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NURS 202 > Lecture 3: Respiratory Assessment > Flashcards

Lecture 3: Respiratory Assessment Flashcards

1
Q

Anterior

A

Front View

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2
Q

Posterior

A

Back View

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3
Q

Mechanics of Respiration

A

Four functions of respiratory system
- Control of respiration
- Changing chest size during respiration
- Inspiration
- Expiration
2. Diaphragm drops, intercostals expand rib cage. Negative pressure in lungs, air rushes in, chest size expands
3. Forced Inspiration
- Heavy exercise, resp distress
- Neck muscles bring up the sternum and rib cage (accessory muscles of respiration)
4. Forced Expiration
- Abdominal muscles contract to push abdominal viscera in and up against diaphragm causing it to move upwards as a dome and squeeze against the lungs

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4
Q

Developmental Considerations: Infants and children

A
  • Vulnerability related to small size and immaturity of pulmonary system + because they need air
  • Typically problems occur because of resp. system
  • Flexibility in sequence of the exam
  • Crying enhanced palpation of tactile fremitus
  • Thoracic cage soft and flexible
  • Sternal or intercostal retractions indicate distress
  • Respiratory rate and pattern
  • On auscultation, localization of breath sounds more difficult
  • Percussion of limited use in newborns
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5
Q

Developmental Considerations: Pregnant Women

A
  • Enlarging uterus elevated diaphragm; decreases vertical diameter of thoracic cage, compensated by increase in horizontal diameter
  • Decreases are used to take breathe
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6
Q

Developmental Considerations: Older Adults

A
  • Lungs more rigid and harder to inflate
  • Decrease in vital capacity
  • Increase in residual volume
  • Decrease in number of alveoli
  • Increase shortness of breath on exertion
  • Increased risk for postoperative complications
  • Typically the heart that causes problems
  • Round, barrel-shaped thoracic cage and kyphosis
  • Chest expansion somewhat decreased
  • Less mobile thorax
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7
Q

Developmental Considerations: Acutely Ill Patients

A
  • Second examiner needed to support patient in upright position for exam
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8
Q

Cultural and Social Considerations

A
  • New and re-emerging of TB in Canada (2010) at unprecedented national low
  • Variation in rates by jurisdiction; disproportionately high in Nunavut
  • Asthma rates down, but contributing factor in 10% of hospital admissions of children age less than 5 years
  • Preventable risk factors for respiratory disease: tobacco smoke, poor air quality
  • Lung cancer is leading cause of cancer death in Canada
  • Women incur greater lung damage from exposure to environmental tobacco compared with men
  • Health practices are modifiable
  • Women have worse repercussions from tobacco than men
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9
Q

Environmental Tobacco Smoke

A
  • Second-hand/third-hand smoke risk
  • Exposure to both increases risk of adverse health effects
  • Especially harmful to young children
  • Increased
    - Respiratory infection
    - Inner ear infection
    - Aggravation of asthma
    - Increased risk of allergies
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10
Q

Health History Questions

A
  • Cough (wet or dry, is anything coming up, how long does it last, when did it start)
  • Shortness of breath (when it occurs, is there a pattern, chest pain)
  • Chest pain with breathing
  • History of respiratory infections (another resp infection, new infection)
  • Smoking history (have you ever smoked? do you smoke? how much did you smoke? have they considered quitting?)
  • Environmental exposure (their occupation, living environment)
  • Self-care behaviours (nutrition, allergies, using scents, vaccines, sleeping behaviours, stress)
  • OPQRSTU (Onset, quality, radiation, timing, what do you think it could be?)
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11
Q

Additional Health History Q’s: Infants and children

A
  • Illness - frequent cold
  • Allergy
  • Chronic respiratory illness
  • Safety - childproofing; inhalation of toxic substances
  • Environmentals smoke
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12
Q

Additional Health History Q’s: Older Adults

A
  • Activity intolerance (shortness of breath?)
  • Level of activity
  • Lung disease (any history for for them or in family)
  • Pain
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13
Q

Mandatory Health History Questions to ask

A
  • PMHx
  • Fam/SC Hx
  • Meds
  • Allergies
  • ROS
  • Immunizations
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14
Q

History Questions for infants and children

A
  • 4-6 colds per year?
  • Smokers at home?
  • Child-proof/choking hazards?
  • New foods introduced?
  • Emergency care interventions? Do parents know CPR?
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15
Q

