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PD Block 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

costal angle/margin

A

-Angle formed by the costal margins at the sternum. It is usually no more then 90 degress

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2
Q

vertebra prominens

A

The spinous process of C7. Can be easier seen and felt if patient bends head forward.

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3
Q

manubriosternal junction (angle of Louis)

A

Visable/palpabal angulation of the sternum and the point at which the second rib articulates the sternum.

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4
Q

right lung

A

3 lobes

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5
Q

left lung

A

2 lobes

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6
Q

respiration

A
  • respiration to keep body adequately supplied with O2 and protected from excess accumulation of CO2
  • exchanging gases (CO2 and O2)
  • mainly involves respiratory surfaces (including alveoli and capillary walls)
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7
Q

ventilation

A
  • ventilation: movement of air into and out of lungs (essential process for oxygenation and respiration processes to occur, so it facilitates respiration – without ventilation, respiration cannot occur)
  • mainly involves the lungs
  • inspiration and expiration
  • inhaled air has many gases (where as respiration is mainly O2 and CO2)
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8
Q

inspection of lungs

A

rate, pattern, depth, sounds, signs of respiratory distress

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9
Q

inspection of thorax

A

AP diameter should be less than lateral diameter (emphysema = barrel chest so can be opposite)

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10
Q

what is located in mediastinum

A

heart, aorta, thymus gland, trachea, esophagus, lymph nodes and important nerves = mediastinum

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11
Q

how many inches should chest expand?

A

2-5 inches (look for symmetry)

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12
Q

tacile fremitus

A

palpable vibrations trasnmitte through chest wall when patient speaks (density of underlying lung tissue and chest wall) -> NOTE SYMMETRY

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13
Q

with respirations, use bell or diaphragm?

A

diaphragm!!

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14
Q

inspiration

A

-air moves into the lungs as a results of thoracic volume increasing and negative pressure in the lungs. The external intercostal muscles and the diaphragm contract to increase the volume of the thorax stretching the lungs alveoli. This creates negative pressure in the lungs allowing air (oxygen) to move in.

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15
Q

expiration

A

-the external intercostal muscles and the diaphragm relax while the internal intercostal muscles contract. This leads to decrease thoracic volume and forcing air (carbon dioxide) out of the lungs.

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16
Q

ascultation

A

-Auscultate all lung lobes and apices from anterior, posterior and lateral sides, comparing bilaterally while having patient take deep breaths. Listen through at least one respiratory cycle at each point.. Check from crackles at bases. Check forced expiration for wheezes. Note any wheezes, rales, crackles, rubs or rhonchi and the position from thoracic landmarks. Note timing, pitch duration and quality of sounds. Check for consolidation using vocal resonance tests- whispered 1-2-3, Egophony (E to A), or “99” s

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17
Q

typical lung sounds

A

resonance, dullness/flat, tympany

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18
Q

resonance

A

health, hollow sound that should be heard over lung regions

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19
Q

dullness/flat

A

heart over liver, heart, bones and heavy muscle

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20
Q

tympany

A

heard as soon as you move lower over stomach

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21
Q

atypical lung conditions and sounds

A
  • Pneumonia: dullness in areas of consolidation
  • Pleural Effusion: dull/flat, decreased excursion
  • Pneumothorax: tympany on percussion
  • Asthma: hyperresonance
  • Bronchitis: hyperresonance/resonance.
  • Emphysema: hyperresonance
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22
Q

name 4 breath sounds

A

tracheal, bronchial, bronchovesicular, vesicular

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23
Q

tracheal sounds

A
  • heard over trachea

- harsh, high pitch and intensity, inspiratory = expiratory (“darth vader”)

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24
Q

bronchial/tubular sounds

A
  • over large airways (ABNORMAL finding if heard anywhere else)
  • primarily heard over manubrium (if heard at all)
  • high pitch and intensity, inspiratory (inspiration > expiration)
  • if heard distant to where normally heard, pt has consolidation (as with pneumonia) or compression of lung
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25
Q

bronchovesicular sounds

A
  • mid chest, posteriorly between scapula

- moderate pitch and intensity, inspiratory = expiratory (upside down V)

