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Sem. A - PAM 1 > Respiratory Assessment > Flashcards

Respiratory Assessment Flashcards

1
Q

Important elements of physical Respiratory assessment are…

A

Inspection

Palpation

Percussion

Auscultation

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2
Q

Surface Anatomy/Landmarks

A
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3
Q

Anatomical Landmarks

A
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4
Q

Identifying Landmarks

A
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5
Q

Lobe Position - Anterior

A
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6
Q

Lobe Position - Posterior

A
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7
Q

Lobe Position - Left Lateral

A
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8
Q

Lobe Position - Right Lateral

A
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9
Q

Before physical examination clinicians must…

A

Explain their intentions and the examinations they wish to carry out.

Gain consent from the patient to carry out examinations.

Ensure the setting is appropriate/private, chaperones present if required, patient positioned comfortably.

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10
Q

History taking should include…

A

Signs & Symptoms

Risk Factors (eg. Smoking)

Pain

Timescale (duration)

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11
Q

Ensure there is a review of systems

A

Cardiovascular (CVS)

Respiratory (RS)

Gastrointestinal/Urinary (GI/GU)

Musculoskeletal (MSK)

Neurological (Neuro)

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12
Q

Inspection of the face & neck should include…

A

JACCO - Jaundice, Anaemia, Clubbing, Cyanosis, Oedema.

Trachea

Jugular Veins (distention?)

Accessory muscle use

Pallor

Cyanosis

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13
Q

Inspection of the Chest will include…

A

Shape of the chest

Symmetry

Scars

Audible sounds

Rate of breathing

Sputum production

Retraction/accessory muscle use

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14
Q

Examples of chest shapes

A
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15
Q

Inspection of the hands will include…

A

Cyanosis

Asterixis (tremor/flapping of the hand when the wrist is extended)

Tar staining

Skin turgor

Clubbing

Oedema

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16
Q

Causes of Clubbing include…

A

Congenital Heart Disease

Bacterial Endocarditis

Cirrhosis

Lung Disease

Chronic Infections

Inflammatory Bowel Disease

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17
Q

Palpation of the chest will include & identify…

A

Lumps/lesions

Skin temp./moisture

Chest expansion & symmetry

Identify areas of tenderness/deformity

Tactile Fremitus (Intensity of vibration palpated on chest wall)

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18
Q

Anterior palpation/fremitus sites

A
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19
Q

Posterior palpation/fremitus sites

A
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20
Q

Percussion identifies…

A

Normal sound - Resonance

Abnormal sounds - Dull, Tympany & Hyperresonance

Useful identifying areas that are solid, fluid or air filled

‘Poor mans ultrasound!’

21
Q

Percussion technique…

A

Hyperextend the middle finger of one hand & place the distal interphalangeal joint against the chest.

With the end of the opposite middle finger, and brisk movement of the wrist, strike the joint of the finger that is pressed against the chest.

22
Q

Anterior locations for Percussion/Auscultation

A
23
Q

Posterior locations for Percussion/Auscultation

A
24
Q

Method of Auscultation

A

Listen over all lobes

Listen to at least 1 respiration on each region

Use the diaphragm of the Stethoscope

Note Intensity, Quality & Added sounds

25
Q

Auscultation Tips!!

A

Where possible, do not listen through clothing.

Ask the patient to take deep breaths through the mouth whilst auscultating.

Ask the patient to cough a few times - helping to clear secretions.

If you hear added breath sounds, try to determine where in the cycle it is heard, eg. expiratory wheeze on exhalation.

26
Q

Sounds created in the larger airways…

A

Sounds from the trachea & main, lobar & segmental bronchi are transmitted throught the rest of the lungs.

Air transmits sound POORLY

Fluid transmits sound WELL

27
Q

Respiratory noises include…

A

Stridor

Bronchial

Vesicular

Rales/Crackles

Wheeze

Crackles

Rhonchi

Pleural Rub

28
Q

Normal Tracheal Respiration

A

Normal over the trachea and main bronchi, they are wide so air movement is fast.

Inspiration & expiration are equal, there may be a small gap inbetween.

29
Q

Normal breath sounds

A

Heard over the rest of the lungs/chest wall.

Inspiration is louder.

Expiration is quieter and shorter.

No gap between.

30
Q

Absent/Reduced breath sounds

A

Compare to other side of chest!

Generalised decreased airflow (hypoventilation).

Localised decreased airflow (mucus plug).

Air in lung (emphysema).

Increased distance between lung & stethoscope (effusion, pneumothorax, obesity).

31
Q

Bronchial breathing

A

Normal heard over the trachea, but abnormal if heard in the rest of the lungs.

Louder & harsher

Inspiration followed by equal/longer expiration.

May be a short gap between.

Indicates consolidation (dense lung).

32
Q

Crackles

A

Fine or Coarse.

Snapping open of small airways.

Air bubbling through fluid.

Predominantly inspiratory.

Normal if they clear with a cough.