Physical exam: Preparation

A
  • Position
  • Draping
  • Timing during a complete examination
  • Cleaning stethoscope endpiece
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16
Q

Equipment needed

A

Stethoscope

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17
Q

Resp Assessment (IPPA): Inspect

A
  1. Thoracic cage (posterior)
    - Shape and configuration of chest wall
    - Anteroposterior/transverse diameter
    - Position patient takes to breathe
    - Skin colour and condition
  2. Thoracic cage (anterior)
    - Shape and configuration of chest wall
    - Facial expression
    - LOC
    - Skin colour and condition
    - Quality of respirations
    - Rib interspaces
    - Accessory muscles
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18
Q

(LOC) Level of Consciousness

A
  1. AVPU Scale
    - Alert: answers questions
    - Voice: responds to commands
    - Pain: responds to painful stimuli
    - Unresponsive: no response to voice or painful stimuli
  2. Function of resp system is to exchange gases
    - Inhales oxygen
    - Breathe out carbon dioxide
  3. Purpose of oxygen in our body?
    - Cells need oxygen to function
    - Limited ability to function without it
    - Keeps brain, heart, and other tissues working
    No oxygen = hypoxia brain starts to shut down, decreasing LOC
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19
Q

Facial Expressions

A
  1. Calm, relaxed
    - Easily breathing, focused on other things
  2. Fearful, panicked
    - Trouble breathing expercing anxiety
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20
Q

Skin colour and condition

A
  • Look at face, fingers/toes, posterior and anterior chest
  • Cyanotic = blue
  • Cyanosis = deoxygenated blood
  • Pallor = reduced or absent blood flow (ischemia)
  • Pallor = pale
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21
Q

Clubbing

A

Nail clubbing occurs when the tips of the fingers enlarge and nail curve around the fingertips, usually over the course of years

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22
Q

What is the normal anteroposterior to transverse diameter?

A

AP:T
Normal is 1:2

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23
Q

What is barrel chest?

A

Chest wall compensates by expanding, bad

24
Q

Supine

A

Lying flat on their back

25
Q

Prone

A

Lying flat on their abdomen

26
Q

Fowler’s position

A

Sitting upright

27
Q

Inhalation

A

Diaphragm contacts (Moves down)

28
Q

Exhalation

A

Diaphragm relaxes (Moves up)

29
Q

Normal Respiration

A
  • Inspiration: Active process, uses energy
  • Expiration: passive process, doesn’t use energy
30
Q

Difficulty Breathing

A
  • Inspiration: Active process + accessory muscle use
  • Expiration: Active processTr
31
Q

Tripod Position

A
  • Easier inspiration and expiration
  • Decreases work of accessory muscles in inspiration
  • Engages pectoralis minor muscle in lifting rib cage
  • i.e. post workout, asthma attack
32
Q

Palpation

A
  • Chest Wall
  • Symmetrical chest expansion
  • Tactile fremitus
  • Superficial lumps or masses
  • Skin - temperature, moisture, turgor
  • No pain or tenderness
  • No hypertrophy of the neck muscles (trapezius, sternocleidomastoid)
  • Straight line of spinous process, symmetrical scapula (posterior)
33
Q

Steps of Symmetrical Chest Expansion

A
  1. Place your hands on the anterior/posterior chest
  2. Thumbs pointing upwards
  3. Ask the patient to take a deep breath
  4. Watch your thumbs. Both should move equally and smoothly
34
Q

Asymmetrical Lung Expansion

A

What if only one of your thumbs moves when the patient takes a deep breath?
There is UNEVEN lung expansion which is abnormal:
- Pneumothorax
- Pneumonectomy

35
Q

Tactile Fremitus

A
  1. Vibration of chest wall
    - Result of sound transmitting through lung tissue
  2. Assessment
    - Examiner feels for changes in intensity of fremitus by palpating chest wall
  3. Causes of decreased fremitus
    - Excess air in lungs
    - Increased thickness of chest wall
  4. Causes of increased fremitus
    - Lung consolidation
    - Air in healthy lung replaced with something else (inflammatory exudate, blood, pus, cells)
    Have the patient say 99, feel the vibration, is it symmetrical?
36
Q

