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Health Assessment > Respiratory > Flashcards

Respiratory Flashcards

1
Q

4 major functions of respiratory system

A
  1. Supply oxygen to the body for energy production
  2. Removing carbon dioxide as a waste product of energy reactions
  3. Maintaining homeostasis (acid-base balance) of arterial blood
  4. Maintaining heat exchange (less important in humans)
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2
Q

Control of respirations

A

involuntary control of respirations is mediated by the respiratory center in the brainstem (pons and medulla)

the major feedback loop is the change in carbon dioxide and oxygen levels in the blood

the normal stimulus to breath for most people is an increase in carbon dioxide in the blood (hypercapnia)

decrease of oxygen in the blood (hypoxemia) also increases respiration but is less effective than hypercapnia

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3
Q

Chronic obstructive pulmonary disease

A

too much supplemental oxygen can cause or worsen hypercapnia in COPD patients

reducing the drive to breath

people with healthy lungs rely on high co2 levels to stimulate brain to breathe. People with COPD and high CO2 levels may become “less sensitive” to a high CO2 level

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4
Q

COPD patients

A

rely more on low oxygen levels to stimulate their breathing

giving too much oxygen removes this stimulus to breathe, thus reduces the removal of CO2 from the lungs

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5
Q

Aging Adult

A

thorax is less mobile

respiratory muscle strength declines after age 50s and continues to decrease into 50s

older adults are at increased risk for pneumonia due to decreased ability to cough, loss of protective airway reflexes and increased amount of secretions

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6
Q

older lungs

A

less elastic and more rigid

have fewer functional capillaries

have decreased lung resiliency

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7
Q

Dyspnea

A

(difficulty breathing)

COPD: Cant breathe or can’t take a deep breathe

Anxiety: feel like I am suffocating

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8
Q

Onset

A

Gradual onset seen with lung changes such as emphsema

sudden onset seen with viral or bacterial infections, acute asthma exacerbation, acute MI, pulmonary embolism(blockage of one of the pulmonary arteries in the lungs)

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9
Q

Orthopnea

A

Dyspnea when lying supine=heart failure

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10
Q

Paroxysmal nocturnal dyspnea

A

(severe dyspnea that awakens a person from sleep)=heart failure

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11
Q

Sleep Apnea

A

Fatigue, snoring and gasping sounds

diminishes the quality of sleep leading to fatigue, depression, irritability, loss of memory, lack of energy and increased risk for MVA or work injuries

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12
Q

Sleep Apnea consequences if left untreated

A

left untreated it can have serious and life-shortening consequences: high blood pressure, heart disease, stroke, diabetes, depression

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13
Q

Coughs

A

continuous coughs are usually associated with acute infections

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14
Q

Early morning coughing

A

is associated with chronic bronchial inflammation or smoking

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15
Q

Late evening coughing

A

usually the result of exposure to irritants during the day

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16
Q

Coughing at night

A

related to postnasal drip or sinusitis

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17
Q

Nonproductive coughs

A

are usually associated with upper respiratory irritations or early congestive heart failure

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18
Q

White Sputum

A

seen with colds, viral infections or bronchitis

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19
Q

Yellow or green Sputum

A

associated with bacterial infections

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20
Q

Brown or black sputum

A

associated with blood (hemoptysis) and seen in serious respiratory infections

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21
Q

Rust Sputum

A

colored is seen in TB or pneumoccal pneumonia

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22
Q

Pink Sputum

A

frothy sputum is seen in pulmonary edema

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23
Q

Wheezing

A

indicates narrowed airways due to spasm or obstruction

is associated with CHF, asthma or excessive secretions

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24
Q

Nasal flaring

A

seen with labored respirations especially in small children

indicative of hypoxia

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25
Q

Pursed lip breathing

A

may be seen in asthma, emphysema or CHF as a physiologic response to slow down expiration and keep the alveoli open longer

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26
Q

Purple complexion

A

ruddy to purple complexion is seen in patients with COPD or CHF as a result of polycythemia

cyanosis is seen in patients who are cold or hypoxic

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27
Q

Barrel Chest

A

AP ratio of 1:1 is called barrel chest and is a result of emphysema and the hyperinflation of the lungs

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28
Q

Kyphosis

A

is an increased curve of the thoracic spine seen in older adults caused by a loss of lung resiliency and loss of skeletal muscle

