WEEK 3 Thorax, Lungs, Breast, Lymph Nodes Lecture Review.pdf

Week 3 Thorax, Lungs and Breasts  Subjective Data – Lung Assessment HX of present illness When did symptoms begin What symptoms are you experiencing How have symptoms changed What makes symptoms better or worse Any recent infections or illness PMHX Hx of respiratory conditi...

Week 3 Thorax, Lungs and Breasts  Subjective Data – Lung Assessment HX of present illness When did symptoms begin What symptoms are you experiencing How have symptoms changed What makes symptoms better or worse Any recent infections or illness PMHX Hx of respiratory conditions Lifestyle and Health Practices Chronic respiratory illness Smoker Lung or chest surgery Secondhand smoke Ever had TB or exposure to TB Work environment Family HX Diet Family members with respiratory illness Exercise Any genetic respiratory conditions Stress Medications Current medications Any adverse effects from new meds Any home remedies Reference lines Anterior Posterior Lateral  Lungs Which lung has three lobes? Right Why? Parietal Pleura Visceral pleura Pleural space Pt is dehydrated. What sound might you hear when auscultating lungs? Hint: Sounds like a rough grating sound. Answer: Pleural rub Pt has the pneumonia (PNA). Pt complains of pain with breathing. What is this called?  Lung Assessment Adventitious breath sounds Vocabulary words of particular interest Dyspnea Cough Orthopnea Paroxysmal Nocturnal Dyspnea Sleep apnea Patient has no history of respiratory issues and is basically healthy. The nurses is auscultating lung sounds and hears some adventitious breath sounds. What might be the cause? What might you ask the patient to do?  Objective data – Lung Assessment Explain Remove clothing from waist up Sit in an upright position Inspection Gown What would you observe related to Stethoscope assessment of the lungs? Color Chest Nails Behavior Respiration Chest expansion What is the order of the lung assessment? Accessory muscles Inspection Palpation Percussion Auscultation Thoracic Assessment - Inspection Pectus excavatum (funnel chest) Barrel chest You are observing your patient during respiration and you notice their chest appears to sink in just below the neck and under the breastbone. You also observe this under the Kyphosis rib cage and in the intercostal spaces. Why is this happening? Scoliosis Patient is attempting to bring more air into the lungs.  Objective data – Lung Assessment Palpation Why are we palpating? What are we palpating for? While palpating, you feel a crackling sensation. What could this be? Crepitus General techniques Examine the posterior thorax and lungs while the patient is sitting Examine the anterior thorax and lungs with the patient supine Compare one side of the thorax and lungs with the other, so the patient serves as his or her own control Proceed in an orderly fashion: Inspect, Palpate, Percuss, and Auscultate  Objective data – Lung Assessment Palpation What is tactile fremitus? You are assessing your patient for tactile fremitus. You place your hands on your patient’s back and ask them to say “99.” Why did you do that? What would be a normal assessment? What does it mean if it is unequal? Objective data – Lung Assessment Percussion What is percussion? Tone Hyperresonance Dullness Resonance Diaphragmatic excursion What is emphysema? During your assessment of your patient with emphysema, what sound would you expect to hear? Objective data – Lung Assessment Auscultation A Apices B Bases Bronchial Vesicular Bronchovesicular Objective data – Lung Assessment You ask your patient to whisper “one- two-three.” What is this called? Auscultation Answer: Whisper pectoriloquy. You ask your patient to repeat “99” while you auscultate their chest. What is this called? It is faint, muffled and difficult to hear. Answer: Bronchophony Should you be concerned? Answer: No. This is normal. Your patient’s documentation states During auscultation, you notice it is very easy to “adventitious breath sounds.” What is understand the “99” sound. Should you be concerned? that? Answer: Yes. A clearly heard “99” may indicate pneumonia Answer: Abnormal breath sounds such as You ask your patient to repeat the letter “E.” What is this crackles or wheezes. called? Answer: Egophony What can you do to be sure you are hearing adventitious breath sounds? The “E” sounds like “A.” Should you be concerned? Answer: Have patient cough Answer: Yes. This is abnormal.  