CP: respiratory 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
actelectasis
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, rusty colored
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
hypoxia
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
Abdomen inwards and rib cage moves outward during inspiration sign of? position of recovery?
diaphragm issue
position of recovery: abdominal binder to increase abdominal pressure
Abdomen moves outwards and rib cage moves inward during inspiration sign of? position of recovery?
Hoover’s sign
Chest wall issue
Position of recovery: leaning forward so your lungs are sitting against the ribs to push out the rib cage during inspiration.
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
(to direct blood to better ventilated areas)–> pulmonary artery pressure increases and R heart works harder –> fails
Digital clubbing is a sign of
chronic low O2 levels
consolidation is present if you hear
percussion: sounds dull
increase tactile fremitus: increase vibration
Egophony: person says ee hears ayy
crackles (common in pneumonia and Pulmonary edema)
broncial breath sounds instead of vesicular
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
tracheal deviation explain procedure
-index finger in middle of suprasternal notch
-compare distance b/w trachea and clavicle on each side
-equal distance
purpose of CWE
evaluate thoracic expansion in order to measure progress or decline of pt condition. looking for symmetry
CWE apical or upper lobe
-heel of hand at 2nd rib
-fingertips towards traps
-thumb horizontal to level of sternal angle
-ask pt to MAX INHALE
CWE anterolateral or middle lobe/ lingula
-hands placed with palms distal to nipple line and thumbs meet in midline
-fingers lie in posterior axillary fold
CWE posterior excursion/lower lobe
-hands placed flat on posterior chest wall at level of 10th rib
thumb meet midline; fingers reach towards anterior axillary fold
Questions to ask with CWE
did you see symmetry of chest wall expansion?
how is the extent of the chest wall motion?
CWE tape measure landmarks
upper chest wall
middle chest wall
lower chest wall
upper:4th costal cartilage
middle: xiphoid process
lower: 9th costal cartilage
explain tape measure CWE procedure
-wrap around thorax
-ask pt to inhale normal allow tape measure to move horizontally
-measure distance from preinspiration to end of normal inspiration
-repeat
CHEST WALL MAX INHALE can be measured with same normal inspiration
Chest Wall examination voice sounds
to access underying pulmonary pathology process by transmitting vocal vibrations through the pathologic process and confirming its prescence
***stethoscope
bronchophony
ask pt to say blue mood (increased vocal transmission Y or N)
if yes –> consolidation due to pneumonia
egophony
ask partner to say eeee but heart E to A could be consolidation due to pneumonia
Whispered pectoriloquy
whisper 99–> consolidation
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
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 hear where can indicate consolidation?
what sounds would you hear with someone with emphysema?
hyperresonant
