CP: RESPIRATORY EXAM (LAB 1) Flashcards
What patients might have orthopnea?
L sided HF, COPD, fluid backup in lungs
A patient who just had thoracic surgery or is severely weak may be at risk for what
pneumonia
cant cough and clear their airways, fluid build up - infection
actelactis
What other areas of the body may respiratory dysfxn/poor breathing mechanics manifest to?
neck pain if accessory inspiratory muscles take over - SCM, scalene
CLBP - need diaphragm to stabilize lumbar spine by creating IAP
Purulent sputum may be a sign of
infection or fever
may not be time for intense exercise
foamy white or frothy pink sputum indicates
cardiac problems, fluid back up into lungs, L CHF
What color sputum should cause concern
red
What vital signs should you be monitoring?
HR, BP, RPP, SaO2, SPO2, PUL. ARTERY
Increased PA pressure indicates
right sided HF
Patients with restrictive lung disease have trouble _____ while patients with obstructive lung disease have trouble _____
inhaling
exhaling
restrictive lung disease
stiffening of the lung tissue or restricted expansion of the chest wall
stiff, fibrotic
examples of restrictive lung disease
pulmonary fibrosis
lung cancer/chemoradiation = scar tissue
Pneumoconiosis
Sarcoidosis
neuromuscular disease
obstructive lung disease examples
asthma
COPD - emphysema, bronchitis (fluid build up, cystic fibrosis)
Someone with obstructive respiratory disease will have ___ CO2 levels and ____ O2 levels
increased CO2, decreased O2
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?
Barrel shaped chest (hyperinflated)
What neurological conditions can be related to respiratory diseases?
SCI - T4 affects ventilation, T8 intercostals
Phrenic nerve damage
ALS - paralyzed muscles
What other questions should you ask if your pt is on supp oxygen?
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%)
If your pt is not alert or is acting confused it might be a sign of
lack of oxygen getting to the brain
Pectus excavatum
sternum is sunken inward, obstructive, need surgery
A kyphotic posture or scoliosis may result in _________
restrictive lung disease, chest cant expand properly
Obesity may contribute to ____ lung disease
restrictive
What characteristics might you see in someone with empysema?
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
What characteristics might you see in someone who has bronchitis?
BLUE BLOATER
chronic hypoxia = cyanotic (poor O2 exchange bc inflammation and mucus)
fluid retention (R HF)
obese - hypoxia and fatigue often reduce activity levels
How can you measure respiratory fxn with speech?
should be able to finish normal sentence without stopping to breathe
T/F: expiration is passive during exercise
F
Paradoxal breathing
chest goes in with inspiration, chest goes out with exhaling
breathe in, belly in
breath out belly out
Kussmaul breahting
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.
T/F: therapists can work with pts to fix kussmal breathing or paradoxal breathing
F
Central cyanosis vs peripheral cyanosis symptoms
central - blue tounge, lip, lower eyelids, warm peripheray
peripheral - cold blue extremities, nail beds
Central cyanosis vs peripheral cyanosis indications
central - CHD, CHF, lung disease
peripheral - low CO, hypovolemic shock
How might chronic hypoxia lead to R HF?
low levels of O2 makes lung vasculature vasconstrict, pulmonary artery pressure increases and heart works harder
?
Digital clubbing is a sign of
chronic low O2 levels
consolidation is present if you hear
Bronchial sounds where they’re not supposed to be, increased fremitus
tracheal deviation might indicate
tumor, pneumorthorax, atelectasis
Atelactasis, agenesis, pneumonextomy and pleural fibrosis would cause deviation of the trachea ____ the diseased side
toward
pneumothorax, pleural effusion or a large mass would deviate the trachea ___ the diseased side
away from
Describe placement for hands during the chest wall exercusion
2nd rib, nipple line then posterior 10th rib, thumbs meet in middle always
what are the three landmarks when using a tape measure to measure chest wall excursion?
upper - 4th costal cartilage
middle - xiphoid
lower - 9th costal cartilage
What do voice sounds asses?
to assess underlying pathology of tracheobronchial tree and lung parenchyma by transmiting vocal vibrations though it and confirming its presence
A positive finding during voice sounds examination is what? What does it indicate?
+ is increased or decreased sounds over the bronchial segment
could be from consolidation due to pneumonia
tactile fremitus test purpose
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
Increased tactile fremitus may indicate
Decreased tactile fremitus may indicate
consolidation, pul edema,
pleural effusion, COPD
Mediate percussion technique
tap over your own middle finger DIP
resonant sounds are heard normally where
over air filled structures (lungs)
a dull sounds near where can indicate consolidation?
Where would you normally hear a dull sound?
Should hear it over diaphragm
what sounds would you hear with someone with emphysema?
hyperresonant
What is diaphragmatic excursion?
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
What is the normal range of diaphragmatic excursion?
3-5cm
