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Physical Assessment > Respiratory > Flashcards

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
Q

While palpating the chest you notice it is increased, what do you consider?

A

this occurs with fluid in the lungs, fibrosis, tumor or infxn

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26
Q

What is the difference is using one hand vs 2 hands while assessing for tactile fremitus?

A

one hand allows for more accuracy while 2 hands increases speed and facilitate identification of asymmetry

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27
Q

What is the purpose of percussing the lungs?

A

allows assessment of underlying structures

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28
Q

What is the usual sound of the lungs when percussing?

A

resonance

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29
Q

Describe resonance

A

a long, low-pitched hollow sound

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30
Q

Describe hyperresponance

A

heard in conditions of overinflation of the lungs

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31
Q

What conditions would you hear hyperresonance in a pt?

A
  1. Emphysema

2. Pneumothorax

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32
Q

What is the position of the pt to percuss the post. thorax?

A

pt should lean forward and round the shoulder

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33
Q

When percussing yield dull sounds?

A

over solidified or fluid-filled areas

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34
Q

In what conditions will I hear dull sounds?

A
  1. pleural effusions

2. during percussion when you move to the left you will hear superficial cardiac dullness

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35
Q

If you percuss over bone what can you expect to hear?

A

flat sounds

36
Q

What are some conditions in which the movement of the diaphragm may decrease?

A
  1. emphysema
  2. atelectasis
  3. respiratory depression
37
Q

Describe tracheal sounds

A

harsh, high-pitched sounds heard during inhalation and exhalation

38
Q

Describe bronchial sounds

A

loud, high-pitches sounds next to the trachea

39
Q

Describe bronchovesiclar sounds

A

med in loudness and pitch heard between the scapulae (post) and next to the sternum (ant.); equal in inspiration and expiration

40
Q

Describe vesicular sounds

A

soft and low-pitched heard over the remainder of the lungs; inspiration> expiration

41
Q

During auscultation you hear diminished lung sounds what may this indicate?

A
  1. emphysema
  2. bronchospasm
  3. shallow breath
42
Q

If a pt is experiencing atelectasis what are some sounds you may hear?

A

may produce diminished lung sounds or popping sound at end- inspiration if the atelectatic alveoli re-expand

43
Q

If Jon has breath sounds in just one lung, what may this indicate?

A
  1. pleural effusion
  2. pneumothorax
  3. tumor
  4. mucus plugs in the airways of the other lung
44
Q

Describe fine crackles/rales

A

high-pitched short crackling caused by collapsed or fluid-filled alveoli opening occurring at the end of inspiration and not clear with cough

45
Q

Describe coarse crackles. rales

A

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
Q

Describe wheezes

A

high-pitched continuous due to blocked airflow as in asthma, infxn, foreign body obs. occurring during expiration and inspiration when severe

47
Q

Describe rhonci

A

low-pitched, continuous, snoring, and ratting due to fluid-blocked airways occurring during expiration or inspiration w/ changing or disappearing w/ cough

48
Q

Describe stridor

A

loud, high-pitched crowing heard w/o stethoscope caused by obst. upper airway during inspiration

49
Q

Describe friction

A

low-pitched grating and rubbing caused by pleural inflammation heard during inhalation or expiration

50
Q

Voices sound if a pt says 99 and the sound is muffled

A

Bronchophony

51
Q

With your stethoscope you hear eeeeeeee when the pt says the letter “E”

A

Egophony

52
Q

With your stethoscope you hear muffled sounds when the pt whispers 1,2,3

A

Whispered Pectoriloquy

53
Q

What position should be in for palpation of the ant and lateral thorax, if the pt is not experiencing dyspnea?

A

supine

54
Q

Describe Eupnea

A

inspiration=expiration; normal breathing and pattern

55
Q

Describe Tachypnea

A

RR>24

- rapid, shallow respirations

56
Q

What are some precipitating factors for tachypnea?

A
  • fever
  • fear
  • exercise
  • respiratory insufficiency
  • pleuritic pain
  • alkalosis
  • pneumonia
57
Q

Describe bradypnea

A

RR<10 with slow and regular respirations

58
Q

Precipitating factos for bradypnea

A
  • diabetic coma
  • drug-induced respiratory depression
  • ICP
59
Q

Describe hyperventilation

A

RR>24 w/ rapid and deep respirations

60
Q

Precipitating factors for hyperventilation

A
  • extreme exertion
  • fear
  • diabetic ketoacidosis (Kussmal Respiration)
  • hypoxia
  • salicylate overdose
  • hypoglycemia
61
Q

Describe hypoventilation

A

RR<10 irregular, shallow respiration

62
Q

Precipitating factors for hypoventilation

A
  • narcotic overdose
  • anesthetics
  • prolonged bed rest
  • splinting
63
Q

Describe Cheyne- Stokes

A

periods of deep breathing altin w/ periods of apnea

64
Q

Precipitating factors of Cheyne- Stokes

A
  • normal children and aging
  • HF
  • Uremia
  • Brain damage
  • drug-induced resp. depression
65
Q

Describe Biot’s (Ataxia) Resp.

A

shallow, deep respirations w/ periods of apnea

66
Q

Precipitating factors for Biot’s Resp.

A
  • resp. depression and brain damage
67
Q

Describe obs. breathing

A

prolonged expiration

68
Q

Precipitating factors

A
  • COPD
  • Asthma
  • Chronic Bronchitis
69
Q

When does barrel chest occur?

A

normally w/ age and COPD

70
Q

When is funnel chest (Pectus Excavatum)?

A

congenital deformity characterized by depression of the sternum and adj. costal cartilage if severe, murmurs may occur

71
Q

Kyphosis

A

“hunchback” associated with aging which can decrease lung expansion and increase cardiac problems

72
Q

Pigeon Chest (Pectus Carinatum)

A

forward displacement of the sternum

73
Q 
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?
A

Asthma

74
Q 
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?
A

Atelectasis

75
Q 
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?
A

Chronic Bronchitis

76
Q

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?

A 
C/O- SOB and "air hunger"
SiSx 
- barrel chest 
- cyanosis 
- hypercabia (increased CO2)
- clubbing 
- diminished breath sounds
77
Q 
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?
A

lobar pneumonia

78
Q

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?

A 
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
Q

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?

A
  • increased RR
  • decreased O2
  • Pulmonary congestion
  • pallor
  • decreased chest wall on the affected side
80
Q

What is pleural effusion?

A

a fluid accumulation in the pleural space

81
Q

Si/Sx of pleural effusion

A
  • cough
  • diminished or absent breath sounds
  • dullness to percuss
  • decreased or absent tactile fremitus
  • no voice transmission
  • SOB
    Occasional sharp chest pain
82
Q

When assessing the respiratory what are 2 focuses?

A
  1. airflow

2. vesicular sounds

83
Q

What are 3 ER situations?

A
  1. choking
  2. post-op PE
  3. Pneumothorax
84
Q

Describe tympany

A

Drum-like sound, empty quality

85
Q

Dull lung sounds are heard where?

A

Partially consolidated lung tissues like pneumonia

Physical Assessment (10 decks)

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