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CardioPulmonary > Practical 2 > Flashcards

Practical 2 Flashcards

1
Q

List muscles of inspiration

A

Diaphragm, external intercostals

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2
Q

List accessory muscles of inspiration

A

SCM, Scalenes, Upper Trap, Pec Major, Pec Minor, Serratus Anterior, Rhomboids, Latissimus Dorsi, Serratus Posterior Superior, Thoracic Erector Spinae

-inspiration is always active

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3
Q

List muscles of expiration

A

Abdominal Muscles, Internal Intercostals (forced expiration)

-normally passive from elastic recoil of lung and relaxation of inspiration musculature, unless it is forced

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4
Q

Define respiration

A

Respiration – Gas Exchange – occurs at the alveolar-capillary interface, replenishing the blood’s oxygen supply and removing carbon dioxide. (Perfusion)

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5
Q

Define ventilation

A

Ventilation - Breathing – the mechanical movement of gases into and out of the lungs

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6
Q

List chart review points

A
  • Primary and secondary diagnoses
  • Vital signs history: BP, HR, RR, temp, SpO2, telemetry if indicated
  • Medications
  • Reports: CXR, ABG’s, PFT’s, smoking history, environmental exposure, nutritional status, psychological history
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7
Q

List general observation

A

general appearance, positioning (professorial posturing), equipment/lines in place, facial characteristic (nasal flaring, pursed lip breathing), appearance of extremities (digital clubbing, signs of decreased peripheral circulation)

Observe bony landmarks, sternum, ribs, clavicles and scapula and note any deviations.

Compare AP and transverse diameter of chest by observation (AP diameter is ½ transverse diameter)

Hyperinflation of chest - COPD

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8
Q

AP diameter of chest is normally ____ compared to transverse diameter?

A

AP is 1/2 diameter of transverse

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9
Q

What could it mean if the chest’s AP diameter is equal to the transverse diameter?

A

Hyperinflated
Barrel-like = COPD
Diaphragm is flatter and less effective

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10
Q

Normal rib angle expectations?

A

(assessed in sidelying)

norm = less than 90 degrees; attached to t-process of vertebra at 45 deg. angle

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11
Q

Rib angle expectations for COPD/Hyperinflation?

A

the rib angles will be >90 degrees and ribs will attach to the vertebrae at >45 degrees

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12
Q

State effect of hyperinflated chest on diaphragm function

A
  • Hyperinflation results in rib angles greater than 90 degrees and attachments to vertebrae greater than 45 degrees, changing diaphragm effectiveness
  • Hyperinflated chest leads to greater air in abdominal cavity that flattens the diaphragm and makes it less effective
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13
Q

Conditions in which chest expansion may be diminished.

A

COPD, pulmonary fibrosis

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14
Q

Conditions in which chest expansion may be asymmetrical.

A

Neurological impairments, or in post-surgical patients, and rib/hip fractures with splinting due to pain.

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15
Q

4 phases of coughing

A
  1. Inspiration,
  2. Hold/closure of glottis,
  3. Force from contraction of abdominal and intercoastal mm,
  4. Expulsion/effectiveness
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16
Q

4 things to look for with sputum assessments.

A

Volume, color, odor and consistency

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17
Q

Describe procedure for auscultating lungs.

A

Sit the pt upright in sitting

Auscultate of the entire lung space (spaces designated on diagram - make sure there is at least one breath in between each bronchopulmonary segment

Progress cranial to caudal

Compare intensity, pitch and quality between R and L

Be systematic – from anterior to posterior

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18
Q

List 4 normal breath sounds

A
  1. Tracheal
  2. Bronchial
  3. Bronchiovesicular
  4. Vesicular
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19
Q

Where would you find a tracheal breath sound and what would it sound like?

A

over trachea (not routine) - loud, high pitched and hollow

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20
Q

Where would you find a bronchial breath sound and what would it sound like?

A

just lateral to manubrium over mainstem bronchi - tubular, loud, high pitched, pause between insp and exp

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21
Q

Where would you find a bronchiovesicular breath sound and what would it sound like?

A

junction of the mainstream bronchi with segmental bronchi; between 1st and 2nd intercostal space, posteriorly between scapulae - similar to bronchial but softer and with no pause between insp and exp

22
Q

Where would you find a vesicular breath sound and what would it sound like?

A

throughout lung parenchyma - soft, low-ptiched, no break between insp and exp sounds, heard primarily during insp

23
Q

List 3 adventitious lung sounds?

