Respiratory Assessment

Question 1

Thoracic cage boundaries

Answer 1

• Posterior boundary: thoracic vertebrae
• Lateral boundary: rib cage
• Anterior boundary: sternum
• Inferior boundary: diaphragm

Question 2

Mediastinum (space bordered by the lungs, ventral surface of the vertebral bodies, and dorsal surface of the sternum)

Answer 2

Contains chest organs

Question 3

Thoracic cage musculature

Answer 3

• Diaphragm (primary muscle of inspiration
  
  • Right and left hemi-diaphragm stimulated by the phrenic nerve (C2-4
  • Inspiration: active diaphragmatic contraction
  • Expiration: passive diaphragmatic relaxation
• Intercostals, SCM, traps, pec major/minor, serratus anterior, others (accessory muscles of inspiration)

Question 4

Inhalation

Answer 4

• Diaphragm contracts (descends) and becomes fixed-
  
  • active muscle involved with inhalation
• Lower ribs, sternum, and upper ribs elevate and expand
  
  • one diaphragm becomes fixed, lower ribs, sternum, upper ribs can expand
  • expansion increases space (influx of air)
• Intrathoracic pressure decreases to promote inflow of air

Question 5

Exhalation

Answer 5

• Diaphragm relaxes (no longer fixed) and ascends to resting position
• Lower ribs, sternum, upper ribs return to resting position
• Intrathoracic pressure increases to promote outflow of air

Question 6

• Other “normal” objective findings wih breathing mechanics

Answer 6

• Respiratory rate: 8-12 breaths/minute
• Exhalation: ~ 2x longer than inspiration

***under normal circumstances

Question 7

Breathing mechanics

Answer 7

• Upper versus lower chest
• Breathing pattern (rate, rhythm, sequence)
  
  • Paroxysmal and Cheyne‐Stokes respirations (abnormal patterns)
• Work of breathing: rate, depth, ease
• Response to palpation
  
  • Facilitator versus inhibitor

Question 8

Excursion of thoracic cage

Answer 8

• Observation or tape measure assessment
• Rib compliance

Question 9

Diaphragmatic activation

Answer 9

Sniff test (can the even activate diaphragm?)

Question 10

Accessory muscles of inspiration assessment

Answer 10

• Observation
• Traditional MMT
• Intercostal mobility

Question 11

Rib compliance-Expansion

Answer 11

• should have decent amount of motion
• can check for musculoskeletal compliance

Question 12

Rib compliance-Spring

Answer 12

• during inhale, amount of space between intercostals should increase
• decrease with exhale
• maybe not enough air in or restricted if abnormal
• *can place fingers in intercostal space

Question 13

What are signs of increase work or breathing?

Answer 13

• nasal flaring
• foreward flexed posture with hands on knees
• increased depth of breathing
• red face

Question 14

Facilitation and Inhibition

Answer 14

• watch how breathing while talking pulse
• upper, diaphragmatic breather
• hand on –> breath more or less
  
  • good to know for interventions

Question 15

Expansion and Symmetry

Answer 15

• stand in front
• same amount in both hands
• left vs right
• can also check for lateral breathing
• lower lobe check to
• **light rest hands, dont restrict breathing!

Question 16

Excursion via Unilateral Tape Measurement

Answer 16

• document with anatomical landmarks
• distal to manubrium, fix on center of chest
• tape parallel to ground
• see how far away fingers move
• dont push hands so they cant move
• rest comfortably

Question 17

Circumferential Tape Measurement

Answer 17

• standing
• not side to side
• total amount
• can be ant or post
• xiphoid process, parallel to floor
• crossing tape
• breath in and deep out
• measures total excursion of chest

Question 18

Sniff test

Answer 18

• works on increased depth of inspiration
• need to make sure they can fire diaphragm (sniff test does this)
• hands on diaphragm & have patient forcefully create a sniff
• thumbs under xiphoid process- feel muscles under contract with a sniff

Question 19

What is the significance of decreased thoracic expansion on pulmonary function?

Answer 19

• decreased thoracic expansion than volume change wont occur as much
• makes it harder to inflate lungs
• ribs need to elevate with inhalation-if doesnt occur than activity tolerance is limited
• why is expansion limited?
  
  • musculo
  • cage weak abd or dia
  • problem with lung tissue

Question 20

Dyspnea

Answer 20

difficulty (uncomfortable) breathing

Question 21

Dyspnea of exertion (DOE)

Answer 21

difficulty breathing with movement or activity

Question 22

Work of breathing (WOB)

Answer 22

ease of difficulty of breathing

Question 23

Tachypnea

Answer 23

inc resp rate

Question 24

Bradypnea

Answer 24

dec resp rate

Question 25

Apnea

Answer 25

absent respirations

Question 26

Hyoxia

Answer 26

reflects low oxygen

Question 27

Hypoxemia

Answer 27

low partial pressure of oxygen within blood

Question 28

Hypercapnia

Answer 28

reflects elevated carbon dioxide

Question 29

orthopnea

Answer 29

difficult breathing when recumbent improved when erect