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Adult assessment tools > Respiratory assessment > Flashcards

Respiratory assessment Flashcards

1
Q

Which lobe of lung is difficult to assess in auscultation?

A

Right middle lobe

Access under right arm - especially in women with breat tissue

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2
Q

What would you involve in an initial respiratory assessment and history taking?

A
  • On approach - ABC
  • Vital signs
  • History (lung disease, smoking, family history, exposure to allergens eg. dust, asbestos and mold)
  • OLDCART
  • Shortness of breath (how many pillows they sleep with, far can they walk?)
  • Sounds - coughs and wheezes
  • Sputum (colour and amount)
  • Haemoptysis
  • Chest pain
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3
Q

What would you do in the physical assessment and inspection? B, C of A-E assessment

A

Shortness of breath
Assessor muscles (pursed lip breathing, tripod position, unable to lie flat, unable to speak in whole sentences)
Sputum - colour, haemoptysis, frothy blood
Colour - cyanosis - pallor
Breath sounds - adventitious, cough, wheezing or stridor
General demeanour (AVPU, GCS, confused, anxiety, pain)

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4
Q

What would be involved in a physical assessment of respiratory assessment?

A
  • Chest movement – depth, symmetry (unequal expansion)
  • Effort – use of accessory, pursed lips, nasal fairing – rate an rhythm
  • Oxygen saturation (88-92% normal for COPD)
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5
Q

What is normal respiration like?

A
  • Rate – 12-18
  • Rhythm – normal and regular
  • Depth
  • Oxygen sats (95 and above)
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6
Q

What are you looking for in an inspection of the chest?

A
  • Back and spine
  • Scars/lesions
  • Shape abnormalities
  • Ratio normally 2:1 - chest twice as wide as deep but can reduce in long term respiratory disease)
  • Eg.
  • Barrel chest )(chronic respiratory disease)
  • Funnel chest (sunken sternum)
  • Pigeon chest (protrusion of sternum)

Costal angle – normal less than 90 degrees

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7
Q

What are you inspecting in the hands of a respiratory assessment?

A

Peripheral cyanosis
Cigerette stains
Clubbing
Fine and flapping tremors

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8
Q

What are you inspecting in the mouth and tongue of a respiratory assessment?

A
  • Mucosal cynosis – central seen in lips and tongue
  • Hydration – dry and cracked lips and tongue can indicate dehydration
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9
Q

What are you inspecting in the eyes of a respiratory assessment?

A
  • Conjunctiva pallor (possible anaemia) – pull eye lids down should be pink eye lids – if white then not enough oxygen
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10
Q

What would a person be looking for whilst doing chest palpations?

A
  • Ensure no spinal injuries or problems before start
  • Palpate firmly down chest noting any 1
    1. Tenderness
    2. Skin temperature
    3. Moisture (sweaty or clammy)
    4. Lumps/lesions
    5. Surgical emphysema – air trapped subcutaneous tissues under skin
    6. Causing difficulty breathing due to swelling feeling crackly under skin as air moves
    7. Symmetry of chest expansion (butterflying as place hands on patient shoulders and ask to take a big breath, hands should move symmetrically (both thumbs points together the thumbs should move apart and back together symmetrically) – could be due to trauma, neurological, muscular.
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11
Q

How would a person auscultation the posterior chest?

A
  1. Ask patient to put arms across chest and breath normal through – this turns scapular out of the way - mouth (not deeply as can cause hyperventilation)
  2. Tell to indicate if dizzy
  3. Use diaphragm then start at apices and work dow bases from side to sign in J shape
  4. Listen to at least 1 complete breath sound on each section
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12
Q

How would you auscultate the anterior chest?

A

ON women can’t hear through breast tissue
1. Listen 1 complete breath cycle from top at collar bone
2. Work down midclavicular line
3. Use bell to listen above the clavicale
4. Use diaphragm for rest of chest down to 6th ribs space
5. On right side listen specially to mid axillary line to examine right middle lobe

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13
Q

What is a normal auscultation sounds?

A

oft low sound like wind in the trees

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14
Q

What are abnormal sounds to hear during auscultation?

A

wheeze, crackles (COPD, infection oedema), deceased or absent breath sounds (emphysema or obstructed airway)

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15
Q

How would you perform percussion of the chest?

A

apping

Can’t do over breast tissue
1. Flat hand with fingers apart
2. Then tap middle finger on a knuckle of other hand
3. Patient put arms across chest
4. Start at apices and percuss down back side to side comparing right and left
5. Avoid over scapular and spine (don’t want to be hitting bones)
6. Locate diaphragm and lung bases by noting dullness

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16
Q

What is the normal percussion sounds of the chest?

A

resonant throughout

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17
Q

What are abnormal percussion sounds of te chest?

A

dullness. - solid something in way ef. Tumour
Or Hyper resonance – too much air eg. Emphysema or pneumothorax

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18
Q

What are additional tests that can be done for respiration?

A
  1. Peak flow (blow into tube)
  2. Lung function treat s
  3. X-rays
  4. Sputum samples
  5. Capillary refill test
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19
Q

What is the pathophysiology of pneumonia?

