Pulmonary Exam and Assessment Flashcards
Classic cardiac symptoms:
chest pain, tightness, pressure, shortness of breath, palpitations, indigestion, burning
Classic pulmonary symptoms:
shortness of breath, dyspnea, wheezing, cough, increased work of breathing, sputum
Risk factors for heart disease
HTN, smoking, elevated cholesterol, family history, stress, sedentary lifestyle, older age, obesity, diabetes
Semi-Fowler’s position:
HOB raised to 45 degrees
Professorial position:
sitting, trunk flexed forward with arms on knees
stabilizes thorax and arms to increase effectiveness of accessory muscles during breathing
Abnormal rib angle:
greater than 90 degrees and attaching to the vertebrae with angles greater than 45 degrees in the hyperinflated chest. Also note that the position of the diaphragm is flattened
Respiratory rate greater than 25 may indicate:
Pulmonary dysfunction
Metabolic acidosis
Systemic stress
Respiratory rate less than 10 indicates:
CNS abnormality or metabolic alkalosis
Normal inspiratory to expiratory ration (I/E):
1:2
Obstructive disease inspiratory to expiratory ration (I/E):
1:3 or 1:4
Tachypnea inspiratory to expiratory ration:
1:1
What causes I/E ration to decrease?
respiratory distress
RR birth to 1 year:
30-60
RR 1-3 years
24-40
RR 3-6 years
22-34
RR 6-12 years
18-30
RR 12-18 years
12-16
RR 18+ years
12-20
S/s of hypoxemia
Confusion Changes in skin color –blue to red Cough Tachycardia Tachypnea SOB Diaphoresis Wheezing
S/s of hypercapnia
Flushed/red skin coloring Tachycardia HTN or hypotension Diaphoresis Decreased mental status, confusion, drowsiness, coma Headache Muscular twitching, myoclonic jerking Papilledema if chronic
Normal diaphragmatic excurison:
3-5 cm
Normal breath sounds:
vesicular – soft, low=pitched sounds heard primarily during inspiration
soft rustling sound
heard throughout all of inspiration and the beginning of expiration
Bronchovesicuar
normal” – heard over junction of the mainstem bronchi with the segmental bronchi
Bronchial breath sounds (tubular sounds)
loud high-pitched sounds
A more hollow, echoing sound normally found only over the right superior anterior thorax
Corresponds to an area over the right main stem bronchus
All of the inspiration and most of expiration heard with bronchial breath sounds
Graded Exercise Test Termination Criteria
Maximal shortness of breath
A fall in PaO2 of greater than 20 mm Hg or a PaO2 less than 55 mm Hg
A rise in PaCO2 of greater than 10 mm Hg or PaCo2 greater than 65 mm Hg
Cardiac ischemia or arrhythmia
Symptoms of fatigue
Increase in diastolic BP readings of 20 mmHg, systolic HTN greater than 250 mmHg, decrease in BP with increasing workloads
Leg Pain
Total Fatigue
Signs of insufficient cardiac output
Reaching a ventilator maximum
Decreased breath sounds heard with:
hyperinflation in chronic obstructive disease
hypoinflation in acute lung disease (pneumothorax, pleural effusion)
Absent breath sounds heard with:
pleural effusion
pneumothorax
sever hyperinflation
obesity
Bronchial breath sounds heard with:
consolidation
atelectasis with adjacent patent airway
Crackles heard with:
secretions if biphasic
deflation if monophasic
Wheezes heard with:
diffuse airway obstruction, if polyphonic
localized stenosis, if monophasic
Sympathomimetic
stimulate adrenergic receptors = bronchodilation
Adrenergic agonists
stimulate adrenergic receptors = bronchodilation
Sympatholytic
inhibits adrenergic receptors = bronchoconstriction
Adrenergic antagonists
inhibits adrenergic receptors = bronchoconstricion
Parasympathomimetics
stimulate cholinergic receptors = bronchoconstricition
Muscarinic agonists
stimulate cholinergic receptors = bronchoconstriction
Parasymatholytics
inhibit cholinergic receptors = bronchodilation
Muscarinic antagonists
inhibit cholinergic receptors = bronchodiallation
