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health assesment > 3.1 Respiratory Assessment > Flashcards

3.1 Respiratory Assessment Flashcards

1
Q

Respiratory System

A

The stimulus to breathe includes
Hypercapnia - Increased CO2
Hypoxia - Decreased O2
Inspiration (Breathing In) - Creates negative pressure
Expiration (Breathing out) - Creates positive pressure

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2
Q

Review of Systems Cough (ROS)

A 
Cough
- When did it start?
- How Often?
- Hacking?
- Dry
Acute Cough - Lasts 2-3 Weeks
Chronic Cough - More than 2 Months
Timing of the cough is important.
- Respiratory Illness cough is continuous
- Work irritants cough is in the afternoon 
- Sinus issues cause coughing at night
- Bronchial Cough (Smokers Cough) happens in the morning
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3
Q

Review of Systems (Sputum)

A 
Color and consistency 
- White is Viral
- Yellow/Green is Bacterial
- Pink and Frothy is indictive of Pulmonary Edema
Bloody (Hemoptysis)
- May indicate tuberculosis
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4
Q

Review of Systems (SOB)

A 
What brings it on?
How long does it last?
What time of day does it occur?
Noticeable Cyanosis?
How many pillows do you sleep with?
Orthopnea: SOB when supine
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5
Q

Review of Systems (Other Issues)

A 
Chest Pain?
Muscle Soreness from coughing?
History of smoking?
Flu/PNA Vaccines?
Screened for TB?
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6
Q

Respiratory System Physical Inspection

A
  • Begin inspecting the Thorax
  • Anything you inspect Anterior you must also inspect Posterior

Inspect Thoracic cage shape, configuration, and color

  • Anteroposterior (AP) diameter should be less than Transverse diameter roughly 1:2
  • Skeletal deformities can limit Thoracic Cage Excursion (How much it expands and closes)

Barrell Chest - AP diameter equals Transverse Diameter
Chest looks like it is in constant inspiration. Common in COPD Patients.

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7
Q

Respiratory System Physical Assessment

A

Skeletal Deformities
Kyphosis - Outward curve of spine “Hunchback”
Scoliosis - Sideways curve of spine

  • Patient facial expression indicates unconscious breathing patterns.
  • Lips and nail bed should be free of cyanosis. Nails should not be clubbing (hypoxia)
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8
Q

Respiratory System Palpation

A
  • Palpate chest over lung fields. Note lumps lesions and temperature
  • Assess chest expansion by placing hands on posterolateral chest wall with thumbs at T9 and T10 vertebrae
    Ask patient to take a deep breath, thumbs should move symmetrically.
    Atelectasis, Pneumonia, Pleural Effusion - Unequal Expansion
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9
Q

Respiratory System Palpation

A

Pain when palpating could mean Pleural Inflammation

99 Test - Test Tactile Fremitus (Vibration)

  • Place ulnar side of palm over lung fields and have patient repeat 99 noting vibration of palm
  • Decreased Fremitus (vibration) may suggest obstruction or thickening, increased fremitus may mean consolidation (air that fills small airways is replaced with something else) (pneumonia).
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10
Q

Respiratory System Palpation

A
  • Assess for Crepitus (crackling) with light palpations
    ABNORMAL
  • Coarse Crackling felt over skin caused by air escaping from lungs into subcutaneous tissue. Common with COPD and Emphysema.
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11
Q

Respiratory System Percussion

A

Resonance - Low pitch, clear, hollow sound over lung tissue.
Hyperresonance - Lower pitched booming sound. Too much air (emphysema, pneumothorax).
Dull - Soft and muffled thuds signals abnormal densities. (Pneumonia, pleural effusion, atelectasis)

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12
Q

Respiratory System Percussion

A

Percuss borders of lungs (resonance)
Percuss abdominal viscera (tympani)
Space between the 2 sounds is the diaphragm, which should be 3-5 cm.

  • Resonance can sound duller in obese or muscular people.
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13
Q

Auscultation of Respiratory System

A
  • When listening, stand behind patient on posterior side of apices (top of lung) at c7 vertebra to base around t10 vertebra. Then from axilla down to 7-8th rib.
  • Press hard enough with stethoscope to make imprint.
  • Patient should take deep breath at each side
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14
Q

Normal Sounds for Respiratory System

A

Bronchial - Heard on anterior side, high pitched, loud, prominent during expiration. Harsh and hollow.

Vesicular - Low-pitched, soft, heard more during inspiration. “Rustling winds through trees”

Bronchovesicular - Moderate pitch and amplitude, heard equally in inspiration and expiration.

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15
Q

Abnormal Sounds

A
  • Decreased or absent sounds maybe obstruction, mucus plug, loss of elasticity (emphysema), pleural thickening, and presence of fluid.
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16
Q

Fine Crackles

A

(Heard when air collides with previously deflated airways)
Fine Crackles - High pitched, short, crackling sounds during inspiration. NOT CLEARED when coughing.
Late inspiration - restrictive disease, pneumonia, or heart failure.
Early inspiration - Obstructive disease, chronic bronchitis, asthma, emphysema.

