Lower Respiratory Complaint Flashcards
What does a pulse oximeter do; what does each light measure?
Direct beams of red and infrared light through a measurement site.
Red light: oxyhemoglobin
Blue light: deoxyhemoglobin
% saturation = red / red + blue
What is an incentive spirometer used for?
Device used to help you keep your lungs healthy after surgery or when you have a lung illness. Teaches you how to take slow deep breaths. Important to breath in SLOWLY
What is a pulmonary function test used for?
- Non-invasive
- Diagnosis of certain lung disorders (obstructive vs restrictive)
When is accessory muscle use seen in breathing?
Asthma, COPD, airway obstruction, viral illness
What can a tracheal deviation be seen in?
Pneumothorax (tension and non-tension), pleural effusion, atelectasis, and a mass
Describe nail clubbing and the pathologies that can lead to it?
- Loss of normal angle between nail and proximal nail fold (>180 degrees)
- CHD, Interstitial lung disease, pulmonary fibrosis, cystic fibrosis, lung abscess, and lung cancer
Discuss tactile fremitus technique and what abnormal findings mean (decreased and increased when)?
- Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as person speaks
- Pt says “99” or “1-1-1”
- Decreased or absent = COPD, Pleural changes (effusions, fibrosis), pneumothorax
- Increased = Pneumonia (consolidation)
What is the normal percussion tone for the lungs?
Resonance
What is the normal percussion tone for the heart?
Flat
When percussing what is each finger referred to as based on its placement?
- Dominant = Plexor finger = strike using middle finger
- Non-dominant = Pleximeter = finger that is struck by dominant hand, at the distal interphalangeal joint of the middle finger
What type of sound would be heard when percussing over an area of pneumonia, effusion/empyema (fluids in lungs)?
Dullness
What type of sound would be heard when percussing over an area affected by pneumothorax (air in lungs)?
Unilateral Hyper-resonance
What is done in a diaphragmatic excursion; normal measurement, what does higher than normal dullness indicate?
- You determine the distance between the levels of dullness during expiration and inspiration.
- Normal is 3-5.5
- If dullness is higher than normal, suspect atelectasis or phrenic nerve paralysis
What does asymmetry found during diaphragmatic excursion indicate?
- Pleural effusion
- High diaphragm secondary to: atelectasis or phrenic nerve paralysis
When listening to lung sounds, what part of stethoscope is used, and what is the direction of listening posts, how many?
- Diaphragm
- Move in a ladder like fashion
- At minimum should listen to each lobe (5 spots)
What are the 4 normal breath sounds and what do you hear/where are they best heard?
1) Vesicular - soft, low pitched, heard over most of lungs
2) Bronchovesicular - slightly higher pitch and heard best at 1st/2nd intercostal space
3) bronchial - loud and high pitched, heard over the bronchi/manubrium
4) Tracheal - Super loud and high pitched. Best over trachea… duh
What is Bronchophony ( abnormal vocal resonance)?
Spoken words get louder and clearer (indicates consolidation)
What is whispered pectoriloquy ( abnormal vocal resonance)?
Whispered words are louder and clearer during auscultation
What is Egophony? (abnormal vocal resonance)?
When patient says “ee” it sounds like “A”
What is the mnemonic for chest X-ray?
A-A-B-C-D-E-F-F-G-G-H-I
Adequate Airway Bones Cardiac size Diaphragms Effusions Fields and fissures Foreign body Great vessels Gastric vessels Hilar masses Impression
What do pursed lips indicate for a patients lung exam?
Obstructive lung disease
Where is the sternal angle?
Also known as the angle of Louis. This is where the second rib meets the manubrium
What is the landmark for needle decompression?
2nd intercostal space just superior to the 3rd rib margin at midclavicular line
What is the landmark for chest tube insertion?
4th intercostal space at mid or anterior axillary line just superior to margin of 5th rib
What vertebral level should you see the lower margin of an endotrachal tube on an X-ray?
T4
Landmark for thoracentesis?
7th intercostal space
How would you monitor thoracic expansion?
Place thumbs at level of 10th ribs, have pt. inhale deeply, monitor for asymmetry
Generalized hyper-resonance may be heard in what lung conditions?
COPD, asthma, emphysema.
You are listening to a lung and notice that the bronchovesicular or bronchial breath sounds are heard further down than you would expect, what does this mean?
Suspect that air-filled lung has been replaced by fluid-filled or solid lung tissue
Describe what crackles (rales) sound like; may occur after prolonged?
- Discontinuous, intermittent, non-musical and brief
- Sometimes likened to sound of “velcro”
- May occur after prolonged recumbancy
Describe what Wheezes sound like; suggest what kind of airways?
- Continous; musical quality and prolonged
- High pitched, hissing or shrill quality
- Narrowed airways (asthma, COPD, bronchitis)
Describe Rhonchi and what kind of airways?
- Relatively low-pitched, snoring quality
- Secretions in large airways
Describe Stridor and indicates?
- Wheeze that is ENTIRELY/PREDOMINANTLY inspiratiory in nature
- Partial obstruction of larynx or trachea (MEDICAL EMERGENCY!!!!!)
Describe Pleural Friction Rub?
- Inflamed/roughened pleural surfaces grate against eachother
Sounds like creaking, usually expiratory
What are characteristics commonly seen in chronic bronchitis (the blue bloater)?
- Overweight and cyanotic
- Elevated hemoglobin
- Peripheral edema
- Rhonchi and wheezing
What are the characteristics commonly seen in emphysema?
- Older and thin
- Severe dyspnea
- Quiet chest
- X-ray: hyperinflation w/ flatted diaphragm
What is the pathological diagnosis of emphysema?
Permanent enlargement and destruction of airspace’s distal to the terminal bronchiole
What is the clinical diagnosis for chronic bronchitis?
Daily productive cough for 3 months or more in at least 2 consecutive years
Multiple rib fractures resulting in paradoxical movement of the throax is known as?
Flail chest
What are kissmaul respiration’s indicative of?
Severe metabolic acidosis -> hyperventilation to reduce amount of CO2
What is? Cheyne-Stokes respiration
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.
If bronchovesicular or bronchial breath sounds are heard more distal than expected, what should you suspect?
Air-filled lung has been replaced by fluid-filled or solid lung tissue
If you hear this adventitious breath sound, this indicates medical emergency!
Stridor! indicates partial obstruction of larynx or trachea
Healthy resting adult respiratory rate?
14-20x per minute
Which patients tend to sit leaning forward with shoulders elevated?
Patients with obstructive lung disorders
What are the accessory muscle of neck for breathing?
Sternomastoid, scalenes, supraclavicular contraction
What is involved in clubbing of the fingernails, vasculature wise?
Vasodilation with increased blood flow to the distal portion of the digits and change in CT possibly due to hypoxia, innervation, or platelet derived GF from fragments of platelet clumps
What is Kussmaul Breathing?
Abnormal respiratory pattern. Deep, rapid breathing. Seen in patients with metabolic acidosis (DKA).
