Module 3 Complete Resp Assessment Flashcards
What is the secondary survey (complete resp. assessment)
IPPA
Inspection
Palpation
Percussion
Auscultation
What is involved in the primary survey? (initial assessment)
General Principles
Initial impressions
LOC
Circulation
Airway
Breathing
What are General Principles we look for in the primary survey
Systematic Approach,
Captures initial first impression and detects immediate threats to life
- Helps prioritize medical interventions
- If clinical condition deteriorates, troubleshoot through ABC’s again
Primary survey: Initial impression
Assess the severity of the patient condition to determine the most appropriate assessment and intervention
- Quick look at patient Vital Signs
- Age, Gender, Weight, Height, General Appearance
- Any other obvious assessment findings
What are the 6 main patient positions?
- Supine
- Prone
- Sims
- Lateral recumbent
- Fowlers
- Trendelenburg
What is HOB?
Head of bed (in degrees)
What do we consider in a patient when surveying LOC?
- Alert (awake/responsive)
- Verbal (respond to verbal commands)
- Painful
- Unresponsive/obtunded (are they responding at all?)
What does obtunded or stupor mean?
- Obtunded = dulled/reduced level of alertness/LOC
- Stupor = Dazed
What do we consider when analyzing circulation?
- Pulse
- Bleeding
- Skin condition (Color/temp, diaphoresis (sweating)
What do we consider when analyzing airways?
- Is the airway open?
- Is there an obstruction?
- Can the patient maintain their own breath?
What do we expect if an airway is blocked?
- Agonal respirations
- snoring respirations
- breath sound absent
What do you look for in a patients breathing?
Respiratory Rate (N: 12-20)
Respiratory Pattern
Depth of respirations
Auscultation to assess breath sounds
Color- Pale, Cyanosis
Work of Breathing
Accessory Muscle Use
Facial Expression – ie. Anxious looking
Patient Position – ie. Tripoding
Skin Condition – ie. Diaphoretic
IPPA purpose and breakdown?
Inspection – Observations of patient condition
Palpation – Touch to determine anatomy, structure and pathology
Percussion – Tap to evaluate underlying structures and pathology based on resonance
Auscultation – Listen to sounds in the chest
What is Cyanosis?
Cyanosis is the reduction of O2 in arterial blood (hypoxemia)
or the reduction in O2 saturated hemoglobin
It is typically defined as the reduction of more than 5 g/dL
can be caused by anemia.
Cyanosis can be identified physically as a blueish tinge in the skin. Where/what are 2 types of cyanosis?
Central and Peripheral cyanosis.
The former is detected around the lips, mucous membranes, and core.
The latter (acrocyanosis) around the extremities. Normal hemoglobin is 15 g/L
What does pursed lip breathing indicate?
Advance stages of obstructive pulmonary disease.
Occurs during exhalation.
Purse lip breathing increases positive pressure at the lips to slow exhalation and prevent collapse of airways and air trapping.
What does pursed lip breathing indicate in an assessment
Sign of increased WOB
often taught to patients with COPD to manage shortness of breath
What does diaphoresis indicate?
Diaphoresis is excessive sweating.
It can appear anywhere but usually observed on the face.
It indicates acute respiratory distress, pain, febrile myocardial infarction
What does the term Febrile mean?
A fever.
Myocardial infarction is typically known as a heart attack. what does the term infarction mean?
Infarctions are tissue death/necrosis due to inadequate blood supply to an area.
What does bleeding in the ears indicate?
Trauma, more specifically brain injury.
Normal Pupillary reflexes (eyes) = equal in size and reactive to light (PERRL).
What do dilated/fixed eyes indicate?
Brain injury
Normal Pupillary reflexes (eyes) = equal in size and reactive to light (PERRL). What do pinpoint eyes indicate?
parasympathetic stimulant (opioids)
Normal Pupillary reflexes (eyes) = equal in size and reactive to light (PERRL). What does double/blurred vision indicate?
Neuromuscular disease, brain injury.
What does Nasal Flaring indicate?
Signs of increased WOB in many conditions (more common in neonatal/paediatric populations)
Dilator narris widens the nasal opening = larger office for gas to enter tracheobronchial tree.
what does tracheal position indicate? what is normal?
Normal tracheal position is midline.
