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PCM Final > Lower Respiratory DSA > Flashcards

Lower Respiratory DSA Flashcards

1
Q

What is the rate of normal adult breathing?

A

RR = 14 - 20 bpm with quiet and regular rhythm

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2
Q

What is Hypopnea?

A

Decreased depth (shallow) and rate (slow) of respiration

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3
Q

What is bradypnea?

A

Regular rhythm BUT slower than normal rate (RR < 14/min)

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4
Q

What is hyperpnea?

A

Increased depth (deep) of breathing and rate (fast) of respiration.

NORMAL IN EXERCISE

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5
Q

What is dyspnea?

A

Feeling short of breath

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6
Q

What is hypoxia?

A

Deficiency in the amount of O2 reaching the tissues.

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7
Q

What is hypoxemia?

A

O2 deficiency in arterial blood.

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8
Q

What is apnea?

A

No breathing.

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9
Q

What is atelectasis?

A

Collapse of lung tissue that affects the alveoli from normal O2 absorption.

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10
Q

What is the pleximeter finger? Plexor finger? How do they relate?

A

Pleximeter finger - hyperextended middle finger of non-dominant hand in percussion.

Plexor finger - “tapping” finger, dominant hand, for percussion.

Plexor finger is placed on pleximeter finger during percussion.

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11
Q

Where is the Sternal Angle?

A

2nd rib joins sternum. (Angle of Louis)

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12
Q

Where do you perform a needle thoracentesis (decompression)?

A

2nd intercostal space, midclavicular line.

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13
Q

Where do you perform a chest tube insertion?

A

4th and 5th intercostal space, just anterior to the mid-axillary line.

5th intercostal space - just inferior to the nipple in a male or inframammary fold in a female.

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14
Q

Where is the neurovascular bundle in relation to each rib?

A

Runs along the inferior margin of each rib.

Note: Place chest tubes/needles over superior margin of rib to avoid bundle.

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15
Q 
Please identify the following:
Otalgia
Tinnitis
Epistaxis
Rhinorrhea
A

Otalgia - Earache
Tinnitis - Ringing or buzzing in ears
Epistaxis - Nosebleed
Rhinorrhea - Runny nose

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16
Q

What does a Pulse Oximeter measure? What is the mechanism?

A

Pulse Oximeter measures peripheral arterial oxygen saturation (SpO2).

Oxygenated hemoglobin - absorb infrared light and allow red light pass through

Deoxygenated hemoglobin - absorb red light and allow infrared light pass through

% Saturation = Red / Red + Blue

17
Q

What causes a bad Pulse Oximeter waveform?

A
  • Improper placement
  • Hypoperfusion
  • Hypothermia
  • Motion artifact
18
Q

What is the End Tidal CO2?

What are normal PETCO2 and PaCO2 values?

A

End Tidal CO2 - concentration of CO2 in exhaled air at the end of respiration. (PETCO2)

CO2 detected in exhaled air is produced by the body and delivered to the lungs by the blood — correlated with PaCO2.

Normal PETCO2 = 35-40 mmHg
Normal PaCOS = 35-45 mmHg

19
Q

What is Atelectasis?

What can help with prevention and treatment?

A

Atelectasis - Loss of lung volume due to collapse of lung tissue (alveoli).

Incentive Spirometer (IS) helps with prevention and treatment of Atelectasis.

20
Q

What is indicated by a patient using accessory muscles?

When can their use be seen?

A

Patients in respiratory distress.

Accessory muscles seen in:

  • Asthmatics
  • COPD
  • Airway Obstruction
  • Viral Illness (RSV)
21
Q

What is Cyanosis? What are the 2 types?

A

Cyanosis - bluish discoloration of skin and mucus membranes resulting from inadequate oxygenation of the blood.

Two types:

  • Nail bed
  • Perioral - seen around the mouth
22
Q

What are the causes of clubbing?

A
  • Congenital heart disease
  • Interstitial lung disease
  • Bronchiectasis
  • Pulmonary fibrosis
  • Cystic fibrosis
  • Lung abscess
  • Malignancy (lung cancer)
  • Inflammatory bowel disease
23
Q

What is Pectus Excavatum?

A

Pectus Excavatum “Funnel Chest”

Depression in lower portion of the sternum - can compress heart and great vessels, cause murmur.

24
Q

What is Pectus Carinatum?

A

Pectus Carinatum “Pigeon Chest”

Sternum displaced anteriorly (increased AP diameter), adjacent costal cartilages depressed.

