Pulmonary Assessment Flashcards
1
Q
What Pulmonary fx tests show
A
- how well the lungs are working
- Problems with lung expansion
- Overly expanded lungs
- Done thru comp analysis
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.
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.
4
Q
Classification according to structure
A
Upper
nose-> larynx
Lower
Larynx -> alveoli
5
Q
Classification according to fx
A
- Conducting zone
passageway of air - Respiratory
gas exchange
6
Q
Purpose of examination
A
Determine:
- Adequate Ventilatory Pump, O2 Uptake, CO2
- Impairments and Functional Limitations
- Elimination to meet the O2 Demands at Rest and during Activities
- Patient’s suitability
- Develop intervention plan
- Establish Baseline to Measure
- Effectiveness and Progress
- Discontinue or Home Program
7
Q
Components of Examination
A
- History & Systems Review
- Observation
- Analysis of Chest Shape and Dimensions
- Posture/ Preferred Positioning
- Breathing Pattern
- Other Findings
- Inspection and Palpation
- Breathing Pattern Assessment
- Chest Mobility
- Palpation: Fremitus, Chest Pain, Mediastinal Shift, Percussion
- Auscultation of breath sounds
- Cough & cough production
- Other tests and measures
8
Q
There are Five Main Symptoms of Respiratory Disease:
A
- Cough
- Sputum & hemoptysis
- Dyspnea
- Wheezes
- Chest pain
9
Q
Where does Pulmonary Pain Pattern usually localized in ?
A
substernal or chest region over the involved lung field
10
Q
Pulmonary Pain Pattern radiates to
A
neck, upper trapezius, coastal margins, thoracic back, scapulae, or shoulders
11
Q
Pulmonary Pain Pattern Usually increase with _____
A
inspiratory movements, such as laughing, coughing, or sneezing
12
Q
Pulmonary Pain Pattern :
neck and anterior chest
A
Tracheobronchial Pain
13
Q
- sharp, localized pain during respiratory movements
2. alleviated when lying on the side (AUTOSPLINTING)
A
Pleural Pain
14
Q
Type of Diaphragmatic Pain: Peripheral
A
- Felt along coastal margin
2. Can be referred to lumbar region
15
Q
Type of Diaphragmatic Pain: Central
A
- Felt along coastal margin.
2. Can be referred to upper trapz and ipsilateral shoulder
16
Q
How to analyze the SYMMETRY OF THE CHEST & TRUNK
A
- Observe Anteriorly, Posteriorly, and Laterally
- Thoracic cage should be Symmetrical
17
Q
How to analyze the MOBILITY OF THE TRUNK
A
- Check Active Movements in all directions
- Identify restricted spinal
motions, thoracic spine
18
Q
How to analyze the SHAPE & DIMENSIONS OF THE CHEST
A
- The AnteroPosterior (AP) and Lateral dimensions
- 1:2
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
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)
21
Q
What is deformity is Sternum is prominent
and protrudes anteriorly
A
PECTUS CARINATUM (Pigeon chest)
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
23
Q
Posture/Preferred Position (Sleeping)
A
- Head-up → Recumbent
- Horizontal position = SOB
24
Q
Diaphragmatic breathing is also known as___
A
Belly Breath
25
Breathing patterns of Diaphragmatic breathing
Diaphragm fiber contracts
Central Tendon is lowered
Central Tendon is mobile
Ribs are stabilized
26
Breathing patterns of Upper Chest Breathing
Central Tendon is stabilized
Diaphragm fiber contracts
Ribs are lifted
Ribs are mobile
27
How to assess breathing pattern
Assess the rate, regularity, and location of ventilation (at rest & with activity)
28
What is the N RR of Adult
12-20 cpm
29
What is the N RR of child
20-40 cpm
30
What is the N RR of Infant
40-60 cpm
31
What is the N ratio of inspiration-expiration at rest
1:2 (at Rest)
32
What is the N ratio of inspiration-expiration with activity
1:1 (with Activity)
33
ratio of inspiration-expiration of COPD
1:4 (at rest, difficulty with expiration)
34
D. Other Findings of Breathing problems
- Jugular Vein Distention
- SCM Prominence
- Peripheral edema
- Cyanosis
- Digital Clubbing
35
(N) Sequence of Inspiration
(1) Diaphragm contracts & descends; abdomen (epigastric area) rises
(2) Lateral costal expansion as the ribs move up & out;
(3) Upper chest rises
36
To assess the Breathing sequence:
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
37
How to assess SYMMETRY OF CHEST MOVEMENT
1. Place your hands on the Pt’s chest
2. Assess the excursion of each side of the thorax
3. During inspiration and expiration
38
How to assess Upper lobe expansion:
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
39
How to assess Middle Lobe Expansion:
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
How to assess Lower lobe Expansion
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
Measure EXTENT OF EXCURSION Method 1
- 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
Measure EXTENT OF EXCURSION Method 2
- Place both hands on the patient’s chest or back as previously described
- Note the distance between your thumbs after a max. inspiration
43
Palpation where vibration felt while palpating over the chest wall as a Pt speaks
TACTILE (VOCAL) FREMITUS
44
Procedure for TACTILE (VOCAL) FREMITUS
1. Place the palms of your hands lightly on the chest wall
| 2. Ask the Pt to repeat “99” several times
45
↑ Fremitus: TACTILE (VOCAL) FREMITUS
