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PMMH > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are some respiratory red flags?

A
  • Cyanosis- indicates pt is hypoxic
  • Tripoding, accessory muscle usage
  • Nasal flaring/ head bopping- in paeds mainly
  • Sternal/ intercostal recession
  • Inability to complete full sentence
  • Confused/ combative- brain is not being perfused, decreasing GCS
  • Tachycardia/bradycardia
  • Loss of wheeze without indication of improvement/ silent chest
  • Tracheal tug
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2
Q

What are the main respiratory PC?

A
  • SOB/Dyspnoea and wheeze
  • Cough/sputum
  • Haemoptysis
  • Chest pain
  • Daytime sleepiness, snoring, disordered sleep
  • Utilise SOCRATES
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3
Q

SOB

A
  • Is it cardiac or pulmonary?
  • Is it on rest or exertion?
  • How much exertion?- is this normal for pt?
  • How many flights of stairs can they climb before pausing?- could they do this normally?
  • Timing- commonly occurs in the morning for COPD pts. Coughing a lot at night could be HF
  • Does positioning relieve it?
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4
Q

Cough, sputum & haemoptysis

A

HX of cough:
- Dry, hacking cough- viral infection
- Chronic, productive cough- COPD, TB, pneumonia
- Wheezing- asthma, COPD, anaphylaxis, HF
- Barking- epiglottis, croup
*Acute<3 weeks- common cause of acute cough is URTI, Bronchitis, Pneumonia, L HF, asthma.
*Subacute: 3-weeks- Asthma, sinusitis, reflux
*Chronic>8weeks- Asthma, postnasal drip, bronchitis

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5
Q

Obstructive sleep apnoea

A
  • If pt complains of tiredness, sleepiness, ask about snoring!
  • Do they wake up with a morning headache
  • This is a respiratory issue where they stop breathing in the middle of the night and wake up gasping for air.
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6
Q

ROS

A
  • Appetite- reduced when unwell which could mean they are not getting enough nutrition, making them further unwell.
  • Significant weight loss may indicate malignancy!
  • Upper gastrointestinal symptoms- is it reflux?- does it taste metallic, does it occur a few hrs after eating? Burning sensation?
  • Severe anaemia may cause breathlessness!
  • Reffered pain- pt may have been coughing from a viral illness for the past few days and may now be experiencing pain from coughing excessively. Costochondritis
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7
Q

Medications with respiratory side effects:

A
  • Beta blockers & NSAIDS cause bronchoconstriction
  • ACE inhibitors produce a dry cough (lisinopril, Ramipril)
  • Oestrogen containing meds increase the risk of PE
  • Amiodorane- pleural efffusion
  • Aspirin- may worsen haemoptysis
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8
Q

Allergies & SHx

A
  • Occupational HX- may have been a mine worker, working with asbestos
  • Hobbies & pets ?
  • Recent travel? >4hrs think DVT
  • Smoker/vaper?
    Lifestyle & alcohol consumption, illicit drugs?
  • Sexual hx- HRT in pregnancy may cause thrombotic conditions!
  • Are they fully immunised?- TB, COVID, Pneumonia, Influenza, Pertussis
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9
Q

End of bed assessment

A
  • Cyanosis/Pallor
  • WOB
    -Positioning/ tripoding
  • Scars
  • Pain/distress?
  • Cachexia- muscle wastage/very skinny - driven by chronic inflammatory response. Progress loss of skeletal muscle- typically in cancer pts or with chronic illnesses!
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10
Q

What are you looking for in pts hands?

A
  • Clubbing: low o2, may be a sign of HF, lung abscess, CF
  • Peripheral cyanosis
  • Nicoteine staining
  • Delayed cap refill
  • JACCOL
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11
Q

PULSE CHECK

A
  • Lung CA may lead to af- CHECK PULSE
  • large/tension pneumothorax can cause pulsus paradox
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12
Q

Asterixis-tremors

A
  • Build up of toxic metabolites in the system, including co2 retention.
  • Ask pt to extend their arms & observe the hands for 20-30secs- tremors indicate high dose bronchodilator drugs!
  • Ask pt to bend their wrists back to 90 with fingers open for 20-30 seconds.- A flapping tremor may occur, indicating possible CO2 retention.
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13
Q

Mouth

A
  • Ensure to look inside pts mouth!
  • Look around mouth
  • Angular stomata- sores around the mouth, may be B12 deficiency
  • Does the tounge look dry?- May indicate mouth breathing!
  • Any nasal flaring, pursed lip breathing?
  • Oral candidiasis- fungal infection. Usually secondary to immune suppression but can be associated with steroid inhaler use!
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14
Q