Adventitious Breath Sounds What is asthma? Your patient is admitted to the ED with During your respiratory assessment, you exacerbation of asthma. auscultate a high pitched sound during inspiration. What is the most prominent adventitious How would you document this sound? breath sound you are most likely to hear? Stridor Wheezing What causes wheezing? Inflammation and bronchospasms What factors may have contributed to the Wheezing exacerbation of the patient’s asthma symptoms? Weather, exercise, illness Stridor Crackles  What is happening? (Kussmaul, Cheyne Stokes, Biot) The patient has been admitted to the ICU with a A patient is brought into the Traumatic Brain Injury (TBI). Their respirations are Emergency Department in Diabetic sometimes deep and sometimes shallow with Ketoacidosis (DKA). Their breathing occasional apnea. How will you document this? is rapid and labored.. They appear to be hyperventilating. Answer: Biot How will you document this? Answer: Kussmaul You are a hospice nurse. You have been called to the patient’s home because the family reports the patient’s breathing is now deep and rapid, followed by periods of not breathing at all (apnea). How will you document this? Answer: Cheyne Stokes Breathing Lungs – Patient Education Smoking Dangers of smoking Vaping Resources to quit smoking Environmental Factors Pollution, dust Vaccination Managing chronic respiratory conditions Physical Activity Anaphylaxis Stress Common Thorax and Lung Variations in Older Adults Increased anteroposterior chest diameter Increase in the dorsal spinal curve (kyphosis) Decreased thoracic expansion Use of accessory muscles to exhale At risk for fractures (osteoporosis) Experience dyspnea with aging lungs decreased lung resiliency, loss of elasticity, fewer capillaries) Decreased ability to cough Weakened muscles & increased thoracic wall rigidity  Question What is the difference between kyphosis and scoliosis? Why is it important to know the difference?  Answer Kyphosis- is a rounding of the thoracic spine involving the thoracic vertebrae. Scoliosis – is a lateral deviation of the spine involving the cervical, thoracic, and lumbar vertebrae. Kyphosis may affect the ability to breathe.  Question Which of the following statement about percussion is true? a. Use the lightest percussion that produces a clear note b. Percussion should be done up and down each side of the chest rather than side to side (one side of the chest to the other) c. Strike using the pad of your tapping finger d. The heart normally produces an area of tympany to the left of the sternum from the 3rd to 5th rib interspaces  Answers a. Use the lightest percussion that produces a clear note Percussion should be done side to side (one side of the chest to the other) for comparison Strike using the tip of your tapping finger The heart normally produces an area of dullness to the left of the sternum from the 3rd to 5th rib interspaces  Question Which of the following statements are true about chest pain? a. It originates only from cardiac issues b. It is only associated with anxiety. c. It may arise from cardiac, vascular, gastrointestinal, musculoskeletal or skin pathology. d. Surrounding structures have no affect on chest pain.  Answers C - It may arise from cardiac, vascular, gastrointestinal, musculoskeletal or skin pathology. Chest pain may be associated with anxiety Lung tissue has no pain fibers; pain in lung conditions usually arises from inflammation of the adjacent parietal pleura Other surrounding structures may also irritate the parietal pleura leading to pain. Question Which of the following clues would suggest pulmonary or cardiac difficulties? a. Clubbing in fingers b. Cyanosis or pallor in skin, nails, & lips c. Pursed lips d. Flaring nostrils  Answer All are correct a. Clubbing in fingers b. Cyanosis or pallor in skin, nails, & lips c. Pursed lips d. Flaring nostrils  Question Which of the following breath sounds are most often auscultated over the majority of both lungs? a. Vesicular b. Bronchial c. Bronchovesicular d. None of the above  Answer Answer: a. Vesicular Bronchial - usually heard over the manubrium Bronchovesicular - usually heard over the 1st and 2nd interspaces  Question Which physical assessment technique is used to assess temperature, turgor, texture, moisture, vibrations, and shape? a. Inspection b. Percussion c. Palpation d. Auscultation  Answer Answer: C. Palpation Rationale: Palpation is an assessment technique that uses the sense of touch. Inspection is the process of performing deliberate, purposeful observation in a systematic manner. Percussion is the act of striking one object against another to produce sound. Auscultation is the act of listening with a stethoscope to sounds produced in the body Question What are facts regarding Kussmaul respiratory pattern? a. It is irregular breathing b. It is a rapid, deep, labored type of hyperventilation associated with diabetic ketoacidosis. c. It is a decreased rate of breathing. d. This is a breathing pattern