Review for 1166 Review for 1166 midterm exammidterm exam

revised Oct 2010revised Oct 2010

ByBy Elizabeth Kelley Buzbee AAS, RRT-Elizabeth Kelley Buzbee AAS, RRT-

NPS, RCPNPS, RCP

QuestionQuestion

You are reading the chart and you You are reading the chart and you need to find the patient’s current need to find the patient’s current Vital Signs prior to giving inhaled Vital Signs prior to giving inhaled Beta II bronchodilator.Beta II bronchodilator.

Where would you look?Where would you look?

answeranswer

I would first go to the NURSE’S I would first go to the NURSE’S GRAPHIC SHEET where she charts GRAPHIC SHEET where she charts her scheduled VS.her scheduled VS.

I would also check the respiratory I would also check the respiratory therapist’s charting for the last VS therapist’s charting for the last VS with the last treatmentwith the last treatment

I will also do my own VS prior to I will also do my own VS prior to starting a medication because I know starting a medication because I know that VS change from minute to minutethat VS change from minute to minute

QuestionQuestion

Where in the patient’s chart would Where in the patient’s chart would you go to find out what diseases the you go to find out what diseases the doctor wants to test the patient for?doctor wants to test the patient for?

answeranswer

I would go to the DOCTOR’S I would go to the DOCTOR’S PROGRESS NOTES where the PROGRESS NOTES where the doctor’s SOAP charting will be found doctor’s SOAP charting will be found with his PLAN.with his PLAN.

I could also look in the PHYSICIANS I could also look in the PHYSICIANS ORDERS to see what kind of lab ORDERS to see what kind of lab work the doctor has already work the doctor has already ordered.ordered.

QuestionQuestion

Where in the chart would you go to Where in the chart would you go to find out what the doctor wants you find out what the doctor wants you to do for this patient right now?to do for this patient right now?

answeranswer

I would go to the PHYSICIAN’S I would go to the PHYSICIAN’S ORDERS to find the current orders I ORDERS to find the current orders I need to do my patient care.need to do my patient care.

QuestionQuestion

Your patient has a HR that is 138 Your patient has a HR that is 138 bpm, his blood pressure is 118/75 bpm, his blood pressure is 118/75 mmHg and his RR is 18 bpm.mmHg and his RR is 18 bpm.

Are the VS normal?Are the VS normal?

answeranswer

a HR that is 138 bpm is elevated a HR that is 138 bpm is elevated

his blood pressure at 118/75 mmHg his blood pressure at 118/75 mmHg is WNLis WNL

his RR at 18 bpm is WNL.his RR at 18 bpm is WNL.

questionquestion

If the doctor has ordered a If the doctor has ordered a ultrasonic mist Q 4 hours by aerosol ultrasonic mist Q 4 hours by aerosol mask with air and you gave the last mask with air and you gave the last one at 2 PM, when is the next one one at 2 PM, when is the next one due?due?

answeranswer

We would give the next Ultrasonic at We would give the next Ultrasonic at 6 PM6 PM

questionquestion

If the doctor orders an MID with If the doctor orders an MID with Atrovent [ipratropium bromide] TID, Atrovent [ipratropium bromide] TID, how often would you do this in a 24 how often would you do this in a 24 hour periodhour period

answeranswer

TID is 3 x a day; Generally we will TID is 3 x a day; Generally we will only do this while the patient is only do this while the patient is awake so breakfast, lunch and awake so breakfast, lunch and dinner time are reasonabledinner time are reasonable

questionquestion

Your patient is getting a SVN with Your patient is getting a SVN with 2.5 mg of Albuterol in 2. 5 ml of 2.5 mg of Albuterol in 2. 5 ml of normal saline. normal saline.

What would be an indication for this What would be an indication for this medication?medication?

answeranswer

It is given to treat or prevent It is given to treat or prevent bronchospasm associated with asthma or bronchospasm associated with asthma or COPDCOPD

The normal saline will act as a wetting The normal saline will act as a wetting agent to help loosen secretions; normal agent to help loosen secretions; normal saline also dilutes the Albuterol so that saline also dilutes the Albuterol so that the drug will last 10-12 minutesthe drug will last 10-12 minutes

Normal saline is less irritating to the Normal saline is less irritating to the airways than sterile waterairways than sterile water

questionquestion

Your patient is a 2 year old toddler Your patient is a 2 year old toddler whose Sp02 is 88% on Room air. He whose Sp02 is 88% on Room air. He has retractions, nasal flaring and is has retractions, nasal flaring and is breathing rapidly.breathing rapidly.

