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Health Assessment | Exam 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Barrel Chest

A
  • Increased AP diameter
  • Costal angle > 90*
  • Cause: overinflation
  • Often seen w/ COPD, cystic fibrosis, aging
  • Shape normal during infancy
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2
Q

Funnel Chest (Pectus Excavatum)

A
  • Depressed lower sternum
  • Compresses heart and greater vessels ⇒ may cause murmurs
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3
Q

Pigeon Chest (Pectus Carinatum)

A
  • Increased AP diameter
  • Anteriorly displaced sternum
  • Costal cartilages adjacent to protruding sternum depressed
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4
Q

Thoracic Kyphoscoliosis

A
  • Raised shoulder and scapular
  • Thoracic convexity
  • Flared interspaces
  • Painful w/ longevity bc it restricts internal organs
  • Tx: brace and surgery
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5
Q

Tripod Position

A
  • Pt sits leaning forward, w/ lips pursed during exhalation and arms supported on their knees or table to optimize oxygen intake
  • Seen in severe asthma or COPD
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6
Q

breath sounds: tracheal

A
  • Quality: harsh, high-pitched
  • Duration: Inspiration = Expiration
  • Location: above supraclavicular notch, over trachea
  • Near trachea sounds are harsher
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7
Q

breath sounds: bronchial

A
  • Quality: loud, high-pitched
  • Duration: Inspiration < Expiration
  • Location: above clavicles
  • If bronchial breath sounds heard in locations distant from listed ⇒ suspect air-filled lung replaced by fluid-filled or solid lung tissue
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8
Q

breath sounds; bronchovesicular

A
  • Quality: medium loudness, medium pitch
  • Duration: Inspiration = Expiration
  • Location: next to sternum, between scapulae
  • If bronchovesicular breath sounds heard in locations distant from listed ⇒ suspect air-filled lung replaced by fluid-filled or solid lung tissue
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9
Q

breath sounds: vesicular

A
  • Quality: soft, low-pitched
  • Duration: Inspiration > Expiration
  • Location: remainder of lungs
  • Near base of lungs are quieter
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10
Q

adventitious sounds: fine crackles

A
  • Soft, high-pitched
  • Cracking, popping sound
  • Heard during inspiration
  • Like rubbing hair next to ear noises
  • Intermittent, nonmusical
  • Occurs in: pneumonia, heart failure, sometimes asthma
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11
Q

adventitious sounds: coarse crackles

A
  • Loud, low-pitched
  • Bubbling, gurgling sounds
  • Heard during early inspiration and possibly expiration
  • Like sipping barely there liquid through straw noises
  • Intermittent, nonmusical
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12
Q

adventitious sounds: wheezes

A
  • High pitched
  • Squeaky, whistling sound
  • Mostly heard during expiration but may also occur during inspiration
  • Musical
  • Occurs in: asthma, bronchitis, COPD, pneumonia
    • During severe asthma exacerbation ⇒ wheezing may decrease or stop due to lack of airflow in bronchial tree ⇒ emergency
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13
Q

adventitious sounds: rhonchi

A
  • Low-pitched
  • Snoring, moaning sounds
  • Heard during both inspiration and expiration but mostly more during expiration
  • Musical
  • Occurs in: chronic bronchitis, any tracheal/bronchi obstruction
    • Suggests secretions in large airways
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14
Q

adventitious sounds: stridor

A
  • High-pitched, continuous
  • Musical
  • Best heard over neck during inspiration
  • Occurs in: trachea stenosis from intubation, airway edema after device removal, epiglottis, croup, foreign body, anaphylaxis
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15
Q

percussion sounds: flat

A
  • Short, soft, high-pitched
  • Extremely dull
  • Means: consolidation seen in atelectasis and extensive pleural effusion
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16
Q

percussion sounds: dull

A
  • Medium pitch, medium length, medium intensity
  • Thudlike
  • Means: solid area seen in lobar pneumonia (alveoli filled w/ fluid and blood cells)
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17
Q

percussion sounds: resonant

A
  • Long, loud, low-pitched
  • Hollow
  • Means: normal lung tissue
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18
Q

percussion sounds: hyperresonant

A
  • Very loud, lower-pitched
  • Means: hyperinflated lungs seen in emphysema, pneumothorax, COPD, asthma
19
Q

percussion sounds: tympanic

A
  • Loud, moderate length, high-pitched
  • Drum-like, musical
  • Means: air collected seen in large pneumothorax, gastric air bubble, air in intestines
20
Q

upper respiratory infection (URI)

