(L2) Lower Respiratory Complaint (Stewart) Flashcards
Definitions: Hypopnea: Bradypnea: Hyperpnea: Tacypnea: Dyspnea: Hypoxia: Hypoxemia: Apnea: Atelectasis: Pleximeter finger: Plexor finger:
Hypopnea: decreased depth and rate of respiration
Bradypnea: Regular rhythm but slower then normal rate (<14)
Hyperpnea: increased depth of breathing and rate of respiration
Tacypnea: Rapid breathing
Dyspnea: feeling short of breath
Hypoxia: Deficiency in amount of O2 reaching the tissues
Hypoxemia: Oxygen deficiency in the arterial blood
Apnea: no breathing
Atelectasis: collapse of lung tissue that affects the alveoli from normal O2 absorption
Pleximeter finger: hyperextended middle finger of non dominant hand in percussion
Plexor finger: tapping finger, dominant hand for percussion
where is a needle thoracentesis inserted?
where is a chest tube inserted?
where does the neurovascular bundle run?
Needle thoracentesis
- 2nd intercostal space, mid-clavicular line
Chest tube insertion:
- 4th intercostal space at mid or anterior axillary line in the 4th intercostal space just superior to the margin of the 5th rib
Neurovascular bundle:
- runs along the inferior margins of each rib
- chest tubes and needles need to be placed over the superior margin of the rib to avoid the bundle
what are some important questions to ask when a patient presents with an respiratory CC?
- ask about events leading up to the episode
- may have been caused by non adherence with medications
- high salt diet may lead to CHF
- exposure to cold or an allergen may trigger an asthma flare
- acute dyspnea immediately following a meal suggests an allergic reaction
- a new productive cough may suggest a pulmonary infection
- recent surgery may increase risk for pulmonary embolism
- recent trauma can be for a pneumothorax
what is the order of the physical exam for the lower respiratory track?
Inspection
Palpation
Percussion
Auscultation
Vital signs is number one and make sure to get oxygen saturation
what is the pulse oximetry
measures the peripheral arterial oxygen saturation (SpO2)
- standard for continuous, noninvasive assessment of good oxygenation
- make sure the curve associated with it is more straight then bumpy
what may cause a bad wave form for the pulse oximetry?
- improper placement
- hypo-perfusion
- hypothermia (due to the peripheral vasoconstriction)
- motion artifact
- poor limb perfusion from extremity elevation, vasoconstriction, or peripheral vascular disease
What is end tidal CO2
Capnography: non-evasive measurement of the partial pressure of CO2 in exhaled breath as the CO2 concentration overtime
EtCO2 = concentration of CO2 in exhaled air at the end of respiration
This measures ventilation of an individual
what does it mean if the skin color appears cyanosis
bluish, means sign of hypoxia
what does a tracheal deviation indicative of on an X ray exam?
- Pneumothorax (tension or non-tension)
- Pleural effusion
- Atelectasis
- or a mass
What are causes of clubbing of an individuals fingers?
- Congenital heart disease
- Interstitial lung disease
- Bronchiectasis
- Pulmonary fibrosis
- Cystic fibrosis
- Lung abscess
- Malignancy (lung cancer)
- Inflammatory bowel disease
what is Pectus excavatum
funnel chest
may cause depression of great vessels, heart or lungs
what is pectus Carnitum?
Pigeon chest
what is barrel chest?
increased AP diameter resembling a barrel seen in COPD
Pink puffer vs a Blue BLoater?
Pink Puffer: Emphysema
BLue Bloater: Chronic bronchitis
what is Traumatic Flail chest
multiple rib fractures that may result in paradoxial movement of the thorax
- on inspiration the injured area caves inward and on expiration it moves outward
What is significant about accessory muscle use?
Respiratory distress to help the individual breathe
- can see in Asthma, COPD, airway obstruction ,viral illness (RSV)
What is a process of palpation of a lung exam?
