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Nursing Care Of Adults 2 (NRSG 3420) Sonorous Wheezes

John Marsh
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Adults 2- Exam 2 study guide

  • Northeastern University

    Nursing Care Of Adults 2 (NRSG 3420)

Exam #2 Modules 4 and 5
Study Guide
Be able to identify all glossary terms at the beginning of each chapter of assigned readings.
Respiratory Assessment
Be able to identify a complete systematic respiratory assessment.
• General assessment
 Clubbing fingers -sponginess of bed and loss of bed angle (sign of
lung disease, malignancies in the lung, chronic infections, chronic
hypoxic conditions)
 Cyanosis – bluish color of skin very late indicator of hypoxia, present
when there is at least 5 g/dL of unoxygenated Hgb
 Nose and sinuses – inspect external nose for lesions, asymmetry,
inflammation. Inspect internal nose for mucosa color, swelling,
exudate, or bleeding.
 Mouth and pharynx – open mouth wide and instruct deep breath to
flatten posterior tongue and allow visualization of pillars, tonsils,
uvula, and posterior pharynx.
 Trachea – position and mobility by palpitation.
 Breathing patterns and rates – 14- 20 RR and eupnea is normal
 Chest configurationo
barrel chest- increase AP diameter, aging and hallmark sign of
emphysema and COPD
o funnel chest (Pectus Excavatum)- depression of lower portion
of sternum, rickets or Marfan’s
o pigeon chest (Pectus Carninatum)- sternum pokes out, rickets
or Marfan’s or severe Kyphoscoliosis
o Kyphoscoliosis- elevation of scapula forming S shaped spine.
 Thoracic inspection – lay pt down, skin color and turgor for evidence
of subQ tissue loss
Where do you put stethoscope to auscultate all lobes of the lungs?
What are normal breath sounds? What are abnormal or adventitious breath sounds?
What does it mean if you hear them?
 Vesicular: insp > exp. Heard over entire lung field except over
sternum and between scapula
 Bronchovesicular: insp = exp. Heard often in 1st or 2nd interspaces
anteriorly between scapule
 Bronchial: exp > insp. If heard at all, over manbrium
 Tracheal: insp = exp. Over the trachea in neck.
 Adventitious (Abnormal)
 Crackles
o General- high-pitched discontinues popping, fluid in airways or
alveoli (HF and pulmonary fibrosis)
o Coarse crackles- discontinues popping in early inspiration,
harsh and moist sounding (Obstructive pulmonary disease)
o Fine crackles- discontinues popping on late inspiration, sounds
like hair rubbing together (pneumonia, restrictive pulmonary
disease, bronchitis)
 Wheezes
o General- usually heard on expiration but may be heard on
inspiration, bronchial wall oscillation and changes in airway
diameter (chronic bronchitis or bronchiectasis)
o Sonorous wheezes- deep low pitched rumbling (secretions or
o Sibilant wheezes- continuous musical high-pitched whistle like
(bronchospasm, asthma, and buildup of secretions)
 Friction Rubs
o Pleural friction rub- harsh crackling sound, like leather being
rubbed together (secondary to inflammation and loss of
lubricating pleural fluid
O2 & RBCs
What is oxyhemoglobin? Why should you consider volume status when interpreting
hemoglobin and hematocrit?
o Large amounts of O2 can be transported in blood b/c O2 combines easily w/
hemoglobin to form oxyhemoglobin
o Volume of O2 physically dissolved in the plasma is measured by the partial
pressure of O2 in the arteries (PaO2); the higher the PaO2, the greater the
amount of O2 dissolved
o Amount of O2 that combines w/ hemoglobin depends on both amount of
hemoglobin in blood & on pO2



Nursing Care Of Adults 2 (NRSG 3420) Sonorous Wheezes

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