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
2
Q
Funnel Chest (Pectus Excavatum)
A
- Depressed lower sternum
- Compresses heart and greater vessels ⇒ may cause murmurs
3
Q
Pigeon Chest (Pectus Carinatum)
A
- Increased AP diameter
- Anteriorly displaced sternum
- Costal cartilages adjacent to protruding sternum depressed
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
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
6
Q
breath sounds: tracheal
A
- Quality: harsh, high-pitched
- Duration: Inspiration = Expiration
- Location: above supraclavicular notch, over trachea
- Near trachea sounds are harsher
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
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
9
Q
breath sounds: vesicular
A
- Quality: soft, low-pitched
- Duration: Inspiration > Expiration
- Location: remainder of lungs
- Near base of lungs are quieter
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
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
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
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
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
15
Q
percussion sounds: flat
A
- Short, soft, high-pitched
- Extremely dull
- Means: consolidation seen in atelectasis and extensive pleural effusion
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)
17
Q
percussion sounds: resonant
A
- Long, loud, low-pitched
- Hollow
- Means: normal lung tissue
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
- Sx onset: 1 -3 days after exposure
- 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
- Closed: spontaneous, traumatic, iatrogenic (caused by exam/Tx)
- 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
- Acute: bronchodilators (ie. inhalers)
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
- Persistent cough (dry or productive)
- 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
