Lower Respiratory Exam Flashcards
Normal adult breathing
Quiet
Regular RR (14-20)
Hypopnea
Decreased depth and rate of respiration
Shallow and slow
Bradypnea
Regular rhythm but slower RR
Hyperpnea
Increased depth of breathing and rate of respiration
Deep, Fast Breathing
Normal in exercise
Tachypnea
Rapid breathing (RR > 20-25)
Dyspnea
Feeling SOB
Hypoxia
Deficiency in amt of O2 reaching tissues
Hypoxemia
O2 deficiency in arterial blood
Apnea
No breathing
Atelectasis ***
Collapse of lung tissue that affects the alveoli from normal O2 absorption
Pleximeter finger
Plexor finger
Hyperextended middle finger of non-dominant hand in percussion
Tapping finger on dominant hand use for percussion
- Basic landmarks
- Midsternal line
- Midclavicular line
- Anterior axillary line
- Midaxillary line
- Posterior axillary line
- What things do you need to do for a LRE?
- Vitals (Including Pulse Ox)
- Inspection
- Palpation
- Percussion
- Ascultation
- Inspection
- Sitting position and breathing pattern
- Use of accessory muscles
- Color of fingers and lips
- Shape of nails
- Breathing
- Ability to speak
- Chest deformities
- Spinal deformities
- Mid-line trachea?
Pulse oximetry
Measures amount of oxygen saturated hemoglobin using the difference between infrared light and red light
Causes of a bad waveform in pulse oximetry
Improper placement
Hypoperfusion
Hypothermia
Motion artifact
Falsely elevated with: carboxyhemoglobin, high levels of glycohemoglobin,methemoglobin, sulfhemoglobin, ambient light)
End Tidal CO2
Concentration of CO2 in exhaled air at the end of respiration
Measures ventilation
Incentive Spirometer
Given to post surgery patients
Steps to use:
1) Move slider on the outside of large column to level you want to reach
2) Hold spirometer in front of you and sit or stand up straight
3) Breathe out normally, close lips around mouthpiece
4) Breathe in and take a slow deep breath, breathing as deeply as you can-when you can’t breathe in anymore, hold breath for 2-5 sec
PFT
Used to diagnose obstructive v. restrictive lung disorders
Spirometry (also a PFT)
Measures lung function by measuring speed/amount of air inhaled and exhaled
Diagnose obstructive v restrictive lung disease
Normal shape of the chest
Thorax is wider than it is deep
Lateral diameter larger than AP diameter
Asymmetrical expansion can be d/t
Pleural effusion
Retraction can be d/t
Severe asthma
COPD
Upper airway obstruction (ie: stridor)
Unilateral lagging can be d/t
Pleural disease
(Asbestosis, trauma, phrenic nerve damage)
What are the main muscles of inspiration
Accessory muscles of inspiration
Diaphragm, internal intercostals
Sternomastoids, scalenes, expiratory intercostals, external obliques, abdominals
Cyanosis is a sign of _
Hypoxia
Tracheal deviation can be seen in:
Pneumothorax
Pleural effusion
Atelectasis
Mass
Clubbing can be seen in :
Congenital Heart Disease
Interstitial Lung Disease
Bronchiectasis
Pulmonary Fibrosis
CF
Lung Abscess
Malignancy
IBD
Pectus excavatum
Funnel chest
Can compress heart and vessels and cause murmur
Pectus carinatum
Pigeon chest
Sternum displaced anteriorly (increased AP diameter)
Adjacent costal cartilages are depressed
Barrel Chest
What disease is associated with it?
Increased AP diameter
COPD (or normal in aging, normal in infancy)
What types of patients are “blue bloaters” ?
- Overweight/cynaotic
- Elevated hemoglobin
- Peripheral edema
- Ronchi and wheezing
- Daily productive cough for last three months or more, in at least two consecutive years
What types of patients are “pink puffers”?
Emphysema
Older and thinner
Severe dypsnea
Quiet Chest
TRIPOD POS
Permanent enlargement and destruction of airspaces distal to terminal bronchiole
Paradoxical movement of chest
On inspiratiomn, injured area caves inward (and caves outward on expiration)
Can occur with trauma to the ribs
- How do you assess whether thoracic expansion is symmetrical?