usually associated with meningitis. Answer Answer b – Kussmaul breathing pattern - It is a rapid, deep, labored type of hyperventilation associated with diabetic ketoacidosis. Auscultation YouTube Quiz https://www.youtube.com/watch?v=YjfcMYG5aqY  Health Assessment – Breast Subjective Data Current complaint/concern (CC) Swelling or masses Change in shape or size Pain or tenderness Discharge Tender with menses Redness, warmth or dimpling Rash Your patient tells you that one of her breasts Mammograms is larger than the other. She asks you if she should be concerned. What is your History (HX) response? Age of menarche Age of menopause Answer: No. Breasts are often asymmetrical Cancer or biopsy Surgeries/implants/explants/augmentation/reduction What would you ask next? Breastfeeding Mastitis or abscess Answer: Is this new? Family history of breast cancer If complaint of lumps or swelling, ask if changes occur during menstrual Anatomical Landmarks Breasts are paired mammary glands that lie over the muscles of the anterior chest wall. At puberty, female breast tissue enlarges in response to the hormones. Male breast has no true functional capability. Female breast – has 2 functions. For purposes of identifying or describing the location of assessment findings, breasts are divided into 4 quadrants. The upper outer quadrant extends into the axillary area and is called the tail of Spense. Breast Tissue Three types Glandular functional part of the breast that allows for milk production. Fibrous provides support for the glandular tissue (Cooper’s ligaments) Fatty provides most of the substance of the breast and determines size & shape of the breast.  Breasts Examination Techniques Inspection Examine the breasts with arms in various positions. Compare one side to other. Proceed in the order of Inspection then Palpation Breast Palpation Vertical Circular Radial Patient Education Breast Awareness Identify changes Pain Appearance Size Redness Recent Changes Self Breast Exam (SBE) Breast Cancer – Patient Education Male Breast Assessment Breast Cancer Gynecomastia Health Assessment – Lymphatics Lymph Nodes Palpation of Lymph nodes Stages of Lymphedema Your patient had a right side mastectomy. While assessing the patient’s lymph nodes, you notice the right arm circumference is larger than the left and you note some non-pitting edema. Should you be concerned? Why or why not?  Common Variations in Older Adults May have a decrease in size and firmness of breasts (due to decreased estrogen levels) Glandular tissue ↓ and fatty tissue ↑ May have more pendulous and saggy breasts May have smaller, flatter nipples that are less erectile. Breasts may feel more granular  Question Which of the following statements about palpation is true? a. The pads of two fingers are used. b. A side to side swiping motion technique is recommended to palpate the breast. c. It’s important to know the Last Menstrual Period (LMP) when doing palpation. d. Deep palpation is used on all areas of the breast.  Answers c. It’s important to know the LMP. Rationale: Those with fibrocystic breasts may have painful, tender, & lumpy areas in the breasts 2 weeks prior to cycle. Pads of three fingers are used. Circular, Wedge or Vertical strip motion are recommendations. Palpation is light, medium or firm  Question You have a 20 year old female present to the clinic who states that one breast is larger than the other. Your first response should be: a. To reassure her that it is not a problem. b. To ask if this if this is a new problem. c. Make an appointment immediately for the specialty clinical. d. Ask if there are any other symptoms.  Answers b. – Ask if this is a new problem  Question Glandular breast tissue is responsible for a.Providing support b.Determining size c.Determining shape d.Milk production  Answers a. Providing support b.Determining size c. Determining shape d.Milk production  Question Vertical, Circular and Radial are all descriptions of a. Lymph node location b.Mammography angles c. Breast palpation d.Breast tissue  Answers a. Lymph node location b.Mammography angles c. Breast palpation d.Breast tissue  Question Breast cancer risk factors include (Choose all that apply) a. Genetics b.Obesity c. Number of pregnancies d.Caffeine  Answers a. Genetics b.Obesity c. Number of pregnancies d.Caffeine  Question In older adults, common breast variations include a. Decreased glandular breast tissue b.Increased firmness of breast tissue c. Increased estrogen levels d. Decreased fatty tissue  Answers a. Decreased glandular breast tissue b.Increased firmness of breast tissue c. Increased estrogen levels d. Decreased fatty tissue Jeopardy Link https://jeopardylabs.com/play/ha-lecture-review-bltl Thank you for your attention