You would recommend?You would recommend?

answeranswer

Supplementary 02 for a child this age Supplementary 02 for a child this age would be best accomplished by placing would be best accomplished by placing the child inside a mist tent [mist the child inside a mist tent [mist tent/croup tent/02 tent are all different tent/croup tent/02 tent are all different names for the same device.]names for the same device.]

nasal cannula for this-sized child are nasal cannula for this-sized child are availableavailable

QuestionQuestion

If you want to find out the patient’s If you want to find out the patient’s diagnosis, you could get this diagnosis, you could get this information out the chart at what information out the chart at what point?point?

answeranswer I would check the DOCTOR’S PROGRESS I would check the DOCTOR’S PROGRESS

NOTES where the doctor will place his NOTES where the doctor will place his educated guess into the A [appearance] educated guess into the A [appearance] portion of the SOAP portion of the SOAP

I would check the PHYSICIANS’ ORDERS for I would check the PHYSICIANS’ ORDERS for orders that hint at the diagnosis—for instance: orders that hint at the diagnosis—for instance: if the PHYSICIANS’ ORDERS include glucose if the PHYSICIANS’ ORDERS include glucose measurements after meals and insulin shots measurements after meals and insulin shots obviously, this patient has diabetes.obviously, this patient has diabetes.

if the patient has bronchodilators ordered if the patient has bronchodilators ordered there is some problem with the lower airways there is some problem with the lower airways that results in bronchospasm that results in bronchospasm

questionquestion

Your PHYCICIAN’s ORDERS include the Your PHYCICIAN’s ORDERS include the phrase “phrase “check pulse ox and keep Sp02 check pulse ox and keep Sp02 above 93%.”above 93%.”

On room air [Fi02 21] your patient’s On room air [Fi02 21] your patient’s Sp02 is 96% with a HR 88 bpm and a RR Sp02 is 96% with a HR 88 bpm and a RR of 12 bpm. This patient’s major concern of 12 bpm. This patient’s major concern is making the TV work correctly and is making the TV work correctly and making sure his lunch comes on time.making sure his lunch comes on time.

What will you do?What will you do?

answeranswer

I would record the Sp02, Fi02 and the I would record the Sp02, Fi02 and the HR and RR in my Respiratory Care HR and RR in my Respiratory Care charting and charting and notnot start 02. start 02.

Because there was no frequency on Because there was no frequency on the pulse oximeter order, I would not the pulse oximeter order, I would not repeat the Sp02 repeat the Sp02 unlessunless the patients VS the patients VS were to worsen-- in which case I want were to worsen-- in which case I want to make sure the Sp02 is above 93% to make sure the Sp02 is above 93% because I do have an order for because I do have an order for that.that.

questionquestion

If your patient has increased If your patient has increased wheezing and rhonchi, what would wheezing and rhonchi, what would this do to his WOB?this do to his WOB?

answeranswer

His WOB would increase as his His WOB would increase as his driving pressure increases; this driving pressure increases; this could be seen as retractions, and could be seen as retractions, and nasal flaring and increased work of nasal flaring and increased work of the muscles of both the abdomen the muscles of both the abdomen and the chest wall. He would most and the chest wall. He would most likely have increased RR and likely have increased RR and increased HRincreased HR

questionquestion

Your patient who has diminished Your patient who has diminished BBS in the basal areas of the lung BBS in the basal areas of the lung and who has diffuse crackles. What and who has diffuse crackles. What is the effect of this on this patient is the effect of this on this patient WOB? WOB?

answeranswer

The diminished basal breath sounds The diminished basal breath sounds imply that the basal alveoli are imply that the basal alveoli are collapsed [atelectasis] & this will collapsed [atelectasis] & this will require increased driving pressure to require increased driving pressure to re-inflate these stiffened lung units.re-inflate these stiffened lung units.

The crackles also imply that there is The crackles also imply that there is atelectasis.atelectasis.

This patient’s WOB is increased due This patient’s WOB is increased due to decreased lung compliance. to decreased lung compliance.

questionquestion

Your patient has intercostal Your patient has intercostal retractions and is breathing fast. retractions and is breathing fast.

