Respiratory Flashcards
what are the components of a respiratory history?
introduction consent PC Hx PC; cough; acute/chronic, character, timing sputum; colour, volume, blood stained dyspnoea; grade I-IV chest pain; pleuritic wheeze; timing haemoptysis; colour, volume PMHx; asthma, bronchitis, chest surgery, TB, pneumonia DHx FHx; asthma, cystic fibrosis, TB SHx systematic questioning summary
what does large volumes of purulent sputum indicate?
bronchiectasis
what does purulent sputum indicate?
infection
what does rusty sputum indicate?
pneumonia
what does pink frothy sputum indicate?
pulmonary oedema
what does mucoid sputum indicate?
COPD
what are the general components of a respiratory examination?
introduction
consent
equipment; examination couch, stethoscope, alcohol wipes
infection control; wash hands and clean stethoscope
position and exposure; chest exposed, semi-supine position (45 degree angle) or sitting on the end of the bed
what are the inspection components of a respiratory examination?
general inspection; oxygen, nebuliser, distressed, external muscles of respiration, pursed lips, cachexic
level of consciousness
audible noises; breathless, wheeze, stridor, hoarse
hands; finger clubbing, nicotine staining, peripheral cyanosis, small muscle wasting, fine tremor, coarse flapping tremor
respiratory and pulse rate
chest wall; inspection, movement, scars, deformities
face; central cyanosis
what are the palpation components of a respiratory examination?
position of trachea
cervical lymphadenopathy
apex beat; location, character
chest expansion; anterior, posterior, lateral
what are the percussion components of a respiratory examination?
supraclavicular, anterior, axillary, posterior aspects of the chest
compare sides
percussion note; resonant, dull, stony dull, hyper-resonant
what are the auscultation components of a respiratory exam?
diaphragm; supraclavicular, anterior, axillary, posterior chest
compare sides
intensity of air entry, breath sounds, added sounds
vocal resonance; say 99, increased over solid areas of ling with open airways (consolidation), decreased by pleural fluid
what are the causes of finger clubbing?
bronchiectasis lung cancer empyema lung abscess pulmonary fibrosis cystic fibrosis cyanotic congenital heart disease liver cirrhosis IBD coeliac disease
what is the cause of wasting of the small muscles of the hand?
compression of the brachial plexus by peripheral lung tumours
what are the signs of CO2 retention?
increased pulse volume
flapping tremor; late sign
what are the causes of tracheal deviation?
towards the lesion; upper lobe/lung collapse, fibrosis, pneumonectomy
away from the lesion; tension pneumothorax, massive pleural effusion
describe the different percussion notes
resonant; normal
dull; solid structure (liver, consolidated lung)
stony dull; fluid filled (pleural effusion)
hyper-resonant; hollow structures (pneumothorax)
describe bronchial breath sounds
higher frequency
heard in solid lung tissue; consolidation, fibrosis
describe wheeze
polyphonic wheeze in expiration; asthma, COPD
focal monophonic wheeze; localised area of large airway narrowing caused by foreign body or tumour
describe crackles
early inspiratory crackles; chronic bronchitis, emphysema
late inspiratory crackles; base of lung, fibrosing alveolitis, pulmonary oedema
what are the components of peak flow?
attach mouth piece
ensure peak flow is set to 0
ask patient to stand and hold meter horizontal
take a deep breath in and make a tight seal with their lips around the mouth piece
blow out as hard and as fast as they can; a fast blast is better than a slow blow
note the number where the sliding pointer has stopped on the scale
repeat x 3
record highest value in L/min
describe the different types of inhaler
reliever; salbutamol
preventer; beclamethasone
SMART; Symbicort, both reliever and preventer
advise them to wash out their mouth after each use; oral candidiasis, side effects if contain steroids
what things should you advise a patient to do before they use their inhaler?
device test; if it hasn’t been used for >5 days, remove the cap, shake the inhaler, release a puff into the air
check the dose counter if present
check the expiry date
describe the procedure of using an inhaler
hold upright
remove the cap and inspect
shake well
sit/stand upright and tilt chin up slightly
breathe out gently and slowly away from the inhaler
put your lips around the mouthpiece, creating a tight seal
breathe in slowly and press the canister once
continue to breath in slowly until lungs feel full
remove inhaler and seal your lips
hold your breath for 10 seconds
breath out gently
replace the cap
rinse mouth with water
second puff; wait 30 seconds and repeat
assess the patients technique
describe the procedure of using a spacer
prepare the inhaler as previous
attach the inhaler mouthpiece to the spacer
breathe out gently and slowly away from the spacer until your lungs feel empty
place your lips around the spacer to create a tight seal
release one dose of the inhaler into the spacer device
breathe deeply, in and out, through the spacer mouthpiece
administer a second dose if required
what are the care instructions required for spacers?
washed with detergent/washing up liquid 1x month and left to air dry
never wiped dry; static causes drug particles to stick
replaced 1x year
describe nasal cannula
24-30%
comfortable
non-acute ward use, if mildly hypoxic
describe Hudson mask
30-40%
step up from nasal cannula
describe venturi mask
often used in COPD blue; 2-4L/min white; 4-6L/min yellow; 8-10L/min red; 10-12L/min green; 12-15L/min
describe non-rebreather mask
85-90% with 15L flow rate
bag with valves stopping almost all rebreathing
acutely unwell patients
describe non-invasive ventilation (CPAP/BiPAP)
continuous positive airway pressure; keeps airways open in sleep apnoea or heart failure
bilevel positive airway pressure; used in COPD and atelectasis
describe invasive ventilation
ventilation bag/machine is attached to an artificial airway to ventilation lungs
used in intensive care and theatre
when should a patient be ventilated?
GCS 8 or less
what are the aims of oxygen saturation?
94-98% in normal patients
88-92% in COPD
how is chest x-ray image quality assessed?
rotation; medial aspect of each clavicle should be equidistant from the spinous processes
inspiration; 5-6 anterior ribs, lung apiece, costophrenic angles and lateral ribs visible
projection; AP or PA
exposure; left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart
what do you look for in the airway part of the chest x-ray?
trachea; deviation
carina
bronchi
hilar structures
what are the causes of tracheal deviation?
true;
pushing; large pleural effusion or tension pneumothorax
pulling; consolidation associated with lobar collapse
apparent; rotation of the patient
what are the causes of hilar enlargement/abnormalities?
bilateral symmetrical enlargement; sarcoidosis
unilateral/asymmetrical enlargement; malignancy
pushed; enlarging soft tissue mass
pulled; lobar collapse
what do you look for in the breathing part of the chest x-ray?
lungs
pleura; hydrothorax, haemothorax, mesothelioma
what do you look for in the cardiac part of the chest x-ray?
heart
heart borders; right atrium and left ventricle
what do you look for in the diaphragm part of the chest x-ray?
pneumoperitoneum; free gas under the diaphragm (bowel perforation)
pseudopneumoperitoneum; false impression of free gas under the diaphragm (Chilaiditi syndrome)
costophrenic angles; lost with fluid or consolidation
what do you look for in the everything else part of the chest x-ray?
mediastinal contours; aortic knuckle, aorto-pulmonary window
bones
soft tissues
tubes, lines, valves and pacemakers
what are the review areas of the chest x-ray?
lung apices retrocardial behind the diaphragm peripheral region of the lungs hilar region
what do you look for in the everything else part of the chest x-ray?
mediastinal contours; aortic knuckle, aorto-pulmonary window
bones
soft tissues
tubes, lines, valves and pacemakers
what are the review areas of the chest x-ray?
lung apices retrocardial behind the diaphragm peripheral region of the lungs hilar region
