Examination Of The Pulmonary Patient Flashcards
Examination of the Pulmonary Patient
Schamroth Sign
Examination of the Pulmonary Patient
Normal respiratory rate of infants, children, and adults:
- Infants = 40 - 60
- Children = 18 - 24
- Normal adult RR =12-20
Examination of the Pulmonary Patient
if you REALLY want lung disease…
Smoking is the greatest risk factor for developing pulmonary disease
Examination of the Pulmonary Patient
What is orthopnea?
Orthopnea or orthopnoea is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.
Examination of the Pulmonary Patient
Chest wall shapes:
Examination of the Pulmonary Patient
Eupnea:
In the human respiratory system, eupnea or eupnoea is normal, good, unlabored breathing, sometimes known as quiet breathing or resting respiratory rate. In eupnea, expiration employs only the elastic recoil of the lungs.
Examination of the Pulmonary Patient
Kussmaul’s respirations:
- Deep, slow or rapid, gasping
- Common in diabetic ketoacidosis
Examination of the Pulmonary Patient
Cheyne-Stokes respirations:
- End of life
- Progressively deeper, faster breathing alternating gradually with shallow, slower breathing.
- May indicate brain stem injury
Examination of the Pulmonary Patient
Biot’s respirations:
- Irregular pattern of rate and depth with sudden, periodic episodes of apnea
- May indicate increased intracranial pressure
Examination of the Pulmonary Patient
Central neurogenic hyperventilation:
- Abnormal breathing patterns
- Deep, rapid respirations
- Often indicating increased intracranial pressure
Examination of the Pulmonary Patient
Agonal respirations:
- Abnormal breathing pattern
- Shallow, slow, or infrequent breathing
- Usually indicating brain anoxia
Examination of the Pulmonary Patient
Apneustic respiration (apneusis):
- Abnormal breathing pattern
- Deep, gasping inspiration with pause at full inspiration followed by brief insufficient release
- Usually indicates brain injury (often of pons)
Examination of the Pulmonary Patient
Hemoptysis
Coughing blood
Examination of the Pulmonary Patient
Dyspnea:
Dyspnea is unpleasant or uncomfortable breathing. It is experienced and described differently by patients depending on the cause.
Examination of the Pulmonary Patient
Ventilatory Response Index (VRI):
→Ask pt to count to 15 in an 8 second time period and count how many breaths it takes
- 0 to 4 rating, score = number of breaths taken.
Examination of the Pulmonary Patient
subcutaneous emphysema:
air trapped under the skin
Examination of the Pulmonary Patient
fremitus
Vibration produces by voice or secretions
Examination of the Pulmonary Patient
Normal TRACHEAL sreath sound:
- Tubular
- (1:1)
- over the trachea
Examination of the Pulmonary Patient
Normal BRONCHIAL breath sound:
- 1:2
- Near sternal angle
Examination of the Pulmonary Patient
Normal BRONCHVESICULAR breath sound:
- 1:1
- Where mainstem bronchi branch to segmental bronchi
Examination of the Pulmonary Patient
Normal VESICULAR breath sound:
- 3:1
Examination of the Pulmonary Patient
Wet” or “coarse” crackles (aka RALES) are due to
fluid or secretions
Examination of the Pulmonary Patient
“Dry” or “fine” crackles usually due to
sudden opening of closed airways
Examination of the Pulmonary Patient
Discontinuous, bubbling or popping sound that can be associated with obstructive and restrictive dz:
CRACKLES
Examination of the Pulmonary Patient
High pitched wheezes:
- Expiratory: indicative of airway obstruction (secretions or bronchospasm).
- Inspiratory: uncommon, more severe obstruction
Examination of the Pulmonary Patient
Continuous, “musical”, or whistling sound usually heard during exhalation due to
bronchoconstriction or retrained secretions:
WHEEZES
Examination of the Pulmonary Patient
Expiratory, high pitched wheezes may be indicative of
airway obstruction (secretions or bronchospasm)
Examination of the Pulmonary Patient
Inspiratory, high pitched wheezes may be indicative of
(Uncommon) a more severe obstruction than when wheezes are expiratory
Examination of the Pulmonary Patient
Low pitched wheezes (ronchi):
- Rhonchi are continuous low pitched, rattling lung sounds that often resemble snoring.
- Obstruction or secretions in larger airways are frequent causes of rhonchi.
- They can be heard in patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis
Examination of the Pulmonary Patient
Stridor:
- Medical emergency
- Continuous very high pitched wheeze heard with inspiration and/or exhalation
- Usually indicates upper airway obstruction
Examination of the Pulmonary Patient
Pleural Rub:
- Dry, crackling sound heard during inspiration and exhalation
- Visceral and parietal pleura rubbing together
- Best heard in the lower lungs
Examination of the Pulmonary Patient
Egophony:
Increase voice transmission, vocal ‘E’sounds like ‘A’
Examination of the Pulmonary Patient
Bronchophony:
- increased voice transmission when whispered
- Repeat “99”
Examination of the Pulmonary Patient
Whispered pectoriloquy:
- extreme bronchophony (increased voice transmition)
- Say “one, two, three”
Examination of the Pulmonary Patient
Mediate Percussion can be used to
- Evaluate tissue densities and indirectly measure diaphragmatic excursion
-
Resonant: loud, low-pitched:
– Hear over air-filled organs (lungs) -
Hyperresonant: very low pitched:
– Heard over tissue with decreased density (diseased lungs/ emphysema) -
Tympanic: high pitched:
– Hear over hollow organs (stomach, gas bubbles in abd) -
Dull: low amplitude medium to high pitch—increased tissue density or lungs w/decreased air
– Heard over solid organs - Flat: very dull sound, high pitch—very dense tissues: – Heard over muscle mass
Examination of the Pulmonary Patient
Tachypnea:
rapid, shallow breathing (RR >24)
Examination of the Pulmonary Patient
Bradypnea:
slow breathing (RR < 10)
Examination of the Pulmonary Patient
heard over the trachea, ratio?
tracheal sound
1:1 with gap
Examination of the Pulmonary Patient
Sound heard over the sternum or manubrium
Bronchial
1:2 with gap
Examination of the Pulmonary Patient
Sound heard anteriorly at the 1st and 2nd ICS and posteriorly between the scapulae
bronchovesicular
1:1 continuos
Examination of the Pulmonary Patient
Heard throughout lung periphery
vesicular
3:1 continuous
