CLASS 13 - RESPIRATORY ASSESSMENT, OXYGEN THERAPY, + RESPIRATORY AND DIAGNOSTIC STUDIES Flashcards
Define Gas Exchange
Process by which oxygen is transported to cells and carbon dioxide is transported from cells
Define Ischemia
Insufficient flow of oxygenated blood to tissues that may result in hypoxemia and subsequent cell injury
Define Hypoxia
Insufficient oxygen reaching cells
Define Anoxia
Total lack of oxygen in body tissues
Define Hypoxemia
Reduced oxygenation of arterial blood
Identify the 4 respiratory defense mechanisms
Gag reflex (to prevent aspiration)
Filtration of air
Mucociliary clearance system (cough reflex + reflex bronchoconstriction)
Alveolar macrophages
What are the effects of aging on:
- elastic recoil
- chest wall compliance
- anteroposteiror diameter
- functioning alveoli
- DECREASED elastic recoil
- DECREASED chest wall compliance
- INCREASED anteroposterior diameter
- DECREASED functioning alveoli
What are the effects of aging on:
- cell-mediated immunity
- specific antibodies
- cilia function
- cough force
- alveolar macrophage function
- DECREASED cell-mediated immunity
- DECREASED specific antibodies
- DECREASED cilia function
- DECREASED cough force
- DECREASED alveolar macrophage function
What are the effects of aging on:
- response to hypoxemia
- response to hypercapnia
- DECREASED response to hypoxemia
- DECREASED response to hypercapnia
What types of questions would you ask a patient about their health history during a respiratory assessment?
surgery or other treatments
phx
- any allergies?
- history of respiratory infection or lung disease?
current health history
- how is your breathing?
- do you have a cough? Is it productive? what colour?
- any SOB or dyspnea? on exertion? when lying down (orthopnea)? does it wake you up at night?
- any chest pain? is it constant or intermittent? with deep breahts? on inspiration or expiration?
self care history
- do you smoke or live with someone who smokes?
- how long have you smoked for?
- how many cigarettes a day do you smoke?
do you take any medications to help your breathing?
What is orthopnea?
SOB when lying down
What is Paroxysmal Nocturnal Dyspnea (PND)?
SOB that wakes you up at night.
What is a sigh? Is it a normal finding?
Greater inspiration + expiration
normal finding
what is tachypnea?
rapid, shallow breathing
what is hyperventilation?
Rapid breathing, larger inspirations
what is bradypnea?
slow breathing, normal volume
what is hypoventilation?
breathing too shallow + too slow to meet the needs of the body
what is a normal anteroposterior-to-transverse ratio?
1:2 or 5:7
Describe barrel chest as an abnormal finding on chest inspection.
anteroposterior-to-transverse ratio of 1:1
ribs are horizontal rather than normal downward slope
associated w normal aging and w chronic emphysema and asthma as a result of hyperinflation of the lungs
Describe scoliosis as an abnormal finding on chest inspection.
Lateral S-shaped curvature of thoracic and lumbar spine.
Describe kyphosis (humpback) as an abnormal finding on chest inspection.
Exaggerated posterior curvature of the thoracic spine.
Describe Pectus Excavatum as an abnormal finding on chest expansion.
Sunken sternum.
Describe Pectus Carinatum as an abnormal finding on chest expansion.
Forward protrusion of the sternum.
What is the shape of the thorax in infants?
Round.
what is accessory muscle use when breathing a sign of?
Increased WOB.
What are the 5 types of percussive sounds?
resonant hyper-resonant tympany dull flat
describe resonant percussive sounds in terms of amplitude, pitch, and quality
medium-loud
low
clear, hollow
describe hyper-resonant percussive sounds in terms of amplitude, pitch, and quality
loud
low
booming
describe tympanic percussive sounds in terms of amplitude, pitch, and quality
loud
high
musical + drum-like
describe dull percussive sounds in terms of amplitude, pitch, and quality
soft
high
muffled thud
describe flat percussive sounds in terms of amplitude, pitch, and quality
v/ soft
high
instant stop of sound, dullness
What does IPPA stand for?
Inspection
Palpation
Percussion
Auscultation
Identify the 4 types of discontinuous lung sounds.
fine crackles
course crackles
atelectatic crackles
pleural friction rub
Identify the 3 types of continuous lung sounds.
High pitched (sibilant) wheeze Low pitched (sonorous) wheeze Stridor
Describe the following voice sounds:
- bronchophony
- egophony
- whispered pectoriloquy
bronchophony - auscultate wile the patient says “99”
egophony: auscultatw while patient says “eeeeeeeeeee”
whispered pectoriloquy: auscultate while patient whispers “one-two-three”
What is diaphragmatic excursion? What is a normal range?
How far the diaphragm moves during inspiration
3-5 cm
how do you measure diaphragmatic excursion?
ask patient to exhale + hold. perrcuss down + mark
ask patient to inhald + hold. percuss down + mark.
difference between the 2 = diaphragmatic excursion.
what is bruxism?
teeth grinding
Describe JVP
reflects pressure + volume in the R atrium
the jugular vein is distended w excess volume.
what does a heart murmur sound like?
blowing or swooshing sound
what causes an S2 split?
valves not closing at the same time during inspiration
What is a VQ scan? what is the purpose of a VQ scan?
A VQ scan is a nuclear medicine scan that used radioactive material to examine ventilation (air flow) and perfusion (blood flow) in the lungs.
The aim of the scan is to look for evidence of a pulmonary embolism.
what is thoracentesis?
what is the purpose of this procedure?
thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and chest wall.
the procedure is done to remove excess fluid (pleural effusion) from the pleural space to help you breathe easier.