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26
Q

vesicular sounds

A
  • over healthy lung tissue (NORMAL SOUND IN HEALTHY LUNGS, all lung fields)
  • soft, relatively low pitch and intensity, inspiratory > expiratory
27
Q

fine crackles

A
  • discountinuous
  • soft, high pitched and very brief
  • “moistening thumb and finger and separating them near your ear”
  • Heard during end of inspiration, high-pitched, discrete crackling sound not cleared by cough.
28
Q

medium crackles

A
  • discontinuous

- Heard during mid-step of inspiration. Lower, more moist, not cleared by cough.

29
Q

coarse crackles

A
  • discontinuous
  • louder and lower pitched (than fine) and last longer
  • “opening a velcro fastener”
  • heard during inspiration, loud bubbly, not cleard by cough.
30
Q

wheezes

A
  • sounds heard continuously during inspiration and expiration or separately on inspiration OR expiration
  • caused by air moving through airways narrowed by constriction or swelling of airway or partial obstruction (in lower airways)
  • sounds like whale whistle (during increased respiratory rates)

Expiration> Inspiration, musical, high pitched, hissing, squeak, continuous.

  • Lower Airways: Suggestive of narrowed airways (or obstructed).
  • Stridor: a wheeze that is predominantly inspiratory, indicating partial obstruction of trachea. Upper airways.
31
Q

rhonchi

A
  • lower pitched sounds with a snoring or moaning quality (burps, bubbles)
  • indicates secretions in large airways (bronchitis, CF)
  • May clear with coughing
  • Continuous through inspiration and expiration (more pronounced during expiration), loud, low, course sound similar to a snore or honk.
  • Large airways: sound from the rattling of secretions. Possible transient airway plugging.
32
Q

egophony

A

“voice of the goat” -> has bleating quality (E->A change),
normally would hear and E, but in this case would sound like a nasaly A
-see with emphysema (consolidation)

33
Q

whispered pectoriloqy

A

“voice of the chest”, whispered words have increased intensity and pitch
-usually don’t hear whispering well, but with this you hear it better (pneumonia, fibrosis)

34
Q

bronchophony

A

“bronchial sounds”, spoken words are lounder than normal, due to consolidation (have pt say 99, normally can make out what they are saying, but if have consolidataion, it is lounder and clearer)

35
Q

diaphragmatic excursion

A

measuring the movement of the thoracic diaphragm with inhalation and exhalation. Steps:
○Ask patient to exhale and hold it
○Percuss along the posterior lung fields until you note a change from resonance to dullness- mark that point
○Ask patient to breath and then repeat on the other side
○Ask patient to inhale and hold it
○Percuss down from marked point until there is a change from resonance to dullness- mark that point
○Ask patient to breath and then repeat on the other side
○Measure and record the distance (cm)
○ Usually between 3-5 cm
○Decreased when lung unable to expand (Pleural effusion, Pneumonia, Atelectasis, Hemothorax, Neuromuscular disease)
○Decreased when lung fully expanded (Emphysema, Asthma)

36
Q

pectus excavatum

A

indented chest

  • can cause compression of heart and lungs
  • fatigue, shortness of breath, chest pain, tachycardia (can have none too)
37
Q

pectus cariantum

A

concave chest (usually no symptoms)

38
Q

what systems would you need to examine during a respiratory complaint

A
  • respiratory
  • musculoskeletal
  • CV
  • HEENT
  • skin and nails
  • abdominal
39
Q

barrel chest

A
  • an increase in A P diameter (broad deep chest, abnormally large ribcage), chronically overinflated with air so rib cage stays partially expanded all the time (breathing less eficiente and aggrevates shortness of breath)
  • isnt disease, but sign of one
40
Q

flail chest

A

loss of stability (part of the rib cage that is seperated from the rest of the chest wall)
-shortness of breath, cyanosis, difficulty breathing

41
Q

scoliosis

A
  • lateral curvature of spine
  • back pain and difficulty breathing
  • uneven shoulders, asymmetry with shoulder blades, uneven waste, one hip higher than the other
42
Q

kyphosis

A
  • hump back, affects thoracic vertebra

- difficulty breathing, fatigure, back pain (aging adults)