Percussion

A
  • Predominant note over lung fields
  • Resonance
    1) Place one hand, with your middle finger flat, on the patient
    2) Use the middle finger of the other hand to tap on the middle phalanx
    3) Produce a hollow tapping sound
  • Usually only hear resonance from back (you shouldn’t hear anything else because no organs)
    *Flatness: bones such as the clavicle, ribs, sternum
    *Dullness: dense organs such as the liver, spleen, heart
    *Resonance: adult lung
    *Hyperresonance: child lung
    *Tympany: abdominal area such as intestines and stomach
37
Q

Hyperresonance

A
  • Lower pitched booming sound when too much air is present
    i.e pneumothorax, emphysema
38
Q

Dull

A
  • Abnormal density in lungs
    i.e. pneumonia, pleural effusion, atelectasis tumor
39
Q

Auscultation

A

Anterior:
- Breath sounds: Abnormal breath sounds, adventitious sounds, include lateral chest
Posterior:
- Breath sounds: Technique, bronchial breath sounds - characteristics, bronchovesicular breath sounds - characteristics, vesicular breath sounds - characteristics
- Adventitious sounds: crackles, wheeze, atelectatic crackles

40
Q

Adventitious Lung Sounds

A

Discontinuous:
- Crackles - fine
- Crackles - coarse
- Atelectatic crackles
- Pleural friction rub
Continuous:
- Wheeze - high pitched (sibilant)
- Wheeze - low pitched (sonorous rhonchi); almost leading to crackles
- Stridor - inability to get air in

41
Q

Breath Sounds: Broncial

A

High pitch, loud volume (trachea, larynx) = HARSH

42
Q

Breath Sounds: Bronchovesicular

A

Moderate pitch, moderate volume (major bronchi around sternum in 1st and 2nd intercostal spaces around scapula posteriorly) = MIX

43
Q

Breath Sounds: Vesicular

A

Low pitch, low volume (peripheral lung field with bronchioles, alveoli) = RUSTLING LEAVES

44
Q

Adventitious breath sounds

A
  • Added sounds not normally heard
  • Superimposed on normal breath sounds
  • Location?
    - Right Lower Lobe?
    - Right Middle Lobe
    - Left Upper Lobe
  • Timing during resp cycle?
  • Cleared by coughing or deep breaths?
    • Crackles (rales)
    • Fine and coarse
    • Atelectatic crackles cleared by coughing
  • Wheeze (rhonchi)
    • High and low pitched
  • Pleural Friction Rub - like hair rubbing on your stethoscope sound
  • Stridor - a gasp
45
Q

Tachypnea

A

“Fast breathing”
> 20 breaths/min

46
Q

Bradypnea

A

“Slow breathing”
< 10 breaths/min

47
Q

Apnea

A

“Lack of breathing”
Period of time without breathing

48
Q

Hyperventilation

A

Increased rate and depth

49
Q

Cheynes-Stokes Respiration

A

Can tell us they are nearing death, waxing and waning sound (breathing sound) -> shows the end is near
Normal infants and older adults during sleep

50
Q

Developmental Considerations: Infants/Children

A
  • Assess while sleeping
  • Count resp. for one minute
  • Round thorax, apneic periods
  • Bronchovesicular up to 6 years
51
Q

Developmental Considerations: Older Adults

A
  • Kyphosis
  • Fatigue during auscultation
52
Q

Measurement: Pulmonary Function Status

A

Pulse Oximeter
- Values evaluated in context of patient’s hemoglobin level, acid-base balance, and ventilatory status

53
Q

Measurement: % of Hemoglobin Carrying Oxygen

A

> 92% for most clients, exception: 88-92% with COPD need to look at all respiratory data

54
Q

Abnormal Findings

A
  1. Configurations of the Thorax
    - Barrel chest (when lungs become overfilled, keeping the rib cage extended for a longer period of time)
    - Scoliosis (sideways curvature of the spine)
    - Kyphosis (an increased front-to-back curve of the spine)
55
Q

Respiratory: Infants

A
  • Bronchovesicular sounds auscultated
  • Thin chest wall means louder breath sounds
  • Normal newborn respirations between 30-40/minute
  • Diaphragm is main source of inspiration/expiration
  • Poorly developed intercostal
56
Q

Respiratory: Pregnancy

A
  • Increased costal angle
  • Deeper respirations
  • Increased tidal volume (need more O2 for the fetus)

NURS 202 (8 decks)

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