Exam 2 Flashcards
what is dyspnea?
- sensation of breathing discomfort
- used to describe difficulty in the mechanical act of breathing
- most common symptom that respiratory therapists are called to treat
what are the factors of a cough?
- Color, Consistency, amount and odor
- length:acute, chronic, recurrent
- sound: barking, brassy, wheezing, dry
How can you determine the level of dyspnea?
modified borg scale
what does a cough do?
Mucous blanket
- important cleansing mechanism of the tracheobronchial tree.
- breaks up secretions
Internal factors of communication
- Empathy
- Optimistic view of people
- Ability to listen
- Genuine liking of people
what does JVD mean?
Jugular venous distention
External factors of communication
- Physical setting
- Privacy
- Limit interruptions
- Comfortable environment
- Limit computer usage
what is hypoxia?
low oxygen in the tissues
what are the chest deformities ?
- Kyphosis: “hunchback”
- Scoliosis: lateral curvature
- Barrel Chest: increased A-P diameter of chest
- Pectus Excavatum: funnel shaped depression over the lower sternum
- Pectus Carinatum: forward projection of the xiphoid process “pigeon chest”
physical examination steps
- Inspection (visually examining)
- Palpitation (touching)
- Percussion (tapping)
- Auscultation (listening with a stethoscope)
what is Tripodding?
Patient must sit upright while bracing his or her elbows on table common in COPD patients.
what is Orthopnea?
patient only able to breathe comfortably in upright position
what is Afebrile?
sites to take temperatures
- Oral: Convenient, Patient comfort, affected by hot or cold liquids, follow directions
- Rectal: Most accurate, uncomfortable, diarrhea
- Ear (tympanic): Less infection risk, convenient
- Axillary: Safe and noninvasive, least reliable (1°F lower than oral)
what is Febrile?
clinical signs of hypothermia
- Below normal body temperature
- Decreased pulse and RR
- Severe shivering
- Coldness or chills
- Pale or bluish cool waxy skin
- Hypotension
- Decreased urinary output
- Lack of muscle coordination
- Disorientation
- Drowsiness or unresponsiveness
- Coma
what us a normal pulse rate?
60-100bpm
what is tachycardia?
> 100 bpm
what is inspiration ?
an active process where the diaphragm contacts and causes intrathoracic pressure to decrease, in turns causes the pressure in the airways to fall and air flows in
what is bradycardia?
< 60 bpm
what is Eupnea?
(RR)
- normal range
- 12-20 bpm
what is Bradypnea?
fewer than 12 breaths per min
what is apnea?
absence of breathing that leads to respiratory arrest
what is tachypnea?
- more than 20 bpm
what is hyperventilation?
increased rate and depth, increasing alveolar ventilation and decreased PACO2
what is hypoventilation?
decreased rate and depth decreasing alveolar ventilation and increased PACO2
what is Kussmauls?
increased rate and depth of breathing
what a normal blood pressure?
120/80mmHg
what is Systolic and
Diastolic?
- systolic: contraction
- diastolic: relaxation
what are biots respiration?
fast, deep respirations abrupt pauses
what is hypotension?
90/60mmHg
what is Pulsus Paradoxus?
is defined as a systolic blood pressure that is more than 10mmHg lower on inspiration than on expiration
what is Orthostatic hypotension?
When blood pressure quickly drops as the individual rises to an upright position or stands: syncope
what is hypertension?
140/90mmHg
what is a normal pulse oximetry?
95-100%
what is Capillary Refill?
Press briefly and firmly on the patient’s fingernail until the nail bed is blanched. Speed at which the blood flow and color return is noted.
what is Unilateral reduction ?
- happens with major part of one lung reduced
- Consolidation
- Pleural Effusion
what are diseases that have a reduction in palpatation?
- Neuromuscular
- COPD
what is Vocal fremitus?
(the word 99)
vibrations created by the vocal cords during speech. They are transmitted down the tracheobronchial tree and through the lung to the chest wall.
what is Tactile fremitus ?
vibrations are felt on the chest wall.
what is Dull percussion note?
- Pleural thickening
- Pleural effusion
- Atelectasis
- Consolidation
what is Hyperresonant percussion note?
- Chronic obstructive pulmonary disease (COPD)
- Pneumothorax
- Asthma
what are the 3 normal breath sounds?
- Bronchial (tracheal) (loud, high pitch, in&Ex)
- Bronchovesicular(bronchi) (moderate pitch&loudness)
- vesIcular(any lung) (high pitch & soft intensity)
crackles
occur when airflow moves secretions or fluid in the airways
coarse crackles
(on inspiration & expiration)
low pitched, rumbling, bubbling or gurgling
- Copd
- cystic fibrosis
- bronchiectasis
- CHF
fine crackles
(end of inspiration)
not continuous, high pitched, crackling & popping sounds
- Atelectasis
- interstitial fibrosis
- early pulmonary edema
- pneumonia
wheezing
(on inspiration & expiration)
- produced by narrowed bronchial airways
- continuous, high pitched musical whistles that are generally heard on expiration, severe cases on inspiration as well.
- Asthma
- bronchospasm
- mucosal edema
- foreign bodies
Bronchial
(equal I:e heard)
- prevented from being vesicular breath sounds because of consolidation
- harsh hallow or tubular. Loud high pitch
Stridor
- continuous, loud high pitched caused by an obstruction in the trachea or larynx. Generally can be heard without a stethoscope.
- Glottic edema
- croup
Pleural friction rub
(between inspiration & expiration)
- continuous, low pitched, coarse creaking or grating.
- pneumonia
- pulmonary fibrosis
- after thoracic surgery
- pulmonary infarction
Diminished
diminished or distant in any respiratory disorder that reduces sound or flow
- Air trapping: drug overdose, flail chest, pneumothorax, obstructive
- air trapping is caused by inflammation & bronchial secretions
Egophony
- E turns to A (when you listen it’ll sound like A; non-normal)
- Bronchial breath sounds, dull percussion note, increased vocal fremitus.
Bronchophony
Patient repeats words “one, two, three” or “ninety-nine” while clinician listens over the chest wall with stethoscope
Consolidation words will be louder, clearer, and with nasal quality.
what is normal ventilation?
- Tidal Volume (7 to 9 mL/kg) ~500mL
- Respiratory Rate (12 to 20)
- I:E ratio (1:2)
what Pathophysiology effects ventilation?
- Lung compliance (ease with which the elastic forces of the lungs accept a volume.
- Airway resistance (impedance to flow;Difference in pressure between two points (mouth and alveoli)
- Peripheral chemoreceptors (oxygen sensitive cells that react to a reduction of oxygen in the arterial blood.)
- Central chemoreceptors(Respiratory centers in the medulla are responsible for coordinating respiration. Stimulated by an increase in H+ in the cerebrospinal fluid)
- Pulmonary Reflexes
- Pain, anxiety, fever (all increase RR)
pulmonary reflexes
- Deflation Reflex- lungs are compressed (atelectasis) increased rate of breathing
- Irritant Reflex- compressed, deflated, or exposed to irritant, rate to increase
- J receptors- when stimulated rapid shallow breathing pattern triggered
Abnormal respiratory pattern
(Increased work of breathing)
- use of accessory muscles
- pursed lip breathing
- retractions
- nasal flaring
what is pursed lip breathing?
- Patient exhales through lips that are held in a whistling, kissing, or blowing a flute position
- The positive pressure created by slowing the air flow provides airways with some stability and ability to resist intrapleural pressures
- Offsets early airway collapse and air-trapping, decrease RR
- Generates a better gas mixing pattern
- Advanced stages of obstructive pulmonary disease
