Lower Respiratory Tract Exam Flashcards
What is considered to be a normal adult breathing rate?
quiet & regular @ respiratory rate of 14-20/min
What is bradypnea?
regular breathing rhythm but slower than normal rate (RR<14/min)
What is hyperpnea?
When is it normal?
increased depth of breathing & rate of respiration
normal during exercise
What is dyspnea?
feeling short of breath
Atelectasis
collapse of lung tissue that affects the alveoli from normal O2 absorption
Which 2 fingers do you use to percuss the lungs?
hyperextended middle finger of non-dominant hand & tapping finger of dominant hand
Where would you insert a needle for a thoracentesis?
2nd intercostal space & midclavicular line
Where would you insert a chest tube?
4th intercostal space @ mid axillary line (just superior to 5th rib to avoid neurovascular bundle)
Common chief complaints for lung exam
cough coughing & spitting up blood trouble breathing wheezing swelling
What should be considered in HPI for cc related to lungs?
medications
exposure to cold/allergen that triggers asthma
allergic reaction (to meal)
pulmonary infection (cough)
recent surgery increases risk for pulmonary embolism
recent trauma (pneumothorax)
What are some associated symptom considerations for lung cc?
ENT: drainage from ear, otalgia (earache), tinnitis, epistaxis, nasal congestion, swollen lymph nodes, sore throad
Respiratory: chest pain, shortness of breath (asthma, pneumonia)
Constitutional associated symptom considerations
fever
sweats
chills
weight loss
PE of lower respiratory track
Inspection
Palpation
Percussion
Auscultation
Pulse oximetry
measures peripheral arterial oxygen saturation
End Tidal CO2
measures ventilation
non-invasive measurement of partial pressure of CO2 in inhaled breath over time
What is a normal PET CO2 reading?
35-40 mm Hg (represents normal partial pressure of CO2 in arterial blood)
What should you look for during inspection?
assess breathing rate, rhythm, depth & effort
skin color (cyanosis?)
trachea (is it midline)
hands (clubbing?)
shape of chest (deformity?)
What does cyanosis indicate?
hypoxia (can see @ nail bed)
What may tracheal deviation indicate?
pneumothorax
pleural effusion
atelectasis
mass
Pectus excavatum
depression in lower portion of sternum that can compress heart & great vessels, cause murmurs
Pectus carinatum
sternum displaced anteriorly (increased AP diameter)
adj costal cartilages are depressed
Barrel Chest
increased AP diameter, seen in COPD
Chronic Bronchitis
daily productive cough for 3 months or more, in at least 2 consecutive years
assoc symptoms: overweight & cyanotic, elevated Hb, peripheral edema, wheezing
Emphysema
permanent enlargement & destruction of airspaces distal to terminal bronchiole
assoc symptoms: older & thin, severe dyspnea, quiet chest, lungs are hyperinflated w/ flat diaphragm
What may asymmetrical expansion of chest wall indicate?
pleural effusion
What may retraction of chest wall w/ breathing indicate?
severe asthma, COPD, upper airway obstruction
What may unilateral lagging of chest wall w/ breathing indicate?
pleural disease (asbesotsis, trauma, phrenic N damage)
Traumatic flail chest
multiple rib fractures may result in paradoxical movements of thorax
injured area will cave INWARD w/ inspiration & move outward w/ expiration
What would use of accessory muscles for breathing indicate?
sign of respiratory distress
seen in asthma, COPD, airway obstruction, viral illness
What should palpation in PE include?
palpate trachea
areas of tenderness
bruising or tenderness over ribs
How to examine if thoracic expansion is symmetrical
place thumbs @ level of 10th ribs, grab lateral to rib cage
have pt inhale deeply & watch distance between thumbs as move apart during inspiration & feel for symmetry of rib cage
What do increased vibration sounds indicate?
What do decreased/absent vibration sounds indicate?
pneumonia
COPD or pleural changes (effusion, fibrosis, etc)
Dullness w/ percussion sounds
fluid or solid tissue replaces air-containing lung
pleural accumulations or lobar pneumonia
Generalized hyperresonance w/ percussion sounds
indicates hyper-inflated lungs (chronic bronchitis or asthma)
Unilateral hyperresonance w/ percussion sounds
indicates large pneumothorax or large air filled bulb in lung
What is considered a normal lung percussion sound?
loud intensity, low pitch, long duration
What is considered a normal diaphragmatic excursion?
What may abnormal indicate?
normal is 3-5.5 cm
pleural effusion or is secondary to atelectasis/phrenic N paralysis
What should you use to auscultate the lungs?
use diaphragm of stethoscope
compare both sides in ladder fashion (2 anterior & 4 posterior)
What are the most important techniques to assess airflow?
listen to sounds generated by breathing
listen for any added sounds
if abnormalities suspected, listen for vocal resonance
What are considered abnormal breath sounds?
stridor
wheezes
crackles
What are stridor sounds associated with?
usually heard on inspiration due to narrowing in upper airway
croup, epiglottitis, upper airway foreign body, anaphylaxis
What is wheezing assoc w?
usually an expiratory sound caused by rapid airflow through narrowed bronchial airway
reactive airway disease, asthma, COPD
What are crackles assoc w?
inspiratory sound caused by small airway closed during expiration & popping open during inspiration
pneumonia, CHF, pulmonary fibrosis, asthma
When do you use an incentive spriometer?
to help w/ atelectasis (treatment & prevention)
re-inflate lung after collapse of alveoli
Pulmonary Function test
non-invasive to show how well lungs are working
diagnose obstructive v restrictive lung disorders
Spirometry (PFT)
measures lung function via amount & speed of air inhaled & exhaled
What should you evaluate on a chest X ray?
Adequate quality Airway Bones/soft tissue Cardiac size Diaphragms Effusions Fields/fissures Foreign body? Great vessels Gastric bubble Hilar masses
Impression-What are your overall findings?
