Respiratory Assessment Flashcards
crackles (rales)
popping sounds heard on auscultation of the lung when air enters diseased airways and alveoli; occurs in disorders such as bronchiectasis or atelectasis and heard likely w/ inspiration in the lower lungs
wheezes
continuous high-pitched whistling sounds produced during breathing
friction rub
a coarse, grating, adventitious lung sound heard when the pleurae are inflamed
apnea
absence of breathing
cyanosis
a bluish discolouration of the skin resulting from poor circulation or inadequate oxygenation of the blood
inspiration
breathing in
expiration
breathing out
hypoventilation
ventilation of the lungs that does not fulfill the body’s gas exchange needs
hyperventilation
increased rate and depth of breathing
bradypnea
abnormally slow breathing
dyspnea
difficult or labored breathing
hypoxia
deficiency in the amount of oxygen reaching the tissues
vesicular breath sounds
soft, fine, breezy, low-pitched sounds heard over peripheral lung tissue; inspiratory > expiratory
bronchial breath sounds
loud, high-pitched, hollow sounds normally heard over the trachea and the large bronchi
bronchiovesicular breath sounds
medium-pitched, moderately loud sounds heard over the mainstem bronchi; inspiration = expiration
what are the anterior thoracic landmarks?
suprasternal notch, sternum, sternal angle, costal angle, Angle of Louis
what are the posterior thoracic landmarks?
vertebral prominens, spinous processes, inferior border of the scapula (at 7th or 8th rib), and the 12th rib
what does the mediastinum contain?
esophagus, trachea, heart, great vessels
lung apices
above clavicle and first rib, through superior thoracic aperture
lobes of the lungs
anterior (mainly upper and middle lobe), posterior (mainly lower lobe), and lateral
components of the tracheal & bronchial tree
trachea, bronchi, cilia and goblet cells, alveoli and alveolar ducts which create large SA for gas exchange
what are the four functions of respiration?
O2 delivery, CO2 removal, homeostasis/acid-base balance, maintaining heat exchange
how is respiration controlled?
main drive to breath is hypercapnia, inspiration is active movement (diaphragm and rib elevation) and expiration is passive recoil of lungs, abdomen and thorax
anterior reference lines
midsternal, midclavicular, anterior axillary
posterior reference lines
vertebral, scapular
lateral reference lines
posterior, andterior and midaxillary lines
respiratory system: developmental considerations for infants and children
surfactant produced continuously at 32 wks, vulnerability related to small size and immaturity of pulmonary system
respiratory system: developmental considerations for pregnant women
enlarging uterus elevates diaphragm, decreases vertical cafe, compensated by increase in horizontal diameter
respiratory system: developmental considerations for older adults
- lungs more rigid + harder to inflate
- decrease in VC
- increase in RV
- decrease in # alveoli
- increased shortness of breath on exertion
- above changes mean increased risk for postoperative complications
preventable risk factors for respiratory disease
tobacco, smoke, poor air quality
what can prenatal tobacco lead to?
low birth weight, chronic hypoxia
questions to ask on a focused respiratory health history
cough, SOB, chest pain, history of resp. infections, past history of resp. disease, smoking history, environmental exposure, self-care behaviour, respiratory impact on daily living
addition HH questions for infants
illness (frequent colds), allergies, chronic resp. illness, safety, environmental smoke
additional HH questions for older adults
activity intolerance, SOB, fatigue, level of activity, lung disease (coping, energy lvls, impact on life), chest pain w/ breathing (rib fracture post-fall)
what to consider when preparing a pt for a respiratory physical exam?
pt is upright, gown open in back
- close draping
- consider timing during complete examination (anterior, posterior, lateral)
- cleaning stethoscope end piece
- client breathing rate (rhythm, effort, use of accessory muscles, comfort)
inspecting the posterior chest
straight spinous processes and symmetric scapulae, antero-posterior/transverse diameter, neck and trapezius muscles, position pt takes to breather, skin colour & condirion, location of lobes of lungs
palpating the posterior chest
symmetrical expansion at T9 or T10, tactile or vocal fremitus, palpate the entire chest wall
percussing the posterior chest
- resonance is predominant note (clear, hollow, low pitched)
- start above the scapula and percuss at 5cm intervals (comparing bilaterally)
auscultating the posterior chest
ask pt to breathe through mouth and slightly deeper than usual
- assess for presence/absence of breath sounds, intensity, symmetry, quality
- assess any adventitious sounds
inspecting the anterior chest
- shape & configuration of chest wall; downward sloping ribs and costal angle <90º
- facial expression
- LOC
- skin colour & condition
quality of respirations, RR, pattern - accessory muscles
palpating the anterior chest
symmetrical chest expansion at the costal margin, tactile fremitus at 4 locations, palpating the anterior chest wall for moisture, tenderness, lumps and masses
percussing the anterior chest
start in supraclavicular area, resonance is predominant, compare sounds bilaterally, borders of cardiac dullness, done at 5 locations bilaterally
expected percussion notes over anterior chest
flat over muscle and bone, cardiac dullness near heart, resonance in IC spaces, liver dullness and stomach tympany
auscultating the anterior chest
assess breath sounds while asking pt to breathe deeply through mouth, compare bilaterally at 5 locations, note presence and quality of sounds
- verbalise the location and quality of the normal lung sounds (B, BV and V), any abnormal breath sounds and include the lateral chest (RML)
respiratory assessment: developmental considerations for infants & children
flexibility in exam sequence, thoracic cage soft & flexible, diaphragm main resp. muscle (will see abdomen move w/ respiration)s, sternal or IC retractions indicate distress, RR and pattern may be irregular, infants are nose breathers up to 3 months, localizing breath sounds are more difficult and percussion yields hyperresonance (limited use in newborns)
respiratory assessment: developmental considerations for pregnant women
wider thoracic cage, wider costal angle, 40% increase in TV
respiratory assessment: developmental considerations for older adults
round, barrel-shaped thoracic cage and kyphosis, chest expansion somewhat decrease and less mobile thorax
respiratory assessment: developmental considerations for acutely ill patients
second examiner needed to support pt in upright position for exam
Bronchial Sounds
heard over the trachea, high pitched; expiration > inspiration
bronchiovesicular sounds
heard over main bronchi, medium pitched insp=expir
vesicular
heard over tissue of the lungs, inspiration> expiration; low and soft pitched
stidor
loud wheezes; caused by narrowing of larger airways
