LECTURE 3: Respiratory Assessment 🫁😫

Question 1

3 Components of respiration

Answer 1

1. Ventilation
   - breathing in & out
2. Diffusion
   - gas exchange
3. Perfusion
   - delivery of blood to a capillary bed

Question 2

respiratory muscles

Answer 2

• pectoralis minor
• diaphragm
• internal intercostal
• external intercostal
• trapezius
• abdominal rectus
• sternocleidomastoid
  visualization of accessory muscle use is a red flag

Question 3

challenges to the respiratory system?

Answer 3

smoking
- first, second, and third hand smoke
- e-cigarettes
- vaping
environmental factors
- home
-occupational
-travel

Question 4

respiratory assessment - subjective data:

Answer 4

OLDCARTSS
presence of cough?
- sputum? characteristics? (colour, texture, volume, blood)
- characteristics of cough (wet/dry)
dyspnea (difficulty breathing)
- SOB, shortness of breath
- SOBOE, shortness of breath on exertion
chest pain
- can be cardiac or respiratory
past medical history
family history
self-care activities (lifestyle)
allergies
immunizations
medications

Question 5

respiratory assessment - objective data - inspection:

Answer 5

• must speak before inspection (subjective data)
  shape of chest:
• barrel chest
• pectus excavatum (funnel chest)
• pectus carinatum (pigeon breast)
• check for cyanosis (blue colouration)

Question 6

respiratory assessment - objective data - palpation:

Answer 6

excursion:
- to see if both lungs are inhaling/exhaling symmetrically
- place hands on back & front, ask patient to inhale/exhale
chest tenderness:
- sternum, point tenderness (pain felt with pressure on specific area)
extra assessments:
- chest excursion (expansion)
- tactile remits (vibration)
abnormal findings:
- lumps/bumps
- crepitus (air in subcutaneous tissue)

Question 7

respiratory assessment - objective data - auscultation (landmarks, flip card):

Answer 7

KNOW WHERE THEY ARE
- suprasternal notch
- angle of Louis (sternal angle)
- costal angle
- scapular, clavicular, axillary lines
- C7

Question 8

auscultation: normal sounds

Answer 8

1. bronchial
2. vesicular
3. broncho-vesicular

Question 9

auscultation: abnormal sounds

Answer 9

1. diminished/absent sounds
2. friction rub
3. crackles
4. wheezes

Question 10

bronchial sounds - description

Answer 10

• loud, hollow “tubular” sounds
• high pitched
• considered abnormal when heard over peripheral lung fields
• distinct pause between inspiration/expiration
• ratio of 1:2 or 1:3

Question 11

vesicular sounds - description

Answer 11

• soft, low pitched
• “rustling” quality with inspiration
• even softer during expiration
• majority of lung sounds
• ratio of 3:1

Question 12

broncho-vesicular sounds - description

Answer 12

• mixture of high-pitch bronchial sounds and low-pitched vesicular sounds
• normally heard in mid-chest
• ratio of 1:1

Question 13

friction rub sounds - description

Answer 13

• low pitched, short, grating sound from inflammation of pleural surface

Question 14

crackles sound - description

Answer 14

• brief, discontinuous, popping lung sounds that are high pitched
• occur when small air sacs fill with fluid

Fine vs. Coarse crackles
- coarse crackles are louder, lower pitch, and last longer than fine crackles

Question 15

wheezes sound - description

Answer 15

• musical sounds caused by narrowing of airways

Question 16

promoting respirations and oxygenation

Answer 16

• promote lung expansion
• promote removal of secretions (sputum)
• maintain patient airway
• promote adequate exchange of oxygen and carbon dioxide

Question 17

developmental variations - infants:

Answer 17

• infants are obligatory nose breathers
• broncho-vesicular sounds are heard
• respirations are primarily abdominal
• after child is 2, breathing shifts to intercostal
• irregular respiratory rhythm

Question 18

developmental variations - pregnancy

Answer 18

• there’s an increase in tidal volume to meed the fetus’ need for oxygen
• later, diaphragm rises and the costal angle widens to accommodate the enlarging uterus

Question 19

developmental variations - elderly/older adults

Answer 19

• alveoli tend to fibrose with age resulting in decreased surface area for gas exchange
• lung capacity decreases due to muscle weakness and less elasticity
• there’s more “dead space”, trapped air, and less vital capacity
• often the thoracic spine curves, gives appearance of barrel chest