Respiratory Assessment Flashcards
(40 cards)
What scars could be on a patient’s chest and what could they indicate?
- Upper left anterior scar - Pacemaker
- Central CABG scar - Cardiac surgery
- Axilla scars - Chest drainage
- Scapula scar - lung surgery
What could barrel chest indicate?
CO2 retention or COPD
Due to chronic hyperinflation
What could pigeon chest or funnel chest indicate?
They are congenital abnormalities that can affect the underlying organs, therefore can cause respiratory distress or affect the cardiovascular system
If chest expansion is higher than 5cm, what can this indicate?
A well conditioned athlete
If chest expansion is lower than 3cm, what can this indicate?
Respiratory distress or COPD
What can a deviated trachea indicate?
- A pneumothorax - as the trachea deviates away from the affected lung
- A tumour or mass (thyroid)
If you can feel something hitting your finger during a tracheal tug exam, what does this indicate?
This is the cricoid cartilage of the trachea hitting the finger due to the lungs pulling it down - indicating respiratory distress
If you are just feeling the thoracic cavity and there is pain or tenderness, what can this indicate?
Fractured Rib
Costacondritis (inflammation of the cartilage that joins the ribs to the sternum)
What 3 nodes to we palpate and why?
Supraclavicular (Virchow’s node/Trosier sign)
Infraclavicular
Axilla
We palpate these 3 specifically as they drain the thoracic cavity, so if these nodes are felt then this could be the start of the infection process in the lungs, or malignancy
Why should vibration decrease as you move down on anterior tactile fremitus?
Because if the vibration increase, then this could indicate consolodation, such as a solid, blood, mucous etc, as it is getting further away from the larynx where vibrations derive from
(1) What could hyperressonance indicate?
(2) What could hyporesonance indicate?
(1) More air in the lungs than there should be - pneumothorax
(2) Consolodation such as solid, mucous, haemothorax, pulmonary oedema
Why do we auscultate in more places posteriorly than anteriorly?
The lungs are more inferior posteriorly than anteriorly
What does flail chest indicate?
Two or more contiguous rib fractures with two or more breaks per rib
What adventitious sounds might you find on auscultation and what do these indicate?
- Expiratory wheeze - Asthma or COPD
- Inspiratory stridor - Upper airway obstruction
- Coarse lobar crackles - Consolodation - Pneumonia
- Basal/fine crackles - Pulmonary oedema secondary to HF
What could moveable and non-moveable nodes mean?
Moveable could be a sign of infection, non-moveable could be a sign of a malignancy
What do you say at the beginning of the respiratory examination?
“I have done my history taking and general assessment and have ascertained that I need to do a respiratory examination.
“I may consider starting posteriorly on a female if she has a lot of breast tissue”
“If you wouldn’t mind exposing the chest for me, if you need a blanket for dignity then please let me know, or if you need a chaperone please let me know”
What respiratory patterns are you looking at?
- Tachypnoea? - asthma, allergies, sepsis
- Bradypnoea? - opioid usage
- Kussmaul breathing? - DKA
- Cheyne-Stokes?
If a patients breathing is shallow when counting a resp rate, what should you do?
Place a hand on the patients chest to feel rise and fall
How do you measure chest expansion?
- Place hands on the chest - you should see the thumbs pushed apart when the patient breaths and lungs expand.
- Measure with tape measure - Under the nipple line with patient sat forward. Get patient to breathe out and measure, get patient to breathe in and measure.
Chest expansion should be between __-__ cm
3-5cm
How do you check for tracheal deviation and what could this indicate?
Two finger technique on either side of the trachea to confirm its midline. If there is deviation - this could indicate a pneumothorax or a tumour.
How do you check for tracheal tug and what does it indicate if you feel it?
1 finger below the larynx, ask patient to breathe in. You should not feel any tapping on the finger when breathing in.
If you feel tapping - this is the cricoid cartilage hitting the finger as the lungs are expanding - indicating respiratory distress
What is trosier sign?
Inflammation of the left supraclavicular node - known as Virchow’s Node when inflamed. Can indicate gastric cancer.
How do you test for anterior tactile fremitus (palpate)?
Place ulnar aspects of the hands on either side of the patient’s chest/sides. Ask the patient to say “99”. Feel for equal vibrations. You should feel the vibrations get less strong as you go down.
