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Respiratory Flashcards

1
Q

If a pt must prop themselves up or sit up while sleeping, what should you consider?

A

orthopnea

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2
Q

What is orthopnea?

A

dyspnea while laying down

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3
Q

Wet or moist coughs are often associated with what?

A

lung infxn

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4
Q

If a pt say they have a pink or reddish phlegm when hey cough what is this most assoc. w/?

A

TB

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5
Q

What color phlegm would you expect with a pt who has a lung infxn?

A

yellow or green mucus

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6
Q

Sara says she began coughing phlegm a week ago but in the last 2 days the phlegm is increasing what could this be a sign of?

A

respiratory disease

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7
Q

Kevin came into the clinic complaining of pain while coughing when you asked during your assessment if he is pain while coughing. What do you know about Kevin and his pain?

A

His pain may occur because of muscle pain or indicative of an underlying lung disease so follow up with more questions

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8
Q

Why is it important to ask about nutritional status during a focused respiratory assessment?

A

to determine the contribution of erythopoiesis and Hgb

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9
Q

During inspection, what are you assessing?

A
  1. skin color
  2. structure of the thoracic cavity
  3. chest configuration
  4. RR (rhythm, rate, and effort)
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10
Q

What is the normal rate of breathing for an adult?

A

12-20

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11
Q

What is the normal rate of breathing for an infant?

A

80+

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12
Q

What is the angle of the costal angle normally?

A

less than 90 degrees

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13
Q

if you pt comes in with discoloration of the mouth slightly blue, what does this look like to you? What do you assess for immediately?

A

this looks like circumoral cyanosis. I should assess the pt for hypoxia or respiratory distress

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14
Q

When you are assessing the respiratory what is the best position for your pt?

A

sitting position with gown and drape

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15
Q

Your pt claims that she has scoliosis, during your assessment what may you see with the clavicles?

A

misalignment causes by deviations in the vertebral column

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16
Q

James says that he has COPD, what do you know about the costal angle?

A

its larger than 90 degrees

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17
Q

During your assessment you notices the lateral deviation of the spine and elevation of one scapula, what may this indicate?

A

scoliosis

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18
Q

What type of breathing is seen in a obese pt?

A

respirations may be shallow and rapid

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19
Q

What is crepitus?

A

crunching feeling under the skin caused by air leaking into subq tissue

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20
Q

How do I palpate the posterior thorax?

A

use the finger pads and lightly palpate beginning with the area above scapula then in a Z fashion palpate the posterior thorax

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21
Q

When I palpate the post. thorax what am I assessing?

A

assess for

  1. muscle mass
  2. growth, nodules, and masses
  3. tenderness
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22
Q

What is fremitus?

A

the palpable vibration on the chest wall when the pt speaks

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23
Q

How do you palpate for tactile fremitus?

A

place hands on various areas of the chest while the pt is saying 99 or 1,2,3

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24
Q

What is the result of a decreased or absent fremitus? Causation?

A

soft voice caused by a very thick chest wall from obesity or from an underlying disease (COPD & pleural effusion)

