Respiratory Flashcards
paroxysmal cough
spasmodic, can occur in tuberculosis or if an inspiratory whoop at the end of the cough, pertussis
Moist cough vs dry cough
moist - usually caused by infection and accompanied by sputum
dry - can be cardiac, ACE inhibitor, allergic, HIV infection associated. Can be brassy sounding if caused by compression of the respiratory tree, (tumor) or hoarse if caused by croup.
high pitched cough
indicates constriction of airway
low pitched cough
indicates presence of secretions or inflammatory conditions
common respiratory complaints
chest pain, cough, sputum production, dyspnea
resp. chest pain associated with fever
infectious process such as pleuritis or costonchondritis
resp. chest pain caused by trauma
can mimic cardiac pain but differs in that it is usually on inspiration, where cardiac pain is not associated with inspiration
sudden onset of sputum
infectious process is probable
platypnea
Opposite of orthopnea, when dyspnea increases in an upright posture and is relieved by lying down, common in patients with emphysema or chronic bronchitis and asthma
paroxysmal nocturnal dyspnea (PND)
sudden onset of shortness of breath after a period of sleep, often in patients with CHF or pulmonary hypertension
associated symptoms for dyspnea
ankle edema suggests heart failure, pain lends to suspicion for pleuritis or cardiac pericarditis
bradypnea
less than 12 respirations per minutes, can indicate neurological or electrolyte disturbance, infection or response to protect again the pain of pleurisy
tachypnea
rapid shallow breathing. more than 25 respirations per minute, seen in hyperventilatory states, as a symptom of splinting from pain of a broken rib or pleurisy, due to massive liver enlargement and ascites which prevents of descent of diaphragm.
kussmal
deep and rapid breathing caused by metabolic acidosis (diabetic ketoacidosis)
cheyne-stokes respirations
regular with periods of apnea followed by a crescendo-decrescendo sequence
seen in brain , damage, drug included respiratory failure, heart failure, may be normal in children and older adults while sleeping, otherwise pathological
sigh
an occasional deep, audible sigh that punctuates a regular respiratory pattern, seen in emotional distress or hypoventilation
Biot pattern of breathing
(ataxic breathing) characterized by unpredictable irregularity. irregular respirations varying in depth and interrupted by periods of apnea, but lacking the regular repetitive pattern of periodic respiration. On occasion it may be regular but the apneic periods may occur in an irregular pattern. When severe is referred to as ataxic breathing. Caused by increased ICP, drug poisoning and brain damage.
Inspection component of the respiratory exam
look for pursing of lips, cyanosis, malodorous breath, nasal flaring, clubbing of fingers, pallor of skin, shape and symmetry of thorax, presence of supernumerary nipples, superficial venous patterns on chest, respiratory rate, pattern of respiration and chest movement, use of accessory muscles or retractions
palpation component of the respiratory exam
palpate for symmetry and massess, crackels and rubs, crepitus, coarse vibrations (usually on inspriation), tactile fremitis and placement of trachea
percussion exam
have patient cross arms and bow head - percuss between scapulae and between ribs in 5 places along the spine
ask patient to raise arms and percuss lateral and anterior chest areas
sit upright and percuss anterior chest clavicle to 3 ICS, 5 ICS, and lower rib
Hyperresonance suggests COPD and other air trapping conditions, or occur superior to atelectasis and pleural effusion. Dullness is deteced over the actual site of atelectasis and pleural effusion, and over tumors or the consolidation/pneumonia.
diaphragmatic excursion
assessment of movement of diaphram from inspiration to expiration. assess by percussing from resonent to dull with large volume in lung and again with all breath expelled. The diffrence should be 5 cm.
vesicular breath sound
heard over healthy lung tissue and low in pitch and intensity
bronchovesicular breath sound
heard over major bronchi, abnormal if over peripheral lung base, moderate in pitch and intensity
bronchial breath sounds
heard over the trachea and abnormal if heard over the peripheral lung base, high pitch and intensity
amphoric breath sounds
abnormal sounds heard with consolidation or a tension pneumothorax, hollow and low-pitched
cavernous breath sound
empty tympanic sounds heard over a fibrotic lesion/cavity
absent or difficult to hear breath sounds
can occur when fluid or exudate is accumulated in the pleural space, when lungs are hyperinflated or when breathing is shallow from splinting for pain.
crackles (formerly rales)
caused by air flowing by fluid.
fine, medium and coarse classifications, heard more often during inspiration, these are fine, high (sibilant) or low pitched (sonorous), short in duration, coarse and last a few milliseconds.