Might she be in respiratory distress? Might she be in respiratory distress? What might you recommend?What might you recommend?

answeranswer

Yes, she is showing s/s of increased WOBYes, she is showing s/s of increased WOB I would measure her RR, HR and get a I would measure her RR, HR and get a

Sp02Sp02 I would listen to her BBSI would listen to her BBS Because the AARC Clinical Practice Because the AARC Clinical Practice

Guidelines state that I can start 02 for s/s Guidelines state that I can start 02 for s/s of increased WOB, I could safely of increased WOB, I could safely recommend 1-2 lpm nasal cannula--until I recommend 1-2 lpm nasal cannula--until I know more.know more.

questionquestion

To assess a patient for a need for To assess a patient for a need for SVN with Albuterol, you would SVN with Albuterol, you would recommend what?recommend what?

answeranswer I would listen to BBS for wheezing or prolonged I would listen to BBS for wheezing or prolonged

exhalationexhalation I would check the patient’s history for asthma, COPD or I would check the patient’s history for asthma, COPD or

other disease associated with bronchospasmother disease associated with bronchospasm I would measure the HR and RR for s/s of increased I would measure the HR and RR for s/s of increased

WOBWOB I would look at the patient for visible s/s of increased I would look at the patient for visible s/s of increased

WOB WOB I would look at the chest for increased AP diameter or I would look at the chest for increased AP diameter or

observe the patient’s assumption of the tripod position observe the patient’s assumption of the tripod position needed to use accessory muscles of inspirationneeded to use accessory muscles of inspiration

I would percuss the chest for hyper-resonance I would percuss the chest for hyper-resonance associated with air-trappingassociated with air-trapping

I would palpate the belly for tensing of the abdominal I would palpate the belly for tensing of the abdominal muscles during a forced exhalation with accessory muscles during a forced exhalation with accessory muscles muscles

questionquestion

If your patient has BBS with If your patient has BBS with prolonged exhalation in the RML prolonged exhalation in the RML and rhonchi over the RUL what and rhonchi over the RUL what would you recommend?would you recommend?

answeranswer

I would give Albuterol by SVN to I would give Albuterol by SVN to treat the bronchospasm that is treat the bronchospasm that is manifested by prolonged exhalationmanifested by prolonged exhalation

The normal saline in the SVN would The normal saline in the SVN would help loosen the secretions associated help loosen the secretions associated with the rhonchiwith the rhonchi

questionquestion

Your patient just pulled an endotracheal Your patient just pulled an endotracheal tube out of his throat. Immediately after tube out of his throat. Immediately after this, his RR rises to 32 bpm from 12 this, his RR rises to 32 bpm from 12 bpm, his HR is 110 bpm from 77 and bpm, his HR is 110 bpm from 77 and you see that he has supraclavicular you see that he has supraclavicular retractions.retractions.

When you listen to his breath sounds When you listen to his breath sounds you hear a sound associated with upper you hear a sound associated with upper airway obstruction. What is this sound?airway obstruction. What is this sound?

answeranswer

Stridor is a sound associated with Stridor is a sound associated with laryngeal swelling. laryngeal swelling.

We would also hear this with a child We would also hear this with a child who is suffering from croupwho is suffering from croup

The cough would be ‘barky’The cough would be ‘barky’

questionquestion

You started a 45% entrainment mask You started a 45% entrainment mask on a patient and after 15- 20 minutes on a patient and after 15- 20 minutes you note that the RR is still 26 bpm you note that the RR is still 26 bpm and that the Sp02 is still 88%.and that the Sp02 is still 88%.

You have checked the function of the You have checked the function of the device. What do you recommend device. What do you recommend right now?right now?

answeranswer

Fi02 45% is not enough; raise it to Fi02 45% is not enough; raise it to 50% and reassess the VS and the 50% and reassess the VS and the Sp02Sp02

Suggest an ABG if this change Suggest an ABG if this change doesn’t increase the Sp02 to above doesn’t increase the Sp02 to above 90%90%

Listen to BBS for other problems Listen to BBS for other problems that need to be dealt with such as that need to be dealt with such as bronchospasmbronchospasm

questionquestion

Your patient is on an bland aerosol Your patient is on an bland aerosol mask at 60%. Her RR is 12 bpm and mask at 60%. Her RR is 12 bpm and her HR is 88 bpm, Her Sp02 is her HR is 88 bpm, Her Sp02 is 100%. 100%.

What do you recommend at this What do you recommend at this time?time?

answeranswer

Because Fi02 is at toxic levels, we Because Fi02 is at toxic levels, we need to get the Fi02 down.need to get the Fi02 down.

