Breath Sounds
Describe the location and qualities of the three major breath sounds
Bronchial: Location- trachea and larynx. Quality- inspiration greater and expiration, High pitched, loud amplitude, harsh, hollow
Bronchialvesicular: Location- major bronchi. Quality- Inspiration=expiration, moderate pitch, medium amplitude
Vesicular: Location- peripheral lung fields. Quality- Inspiration is greater than expiration. Low pitch, soft amp.
What are the structural differences between the right and left lungs?
Right lung: three lobes, shorter than left bc of liver
Left Lung: 2 lobes, Narrower due to heart apex pointing left
What factors of respiration change in older adulthood?
lung elasticity decreases, respiratory muscle strength decreases, costal cartilage calcifies
In what formation does one auscultate the lungs?
Ladder
What are the four major functions of respiration?
Supply O2 to the body for energy, remove CO2 as a waste product, maintain homeostasis (acid-base balance), thermoregulation.
What is the quality of a wheeze (ronchi) and what does it indicate?
musical, more so heard on exhalation. Indicates contrition of airways. Ronchi - low pitched, single note wheeze. Heard on both inhalation and exhalation. Indicated obstruction of airflow
Where would you locate the apex and base of the lungs posteriorly?
Apex is at C7, the base is at T10 on expiration and T12 on inspiration
What factors of respiration change during pregnancy?
Tidal volume increases by 40%, chest cage ligaments relax in response to increased estrogen levels to compensate for the raised diaphragm, physiologic dyspnea - an increased awareness of the need to breathe.
What are factors that can increase tactile fremitus? Decrease?
Increase: increased density of Lung tissue, i.e. pneumonia
Decrease: anything that obstructs the transmission of vibrations i.e. fat, emphysema
What controls respiration?
Major feedback loop regulated by changed in CO2 and O2 levels
breath is normally stimulated by an increased level of CO2 in the blood (hypercapnia)
Low O2 can also stimulate respirations
What is the quality of a crackle?
Heard primarily on inhalation as deflated airways pop back open or air meets a build-up of secreationscreating a crackling sound.
What is the purpose of the Pleurae?
Line the thorax, provide negative pressure, provide lubrication for smooth lung expansion, allow for potential space
Visceral: lines outside of the lungs, extending into fissures
Parietal: Lines inside of thorax
babies are obligate nose breathers until what age?
3 months
What sound would you expect when percussing the lungs?
Resonance
What is a normal anteroposterial diameter ratio?
1:2 - 0.7
What is an atelectatic crackle?
non-pathological adventitious lung sound. Only heard in the periphery and only last a few breathes
What comprises the "dead space" of the lungs
Bronchi and trachea
What can a costal angle of greater than 90 degrees indicate?
COPD or pregnancy
Flaring of nares and visible use of accessory muscles indicates what?
Hypoxia
What is Stridor?
High pitched, monotone sound on the inhale. Indicates obstruction of the upper respiratory tract typically due to inflammation, or foreign body. Heard in trachea and larynx
What are the important landmarks on the rib cage in terms of lung anatomy?
Sternal angle: where bifurcation occurs
4th interconstal space: horizontal fissure R lung
5th intercostal space: R horizontal fissure
6th intercostal space: R and L oblique fissure
What are the methods of measuring pulmonary function status?
Forced expiratory time
spirometer
pulse oximeter
6-min walk test (aging adults)