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29
Q

Kyphosis symptoms

A

can cause significant back pain and limited mobility

severe deformities impair cardiovascular function

example of compensation by hyperextension of head to maintain level of vision

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30
Q

Precuts Carinatum

A

Forward profusion of the sternum

called pigeon chest

more rare than Pectus Excavatum

requires no treatment, but if severe surgery is an option

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31
Q

Pecuts Excavatum

A

Markedly sunken sternum

more notable on inspiration

usually congenital and not symptomatic

severe sternal depression can be a source of embarrassment and distressing especially to adolescent boys

surgery may be indicated

32
Q

Scoliosis

A

is a lateral deviation of the spine

deviation may cause individuals to have body image disturbances as shoulder and hip may be elevated

in severe cases of spinal curvature, respiratory compromise can occur

33
Q

Tripod Position

A

Patient will lean forward (enhances use of accessory muscles and use arms to support weight and lift chest to increase breathing capacity)

often seen with COPD

34
Q

Eupnea

A

Regular unlabored pattern with a rate of 12 to 20

35
Q

Tachypnea

A

More than 24 breaths per minute

seen with fever, anxiety, respiratory insufficiency, pain

first sign of respiratory distress

36
Q

Bradypnea

A

less than 10 breaths per minute and regular

Normal in well conditioned athletes

seen with narcotic use, diabetic coma and increased intracranial pressure

37
Q

Apnea

A

Absence of breathing

38
Q

Hypoventilation

A

decreased rate, decreased depth and irregular pattern

usually associated with narcotics or anesthesia

39
Q

Hyperventillation

A

increased rate and depth

usually occurs with extreme exercise, fear, or anxiety

is seen in disorders of the CNS, aspirin overdose, hypoxia, hypoglycemia, acidosis and infection

40
Q

Kussmau

A

rapid, deep, labored

hyperventilation associated with diabetic ketoacidosis

41
Q

Biot Respiration

A

Irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea

seen with meningitis or severe brain damage

head trauma

42
Q

Cheyene-Stokes Respirations

A

Regular pattern characterized by alternating periods of deep, rapid breathing followed by periods of apnea

may result from severe congestive heart failure, drug overdose, increased ICP or renal failure

43
Q

Ataxic

A

Significant disorganization with irregular and varying depth of respiration

indicates respiratory compromise

breathing of a dying patient

44
Q

Characteristics of respiratory distress

A

Anxious expression

nasal flaring

circumoral cyanosis

sternocleidomastoid contractions

substernal and intercostal retractions

hyper expanded chest

45
Q

Tenderness and sensation

A

muscle soreness from excessive work of breathing may be palpated as tenderness

increased warmth can be a sign of infectoin

46
Q

Crepitus

A

Crepitus, also called subcutaneous emphysema is a cracking sensation that occurs when air escapes into subcutaneous tissue

47
Q

When does crepitus occur

A

after thoracic injury, around a chest tube, or tracheotomy

it can also be palpated in areas of extreme congestion or consolidation as air passes through the exudate

48
Q

Unequal chest expansion

A

can occur with severe atelectasis (collapse or incomplete expansion), pneumonia, chest trauma or pneumothorax (air in the pleural space)

might guard to prevent pain cuz of the trauma

49
Q

Decreased chest expansion

A

(excursion) at the base of the lungs is characteristics of COPD due to decreased function of the diaphragm

50
Q

Resonance

A

the percussion tone elicited over normal lung tissue

low pitched, hollow sounds heard over normal lung tissue (resonant sounds)

51
Q

hyperresonance

A

is elicted in cases of trapped air such as emphysema or a pneumothorax

indicate increased air in the lungs or pleural space

the louder and lower pitched than resonant sounds

52
Q

Flatness in percussion of lungs

A

is over bone

53
Q

Dullness

A

is present over fluid or solid tissue

this can be an organ when dullness is heard in a pleural space it backs be a sign of lobar pneumonia, pleural effusion or tumor

heard over airless tissue and can be replicated by percussing the thigh or bony structure

54
Q

Auscultate for Breath sounds

A

Do. not attempt to listen through clothing

ask patient to breath deeply through their mouth for each are of auscultation

listen to inspiration and expiration at each point

55
Q

Bronchial Normal breath sounds

A 
Location: trachea and thorax
Pitch: High
Quality: Harsh or Hollow 
Amplitude: Loud 
Duration: Short on inspiration, long on expiration
56
Q

Vesicular Normal breath sounds

A 
Location: Peripheral lung fields
Pitch: low 
Quality:Breezy
Amplitude: soft
Duration: long in inspiration and short in expiration
57
Q

