Lower respiratory tract exam DSA Flashcards
Definitions: Hypopnea: Bradypnea: Hyperpnea: Tacypnea: Dyspnea: Hypoxia: Hypoxemia: Apnea: Atelectasis: Pleximeter finger: Plexor finger:
Hypopnea: decreased depth and rate of respiration
Bradypnea: Regular rhythm but slower then normal rate (<14)
Hyperpnea: increased depth of breathing and rate of respiration
Tacypnea: Rapid breathing
Dyspnea: feeling short of breath
Hypoxia: Deficiency in amount of O2 reaching the tissues
Hypoxemia: Oxygen deficiency in the arterial blood
Apnea: no breathing
Atelectasis: collapse of lung tissue that affects the alveoli from normal O2 absorption
Pleximeter finger: hyperextended middle finger of non dominant hand in percussion
Plexor finger: tapping finger, dominant hand for percussion
where is a needle thoracentesis inserted?
where is a chest tube inserted?
where does the neurovascular bundle run?
Needle thoracentesis
-2nd intercostal space, midclavicular line
Chest tube insertion:
-4th intercostal space at mid or anterior axillary line in the 4th intercostal space just superior to the margain of the 5th rib
Neurovascular bundle
- runs along the inferior margains of each rib
- chest tubes and needles need to be placed over the superior margin of the rib to avoid the bundle
what are some important questions to ask when a patient presents with an respiratory CC?
- ask about events leading up to the episode
- may have been caused by non adherence with medicaftions
- high salt diet may lead to CHF
- exposure to cold or an allergen may trigger an asthma flare
- acute dyspnea immediately following a meal suggests an allergic reaction
- a new productive cough may suggest a pulmonary infection
- recent surgery may increase risk for pulmonary embolism
- recent trauma can be for a pneumothorax
what is the order of the physical exam for the lower respiratory track?
Inspection
Palpation
Percussion
Auscultation
Vital signs is number one and make sure to get oxygen saturation
what is the pulse oximetry
measures the peripheral arterial oxygen saturation (SpO2)
- standard for continuous, noninvasive assessment of good oxygenation
- make sure the curve associated with it is more straight then bumpy
what may cause a bad wave form for the pulse oximetry?
- improper placement
- hypoperfusion
- hypothermia (due to the peripheral vasoconstriction)
- motion artifact
- poor limb perfusion from extremity elevation, vasoconstriction, or peripheral vascular disease
What is end tidal CO2
Capnography: non evasive measurement of the partial pressure of CO2 in exhaled breath as the CO2 concentration overtime
EtCO2 = concentration of CO2 in exhaled air at the end of respiration
This measures ventilation of an individual
what does it mean if the skin color appears cyanosis
bluish, means sign of hypoxia
what does a tracheal deviation indicative of on an X ray exam?
- Pneumothorax (tension or non-tension)
- Pleural effusion
- Atelectasis
- or a mass
What are causes of clubbing of an individuals fingers?
- Congenital heart disease
- Interstitial lung disease
- Bronchiectasis
- Pulmonary fibrosis
- Cystic fibrosis
- Lung abscess
- Malignancy (lung cancer)
- Inflammatory bowel disease
what is Pectus excavatum
funnel chest
may cause depression of great vessels, heart or lungs
what is pectus Carnitum?
Pigeon chest
what is barrel chest?
increased AP diameter resembling a barrel seen in COPD
Pink puffer vs a Blue BLoater?
Pink Puffer: Emphysema
BLue Bloater: Chronic bronchitis
what is Traumatic Flail chest
multiple rib fractures that may result in paradoxial movement of the thorax
-on inspiration the injured area caves inward and on expiration it moves outward
What is significant about accessory muscle use?
REspiratory distress to help the individual breathe
-can see in Asthma, COPD, airway obstruction ,viral illness (RSV)
What is a process of palpation of a lung exam?
- Check rib motion with thoracic expansion (placing thumbs at the level of the 10th ribs
- look for areas of tenderness
-OMM treatments
(Doming the diaphragm, rib raising-helps normalize sympathetic nervous system, tapotement, thoracic pump, helps with atelctasis)
What is tactile fremitus and what does it mean if it is decreased or increased
feeling for palpable vibrations when an individual says “99”
Decreased:
- COPD
- Pleural changes, effusions, fibrosis, Air
Increased:
-Pneumonia (consolidation)
when percussing, what should be heard and what is heard if abnormal?
REsonance is healthy percussion
Dullness:
-fluid or solid tissue
Hyperresonance
- heard with hyperinflated lungs,
- COPD
- Asthma
Unilateral hyperresonance suggest?
- large pneumothorax
- large air-filled in lung
Tympanic: think abdomen
what is the Diaphramatic excursion?
determining where the diaphragm is during inhalation and exhalation
-right is normally slightly higher due to the liver
asymmetry with diaphragm
- Pleural effusion
- high diaphragm secondary to atelectasis or phrenic nerve paralysis
when auscultating what must the patient do?
must breath through the mouth
make sure to be on skin
use the diaphragm of the stethoscope
what are the normal breath sounds?
- Vesicular
- Bronchovesicular
- Bronchial
- Tracheal
these differe based on what anatomical structure you are over
what are adventitious lung sounds?
- stridor
- wheezes
- crackles
what is a common cause for stridor?
-result from narrowing in the upper airway
common causes
- croup
- epiglottitis
- upper airway foreign body
- anaphylaxes