A
  • Acute infection involving upper resp tract: nose, sinus, pharynx, larynx
  • Usually viral
    • Sx onset: 1 -3 days after exposure
      • S&S: Cough, sore throat, otalgia, rhinitis, congestion, phlegm, fever
    • Duration: 7- 10 days
  • Types of infection:
    • Rhino-sinusitis: common cold
    • Sinusitis
    • Laryngitis: dry cough w/o sputum
    • Pharyngitis/Tonsillitis
    • Otitis
    • Bronchitis: inflammation of bronchial tree that comes w/ cough (may be dry or productive), congestion, sometimes wheezing
21
Q

Pneumonia

A
  • What: infection of terminal bronchioles
    Causes: bacteria, virus, fungi, aspiration
  • S&S:
    • Fever
    • Cough (may/may not be productive of mucus/phlegm)
      • Bacterial pneumonia: sputum mucoid or purulent and may be blood-streaked, diffusely pinkish, rusty
      • Viral pneumonia: dry hacking cough may become productive of mucoid sputum
    • Malaise, fatigue
    • Pleuritic pain
    • Decreased breath sounds or crackles
      • Crackles or absent sounds due to so much consolidation in lungs
    • Tachypnea
    • Dullness w/ percussion bc of consolidation of fluid where air should be in lungs
22
Q

Pneumothorax

A
  • What: air leaks from lungs to → pleural space in between lung and chest wall → collapses lungs
    • Closed: spontaneous, traumatic, iatrogenic (caused by exam/Tx)
      • Causes include high altitudes, deep scuba diving, etc.
      • Risk factors for spontaneous pneumothorax: adolescent, thin, tall boys
    • Open: due to penetration
      • Causes surgical accidents
    • Tension: air leaking to pleural space
  • S&S:
    • Very ill-appearing
    • SOB
    • Chest pain (CP)
    • Tachycardia
    • Cyanosis
    • Anxiety
    • Resp distress
    • Tracheal displacement
  • Tx: get into pleural space to let air out so lung can refill
23
Q

Asthma (what, S&S, Tx)

A
  • What: hyperreactive airway disease causing bronchoconstriction, obstruction, and inflammation
    • Reversible → can be treated w/ meds during Sx attack
  • S&S:
    • Tachypnea
    • Tachycardia
    • Secondary muscle use (🚩)
    • Expiratory wheezing
    • Chest “tightness”
  • Tx: goal have pt in mild persistent to moderate persistent range w/ appropriate Tx
    • Acute: bronchodilators (ie. inhalers)
      • Quick-acting inhalers: only for immediate Sx relief
    • Chronic: anti-inflammatory (ie. long-acting steroids)
      • Long-acting Tx: helps limits amt of attacks so they wouldn’t need short acting as much ⇒ not for Sx relief
24
Q

Asthma Type I: Mild Intermittent

A
  • Sx occur less than couple times/wk during waking hrs
  • < 2/month at night (waking up coughing/wheezing)
  • In between attacks no Sxs occur
  • Brief attacks
  • Intensity varies
  • Peak flow variability < 20%
  • Have pt keep inhalers
25
Q

Asthma Type II: Mild Persistent

A
  • Sx occurs more than 2/wks but not daily
  • < 2/month at night (waking up coughing/wheezing)
  • Can still have asthma attacks that interfere w/ activity temporarily
  • Peak flow variability 20 - 30%
26
Q

