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Respiratory Flashcards

1
Q

Dyspnea

A

difficult or labored breathing with SOB

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2
Q

Orthopnea

A

Dyspnea begins or increases when lying down

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3
Q

Platypnea

A

Dyspnea increases in the upright position

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4
Q

Paroxysmal nocturnal dyspnea

A

Sudden onset SOB after period of sleep

Sitting upright is helpful

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5
Q

Sequence of assessment

A

Inspection, palpation, percussion, and auscultation

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6
Q

Pectus carinatum

A

Pigeon chest

Prominent sternal protrusion

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7
Q

Pectus excavatum

A

Funnel chest

Indentation of the lower sternum above the diploid process

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8
Q

Tachypnea

A

D/t pain from broken rib, pleurisy
Massive liver enlargement of ABD ascites prevent lowering of diaphragm
Metabolic acidosis, CNS lesions (pons), anxiety, aspirin poisoning, hypoxia, pain

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9
Q

Bradypnea

A

Neurologic or electrolyte disturbance
Infection
Cardiorespiratory fitness
Metabolic alkalosis, CNS lesions (cerebrum), myasthenia gravis, narcotic overdose, obesity

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10
Q

Hyperpnea

A

Breathing deeply

Anxiety, exercise, CNS or metabolic disease

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11
Q

Hypopnea

A

Shallow breathing

Pleuritic pain prevents excursion

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12
Q

Kussmaul

A

Deep and rapid

Metabolic acidosis

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13
Q

Biot

A

Periods of apnea between breaths
Often irregular
Associated with increased ICP, respiratory compromise from drug poisoning, brain damage at the medulla
Poor prognosis

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14
Q

Ataxia

A

Significant distortion with irregular and varying depths of respiration

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15
Q

Palpable course grating vibration palpated

A

Usually indicates pleural friction rub

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16
Q

Barrel chest

A

Chronic asthma, emphysema

May not demonstrate bilateral symmetrical expansion because the chest is already so inflated

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17
Q

Apneustic breathing

A

Long inspiration and essentially expiration apnea

esp. when pons is affected

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18
Q

Period apnea in newborn

A

Normal condition = irregular pattern of rapid breathing with brief periods of apnea usually associated with REM sleep

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19
Q

Decreased or absent fremitus

A

Excess air in the lungs

Emphysema, pleural thickening, effusion, massive PE, bronchial obstruction

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20
Q

Increased fremitus, course or rough

A

Presence of fluids, solid mass within lungs, lung consolidation, heavy bronchial secretions, compressed lung, tumor

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21
Q

Gentle, tremulous fremitus

A

Some lung consolidations, inflammatory/infectious process

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22
Q

Trachea pulls towards

A

Affected lung with volume loss from fibrosis or atelectasis (tumor, adenopathy)

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23
Q

Tension pneumo

A

Trachea pulls AWAY from affected d/t increased pressure

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24
Q

Simple pneumo

A

Trachea pulls TOWARDS affected lung

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25
Q

Mediastinitis

A

Trachea pushed FORWARD

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26
Q

Hyperresonance

A

Associated with hyperinflation may indicate emphysema, pneumothorax, asthma

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27
Q

Dullness or flatness

A

PNA, atelectasis, pleural effusion, pneumo, asthma

Excess of heart (cardiac dullness)

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28
Q

Diaphragmatic excursion

A

Normal 3-5 cm

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29
Q

Vesicular

A

Heard over most of the lung fields

Low pitch, soft, short

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30
Q

Bronchovesicular

A

Over main bronchus area and over upper right posterior lung field
Medium pitch
expiration = inspiration

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31
Q

Bronchial

A

Heard only over trachea
High pitch
Loud, long expiration, sometimes more than inspiration

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32
Q

Sibilant

A

High-pitched

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33
Q

Sonorous

A

Low-pitched

34
Q

Rhonchi

A

Sonourous wheeze
Deeper, more rumbling, pronounced during expiration
tend to DISAPPEAR after cough

35
Q

Fine crackles

A

High-pitched, discrete

End of inspiration

36
Q

Course crackles

A

Loud, bubbly

During inspiration

37
Q

Hamman sign

A

Mediastinal crunch found with mediastinal emphysema

Loud crackles, clicking, gurgling

38
Q

Bronchophony

A

Extreme in the presence of lung consolidation

Even a whisper heard clearly and intelligibly

39
Q

Egophany

A

Nasal quality
e becomes stuffy broad a
Consolidation of lung

40
Q

Apgar

A

HR, respiratory effort, muscle tone, response to catheter in nostril, color

41
Q

Health infant thoracic cage

A

30-36 cm

42
Q

Newborn RR

A

30-80

43
Q

1 year RR

A

20-40

44
Q

3 year RR

A

20-30

45
Q

6 year RR

A

16-22

46
Q

10 year RR

A

16-20

47
Q

17 year RR

A

12-20

48
Q

Asthma s/s

A

Tachypnea, nasal flaring, intercostal retractions
Tachycardia, diminished fremitus
Occasional hyper resonance, occasional limited diaphragmatic descent
Prolonged expiration, wheezes, diminished LS

