Respiratory Flashcards
On general inspection what are you looking for?
Medications –> oxygen, inhalers and nebuliser
General well being are they cyanosed or difficulty breathing
If there is any audible breathing and wheezing
What is clubbing a sign of?
Interstitual lung disease, lung cancer and bronchiectasis
What signs are you looking for in the hands?
Clubbing cyanosis Tar staining Pale palmer creases Capillary refill time Co2 flap
What are you looking for in Co2 flap?
First you look for fine tremors
Then look for CO2 retention when persons are out for 30 seconds (state this)
What would fine tremor be a indication of?
Side effect of beta 2 agonist ( salbutamol)
What would Co2 retention indicate?
Type 2 respiratory failure (COPD)
What 4 things are you assessing at the same time when taking a pulse?
Rate ( tachycardic –> c02 retention)
Rhythm
Character (bounding)
Also respiratory rate –> 12-20
What assessment are you doing at the face lips and tongue?
Look at eyes for conjunctivae for pallor and corneal arcus
In the mouth for central cyanosis, lips for peripheral and angular stomatis
Face= look for horners syndrome
What do you check in the neck?
JVP and lymph
Which lymphs do you check?
Sub mental, sub madnibular, pre auricular, post auricular, posterior cervical, anterior cervical and supraclavicular lymph nodes
What chest deformities do we look for?
Barrel chest
Pectus carintum
Pectus excavatum
What scars do we look for?
Lobectomy scar–> axillia and back
Mix axillary line
What do you palpate?
Trachea
Apex beat
Tactile vocal resonance/fremitus
Chest expansion
What would unequal chest expansion indicate?
Lung collapse
Pneumonia
What would positive tactile vocal fremitus indicate?
Fluid overload, consolidation or tumour
You have increased volume
What would normal percussion sound like?
Resonance
What would dull percussion indicate?
Increase tissue density
Consolidation, fluid, tumour or lung collapse
What type of percussion is heard in pleural effusion?
Stony dullness
What type of percussion is heard in pneumothorax?
Hyper resonance
Reduce tissue density
What should you ask the patient do as you auscultate there lungs?
Inhale and exhale from their mouth
What are the types of breath sounds you can get?
Fine crackles Coarse crackles Wheeze Pleural rub Stridor
What does coarse crackles indicate?
They indicate pneumonia or fluid
What does wheeze indicate on auscultation?
COPD or Asthma
What does fine crackles indicate on auscultation?
Pulmonary fibrosis
What does stridor indicate on auscultation?
Indicate a narrow of the airway
High pitched sound
What are you identifying when assessing quality?
Vesicular (normal)
Bronchial ( harsh sounding)
What does reduce air sound indicate?
Fluid/ consolidation or collapse of the lungs
What should you examine at the end?
Sacral and ankle oedema
What are your end pieces?
PEFR
Chest Xray
Measure temperature, BP, Oxygen sats
Cardiovascular examination
What are the key questions to ask of suspected DVT?
1) Been on a long hall flight?
2) Which leg and where is the pain/symptoms?
3) Are you on COCP and for how long?
4) When was your last period (too rule out pregnancy)
5) Do you stand up for a long period of time?
What key questions do you ask about long hual flights regarding DVT?
How long?
What were you doing on the flight? Did you walk around or where you sleeping the whole time?
Did you wear flight socks?
What heart failure questions do you as in a history?
Swelling of the ankles?
Have to prop your self up at night to sleep?
Wake up gasping for air at night and coughing?
More breathlessness?
Coughing and producing any thing?
Any heart problems= if they have had surgery ask what for
What should you always ask about in a history?
Weight loss
fever
night sweats
What should you ask female?
If they are on COCP, HRT or when there last period was (pregnancy)
All increae chance of DVT/PE
What two broad questions should you ask regarding exacerbating factors for respiratory condition?
Long hual flight
Pets
If you ask about weight loss what other question do you ask aswell?
appetite
What questions do you in haemoptysis history to exclude other causes?
Travel leg swelling Pleuretic chest pain Purulent sputum (green grey colour) Pyrexia
What are the important assoicated symptoms of haemoptysis?
WL/appetite Pain SOB Cough Sputum and mix with blood