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25
While palpating the chest you notice it is increased, what do you consider?
this occurs with fluid in the lungs, fibrosis, tumor or infxn
26
What is the difference is using one hand vs 2 hands while assessing for tactile fremitus?
one hand allows for more accuracy while 2 hands increases speed and facilitate identification of asymmetry
27
What is the purpose of percussing the lungs?
allows assessment of underlying structures
28
What is the usual sound of the lungs when percussing?
resonance
29
Describe resonance
a long, low-pitched hollow sound
30
Describe hyperresponance
heard in conditions of overinflation of the lungs
31
What conditions would you hear hyperresonance in a pt?
1. Emphysema | 2. Pneumothorax
32
What is the position of the pt to percuss the post. thorax?
pt should lean forward and round the shoulder
33
When percussing yield dull sounds?
over solidified or fluid-filled areas
34
In what conditions will I hear dull sounds?
1. pleural effusions | 2. during percussion when you move to the left you will hear superficial cardiac dullness
35
If you percuss over bone what can you expect to hear?
flat sounds
36
What are some conditions in which the movement of the diaphragm may decrease?
1. emphysema 2. atelectasis 3. respiratory depression
37
Describe tracheal sounds
harsh, high-pitched sounds heard during inhalation and exhalation
38
Describe bronchial sounds
loud, high-pitches sounds next to the trachea
39
Describe bronchovesiclar sounds
med in loudness and pitch heard between the scapulae (post) and next to the sternum (ant.); equal in inspiration and expiration
40
Describe vesicular sounds
soft and low-pitched heard over the remainder of the lungs; inspiration> expiration
41
During auscultation you hear diminished lung sounds what may this indicate?
1. emphysema 2. bronchospasm 3. shallow breath
42
If a pt is experiencing atelectasis what are some sounds you may hear?
may produce diminished lung sounds or popping sound at end- inspiration if the atelectatic alveoli re-expand
43
If Jon has breath sounds in just one lung, what may this indicate?
1. pleural effusion 2. pneumothorax 3. tumor 4. mucus plugs in the airways of the other lung
44
Describe fine crackles/rales
high-pitched short crackling caused by collapsed or fluid-filled alveoli opening occurring at the end of inspiration and not clear with cough
45
Describe coarse crackles. rales
loud, moist, low-pitched, bubbling due to a collapsed or fluid or filled alveoli open occurring at the end of inspiration and does not clear with cough
46
Describe wheezes
high-pitched continuous due to blocked airflow as in asthma, infxn, foreign body obs. occurring during expiration and inspiration when severe
47
Describe rhonci
low-pitched, continuous, snoring, and ratting due to fluid-blocked airways occurring during expiration or inspiration w/ changing or disappearing w/ cough
48
Describe stridor
loud, high-pitched crowing heard w/o stethoscope caused by obst. upper airway during inspiration
49
Describe friction
low-pitched grating and rubbing caused by pleural inflammation heard during inhalation or expiration
50
Voices sound if a pt says 99 and the sound is muffled
Bronchophony
51
With your stethoscope you hear eeeeeeee when the pt says the letter "E"
Egophony
52
With your stethoscope you hear muffled sounds when the pt whispers 1,2,3
Whispered Pectoriloquy
53
What position should be in for palpation of the ant and lateral thorax, if the pt is not experiencing dyspnea?
supine
54
Describe Eupnea
inspiration=expiration; normal breathing and pattern
55
Describe Tachypnea
RR>24 | - rapid, shallow respirations
56
What are some precipitating factors for tachypnea?
- fever - fear - exercise - respiratory insufficiency - pleuritic pain - alkalosis - pneumonia
57
Describe bradypnea
RR<10 with slow and regular respirations
58
Precipitating factos for bradypnea
- diabetic coma - drug-induced respiratory depression - ICP
59
Describe hyperventilation
RR>24 w/ rapid and deep respirations
60
Precipitating factors for hyperventilation
- extreme exertion - fear - diabetic ketoacidosis (Kussmal Respiration) - hypoxia - salicylate overdose - hypoglycemia
61
Describe hypoventilation
RR<10 irregular, shallow respiration
62
Precipitating factors for hypoventilation
- narcotic overdose - anesthetics - prolonged bed rest - splinting
63
Describe Cheyne- Stokes
periods of deep breathing altin w/ periods of apnea
64
Precipitating factors of Cheyne- Stokes
- normal children and aging - HF - Uremia - Brain damage - drug-induced resp. depression
65
Describe Biot's (Ataxia) Resp.
shallow, deep respirations w/ periods of apnea
66
Precipitating factors for Biot's Resp.
- resp. depression and brain damage
67
Describe obs. breathing
prolonged expiration
68
Precipitating factors
- COPD - Asthma - Chronic Bronchitis
69
When does barrel chest occur?
normally w/ age and COPD
70
When is funnel chest (Pectus Excavatum)?
congenital deformity characterized by depression of the sternum and adj. costal cartilage if severe, murmurs may occur
71
Kyphosis
"hunchback" associated with aging which can decrease lung expansion and increase cardiac problems
72
Pigeon Chest (Pectus Carinatum)
forward displacement of the sternum
73
``` Your pt was admitted showing the follow Si/Sx: - diminished breath sounds - RR of 30 - O2 sat is 78 - wheezing heard with stethoscope C/o of: SOB, Anxiety, and chest pain What would you consider? ```
Asthma
74
``` Pt: C/O: Dyspnea Si/Sx: - decrease or absent breath sounds - RR of 33 -O2 sat is 78 - during percussion you hear dullness What would you consider? ```
Atelectasis
75
``` Pt c/o that she is tired and exhibits the following SI/SX - chronic productive cough - wheezing - rhonchi - edemal plethora - RR >24 What would you consider? ```
Chronic Bronchitis
76
Emphysema is a condition of chronic inflammation of the lungs leading to destruction of the the alveoli, what are some SI/Sx and what your pt c/o?
``` C/O- SOB and "air hunger" SiSx - barrel chest - cyanosis - hypercabia (increased CO2) - clubbing - diminished breath sounds ```
77
``` Pt was admitted c/o of fatigue, chills, and dyspnea. In your assessment you notice the following: - temp 102 - cough w/ green phlegm - O2 of 77 - crackles in the RL lobe of the lung - dullness to percuss What do you recognize this as? ```
lobar pneumonia
78
Your pt has air moving into the pleural space causing partial or complete collapse of the lung. What do you recognize this as? Si/Sx?
``` pneumothorax Si/Sx - increase RR - decrease O2 - Hyperresonance to percuss over affected area - diminished or absent breath sounds over affected area - decrease chest wall expansion - SOB - sharp pain with inspiration ```
79
Your pt in room 214 was admitted for LHF c/o of SOB, orthopnea and anxiety. What are some things you may notice during your assessment?
- increased RR - decreased O2 - Pulmonary congestion - pallor - decreased chest wall on the affected side
80
What is pleural effusion?
a fluid accumulation in the pleural space
81
Si/Sx of pleural effusion
- cough - diminished or absent breath sounds - dullness to percuss - decreased or absent tactile fremitus - no voice transmission - SOB Occasional sharp chest pain
82
When assessing the respiratory what are 2 focuses?
1. airflow | 2. vesicular sounds
83
What are 3 ER situations?
1. choking 2. post-op PE 3. Pneumothorax
84
Describe tympany
Drum-like sound, empty quality
85
Dull lung sounds are heard where?
Partially consolidated lung tissues like pneumonia

Physical Assessment (10 decks)

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