Pulmonary Exam & Assessment Flashcards by Demond Fleming

during a chart review, what are you looking for under:
- orders

new O2 needs, changing O2 needs
look at O2 goals

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during a chart review, what are you looking for under:
- teams involved in care

primary vs consulted
is pulmonology consulted? do they need to be?

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during a chart review, what are you looking for under:
- vital signs and labs

trends during hospital stay

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during a chart review, what are you looking for under:
- imaging

urgent/emergent vs. routine imaging
** be aware of imaging ordered “stat”

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during a chart review, what are you looking for under:
- surgeries

how long were they requiring mech. ventilator –> their pulmonary status may not support high intensity exercise right away

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during a chart review, what are you looking for under:
- nursing mobility

OOB to chair/bathroom?
any ambulation
changes in bed position, turning schedule

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during a chart review, what are you looking for under:
- insurance coverage

qualification for rehab placement, post acute PT services
O2 needs –> pulmonary rehab

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during a chart review, what are you looking for under:
- oxygen delivery

do they use certain devices for sleep and different device when awake?
communication with respiratory therapy on status, options, etc.

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what do you want to know about the patient’s prior level of function?
– _____ set up
– baseline functional mobility/ADLs
– baseline activity tolerance
– use of assistive device
– use of O2
– Falls
– types of pulmonary symptoms

– home
– limited by activity tolerance/pulmonary symptoms, something else?
– tasks they can complete, shortness of breath vs. fatigue with activities
– specific situations requiring AD, how is device used with O2 simultaneously
– type, amount, frequency. portable O2 or stationary concentrator. are they compliant?
– tripping over O2 devices?
– can we make suggestions on energy conservation/activity pacing?

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portable oxygen =
stationary concentrator =

– bring with you. like a bag or portable tank. doesn’t last long. patients that only need a little bit of O2
– device that stays at home with a long cord –> be careful of tripping over the cord

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what are things to observe about a patient’s posture?

tripoding –> anchoring of UE to help breathing mechanics
kyphosis/scoliosis/rounded shoulders
supine vs. sitting
hyperinflation signs (ex. clavicles near ears)
body habitus

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what are things to observe about a patient’s musculoskeletal appearance?

accessory muscle use
muscle wasting
cachexia (weight loss)

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what are signs of hypoxemia/hypoxia to be aware of in your patients?

cyanosis or grayed appearance
pallor, mottling
AMS
tachycardia
dyspnea

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what should you observe about your patient’s breathing patterns?

rate, rhythm, effort
cough assessment
sounds
at rest vs. during conversation vs during activity
mouth open vs mouth closed

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what are different types of coughs?

– productive/wet –> clear/discolored secretions can differentiate between pathology or infection
– non-productive/dry
– hemoptysis
– barking or whooping

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frothy/foamy secretions indicate:

pulmonary edema
HF

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what are we looking for during a cough assessment?

strength –> more productive with abdominal splinting?
effectiveness –> does coughing change symptoms?
duration vs. frequency
secretion management –> risk for aspiration

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what is the interpretation/diagnosis of cough types:
– productive
– non productive

– bacterial PNA, obstructive disease
– viral PNA, IPF, smoking

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what is the interpretation/diagnosis of cough types:
– purulent
– blood-tinged
– blood-predominant

– bronchiectasis, chronic bronchitis, fungal PNA
– TB, cancer, early fibrosis
– alveolar hemorrhage, PE, UGIB

what is the interpretation/diagnosis of cough types:
– brassy
– frothy
– violent
– barking/whooping

– aortic aneurysm
– HF, pulmonary edema
– foreign body aspiration, choking
– pertussis (whooping cough)

what structures do we want to palpate in our pulmonary patients?

muscles of ventilation
chest wall mobility
thoracic cavity mechanics
tactile fremitus

what does mediate percussion evaluate?

lung density and diaphragmatic excursion

what 3 types of sounds can be produced with mediate percussion?

normal
dull = “thud” or dense resonance felt over area of fluid consolidation or non-aerated tissue
tympanic = loud, hollow resonance felt over area of hyperinflation

what is the technique used to perform mediate percussion?

middle finger of non-dominant hand placed flat on the chest wall in the IC space
middle finger of dominant hand strikes the finger on the chest wall in rapid succession

