Physical Dx of Respiratory System Flashcards
compare symptom and sign
symptom - from patient; subjective
signs - from PT; objective measures/tests
what is tidal volume
amount of air a person inhales and exhales at rest
500-700 ml
what is inspiratory reserve volume
amount of air a person can maximally inspire at end of normal respiration
~2 L
what is expiratory reserve volume
amount of air a person can maximally exhale at end of normal exhalation
~1 L
what is vital capacity
IRV + TV + ERV
amount of air a person can take in and out of lungs
~3.5 L
what is residual volume
air that stays in lungs after ERV
~1.3 L
what is total lung capacity
VC + RV
~5 L
discuss eupnea
normal, regular and comfortable
12-20 cpm
younger and athletes have lower
tachypnea
normal to abnormal
> 20 cpm
can be exercise or disease
bradypnea
< 12 cpm, slow
cam be electrolyte imbalance, obesity, hormonal
hyperpnea
hyperventilation c deep breathing
form of tachypnea but deeper
> 20 cpm
can be neuro, psych, metabolic, diseases
sighing
deeper breath in bet normal breaths
air tapping
inc diff in exhalation
asthma and COPD
cheynes-stokes
inc depth c apnea in bet
medical emergency
kussmaul
rapid, tachypnic, deep, labored
d/t DKA
to blow many CO2
biot
irreg breathing but equal depth then apnea in bet
damage to medulla
ataxic
disorganization c irreg and varying depths
poorest prognosis
basta magulo
damage to medulla oblungata
causes rate and depth to inc
acidosis
CNS lesions - pons
anxiety
ASA
hypoxemia
pain
causes rate and depth to dec
alkalosis
CNS lesion - cerebrum
MG
obesity
dyspnea
SOB
usually pulmonary or cardiac compromise
questions to ask about dyspnea
present when resting
how much walking, level, stairs, speed
do you need to stop walking or climbing
what other activities does it happen
what are the forms of dyspnea
orthopnea
PND
platypnea
trepopnea
orthopnea
SOB when supine; feeling drowned
d/t weaker heart than PND
measured by pillows - 3 pillow orthopnea
paroxysmal nocturnal dyspnea
sudden SOB after a period of recumbency
wakes up 3-5 hrs p then SOB
has strogner heart kaya delayed
platypnea
SOB that inc when upright
ASD: causes R-L shunt kaya deoxygenated mag ffllow = SOB
worsening VQ mismatch
trepopnea
SOB on sidelying
uni lung prob and happens when lying on normal lung
just lie on damaged lung
10 Ps of rapid onset dyspnea
pneumonia
pneumothorax
pulmo constriction/asthma
peanut
pulmonary embolus
pericardial tamponade
pump failure
peak seekers
psychogenic
poisons
discuss cough
sx of respi prob that can be local/general
usually reflexive but can be voluntary
sequence of events in coughing
- deep inspiration and closure of glottis
- contraction of chest, abdominals and pelvic muscles
- air and secretion exhaled
what is sputum
assoc c cough
can be varying amounts and consistency
sputum can help identify diseases
sputum in bacterial infection
yellow, green, rust, clear, purulent, blood streaked
mucoid or viscid
sputum in viral infection
mucoid or viscoid
usually no color but can be blood streaked
sputum in chronic infectious diseases
yellow or any color
abundant in morning
can have streaking or many blood
sputum in carcinoma
slight blood streaking
sputum in infarction
blood clotted
sputum in tuberculous cavity
large amounts of blood
sweet, fruity breath
DKA or starvation ketosis
fish, stale
uremia
renal failure - too much urea, nitrogen and creatinine
ammonia like
uremia din - usually pag matagal di nag dialysis
musty fish, clover
hepatic failure, liver problem
foul, feculent
intestinal obstruction, diverticulum
foul, putrid
nasal/sinus pathology
foreign body na nabulok
cancer
respi infections
halitosis
ulcer sa kung san man
tonsils, gums, or esophagus ganun
GERD, bacteria sa stomach
cinnamon
PTB
significance of tripod pos
tripod = exchange of O2 and CO2 in pulmonary bed
sign of respiratory distress
what are some general impressions that indicates respi distress
tripod pos
cyanotic/pale
low mental status
diff speaking or slow
discuss thoracic contour
no symm - wider than deep
transverse > AP and inc c age
barrel chest is a sign of ___
air trapping
chronic asthma
emphysema
cystic fibrosis
discuss pectus excavatum
sunken chest
asymptomatic unless too deep and compresses lung and heart
discuss pectus carinatum
pigeon chest
does not impact negatively unless assoc c metabolic probs or bony probs
effect of kyphosis
compresses and limits airways
effect of scoliosis
compressive also but progressive
can be detected early to prevent sx
usual causes of unequal chest expansion
collapsed lung
fibrosis, contractures, jt mob prob
extrapleural air
fluid
mass/tumor
what are retractions
suggest obstruction in respi tract
in effort to higop more air = suctioning effect
MD emergency
signs of upper airway obstruction
inspiratory stridor - expi for sever
hoarse cough or barking
alar flaring
retraction of suprasternal notch
cyanosis
signs of supraglottic obstruction
quiter stridor
muffling voice - hot potato mouth
dysphagia
no cough
awkward pos of head/neck - finding air
signs of infraglottic obstruction
louder stridor
hoarse voice
swallowing normal
barking cough, harsh
no factor in head pos
peripheral signs of airway prob
cyanosis
pursing lips
clubbing
alar flaring
discuss vesicular breath sounds
normal, low pitch
most common and over most part of lungs
3:1 - soft and short expi
discuss bronchovesicular breath sounds
N - on main bronchus and upper 3rd of chest
mid range
equal expi and inspi - 1:1
discuss bronchial/tracheal (tubular) breath sounds
N - over trachea
high pitch and hollow
longer expirations
discuss fine crackles breath sounds
high-pitched crackling at end of inspi
not cleared by cough
adventitous
discuss coarse crackles breath sounds
loud, bubbly noise on inspi
not cleared by cough
adventitous
discuss medium crackles breath sounds
lower, moist sound at mid inspi
not cleared by cough
adventitous
discuss wheezes as breath sounds
sibilant, high pitch - inspi but louder on expi
narrower tube
do not start PT if meron
discuss pleural friciton rub
rub hair sound - parenchymal infection
loud on lower lat ant surface
inspi or expi
painful = shallow breathing
what do you usually palpate
thoracic expansion
palpation crepitus
pleural friction rub
tactile fremitus
percussion
discuss thoracic expansion
check for chest expansion c hands on ribs
discuss crepitus
crackly, bubble wrap like when pressing on chest
air in subcuataneous tissue from trauma
discuss pleural friction rub in palp
(+) pleural inflammation
on inspi - grating vibration
discuss tactile fremitus
and 2nd ICS - bifurcation
99, tres tres, mickey mouse
causes inc tactile fremitus
fluid in lungs
tumors
lung compressions/consolidations
bronchial secretions
causes dec tactile fremitus
excess air in lungs
emphysema
pleural thickening/effusion
massive pulmonary edema
bronchial obstruction
discuss percussion over chest
dull - more solid
resonant - airy
more vibrations on solid over air