- What part of the exam does this fall under?
- Place thumbs on 10th rib level with fingers parallel to lateral rib cage
- Slide hands medially to raise loose fold of skin each side between thumb and spine
- Ask patient to inhakle deeply
- Watch distance between thumbs
- Feel for range and symmetry of the rub cage as it expands and contracts
- Palpation
- What is tactile fremitus?
- Where should you perform test for this?
- When will tactile fremitus be increased?
- When will it be decreased?
- palpable transmissions thru bronchopulmonary tree to chest wall when patient speaks
- See image
- Pneumonia
- COPD, fibrosis, pneumothorax, thick wall, infiltrating tumor
- What is tactile fremitus called when using a steth?
- Egophony
- Where should you percuss?
- What fashion should you percuss in?
- See image
- Non dominant hand is on chest/back
- Strike distal interphalangeal joint of middle finger (use other fingers on chest wall to minimize dampening)
- Ladder fashion
- 2-3 taps per spot
- In what types of conditions will you hear hyperresonance upon percussion?
- In what types of conditions will you hear a dull sound upon percussion?
- Hyperresonance with excess air
- Pneumothorax
- Air filled Bulla in lung (COPD/Emphysema)
- Asthma
- Dull with excess fluid
- Effusion
- Hemothorax
- Empyema
- Fibrous tissue or tumor
- How do you perform diaphragmatic excursion?
- Patient exhales completely and holds exhalation
- Doc feels for diaphragm and marks with pen
- Patient breathes normally for a few breaths
- Patient inhales completely and holds it
- Percuss for level of diaphragm and mark with pen
- Distance between two lines =diaphragmatic excursion
- Normal is 3.5-5 cm
- Asymmetry w/ pleural effusion or high diaphragm secondary to atelectasis or phrenic nerve paralysis
- What are key techniques when ascultating ?
- Patient breathes thru open mouth
- Compare sides in ladder like fashion
- Listen to two spots on front and four on the back
- Listen for normal and adventitious breath sounds
- If you suspect abmnormalities, listen for vocal resonance
- What are the normal breath sounds?
- Vesicular
- Bronchovesicular
- Bronchial
- Tracheal
- What are the adventitious breath sounds?
- Stridor
- Wheezes (Rhonchi)
- Crackles (Rales)
Stridor
- Generally inspiratory
-
Caused by narrowing in upper airway:
- Croup
- Epiglottitis
- Upper airway foreign body
- Anaphylaxis
- Wheezing
- Generally expiratory
- Continuous musical sound
-
Caused by rapid airflow thru narrowed bronchial airway:
- RAD
- Asthma
- COPD
- Crackles
- Inspiratory
-
Caused by small airway closed during expiration opening during inspiration
- Pneumonia
- CHF
- Atelectasis
- Pulmonary Fibrosis
- Bronchiectasis
- COPD
- Asthma
- When is vocal resonance abnormal?
- Bronchopony-spoken words get louder
- Whispered pectoriloqy-whispered words are louder and clearer during ascultation
- Egophony-when patient says “ee” it sounds like “A” (which is nasal and localized)
- What are the ABCs of taking a chest x ray?
- A=aqeduate/asessment of quality and Airway
- B=Bones and Soft Tisue
- C=Cardiac Size/Valves
- D=Diaphragms
- E=Effusions/Endotracheal tube/EKG Leads/Wires
- F=Fields and fissures/foreign bodies
- G=Great vessels/gastric bubbles
- H=Hilar masses
- I=Impression
- Trachea
- Spinous process
- Carina
- Right hilum and pulmonary artert
- Aortic knob
- Left hilum and pulmonary artery
- Right atrium
- Left ventricle
- Costophrenic angle
- Right hemidiaphragm
- Costocardiac angle
- Left hemidiaprhagm
Tension pneumothorax
COPD
- Interstitial lung disease
Pleural effusion
Trauma pt with breathing tube
Fractured ribs
Possible hemothorax