Raised JVP:

A

Causes:
- RHF
- Cor pulmanale
- Arrhythmia
- PE
- Pneumothorax

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15
Q

Lymph nodes

A
  • Make sure you learn the names and how to palpate for them
  • Are they enlarged?
  • Supraclavicular- if that’s enlarged, it may be a sign of abdominal cancer!
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16
Q

Inspecting the chest:

A
  • Be systematic! Start from the front, then move to the back
  • Look for: SWEADES, Chest shape,
    General observation:
  • Resp rate- is it appropriate for age?
  • Any additional sounds?- Cough, wheeze, absent
  • Cachexia?
  • Accessory muscle usage
  • Any pacemakers, ICD, CABG scar
  • Any kyphosis- as long as causing long term back ache, it can cause DIB due to compression of heart and lungs
  • Pigeon chest, any defects in the sternum?
  • Barrel chest- What’s the anterior posterior ratio?- The width of their chest should be bigger than the depth of their chest!
17
Q

What is kusmaul breathing?

A
  • Fast and deep breathing, indicates metabolic acidosis, often seen in DKA
18
Q

What is cheynestrokes respiration?

A
  • Irregular breathing with intermittent periods of increased and decreased rates of breaths with periods of apnoea
  • May be drug induced
19
Q

Don’t forget the legs

A
  • Peripheral oedema- lower legs & sacrum
  • DVT
20
Q

PALPATION

A
  • identify tender areas
    Chest expansion;
  • Is it symmetrical?
  • Look anteriorly and posteriorly!- place hands over chest wall and place thumbs on xiphoid and get pt to inhale first and exhale slowly
21
Q

Tactile fremitus

A
  • Sound vibration produced in the larynx during phonation are transmitted to the bronchi and lungs which are communicated to the chest wall.
    Tactile fremitus= palpation of these vibrations on the chest wall as pt speaks.
  • Get pt to say 99, place ulna aspects (pinky finger) of hand bilaterally on the back of pts chest.
  • Palpate twice anterior and posterior

WHAT IT MEANS:
- In healthy lungs, vibrations are barely palpable
- When tissue is consolidated (full of fluids/ mucus/debris), the vibrations increase

22
Q

Percussion

A
  • Produces a sound of vibration under underlying tissue.
  • Increased resonance indicates increased AIR trapped in the lungs/ pleural space.
  • Decreased resonance indicates FLUID in the pleural space or consolidation (pus/exudate) of the lungs.
  • Dull sounds will be heard around the 3rd/4th rib on the left sternal border due to the heart!!
23
Q

Percussion sounds

A

— Normal resonance- low pitched, hollow
— Hyper resonance- Louder, low pitched
— Hypo-resonance- dull/ thud like , high pitched sound- Fluid filled

24
Q

Auscultation

A
  • Sound is produced by air movement through the bronchi
  • Crackles often heard at the basis
25
Q

What are normal breath sounds called?

A
  • Vesicular, gentle & quiet, no gap between inspiratory and expiratory.
  • Bronchial- heard over the trachea- loud, harsh, high pitched
26
Q

Crackles

A
  • Rales, intermittent, usually on inhalation
  • Crackles heard at the bases of the lungs are likely to be due to pulmonary oedema
  • Stridor- harsh inspiratory sound, caused by partial obstruction in the airway.
  • Pleural rub- creaking sound
27
Q

Vocal fremitus

A
  • Listening for vibration without stethoscope
  • Increased transmitted voice sounds, think exudate and fluid in their lungs- think Pnemonial pleural effusion.
  • If it’s heard louder, the airway is blocked by inflammation/secretion
28
Q

Bronchophony

A
  • Get pt to say 99, it should be muffled.
  • HOWEVER, if heard over areas of consolidation, it will sound loud and clear.
  • IF, you have a pt with a productive cough, malaise, fatigue with a temp and you suspect pneumonia, perform this.
29
Q

Egophony

A
  • Get pt to say EEEE, it should sound muffled.
  • HOWEVER, if heard over areas of consolidation, the sound should be heard as AAAAA
30
Q

Whispered pectoriloquy

A
  • Get pt to whisper 123, you should not hear them through stethoscope!
  • Over consolidation, it should be loud & clear!!
31
Q

Difference between hospital & community acquired pneumonia:

A
  • Hospital acquired pneumonia is classified as a respiratory tract infection, develops 48hrs after admission!- This bacteria is often resistant to antibiotics
  • Community is often not resistant to antibiotics

PMMH (12 decks)

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