Respiratory Assessment Flashcards
Thoracic cage boundaries
- Posterior boundary: thoracic vertebrae
- Lateral boundary: rib cage
- Anterior boundary: sternum
- Inferior boundary: diaphragm
Mediastinum (space bordered by the lungs, ventral surface of the vertebral bodies, and dorsal surface of the sternum)
Contains chest organs
Thoracic cage musculature
- 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)
Inhalation
- 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
Exhalation
- 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
- Other “normal” objective findings wih breathing mechanics
- Respiratory rate: 8-12 breaths/minute
- Exhalation: ~ 2x longer than inspiration
***under normal circumstances
Breathing mechanics
- 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
Excursion of thoracic cage
- Observation or tape measure assessment
- Rib compliance
Diaphragmatic activation
Sniff test (can the even activate diaphragm?)
Accessory muscles of inspiration assessment
- Observation
- Traditional MMT
- Intercostal mobility
Rib compliance-Expansion
- should have decent amount of motion
- can check for musculoskeletal compliance
Rib compliance-Spring
- 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
What are signs of increase work or breathing?
- nasal flaring
- foreward flexed posture with hands on knees
- increased depth of breathing
- red face
Facilitation and Inhibition
- watch how breathing while talking pulse
- upper, diaphragmatic breather
- hand on –> breath more or less
- good to know for interventions
Expansion and Symmetry
- 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!
Excursion via Unilateral Tape Measurement
- 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
Circumferential Tape Measurement
- 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
Sniff test
- 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
What is the significance of decreased thoracic expansion on pulmonary function?
- 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
Dyspnea
difficulty (uncomfortable) breathing
Dyspnea of exertion (DOE)
difficulty breathing with movement or activity
Work of breathing (WOB)
ease of difficulty of breathing
Tachypnea
inc resp rate
Bradypnea
dec resp rate
Apnea
absent respirations
Hyoxia
reflects low oxygen
Hypoxemia
low partial pressure of oxygen within blood
Hypercapnia
reflects elevated carbon dioxide
orthopnea
difficult breathing when recumbent improved when erect
