CP: respiratory lab 1 Flashcards by Chavez Girls

What patients might have orthopnea?

L sided HF, COPD, fluid backup in lungs

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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

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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

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Purulent sputum may be a sign of

infection or fever
may not be time for intense exercise

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foamy white or frothy pink sputum indicates

cardiac problems, fluid back up into lungs, L CHF

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What color sputum should cause concern

red, rusty colored

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What vital signs should you be monitoring?

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

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Increased PA pressure indicates

right sided HF

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

inhaling
exhaling

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restrictive lung disease

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

stiff, fibrotic

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examples of restrictive lung disease

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

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obstructive lung disease examples

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

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

increased CO2, decreased O2

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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)

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What neurological conditions can be related to respiratory diseases?

SCI - T4 affects ventilation, T8 intercostals

Phrenic nerve damage

ALS - paralyzed muscles

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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%)

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

lack of oxygen getting to the brain
hypoxia

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Pectus excavatum

sternum is sunken inward, obstructive, need surgery

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A kyphotic posture or scoliosis may result in _________

restrictive lung disease, chest cant expand properly

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Obesity may contribute to ____ lung disease

restrictive

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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

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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

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How can you measure respiratory fxn with speech?

should be able to finish normal sentence without stopping to breathe

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T/F: expiration is passive during exercise

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

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