NSG 6020 Midterm

NSG 6020 Midterm What age does bronchiolitis occur? - most common at age 6 months- does not occur after age 2 main symptom of bronchiolitis - wheezing-lasts about 7 days most common cause of bronchiolitis - RSV Treatment for bronchiolitis - No specific treatment Order of lung exam - inspect, palpate, percuss, auscultate Pectus Excavatum - congenital posterior displacement of lower aspect of sternum -hollowed-out appearance -concave appearance of lower sternum Pectus carinatum - at birth -post CABG mid childhood and 11-14 year old pubertal males undergoing a growth spurt -convex deformity -97% have MVP Barrel Chest - associated with emphysema and lung hyperinflation -accompanying x-ray demonstrates increased ant-post diameter as well as diaphragmatic flattening Tactile fremitus - palpable vibrations of the bronchiopulmonary tree as the patient is speaking (99 or 1-2-3) -impeded in COPD, pulm effusion or pneumothorax -increased in consolidation and PNA percussion: flatness - (thigh) Large Pleural effusion Percussion- dullness - (liver) Lobar PNA Percussion: resonance - (Lung) simple chronic bronchitis Percussion: hyperresonance - None -emphysema, pneumothorax Percussion: tympany - (gastric bubble) -large pneumothorax Auscultation: vesicular - soft and low pitched; usually heard over most of both lungs Auscultation: bronchial - louder and higher in pitch; usually heard over the manubrium Auscultation: bronchovesicular - intermediate intensity and pitch; usually heard over the 1st and 2nd interspaces Auscultation: tracheal - over the trachea and neck, very loud Rhonchi - low-pitched snore-like sounds, often characterized by secretions w/in the large airways -sometimes cleared with a cough Wheezes - continuous, high-pitched, musical, sounds that are produced by air flowing through narrowed bronchi -predominately expiratory stridor - loud, rough, continuous, high-pitched sound that is pronounced during inspiration -indicates proximal airway obstruction absent/attenuated sounds - NO airflow to the region being auscultated -can occur in a pneumothorax, hemothorax, pleural effusion, or parenchymal consolidation Crackles - intermittent, nonmusical, very brief, more pronounced during inspiration -fine or course fine (softer, higher in pitch) course (louder, lower in pitch) Bronchophony - ask pt to say "99" -should be muffled and indistinct -CLEAR sounds are called bronchophony Egophony - ask pt to say "ee" -you should hear a muffled long ee sound -"ee" sounds like "ay" it is positive and called egophony -present over consolidation whispered pectoriloquy - ask pt to say "99 or 1-2-3" -whispered voice is normally faint and indistinct -louder, clearer sounds are called whispered pectriloquy- heard over consolidation