49
Q

Atelectasis s/s

A

Delayed/diminished chest wall movement, narrow intercostal spaces on affected side, tachypnea
Diminished fremitus, apical impulse and trachea deviated to affected side
Dullness over affected lung
Upper lobe: bronchial breathing, epiphany, whispered pectoriloquy
Lower lobe: diminished or absent LS
Wheezes, rhonchi, crackles

50
Q

Bronchiectasis s/s

A

Tachypnea, respiratory distress, hyperinflation, clubbing

Crackles, coarse, rhonchi

51
Q

Bronchitis s/s

A

Occasional tachypnea, occasional shallow breathing
Resonance
Occasional crackles, exp wheezes, rhonchi

52
Q

COPD s/s

A

Respiratory distress, audible wheeze, cyanosis, distended neck veins (RHF), clubbing
Limited diaphragm movement
Somewhat diminished vocal fremitus
Occasional hyper resonance
Postpertussive rhonchi (sonorous wheeze) and sibilant wheeze
Inspirational crackles
LS dim

53
Q

Emphysema s/s

A 
Tachypnea, deep breathing, pursed lips, barrel chest, thin
Liver displaced down
Diminished remits
Hyperresonance
Limited descent of diaphragm
Dim LS
Dim heart sounds
Occasional adventitious LS
54
Q

Pleural effusion and thickening s/s

A

Diminished and delayed respiratory movement on affected side
Cardiac apical and impulse trachea shift to OPPOSITE side
Tachycardia
Dullness to flatness
Hyperresonant in area superior to effusion
Dim to absent LS
Broncophony, whispered pecteriloquy
Egophany and/or crackles in area superior to effusion
Occasional friction rub

55
Q

PNA s/s

A

Tachypnea, shallow, flaring nostrils occasional cyanosis, splinting
Increased fremitus at consolidation empyema or pleural effusion, tachypnea, dullness,
Crackles with occasional rhonchi
Bronchial LS
Egophany, broncophany, whispered pectoriloquy

56
Q

Pneumothorax s/s

A

Tachycardia, cyanosis, respiratory distress, bulging intercostal spaces, respiratory lag on affected side, tracheal deviation with tension pneumonia
Dim to absent remits, apical impuse, trachea, mediastinum shift to SAME side, tachycardia, subQ crepitus from air leak
Hyperresonance
Dim to absent LS
Succession splash audible if air and fluid mix
Sternal and precordial clicks and crackling (Hamman sign) if air underlies that area
Dim to absent whispered voice sounds

57
Q

Asthma

A

Small airway obstruction due to inflammation and hyperreactive airways
Acute episodes triggered by allergens, anxiety, cold air, exercise, URI, cigarettes
Results in mucosal edema, increased secretions, bronchoconstriction with increased airway resistance
Episodes of paroxysmal dyspnea
CP/tightness
Episodes for minutes, hours, days
Tachypnea, paroxysmal coughing with wheezing on expiration and inspiration
Hypoxemia
Decreased peak expiratory flow rate

58
Q

Atelectasis

A

Incomplete expansion of the lung/collapse
Compression (exudate, tumors) or resorption of gas from the alveoli in presence of airway obstruction
Loss of elastic recoil of lung d/t thoracic or abdominal surgery, plug, exudate, foreign body
Sx of post PNA
Consolidation

59
Q

Bronchitis

A 
Inflammation of large airways
Increased mucus secretion
Acute bronchitis d/t infection
Chronic bronchitis d/t irritant
Fever, CP, cough
Hacking, nonproductive cough
60
Q

Pleurisy

A

Inflammatory process involving the visceral and parietal pleura
Result of infection or connective tissues disease (SLE), neoplasm, asbestos
Sudden onset CP with breath (pleuritic)
Rubbing of pleural surface felt by patient
Referred shoulder pain to affected side
Rapid shallow dim LS
Pleural friction rub
Fever

61
Q

Pleural effusion

A

Excessive non-purulent fluid in the pleural space
Infection, HF, renal insufficiency, connective tissue disease, neoplasm, trauma
Cough, progressive dyspnea
Pleuritic CP with inflammatory effusion
Dullness, tactile fremitus
Fluid may be mobile

62
Q

Empyema

A

Purulent exudative fluid collected in the pleural space
Non-free-flowing purulent fluid collection develops most commonly from adjacent infected or traumatized tissues
PNA, pneumo, bronchopleural fistula may develop
Febrile, tachypnic, cough, CP, ill
Cough with blood or sputum
Distant/absent LS
Dull percussion
Pleural opacity that does not flow freely

63
Q

Lung abscess

A

Well-defined, inflammatory, purulent mass can develop central necrosis
Aspiration of food or infection material (dental)
Malaise, fever, SOB
Percussion dull, pleural friction fut
Cough purulent, foul sputum

