Respiratory Assessment Flashcards
Respiration
Four functions of respiratory control are respiration control, changing chest size during respiration, inspiration and expiration
Mechanics of Respiration
Diaphragm drops, intercostals expand rib cage (negatibe pressure in lungs, air rushes in, chest size expands
Diaphragm moves back up, air is expelled
Developmental considerations
Infants and children-vulnerability related to small size and immaturity of pulmonary system
Pregnant women-enlarging uterus elevates diaphragm
Older adults-lungs are more rigid, decrease it vital capacity
environmental tobacco smoke
second and third hand smoke risk
exposure to both increases risk of adverse health effect
increased respiratory infection, inner ear infection, aggravation of asthma
Subjective data
Cough
Shortness of breath
Chest pain when breathing
History of repiratory infections
Smoking history
Environmental exposure
Self care behaviours
OPQRSTU
Additional Health history Questions
Infants- Illness, allergies, chronic respiratory illness, safety, environmental smoke,
Older adults-activity intolerance, level of activity, lung disease, pain
History questions for infants
4-6 colds per year
smokers at home
child proof or choking hazards
new foods introduced
Do parents know CPR
Inspect
Thoracic cage-shape and configuration, skin colour and breathe, accessory muscles, facial expression, level of consciousness
Level of consciousness
alert-answers questions
Voice-responds to commands
Pain-responds to painful stimuli
Unresponsive-no response
Function of respiratory system
To exchange gases, inhale oxygen and breath out carbon dioxide
Purpose of oxygen in our body is that cells need oxygen to function, keep brain and tissues working
Skin colour and condition
Cyanotic=blue (deoxygenated blood)
Pallor=pale (reduced or absent blood flow)
Anteroposterior to transverse diameter
1:2
AP-T
Patient positions
supine-lying flat on back
Prone-lying flat on their abdomen
Fowler’s position-upright sitting
Normal respiration
Normal-active process, uses energy
Expiration-passive process
Does’t use energy
Difficulty breathing
Inspiration-active process and accessory muscle use
Expiration-active process!
Tripod position
Easier inspiration and expiration
Decreased work of accessory muscle in inspiration
Engages pectoralis minor muscle in lifting rib cage
Palpation
chest wall
symmetrical chest expansion
tactile femitus
superficial lumps or masses
Skin-temperature, moisture turgor
No pain or tenderness
No hypertrophy of the neck muscles
Straight line of spinous process
Percussion
Predominant note over lung fields-resonance
Hyper-resonance
Lower pitched booming sound when too much air is present
Dull resonance
abnormal density in lungs
Auscultation
Anterior-breath sounds (adventitious sounds)
Posterior-breath sounds -bronchial, vesicular, bronchial breath sounds, adventitious sounds (crackle, wheeze, atelectatic crackle)
Adventitious lung sounds
Discontinuous
Crackles-fine
Crackles-coarse
Atelectatic crackles
Pleural friction rub
Continuous
Wheeze-high pitched
Wheeze-low pitched
Stridor
Breath sounds
Bronchial-high pitch, loud volume trachea larynx=harsh
Bronchovesicular- moderate pitch, moderate volume
Vesicular-low pitch, low volume
What are adventitious breath sounds
added sounds not normally heard
Superimposed on normal breath sounds
Assessing Respirations
Tachypnea >20 breaths/minute
Bradypnea <10 breaths/minute
Apnea Hyperventilation increased rate + depth
Cheynes-Stokes respiration- normal infants + older adults during sleep
Developmental Considerations
Infants/Children -assess while, sleeping, count respiration, round thorax, broncho-vesicular
Older adults-kyphosis, fatigue, fatigue during auscultation
person acutely short of breathe
Measurement
Pulmonary function statues-pulse oximeter (values counted in context of patient’s hemoglobin level, acid based balance and ventilatory status
95-99% is normal
88% with COPD
