Module 7 - Respiratory Assessment Flashcards
What is the main function of the lungs?
Exchange of gases and maintain homeostasis
What is the secondary function of the lungs?
pH balance - acid base balance
- O2 inhalation
- CO2 expiration
Anatomy of Upper Respiratory Tract
- Nose
- Sinuses
- Pharynx
- Larynx
- Epiglottis
Anatomy of Lower Respiratory Tract
- Trachea
- Lungs
- Accessory muscles
- Bronchi/Bronchioles (Spongy material)
- Alveolar ducts/Alveoli (Air sacs filled with hemoglobin in the bronchioles)
Components of the Thoracic cage
- Thoracic cage
- Ribs (12 pairs)
- Vertebrae (12 pairs)
- Diaphragm - Muscular septum that separates the thoracic cavity to the abdomen
- Costochondral Junction - the points where the ribs join their cartilages - NOT palpable
Anterior Thoracic Landmark - Suprasternal notch
U shaped depression above the sternum in between the clavicles
Anterior Thoracic Landmark - Sternum
“breastbone” which has 3 parts: Manubrium, body, xiphoid process
Anterior Thoracic Landmark - Sternal Angle
“Angle of Louis” is the articulation of the manubrium (Sternum) it is a useful place to start to count the ribs
Anterior Thoracic Landmark - Costal Angle
Right and left costal margins form an angle where they meet at the xiphoidal process
Posterior Thoracic Landmark - Vertebra Prominens
Start at base of the neck - Spinal columns C7 and lower one at T1
Posterior Thoracic Landmark - Scalpula
Symmetrically in hemithorax, lower tip is usually at the level of the seventh or eighth rib
- “Shoulder Blade”
- Joining force between clavicle and humerus
Anatomy of Lung Lobes
- Not symmetrical
- Anterior contains primary upper and middle lobes
- Posterior lobes contains lower lobes
- Right lung is shorter due to liver
- Left lung is narrow due to heart
- Left lung has two lobes (no middle lobe)
- Separated by fissures that run obliquely through the chest
Health History - Respiratory Questions
- Cough
- Sputum
- Description of Cough
- SOB
- Chest Pain
- History of Infections
- Smoking
- Environmental
- Self care practices - Doctors appointments, Immunizations
Subjective Data - Cough questions
- Do you have a cough?
- When did it start?
- How long? How often?
- Description of cough
- Sputum - Colour, Amount
- Treatments?
Subjective Data - SOB questions
- Severity
- Factors
- When does it occur?
- Allergies
- Sounds
- Treatments?
Abnormal Chest Expansion - Barrel Chest
- Can associate with normal aging
- Can associate with COPD (emphysema) and asthma
- Chest appears to be partially inflated
- Broad chest
- Ribs are horizontal instead of downward
Abnormal Chest Expansion - Pectus Excavatum
- Sunken sternum
- Depression at 2nd intercostal space
- Can notice more on inspiration
Abnormal Chest Expansion - Pectus Carinatum
- Forward perfusion of the sternum
- Ribs slope on either side
Abnormal Chest Expansion - Scoliosis
- Lateral S shape curvature of the thoracic and lumbar spine
- Unequal shoulder/scapular heights
- Occurs during the growth spurt before puberty
Abnormal Chest Expansion - Kyphosis
- “Humpback” common in aging
- Curvature of thoracic spine
- Significant back pain
- Limited mobility
Respiration Patterns - Tachypnea
Increased breathing rate - more than 24/min
Respiration Patterns- Hyperventilation
- Increase in rate and depth
- Can occur in extreme fear/anxiety situations
- Can occur during to Diabetic Ketoacidosis
Respiration Patterns- Bradypnea
- Slow breathing
- Decreased rate of 10/min
Respiration Patterns- Cheyne-Stokes Repirations
- Increased rate and depth for 30-45 seconds with a period of apnea for 20 seconds
- Common in heart failure, meningitis, drug overdose
Respiration Patterns- Apnea
- Cessation of breathing
- No movement of the muscles
Respiration Patterns- Atlectasis
Collapse or closure of the lung/partial lung
Respiration Patterns- Cyanosis
Blueish tinge to the skin and mucous membranes caused by low oxygen levels in the blood or circulation issues
Respiration Patterns- Dyspnea
Shortness of breath
Respiration Patterns- Hypercapnia
Too much CO2 in the lungs and elevated levels in the blood
Respiration Patterns- Hypoventilation
Slow rate and depth - inadequate to perform gas exchange
Respiration Patterns- Hypoxemia
Low level of O2 in the blood - arterial blood
Respiration Patterns- Hypoxia
Low oxygen levels in tissues
Respiration Patterns- Orthopnea
Shortness of breath when lying flat
Respiration Patterns- Biot’s Respiration
Irregular pattern
Occurs in heart trauma, heat stroke
Respiration Patterns- Chronic Obstructive Breathing
Normal inhalation and prolonged expiration - Wheezing sound - COPD patients
Tactile Fremitus
Palpable vibrations felt at posterior/anterior chest wall
- Client’s say “99”
- Sound generation from larynx is transmitted through bronchi and lungs to chest wall
Increased tactile fremitus
- Increased density
- Better for conducting vibrations
- Can occur with pneumonia patients
Decreased tactile fremitus
- Obstruction of vibrations
- Occurs in patients with emphysema, obstruction of bronchi, pleural effusion
Rhonchal Fremitus
Vibration felt when inhaled air passes through thick secretions in larger bronchi
Pleural Friction Fremitus
- Inflammation of parietal and visceral pleura
- Decreased in lubricating fluid
What are the 3 locations of the normal breathing sounds?
- Bronchial
- Bronchovesicular
- Vesicular
Bronchial sounds
- Pitch = high
- Amplitude = low
- Harsh, hollow, tubular
- Trachea and larynx
Bronchovesicular sounds
- Pitch = moderate
- Amplitude = moderate
- Mixed sound
- Bronchi
Vesicular sounds
- Pitch= low
- Amplitude = soft
- Rustling sound
- Lungs
Abnormal Sounds - Crackles
- High pitched crackles
- Popping sounds during inspiration
- Asthma patients, bronchitis and pneumonia
Abnormal Sounds - Crackles Coarse
- Loud low pitched
- Pulmonary edema, pneumonia
Abnormal Sounds - Atelectatic Crackles
- Fine crackles - does not last long
- Occurs in older adults/bedridden patients
Abnormal Sounds - Pleural friction rub
- Superficial sound
- Coarse and low pitched
- Inflammation
- Rubbing together
- Painful
Continuous Sounds - Wheezing (high)
- High pitched
- Compressed air
- Asthma, chronic emphysema
Continuous Sounds - Wheezing (low)
- Moaning sounds
- Prominent during expiration
- Obstruction of airway
Continuous Sounds - Stridor
- High pitched
- Upper airway obstruction
- Foreign body
- Life threatening
What are the 3 main accessory muscles?
Diaphragm, External inter-coastal and Scalene muscles
What are the normal range of findings for the Thorax/Lungs?
- Shape and Configuration
- Position
- Symmetrical Chest Expansion
- Tactile fremitus
- Normal breath sounds over lung fields