rhonchi
caused by air passing over a solid or thick secretion
these originate in larger airways, are course, low pitched sounds, more continuous and prolonged, with a snoring like quality
sibilant higher pitched rhonchi are from smaller bronchi as in asthma
the more sonorous, lower pitched rhonchi arise from larger bronchi, as in tracheobronchitis
wheezes
caused by air flowing through constricted passageways, usually heard bilaterally in a bronchospasm of asthma or acute bronchitis, if unilateral, are localized or stridor, they are caused by foreign body obstruction
if wheeze is consistent, a tumor or abscess is compressing a part of the airway
during inspiration or expiriations, this is a continuous high pitched musical sound
friction rub
heard outside the airways, a harsh, dry crackling, rubbing or low pitched sounds at both inhalation and exhilation, caused by inflammation fo the pleural or pericardial tissue (pericarditis or pleurisy)
pericarditis
an inflammation of the pericardium (the fibrous sac surrounding the heart). A characteristic chest pain is often present.
pleurisy
Pleurisy is inflammation of the lining of the lungs and chest (the pleura) that leads to chest pain (usually sharp) when you take a breath or cough.
mediastinal crunches (Hamman’s sign)
loud wet crackling sounds heard at the end of expiration, synchronous with the heartbeat and asynrchonous with respiration, caused by mediastinal emphysema
succession splashes
loud, wet sounds similar to splashes heard in pleural cavity or in the lungs, caused by presence of air and fluid in the pleural cavity or within the lungs.
bronchitis (acute, chronic)
Hx - cough, fever with chills, muscle aches, nasal congestion, sore throat, sputum production, and history of smoking
Exam - normal breath sounds or diffuse crackles/rhonchi, injected pharynx, mild dyspnea
Dx - CXR (r/o pneumonia), O2 sat, sputum culture
pneumonia
S/S, Hx- vary based on organism, may include cough with sputum production, fever, pleuritic chest pain
Exam - flushed appearance, confusion, crackles over affected lung, rhonchi, diminished breath sounds, pleural friction, dullness on percussion over affected lung, decreased tactile and vocal fremitus, grunting, nasal flaring, tachypnea
Dx. CXR, sputum culture, CBC, bronchoscopy
tuburculosis
S/S, Hx - exposure, cough with or without sputum, fatigue, fever, night sweats, anorexia, pleuritic chest pain
Exam - crackles on auscultation, tachypnea, decreased breath sounds
Dx - TB skin test, sputum culture, CXR, bone Xray
tactile fremitus
fremitus is the palpable vibrations transmitted throughout the bronchopulmonary tree to the chest wall when the patient speaks 99 or one on one, use ulnar or bony palm to feel vibrations.
Fremitus is decreased or absent when the voice is soft or when transmission is impeded such as with obstructed bronchus, COPD, separation of the pleural surfaces by fluid in pleural effusion, fibrosis with pleural thickening, air of pneumothorax, infiltrating tumor of a very thick chest well.
Fremitus is increased when tramsission of sound is increased, as through the consolidation of pneumonia.
vocab for locating findings on the circumference of the chest
anterior - midsternal, midclavicular and (right or left) anterior axillary line
anterior oblique (side) - posterior axillary line, midaxillary line and anterior axillary line
posterior - vertebral line, scapular line, posterior axillary line
supraclavicular
above clavicles
infraclavicular
below clavicle
interscapular
between scapulae
infrascapular
below scapulae
the pleurae
visceral pleura - covers outer surface of the lung
parietal pleura - line the inner rib cage and upper surface of the diaphragm
respiratory expansion test
placing thumbs at the level of and parallel to the 10th ribs, grasping lateral rib cage, slide them medially a bit to raise loose skin folds between the thumbs and the spine, ask the patient to inhale deeply and watch the divergence of thumbs during inspiration for symmetry
egophony
an increased resonance of voice sounds heard when auscultating with stethoscope, often caused by lung consolidation and fibrosis. It is due to enhanced transmission of high-frequency noise across fluid, such as in abnormal lung tissue, with lower frequencies filtered out. It results in a high-pitched nasal or bleating quality in the affected person’s voice. Ask the patient to say “Eeee” several times. Over consolidated lung areas, the sound is heard as an “A” (aaay). E to A transition indicates consolidation.
hyperpnea, hyperventilation
rapid deep breathing, can be caused by exercise, anxiety,metabolic acidosis.
obstructive breathing
in obstructive lung disease, expiration is prolonged d/t narrowed airways increasing the resistance to air flow, causes include asthma, chronic bronchitis and COPD.
respiratory ROS questiosn
dyspnea, nocturnal orthopnea, how many pillows? , fever, chills, night sweats,
respiratory MH and FH questions
allergies, emphysema, bronchitis, asthma, pneumonia, recent or recurrent upper respiratory infections, TB. history of malignancy, conditions stemming form other systems, including heart failure, GERD, allergies, last CXR, last skin test for TB, results. FH should be similar
Focused Resp Exam
Full respiratory/thorax. Also include cardiac, musculoskeletal, neuro and upper respiratory (ear, nose and throat). Also, skin and nails (color and clubbing).