A
  1. Wheezing
  2. Crackles
  3. Pleural rub
24
Q

Describe wheezing

A

most frequently heard on expiration, associated with airway obstruction- if on inspiration indicates more severe airway obstruction. Is specifically either high pitched or low-pitched. If continued sound in someone with airway obstruction is called stridor

25
Q

Describe crackles

A

common heard during inspiration may mean restrictive or obstructive respiratory disorder, could be from sudden opening of closed airways or due to movement of secretions. Discontinuous sounds, sound like brief bursts of popping bubbles

26
Q

Describe pleural rub

A

sounds like 2 pieces of leather or sandpaper rubbing together, occurs with insp and exp. Can indicate pleural inflammation.

27
Q

Describe egophony

A

patient is asked to say “E” and the sound is auscultated as “A” over consolidated areas.

28
Q

Describe bronchophony

A

patient is asked to say “99”. Over healthy lung it is not understandable. Over consolidated areas it is auscultated clearly.

29
Q

Describe whispering petroliloguy

A

patient is asked to whisper and whispered words are heard distinctly through the stethoscope. Over healthy lung, whispering is unintelligible.

30
Q

An increase in lung tissue density (consolidation) may cause ____ sound transmission.

A

increased

31
Q

A decrease in lung tissue density (emphysema) can cause ____ sound transmission.

A

decreased

32
Q

Give instructions for splinted coughing.

A

Hold a pillow or folded towel over surgical incision and push on your incision when coughing

33
Q

State when splinted cough may be indicated

A

Post-operatively with sternotomy, thoracotomy and abdominal surgical incisions. Reduces pain and improves cough.

34
Q

Instruct in diaphragmatic breathing

A

Start in supine position with posterior pelvic tilt

Can position pt.’s hands on their abdomen for feedback

Ask pt. To “sniff” to move diaphragm. Try 3 sniffs, then exhale. String together sniffs, then try one long sniff.

Can progress using above techniques in sitting, standing, walking, functional activities

35
Q

What muscles do COPD patients use and why might diaphragmatic breathing not work with them?

A

They use accessory muscles b/c that is all they have. Diaphragm is flattened and inefficient so may not work well enough.

36
Q

Describe postural drainage

A

Positioning the body to allow gravity to assist with draining secretions from each of the lung segments

37
Q

List precautions for postural drainage.

A

pulmonary edema, hemoptysis, massive obesity, large pleural effusion, massive ascites (fluid build-up)

38
Q

List contraindications for postural drainage.

A

Increased intracranial pressure, hemodynamically unstable, recent esophageal anastomosis, spinal fusion or injury, recent head trauma, diaphragmatic hernia, recent eye surgery (prone position)

39
Q

List precautions for percussion or vibration.

A

uncontrolled broncospasm, osteoporosis, rib fractures, metastatic cancer to ribs, tumor obstruction of airway, anxiety, coagulopathy, convulsive or seizure disorder, recent pacemaker placement

40
Q

List contraindications for percussion or vibration.

A

Hemoptysis, untreated tension pnuemotnorax, platelet amount less than 20,000 / mm3, hemodynamically unstable, open wound burns in thoracic area, pulmonary embolism, subcutaneous emphysema, recent skin grafts on flaps of thorax

41
Q

Best position for patient with intercostal weakness.

A

Supine

42
Q

Best position for patient with kyphosis

A

Supine

43
Q

Best position for patient with limited diaphragmatic excursion

A

Supine

44
Q

Best position for patient with R lower lobe pneumonia

A

S/L

45
Q

Best position for patient with partial R paralysis (extremities and trunk).

A

S/L

46
Q

Best position for patient with weak spinal extensors

A

Sitting

47
Q

Best position for patient with COPD, significant accessory muscle use, rapid RR….and why?

A

Supine - puts the patient in a gravity eliminated position for both the diaphragm and accessory muscles for gas exchange

48
Q

Best position for patient with CVA, left sided weakness and tightness and limited L lateral costal expansion…and why?

A

L S/L - to allow the patient to let the R side expand for easier respiration
* R S/L - for intervention

49
Q

Best position for patient s/p CABG (3 months) w/limited pec range, upper chest tightness

A

Sitting - to encourage more diaphragmatic breathing so gravity can facilitate the muscle

OR Supine - gravity eliminated for upper accessory muscles and for diaphragm

50
Q

Best position for pediatric patient with CP, generally limited chest wall mobility

A

SITTING/STANDING - to support breathing in the diaphragm due to limited chest wall excursion

OR SUPINE - gravity eliminated for upper accessory muscles and for diaphragm

51
Q

Best position for patient post-op thoracotomy with poor inspiratory effort, poor cough effort, shallow, upper chest breathing pattern.

A

SITTING/STANDING - to support diaphragmatic breathing and proper swallowing

CardioPulmonary (1 decks)

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