presence of secretions in the airways
46
↓ or Absent: TACTILE (VOCAL) FREMITUS
air is trapped due to obstructed airways
47
Procedure: Palpation for CHEST WALL PAIN
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
Location of pulmonary origin for chest wall pain:
- localized to a region of the chest or neck region
49
Chest wall pain of MSK origin can be felt when :
- often increases with direct point pressure during palpation and during a deep inspiration
50
MEDIASTINAL SHIFT is normal if
Trachea is oriented centrally in relation to the suprasternal notch symmetry of the mediastinum
51
MEDIASTINAL SHIFT
Trachea shifts due to:
Intrathoracic Pressure
| Lung volumes
52
Mediastinal Shift
Atelectasis
Ipsilateral ✔
Contralateral ✘
53
Mediastinal Shift
Pneumonectomy
Ipsilateral ✔
Contralateral ✘
54
Mediastinal Shift
Lobectomy
Ipsilateral ✔
Contralateral ✘
55
Mediastinal Shift
Edema
Ipsilateral ✘
Contralateral ✔
56
Mediastinal Shift
Hemothorax/ Pneumothorax
Ipsilateral ✘
Contralateral ✔
57
Mediastinal Shift
Abdominal Hernia
Ipsilateral ✘
Contralateral ✔
58
Purpose of mediate percussion
- Assess lung density:
| - air-to-solid ratio in the lungs
59
this maneuver produces a resonance
mediate percussion
60
the pitch from mediate percussion varies with the density of the _____
underlying tissue
61
Procedure for mediate percussion
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
Pitch indicates from percussions
- (N)/resonant:
Air = solid
63
Pitch indicates from percussions
- Dull and Flat:
```
Air > Solid
solid matter (tumor, consolidation
```
64
Pitch indicates from percussions
- Hyperresonant (tympanic):
Air > Solid (emphysema)
65
Refer to Physician after testing mediate percussion when
- (+) asymmetrical
- Abnormal Findings
- for additional objective tests
- (e.g. chest radiograph)
66
process of listening to breath sounds examination of the lungs
Auscultation
67
How does breath sounds occurs
Breath sounds occur due to movement of air in the airways during inspiration & expiration
68
What does ausculation do?
- Identify the areas where congestion exists
| - Determine the airway clearance techniques should be performed and its effectiveness, to continue/discontiue
69
Classification of Breath Sounds
- Normal
-occur in the absence of pathology and heard predominantly during inspiration
70
Classification of Breath Sounds
| - Adventitious
– abnormal sounds in the lungs that are heard with the stethoscope
71
Classification of Breath Sounds
| - Vocal Sounds
- abnormal transmission of vocal sounds may be heard through fluid-filled areas of consolidation, cavitation lesions, or pleural effusions.
72
Auscultation of breath sounds
Procedure:
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
Auscultation of breath sounds
| Landmarks
- (T2, T6, T10)
- Both sides
- Ask the Pt. to breathe in deeply & out quickly through the mouth
74
What to note when getting the ausculation?
- Note the quality, intensity, and pitch of the breath sounds
75
Trachea bifurcates into its mainstem bronchi at the levels of the:
- sternal angle anteriorly
| - T4 spinous process posteriorly
76
Anteriorly
- Apex of each lung rises about ______of the clavicle.
2 cm to 4 cm above the inner third
77
- Lower border of the lung crosses the ___at the midclavicular line and the ___at the midaxillary line.
6th rib and 8th rib
78
Anteriorly, horizontal fissure runs close to the ___and meets the ____in the midaxillary line near the 5th rib.
4th rib , oblique fissure
79
Posteriorly
- Lower border of the lung lies at about the level of the ____
T10 spinous process
80
Oblique fissure
- approximated by a string that runs from the ___ spinous process obliquely down and around the chest to the ___at the ____
T3, 6th rib, midclavicular line
81
Abnormal Breath Sounds
| - “popping bubbles” or like hair being rubbed
Crackles
82
Crackles
| - “Wet or coarse”
– secretions
83
Crackles
| - “Dry or Fine”
– atelectasis
84
Abnormal Breath Sounds
| high-pitched whistling sound heard during exhalation
Wheezes/ Rhonchi
85
Abnormal Breath Sounds
| Wheezes/ Rhonchi is due to
bronchospasm or narrowing of Airways
86
Abnormal Breath Sounds
| Stertor
- Low pitched or “snoring”
| - Air is blocked through the upper airways
87
Abnormal Breath Sounds
| Stridor
Extremely high-pitched wheeze
| Significant obstruction MEDICAL EMERGENCY
88
absence of an area of lung tissue
ATELECTASIS
89
Abnormal Voice Sound
| - Occurs when whispered sounds are heard clearly during auscultation
Whispered Pectoriloquy
90
Abnormal Voice Sound
↑ intensity of sound
↑ clarity of sound
“99” “tres tres”
Bronchophony
91
Abnormal Voice Sound
- Change in quality of sound
- “ee” to “aa”
- Fluid in air spaces
Egophony
92
Assess the Strength, Depth, Length, and Frequency
Effective Cough:
Sharp and Deep
93
Assess the Strength, Depth, Length, and Frequency
Pulmonary dysfunction:
Cough is weak, shallow, soft, or throaty
94
What is PAROXYSMAL/SPASMODIC:
o sudden onset cough or
| o sustained cough
95
Which head of the stethoscope is used to detect higher-pitched sounds and is typically used when performing lung auscultation?
Diaphragm
