Respiratory Flashcards
Lung major function
Provides continuous gas exchange
Three processes in lungs
Ventilation
Perfusion
Diffusion
Upper airway filters what?
Airborne particles, humidifies & warms inspired gases
Lower airway serves?
for gas exchange
Respiration is controlled by
brainstem
Accessory muscles of inspiration
SCM
Scalene
Intercostals
Expiration is
passive
Diaphragm is what?
primary muscle of inspiration
Diaphragm contracts
moves down
Exhale: moves up
Before beginning exam (4 things)
Quiet environment
Proper positioning
Bare skin for auscultation
Patient comfort
Observe pt breathing patterns
Rate
Depth
Effort
Assess what else?
A-P diameter
patients color
Pertinent History
Chronic conditions Exposure to a new medication Recent change in diet Substance abuse/overdose Prior DVT, PE Recent trauma to chest
Abnormal retractions of interspaces during respiration
Retractions: sinking in of soft tissues
Lower interspaces
Supraclavicular in acute asthma exacerbation
Impaired respiratory movement
Flail Chest & paradoxical
i. Put thumbs about 2 in apart on back
ii. Have them take a breath
iii. The thumbs should move up symmetrically
Chest excursion
- Sounds waves when you talk cause vibrations
2. Use ulnar surface of hand
vocal or tactile remits (palpable vibrations)
Percussion helps to identify
Underlying tissues are air-filled, fluid-filled, or solid
when fluid or solid tissue replaces air containing lung
Dullness
Examples of dullness sounds
i. Pleural Effusions
ii. Hemothorax (blood in one cavity of lung)
iii. Tumor
Example of Unilateral Hyperresonance
Pneumothorax
More air
Hyperresonance
Example of generalized hyperresonance
COPD
Ausculation: how many locations
8 anterior, 8 lateral
10 posterior
Where do you start auscultating?
posteriorly & symmetrically
Should listen to at least
6 locations anteriorly and posteriorly
Normal breath sounds
Bronchial
Bronchovesicular
Vesicular
- heard over trachea, high-pitched
2. expiration > inspiration
i. Bronchial
- heard over major bronchi, between the scapulae, around the sternum, medium-pitched
- inspiration = expiration
ii. Bronchovesicular
- heard over peripheral lung fields, soft-pitched
2. inspiration > expiration
Vesicular
Abnormal Sounds
Absent
Decreased
Bronchial (if heard in other locations of lung)
- Discontinuous, intermittent, nonmusical, brief sounds
heard with inspiration
more at bases
Crackles
Crackles caused by
air moving through secretions and collapsed alveoli
Associated conditions with crackles
- pulmonary edema and early heart failure, pneumonia, fluid
- Continuous, high pitched, musical sound, longer than crackles
heard greater with expiration
Wheeze
Associated conditions with wheezing
a. Asthma, (COPD) chronic obstructive pulmonary disease
- Loud, low pitched, snoring quality, rough sound
- Heard high up, over trachea & bronchi
Acute bronchitis
Rhonchi
- Inspiratory musical wheeze
- Loudest over trachea
- Suggests obstructed trachea or larynx
Stridor
a. Created by turbulent air flow
loudest during inspiration
softest during expiration
normal breath sounds
i. Air moves to smaller airways hitting walls
ii. More turbulence, Increased sound
inspiration
i. Air moves toward larger airways
ii. Less turbulence, Decreased sound
expiration
Causes of decreased of absent breath sounds
Asthma COPD Pleural Effusion Pneumothorax Adult Respiratory Distress Syndrome (ARDS) Atelectasis
early RAT (hypoxia)
Restless
Anxiety
Tachycardia/tachypnea
late to BED (hypoxia)
i. Bradycardia
ii. Extreme restlessness
iii. Dyspnea
In pediatrics: FINES (hypoxia)
i. F: Feeding difficulty
ii. I: Inspiratory Stridor
iii. N: Nares Flare
iv. E: Expiratory grunting
v. S: Sternal Retractions
i. Encourages pt post-operatively
ii. Want lungs to expand
iii. Providing pain medication prior
iv. 5-10x an hour
a. Incentive Spirometry
i. Helps clear lungs of mucous
ii. Vibrates
iii. Cystic fibrosis
b. Acapella Device
a. Group of tests that measure how well the lungs take in & release air
R. Pulmonary Function Test (PFT)
S. Assessment Methods
Peak flow meter
pulse ox
sputum collection (best in AM)
Positioning
High Fowlers
very precise amount
i. 1-6L/min
nasal cannula
i. Never less than 5L/min – can retain CO2
face mask
see most often)
1. 6-12L/min
simple mask
10-15 L/min
partial rebreather non rebreather
4-10L/min; most precise flow concentration
Venturi Mask