Asthma Type III: Moderate Persistent

A
  • Asthma attacks at least couple times/wk ⇒ interferes w/ daily activities and lasts for days at a time
  • Waking up at night w/ Sxs
  • Sx pops up most days
  • Have to use inhaler almost every day
  • Greater peak flow variability 30% +
27
Q

Asthma Type IV: Severe Persistent

A
  • Pt can’t be at home anymore
  • Continuous Sxs
  • Severe activity limitations
  • Frequent attacks at night
28
Q

COPD: Chronic Bronchitis

A
  • What: inflamed and narrowing of airway/bronchi lining ⇒ hypersecretion of mucus by goblet cells ⇒ difficulty breathing
  • S&S:
    • Productive chronic cough (minimum 3 months x 2 yrs)
    • Sputum mucoid to purulent may be bloody
    • Ronchi
    • Crackles
    • Recurrent wheezing
    • Cyanosis (most w/ emphysema due to increased CO2)
    • Dyspnea
  • Risk factors: Age & Prolonged Hx of tobacco abuse
29
Q

COPD: Emphysema

A
  • What: chronic lung disease damaging and enlarging alveoli ⇒ difficulty breathing
  • S&S:
    • Enlarged alveoli that tries to hold onto air
    • Barrel chest due to flattening of costal angle
    • SOB
    • Tripod position (secondary muscle use 🚩)
    • Decreased breath sounds (crackles, wheezing, cough) depending on where they are in disease progression state
    • Clubbing
    • Polycythemia (↑ hgb) as body attempts to get more oxygen
    • Hypoxemia (↓ O2)
    • Hypercarbia (↑ CO2 < bronchitis)
    • Cyanosis (during severe conditions)
    • Malnutrition (during severe conditions)
  • Risk factors: Age & Smoking
30
Q

Lung Cancer

A
  • What: neoplasm of lung (abnormal growth of cells in lungs)
    • # 1 cause of mortality related to cancer in both men and women but not most common cancer ⇒ high mortality rate
    • Small cell lung cancer: more aggressive and pre-advanced at time of diagnosis
    • Non-small cell lung cancer: involves adenocarcinomas, treated w/ surgery, tend to have better outcomes
  • S&S
    • Persistent cough (dry or productive)
      • Sputum may be bloody
    • Anorexia
    • Weight loss
    • Hemoptysis
    • Normal to decreased breath sounds
    • Dyspnea
  • Risk factors:
    • Age !
    • Tobacco abuse/smoking
    • Asbestos
    • Radon
    • Vit A deficiency and excess
31
Q

How to Document Dyspnea Subjective Grades 0-4

A
  • Grade 0: not troubled by breathlessness except w/ strenuous exercise
  • Grade 1: troubled by SOB when hurrying on lvl path or walking up slight hill
  • Grade 2: walks more slowly on lvl path than ppl of same age bc of breathlessness or has to stop to breathe when walking on lvl path at own pace
  • Grade 3: stops to breathe after walking ~100 yrds on lvl path
  • Grade 4: too breathless to leave house or breathless when dressing/undressing
32
Q

How to Document Dyspnea Objective

A
  • Tachypnea: shallow breathing w/ increased RR
  • Bradypnea: slower rate of breathing (may be periodic, regular intervals)
  • Apnea: absence of breathing (may be episodic, irregular intervals)
  • Hyperpnea: increased depth of breathing
  • Kussmaul: rapid, deep breathing w/o pauses
    • In adults: > 20 RR, labored breathing w/ deep breaths that resembles sighs
  • Cheyne-Stokes: breaths that gradually become faster and deeper than norm, then slower, and alternate w/ periods of apnea
    • Cause: diabetes, severe life crisis
    • Doesn’t resolve until you treat underlying condition
    • Common in: end of life oncology pts, severe heart failure
  • Biot: rapid, deep breathing w/ abrupt pauses between each breath; equal depth to each breath
    • Cause: damaged brain pons often due to stroke or trauma that increases region’s pressure
33
Q