_____ on stethoscope is best for hearing normal sounds _____ on stethoscope is best for hearing abnormal sounds

diaphragm bell

when performing lung auscultations, it is performed over ____

entire lung space in systematic manner, anteriorly then posteriorly

during lung auscultation, at least on breath should be auscultated in _______

each bronchopulmonary segment

how are normal sounds created in the airways?

by the turbulence of airflow in airways

what patient position is easiest to hear lung sounds?

sitting

** slide 22 ** respiratory auscultation pattern, anterior and posterior -- what is one benefit of this pattern?

compares similar segments from one another by switching back and forth between R and L sides

true or false. there is ONE correct way to perform lung auscultations.

false - no right or wrong way - just make sure you're consistent -- you need to be able to compare anatomically sounds from R vs. L

Normal Breath sounds: bronchial: -- heard over _____ -- __(louder/softer)__, __(higher/lower)___ pitched than vesicular -- __(louder/softer)___ during exhalation, but still heard at _____ of inhalation

-- tracheobronchial tree -- louder, higher -- louder ; end

normal breath sounds: bronchiovesicular: -- heard over ____ -- __(louder/softer)___ version of bronchial -- heard _____ during inhalation and exhalation

-- mainstem and segmental bronchi OR between shoulder blades -- softer -- equally

normal breath sounds: vesicular: -- heard through _____ -- __(loud/soft)___, __(higher/lower)___ pitched -- ___(louder/softer)___ during inhalation, but still heard at _______ of exhalation

-- all lung fields -- soft, lower -- louder ; beginning

abnormal breath sounds aka adventitious lung sounds: -- increased tissue density _____ sound transmission

increases -- water carries sound better than air

abnormal breath sounds: identify and give example of pathology for each: -- consolidative pathology creates _______ sounds -- areas of hyperinflation create ______ sounds -- areas without air movement at all create _____ sound

-- stronger/louder --> pneumonia, tumors -- weaker/softer --> emphysema -- no --> pneumothorax, obstructive atelectasis

abnormal breath sounds while auscultating: whispered pectoriloquy: -- whispered words (usually counting) are heard _____ in the presence of fluid consolidation -- what is normal?

-- loudly -- wouldn't be heard at all

abnormal breath sounds while auscultating: bronchophony: -- normal volume words/numbers are heard _____ in the presence of fluid consolidation -- what is normal?

-- louder than normal -- would be heard at normal volume

abnormal breath sounds while auscultating: egophony: -- high-pitched, _____ sounds transmitted through areas of fluid consolidation -- EEE sounds like _____ -- what is normal?

-- nasal -- AAA -- EEE sounds like EEE

abnormal breath sounds can be categorized into ____ or _____ sounds

continuous or discontinuous

abnormal breath sounds: wheezes: -- ______ sound -- more common to hear during _____ from ____ -- wheezing with ______ indicates a more severe airway obstruction -- must differentiate between ___ and _____ wheeze to differentiate pathology -- example:

-- continuous, musical -- exhalation from airway obstruction -- inhalation -- expiratory or inspiratory -- asthma

abnormal breath sounds: rhonchi: -- _____ sound -- heard during ___ -- caused by ____

-- continuous, lower pitch than wheezing -- inhalation and exhalation -- copious airway secretions

abnormal breath sounds: stridor: -- ____ sound -- ____ intensity than wheezing -- ____ upper airway obstruction -- can be caused by:

-- continuous, high-pitched -- higher -- severe --> medical emergency! -- edema, anaphylactic allergic reaction, tumor burden, bleeding, choking, recent extubation

abnormal breath sounds: crackles (Rales): -- ______ sound -- sounds like: -- most common during _____ as a result from sudden opening of closed airways -- causes:

-- discontinuous -- brief bursts of popping bubbles, velcro ripping apart, wood burning -- inhalation -- bronchitis, atelectasis, pulmonary edema, fibrosis

abnormal breath sounds: pleural rub: -- ______ sound -- sounds like: -- indicates: -- heard best at _____ -- usually accompanied by ____

-- continuous or discontinuous -- pieces of leather or sandpaper rubbing together -- inflammation of pleura -- lower lateral chest wall -- pain

what is the PT role with breath sounds?

we are not diagnosing! However, knowledge of different breath sounds can guide our interventions to assist in improving abnormal breath sounds

how can we bridge the gap between baseline and current baseline?

activity pacing, energy conservation, compensatory strategies, AD use