Bronchovesicular Normal breath sounds

A

Location:over major bronchi

posterior: Between the scapulae
anterior: around the sternum in the 1st and 2nd ICS

pitch: moderate
quality: mixed
amplitude: moderate
duration: same during inspiration and expiration

58
Q

Adventitious sounds

A

these are sounds added or superimposed over normal breath sounds

fine crackles, coarse crackles, pleural friction rub, wheezes, stridor, and atelectatic crackles

59
Q

Fine crackles

A

High pitched short popping sounds heard during inspiration

not cleared with coughing

associated with restrictive diseases and obstructive disorders

60
Q

Coarse crackles

A

low pitched, bubbling, moist sounds that persist from inspiration through expiration

sounds like velcro

conditions where inhaled air comes into contact with secretions like pneumonia, pulmonary edema, pulmonary fibrosis

61
Q

Pleural Friction Rub

A

Low pitched, dry, grating sound

occurs during both inspiration and expiration

results of rubbing two inflamed pleural surfaces

seen in pleuritis

62
Q

Wheezes Siblant

A

(sibilant)

high pitched musical sounds heart primarily during expiration

air is passing through constricted passages (constriction of the airways)

heard in acute asthma or chronic emphysema

may signal asthma

63
Q

Wheeze Sonorous Ronchi

A

Low pitched snoring or moaning heard primarily during expiration but may be heard throughout the respiratory cycle

these wheezes may clear with coughing

heard in cases of bronchitis or single obstructions, snoring before an episode of sleep

64
Q

Stridor

A

A high pitched, whistling sound most often heard while taking in a breath

airflow is disrupted by a blockage in the larynx (voice box) or trachea (windpipe)

seen with severe Broncholaryngospasm- croup

65
Q

Atelectatic Crackles

A

(morning rales)

not pathologic

short, popping, crackling sounds that last only a few breaths

when sections of alveoli are not fully inflated, they deflate slightly and accumulate secretions

will usually disappear if patient coughs or take several deep breaths

may result from pulmonary congestion

66
Q

Bronchophony

A

Ask the patient to repeat 99 while listening

voice should sound soft, muffled, and indistinct

if the words are easily understood and louder in areas of increased density this could indicate consolidation(liquid)

conditions:pneumonia, atelectasis or tumor

67
Q

Egophony

A

ask a patient to repeat the letter “E” while you listen

voice should be soft, muffled and “E” indistinguishable

over areas of consolidation(liquid) or compression it sounds like “A”

68
Q

Whispered Pectoriloquy

A

Ask the patient to whisper a phrase like 1-2-3 while you listen

transmission of sound should be faint and muffled

over areas of consolidation(liquid) or compression, the sound is clearly transmitted and distinct
-sounds like the patient is whispering into the stethoscope

69
Q

Pneumothorax

A

X ray of collapsed lung.

Alveoli are deflated and no air exchange occurs in the lung so breath sounds in the lung are absent.

unequal chest expanision

hyperressonance on percussion

decreased fermitus or absent

breath/voice sounds decreased or absent

trachea would be pushed away from the pneumothorax to the unaffected side

70
Q

Atelectasis

A

“white out”

a section of alveoli collapses due to obstruction, like thick mucous, or a foreign body. can also collapse in a newborn due to lack of surfactant

expansion of the affected side will lag

Decreased tactile fremitus or absent over affected area

dullness on percussion over the area

breath and voice sounds will be decreased or absent

trachea would be pulled toward the atelectasis (affected side)

71
Q

Pneumonia

A

on the chest x ray there is an ill defined area of increased density in the right upper lobe

alveoli are now filled with bacteria, cellular debris, fluid and blood. If enough of the alveoli fill, the patient will have less surface area of the lung for oxygenation=hypoxemia

asymmetrical chest expansion decrease on affected side

increased tactile fremitus

dulness on percussion over affected lobes

breath sounds will be louder with crackles

voice sounds: bronco phony, ego phony, whispered pectoriloquy will all be heard clearly

72
Q

Emphysema

A

(COPD)

caused by destruction of pulmonary connective tissue

results in “air trapping”-hyperinflated lungs

barrel chest-use of accessory muscles-tripod

decreased tactile fremitus and chest expansion

decreased breath sounds

hyper resonant on percussion

73
Q

Use of accessory muscles

A

The use of accessory muscles for respiration indicates the client is having difficulty breathing

74
Q

Diaphragmatic and pursed-lip breathing

A

two controlled breathing techniques that help the client conserve energy

75
Q

Fremitus

A

the feeling of vibrations while the patient says 99. Percent

76
Q

Smoking

A

obstructive airway disease

Health Assessment (9 decks)

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