lateral breathing
In order to auscultate over correct regions of the lungs, you
must know your surface anatomy & landmarks & what
lies below.
$osterior – rib > is the hori2ontal lung fissure? ribs @#AB
below bra line? ribs >#C under sports bra? rib C at
inferior
scapula? lung base at rib D? !3 spinous process is obli5ue
fissure
Eateral – lung base at rib @nterior – 0ibs A#3 above the axilla?
rib A deep to clavicle? sternal angle & lung carina at rib +,
xiphoid Function
at rib D? trachea at Fugular notch? lung base at rib AA?
midclavicular rib D is obli5ue fissure
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CardioPulm Midterm Review/ompare & contrast the appearance
of the thorax throughout development & what changes occur with
diseases like
emphysema.
Normal adult – +x wide as deep *elliptical, down#sloped
ribs, cage occupies G trunk /7$ – barrel chest, hori2ontal
ribs, cage occupies HG trunk
Normal baby – triangular chest, Ax wide as deep,
hori2ontal(locked ribs, cage occupies A(3 trunk
Dmo – can see neck, ribs slope down, rectangular chest, cage
occupies G trunk, more elliptical
nderstand the continuum of ventilators and supplemental oxygen.
e able to calculate 9i7+.
9i7+ – room air ) +A: 7+. 9or Ast
E of supplement, ) +>: 7+. 9or every subse5uent E
supplement, add >:.-entilators – more machine –
/ I8- /$$ supplemental 7+ – more patient
/ is non#weaning, delivers -! w( any pt effort, preset
00
I8- is weaning, spontaneous breaths of pt#determined volume,
vent supplements to get minimum
minute ventilation
upplemental 7+ – more 7+ – i$$ mask nasal
cannula – less 7+
8ore 7+ – non#rebreather partial
rebreather simple ( closed – less 7+
1hat are the phases of cough and what does a normal one sound
like6
Normal cough – inhale *diaphragm hold *glottis
build force *abdominals expulsion *glottis J
abdominals
Normal sound – dry, loud, low tone, resonant,
multi#cough
1hat are ventilatory strategies6 e able to give examples.$elvis
– posterior tilt for diaphragm
houlder – I0, extension, for diaphragm
;ead ( neck – extension for clear airway-entilatory exercise
progression – bed at >Ko (
sidelying sit stand walk
-erbal & tactile cues & eye ga2e – voice harsh for
inhale, soft for exhale
reathing pattern!ype of contraction
1hat the trunk is doing – extend for inhale, flex for exhale
1hat are the Lbig 3M muscles of respiration6 ccessory muscles6ig
3
iaphragm – /3#/K – Ao ventilation, pressure
regulation, concentric inhale, eccentric exhale for speech
Intercostals – !A#!A+ – stabili2e rib cage on inhale,
assist chest expansion, assist forced exhaleucked in during
paradoxical breathingbdominals – !D#EA – visceral support,
pressure support for diaphragm, forced exhale ( cough
ccessory – assist rib cage elevation during inhale –
hypertrophied with difficult breathing or knock#out of big 3
'rector spinae $ectoralis maFor ( minor
erratus anterior calenesternocleidomastoid !rape2ius
If the patient experiences a spinal cord inFury, how are the
above muscles effected & what happens to the breathing
pattern6
1atch for autonomic dysreflexia for /I at !D or above8ay
need to work on chest mobility
Eevel of /I determines muscles impaired.
If bdominals out, re5uire abdominal binder, diaphragm will
function but be at disadvantage +o abs.
ssisted cough techni5ues.
If intercostals out, will see chest paradoxical breathing. bs
will also be out – see above.If diaphragm out, need to look to
accessory muscle use. Intercostals & abs will also be out – see
above.
8ay need breathing trainer if diaphragm is fair /an weight
abdomen if diaphragm is fairJ
If even higher than diaphragm, work on glossopharyngeal
breathing
