Respiratory Flashcards
Demonstrate how you would investigate symmetrical inflation of the lung and describe the anatomical basis.
In both visual and chest movement tests - looking for asymmetrical expansion. Patient should be sitting on the edge of couch/chair
Visual observation of movements of the anterior chest wall. Observe the movements of the rib cage and sternum during:
Quiet and deep breathing
Chest movements:
1) Examiner stands facing the patient.
2) Place hands on the subjects anterior chest wall (just below 5th or 6th ribs) with fingers extended around the side of the chest. Thumbs should meet at the anterior midline.
3) Ask the patient to take a deep breath and observe how far the tips of the examiners thumb moves apart (about 5 cm). They should move equally apart
4) Repeat this process posterior at the vertebral level T10. (T7 is the inferior angle of the scapula)
Movement of anterior chest wall = Upper and middle lobes
Movement of posterior chest wall = lower lobe
Observe and describe the breathing pattern and breathing rate.
Measure the rate of movement of the anterior chest wall for 60 seconds while the subject breathes quietly. Do this without the patient being aware. Pretend you are measuring the pulse.
Demonstrate percussion of upper/lower/middle lobe(s) of right/left lungs.
Hollow drum-like sound over air filled spaces
Dull sound over solid organs or over liquid
Percussion of chest wall anteriorly is easier if they are in the supine position.
Percussion of the chest wall posteriorly is easier if they are sitting on the edge of the couch.
See diagram for sites of percussion - learn order of the different sites
Describe where you would auscultate upper/middle/lower lobe(s) of right/left lungs.
If necessary ask the subject to take deep breaths through the open mouth. The diaphragm is used to examine all areas apart from the apex where the bell is used.
The bronchial breath sounds over the trachea has a higher pitch, louder, inspiration and expiration are equal and there is a pause between inspiration and expiration. This is done over the trachea, manubrium and sternal angle. The vesicular breathing is heard over the thorax, lower pitched and softer than bronchial breathing.
In females the lower lobes of on the anterior chest walls are below the base of the breast. (6th rib)
Use stethoscope: Demonstrate where you would auscultate upper/middle/lower lobe(s) of right/left lungs
See diagram - Anterior chest wall: 3rd, 5th and 6th ICS = Superior, middle and lower lobe.
Describe and demonstrate the surface marking of upper, middle, lower lobe of right/left lungs.
Right lung:
Describe and demonstrate the surface marking of oblique and horizontal fissure of right/left lung.
Mark two points OF1 and OF2.
OF1) Posteriorly - lung border at the level of spine T3
OF2) Anteriorly - lower border of the lung at the 6th intercostal cartilage
Join these two point together with a smooth curved line running around the lateral thoracic wall - oblique fissure
The horizontal fissure (right lung):
1) Palpate the 4th costal cartilage on the right side
2) Draw a line along the 4th costal cartilage and rib backwards to meet the oblique fissure in the mid-axillary line
Describe and demonstrate the surface marking of inferior margin of parietal pleura of right/left lung.
Right parietal pleura:
See ibook with full steps
Left parietal pleura
Mark all the points similarly to the right with the following exceptions: at (D) and (E), the pleura deflects sharply to the left to allow for the cardiac notch of the left lung
Describe and demonstrate the surface marking of inferior margin of the visceral pleura of right/left lung.
The visceral pleura is closely associated with the lungs - so look at lungs surface markings
Describe and demonstrate the triangle of safety for a chest drain.
The borders of the safe triangle for a chest drain:
Posterior - latissimus dorsi - posterior axillary fold
Anterior - Pectoralis major - anterior axillary fold
Inferior - 5th intercostal space at mid-axillary line
Superior - below apex of axilla
Needle points at the 2nd, 3rd, 4th and 5th ICS, midaxillary line, above the border or rib, upwards and medially.
Describe and demonstrate the surface marking and palpation of of the trachea at the suprasternal notch
1) Examiner should stand facing the subject
2) Palpate with index finger (of right hand) from the jugular notch
3) Is the trachea palpable in the midline
