Respiratory Assessment Flashcards
Apex of lungs means
Top of lungs
Base of lungs means
Bottom of Lungs
Left lung has ? lobes
2 lobs (upper, lower) + cardiac notch
Right lung has ? lobes
3 lobes (upper, middle, lower)
Lung air sacs are the
Alveoli
the voice box is another name for the
pharynx
Airways in the body include:
Nasal passages, mouth, pharynx, larynx, trachea, bronchi, and bronchioles
The lungs sit on…
the diaphragm muscle
Ventilation is the…
expansion of chest, inspiration + expiration
Respiration is the…
Gas exchange, O2 in, CO2 out
Chemoreceptors tell…
tell the lungs when to breathe, they measure the O2 & CO2 levels in the body
Where does gas exchange occur externally
In the alveolar-capillary
Where does gas exchange occur internally?
In the Capillary-tissue
How many ribs & Intercostal spaces
12 ribs, 12 ICS, & 1 vertebrae
The lungs are symmetrical T or F
False
Mediastinum is the….
Space between the lungs
Where does gas exchange take place?
Alveoli
The primary stimulus for breathing is…
Carbon Dioxide(CO2)
The secondary stimulus for breathing is…
Oxygen(O2)
Hypercapnia refers to…
- high carbon dioxide in the blood(hyperventilating)
- Stimulates the drive to breathe
Infants: What impacts oxygenation
- Immature lower airway, nervous system, and immune system
- Narrow airways
- Risk of choking
Children: What impacts oxygenation
- Upper respiratory infections are common
- Asthma can start & diagonsed
Adolescents: What impacts oxygenation
- Smoking & E-cig usage occurs more often
Adults: What Impacts oxygenation
- 15% of US adults are cigarette smokers
- Changes in the resp. system begins in middle age and increases with age
Older Adults: What Impacts oxygenation
- Reduced lung expansion and less alveolar inflation
- Difficulty clearing airways> muscles are weaker
- Declining immune response
- Chemoreceptors respond more slowly
Factors that impact oxygenation
- Stress - Obesity
- Allergies - Exercise
- Air quality - Smoking
- Altitude - Second-hand smoke
- Temperature - Pregnancy
Health history questions (subjective data)
- Past health history - Demographic data
- Medications - Health
- Vaccines - Environment
- Family history - Resp. questions
- Smoking/vaping - Occupation
Physical assessment (objective data)
- General survey
- Vital signs
- Inspect
- Palpate
- Auscultate
- Percussion
What to look for in General survey
- items in the room> medications, O2
- family/ friends present
- Alertness and orientation
- Inspection> breathing status/ positioning
Normal respiratory rate
12-20
Eupnea
normal respiration rate, 12-20
Bradypnea
slow respirations, <10
Tachypnea
Fast respirations, <24
Apnea
Absence of breathing
Dyspnea
Shortness of breath
Inspection: Face
- look for signs that give us more info about the resp. system
- breathing pattern, breathing effort, and quality
- Pursed lips - Flared nostrils - grunting
Inspection: position
- tripod sitting, look at positioning
- How are they positioned
Inspection: nails/skin
- cyanosis/ pallor of skin or nails
- clubbing of nails
Inspection: chest
- chest movement
- Anteroposterior to lateral ratio
- Do they have barrel chest?
Inspection: Thoracic Cage
- observe the thorax with the client sitting up
- scapulas should be symmetrical
- straight spine
Inspection: Posture
- look for scoliosis and kyphosis
Palpitation
- Feel for lumps & masses, any pain or tenderness, crepitus, fremitus
- watch for guarding of body due to pain
Palpitation: expansion
- Assess chest expansion
- Place hands on the anterior chest, have client take deep breaths
- Hands should move symmetrically
Percussion
- Percus for tone
- place client in sitting position
- start at the top of the lung
- move down and outward
- compare L and R
- Percuss over intercoastal spaces
- top-down in latter formation
Percussion: Abnormal findings
- Tympany(common over stomach, not lungs)
- Dullness(over fluid or solid tissue)
- Flatness( over muscle mass and bones)
- Hyperresonance( can indicate trapped air)
Auscultation
- be in a quiet room
- instruct patient to breathe slowly through their mouth
- move stethoscope from side to side, going from top to bottom
- listen for one full respiration in each spot
- listen on skin directly
- 6 spots anterior
- 8 spots posterior
Normal breath sounds
- Bronchial: high pitched, loud
- Bronchovesicular: moderate pitch,1:1, equal insp. & exsp.
- Vesicular: soft, low, 3:1, insp>longer, exsp> shorter
Adventitious(abnormal) lung sounds
- Crackles
- Wheezing
- Pleural rub
- Stridor
- Grunting
What is hypoxia?
Low oxygen in your tissues
What is crepitus?
Crackling skin caused by air in the subcutaneous tissue
When percussing the lung, a normal finding is…
Resonance
Which lung has 3 lobes?
Right
Vesticular is an abnormal breath sound T or F
False
Developmental Variations: Infants
- normal resp. 30-53, higher when crying
- infants are diaphragmatic breathers
- <6 months, obligate nose breathers
- uneven or irregular breathing patterns
- Chest should be smooth and round
Developmental Variations: Toddler
- until 6, immunity lower so increased risk of upper resp. infections
- short, small airways- easily obstructed
- put anything in mouth
- drowning can occur in little amounts of water
Developmental Variations: Preschool/school-age
- Mature heart, lungs, circulatory system
- Upper resp. infection resolve easier
- increase incident of asthma
- exposure to viruses at daycare/school
- chest size same ratio as adults
Developmental Variations: Older adults
- Kyphosis is common
- decreased chest expansion, ability to take deep breaths, ability to cough
- loss of muscle
- Declining immune system
- chemoreceptors respond slower
Indications of Hypoxia
-cyanosis of skin and nails
- pain in back
- cough green mucous
- Developmental Variations
- Pain
Hypoxia is
lack of, low O2
Normal data includes:
- chest rises symmetrically
- Spine is straight
- No masses or tenderness
- Lungs are resonant when percussed
Abnormal data includes:
- labored breathing
- ICS muscles retractions
- Sitting in tripod position
- crackles or wheezing
Possible education and interventions
- smoking cessation
- vaccinations
- Avoid pollutant
- Exercise weekly
