Lower Respiratory Exam Lab Flashcards
Steps for lower respiratory exam
Inspect pt
Palpate (anterior & posterior chest, tactile fremitus)
Percussion (ant & post chest & diaphragmatic excursion)
Auscultate (2 ant, 4 post & 1 R lateral)
Where is a needle thoracentesis placed?
2nd intercostal space just superior to 3rd rib margin @ mid-clavicular line
used for emergent decompression of tension from pneumothorax
Where is a chest tube inserted?
4th intercostal space @ mid or anterior axillary line just superior to margin of 5th rib
Where should you look for an endotracheal tube?
@ level of T4 vertebra on chest X ray
What do you evaluate during pt respiration?
rate, rhythm, depth & effort
What is a normal respiration rate?
14-20 breaths per minute
What may asymmetrical movement of chest during respiration indicate?
pleural effusion
What may intercostal retractions during respiration indicate?
severe asthma, COPD, upper airway obstruction
What is pursed lip breathing assoc w/?
COPD or obstructive lung disease
What is tripoding?
pt w/ obstructive lung disorders tend to sit & lean forward w/ shoulders elevated
What should you inspect on the neck during respiration?
contraction of accessory muscles tracheal position (should be midline)
When does lateral displacement of trachea occur?
tension pneumothorax
What do you inspect the fingernails for?
signs of clubbing
loss of normal angle btwn nail & proximal nail fold (>180 degrees)
What does palpation of chest include?
areas of tenderness
rib motion (inhalation v exhalation dysfunction)
thoracic expansion
tactile fremitus
How do you assess for thoracic expansion?
place thumbs @ level of 10th ribs & grab parallel to lateral rib cage
have pt inhale deeply & watch distance between thumbs as move apart, feel for range & symmetry of rib cage as expands & contracts
What is tactile fremitus?
palpate vibrations transmitted thru bronchopulmonary tree to chest wall as pt speaks (says 99)
perform on ant & post chest & use ULNAR sides of hand
When would increased tactile fremitus occur?
pneumonia (increased transmission thru consolidated tissue)
When would decreased tactile fremitus occur?
COPD, pleural effusions, fibrosis, pneumothorax, thick chest wall, infiltrating tumor
What is important in technique for percussion of chest?
strike extended middle finger @ DIP w/ quick & sharp motion
Flat percussion characteristics
soft intensity
high pitch
short duration
Dull percussion characteristics
medium intensity
medium pitch
medium duration
Resonant percussion characteristics
loud intensity
low pitch
long in duration
healthy lung
Hyper-resonant percussion characteristics
very loud
lower pitch
longer duration
Tympanitic percussion characteristics
loud
high pitch
longer
gastric air bubble
When does dullness occur?
fluid or solid tissue replaces air-containing lung
lobar pneumonia (b/c alveoli filled w/ fluid & RBCs) pleural accumulations (effusion, hemothorax, empyema, fibrosis or tumor)
When does hyper-resonance occur?
hyper-inflated lungs
COPD/emphysema
asthma
When does unilateral hyper-resonance occur?
large pneumothorax
large air-filled bulla in lung
What is normal diaphragmatic excursion?
3 to 5.5 cm (distance btwn 2 levels of diaphragm-during inhalation & expiration)
What does dullness @ higher level in diaphragmatic excursion indicate?
suggests pleural effusion or high diaphragm (due to atelectasis or phrenic N paralysis)
How do you auscultate lungs?
have pt breathe deeply in & out thru OPEN mouth
Crackles in breath sounds
discontinuous, intermittent, nonmusical & brief
fine crackles sound like velcro & coarse crackles are louder & lower in pitch
Wheezes in breath sounds
continuous, musical quality & prolonged (not always during entire respiratory cycle)
suggests narrowed airways
Rhonchi breath sound
relatively low-pitched w/ snoring quality
suggests secretions in large airways
Stridor in breath sound
high pitched wheeze that is usually only during INSPIRATION
louder in neck & indicates partial obstruction of larynx or trachea
Which breath sound indicates a medical emergency?
stridor
Pleural friction rub
sounds like cracking, usually during expiration & in small area on chest wall
rough pleural surfaces rubbing against each other
Bronchophony
pt says “99” while listen
abnormal: spoken words become louder & clearer (indicates consolidation)
Egophony
pt says “ee”
abnormal: “ee” sounds like “A” (usually indicates pneumonia if pt has fever & cough)
Whispered pectoriloquy
pt whispers “99” or “1, 2 3”
abnormal: whispers are heard louder & clearer during auscultation
