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Physical Assessment > 4 - Respiratory > Flashcards

4 - Respiratory Flashcards

1
Q

Respiration maintains adequate _____ ______ to tissues

A

oxygen supply

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2
Q

What does respiration do?

A
  • Removes carbon dioxide and metabolic wastes

- Maintains homeostasis or arterial blood

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3
Q

List & Describe the 2 processes of respiration

A

1) Ventilation - inspiration and expiration (gas moves in and out of lungs)
2) Diffusion - oxygen and carbon dioxide moves from areas high to low concentration (ex. alveoli - capillary - cells)

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4
Q

List 3 respiratory disorders

A
  • asthma
  • COPD
  • allergies
  • lung cancer
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5
Q

What are the 3 parts of the thoracic cavity?

A

1) Mediastinum
2) Right pleural cavity
3) Left pleural cavity

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6
Q

What does the mediastinum contain?

A
  • heart
  • arch of aorta
  • superior vena cava
  • lower esophagus
  • lower part of trachea
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7
Q

What does the right and left pleural cavity contain?

A

lungs

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8
Q

Right lung has __ lobes

A

3

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9
Q

Left lung has ___ lobes

A

2

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10
Q

What is the parietal pleura?

A

protects the chest wall and diaphragm

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11
Q

What is the visceral pleura?

A

protects the lungs

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12
Q

What protects most of the respiratory system

A

Thoracic cage

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13
Q

What does the thoracic cage consist of?

A
  • 12 thoracic vertebrae
  • 12 pairs of ribs
  • Sternum
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14
Q

Anterior Chest:

_____ (highest point of lung) is 2-4 cm above the inner 1/3 of clavicle

A

Apex

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15
Q

Anterior Chest:

_____ (lower border of lung) rests on diaphragm at ~ 6th rib in midclavicular line

A

Base

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16
Q

Lateral Chest:

Where is the apex?

A

Apex at axilla

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17
Q

Lateral Chest:

Where is the base?

A

Base extends to 7th or 8th rib

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18
Q

Posterior Chest:

Where is the apex?

A

Apex located at C7

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19
Q

Posterior Chest:

Where is the base?

A

Base located at T10 (inspiration expands lungs, with base dropping to T12)

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20
Q

What are some general respiratory assessment questions?

A
  • Chronic illnesses (ex. asthma, COPD, lung cancer)
  • Acute illnesses (pneumonia, chest injury)
  • Allergies
  • Medications (corticosteroids, inhalers)
  • Smoking history (current, past, frequency)
  • Home oxygen
  • Environment (air pollution, allergens, pets, air filter system, occupational, recent travel)
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21
Q

What kind of questions do you ask if someone comes in with cough, SOB or chest pain with breathing?

A

OLD CART

Onset
Location
Duration
Characteristics
Aggravates/Alleviates
Radiate
Treatment
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22
Q

What do you inspect when observing respirations?

A
  • Rate, Rhythm, Depth, Effort in Breathing
  • Audible breathing
  • Cyanosis
  • Nasal flaring
  • Chest expansion
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23
Q

Bradypnea

A

slow breathing

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24
Q

Tachypnea

A

rapid breathing

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25
Q

Hyperpnea

A

rapid deep breathing

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26
Q

Apnea

A

no breathing

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27
Q

Kussmaul

A

deep breathing

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28
Q

Biot

A

unpredictable irregular breathing

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29
Q

Cheyne-Stokes

A

deep breathing alternating with apnea

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30
Q

What do you inspect when observing anterior and posterior chest?

A
  • Skin, color, and condition
  • Size, shape and symmetry of the chest wall
    • lateral/anteroposterior diameter
    • vertebral column alignment
  • Position the patient takes to breath (ex. sit leaning forward)
  • Abnormal retraction
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31
Q

What do you do when palpating the anterior and posterior chest?

A
  • Assess any observed abnormalities during inspection
  • Identify areas of tenderness
  • Assess respiratory excursion (lung expansion)
  • Assess tactile fremitus (transmission of vibrations from larynx to chest surface)
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32
Q

How do you palpate for respiratory excursion (lung expansion) ?

A
  • Place hands on back at level T9 or T10
  • Thumbs ~ 1” apart
  • Pinch a small fold of skin between thumbs
  • Relax hands
  • Ask patient to take a deep breath
  • As patient inhales deeply, your thumbs should move apart (lungs expanding) symmetrically
33
Q

How do you palpate for tactile fremitus (transmission of vibrations from larynx to chest surface) ?

A
  • Ball of both hands
  • Over intercostal spaces
  • Patient repeats “99” or “1-1-1”
  • Compare sides for symmetry
  • Palpable vibrations transmitted through the bronchopulmonary tree to the chest well
34
Q

What is percussion?

A

Tapping sets the chest wall and underlying tissues in motion producing

  • Audible sounds
  • Palpable vibrations
35
Q

What does percussion allow for?

A

The determination of whether underlying tissues are:

  • Air-filled (hyper-resonant/tympanic)
  • Fluid filled (dull)
  • Solid mass (dull/flat)
36
Q

What is auscultation used for?

A

to assess air flow through the tracheobronchial tree

37
Q

What does auscultation involve?

A
  • Listening to sounds generated by breathing
  • Listening for any adventitious (added) sounds
  • Listen to sounds of patients’ spoken or whispered voice
38
Q

What are some adventitious sounds?