Red Flags

A
  • Loss of synchrony between left and right lung ⇒ suggests pt has blood or fluid in space ⇒ lungs not inflating
  • Presence of stridor ⇒ caused by obstruction in upper airway
  • Secondary muscle use ⇒ means pt needs to use other muscles to breathe and get oxygen even at rest
  • Expiratory grunt ⇒ sign of resp distress
    • Grunting comes w/ closure of glandis that switches back and forth between esophagus and trachea to increase end expiratory lung pressure to prolong alveolar gas exchange ⇒ enhances ventilation and perfusion
  • Cyanosis ⇒ might indicate intrathoracic disease w/ lower resp involvement
  • During severe asthma exacerbation ⇒ wheezing may decrease or stop due to lack of airflow in bronchial tree ⇒ emergency
34
Q

age-related considerations INFANTS

A
  • Hemoptysis rare
  • Barrel chest normal until they’re 2 yo
  • Have thinner chest wall w/ more prominent bony structures compared to adults
  • Have larger head circumference compared than chest circumference until they’re 2 yo
35
Q

age-related considerations CHILDREN

A
  • Hemoptysis rare
  • Cyanosis more common in children
36
Q

age-related considerations OLDER ADULTS

A
  • Barrel chest can occur again as normal part of aging due to normal gradual loss of muscle, strength, thorax, diaphragm, and lung resiliency
  • Still make sure to rule out COPD though
  • Alveoli becomes less elastic ⇒ ↑ fatigue, dyspnea, exertion
  • Mucous membranes become drier
37
Q

age-related considerations PREGNANT WOMEN

A

Experiences changes in resp function but not RR

38
Q

health education and promotion

A
  • tobacco cessation
  • vax: influenza, pneumococcal, pertussis, covid
39
Q

Inspection of Chest Shape’s

A
  • Norm ratio: 0.7 – 0.75
  • Increases w/ age
  • AP diameter may increase in COPD
40
Q

Inspection of Ribs Costal Angle

A
  • Norm: < 90*
  • If angle is > 90* ⇒ caused by overinflation of lungs mostly associated w/ COPD but also seen in cystic fibrosis
41
Q

Percussion for Underlying Tissue

A
  • Percuss for sound to find out if underlying tissue has air or fluid, in excess, etc.
    • Sounds: flat, dull, resonant, hyperresonant, tympanic
  • Step: tap on intercostal spaces between each rib
  • Norm: sound is resonant
42
Q

Palpation of Chest Expansion

A
  • Steps: both hands on back → slide them medially just enough to raise loose fold of skin on each side between thumb and spine → ask pt to inhale deeply → let hands expand w/ chest movement → watch distance between thumbs as they move apart during inspiration → feel for range and symmetry of rib cage as it expands and contracts
  • Norm: bilateral, equal movement of thumbs/hand apart
  • Unequal movement ⇒ lung deflated
  • Causes of unilateral decrease or delay in chest expansion include: pleural effusion, lobar pneumonia, pleural pain w/ associated splinting, unilateral bronchial obstruction, chronic fibrosis of underlying lung/pleura
43
Q

Palpation of Tactile Fremitus

A
  • Fremitus: palpable vibration transmitted thru bronchopulmonary tree to chest wall as pt is speaking
  • Steps: use ball (bony part of palm at base of fingers) or ulnar surface of your hand to optimize vibratory sensitivity of bones in hand → ask pt to repeat words “99” or “1 on 1” → if fremitus faint, ask pt to speak more loudly or in deeper voice
  • Fremitus decreased or absent when pt voice is too soft or when transmission of vibration from larynx to surface of chest impeded
    • Causes include: thick chest wall, obstructed bronchus, COPD, pleural effusion (fluid in pleural space impacting lung tissue), fibrosis (pleural thickening), pneumothorax (collapsed lung), infiltrating tumor
  • Fremitus increased over areas where there’s consolidation (pneumonia) unilaterally from increased transmission
  • Norm: symmetrical vibrations felt when pt is speaking

Health Assessment | Exam 2 (3 decks)

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