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PNP: Physical Assessment > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Age Related Tachypnea (4)

A
  1. Younger than two months: >60 bpm
  2. Two-12 months: >50 bpm
  3. 1-5 years old: >40 bpm
  4. 5 years an older: >20 bpm
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2
Q

Respiratory Inspection (2)

A
  1. Retractions are suprasternal and severe in high obstruction
  2. Retractions are infrasternal and less evere in low obstructions
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3
Q

Percussion Sounds (6)

A
  1. Flatness: Over Thigh
  2. Dullness: Over liver
  3. Resonance: Over lung
  4. Hyperresonance: none normally present
  5. Tympany: Gastric air bubble or puffed out
    cheek
  6. Omit the area under the scapula
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4
Q

Tactile fremitus vibrations (2)

A
  1. Vibration increases over area of lung consolidation

2. Vibrations decrease or are absent when bronchus is obstructed or occupied by fluid

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5
Q

Normal Lung Sounds (3)

A
  1. Soft and nonmusical
  2. Heard on inspiration and early expiration (longer inspiratory, shorter expiratory)
  3. Will be diminished by those factors that affect sound generation—hypoventilation or narrowed airway or sound transmission such as lung destruction, pleural effusion or pneumothorax
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6
Q

Tracheal Breath Sounds (4)

A
  1. Hollow and non-musical
  2. Heard clearly in both phases of respiratory cycle
  3. Heard best at suprasternal notch or lateral neck (trachea)
  4. Represents intrapulmonary sound but can be disturbed if upper airway patency is altered
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7
Q

Vesicular Breath Sounds (5)

A
  1. Soft and non-musical
  2. Heard on inspiration and early expiration
  3. Diminished by factors affecting sound generations such as hypoventilation and airway narrowing
  4. Diminished by factors affecting sound transmission such as pleural effusion
  5. Rules out clinically significant airway obstruction
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8
Q

intrapulmonary factors that affect sound transmission (4)

A
  1. Pneumothorax
  2. Hemothorax
  3. Intrapulmonary masses
  4. Lung consolidation
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9
Q

extrapulmonary factors that affect sound transmission (4)

A
  1. Obesity
  2. Chest deformities
  3. Abdominal distention due to ascites
  4. Parenchymal destruction
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10
Q

Bronchial Breath Sounds (3)

A
  1. Soft and non-musical
  2. Heard on both phases of respiratory cycle (mimics tracheal sounds)
    - Equal inspiratory and expiratory phase
  3. Indicates patent airway surrounded by consolidated lung tissue - pneumonia or fibrosis
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11
Q

Stridor (4)

A
  1. High pitched and musical
  2. Best heard over upper airway or at a distance without a stethoscope
  3. Indicates upper airway obstruction
  4. Associated with extrahoracic lesions (laryngomalacia, vocal cord lesion) or intrathroacic lesions (tracheomalacia, bronchomalacia, extrinsic compression) when heard on expiration
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12
Q

Paradoxical Vocal-Cord Motion (2)

A

Vocal cord dysfunction…can occur with stridor

  1. Inappropriate adduction of the vocal cord
  2. Resultant airflow limitation at the level of the larynx, accompanied by stridorous breathing
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13
Q

Wheeze (4)

A
  1. Musical and high pitched
  2. May be heard on inspiration, expiration or both
    - Usually is initially expiratory; worry when it’s on both
  3. Suggests airway narrowing or blockage (foreign body tumor) when it is localized
  4. Associated with generalized airway narrowing and airflow limitation when widespread (COPD, Asthma)
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14
Q

What can cause monophanic (homophanic) wheezing? (7)

A

Large airway obstruction…

  1. Inhaled foreign body
  2. Endobronchial tuberculosis
  3. Bronchial adenoma
  4. Enlarged mediastinal nodes
  5. Achalasia
  6. Malignant mediastinal tumors
  7. In patients with monophonic localized
    wheezing, mass lesion needs to be considered
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15
Q

What can cause polyphonic (heterophonous) wheezing? (what it is and 3 causes)

A

Small airway obstruction, and expiratory wheezing is predominantly present

  1. Asthma
  2. Bronchiolitis
  3. Transient Earlier wheezing
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16
Q

Transient Earlier Wheezing (3)

