respiratory Flashcards
hands + arms
tar staining warmth cyanosis finger clubbing cap refill tremors pulse + resp rate
warm and sweaty hands
co2 retention
cool hands
poor peripheral perfusion
resp causes finger clubbing
lung ca
interstitial lung disease
CF
bronchiecstasis
reps cause fine tremor
beta-2-agonist use (salbutamol)
resp cause flapping tremor
co2 retention
head + face
conjunctivae: anaemia
tongue + lips: cyanosis
face: redness, swollen tonsils
facial features of Horner’s syndrome
ptosis
miosis
enopthalmos
neck
tracheal position
crico-sternal distance
lymph nodes
causes tracheal deviation
pneumothorax
pleural effusion
examination back of chest
inspection chest expansion percussion auscultate vocal resonance
palpation front chesr
tracheal position
crico-sternal distance
apex beat
chest expansion
causes of reduced chest expansion
pulmonary fibrosis
pneumothorax
pneumonia
pleural effusion
percussion notes
resonant: normal
dullness: consolidation, lobar collapse
stoney-dullness: pleural effusion
hyper-resonance: decreased tissue density e.g. pneumothorax
vesicular breath ounds
normal
bronchial breath sounds
harsh sounding
associated with consolidation
added breath sounds
wheeze
stridor
coarse crackles
crepitations
increased vocal resonance
increased tissue density; consolidation, tumour
decreased vocal resonance
pleural effusion
pneumothorax
resp systemic enquiry
cough sputum heamoptysis SOB wheeze chest pain (pleuritic) earache sore throat
resp causes SOB
pneumonia, COPD, asthma
resp causes productive cough
pneumonia
COPD
bronchiecstais
resp causes dry cough
pulmonary fibrosis
resp causes haemoptysis
lung Ca
causes wheeze
asthma
COPD
pleuritic chest pain cuases
PE
pleurisy
using peak flow meter
- stand up if can
- zero device
- maximum inspiration
- airtight seal around mouthpiece, hold meter horizontal and so fingers don’t touch slide
- forcefully exhale as fast as can
- note reading from scale
- use best reading out of 3 for chart
recognising normal PEFR
look on chart and read for patient age, sex and height
M: 100l/min below average is okay
F: 85l/min below average is okay
4 core inhaler groups
pressurised metered dose inhaler
pMDI with spacer device
breath accutated pressuriesed metered dose inhaler
dry powder inhaler
using pMDI
- sit/stand upright and lift chin
- remove cap and shake
- breath out
- mouthpeice in mouth
- breath in and press down canister
- hold breath ~10s
- if need 2nd dose wait 30-60s
using pMDI with spacer
- remove cap, shake and insert into spacer
- mouthpiece in mouth
- ensure valve opens with breathing (clicking noise)
- press down canister
- slow breath in, hold ~10s
- breath out through mouthpeice
- wait 30-60s if having 2nd dose
using turbohaler
- check dose counter
- open and unscrew lid
- load dose: turn base fully anticlockwise then fully clockwise until clicks
- breath out
- mouthpiece in mouth
- strong fast breath in
- hold breath 10s
- breath out gently
obstructive spirometry pattern
FEV1 <80%
FEV reduced but less so
FEV1/FEV ratio reduced
causes of obstructive lung disease
COPD
asthma
emphysema
bronchiecstasis
restrictive spirometry pattern
FEV1 <80%
FEV<80%
FEV1/FEV ratio normal
restrictive lung disease causes
pulmonary fibrosis
pulmonary oedema
