respiratory Flashcards
lung lobes
3 right lobes, 2 left
red flag respiratory symptoms
hemoptysis
apnea
respiratory distress
chest pain
absent breath sounds
hypertensive crisis
normal AP to lateral ratio
1:2
childen 1:1
normal lung percussion
resonant
what does dull percussion indicate
infection or tumor
what does hyperresonant percussion indicate
hyperinflation - COPD, pneumothorax, asthma
normally heard in children or thin adults
what does flatness percussion indicate
fluid in the pleural space
effusion
pregnancy considerations
diaphragm displaced upward
dyspnea is common
costal angle increases
increased vital capacity
tidal volume increased 40%
increased ventilation
geriatric considerations
dry mucous membranes
slight hyperresonance with percussion
difficulty breathing gand holding breath
decreased chest expansion
AP diameter increased
fatigue more easily
decreased lung elasticity & muscle mass
pediatric considerations
modify physical exam order
shorter airway, upper airway sounds transmitted to lower airway
RR variable
premature infant considerations
weak respiratory muscles
hypoxia and apnea common
alveoli collapse easily
obligatory nose breathers
newborn/infant considerations
large tongue
obligatory nose breathers
small airways
flat diaphragm, abdominal breathers
toddler considerations
increased growth and maturation of alveoli
decreased RR
consider foreign body aspiration
school age considerations
complete lung development by 8 yrs
5 A’s model
for tobaccos cesation
ask
advise
assess
assist
arrange
cause of inspiratory stridor
inflammation in eppiglottitis, larynx, trachea
cause of inspiratory stridor
swelling in larynx, trachea, bronchi
pack per year history
packs per day * number of years
tactile fremitus
say “ninety nine” and feel vibrations
vibrations should be stronger anteriorly and symmetric
increase in tactile fremutis indicates air trapping - asthma, pneumonia, emphysema
denser or inflamed lung tissue
bronchophony
“ninety nine” is distinct and not muffled when auscultating
clear indicates consolidation
egophony
say “e” while auscultating
sound changes to A
clear indicates consolidation
whisper pectoriloquy
whisper “1,2,3” continously while auscultating
clear indicates consolidation
who should be screened for lung cancer?
55-77 smoking hx
low dose CT
especially currently or >30yr pack hx
pack year hx
packs per day * years
order of exam
inspection
palpation
percussion
auscultation
anterior/posterior auscultation points
12 anterior
14 posterior
tracheal breath sounds
loudest and high pitched, usually heard over the upper aspect of the trachea, best heard on the anterior aspect of the neck
bronchial breath sounds
louder and higher in pitch, usually heard over the lower aspect of the trachea, best heard over the manubrium
bronchovesicular breath sounds
intermediate intensity and pitch, usually heard over the major bronchi in the midchest area anteriorly or between the scapulae posteriorly
vesicular breath sounds
soft intensity, low pitched, with a rustling quality during inspiration and softer with expiration, usually heard bilaterally over most of the peripheral fields
