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NUR350 > Respiratory Assessment > Flashcards

Respiratory Assessment Flashcards

1
Q

Upper Airways

A
  1. Mouth & oropharynx (open space behind the mouth)
  2. Nose & nasopharynx (open space behind the nose)
  3. Pharynx
  4. Larynx
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2
Q

Lower Airways

A
  1. Trachea
  2. Carina
  3. Bronchi
  4. Terminal Bronchioles
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3
Q

Larynx

A
  • vocal cords

- cartilage structure that help prevent collapse

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4
Q

Laryngeal pharynx

A
  • open space behdin parynx

- made up of oropharynx, nasopharynx and laryngeal pharynx

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5
Q

Epiglottis

A

flap that covers larynx during swallowing to prevent aspiration

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6
Q

Trachea

A

large tube connecting larynx to bronchi, cartilage keeps the airway patent and clear

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7
Q

Carina

A

bifurcation points of trachea, extremely sensitive

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8
Q

Right Bronchi

A

more vertical than left, more likely to see aspiration on right bronchi

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9
Q

Terminal Bronchioles

A
  • narrowing airways that slows down the air
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10
Q

Acinus

A
  1. respiratory bronchioles
  2. alveolar ducts
  3. alveolar sacs
  4. alveoli
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11
Q

Aveoli

A
  • like a balloon, takes effort to get in but no effort to take them out

Made up of:

  1. Type 1 alveolar cells (structure)
  2. Type 2 alveolar cells (secrets surfactant)
  3. Alveolar macrophages (immune component that ingests foreign particulars)
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12
Q

Surfactant

A

lipoprotein that coats the inner surface of the alveolus

- lowers surface tension during expiration so that alveolus doesn’t collapse

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13
Q

Pleura

A

Double-walled sacs that hold alveoli

Made up of:

  1. Visceral pleura (inner layer closest to lungs)
  2. Parietal pleura (outer layer closest to thoracic cavity)
  3. Pleural space (contain small amount of fluid, allows for smooth, friction free movement)
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14
Q

Pleural effusion

A

Build up of excess fluid between layers of the pleura, caused by infection

  • inflammation of the pleural layers lead to pleural friction rub (abnormal lung sound - low pitch grating noise)
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15
Q

Four Major Functions of the Respiratory System

A
  1. Supply oxygen to the body
  2. Remove CO2
  3. Maintain homeostasis (acid-base balance)
  4. Maintain heat exchange
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16
Q

Maintain blood pH level

A

Blood pH needs to be within a narrow range, outside of this range is fatal

Maintaining pH requires alteration of CO2 in blood

CO2 acts like ACID
hypoventilation - higher CO2, more acidic
hyperventilation - lower CO2, less acidic

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17
Q

Control of respirations

A

typically involuntary and mediated by the respiratory centre in the brain stem

breathing patterns change in response to varying levels of CO2 and O2 in blood

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18
Q

Stimulus to breathe

A

Normal stimulus to breathe is an increase in CO2 - hypercapnia

decrease in O2 also increases respirations - hypoxemia

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19
Q

Thoracic cavity

A

increase during inspiration

decrease during expiration

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20
Q

Thoracic Cage

A
  1. sternum
  2. 12 pairs of ribs
  3. 12 thoracic vertebrae
  4. diaphragm
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21
Q

Suprasternal notch

A

hollow u-shaped depression just above the sternum between clavicles

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22
Q

Sternum

A
  1. Manubrium of sternum
  2. body of sternum
  3. Xiphoid process
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23
Q

Manubriosternal angle (angle of Louis)

A
  • distint bony ridge
  • continuous with second rib
  • marks the site of tracheal bifurcation into right and left main bronchi
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24
Q

Costal angel

A

should be 90 degrees or less

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25
Q

12 pairs of ribs

A

1st 7 ribs attach directly to sternum
ribs 8, 9, 10 attach to the ribs above cartilage (false ribs)
ribs 11 and 12 are floating ribs, can be felt during deep palpation

26
Q

Vertebra prominens

A

C7, most bony protrusion

27
Q

Spinous processes

A

aligns with their same-numbered ribs until T4

28
Q

Inferior angle of scapula

A

lower tip is usually at the level of the seventh or eighth rib

29
Q

T12

A

palpate midway between the spine and side to identify the free tip of the 12th rib

30
Q

Anterior Reference Lines

A

Anterior axillary line
Midclavicular line
Midsternal line

31
Q

Posterior Reference Lines

A 
Scapular line (runs along interior angle of scapula)
Vertebral line
32
Q

Axillary Reference Lines

A

Anterior axillary line
Midaxillary line
Posterior axillary line

33
Q

Lungs

A

Made up of:

  1. Mediastinum (middle column between L and R lungs)
  2. Right pleural cavity
  3. Left pleural cavity
34
Q

Right lung is ____ because of ____

Left lung is ____ because of ____

A

R is shorter due to liver

L is narrower due to heart

35
Q

Right oblique fissure

Left oblique fissure

A

5th rib midaxillary line to 6th rib midclavicular line

R separates RLL and RML
L separates LUL and LLL

36
Q

Lobes of the Lungs (anterior)

