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Cardiopulmonary PT > Pulmonary Assessment > Flashcards

Pulmonary Assessment Flashcards

1
Q

What Pulmonary fx tests show

A
  1. how well the lungs are working
  2. Problems with lung expansion
  3. Overly expanded lungs
  4. Done thru comp analysis
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2
Q

What is the fx of RS

A 
FUNCTION:
Gas exchange
Helps regulate blood pH
Contains receptors for sense of smell, filters inspired air, phonation, excretes
small amount of water and heat.
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3
Q

What is the fx of RS

A 
FUNCTION:
Gas exchange
Helps regulate blood pH
Contains receptors for sense of smell, filters inspired air, phonation, excretes
small amount of water and heat.
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4
Q

Classification according to structure

A

Upper
nose-> larynx
Lower
Larynx -> alveoli

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5
Q

Classification according to fx

A
  1. Conducting zone
    passageway of air
  2. Respiratory
    gas exchange
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6
Q

Purpose of examination

A

Determine:

  1. Adequate Ventilatory Pump, O2 Uptake, CO2
  2. Impairments and Functional Limitations
  3. Elimination to meet the O2 Demands at Rest and during Activities
  4. Patient’s suitability
  5. Develop intervention plan
  6. Establish Baseline to Measure
  7. Effectiveness and Progress
  8. Discontinue or Home Program
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7
Q

Components of Examination

A
  1. History & Systems Review
  2. Observation
    1. Analysis of Chest Shape and Dimensions
    2. Posture/ Preferred Positioning
    3. Breathing Pattern
    4. Other Findings
  3. Inspection and Palpation
    1. Breathing Pattern Assessment
    2. Chest Mobility
    3. Palpation: Fremitus, Chest Pain, Mediastinal Shift, Percussion
  4. Auscultation of breath sounds
  5. Cough & cough production
  6. Other tests and measures
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8
Q

There are Five Main Symptoms of Respiratory Disease:

A
  1. Cough
  2. Sputum & hemoptysis
  3. Dyspnea
  4. Wheezes
  5. Chest pain
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9
Q

Where does Pulmonary Pain Pattern usually localized in ?

A

substernal or chest region over the involved lung field

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10
Q

Pulmonary Pain Pattern radiates to

A

neck, upper trapezius, coastal margins, thoracic back, scapulae, or shoulders

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11
Q

Pulmonary Pain Pattern Usually increase with _____

A

inspiratory movements, such as laughing, coughing, or sneezing

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12
Q

Pulmonary Pain Pattern :

neck and anterior chest

A

Tracheobronchial Pain

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13
Q
  1. sharp, localized pain during respiratory movements

2. alleviated when lying on the side (AUTOSPLINTING)

A

Pleural Pain

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14
Q

Type of Diaphragmatic Pain: Peripheral

A
  1. Felt along coastal margin

2. Can be referred to lumbar region

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15
Q

Type of Diaphragmatic Pain: Central

A
  1. Felt along coastal margin.

2. Can be referred to upper trapz and ipsilateral shoulder

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16
Q

How to analyze the SYMMETRY OF THE CHEST & TRUNK

A
  • Observe Anteriorly, Posteriorly, and Laterally

- Thoracic cage should be Symmetrical

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17
Q

How to analyze the MOBILITY OF THE TRUNK

A
  • Check Active Movements in all directions
  • Identify restricted spinal
    motions, thoracic spine
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18
Q

How to analyze the SHAPE & DIMENSIONS OF THE CHEST

A
  • The AnteroPosterior (AP) and Lateral dimensions

- 1:2

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19
Q

What is deformity is

  • Circumference: Upper chest > Lower chest
  • Sternum prominent
  • AP diameter > Normal
  • Pt with COPD who are Upper
  • Chest Breathers
A

BARREL CHEST

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20
Q

What is deformity is

  • Depressed lower part of the Sternum
  • Lower Ribs flare out
  • Diaphragmatic breathers
    • excessive abdominal protrusion
    • little upper chest movement
A

PECTUS EXCAVATUM (Funnel breast)

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21
Q

What is deformity is Sternum is prominent

and protrudes anteriorly

A

PECTUS CARINATUM (Pigeon chest)

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22
Q

Body posture of a person in short of breathe

A
  • Difficulty breathing
  • leans forward on hands or forearm
  • Stabilize & Elevate the Shoulder girdle
  • Accessory muscles
  • Pectoralis & Serratus Anterior muscles
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23
Q

Posture/Preferred Position (Sleeping)

A
  • Head-up → Recumbent

- Horizontal position = SOB

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24
Q

Diaphragmatic breathing is also known as___

A

Belly Breath

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25
Q

Breathing patterns of Diaphragmatic breathing

A

Diaphragm fiber contracts
Central Tendon is lowered
Central Tendon is mobile
Ribs are stabilized

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26
Q

Breathing patterns of Upper Chest Breathing

A

Central Tendon is stabilized
Diaphragm fiber contracts
Ribs are lifted
Ribs are mobile

