Respiratory Flashcards
Dyspnea
difficult or labored breathing with SOB
Orthopnea
Dyspnea begins or increases when lying down
Platypnea
Dyspnea increases in the upright position
Paroxysmal nocturnal dyspnea
Sudden onset SOB after period of sleep
Sitting upright is helpful
Sequence of assessment
Inspection, palpation, percussion, and auscultation
Pectus carinatum
Pigeon chest
Prominent sternal protrusion
Pectus excavatum
Funnel chest
Indentation of the lower sternum above the diploid process
Tachypnea
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
Bradypnea
Neurologic or electrolyte disturbance
Infection
Cardiorespiratory fitness
Metabolic alkalosis, CNS lesions (cerebrum), myasthenia gravis, narcotic overdose, obesity
Hyperpnea
Breathing deeply
Anxiety, exercise, CNS or metabolic disease
Hypopnea
Shallow breathing
Pleuritic pain prevents excursion
Kussmaul
Deep and rapid
Metabolic acidosis
Biot
Periods of apnea between breaths
Often irregular
Associated with increased ICP, respiratory compromise from drug poisoning, brain damage at the medulla
Poor prognosis
Ataxia
Significant distortion with irregular and varying depths of respiration
Palpable course grating vibration palpated
Usually indicates pleural friction rub
Barrel chest
Chronic asthma, emphysema
May not demonstrate bilateral symmetrical expansion because the chest is already so inflated
Apneustic breathing
Long inspiration and essentially expiration apnea
esp. when pons is affected
Period apnea in newborn
Normal condition = irregular pattern of rapid breathing with brief periods of apnea usually associated with REM sleep
Decreased or absent fremitus
Excess air in the lungs
Emphysema, pleural thickening, effusion, massive PE, bronchial obstruction
Increased fremitus, course or rough
Presence of fluids, solid mass within lungs, lung consolidation, heavy bronchial secretions, compressed lung, tumor
Gentle, tremulous fremitus
Some lung consolidations, inflammatory/infectious process
Trachea pulls towards
Affected lung with volume loss from fibrosis or atelectasis (tumor, adenopathy)
Tension pneumo
Trachea pulls AWAY from affected d/t increased pressure
Simple pneumo
Trachea pulls TOWARDS affected lung
Mediastinitis
Trachea pushed FORWARD
Hyperresonance
Associated with hyperinflation may indicate emphysema, pneumothorax, asthma
Dullness or flatness
PNA, atelectasis, pleural effusion, pneumo, asthma
Excess of heart (cardiac dullness)
Diaphragmatic excursion
Normal 3-5 cm
Vesicular
Heard over most of the lung fields
Low pitch, soft, short
Bronchovesicular
Over main bronchus area and over upper right posterior lung field
Medium pitch
expiration = inspiration
Bronchial
Heard only over trachea
High pitch
Loud, long expiration, sometimes more than inspiration
Sibilant
High-pitched
Sonorous
Low-pitched
Rhonchi
Sonourous wheeze
Deeper, more rumbling, pronounced during expiration
tend to DISAPPEAR after cough
Fine crackles
High-pitched, discrete
End of inspiration
Course crackles
Loud, bubbly
During inspiration
Hamman sign
Mediastinal crunch found with mediastinal emphysema
Loud crackles, clicking, gurgling
Bronchophony
Extreme in the presence of lung consolidation
Even a whisper heard clearly and intelligibly
Egophany
Nasal quality
e becomes stuffy broad a
Consolidation of lung
Apgar
HR, respiratory effort, muscle tone, response to catheter in nostril, color
Health infant thoracic cage
30-36 cm
Newborn RR
30-80
1 year RR
20-40
3 year RR
20-30
6 year RR
16-22
10 year RR
16-20
17 year RR
12-20
Asthma s/s
Tachypnea, nasal flaring, intercostal retractions
Tachycardia, diminished fremitus
Occasional hyper resonance, occasional limited diaphragmatic descent
Prolonged expiration, wheezes, diminished LS
Atelectasis s/s
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
Bronchiectasis s/s
Tachypnea, respiratory distress, hyperinflation, clubbing
Crackles, coarse, rhonchi
Bronchitis s/s
Occasional tachypnea, occasional shallow breathing
Resonance
Occasional crackles, exp wheezes, rhonchi
COPD s/s
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
Emphysema s/s
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
Pleural effusion and thickening s/s
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
PNA s/s
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
Pneumothorax s/s
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
Asthma
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
Atelectasis
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
Bronchitis
Inflammation of large airways Increased mucus secretion Acute bronchitis d/t infection Chronic bronchitis d/t irritant Fever, CP, cough Hacking, nonproductive cough
Pleurisy
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
Pleural effusion
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
Empyema
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
Lung abscess
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
Pneumonia
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
Influenza
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
Tuberculosis
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
Pneumothorax
Air or gas in the pleural cavity
Trama, spontaneous
Large collection of air causes CP, dyspnea
Unexplained, persistent tachycardia
Tension pneumo
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
Hemothorax
Blood in the pleural cavity Trauma or medical procedure (thora, central line, pleural biopsy) Dyspnea, lightheadedness Distant or absent LS Percussion dull Tachycardia, hypotension
Hemopneumothorax
Air is present with the blood of hemothorax
Lung CA
Bronchogenic carcinoma, malignant from bronchial epithelium
Tobacco, asbestos, radiation
Cough, wheeze, emphysema, atelectasis, pneumonitis, hemoptysis
May develop malignant pleural effusion
Pulmonary embolism
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
Diaphragmatic hernia
Imperfectly structure diaphragm 1/2000 live births
BS heard in the chest
Heart displaced right
Tachypnea, retraction, grunting
Cystic fibrosis
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
Epiglottitis
Acute, life threatening esp. following H flu infection Children 3-7 Drools High fever Beefy red epiglottis
Croup
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
Tracheomalacia
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
Bronchiolitis
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
Emphysema
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
Bronchiectasis
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
Chronic bronchitis
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