I suggest we decrease the Fi02 from I suggest we decrease the Fi02 from 60% to 50% and recheck the Sp02 & 60% to 50% and recheck the Sp02 & VSVS

Keep decreasing the Fi02 every 30 Keep decreasing the Fi02 every 30 minutes as long as the Sp02 is above minutes as long as the Sp02 is above 95% and as long as the patient shows 95% and as long as the patient shows no s/s of increased WOB or hypoxemiano s/s of increased WOB or hypoxemia

questionquestion

Your patient is breathing shallowly, and is Your patient is breathing shallowly, and is complaining of pain during inspiration over the complaining of pain during inspiration over the lower right chest wall.lower right chest wall.

When you attempt to percuss the patient, he When you attempt to percuss the patient, he recoils and c/o pain and tenderness over the recoils and c/o pain and tenderness over the lower right chest walllower right chest wall

On auscultation, you hear a rubbing on On auscultation, you hear a rubbing on inspiration. inspiration.

The nurse recommends you give the SVN with The nurse recommends you give the SVN with 2.5 mg Albuterol about 30 minutes early2.5 mg Albuterol about 30 minutes early

You reply?You reply?

answeranswer

No, I would not give the SVN No, I would not give the SVN earlyearly, , because this breath sound is because this breath sound is associated with a pleuritic problems associated with a pleuritic problems such as effusion or pleurisy-- not such as effusion or pleurisy-- not bronchospasm.bronchospasm.

We need to notify the doctor of this We need to notify the doctor of this changechange

questionquestion

Your patient’s skin is pale, cool and Your patient’s skin is pale, cool and damp. His capillary refill is 3 damp. His capillary refill is 3 seconds and his pulse rate is rapid seconds and his pulse rate is rapid and irregular.and irregular.

The EMS wants to start him on The EMS wants to start him on Incentive spirometryIncentive spirometry

You recommend? You recommend?

answeranswer

We need to get a systemic blood We need to get a systemic blood pressure by cuff because this is a pressure by cuff because this is a cardiovascular issue & we need to call cardiovascular issue & we need to call the doctorthe doctor

We need to assess the patient’s LOCWe need to assess the patient’s LOC We need to start this patient on 02 for We need to start this patient on 02 for

possible increased work of the heartpossible increased work of the heart We need to watch this patient carefully We need to watch this patient carefully

for possible s/s of a need for CPRfor possible s/s of a need for CPR

questionquestion

Your patient has a disease that Your patient has a disease that places him in RESPIRATORY places him in RESPIRATORY ISOLATION.ISOLATION.

How will you prepare to go into the How will you prepare to go into the roomroom

answeranswer

Wash hands & place gloves [we do Wash hands & place gloves [we do this with everyone] this with everyone]

Place mask on to protect myselfPlace mask on to protect myself Keep my patient inside the room Keep my patient inside the room

with the door shut to protect other with the door shut to protect other folks from the infectionfolks from the infection

If a ‘laminar flow’ room is available If a ‘laminar flow’ room is available place, patient inside one.place, patient inside one.

questionquestion

Your patient has a Sp02 that is only Your patient has a Sp02 that is only 90% on 8 lpm nasal cannula and the 90% on 8 lpm nasal cannula and the doctor wants to keep his Sp02 above doctor wants to keep his Sp02 above 93%.93%.

What do you recommend?What do you recommend?

answeranswer We need to raise the flow rate from 8 lpm to 9 We need to raise the flow rate from 8 lpm to 9

lpm to get the Sp02 up…..but we cannot go lpm to get the Sp02 up…..but we cannot go that high on a nasal cannula.that high on a nasal cannula.

At this point, we At this point, we might might switch to a simple mask switch to a simple mask at 9 lpm…but that can only get to Fi02 50% at 9 lpm…but that can only get to Fi02 50% which isn’t much higher than a 8 lpm N/C which isn’t much higher than a 8 lpm N/C which can only get to 45%which can only get to 45%

We might recommend an entrainment mask at We might recommend an entrainment mask at 50% because the N/C & a simple mask are 50% because the N/C & a simple mask are both low flow systems which will deliver less both low flow systems which will deliver less 02 as the patient’s minute ventilation rises02 as the patient’s minute ventilation rises