33
Q

Wheeze

A

Narrowed, partially obstructed airways.

Lower airway obstruction.

Predominantly expiratory.

Short=mild.

Long=severe.

Can be localised or generalised.

34
Q

Stridor

A

Higher pitched sound.

Upper airway obstruction.

Usually inspiratory.

Croup, Epiglottis, Burns, FB, Tumour.

Often easily audible at the mouth.

DANGEROUS.

35
Q

Pleural Friction Rub

A

2 inflamed pleural layers rubbing together.

‘Creaking like old leather.’

Inflammation spread from underlying lobe.

Heard during inspiration & expiration.

Often dominant during expiration.

Often localised, eg. PE, Pneumonia.

36
Q

Alternative terminology

A

Normal breath sounds-Tracheal, Vesicular

Crackles-Crepitations(JRCALC), Creps, Rales

Wheeze-Rhoncus, Rhonchi

37
Q

Breath sounds associated with conditions

A

Pneumothorax-Decreased/Absent

Consolidation-Bronchial, Crackles

Pneumonia-Bronchial/Decreased, Crackles & ?Wheeze

Pleural Effusion-Decreased/Absent

Asthma-Prolonged expiration, ?Decreased, Wheeze

Pulmonary Oedema-Decreased, Crackles, ?Wheeze

Emphysema-Decreased air entry, Prolonged expiration

38
Q

Special tests during Respiratory assessment include…

A

Broncophony:

  • normal - soft & muffled
  • abnormal - louder & clearer

Egophony:

  • normal - prolonged ‘eeee’
  • abnormal - ‘e’ changes to ‘a’

Whispered Pectoriloquy:

  • normal - whisper is muffled
  • abnormal - whisper is clearer

Tactile Fremitus

39
Q

Respiratory RED FLAGS

A

++ respiratory effort

unable to speak

wheeze/silent chest

stridor

RR <10

RR >29

reduced/absent breath sounds

reduced SaO2

PF <33% expected

etCO2 <45mmHg

HR100+ or <40

arrythmias

pallor/cyanosis

respiratory exhaustion

reduced BP

confusion/combative behaviour

decreasing LOC/GCS

40
Q

Pneumothorax

A

S&S:

  • sudden ons DIB
  • unilateral pleuritic pain
  • tachycardia/tachypnoea
  • ? unequal chest wall movement

PN: ? hyper-resonant over affected area

Ausc: ? reduced sounds over affected area

Misc:

  • TVF
  • ? reduced/absent sounds
  • ? tracheal deviation
41
Q

Consolidation/Pneumonia

A

S&S:

  • dyspneoa
  • pyrexial
  • cough (sputum)
  • pleuritic pain/myalgia
  • tachycardia

PN: dull over airless area

Ausc:

  • bronchial over affected area
  • late inspiratory crackles

Misc: TVF increased over affected area

42
Q

Indicator scores: Community Acquired Pneumonia(CAP)

A

new onset confusion +1 point

RR >30 +1 point

systolic BP <90mmHg & diastolic <60mmHg +1 point

pt age >65 +1 point

A+E mandatory if score >2

43
Q

Pleural Effusion

A

S&S:

  • ? tracheal deviation in large unilateral effusion
  • S&S of underlying cause

PN: dull/flat over fluid

Ausc:

  • decreased/absent
  • ? bronchial near top of large effusion

Misc:

  • TVF decreased/absent
  • may increase near top of large effusion
44
Q

Asthma

A

S&S:

  • dyspnoea
  • cough
  • unable to complete sentences

PN: resonant/hyper-resonant

Ausc: expiratory wheezes/crackles

Misc: assess RR, PF, HR to differentiate between acute, severe & moderate

45
Q

Chronic Bronchitis

A

S&S:

  • chronic productive cough
  • SOB
  • cyanosis

PN: resonant

Ausc:

  • coarse crackles on insp/exp
  • possible wheezes/rhonchi

Misc:

  • Hx suggestive
  • Low SpO2
  • TVF normal
46
Q

COPD

A

S&S:

  • SOB
  • exacerbation of previously stable condition
  • accessory muscle use

PN: diffusely hyper-resonant

Ausc:

  • decreased/absent
  • possible crackles, wheezes & rhonchi

Misc:

  • TVF decreased
  • measure capnography and SpO2
47
Q

Risk factors for PE

A

Malignancy

Immobilisation

Obesity

Recent surgery

Recent trauma

Hx of DVT/PE

Pregnancy

OCP

Limb fracture

48
Q

Indicator scores - PE

A
49
Q

PRF?

A

Document:

  • air entry on each side
  • quality
  • added sounds
  • location

simple diagrams work well

Note:

  • obvious distress
  • position & use of accessory muscles
  • RR, depth, & adequacy(perfusion/cyanosis)
  • expansion symmetry
  • trachea
  • presence or absence of:

added breath sounds

percussion and palpation findings

pain or bony tenderness & signs of injury

location of any abnormality

Sem. A - PAM 1 (4 decks)

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