CP: RESPIRATORY EXAM (LAB 1)

Question 1

What patients might have orthopnea?

Answer 1

L sided HF, COPD, fluid backup in lungs

Question 2

A patient who just had thoracic surgery or is severely weak may be at risk for what

Answer 2

pneumonia

cant cough and clear their airways, fluid build up - infection

actelactis

Question 3

What other areas of the body may respiratory dysfxn/poor breathing mechanics manifest to?

Answer 3

neck pain if accessory inspiratory muscles take over - SCM, scalene

CLBP - need diaphragm to stabilize lumbar spine by creating IAP

Question 4

Purulent sputum may be a sign of

Answer 4

infection or fever
may not be time for intense exercise

Question 5

foamy white or frothy pink sputum indicates

Answer 5

cardiac problems, fluid back up into lungs, L CHF

Question 6

What color sputum should cause concern

Answer 6

red

Question 7

What vital signs should you be monitoring?

Answer 7

HR, BP, RPP, SaO2, SPO2, PUL. ARTERY

Question 8

Increased PA pressure indicates

Answer 8

right sided HF

Question 9

Patients with restrictive lung disease have trouble _____ while patients with obstructive lung disease have trouble _____

Answer 9

inhaling
exhaling

Question 10

restrictive lung disease

Answer 10

stiffening of the lung tissue or restricted expansion of the chest wall

stiff, fibrotic

Question 11

examples of restrictive lung disease

Answer 11

pulmonary fibrosis
lung cancer/chemoradiation = scar tissue
Pneumoconiosis
Sarcoidosis
neuromuscular disease

Question 12

obstructive lung disease examples

Answer 12

asthma
COPD - emphysema, bronchitis (fluid build up, cystic fibrosis)

Question 13

Someone with obstructive respiratory disease will have ___ CO2 levels and ____ O2 levels

Answer 13

increased CO2, decreased O2

Question 14

Obstructive disease make it hard to exhales, which eventually makes it hard to inhale bc youre not getting air out. What physical manifestation might you see?

Answer 14

Barrel shaped chest (hyperinflated)

Question 15

What neurological conditions can be related to respiratory diseases?

Answer 15

SCI - T4 affects ventilation, T8 intercostals

Phrenic nerve damage

ALS - paralyzed muscles

Question 16

What other questions should you ask if your pt is on supp oxygen?

Answer 16

what type, how much, how is it delivered

check SpO2 levels to see how well they can be oxygenated on the supp oxygen (ex: are they still only getting to 93%)

Question 17

If your pt is not alert or is acting confused it might be a sign of

Answer 17

lack of oxygen getting to the brain

Question 18

Pectus excavatum

Answer 18

sternum is sunken inward, obstructive, need surgery

Question 19

A kyphotic posture or scoliosis may result in _________

Answer 19

restrictive lung disease, chest cant expand properly

Question 20

Obesity may contribute to ____ lung disease

Answer 20

restrictive

Question 21

What characteristics might you see in someone with empysema?

Answer 21

pursing lips to prolong exhale and prevent collapse

cachexia bc so much energy to breathe

hunched posture to use accessory muscles to help

pink undertone bc blood oxygen levels are normal/high

PINK PUFFER

Question 22

What characteristics might you see in someone who has bronchitis?

Answer 22

BLUE BLOATER

chronic hypoxia = cyanotic (poor O2 exchange bc inflammation and mucus)

fluid retention (R HF)

obese - hypoxia and fatigue often reduce activity levels

Question 23

How can you measure respiratory fxn with speech?

Answer 23

should be able to finish normal sentence without stopping to breathe

Question 24

T/F: expiration is passive during exercise

Answer 24

F

Question 25

Paradoxal breathing

Answer 25

chest goes in with inspiration, chest goes out with exhaling breathe in, belly in breath out belly out

Question 26

Kussmaul breahting

Answer 26

deep, labored breathing pattern that occurs in response to metabolic acidosis, especially diabetic ketoacidosis (DKA) body compensating for excess acid by blowing off CO₂ to raise blood pH.

Question 27

T/F: therapists can work with pts to fix kussmal breathing or paradoxal breathing

Answer 27

F

Question 28

Central cyanosis vs peripheral cyanosis symptoms

Answer 28

central - blue tounge, lip, lower eyelids, warm peripheray peripheral - cold blue extremities, nail beds

Question 29

Central cyanosis vs peripheral cyanosis indications

Answer 29

central - CHD, CHF, lung disease peripheral - low CO, hypovolemic shock

Question 30

How might chronic hypoxia lead to R HF?

Answer 30

low levels of O2 makes lung vasculature vasconstrict, pulmonary artery pressure increases and heart works harder ?

Question 31

Digital clubbing is a sign of

Answer 31

chronic low O2 levels

Question 32

consolidation is present if you hear

Answer 32

Bronchial sounds where they’re not supposed to be, increased fremitus

Question 33

tracheal deviation might indicate

Answer 33

tumor, pneumorthorax, atelectasis

Question 34

Atelactasis, agenesis, pneumonextomy and pleural fibrosis would cause deviation of the trachea ____ the diseased side

Answer 34

toward

Question 35

pneumothorax, pleural effusion or a large mass would deviate the trachea ___ the diseased side

Answer 35

away from

Question 36

Describe placement for hands during the chest wall exercusion

Answer 36

2nd rib, nipple line then posterior 10th rib, thumbs meet in middle always

Question 37

what are the three landmarks when using a tape measure to measure chest wall excursion?

Answer 37

upper - 4th costal cartilage middle - xiphoid lower - 9th costal cartilage

Question 38

What do voice sounds asses?

Answer 38

to assess underlying pathology of tracheobronchial tree and lung parenchyma by transmiting vocal vibrations though it and confirming its presence

Question 39

A positive finding during voice sounds examination is what? What does it indicate?

Answer 39

+ is increased or decreased sounds over the bronchial segment could be from consolidation due to pneumonia

Question 40

tactile fremitus test purpose

Answer 40

spoken words produce vibration over chest wall which we can feel (tactile fremitus) identify presence or absence of tactile fremitus to tell you about the density of the underlying lungs and thoracic cavity

Question 41

Increased tactile fremitus may indicate Decreased tactile fremitus may indicate

Answer 41

consolidation, pul edema, pleural effusion, COPD

Question 42

Mediate percussion technique

Answer 42

tap over your own middle finger DIP

Question 43

resonant sounds are heard normally where

Answer 43

over air filled structures (lungs)

Question 44

a dull sounds near where can indicate consolidation? Where would you normally hear a dull sound?

Answer 44

Should hear it over diaphragm

Question 45

what sounds would you hear with someone with emphysema?

Answer 45

hyperresonant

Question 46

What is diaphragmatic excursion?

Answer 46

measuring distance of diaphragm at max exhalation and as it ascends with relaxation use mediate percussion to find the lowest point where a resonant tone is heard (lowest position of diaphragm during max inspiration) then find lowest position of resonance during exhalation

Question 47

What is the normal range of diaphragmatic excursion?

Answer 47

3-5cm