Deviations indicate severe disease.
What are the causes of the following tracheal deviation: Displacement towards the lesion?
edit later
Lobar Collapse
Pneumoectomy
Pulmonary fibrosis
What are the causes of the following tracheal deviation: Displacement away from the lesion?
Large pleural effusion
Tension pneumothorax
What are the causes of the following tracheal deviation: other displacement
mediastinal masses
What is a Pneumonectomy?
Removal of a lung/lobe
What is a pleural effusion?
Extra fluid build up around the lungs in the pleural cavity
What is a pulmonary fibrosis?
When the lung tissue is scarred, causing it to become stiff.
It creates a abnormal pressure in the chest cavity
What is pleural fibrosis?
Condition when the membrane that surrounds the lungs (pleura) becomes inflamed
What is a pneumothorax?
Lung collapse
What is JVD?
Jugular venous pressure.
It indicates right sided heart failure.
extension greater than 3-4 cams is abnormal
What are some signs of WOB?
Dyspnea (SOB)
Abnormal ventilatory patterns
Accessory muscle use
Nasal flaring
purse lip breathing
retractions
What is Hemoptysis
when you cough up blood from your lungs
What are common terms to describe dyspnea?
tight chest
increased effort to breath
air hunger
suffocation
can’t breath
can’t get a full breath
What should you ask patients about dyspnea?
What is the goal?
How would you describe your shortness of breath?
When did the shortness of breath start/onset
-Acute: minutes to hours
-Chronic: days/months/years
Activity related to shortness of breath (at rest, on exertion)
Position changes related shortness of breath (sitting versus laying down flat)
History of present illness in relation to shortness of breath
Goal = Establish baseline work of breathing
What are types of Dyspnea? (5)
Acute: sudden onset
Chronic/ progressive:
occurs over time.
Paroxysmal:
sudden “attack” or exacerbation (worsening of breath)
Episodic:
occurs with certain activity or during times
Exertional:
only occurs during exertion.
Which accessory muscles assist in inspiration when WOB is high?
Scalenes
Sternocleidomastoids
Pectoralis major
Trapezius
Which accessory muscles assist in expiration when WOB is high?
Rectus abdonminis
external and internal obliques
transversus abs
Tripoding usually involves leaning forward with hands (resting) to support the upper body.
What muscle is primarily used for inspiration in this case?
The pecs.
What is Abdominal Paradox known as and why is it bad?
“see saw breathing”
Ominous sign of diaphragm fatigue.
breathing is pulled deep and lower down the body.
Define Hoover Signs?
Associated with COPD and severe hyperinflation.
low diaphragm position, pulls lateral margin of chest in on inspiration. (think intercostal)
Respiratory Alteranans
A period of alternating breath periods between the chest and abs region. (one goes for a bit, than the other)
What is the difference between pleuritic and non-pleuritic chest pain
Pleuritic chest pain is characterized by being well localized, sharp in nature and exacerbated by inspiration.
Chest pain that does not have these characteristics is described as non-pleuritic.
What makes pleuritic chest pain (pleurisy) worse?
Inspiration and coughing.
Splinting (changing positions) can help relieve pain.
What is nonpluritic pain?
Constant and centrally located (directly under breastbone)
Pain can radiate through the upper body.
Visually, we can see clutching.
what is myocardial ischemia?
When blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis)
note, a rupture is a heart attack.
TLDR; blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen.
What is splinting?
A protective pain response
accompanied with resistance to taking deep breaths.
Common after thoracic procedures and chest wall trauma.
Increased risk for atelectasis/pneumonia
Why are coughs important and what do they tell us?
They are a involuntary protective mechanism.
Coughs eject/expel air from lungs (to prevent bacteria/infection)
Prevents aspiration (foreign bodies/objects)
What is Orthopnea?
The sensation of breathlessness in the recumbent position?
AKA relieved by sitting or standing.
What is Paroxysmal Nocturnal Dyspnea (PND)?
Sensation of SOB that awakens the patient, often after 1 or 2 hrs of sleep.
Relieved in the upright position.
What is Trepopnea?
Difficulty laying on one side
What is Platypnea?
Dyspnea occurring in an upright position.
What is a normal I:E ratio?
1:2
Accessory muscles that assist inspiration create a subatmospheric pressure in pleural space.
how do they do this and where does this occur most often?