bronchophony
an increased volume in one area when the patient is repeating during auscultation either “99” or “1-2-3”. indicates area of consolidation or effusion
pectoriloquy
whispered pectoriloquy, when auscultating the patient repeats either “99” or “1-2-3” in a whisper. In areas where the volume is increased, a consolidation is indicated.
indications of consolidation exam (ausultation tests)
if suspected, use the bronchophony, egophony and whispered pectoriloquy tests
acute bronchitis
cough is the most common symptoms, can persist several weeks after intitial infection, during acute phase it will be productive and there may be symptoms of fever, malaise, chills, chest discomfort, and headache. Chills and chest discomfort are mild compared to those associated with pneumonia. Wheezes or crackles on auscultation will disappear with cough. Fremitus equal, no egophony.
COPD
chronic bronchitis, emphysema or asthma. most commonly assoc. with smoking, onset in middle age. when younger patients or non-smokers develop Sx alpha-1-1antitrypsin deficiency should be suspected.
dyspnea
sensation of shortness of breath
hyperventilation
Hyperventilation is rapid or deep breathing that can occur with anxiety or panic. It is also called overbreathing, and may leave you feeling breathless
hypoxia
a pathological condition in which the body as a whole (generalized hypoxia) or a region of the body (tissue hypoxia) is deprived of adequate oxygen supply. A mismatch between oxygen supply and its demand at the cellular level may result in a hypoxic condition. Hypoxia in which there is complete deprivation of oxygen supply is referred to as anoxia.
hypercarbia
the physical condition of having the presence of an abnormally high level of carbon dioxide in the circulating blood
agonal breathing
Agonal respiration is an abnormal pattern of breathing characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus. Possible causes include cerebral ischemia, extreme hypoxia or even anoxia. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death.
orthopnea
the sensation of breathlessness in the recumbent position, relieved by sitting or standing
pectus excavatum
caved-in or sunken appearance of the chest, potential for respiratory or cardiac dysfunction
pectcus carinatum
“pigeon chest” protrusion of sternum and anterior ribs
bony deformities of thorax
rotational scoliotic changes
rachitic rosary
bony knobs at the costovertebral joints seen in Ca deficiency, hypoparathyroidism, rickets
auscultation order of thorax
anterior to lateral to posterior chest walls
bronchiolitis
Bronchiolitis is swelling and mucus buildup in the smallest air passages in the lungs (bronchioles), usually due to a viral infection (respiratory syncytial virus, adenovirus, parainfluenza).
Croup (laryngotracheobronchitis or LBT)
a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a “barking” cough, stridor, and hoarseness. It may produce mild, moderate, or severe symptoms, which often worsen at night. Findings include barking cough, mild fever and inspiratory stridor.
spasmadic croup
peak occurrence in 1-4 year olds. etiology UNK, mild UIR hx,, often sudden occurrence, low or no fever, laryngitis and inspiratory stridor
acute epiglottitis
a medical emergency, pane with 1-8 year olds, bacterial etiology, rapid onset, high fever and toxic. “cherry red” epiglottis, severe respiratory distress, potential for airway obstruction, drooling is a classic sign
actue bacterial tracheitis
an uncommon infectious cause of acute upper airway obstruction, it is currently more prevalent than acute epiglottitis. Patients may present with crouplike symptoms, such as barking cough, stridor, and fever; however, patients with bacterial tracheitis do not respond to standard croup therapy and may experience acute respiratory decompensation. a high fever and toxic appearance, with purulent secretions
retrophayrngeal abscess
potential airway obstruction, high fever, toxic, onset gradual with peak in 1-3 year olds.
atelectasis
collapsed alveoli due to decreased deep breathing, often a post-op condition, decreased breath sounds are present, cough can expand the collapsed alveoli - spirometry to treat
pulmonary edema
crackles/rales on auscultation, orthopnea is common, +PND (paroxysmal nocturnal dyspnea), must rule out CHF
pneumothorax
is the collection of air in the space around the lungs. this buildup of air puts pressure on the lung, so it cannot expand as much as it normally does during inspiration. symptoms include acute shortness of breath, absent breath sounds and hyperresonnance to percussion (air in the pleural space)
hemothorax
a collection of blood in the space between the chest wall and the lung (the pleural cavity). r/o trauma. dull to percussion and absent breath sounds.
acute respiratory distress syndrome (ARDS)
a lung syndrome that causes inflammation of the lung parenchyma leading to impaired gas exchange with a systemic release of inflammatory mediators, causing inflammation, hypoxemia and frequently multiple organ failure. The predisposing factors are sepsis, multiple blood transfusions, pulmonary contusion, aspiration of gastric contents and drug abuse or overdose, burns, pancreatitis, smoke inhalation, pneumonia & near drowning. “shock lung”
infant respiratory distress syndrome
hyaline membrane disease or prematurity