A
  1. Infection of alveoli and bronchioles
  2. loss of mechanisms of keeping alveoli sterile
  3. Pathogens get into alveoli results in macrophages triggering inflammatory response and recruitment of neutrophils causing inflammation.
  4. Also results in leaky capillaries so alveoli fills with extroday which becomes populated with neutrophils, fibrin and erythrocytes
  5. Causes ‘consolidation’ which is pneumonia (can be sticky and concentrated in one lobe or patchy throughout whole lungs) as fills with neutrophils, erythrocytes and fibrin
  6. Narrow airways and reduced external respiration.
  7. Reduced Oxygen diffusion into blood, reduced lung expansion, patient feels SOB, resp rate and work of breathing increased
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20
Q

What would be different in a normal chest of someone without pneumonia?

A

Air below the bronchi is normally sterile due to cough reflex, muscocillary escalator, alveoli macrophages, immunogloblinaries, antibodies.

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21
Q

What are some signs and symptoms of pneumonia?

A
  • Short of breath,
  • using accessory muscles,
  • work of breathing increased,
  • unable to speak in whole sentences,
  • increased respiratory rate,
  • cough with green/rust coloured sputum which sometimes has blood in it. Can be haemopatist (blood in sputum). (can send off sputum sample) –
  • pain (causing shallow breathing – exhaserbated the problem)
    – cyanosis and hypoxemia
    -tachycardia
    – temperature increase
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22
Q

How can pneumonia develop and deteriorate?

A
  1. hypoxia (due to reduced gas exchange
  2. – cause confusion and level of consciousness)
  3. look cyanosed due to lack of oxygen
  4. when developed can see elevated CO2 levels.
  5. dehydration (don’t want to eat or drink)
23
Q

What further investigations can be done for pneumonia?

A

chestx-ray,
arterial blood gas
sputum sample

24
Q

Explain a plan to combat pneumonia

A
  1. Resolve infection using antibiotics
  2. Maintain oxygenation (Oxyegn in line with BTS guideline)
  3. Enhance ventilation (position, physio)
  4. Manage pain/fever
  5. Monitoring identify deterioration
  6. communicate to. reduce anxiety
25
Q

What is an exacerbating contributing factor for pneumonia?

A

Smoking

26
Q

Whats the pathophysiology of normal without pneumothorax?

A
  • (there are two pleural in lungs outer (periater) and inner (visceral))
  • between these is pleural fluid.
  • Which helps reduce friction as we breath so they can move smoothly over each other.
  • Helps hold the lungs open due to negative pressure cause balance between pressure and recoil of elastic of lungs.
27
Q

What is the pathophysiology of pneumothorax?

A

Air in pleural space causing mismatch of pressure so lungs to collapse.

Can be - 1. Outside air as hole in pariatel pleura (more common in trauma) 2. Lung air enters due to hole in visceral pleura.

  1. Air trapped in pleura space and negative pressure is gone so natural recoil of the lungs is stronger so lung pulled in.
  2. Pressure on lung increases
  3. Lung collapses so no air entering the lung
  4. Reduced enetrnal respiration and gaseous exchange
28
Q

What are signs and symptoms of pneumothorax?

A

– Auscultation
– none/limited breath sounds
– hypoxia and hypocymia caused
– cyanosis
– increased work of breathing,
- accessory muscle use
– low saturation
– raised rate of respiration
– uneven palpation (look for symmetry would find uneven)

29
Q

How can pneumothorax develop and deteriorate?

A
  1. increased heart rate (pressure on thoracic cavity which effects venous return to heart so less blood in heart)
  2. reduced SV.
  3. reduced contracting ability of heart
  4. increased heart rate
30
Q

Explain the plan for pneumothorax of treatment

A
  1. Maintain oxygenation
  2. Prepare patient for insertion of chest drain
  3. Manage pain
  4. Maintain patient in upright position
    Monitor vital signs to avoid further deterioration
31
Q

What is COPD?

A
  • Umbrella term to describe range of pulmonary condition
    – inflammation and death of lung tissues caused by smoking and toxins
    – combined chronic bronchitis and emphysema and some times asthma to make COPD.
32
Q

What is the pathophysiology of chronic bronchitis?

A
  • persistant cough and increased sputum production, least 3 months in 2 consecutive years)
    – large airways smaller due to exposure to tabacco
  • cause inflammation due to infiltration of neurtophils, lymphocytes and macrophages into bronchial walls
  • oedema of bronical mucous
  • fibrosis (thickening and narrows blood vessels causing obstruction)
  • overproduction of mucous cells and goblet cells and inflammatory mechanisms proteins called myosin produced by epithelial cells leads to thick, sticky mucus.
    – mucus plugs which block airways
    – damage to the cilia - foreign bodies and mucus don’t leave and mucus not cleared.
    – narrow airways cause resisted air flow and external respiration
    – ventilation perfusion mismatch not enough ventilation so oxygen can’t go into blood.
33
Q

Symptoms of chronic bronchitis

A
  • Persistant cough for at least 3 months in 2 consecutive years
  • hypoxia eventually leading to hypocimia
  • cyanosis
  • Shortness of breath
  • low Oxygen sats (88-92% normal in COPD)
  • Mucus cough
  • INcreased chance of chest infections
  • Sputum (green)
  • Ausltations (wheezing or gargling sounds)
34
Q

What are normal oxygen saturation for COPD?

