2. Respiratory Assessment Flashcards
Respiratory assessment
IPPA Inspection palpation percussion auscultation - listen
What does inspection involve
- Tongue/lips
- Skin colour
- Neck vein distension
- Use of accessory muscles
- Extremities (fingers and toes clubbing, odema)
- Many more
- Inspection of chest wall
o Configuration (size and contour
o Chest movement (rate, rhythm, amplitude, depth, skin rash)
o Abnormalities (barrel chest, pigeon chest, funnel chest)
What does palpation involve?
- Using hands to feel various structure to assess:
- Temperature
- Muscle tone
- Tenderness
- Oedema
- Crepitus (air in S/C tissue)
What does percussion involve?
- Produces sound by tapping on chest wall with fingers
- Resonant: low pitched (normal lungs) LUNG TISSUE
- Hyper resonant: loud, lower pitched (hyperinflated lung)
o E.g. acute asthma, COPD AIR TRAPPED - Tympanic: drum like, loud, empty quality
o E.g. gas-filled stomach/intestine, pneumothorax) STOMACH - Dull: medium-intensity pitch (pneumonia, fluid filled pleural space)
- Flat: soft high-pitched (very dense tissue) BONES
What does auscultation involve?
- Listening to chest sounds with stethoscope to assess
- Character of breath sounds
- Presence of adventitious sounds
- Character of spoken/whispered voice
- Adventitious breath sounds
o Wheeze - on inspiration is upper airway involvement due to oedema (stridor)
On expiration is lower airway involvement due to constriction (bronchoconstriction)
o Rhonchi - continuous low pitched, rubbing sound indicating of secretions e.g. bronchitis
o Crackles - soft, high pitched, popping sound
Indication of fluid in alveoli e.g. pneumonia
o Pleural friction rubs
High pitched, loud grating or creaking sounds
When inflamed pleural surfaces rub together during respiration
Heard on both inspiration and expiration
Easily confused with pericardial friction rub- ask patient to hold his breath briefly: ú a pleural rub stops when breathing stops ú If rubbing sound continues, it’s a pericardial friction rub → inflamed pericardial layers continue rubbing together with each heart beat
o Stridor
Continuous musical sound of constant high pitch
Harsh sound heard during inspiration
Caused by obstruction of the upper airway e.g. epiglottitis
Sign of respiratory distress
Requires immediate attention
What is peak flow?
- Measures forced flow expiration Shows idea of narrow or obstructed airways
- Measurement of the peak expiratory flow - giving idea of how narrow or obstructed
What are normal breath sounds?
- Vesicular Soft, low pitched heard in all lung fields
- Bronchovesicular Loud, high pitched
- Bronchial Medium in pitch
- Tracheal Loud: heard over the trachea
Abnormalities with the chest?
- barel chest
- pectus carinatum
- Funnel chest
- Tactile fermitus
What is Barrel chest?
= rounding, bulging chest lung hyperinflation, isn’t a disease means underlying condition
- Caused by chronic conditions COPD, emphysema because lungs are chronically overinflated with air so the rib cage stays partially expanded all the time
What is Pectus Carinatum?
(pigeon chest) = where part of the breastbone is pressed outwards or raised up (chest wall deformity)
- No certain of cause tissue that connects breast to ribs grows too fast
What is Funnel Chest?
(pectus excavatum) congenital deformity of the chest wall that causes several ribs and breastbone (sternum) to grow inward direction
o Exact cause is unknown, but it may be inherited condition as it runs in families
What is Tactile frremitus?
= palpation of the chest wall to detect changes in the intensity of vibrations created with certain spoken words in a constant tone
• Vibration of the chest wall due to vocalization of “99”.
• Increased fremitus – lungs become filled with fluid or more dense
• Decreased – lung hyperinflated – barrel chest
Absent – Pneumothorax and lung alveolar collapse (Atelectasis)
Type of inhalers?
Short acting relivers
- Short acting beta-agonist (SABA)
- Short acting muscarinic antagonist (SAMA)
Long lasting- symptom relivers/ exacerbation preventers
• Long acting muscarinic antagonist (LAMA) E.g. spiriva, tiotropium
• Long acting beta agonist (LABA)
• LABA/LAMA
• Inhaled Corticosteroid (ICS/ LABA) Symbicort
What is a MDI inhalerr?
METERED DOSE INHALERS (MDI)
• Disperse medication through aerosol spray, mist or fine power to penetrate lung airways
• Drugs can be administered in high concentration with few S/Ee
What is a spacer used for?
• Helps medication get straight into the lungs rather than sitting on tongue
o Maximising effect of medication
o More medication reaches the lungs and less is swallowed
o Comes with mask ideal for babies and young children
o Helps to reduce S/E e.g. thrush