43
Q

gibbus

A
  • type of kyphosis (posterior curve presentes sharply angled (curvature is not smooth)
  • same signs and symptoms as above
  • associated with colapse vertebra (osteoporosis)
44
Q

lordosis

A
  • swayback (when spine curves too far inward)
  • prominence of buttocks, when laying on back, will have space beneath the lower back and surface
  • congenital or from obesity or pregnancy
45
Q

sputum production

A
  • can be indicative of different diagnoses (onset, pattern, what position makes the patient most comfortable, blood tinged, severity, etc…)
  • in more than small amounts with any consistency suggests presence of disease
  • if onset is acute, infection is most probably
46
Q

hemoptysis

A
  • coughing up blood

- can be accompanied by chest pain, dyspnea, fever, nausea, tachypnea, vomiting

47
Q

dyspnea

A
  • difficulty or painful breathing (shortness of breath)

- intense tightening in the chest or feeling of suffocation

48
Q

shortness of breath

A
  • shortness of breath, anxiety

- intense tightening in the chest or feeling of suffocation

49
Q

tachypnea

A

rapid breathing (>20bpm) (breathing difficulty, wheezing, rib retraction, nasal flaring, cyanoisis and use of accessory muscles

50
Q

bradypnea

A

-slow breathing (

51
Q

eupnea

A

normal breathing

52
Q

pleural rub

A
  • 2 pleural layers rubbing together (makes a scraping, rasy sound that occurs at the end of inhalation and start of exhalation)
  • can be with or without fluid (with = effusion)
  • chest pain that is worse with breathing
53
Q

cyanosis

A
  • lack of blood O2

- blue hue to skin, gums, fingernails, mucous membranes

54
Q

chest pain

A

-pressure, fullness or tightness in chest, crushing pain that radiates from back/neck/jaw/shoulder/arms (LEFT ARM!!), pain that lasts for a few minutes, gets worse with activity, shortness of breath, cold sweats, dizziness or weakness, nasua or vomiting

55
Q

stridor

A
  • high pitched, harsh sounds heard during inspiration
  • upper airway obstruction!! (sign of respiratory distress!) -> foreign body!
  • high pitched, wheezing sound caused by dirupted airflow (blockage) -> shows significant problem in trachea or larynx
  • low pitched or squeaky breathing sound
  • hoarseness
56
Q

orthopnea

A

sensation of breathlessness in recumbent position (relieved by sitting or standing)

57
Q

wheezing

A
  • whistling sound and labored breathing (particularly when exhaling)
  • difficulting rbeathing, rapid breathing, cyanosis
  • COPD, asthma, pneumonia
58
Q

diseases that cause consolidation

A
  • pneumonia
  • cause lung tissue to be dense!
  • dense tissue transmits sound from the lung bronchi much more efficiently than through the air filled alveoli of normal lung
59
Q

what causes crackles?

A

fluid in small airways or atelectasis

60
Q

atelectasis

A

when alveoli has no air in it (closed)

61
Q

crackles

A
  • discontinuous sounds (intermittent, nonmusical, brief)
  • heard on inspiration or expiration (more likely inspiration though)
  • popping sounds produced are created when air is forced through respiratory passages that are narrowed by fluid, mucus, pus or fibrosis
  • often associated with inflammation or infection of small bonito, bronchioles and alveoli
  • fine, medium or coarse versions
62
Q

pleural friction rub

A
  • aka pleural effusion
  • low pitched, grating, creaking sounds that occur with inflamed plural surfaces rub together during respiration
  • most often heard on inspiration than expiration
  • easy to confuse with pericardial rub
  • to eliminate confusion, have patient hold breath (if sound goes away, then pleural)
63
Q

what abnormal lung sounds are produced due to secretions?

A

crackles (rales) and rhonchi

  • crackles in small, lower airways
  • rhonchi in larger upper airways
64
Q

what abnormal lung sounds are produced due to obstruction of airflow

A

wheezes and stridor

PD Block 2 (5 decks)

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