17
Q

Coarse Crackles

A

(Air inhaled collides with secretions in the trachea and large bronchi)

  • Loud, low pitched, bubbling or gurgling. Decrease with coughing and suctioning but reappear.
  • Due to pulmonary Edema, pneumonia, depressed cough reflex.
18
Q

Atelectasis Crackles

A

(Alveoli are not fully aerated, they deflate and accumulate secretions.)

  • Similar to fine crackles but do not last. They disappear with deep breathing and coughing.
  • Common in post-op patients, or bedridden patients.
19
Q

High pitched Wheeze

A

Musical squeaking that sound polyphonic (multiple pitches at once)

  • Usually heard during expiration but sometimes inspiration as well.
  • Occurs when air is squeezed through narrow airways.
  • Common with diffuse airway obstructions like Asthma or Chronic Emphysema.
20
Q

Low Pitched Wheeze

A
  • Monophonic single pitched musical snoring or moaning, may clear somewhat with coughing.
  • Caused by airway obstruction with bronchitis, bronchus obstruction, or an airway tumor.
21
Q

Stridor

A

High-pitched monophonic inspiratory crowing sound.

  • Louder in neck than chest walls and can be heard with stethoscope.
  • Caused by upper airway obstruction and indicates inflamed tissue, lodged foreign object, croup.
  • In children signifies acute epiglottis.
  • No air is being let in or out (LIFE THREATENING)
22
Q

Pleural Friction Rub

A
  • Superficial sound that is coarse.
  • Caused when pleurae become inflamed and lose normal lubrication.
  • If pain is present with a rub it is called “Pleuritis”
23
Q

Developmental Concerns for Infants

A
  • Let infants hold infant, supported by head or chest.
  • Children can sit in parents lap
  • Infants have barrel chest until age 6.
    After age 6 maybe asthma or cystic fibrosis.
  • Depressed Respiratory rate can be from maternal drugs, low intrauterine blood supply, or obstruction.
24
Q

Special Conditions for Newborns

A
  • Chest circumference should be smaller than head circumference until 2 y/o. Chest wall should be thin with little musculature.
  • Newborns first respiratory assessment is part of APGAR scoring.
  • Infants breathe through nose rather than mouth until 3 months. (No flaring of nostrils, sternal retractions, or intercostal retractions unless infant is in respiratory distress)
  • Diaphragm is major respiratory muscle for newborns, not intercostal, so inspirations are seen more in abdomen.
25
Q

Special Conditions in Pregnant Women

A
  • Thoracic Cage may be wider
  • Respirations may be deeper. (Can only be quantified with pulmonary function tests)
  • Due to pressure of growing uterus on women’s diaphragm.
26
Q

Special Conditions in Elderly

A
  • May have increased anteroposterior (AP) diameter.
    (Barrel Shape, Kyphosis)
  • Because of decreased subcutaneous fat you may palpate bony prominences
  • Patient may fatigue easily, especially during auscultation, when deep mouth breathing is required.
27
Q

Broncophony (Special Lung Test)

A

Tell patient to repeat 99 while listening to chest wall with stethoscope.

  • Normal is soft, muffled, and indistinct.
  • Pathology that increases lung density enhances transmission voice sounds. Hearing a clear voice indicates consolidation.
28
Q

Egophony (Special Lung Test)

A

Auscultate chest while patient goes “eeee”

  • Should hear “eee”
  • Areas of consolidation you hear “aaaa”
29
Q

Whispered pectoriloquy (Special Lung Test)

A
  • Ask patient to whisper phrase
  • Normal response should be faint and muffled
  • Phrase can be heard over areas of consolidation
30
Q

Abnormal Findings

A

Sigh - Psychological condition, inhalations expand alveoli and can lead to hyperventilation

Tachypnea - Increased respirations (20+) possibly due to fever or exercise

Bradypnea - Decreased respirations (10-) due to diabetic coma or an overdose

Hyperventilation - Increased rate and depth of respiration. Blows off CO2 from ketoacidosis.

Hypoventilation - Shallow and decreased breathing that does not allow o2 in. Common with overdose

Cheyne-Strokes Respiration - Fast with periods of apnea (regular). Common with renal failure or overdose.

Biots - Like Cheyne strokes but irregular. Possibly due to heat stroke or meningitis.

31
Q

Order of Assessment

A
  • Inspect breathing pattern and position
  • Remember you must assess front and back
  • Assess rib cage symmetry and breathing
  • Check thoracic expansion (put thumbs under the end of thorax and check for symmetry when breathing.
  • Assess for crepitus (popping) on upper lungs
  • Assess Terminus (ulnar hand saying 99)
  • Percuss for resonance
  • Check for diaphragmic excursion. (Have patient exhale , and hold her breath. Percuss until you feel dull sound (beginning of diaphragm). Then deep breath in and continue percussing until dull again.) end of diaphragm.
  • Next is auscultation for wheezing
  • Next auscultate with patient saying 99

health assesment (14 decks)

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