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.