A

88-92%

35
Q

What is the pathophysiology of emphysema?

A
  1. Damage to alveoli and pulmonary capillaries
  2. Enzyme protease damaged elastin and destroys alveoli wall (normal antitriptidase)
  3. Causes bulli as alveoli sacs damaged and holes in lungs
  4. Reduces recoil of lungs causing air trapping (not effectively pushing in and out)
36
Q

What is a normal person pathophysiology to prevent emphysema?

A
  1. Have antitriptidase enzyme which counteracts the protease enzyme in lung which keeps elastin in alveoli wall.
37
Q

What are some symptoms of emphysema?

A
  1. reduced ability to exercise
  2. cough
  3. barrel chest (rounded)
  4. short of breath
  5. increase resps
  6. hypoxia and hypociamia
  7. sats below 90%
  8. increases work of breathing
  9. change costal angle (greater than 90 degrees)
  10. accessory muscles used
  11. expiration time is prolonged and may use pursed lip breathing
  12. favour the tripod positions
  13. can cause pulmonary hypertension putting pressure on right side of the lungs (can cause poor comma nali due to enlargement of right side of heart which can cause right sided heart failure which can cause oedema)
38
Q

What is the pathophysiology of asthma?

A
  1. triggered by hyper responsive reaction of allergen effecting bronchi and bronchioles
  2. trigger immune response
  3. Cause bronchospams and brochoconstriction (cytokines, leukotriences and prostaglandin)
  4. Increased mucous production
  5. Inflammation of bronchioles
  6. Narrowed airways as smooth muscles contracted
  7. Lead to air trapping and increased pressure causing further reduction of expiration
39
Q

What are some symptoms of asthma?

A
  1. Restrict external respiration
  2. Increased work of breathing
  3. Accessory muscles used
  4. Reduced saturations
  5. Reduced depth of breathing (peak flow)
  6. Auscultation (wheezing if very severe then no sound)
  7. Hypoxaemia (low oxygen) and Hypercapsima (high CO2)
  8. Tripod position
  9. No whole sentences
  10. dry cough or sputum cough (note colour)
  11. Monitor for fatigue,
  12. awareness of hydration
  13. Nasal flaring or pursed lips
  14. Pain or tightness in chest
  15. Prolonged expiration
  16. Level of consciousness
40
Q

What would you look out for if asthma has exculated or deteriorated?

A
  1. Fatigue or lowing respiration rate
  2. Auscultation (no sounds)
  3. WOB - can lead to tachycardia
  4. Confusion or level of consciousness
  5. Hyperinflation due to further increased pressure in thoracic cavity
41
Q

What is your immediate plan for asthma?

A
    1. Open airways (reduce bronchospams, reduce inflammation and reducing mucus production and clear airways)
    1. Maintain oxygen levels
    1. Appropriate monitoring of vital signs to identify deterioration
    1. Monitor PEAK flow and work of breathing (33-50%)
    1. Appropriate communication – using closed questions
42
Q

What are some abnormal statistics for asthma patients?

A
  1. Peak flow - 33-50%
  2. RR - over 25bpm
  3. HR above 110bpm
  4. Sats less than 92%
  5. Silent chest
  6. Cyanosis
  7. PaO less than 8 normal is 11-14
43
Q

What is the immediate plan for COPD patients?

A
  1. Lung function tests
  2. Peak flow
  3. Irreversible (communication)
  4. Manage exacerbations
  5. Promote self management
  6. Oxygen therapy long term to target sats at 88-92%
  7. Use bronchodilators and steroids
44
Q

What is external respiration?

A

External – takes place in the lungs as oxygen into blood and carbon dioxide into alveoli and out

45
Q

What is internal respiration?

A

Happens in tissues – Oxyegn out blood into tissue and Carbon dioxide is moved into blood

46
Q

Define - hypoxemia?

A

Reduced Oxyegn in arterial blood

47
Q

Define - hypoxia

A

Lack oxygen in tissues

48
Q

What is type 1 respiratory failure?

A

Low levels oxygen and normal or low carbon dioxide

49
Q

What is type 2 respiratory failure?

A

Low Oxygen and high carbon dioxide

50
Q

Define - hypercapnia

A

High levels carbon dioxide in blood

51
Q

What is respiratory acidosis?

A

Accumulation of carbon dioxide in blood which can lower blood Ph
(normal levels should be 7.35-7.45)

52
Q

What is shortness of breath?

A

Feeling like you can’t breath or breathing in inappropriately difficult for level of activity

53
Q

What are the causes of pneumonia?

A
  • Inhaled pathogens – bacteria viral or fungal
  • Community acquired and hospital acquired
  • Aspiration
  • Secondary infection ef. Covid of influenza leading to pneumonia

Adult assessment tools (12 decks)

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