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27
Q

How to assess breathing pattern

A

Assess the rate, regularity, and location of ventilation (at rest & with activity)

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28
Q

What is the N RR of Adult

A

12-20 cpm

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29
Q

What is the N RR of child

A

20-40 cpm

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30
Q

What is the N RR of Infant

A

40-60 cpm

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31
Q

What is the N ratio of inspiration-expiration at rest

A

1:2 (at Rest)

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32
Q

What is the N ratio of inspiration-expiration with activity

A

1:1 (with Activity)

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33
Q

ratio of inspiration-expiration of COPD

A

1:4 (at rest, difficulty with expiration)

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34
Q

D. Other Findings of Breathing problems

A
  • Jugular Vein Distention
  • SCM Prominence
  • Peripheral edema
  • Cyanosis
  • Digital Clubbing
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35
Q

(N) Sequence of Inspiration

A

(1) Diaphragm contracts & descends; abdomen (epigastric area) rises
(2) Lateral costal expansion as the ribs move up & out;
(3) Upper chest rises

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36
Q

To assess the Breathing sequence:

A
  1. Pt assume a comfortable position (semireclining or supine)
  2. Place your hands on the Pt’s
    epigastric region & sternum
  3. Observe movements in these two areas
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37
Q

How to assess SYMMETRY OF CHEST MOVEMENT

A
  1. Place your hands on the Pt’s chest
  2. Assess the excursion of each side of the thorax
  3. During inspiration and expiration
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38
Q

How to assess Upper lobe expansion:

A
  1. Face the Pt
  2. Place the tips of your thumbs at the midsternal line at the sternal notch
  3. Extend your fingers above the clavicles
  4. Ask Pt to fully exhale & then inhale deeply
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39
Q

How to assess Middle Lobe Expansion:

A
  1. Face the Pt
  2. Place the tips of your thumbs at the xiphoid process
  3. Extend your fingers laterally around the ribs\
  4. Ask Pt to breathe in deeply
40
Q

How to assess Lower lobe Expansion

A
  1. Place the tips of your thumbs along the pt.’s back at the SP (lower thoracic level)
  2. Extend your fingers around the ribs
  3. Ask the Pt to breathe in deeply
41
Q

Measure EXTENT OF EXCURSION Method 1

A
  • Measure the girth of the chest with a tape measure
    - At three levels (axilla, xiphoid, lower costal)
    - document change in girth after a max. inspiration & a max. expiration
42
Q

Measure EXTENT OF EXCURSION Method 2

A
  • Place both hands on the patient’s chest or back as previously described
    - Note the distance between your thumbs after a max. inspiration
43
Q

Palpation where vibration felt while palpating over the chest wall as a Pt speaks

A

TACTILE (VOCAL) FREMITUS

44
Q

Procedure for TACTILE (VOCAL) FREMITUS

A
  1. Place the palms of your hands lightly on the chest wall

2. Ask the Pt to repeat “99” several times

45
Q

↑ Fremitus: TACTILE (VOCAL) FREMITUS

A

presence of secretions in the airways

46
Q

↓ or Absent: TACTILE (VOCAL) FREMITUS

A

air is trapped due to obstructed airways

47
Q

Procedure: Palpation for CHEST WALL PAIN

A

Procedure:

  1. Firmly press against the chest wall with your hands to identify any specific areas of pain potentially of MSK origin
  2. Ask the Pt. to take a deep breath
  3. Identify any painful areas of the chest wall
48
Q

Location of pulmonary origin for chest wall pain:

A
  • localized to a region of the chest or neck region
49
Q

Chest wall pain of MSK origin can be felt when :

A
  • often increases with direct point pressure during palpation and during a deep inspiration
50
Q

MEDIASTINAL SHIFT is normal if

A

Trachea is oriented centrally in relation to the suprasternal notch symmetry of the mediastinum

51
Q

MEDIASTINAL SHIFT

Trachea shifts due to:

A

Intrathoracic Pressure

Lung volumes

52
Q

Mediastinal Shift

Atelectasis

A

Ipsilateral ✔

Contralateral ✘

53
Q

Mediastinal Shift

Pneumonectomy

A

Ipsilateral ✔

Contralateral ✘

54
Q

Mediastinal Shift

Lobectomy

A

Ipsilateral ✔

Contralateral ✘

55
Q

Mediastinal Shift

Edema

A

Ipsilateral ✘

Contralateral ✔

56
Q

Mediastinal Shift

Hemothorax/ Pneumothorax

A

Ipsilateral ✘

Contralateral ✔

57
Q

Mediastinal Shift

Abdominal Hernia

A

Ipsilateral ✘

Contralateral ✔

58
Q

Purpose of mediate percussion

A
  • Assess lung density:

- air-to-solid ratio in the lungs

59
Q

this maneuver produces a resonance

A

mediate percussion

60
Q

the pitch from mediate percussion varies with the density of the _____

A

underlying tissue

61
Q

Procedure for mediate percussion

A
  1. Place the middle finger of the nondominant hand flat against the chest wall along an intercostal space
  2. with the tip of the middle finger of the opposite hand, firmly tap on the finger positioned on the chest wall
  3. Repeat the procedure at several points on the right & left and anterior and posterior aspects of the chest wall
62
Q

Pitch indicates from percussions

  • (N)/resonant:
A

Air = solid

63
Q

Pitch indicates from percussions

  • Dull and Flat:
A 
Air > Solid
solid matter (tumor, consolidation
64
Q

Pitch indicates from percussions

  • Hyperresonant (tympanic):
A

Air > Solid (emphysema)

65
Q

Refer to Physician after testing mediate percussion when

A
  • (+) asymmetrical
  • Abnormal Findings
  • for additional objective tests
  • (e.g. chest radiograph)
66
Q

process of listening to breath sounds examination of the lungs

A

Auscultation

67
Q

How does breath sounds occurs

A

Breath sounds occur due to movement of air in the airways during inspiration & expiration

68
Q

What does ausculation do?

A
  • Identify the areas where congestion exists

- Determine the airway clearance techniques should be performed and its effectiveness, to continue/discontiue

69
Q

Classification of Breath Sounds

  • Normal
A

-occur in the absence of pathology and heard predominantly during inspiration

70
Q

Classification of Breath Sounds

- Adventitious

A

– abnormal sounds in the lungs that are heard with the stethoscope

71
Q

Classification of Breath Sounds

- Vocal Sounds

A
  • abnormal transmission of vocal sounds may be heard through fluid-filled areas of consolidation, cavitation lesions, or pleural effusions.
72
Q

Auscultation of breath sounds

Procedure:

A
  1. Quiet Setting
  2. Pt in a comfortable, relaxed, sitting position
  3. Allow access to the chest wall
  4. Place the diaphragm of the stethoscope directly along the anterior/posterior chest wall
73
Q

Auscultation of breath sounds

Landmarks

A
  • (T2, T6, T10)
  • Both sides
  • Ask the Pt. to breathe in deeply & out quickly through the mouth
74
Q

What to note when getting the ausculation?

A
  • Note the quality, intensity, and pitch of the breath sounds
75
Q

Trachea bifurcates into its mainstem bronchi at the levels of the:

A
  • sternal angle anteriorly

- T4 spinous process posteriorly

76
Q

Anteriorly

  • Apex of each lung rises about ______of the clavicle.
A

2 cm to 4 cm above the inner third

77
Q
  • Lower border of the lung crosses the ___at the midclavicular line and the ___at the midaxillary line.
A

6th rib and 8th rib

78
Q

Anteriorly, horizontal fissure runs close to the ___and meets the ____in the midaxillary line near the 5th rib.

A

4th rib , oblique fissure

79
Q

Posteriorly

  • Lower border of the lung lies at about the level of the ____
A

T10 spinous process

80
Q

Oblique fissure

  • approximated by a string that runs from the ___ spinous process obliquely down and around the chest to the ___at the ____
A

T3, 6th rib, midclavicular line

81
Q

Abnormal Breath Sounds

- “popping bubbles” or like hair being rubbed

A

Crackles

82
Q

Crackles

- “Wet or coarse”

A

– secretions

83
Q

Crackles

- “Dry or Fine”

A

– atelectasis

84
Q

Abnormal Breath Sounds

high-pitched whistling sound heard during exhalation

A

Wheezes/ Rhonchi

85
Q

Abnormal Breath Sounds

Wheezes/ Rhonchi is due to

A

bronchospasm or narrowing of Airways

86
Q

Abnormal Breath Sounds

Stertor

A
  • Low pitched or “snoring”

- Air is blocked through the upper airways

87
Q

Abnormal Breath Sounds

Stridor

A

Extremely high-pitched wheeze

Significant obstruction MEDICAL EMERGENCY

88
Q

absence of an area of lung tissue

A

ATELECTASIS

89
Q

Abnormal Voice Sound

- Occurs when whispered sounds are heard clearly during auscultation

A

Whispered Pectoriloquy

90
Q

Abnormal Voice Sound
↑ intensity of sound
↑ clarity of sound
“99” “tres tres”

A

Bronchophony

91
Q

Abnormal Voice Sound

- Change in quality of sound
- “ee” to “aa”
- Fluid in air spaces
A

Egophony

92
Q

Assess the Strength, Depth, Length, and Frequency

Effective Cough:

A

Sharp and Deep

93
Q

Assess the Strength, Depth, Length, and Frequency

Pulmonary dysfunction:

A

Cough is weak, shallow, soft, or throaty

94
Q

What is PAROXYSMAL/SPASMODIC:

A

o sudden onset cough or

o sustained cough

95
Q

Which head of the stethoscope is used to detect higher-pitched sounds and is typically used when performing lung auscultation?

A

Diaphragm

Cardiopulmonary PT (5 decks)

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