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NB 203- Patient Assessment > Respiratory Assessment > Flashcards

Respiratory Assessment Flashcards

1
Q

Respiratory Assessment Overview

A
  1. Focussed respiratory assessment
  2. General Inspection
  3. Inspection of chest (anterior)
  4. Palpation of chest (ant)
  5. Percusion of chest (ant)
  6. Ausculation of chest (ant)
  7. Inspection of chest (posterior)
  8. Palpation of chest (post)
  9. Percusion of chest (post)
  10. Ausculation of chest (post)
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2
Q

Respiratory focussed history

A
  1. Cough
  2. Sputum production
  3. Blood in sputum (haemoptysis)
  4. Wheeze
  5. SOB(Dyspnoea)/DIB – day/night (obstructive sleep apnoea)
  6. Chest pain on breathing
  7. Night sweats
  8. Fever
  9. Weight loss – how much in how long (can be sign of carcinoma or lung disease)
  10. History – Asthma/COPD/ Surgery/Disease/Smoking/Family
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3
Q

Respiratory General Inspection (not incl. thorax)

A
  1. Face
    • Colour (cyanosis, pink)
    • Lips (colour, pursed)
    • Nose (cyanosis, flaring)
  2. Eyes
    • conjunctiva pallor (inside eyelids) - anaemia
  3. Mout
    • Mucous membrane colour (cycanosis) and moisture
  4. Neck
    • Contraction of accessory muscles (sternocleidomastoid, scalene muscles, supraclavicular contraction)
    • Trachea midline
  5. Hands
    • Colour (pink, pale, cyanosed = hypoxic)
    • Warmth (perfusion)
    • Clubbing (many reasons incl. lung disease)
    • Koilonychias (chronic hypoxia)
    • Flap (fine tremor = beta agonists (salbutamol) - flapping tremmor late sign of CO2 retention)
  6. Feet
    • Colour
    • Warmth
    • Clubbing
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4
Q

Respiratory Inspection of Anterior Chest

A
  1. Colour (perfusion)
  2. scars (surgeries/trauma)
  3. Shape/Symetry (barrel, pectus carinatum (pigeon, pectus excavatum (funnel)
  4. Deformity
  5. Abnormal movments (recession, paradoxical breathingm bilat chest rise)
  6. Extra sounds (wheezing/stridor (obstruction in larynx)
  7. Surgical emphysema
  8. Ability to cough (can clear secretions)
  9. Resp rate (12-20) - “woudl do for atleast 30 secs”
  10. Rhythm (kussmauls (systemic acidosis), cheyne stokes (Stroke/dying), Prolonged epiratory (COPD)
  11. Depth (adequat and bilat)
  12. Effort (DIB, SOB - diease/infection of lung)
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5
Q

Respiratory Palpation of of Anterior Chest

A
  1. Bony structures
    • Clavicles Sternum & Ribs
    • Areas of tenderness, abnomalities (masses/sinus tracts)
  2. Tracheal deviation (shifting of lungs - tension, lobal pneumona, anatomical defect)
  3. Tactile vocal fremitus (say 99 and feel on hands)
    • Increase = consolidation
    • Decrease = thick chest wall, obstructed bronchus, COPD, Pleural effusion, pleural fibrosis, pneumothorax)
  4. Respiratory excursion (chest expansion) - hands on front and deep breath
    • reduced movment on one side - many reasons
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6
Q

Respiratory Percussion of Anterior Chest

A
  1. Above clvicles
  2. Every second rib

Dull (hypo-resonant) = fluid consolidation

High pith (hyper-resonant) = trapped air

Normal = resonant

**Left 3rd -5th rib = dull due to heart

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7
Q

Respiratory Auscultation of Anterior Chest

A
  1. Above clavicles
  2. Every second intercostal space
  3. Mid axillar
  4. Transmitted voice sounds (say 99)
    1. bronophony (louder & clearer),
    2. pectoriloquy (whisper =louder),
    3. egophony (‘ee’ sounds like ‘aa’)-
    • suggests consolidation (air filled lung has become airless)
  • Vesicular (most of both lungs)
  • Broncho-vesicular (1st&2nd intercostal anteriorly)
  • Bronchial (over manubrium if heard at all)
  • Tracheal (over trachea in neck)
  • Wheezes – narrowed airways – asthma, COPD, bronchitis
  • Ronchi – (low pitched wheeze like snoring) secretions in large airways
  • Crackles (or rales) – pneumonia, fibrosis, early congestive heart failure

Anterior =

  • L side – predominantly LUL
  • R Side – RUL and RML

Laterally =

  • L side – LUL (superiorly and anteriorly) LLL (inferiorly & posteriorly)
  • R side – RUL (superiorly and anteriorly) RML (inferiorly & anteriorly) LLL (inferiorly & posteriorly)
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8
Q

Respiratory Inspection of Posterior chest

A

Same as front

Ask patient to cross arms to move scapulae out of the way

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9
Q

Respiratory percussion of posterior chest

A
  1. Above scapulae
  2. Every scond rib
  3. Ladder like fashion
    • Diapragmatic excrusion (resonance should extend 3-5 cm on inspiration and be symetrical)
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10
Q

Respiratory ausculation of posterior chest

A
  1. Above clavicles
  2. every second intercostal space
  3. Mid axillar
  4. Transmtted voice sounds
  • Vesicular (most of both lungs)
  • Broncho-vesicular (between scapulae)
  • Bronchial (over manubrium if heard at all)
  • Wheezes – narrowed airways – asthma, COPD, bronchitis
  • Ronchi – (low pitched wheeze like snoring) secretions in large airways
  • Crackles (or rales) – pneumonia, fibrosis, early congestive heart failure

Posterior =

  • L side – predominantly LLL except above T3 (LUL)
  • R Side – predominantly RLL except above T3 (RUL)

** See p.287 of Bates for details on lobe/fissure positions

Laterally =

  • L side – LUL (superiorly and anteriorly) LLL (inferiorly & posteriorly)
  • R side – RUL (superiorly and anteriorly) RML (inferiorly & anteriorly) LLL (inferiorly & posteriorly)
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NB 203- Patient Assessment (10 decks)

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