25
Q

How does AP diameter change in Barrel Chest?

Which clinical condition is associated with Barrel Chest?

A

Increased AP Diameter

COPD is associated with Barrel Chest

26
Q

What is the difference between a “Blue Bloated” and “Pink Puffer?”

A

Blue Bloater
- Chronic bronchitis - daily productive cough; overweight and cyanotic, elevated hemoglobin, peripheral edema, rhonchi and wheezing.

Pink Puffer
- Emphysema - permanent enlargement and destruction of airspaces; older and thin, severe dyspnea, quiet chest.

27
Q

How do you perform Thoracic Expansion?

A
  1. Place thumbs at level of 10th ribs posteriorly, slide medially to created a loose fold of skin on each side b/t thumb and spine.
  2. Ask patient to INHALE DEEPLY, watch distance between thumbs MOVE APART during inspiration and feel for range/symmetry of rib cage.
28
Q

What is Tactile Fremitus?

How do we assess Tactile Fremitus?

What is indicated by decreased/absent fremitus? Increased fremitus?

A

Tacticle Fremitus - palpable vibration transmitted through the bronchopulmonary tree to the chest wall as the patient speaks.

Assessment - Use ball or ulnar surface of hands. Perform on both sides at same time.
Ask patient to say 99 or 1-1-1.

Decreased/Absent
- COPD, pleural effusion, fibrosis, pneumothorax, thick chest wall

Increased
- Pneumonia

29
Q

How do you perform a Diaphragmatic Excursion? What is indicated by Diaphragmatic Excursion asymmetry?

A
  1. Patient exhale completely and hold.
  2. Percuss for level of diaphragm and mark with a pen.
  3. Patient breathes normally for a few breaths.
  4. Patient inhales completely and holds it.
  5. Percuss for level of diaphragm and mark with a pen.
  6. Distance between the two is the Diaphragmatic Excursion.

Normal = 3-5.5 cm

Asymmetry indicates pleural effusion.

30
Q

What are the 4 types of normal breath sounds? Where are they typically heard?

A

Typical Breath Sounds:

  1. Tracheal - best heard over trachea in neck
  2. Bronchial - over trachea
  3. Bronchovesicular - over main bronchi
  4. Vesicular - Over lesser bronchi, bronchioles, and lobes
31
Q

What is Stridor?

What are the common causes?

A

High pitched wheeze entirely or predominantly inspiratory.

Louder in neck than over chest wall.

Causes:

  • Croup
  • Epiglottitis
  • Upper airway foreign body
  • Anaphylaxis
32
Q

What is Wheezing?

What are the common causes?

A

Continuous; musical quality and prolonged (not necessarily entire cycle)

Wheezing is relatively high pitched, musical, hissing or shrill quality.

Common Causes:

  • Reactive Airway Disease (RAD)
  • Asthma
  • COPD
33
Q

What are Crackles (Rales)? What are their common causes?

A

Discontinuous; intermittent, non-musical and brief.

Two Types:

  • Fine Crackles: soft, high pitched, very brief.
  • Coarse Crackles: louder, lower in pitch, brief.

Common Causes:

  • Pneumonia
  • Congestive Heart Failure
  • Atelectasis
  • Pulmonary Fibrosis
  • COPD
  • Asthma
34
Q

What is Bronchophony? Whispered Pectoriloquy? Egophony?

A

Bronchophony - spoken words become louder during auscultation.

Whispered pectoriloquy - whispered words louder and clearer during auscultation.

Egophony - when patient says “ee” it sounds like “A” during auscultation - which is nasal and localized.

THESE ARE ABNORMAL - Distinctness increases with lung consolidation.

35
Q

What are the characteristics of Vesicular breath sounds?

A

Soft and low pitched.
Heard through inspiration and 1/3 expiration
Heard over most of lungs (parenchyma)

36
Q

What are the characteristics of Bronchovesicular breath sounds?

A

Intermediate in intensity and pitch

EQUALLY in inspiration & expiration

Heard best in 1st & 2nd interspaces anteriorly and between the scapulae

37
Q

What are the characteristics of Bronchial breath sounds?

A

Loud and high pitched

MOSTLY expiratory with some inspiratory

Heard best over manubrium

38
Q

What are the characteristics of Tracheal breath sounds?

A

Very loud and high pitched

EQUALLY in inspiration & expiration

Heard best over trachea in neck

PCM Final (5 decks)

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