Respiratory Flashcards
define dyspnea
Shortness of breath
define orthopnea
SOB when lying down
what are some DOH that relate to respiratory disease?
- Physical environment
- Employment conditions
- Biology and genetics
- Culture
- Personal health practices and coping skills
- Diet and nutrition: evidence has been found that diet may be linked to chronic respiratory diseases (asthma and COPD)
- Social environment and support networks
- Education
- Socioeconomic status
What are some abnormal chest configurations?
- scoliosis
- kyphosis
- pigeon chest
- barrel chest
- funnel chest
Define scoliosis
- lateral curvature and rotation of thoracic and lumbar spine
- may cause distortion of the lungs, which results in decreased lung volume
Define kyphosis
- exaggerated posterior curvature of thoracic spine
- my decrease lung expansion and increase cardiac problem
Define barrel chest
- anteroposterior diameter is equal to transverse diameter and ribs are horizontal
- accompanies COPD
what is tactile fremitus?
palpable vibration when the patient speaks
what does increased fremitus indicate?
compression or consolidation in the lungs
What does decreased fremitus indicate?
thickness of the chest
- COPD, pleural effusion
Where would you feel the strongest vibrations (fremitus)?
prominent between scapulae and around the sternum, sites where major bronchi are closest to chest wall. Decreases as you move down due to more tissue impeding sound transmission.
What is the significance of unilateral decreased expansion?
chest expansion is unequal with marked atelectasis or pneumonia, thoracic trauma, pneumothorax.
What is the significance of bilateral decreased respiratory expansion?
lag in expansion occurs with atelectasis, pneumonia, and postoperative guarding
What is the normal sound you should hear over the lungs?
resonance
What is the significance of dullness on percussion of the lungs?
signals abnormal density in lungs
ex. pneumonia, pleural effusion, atelectasis, tumour
What is the measure for normal diaphragmatic excursion?
3-5 cm or 7-8(well conditioned)
what is the significance of decreased excursion?
characterizes pleural effusion and atelectasis of lower lobes
Where would you hear vesicular breath sounds? What would you hear?
lung areas
- soft and low pitched
Where would you hear bronchial breath sounds? What would you hear?
next to the trachea (usually only on the anterior side)
- loud, high pitched
Where would you hear bronchovesicular breath sounds? What would you hear?
around the sternal border
- medium loudness, medium pitch
What are some adventitious breath sounds?
- fine or coarse crackles
- wheezes
- ronchi
- friction rub
- stridor
Auscultating for Bronchophony
- tell patient to say “99”
- normal: soft, indistinct
- abnormal: can hear words clearly due to disease that increases lung density
Auscultating for Egophany
- ask patient to say “eeeee”
- normal: should hear “ee”
- abnormal: long “aaaa” due to consolidation or compression
Auscultating for whispered pectoriloquy
- whisper “1,2,3”
- normal: faint, muffled, almost inaudible
- abnormal: clear, faint due to small amounts of consolidation
Define Asthma (palpate, percuss, ausc)
- condition in which your airways narrow and swell and may produce extra mucus
- palpate: decreased tactile fremitus
- percuss: resonance
- ausc: wheezing
Define Atelectasis (palpate, percuss, ausc)
- the collapse of the alveoli that prevents normal gas exchange between carbon dioxide and oxygen
- Palp: lack of tactile fremitus
- Percuss: dull over affected areas
- ausc: decreased/absent breath sounds, possibly fine crackles
What are the symptoms of atelectasis?
hypoventilation, chest pain, shortness of breath (dyspnea), coughing, lips and skin turning blue (cyanosis), inc resp&rate
Define chronic bronchitis (palp, percuss, ausc)
- Chronic inflammation of the bronchial tree causing increased mucus production and blocked airways
- palp: normal fremitus
- percuss: resonant
- ausc: wheezes
Define lobar pneumonia (palp, percuss, ausc)
- Infection in fluid in bacteria causing area of consolidation
- palp: increased fremitus
- percuss: dull
- ausc: crackles, Bronchophony, egophony, whisper pectoriloquy, wheezes, bronchial breath sounds, decreased breath sounds
Symptoms of lobar pneumonia
cough, fever, shortness of breath, shallow breathing, chest pain, loss of appetite, low energy, fatigue
Define pneumothorax (palp, percuss, ausc)
- Air moves into pleural space causing lung collapse
- Full collapse: causes tracheal deviation
- palp: decreased fremitus
- percuss: hyperresonance
- ausc: decreased or absent breath sounds
Define pleural effusion (palp, percuss, ausc)
- Have fluid that fills in pleural space, that causes lung tissue that can be compressed or moved out of the way
- palp: decreased fremitus and decreased chest expansion on affected side
- percuss: dullness
- ausc: decreased or absent breath sounds
Define congestive heart failure (palp, percuss, ausc)
- o Increase in pulmonary veins causing interstitial edema around alveoli
- palp: normal fremitus, skin can be cool and clamy
- percuss: resonance
- ausc: wheezes or crackles at bases
What is primary prevention in respiratory?
preventing the initial occurrence of a chronic respiratory illness
What are some examples of primary prevention?
- Avoiding prolonged exposure to chemicals
- Education about air quality and smoking
- Vaccines
- Healthy living
What is secondary prevention in respiratory?
Activities aimed at early identification and treatment to delay progression and disability
What are examples of secondary prevention strategies?
- Comprehensive Health Assessment
- Explain risk factors for lung disease including smoking and exposure to pollution and chemical irritants
- Share brochures COPD/emphezema
- Ensure patient and/or family can read and interpret literature (why?)
- Teach patient to self-screen for warning signs worsening condition of lung disease such as persistent cough, chest pain, recurring lung infections, weight loss.
- Encourage client to have seasonal flu shot.
- Encourage annual physical examination with MD or Nurse Practitioner, including CXR as needed
- Encourage family to support clients smoking reduction/cessation
What is tertiary prevention in respiratory?
Ameliorating disease severity and disability, maximizing recovery from illness, enhancing quality of life
Examples of tertiary prevention strategies?
• Maintain effective airway: DB&C, encourage fluid intake (if not contraindicated) ,teach purse lip breathing, auscultate chest every shift, O2 therapy teaching, adequate nutrition, regular planned activity
Describe incentive spirometry
- method of encouraging voluntary deep breathing by providing visual feedback to patients about inspiratory volume.
- Used to promote deep breathing and to prevent atelectasis in the post-operative patient.
What are the benefits of purse-lipped breathing?
To prevent alveolar collapse, increase arterial oxygen saturation
What are the benefits of diaphragmatic breathing?
Promote relaxation and provide pain control. Improves efficiency of breathing by decreasing air trapping and reducing work of breathing
What are the benefits of consecutive coughing?
Help remove mucus more effectively and completely than one forceful cough
what are the benefits of early ambulation?
Promote return of regular deep breathing and prevention of postoperative complication and improves circulation to the lungs
