Lower Respiratory DSA Flashcards
What is the rate of normal adult breathing?
RR = 14 - 20 bpm with quiet and regular rhythm
What is Hypopnea?
Decreased depth (shallow) and rate (slow) of respiration
What is bradypnea?
Regular rhythm BUT slower than normal rate (RR < 14/min)
What is hyperpnea?
Increased depth (deep) of breathing and rate (fast) of respiration.
NORMAL IN EXERCISE
What is dyspnea?
Feeling short of breath
What is hypoxia?
Deficiency in the amount of O2 reaching the tissues.
What is hypoxemia?
O2 deficiency in arterial blood.
What is apnea?
No breathing.
What is atelectasis?
Collapse of lung tissue that affects the alveoli from normal O2 absorption.
What is the pleximeter finger? Plexor finger? How do they relate?
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.
Where is the Sternal Angle?
2nd rib joins sternum. (Angle of Louis)
Where do you perform a needle thoracentesis (decompression)?
2nd intercostal space, midclavicular line.
Where do you perform a chest tube insertion?
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.
Where is the neurovascular bundle in relation to each rib?
Runs along the inferior margin of each rib.
Note: Place chest tubes/needles over superior margin of rib to avoid bundle.
Please identify the following: Otalgia Tinnitis Epistaxis Rhinorrhea
Otalgia - Earache
Tinnitis - Ringing or buzzing in ears
Epistaxis - Nosebleed
Rhinorrhea - Runny nose
What does a Pulse Oximeter measure? What is the mechanism?
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
What causes a bad Pulse Oximeter waveform?
- Improper placement
- Hypoperfusion
- Hypothermia
- Motion artifact
What is the End Tidal CO2?
What are normal PETCO2 and PaCO2 values?
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
What is Atelectasis?
What can help with prevention and treatment?
Atelectasis - Loss of lung volume due to collapse of lung tissue (alveoli).
Incentive Spirometer (IS) helps with prevention and treatment of Atelectasis.
What is indicated by a patient using accessory muscles?
When can their use be seen?
Patients in respiratory distress.
Accessory muscles seen in:
- Asthmatics
- COPD
- Airway Obstruction
- Viral Illness (RSV)
What is Cyanosis? What are the 2 types?
Cyanosis - bluish discoloration of skin and mucus membranes resulting from inadequate oxygenation of the blood.
Two types:
- Nail bed
- Perioral - seen around the mouth
What are the causes of clubbing?
- Congenital heart disease
- Interstitial lung disease
- Bronchiectasis
- Pulmonary fibrosis
- Cystic fibrosis
- Lung abscess
- Malignancy (lung cancer)
- Inflammatory bowel disease
What is Pectus Excavatum?
Pectus Excavatum “Funnel Chest”
Depression in lower portion of the sternum - can compress heart and great vessels, cause murmur.
What is Pectus Carinatum?
Pectus Carinatum “Pigeon Chest”
Sternum displaced anteriorly (increased AP diameter), adjacent costal cartilages depressed.
How does AP diameter change in Barrel Chest?
Which clinical condition is associated with Barrel Chest?
Increased AP Diameter
COPD is associated with Barrel Chest
What is the difference between a “Blue Bloated” and “Pink Puffer?”
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.
How do you perform Thoracic Expansion?
- 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.
- Ask patient to INHALE DEEPLY, watch distance between thumbs MOVE APART during inspiration and feel for range/symmetry of rib cage.
What is Tactile Fremitus?
How do we assess Tactile Fremitus?
What is indicated by decreased/absent fremitus? Increased fremitus?
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
How do you perform a Diaphragmatic Excursion? What is indicated by Diaphragmatic Excursion asymmetry?
- Patient exhale completely and hold.
- Percuss for level of diaphragm and mark with a pen.
- Patient breathes normally for a few breaths.
- Patient inhales completely and holds it.
- Percuss for level of diaphragm and mark with a pen.
- Distance between the two is the Diaphragmatic Excursion.
Normal = 3-5.5 cm
Asymmetry indicates pleural effusion.
What are the 4 types of normal breath sounds? Where are they typically heard?
Typical Breath Sounds:
- Tracheal - best heard over trachea in neck
- Bronchial - over trachea
- Bronchovesicular - over main bronchi
- Vesicular - Over lesser bronchi, bronchioles, and lobes
What is Stridor?
What are the common causes?
High pitched wheeze entirely or predominantly inspiratory.
Louder in neck than over chest wall.
Causes:
- Croup
- Epiglottitis
- Upper airway foreign body
- Anaphylaxis
What is Wheezing?
What are the common causes?
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
What are Crackles (Rales)? What are their common causes?
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
What is Bronchophony? Whispered Pectoriloquy? Egophony?
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.
What are the characteristics of Vesicular breath sounds?
Soft and low pitched.
Heard through inspiration and 1/3 expiration
Heard over most of lungs (parenchyma)
What are the characteristics of Bronchovesicular breath sounds?
Intermediate in intensity and pitch
EQUALLY in inspiration & expiration
Heard best in 1st & 2nd interspaces anteriorly and between the scapulae
What are the characteristics of Bronchial breath sounds?
Loud and high pitched
MOSTLY expiratory with some inspiratory
Heard best over manubrium
What are the characteristics of Tracheal breath sounds?
Very loud and high pitched
EQUALLY in inspiration & expiration
Heard best over trachea in neck