A

mostly upper lobes

- top of lungs starts above the clavicle

37
Q

Lobes of the Lungs (posterior)

A

mostly lower lobes

upper lobe: T1 to T3
lower lobe: T3 to T10 (expiration) or T12 (inspiration)

38
Q

Lobes of the Lungs (right lateral)

A

Horizontal fissure

  • separates RUL and RML
  • 4th rib to 5th rib midaxillary

Right oblique fissue

  • separates RML and RLL
  • 5th rib midaxi to 6th rib midclavi
39
Q

Dev Considerations

infants and children

A
  • surfactant not present in sufficient amounts until 32 weeks gestation (injection may be given for infants born before 32 weeks)
  • smaller size of airways and structures, easier to block these passages
  • shorter distance, easier for upper resp infection to travel down
  • immune system immaturity, immune system not fully mature until 5-6 yos
40
Q

Dev Considerations

pregnancy

A
  • decrease space for lung expansion, diaphragm elevates 4cm and increased awareness due to pressure
  • increased circumference of thoracic cage
  • increased O2 demand, increase tidal volume but same resp rate
41
Q

Dev Considerations

aging adult

A
  • costal cartilage calcification, more rigid
  • decreased respiratory muscle strength, less easily inflated and deflated
  • decreased elasticity within the lungs, collapse of alveoli and less surface area for gas exchange
  • increase in small airway closure, increase risk of SOB
42
Q

Subjective Respiratory Assessment

A
  • cough (sputum, phlegm, hemoptysis)
  • SOB (dyspnea, breathlessness)
  • chest pain with breathing
  • past history of resp infections
  • smoking history
  • environmental exposure
  • self-care behaviours (immunization)
43
Q

Hemoptysis

A

blood in sputum

44
Q

Objective Respiratory Assessment - Inspection

A
  • skin colour and condition
  • nail beds
  • thoracic cage (shape and configuration)
  • respirations: rate, rhythm, depth, pattern
  • WOB, position and facial expression
  • LOC
  • signs of distress
  • sputum
45
Q

Barrel chest

A

chest appears to be partially inflated all the time

  • lateral width is the same as anterior/posterior view
  • air getting trapped
46
Q

Scoliosis

A

sideway curvature of the spine

47
Q

Kyposis

A

excessive outward curve, rounding of the upper back, hunchback

48
Q

Pectus excavatum

A
  • structural deformity of the anterior thoracic wall

- produces a depression in sternum

49
Q

Pectus carinatum

A
  • rare chest wall deformity that cause breastbone to push outward
  • sternum protrudes
  • pigeon chest or keel chest
50
Q

Signs of distress

A

Tracheal tugging
- suprasternal indrawing
Nasal flaring
Retractions/indrawing

51
Q

Objective Respiratory Assessment - Palpation

A
  • General (lumps, masses, temperature, tenderness, bruising, diaphoresis)
  • Symmetrical chest expansion (anterior and posterior)
    (asymmetry could suggest lung collapse, atelectasis, pneumonia, fractured rib)
  • tactile fremitus (tactile vibration, “ninety-nine)
  • crepitus (bubble wrap under skin, air leaked into subcu tissue)
52
Q

Decreased fremitus

A

anything obstructs transmission of vibrations (obstructed bronchus, pleural effusion, pneumothorax)

53
Q

Increased fremitus

A

occurs with compression or consolidation of lung tissue (pneumonia)
- bronchus is patent and consolidation extends to the lung surface

54
Q

Pneumothorax

A

collapsed lung, air leaks into the space between lung and chest wall

55
Q

Pneumonia

A

consolidation of lung tissue

  • alveoli become filled with pus, bacteria, blood cells
  • tissue becomes denser
  • makes vibrations more pronounced
56
Q

Objective Respiratory Assessment - Percussion

A
  • compare side to side
  • percussion between ribs
Percussion notes:
Resonance
Hyperresonance (air filled)
Dullness (liver, heart, over bone)
Tympany (stomach)
57
Q

Objective Respiratory Assessment - Auscultation

A
  • compare side to side

Expected breath sounds:
Bronchial (tracheal) - around tracheal and larynx, inspiration < expiration [anterior]
Bronchovesicular - heard over main bronchi, inspiration = expiration
Vesicular - rest of lungs, inspiration > expiration

58
Q

Adventitious Breath Sounds

A

a. Crackles (fluid in lungs)
- fine: hair between fingers
- coarse: velcro ripped apart
b. Wheezes (lower airway narrowing)
- high pitch squeaky sound
c. Rubs (inflamed pleural)
- leather rubbing
d. Stridor (narrowing of upper airway, in larynx or trachea, or foreign objects)
- whale sounds

59
Q

Diminished or absent sounds

A

blockage of air transmission

60
Q

Increased sounds

A

pus or secretion in alveoli

61
Q

Special tests

A

Bronchophony “ninety-nine”
Egophony “eeeee”
Whispered pectoriloquy “one two three” (detect consolidation)

NUR350 (27 decks)

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