We need to follow up with repeat Sp02, VS and We need to follow up with repeat Sp02, VS and consider calling the doctor for an ABG if this consider calling the doctor for an ABG if this change doesn’t fix the Sp02change doesn’t fix the Sp02

questionquestion

Dullness to percussion and crackles Dullness to percussion and crackles are associated with what disorders?are associated with what disorders?

answeranswer

Alveolar consolidation is associated Alveolar consolidation is associated with dullness to percussionwith dullness to percussion

Atelectasis is associated with Atelectasis is associated with cracklescrackles

This could be due to some alveolar This could be due to some alveolar involvement such as pneumonia, involvement such as pneumonia, pneumonitis or congestive heart pneumonitis or congestive heart failurefailure

QuestionQuestion

There is hyper-resonance to There is hyper-resonance to percussion and you see a patient percussion and you see a patient with an increased AP diameter.with an increased AP diameter.

What disorders are associated with What disorders are associated with these?these?

answeranswer

these s/s are associated with air-these s/s are associated with air-trapping with is associated with airway trapping with is associated with airway obstructions from such diseases such as obstructions from such diseases such as in asthma, COPD. in asthma, COPD.

If you listen to the chest you most likely If you listen to the chest you most likely will hear expiratory wheezes, some will hear expiratory wheezes, some course crackles from fluid in the course crackles from fluid in the airways and maybe distant breath airways and maybe distant breath sounds. You may hear prolonged sounds. You may hear prolonged exhalation timeexhalation time

questionquestion

Your patient has a Pa02 of 45 mmHg Your patient has a Pa02 of 45 mmHg on an entrainment mask at 35%. on an entrainment mask at 35%.

To correct his hypoxemia [get the To correct his hypoxemia [get the Pa02 to 80 mmHg] what Fi02 should Pa02 to 80 mmHg] what Fi02 should you select?you select?

answeranswer

Pa0Pa022 actualactual : Fi0 : Fi022 actualactual as Pa0 as Pa022 you wantyou want: Fi0: Fi022 you needyou need

45 mmHg : .35 as 80 mmHg: x45 mmHg : .35 as 80 mmHg: x

45 X = .35 (80)45 X = .35 (80)

45 X = 2845 X = 28

= 62% Fi02 we need= 62% Fi02 we need

This patient needs a partial Non-rebreather This patient needs a partial Non-rebreather mask to get the Pa02 back to normalmask to get the Pa02 back to normal

questionquestion

Your patient has the following:Your patient has the following: HR is 88 BPMHR is 88 BPM RR is 18 BPMRR is 18 BPM Sp02 is 95%Sp02 is 95% Patient is alert and resting quietlyPatient is alert and resting quietly There are no retractions, no labored There are no retractions, no labored

breathingbreathing What could you say about this patient?What could you say about this patient?

answeranswer

Pt has normal VS and normal Sp02 Pt has normal VS and normal Sp02 There are no s/s of respiratory There are no s/s of respiratory

distress nor of increased WOBdistress nor of increased WOB

questionquestion

Your patient has been placed on 60% Your patient has been placed on 60% entrainment device on his face tent. entrainment device on his face tent. If the set flow rate is 8 LPM, what is If the set flow rate is 8 LPM, what is the total flow rate?the total flow rate?

answeranswer

At 60% and 8 LPMAt 60% and 8 LPM Based on the magic box, there is 1 Based on the magic box, there is 1

LPM of air entrained for each 1 LPM LPM of air entrained for each 1 LPM of 02of 02

8 LPM + (8 x 1) = 16 LPM8 LPM + (8 x 1) = 16 LPM

Question Question

In the situation above in which the In the situation above in which the patient has a total flow of 16 LPM, patient has a total flow of 16 LPM, could we call the entrainment device could we call the entrainment device a high flow system?a high flow system?

answeranswer

Not really, the flow rate needs to be Not really, the flow rate needs to be 2-3 x the VE to be a true high flow 2-3 x the VE to be a true high flow system.system.

We could increase the 02 flow to 15 We could increase the 02 flow to 15 which would result in a total flow of which would result in a total flow of 30 LPM which is better30 LPM which is better

questionquestion

If you hear bronchial breath sounds If you hear bronchial breath sounds over the larger airways this would over the larger airways this would be:be:

answeranswer

This is normal over the larger This is normal over the larger airway.airway.