- Check rib motion with thoracic expansion (placing thumbs at the level of the 10th ribs
- look for areas of tenderness
- OMM treatments
(Doming the diaphragm, rib raising-helps normalize sympathetic nervous system, tapotement, thoracic pump, helps with atelctasis)
What is tactile fremitus and what does it mean if it is decreased or increased
feeling for palpable vibrations when an individual says “99”
Decreased:
- COPD
- Pleural changes, effusions, fibrosis, Air
Increased:
- Pneumonia (consolidation)
when percussing, what should be heard and what is heard if abnormal?
Resonance is healthy percussion
Dullness:
- fluid or solid tissue
Bilateral hyper-resonance suggest?
- heard with hyper-inflated lungs,
- COPD
- Asthma
Unilateral hyper-resonance suggest?
- large pneumothorax
- large air-filled in lung
Tympanic: think abdomen
what is the Diaphramatic excursion?
determining where the diaphragm is during inhalation and exhalation
- right is normally slightly higher due to the liver
asymmetry with diaphragm
- Pleural effusion
- high diaphragm secondary to atelectasis or phrenic nerve paralysis
when auscultating what must the patient do?
must breath through the mouth
make sure to be on skin
use the diaphragm of the stethoscope
what are the normal breath sounds?
- Vesicular
- Bronchovesicular
- Bronchial
- Tracheal
these differ based on what anatomical structure you are over
what are abnormal/adventitious lung sounds?
- stridor
- wheezes (rhonchi - low pitched wheezes)
- crackles (rales)
what is a common cause for stridor?
Result from narrowing in the upper airway
Common causes:
- croup
- epiglottitis
- upper airway foreign body
- anaphylaxes
what are common causes for wheezing?
Generally an expiratory sound but can be inspiratory, continuous musical sounds
Common causes
- reactive airway disease
- Asthma
- COPD
what are common causes of crackles in the lungs?
An inspiratory sound
Continuous musical sounds
Common causes:
- pneumonia
- CHF
- Atelectasis
- pulmonary fibrosis
- Bronchiectasis
- COPD
- Asthma
what is Atelectasis?
The loss of lung volume due to collapse of lung tissue (alveoli)
can be sween pist surgery
Incentive spirometer can help with treatment and prevention
what are the vocal resonance normal and abnormal findings?
Normal:
- words are muffled and indistinct to auscultate
- whispered words are faint and indistinct, if heard at all
- when patient says see you hear a long muffled E
Abnormal:
- Distinctness increased with lung consolidation
- Bronchophony- spoken words get louder
- whispered pectoriloquy: whispered words are louder and clearer during auscultation
- egophony: when patient says see it sounds like A
what is the Pulmonary function test used for?
- non invasive
- show how well the lungs are working
- diagnose certain lung disorders
- obstructive vs restrictive
How can spirometry be used as a PFT?
measures the lung function
amount and speed of air inhaled and exhaled
- diagnose conditions
- obstructive vs restrictive
What is Cheyne-Strokes breathing?
A type of abnormal breathing characterized by a gradual increase in breathing, and then a decrease. This pattern is followed by a period of apnea where breathing temporarily stops. The cycle then repeats itself.
What is Kussmaul breathing?
Abnormal respiratory pattern. Deep, rapid breathing. Seen in patients with metabolic acidosis (DKA).
What is pursed lip breathing?
Maintains the pressure within the lungs for more time for gas exchange
What is a pleural effusion and what causes it?
Pus that collects in pleural space from CHF, pneumonia, malignancies and PE
Transudate: fluid leaking (fluid leaking form blood vessels)
Exudates (fluid leaks from inflammation of the pleura and lung)
What is empyema?
Abscess in the lung parenchyma
Requires drainage (chest tube)
Can collect in pleural space (pleural effusion)
What is normal PETCO2?
What is normal PaCO2?
35-40mmHG
35-45mmHG