A
  1. Usually disappear in early toddlerhood
  2. Patients frequently see rattle as a wheeze
  3. Rattles get misdiagnosed in young children as wheeze
17
Q

Rhonchus (6)

A
  1. Musical and similar to snoring
  2. Lower in pitch than a wheeze
  3. May be heard on inspiration, expiration, or both
    - Coarser breath sounds at the end of inspiration that clear with coughing; sound is a variation of a wheeze
  4. Associated with fluid films and abnormal airway collapsibility
  5. Often clears with coughing →suggests large airway involvement
  6. Can occur with mucosal thickening or edema or bronchospasms
18
Q

Fine Crackles (7)

A
  1. Nonmusical
  2. Short and explosive
  3. Heard on mid to late inspiration and occasionally on expiration
  4. Unaffected by cough
  5. Gravity dependent
  6. Not transmitted to mouth
  7. Can be present in pneumonia and interstitial lung disease
19
Q

Coarse Crackles (7)

A
  1. Non-musical, short and explosive
  2. Heard on early inspiratory and throughout expiration
  3. Affected by cough
    - Changes or disappears with cough
  4. Transmitted to mouth
  5. Indicates intermittent airway opening
  6. May be related to sections – bronchitis
  7. Difficult to hear in young children
20
Q

Pleural Fiction Rub (6)

A
  1. Non-musical and explosive
  2. Biphasic (hallmark rule)
    - Expiratory sequence of sound mirrors the inspiratory sequence
  3. Typically heard over basal regions
  4. Associated with pleural inflammation or pleural tumors
  5. Wave form is similar to crackle but longer in duration and lower in frequency
  6. Heard in inflammatory diseases or malignant pleural disease
21
Q

Squawk (3)

A
  1. Mixed with a short musical component similar to a short wheeze
  2. Accompanied or preceded by crackles
  3. Distal airways are affected—interstitial lung disease if not acutely ill or pneumonia in patients who are acutely ill.
22
Q

What is barking or brassy cough associated with? (3)

A
  1. Croup
  2. Tracheomalacia
  3. Habit cough
23
Q

What is honking cough associated with?

A

Psychogenic cough

24
Q

What is paroxysmal (+/- inspiratory whoop) cough associated with? (2)

A
  1. Pertussis

2. Parapertussis

25
Q

What is staccato cough associated with?

A

Chlamydia in infant

26
Q

What is cough productive of casts cough associated with? (2)

A
  1. Plastic bronchitis

2. Asthma

27
Q

What is chronic wet cough in am only associated with?

A

suppurative lung disease

28
Q

Croup (6)

A
  1. History is consistent for URI with or without low grade fever and runny nose
  2. Barking cough usually starts late in the evening after the child has been asleep; the child may not look very sick but will have a barking cough
  3. Child can be progressively worse each night, usually worse by the 2nd or 3rd night.
  4. Can have mild croup with just expiratory stridor
  5. Can have severe croup with expiratory and inspiratory stridor
  6. Steeple sign on lateral neck film
29
Q

Pulsus Paradoxus

A

Associated with asthma; drop in systolic BP of 10mmHg or more with inspiration

30
Q

Spirometry Asthma Diagnostic

A
  1. Degree of respiratory compromise
  2. Peak expiratory flow rate over 6 but likely is not practical assess under 8 year
  3. 30% to 50% of predicted or patient’s personal best—severe obstruction
31
Q

Asthma blood gases in severe obstruction (2)

A
  1. PCO2 is decreased initial and then may elevate as a sign of muscle fatigue
  2. Hypoxia or hypercapnia lead to acidosis
32
Q

Pertussis (5)

A
  1. Can occur even if infant is fully immunized
  2. Cough can persist for up to 6 months after acute illness
  • **3. Infants may not have characteristic whoop but do have paroxysmal coughs w/ turning red or blue (croupy barking cough that is paroxysmal)
  • May vomit after cough
  1. Incubation period: 7-10 Days
  2. Three phases: catarrhal, paroxysmal, convalescent
33
Q

Viral Pneumonia Clinical Presentation (7)

A
  1. Gradual
  2. Associated with preceding upper airway symptoms (rhinorrhea, congestion)
  3. Diffuse and bilateral findings
  4. Non-toxic appearance
  5. Wheezing is more frequent
  6. Rhinorrhea
  7. Myalgia

PNP: Physical Assessment (21 decks)

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