They assist/replace the diaphragm in advance obstructive lung disease.
What do accessories muscles help do during expiration?
Increase intrapleural pressure.
What are 3 commonly observed retraction types?
Substernal retractions
supraclavicular
intercostal retractions
What does barking/harsh/dry/stridor coughs suggest?
Laryngeal disorder
Wheezy cough suggests what?
Narrowing of airways
-i.e Bronchial disorder like COPD
Acute productive coughs suggest?
allergic asthma, bacterial, viral
Define Sputum
substance expelled from airways, mouth, sinuses, and nose.
Define Phlegm
Strictly secretions from the lungs
what are some causes of hemoptysis?
on the more specific spectrum?
Tobacco use
Foreign body aspiration
Trauma
TB
Pulmonary edema
Hemoptysis vs Hematemesis?
Bleeding from different locations
typsis = respiratory tract
mesis = from the digestive tract
What is Barrel chest?
When ribs lose the 45 degree angle and become horizontal.
Sign of COPD -> sign of hyperinflation
Pectus carinatum?
When the sternum protrudes out anteriorly
Pectus excavatum?
Sternum depressed (partial or complete)
Scoliosis?
Lateral curvature of the spine
Kyphosis?
Abnormal anteroposterior curvature of the spine. (hunchback basically)
Kyphoscoliosis?
Combo of scoliosis and kyphosis.
More severe than both by themselves.
What is Flail chest?
a form of trauma when 3+ ribs next to each other are broken in at least 2 places.
3 types of Fremitus?
Vocal
Tactile
Ronchial
Ronchial Fremitus
Palpable vibrations that indicate thick secretions
Tactile fremitus is palpated in which manner?
palpating down the back while the patient states 99
What does increased vibrations indicate?
Lung tumor
Pneumonia
Atelectasis
What does decreased vibrations indicate?
Bronchial obstruction,
mucous plug
Pneumothorax
Pleural Effusion
Hyperinflation
Muscular/Obese Chest wall
Causes of Fremitus decreasing?
Excess air in lungs
Increased thickness of chest wall
Causes of Fremitus increasing?
Lung consolidation aka air being replaced by something else.
What does subcutaneous emphysema (air leaks) feel like?
Small bubbles or rice krispies.
When percussing, what does hyperresonance indicate?
hyperinflation or pneumothorax
When percussing, what does hyperresonance sound like
Louder and lower pitched than normal
Hollow sounding.
When percussing, what does hyporessonsance sound like?
High pitched + short duration.
Dull + flat
When percussing, what does hyporessonsance indicate?
Refer to:
https://medschool.co/exam/resp/chest-percussion
Pneumonia
Tumor
Atelectasis
Pleural effusion
Is percussion accurate in diagnsosis?
By itself, no.
When should you avoid percussion?
Neonates/pediatrics.
Geriatrics with fragile bones
broken bones/areas of pain.
How many points do you auscultate on posteriorly?
6
How many points do you auscultate anteriorly
4
How many points do you auscultate laterally?
1 on each side (left and right)
What are 4 breath sounds characteristics?
Pitch - high or low freq
Amplitude - intensity or loudness
Distinct characteristics - presence of normal/abnormal breath sounds.
Duration - I:E
Normal breath sounds (3)
Bronchial
Bronchovesicular
Vesicular
Adventitious Breath sounds (7)
Stridor
crackles
wheezes
Bronchial breath sounds
Pleural friction rub
Diminished breath sounds
What is the difference between hypoventilation and hypopnea?
Hypoventiliation is decreased rate and depth
Hypopnea is decreased depth of respiration
What is the difference between hypoventilation and hypopnea?
Hypoventilation is decreased rate and depth
Hypopnea is decreased depth of respiration
Biot’s breathing is caused by ____ and also referred to as _____
Damage to the pons due to stroke or trauma or opioid OD
Ataxic or ataxia
A patient with diabetic ketoacidosis would have _______ breathing, _______ than average urine output , ___________ skin turgor
Kussmaul
Greater than average
Decreased turgor because of dehydration
Why does purse lip breathing help patients with COPD?
This technique helps to keep airways open longer so that you can remove the air that is trapped in your lungs by slowing down your breathing rate and relieving shortness of breath.
