Respiratory Flashcards
What is hypopnea
Decreased depth (shallow) and rate (slow) of respiration
Bradypnea
Regular rhythm but slower than normal rate (RR < 14/min)
Hyperpnea
Increased depth (deep) of breathing and rate (fast) of respiration (normal in exercise)
tachypnea
Rapid breathing (RR>20-25/min)
dyspnea
Feeling short of breath
hypoxia
Deficiency in the amt of O 2
reaching the tissues
hypoxemia
oxygen deficiency in arterial blood
apnea
no breathing
Atelectasis
collapse of lung tissue that affects the alveoli from normal O2 absorption
Pleximeter finger
hyperextended middle finger of non-dominant hand in percussion
Plexor finger
“tapping” finger, dominant hand, for percussion
Where do you insert:
1) Needle thoracentesis
2) Chest tube
1) Needle thoracentesis: 2nd IC space, midclavicular for pressure and then 7th for fluid aspiration
2) Chest tube: 4th IC mid or anterior axillary line
Where is the lower margin of the endotracheal tube on a chest xray?
T4
What is the 7th IC space a landmark for?
Thoracentesis for fluid aspiration
What are some respiratory symptom considerations?
Chest pain Shortness of breath: (SOB or dyspnea) with or without activity Cough (productive? color?) Wheezing Hemoptysis (coughing up blood) Asthma Pneumonia
What is the order of a lower respiratory track exam?
inspection
palpation
percussion
auscultaiton
Explain a puls Ox test. What are you measuring? What may interfer with this? What causes a bad wave?
measures peripheral arterial oxygen saturation (SpO 2)
interference from: Hypothermia (vasoconstriction and shivering)
bad wave caused by: Improper placement, hypoperfusion, hypothermia, motion artifact
Explain an end tidal CO2 test. What are you measuring? What may interfer with this? What causes a bad wave?
Measures ventilation, non-invasive measurement of the partial pressure of CO2 in exhaled breath as the CO2 concentration over time
NORMAL PETCO2, PaCO2 35-40 mmHg
What other things should you look at during physical exam?
- Sitting position and breathing
pattern. - Use of accessory Muscles
- Color of fingers and lips. Shape of nails.
- Breathing thru pursed lips.
- Ability to speak
- Chest deformities
- Spinal deformities
- Is the trachea in the mid-line
- Chest excursion
- Tactile fremitus
- Percussion
- Lung Sounds
- Lymphadenopathy
What is a normal breathign like? rate, rhythm, depth, and effort
Normal = 14-20 times/min, Regular,
Quiet, No distress or labor
What is cyanosis indicative of?
Bluish discoloration of skin and mucus membranes resulting from inadequate oxygenation of the blood.
What can a tracheal deviation indicate?
BIG ONE: Tension pneumothorax
also seen with:
Pleural effusion
Atelectasis
Mass
What causes clubbing of nails?
Congenital heart disease Interstitial lung disease Bronchiectasis Pulmonary fibrosis Cystic fibrosis Lung abscess Malignancy (Lung cancer) Inflammatory Bowel Disease
What is the difference between chronic bronchitis and emphysema (THINK: pink puffer and blue bloater)
CB: productive cough for 3+ months overweight, cyanotic, elevated hemoglobin, peripheral edema, coughing, wheezing
EMPH: older, thin, severe dyspnea, quiet chest, hyperinflation on XRAY
What does assymetrical chest expansion mean? retraction? unilateral lagging?
Asymmetrical expansion: pleural effusion
Retraction: severe asthma, COPD, or upper airway obstruction (stridor?)
Unilateral lagging: pleural disease (asbestosis, trauma, or phrenic nerve damage)
What is accessory muscle use? When is it seen?
Sign of respiratory distress Can see in Asthma, COPD, Airway obstruction, Viral illness (RSV)
How do you check of symmetrical thoracic expansion?
Place thumbs at level of 10th ribs, fingers loosely grasping and parallel to lateral rib cage, slide them medially just enough to raise a loose fold of skin on each side bw your thumb and spine
Ask the patient to inhale deeply, watch the distance bw your thumbs as they move apart during inspiration and feel for the range and symmetry of the rib cage as it expands and contracts
What is tactile fermitus? When is it decreased/absent? When is it increased?
Palpable vibrations (use ball of hands or ulnar surface), have patients say 99 or 1-1-1-
Decreased or absent: COPD, pleural changes
increased: pneumonia (consolidation)
What does it mean when your percussion of the lungs is dull and not resonant?
Fluid or solid tissue replaces air-containing lung or occupies space beneath percussing fingers
• Lobar pneumonia (alveoli filled with fluid and blood cells)
• Pleural accumulations: emphysema
What does it mean when your percussion of the lungs is hyperresonant and not resonant?
Chronic bronchitis COPD (especially emphysema) • Asthma
What does it mean when your percussion of the lungs is hyperresonant unilaterally and not resonant?
• Large Pneumothorax • Large air-filled bulla in lung (COPD/Emphysema)
What is the normal diaphragmatic excursion? What is asymmetry indicative of?
3-5.5 cm
Pleural effusion
High diaphragm secondary to: atelectasis or phrenic nerve paralysis
What does STRIDOR indicate?
Generally an inspiratory sound but can be expiratory or biphasic. Result form a narrowing in the upper airway
Common Causes Croup Epiglottitis Upper airway foreign body anaphylaxis
What does WHEEZING indicate?
Generally an expiratory sound but can be inspiratory or biphasic Continuous musical sounds Caused by rapid airflow through a narrowed bronchial airway
Common Causes Reactive airway disease (RAD) Asthma COPD
What do CRACKLES indicate?
An inspiratory sound Continuous musical sounds Thought to be caused by small airway closed during expiration, “popping” open during inspiration
Common causes Pneumonia, CHF, Atelectasis, pulmonary fibrosis, bronchiectasis, COPD, Asthma
What is atelectasis? When do you see it? What helps it?
the loss of lung volume due to the collapse of lung tissue (alveoli)
Can be seen post-surgery Post surgical fever consider atelectasis as the cause
IS(incentive spirometer) - helps with atelectasis, treatment and prevention
What does the incentive spirometer do?
Breath out all the way, breath in slowly and as deep as you can, move the ball inside the spirometer as high as you can. when you can’t breathe in anymore, hold breath for 2-5 seconds
What is normal vocal resonance like?
words are muffled and indistinct to auscultation
whispered words are faint and indistinct, if heard at all
when patient says “ee”, you hear a muffled long E on auscultation
What is bronchopony?
spoken words get louder
What is whispered pectoriloquy
whispered words are louder and clearer during auscultation
What is egophony?
when patient says “ee” it sounds like “A” (which is nasal and localized)
What is a pulmonary function test?
AKA sit inside a box and see how well your lungs work:
helpful to diagnose obstructive vs restrictive, NONINVASIVE
What are the A-I for Chest Xrays
A - Adequate, Airway Bones Cardiac Size Diaphragms Effusions, Endotracheal Tube, EKG Fields, Fissures, Foreign Body Great vessels Gastric bubble Hilar masses Impression
What do you percuss/auscultation on chest? What spots?
2 anterior posts, 1 right middle post, 4 posterior posts
What do these sound like:
1) vesicular breath sounds
2) bronchovesicular sounds
3) bronchial sounds
4) tracheal
1) vesicular breath sounds: soft, low pitched, heard through inspiration, 1/3 of expiration
2) bronchovesicular sounds: intermediate intensity and pitch, inspiration=expieration
3) bronchial sounds: loud and high pitched, expiratory > inspiratory
4) tracheal: loud, high pitched inspiration=expiration