If this same sound was heard over If this same sound was heard over the periphery of the lung we would the periphery of the lung we would be concerned about atelectasis or be concerned about atelectasis or pneumonia in which the lung has pneumonia in which the lung has become more densebecome more dense

questionquestion

If your patient has rhonchial If your patient has rhonchial fremitus on palpation, and you hear fremitus on palpation, and you hear coarse inspiratory & expiratory coarse inspiratory & expiratory crackles that clear after a cough, crackles that clear after a cough, your patient has what problem ?your patient has what problem ?

answeranswer

Coarse crackles and rhonchial Coarse crackles and rhonchial fremitus are both associated with fremitus are both associated with fluid in the airways which would fluid in the airways which would change with coughing effectively.change with coughing effectively.

This could be associated with This could be associated with bronchitisbronchitis

questionquestion

Your order states that you must keep Your order states that you must keep your patient Sp02 above 92%.your patient Sp02 above 92%.

Your patient has been gradually Your patient has been gradually increased from 1 LPM nasal cannula to 5 increased from 1 LPM nasal cannula to 5 LPM nasal cannula over a couple hours, LPM nasal cannula over a couple hours, the Sp02 is finally above 92%, and the the Sp02 is finally above 92%, and the RR has returned to normal with a normal RR has returned to normal with a normal HR. HR.

What else can you do for your patient to What else can you do for your patient to make him more comfortable?make him more comfortable?

answeranswer

Add an cool bubble humidifier to the Add an cool bubble humidifier to the nasal cannulanasal cannula

Continue to monitor the VS and Continue to monitor the VS and Sp02Sp02

QuestionQuestion

Your patient is wearing a Non-Your patient is wearing a Non-rebreather mask in the recovery rebreather mask in the recovery room. He is breathing slowly and room. He is breathing slowly and shallowly. shallowly.

For what For what oneone particular hazard of 02 particular hazard of 02 might we be worried about in this might we be worried about in this case?case?

answeranswer

absorption atelectasis absorption atelectasis is a is a particular hazard of patients who are particular hazard of patients who are in post op.in post op.

Post op patients are already at high Post op patients are already at high risk of post-op atelectasisrisk of post-op atelectasis

As the 02 molecules replace the N2 As the 02 molecules replace the N2 molecules they are quickly diffuse molecules they are quickly diffuse into the capillaries and the lung into the capillaries and the lung collapses collapses

questionquestion

Your patient has been on 70% 02 Your patient has been on 70% 02 for several days. What single for several days. What single particular hazard of 02 is he at risk particular hazard of 02 is he at risk for? for?

answeranswer

He is at increased risk of 02 toxicity He is at increased risk of 02 toxicity in which increased 02 radicals will in which increased 02 radicals will damage the lung tissuedamage the lung tissue

questionquestion

Your patient has chronic Your patient has chronic hypercapnia associated with morbid hypercapnia associated with morbid obesity. His normal Pa02 ranges obesity. His normal Pa02 ranges between 55- 65 mmHg.between 55- 65 mmHg.

If he is placed on a higher level of If he is placed on a higher level of Fi02 than he needs, what particular Fi02 than he needs, what particular hazard of 02 would he be at risk for?hazard of 02 would he be at risk for?

answeranswer

02 triggering a lost of his 02 triggering a lost of his hypoxic hypoxic drivedrive

The Pa02 rises to ‘normal’ his brain The Pa02 rises to ‘normal’ his brain stops asking for breathsstops asking for breaths

Because the PaC02 started off Because the PaC02 started off abnormally high, and because his body abnormally high, and because his body has adjusted to that his PaC02 starts has adjusted to that his PaC02 starts to rise to the point that it becomes a to rise to the point that it becomes a sedative [PaC02 above 70 mmHg]sedative [PaC02 above 70 mmHg]

QuestionQuestion

When performing percussion for When performing percussion for diaphragmatic excursion , we would diaphragmatic excursion , we would percuss until the resonance becomes percuss until the resonance becomes dull.dull.

This means:This means:

answeranswer

If you are percussing If you are percussing below the rib cagebelow the rib cage, , you are percussing abdominal structures; you are percussing abdominal structures; this is the end of the diaphragm. The this is the end of the diaphragm. The diaphargm can be found between the 9diaphargm can be found between the 9thth and the 12and the 12thth ribs depending on how deep ribs depending on how deep the breath is.the breath is.

If you are still If you are still above the diaphragmabove the diaphragm, this , this change to dullness would imply that there change to dullness would imply that there is consolidation, atelectasis or pleural is consolidation, atelectasis or pleural effusion present over the areaeffusion present over the area