A
  • crackles/rales
  • wheezing
  • rhonchi
  • friction rub
39
Q

What are breath sounds described in terms of?

A
  • location
  • ratio of inspiration to expiration
  • intensity
  • pitch
40
Q

What do crackles/rales sound like?

A

-Short, popping inspiration and/or expiration

41
Q

Mechanism of crackles/rales?

A

Air forced through bronchi narrowed by fluid/mucus/pus

42
Q

Conditions that cause crackles/rales?

A
  • Infection
  • Inflammation
  • Heart failure
43
Q

What do wheezes sound like?

A

High-pitched, musical inspiration and/or expiration

44
Q

Mechanism of wheezes?

A

airway narrowing

45
Q

Conditions that cause wheezes?

A
  • Asthma
  • COPD
  • Bronchitis
46
Q

What does stridor sound like?

A

-High-pitched, musical

INSPIRATION ONLY

47
Q

Mechanism of stridor?

A

Mechanical obstruction at trachea/upper airway

48
Q

Conditions that cause stridor?

A
  • Tumor

- Pneumonia

49
Q

What does Friction Rub sound like?

A

Deep, harsh, grating/creaking

Mostly INSPIRATION

50
Q

Mechanism of Friction Rub?

A

Inflamed pleural surfaces lose normal lubricating fluid

51
Q

Conditions that cause Friction Rub?

A

Pleuritis

Pneumonia

52
Q

What would indicate Bronchophony ?

A

Patient says “99” and it is louder and clearer

53
Q

What would indicate egophony ?

A

Patient says “EE” and it comes outs E to A

??? WTF

54
Q

What is whispered pectoriloquy?

A

Whisper “99” and it comes out louder and clearer

55
Q

__________:

  • Percussion is dull over airless area
  • Bronchial breath sound
  • Late inspiratory crackles
  • Increased tactile fremitus
A

Consolidation

56
Q

______:

  • Percussion is diffusely hyperresonant
  • Decreased/absent breath sounds
  • May have wheezes, crackles, rhonchi
  • Decreased tactile fremitus
57
Q

______ ________:

  • Percussion is resonant
  • Vesicular breath sounds
  • May have scattered crackles, wheezes, rhonchi
  • Normal tactile fremitus
A

Chronic bronchitis

58
Q

What is spirometry?

A

A tool used to objectively assess airflow obstruction and stage severity of pulmonary disease

  • Measures the total volume of air a patient can expel from the lungs after maximal inhalation
  • Gold standard for diagnosing asthma and COPD
  • Monitoring progression/control
59
Q

How long should a short-acting beta agonist be withheld prior to spirometry test?

60
Q

How long should an anticholinergic be withheld prior to spirometry test?

61
Q

How long should a long-acting beta agonist be withheld prior to spirometry test?

A

12-24 hours

62
Q

How long should a long-acting anticholinergic be withheld prior to spirometry test?

63
Q

What are some spirometry indications?

A
  • Significant occupational exposure to respiratory irritants
  • Smokers of > 20 pack years
  • Recurrent or chronic respiratory symptoms
  • Family history of respiratory disease
  • Assess/monitor bronchodilator therapy
  • Adverse reactions to drugs (ex. amiodarone)
64
Q

PFTs

A

pulmonary function tests

65
Q

What are some spirometry relative contraindications?

A
  • recent surgery (within 4 weeks)
  • aneurysm (cerebral, thoracic, abdominal)
  • recent eye surgery
  • recent stroke
  • severe uncontrolled hypertension
  • pneumothorax
  • unstable cardiac status
  • MI within last month
  • Active TB, Hepatitis B, Hemoptysis or oral bleeding (cross infection concerns)
66
Q

What is FVC ?

A

Forced vital capacity:

-Total volume of air that can be forcibly exhaled in one breath after full inspiration (L)

67
Q

What is FEV1 ?

A

Forced expiratory volume in 1 second:

-Volume of air expired in first second during maximal expiratory effort (L)

68
Q

What is PEF ?

A

Peak expiratory flow:

-Maximal flow speed achieved during forced expiration after full inspiration (L/min)

69
Q

What is FEV1/FVC ratio ?

A

Proportion of forced vital capacity exhaled in the first second (%, post bronchodilator)

70
Q

How is asthma diagnosed?

A

FEV1/FVC ratio < LLN and > 12% increase in FEV1 (and minimum > 200 mL for adults) post-bronchodilator (or after course of controlled therapy)

71
Q

How is COPD diagnosed?

A

FEV1/FVC < 0.7
AND

Mild: FEV1 > 80% predicted
Mod: 50% < FEV1 < 80% predicted
Sev: 30% < FEV < 50% predicted
Very Sev: FEV1 < 30% predicted

*All values post-bronchodilator

72
Q

For asthma, when do you need to repeat spirometry?

A

every 1-2 years afterward

73
Q

What indicates a loss of asthma control?

A

FEV1 < 90% of personal best

74
Q

T or F: Long-term lung function often declines over time, even in well-controlled patients

75
Q

When do you redo spirometry in COPD?

A

spirometry at 1-2 year intervals after diagnosis can help chart rate of lung function decline

76
Q

What can establish presence of a complicated exacerbation?

A

FEV1 < 50% predicted

77
Q

LLN

A

lower limit of normal (for age, sex, height, ethnicity); typically 0.8 - 0.9 for age 6-17 and 0.75-0.8 for adults

78
Q

see diagnostic flow diagram and cases !!!

Physical Assessment (6 decks)

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