64
Q

Pneumonia

A

Inflammatory response of bronchioles and alveoli to infective agent
Acute infection of the pulmonary parenchyma may be due to different organisms
Inflammatory exudate leads to lung consolidation
Rapid (hours to days)
Cough, pleuritic CP
Chill, fever, N/V
RLL can involve nerves and involve RLQ of ABD
Crackles and rhonchi
Dullness

65
Q

Influenza

A

Viral infection of lung
Susceptible to secondary bacterial infection
Interstitial inflammation and necrosis throughout the bronchiolar and alveolar tissue
Cough, fever, malaise, HA, coryza, mild sore throat
Crackles, rhonchi, tachypnea

66
Q

Tuberculosis

A

Chronic
Tubercle bacillus inhaled
Potential for post primary spread locally or systemically
Latent then active
Acive: fever, cough, weight loss, night sweats, consolidation, pleural effusion, blood streaked sputum

67
Q

Pneumothorax

A

Air or gas in the pleural cavity
Trama, spontaneous
Large collection of air causes CP, dyspnea
Unexplained, persistent tachycardia

68
Q

Tension pneumo

A

Air leaks continually into the pleural space resulting in a life threatening emergency from increased P in pleural space
Mediastinal shift with tracheal deviation away from involved side

69
Q

Hemothorax

A 
Blood in the pleural cavity
Trauma or medical procedure (thora, central line, pleural biopsy)
Dyspnea, lightheadedness
Distant or absent LS
Percussion dull
Tachycardia, hypotension
70
Q

Hemopneumothorax

A

Air is present with the blood of hemothorax

71
Q

Lung CA

A

Bronchogenic carcinoma, malignant from bronchial epithelium
Tobacco, asbestos, radiation
Cough, wheeze, emphysema, atelectasis, pneumonitis, hemoptysis
May develop malignant pleural effusion

72
Q

Pulmonary embolism

A

Embolic occlusion of pulmonary arteries
R/f: age, DVT, surgery, heart dz ,CA, fracture of pelvis or leg, obesity
Pleuritic CP with or without dyspnea
Low grade T, isolated tachycardia, hypoxia

73
Q

Diaphragmatic hernia

A

Imperfectly structure diaphragm 1/2000 live births
BS heard in the chest
Heart displaced right
Tachypnea, retraction, grunting

74
Q

Cystic fibrosis

A

Autosomal recessive disorder of exocrine glands involving lungs, pancreas, sweat glands
Thich mucus clogs bronchi, bronchioles
Bronchiectasis from cyst formation
Cough with sputum in child < 5 years is halmark
Child’s skin “tastes salty”
Malabsorption, bulky stool, constipation, weight gain, meconium ileum, obstruction
Barrel chest
Nasal polyps
Low BMI
Clubbing, pulmonary HTN, cor pulmonale

75
Q

Epiglottitis

A 
Acute, life threatening 
esp. following H flu infection
Children 3-7
Drools
High fever
Beefy red epiglottis
76
Q

Croup

A 
Laryngotracheal bronchitis
Infection with virus (parainfluenza), child 1.5-3 years
Subglottic infection (laryngotracheobronchitis)
Aspirated foreign body may mimic croup
UTI
Child awakes with harsh, barking cough
Stridor (inspiratory)
Restless, irritable
Fever sometimes, no drooling
77
Q

Tracheomalacia

A

Lack of rigidity or floppy trachea/airway
Tends to be benign, grow out of it
Noisy breathing or wheezing in infany
R/o fixed lesion, vascular lesion, tracheal stenosis, foreign body

78
Q

Bronchiolitis

A

Bronchiolar inflammation leading to hyperinflammation of lungs commonly in infants <6 months
Repiratory syncytial virus; adenovirus, parainfluenza, metapneumovirus
URI
Poor feeding, vomit, diarrhea, lethargy, anxious
Rapid, short, wheezing, grunting, dim LS
AMS
Increased AP diameter
Hyperresonant

79
Q

Emphysema

A 
Lose elasticity and alveoli enlarge
Extensive smoking history
Chronic bronchitis is a precursor 
Alveolar gas is trapped in expiration
Infrequent cough without much sputum
Barrel chest
Overinflated lungs are hyper resonant
Prolong expiratory effort
80
Q

Bronchiectasis

A 
Chronic dilation of the bronchi/bronchioles by repeated pulmonary infection and bronchiole obstruction
CF
Cough with large amounts of sputum
Severe hemoptysis
Tachypnea, clubbing
Crackles, rhonchi
81
Q

Chronic bronchitis

A

Large airway inflammation chronic irritant exposure > 40
Chronically inflamed leading to mucus
Smoking hx
Recurrent bacterial infection
Dyspnea (mild)
Cough and sputum (large)
Wheezing, crackles
Hyperinflation with decreased LS and flat diaphragm
May cause Right sided heart failure with edema

Advanced Assessment (14 decks)

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