Respiratory Assessment And History Taking Flashcards
Airway assessment
Determine if the airway is open and clear, if not, consider the need for interventions
Airway intervention considerations
Manual airways adjustment maneuvers, BLS airway adjunct (OPA/NPA), secretion management (recovery position, suctioning), foreign body airway obstruction management, stridor
Breathing assessment
Rate, depth, quality. Consider the need for interventions
Breathing intervention considerations
Nasal cannula (1-4L/min with 100% O2) chest pain or CVA symptoms, NRB (15L/min with 100% O2) signs of obvious respiratory distress with an elevated respiratory rate, BVM (15L/min or >30 breaths/min) signs of obvious ineffective ventilations
Circulation assessment
Radial/carotid rate, rhythm and quality. Consider interventions
Circulation intervention considerations
Pulse less than 50 / greater than 150 (apply AED pads, consider ALS intercept), no pulse (CPR, AED pads)
Head to toe assessment
Whole body, head, neck, chest
Whole body evaluation
Any rash/hives/swelling, any medic alerts
Head evaluation
Pain/discomfort (OPQRST), lightheaded/dizzy/syncopal, visual disturbances, ringing or rushing in the ears, facial droop present, speech deficits
Neck evaluation
Pain or discomfort (OPQRST), any JVD/ trachea midline, any subcutaneous emphysema
Chest evaluation
Any pain or discomfort (OPQRST), any SOB/difficulties breathing, any increased WOB, speech pattern, medication patches/surgical scars, auscultate lungs/heart tones
IPPA
Inspection, palpation, percussion, auscultation
IPPA purpose
To define pathology in order to treat effectively and efficiently
IPPA interpretation
Findings may indicate certain disease processes
IPPA limitations for palpation
has to be done with respect to the patient and in reflection of patients pain level and thoracic expansion is not clinically diagnostic
IPPA limitations for percussion
Cannot be done on elderly or very young patients and diaphragmatic excursion is not clinically diagnostic
IPPA - inspection
Appearance, LOC, WOB, patient condition (history), emergent reason, environment, surroundings, support, vitals
IPPA - inspection; general appearance
Colour (cyanotic, pale), peripheral cyanosis, central cyanosis, pallor, looks ill, scars, bruising, deformities
IPPA - inspection; WOB
Normal, increased (accessory muscle use - retractions, tracheal tug, nasal flaring, pursed lip breathing, stridor, tripod position)
IPPA - inspection; vital signs
BP, HR, RR (rate, rhythm, quality), SpO2, extremities, clubbing, capillary refill, peripheral edema, JVD
IPPA - palpation
Act of touching the patients chest wall to evaluate underlying structure and anatomy
Used to assess pain, fremitus, thoracic expansion, tracheal position, and subcutaneous emphysema
IPPA - palpation; pain
Gently palpating the patients skin can reveal areas of pain
IPPA - palpation; tracheal position
Normal is midline, shifts from the midline are indicative of disease (unilateral pneumonia, pneumothorax, pleural effusion, tumours
What way does the trachea shift for certain diseases?
Towards atelectasis
Away from pneumothorax, pleural effusion, large tumour
IPPA - palpation; vocal fremitus
Vibrations created by the vocal cords during phonation which are transmitted through the parenchyma to the chest wall
IPPA - palpation; tactile fremitus
When these vibrations are felt on the chest wall by a practitioner; having a patient say 99 while repeatedly bilaterally placing hands on patients chest
IPPA - palpation; subcutaneous emphysema
Chest wall skin can be palpated for the condition and temperature (perfusion), palpated for air leaks that move from lungs to skin, fine beads of air in skin produce a crackle sound
IPPA - percussion
Tapping on the chest wall to evaluate underlying structures and pathology, produces a vibration that evaluates the lung to a depth of 5-7cm below chest wall
IPPA - auscultation
Process of listening to sounds produced by the body, done via stethoscope, patient should be sitting up ideally
Abnormal breath sounds
Considered Adventia; continuous - longer than 25ms (wheezes, rhonchi, stridor)
Discontinuous - intermittent, short duration less than 20ms (crackles, rubs)
Bronchial breath sounds
Are considered abnormal when they replace vesicular breath sounds with an increase in lung tissue density due to disease
Diminished breath sounds
Shallow breathing, obese patients, COPD and emphysema (significant hyperinflation)
Adventitia
Stridor, wheezes, crackles, rubs
Stridor
Continuous sound heard on inhalation, occurs during upper airway obstruction, loud and high pitched, crowing, can be heard without a scope
Wheezes
Generated by bronchospasms that do not clear with cough, narrowed airway as air passes through at high velocity (higher pitch=narrower airway)
Wheezes - polyphonic
Several musical notes, usually E, indicative of multiple airway involvement
Wheezes - monophonic
Single musical note, indicates singular obstruction of a bronchus
Wheezes - rhonchi
Low pitched continuous sounds that can be caused by excessive secretions and may clear with a cough (wet wheezes)
What causes crackles?
Movement of excessive secretions/fluid in the airway as air passes through/collapsed airways popping open on I
Crackles
Clear with a cough, coarse, heard in I and E, associated with rhoncial fremitus
Early inspirations crackles
Sudden opening of large, proximal airways which closed during E due to high compliance or decreased elasticity, scanty (do not clear with cough), COPD, CB, Asthma
Late inspiratory crackles
Sudden opening of collapsed peripheral airways and alveoli on I, collapse due to increased P.
More common in the dependant lung regions where gravity predisposes the airway/alveoli to collapse E
When do crackles occur?
Restrictive defence; atelectasis, pneumonia, pulmonary edema, fibrotic disease
Pleural friction rub
Creaking or grinding sounds, creaky leather, gets louder with deep breathing, very painful
When does pleural friction rub occur and what is it associated with?
Occurs when irritated inflamed pleural surfaces rub together on I or E
Associated with pneumonia, TB, pleurisy, pleural effusions
Respiratory patterns
Cheyne-Stokes respiration, hyperventilation, apneustic, cluster breathing, ataxic breathing
Cheyne-Stokes respiration
Denotes a cyclic pattern of alternating hyperpnea and apnea.
A bilateral hemispheric or diencephalic insult.
May indicate incipient transtentorial herniation.
CHF, COPD, OSA, Uremia
Hyperventilation
Injury in the pontine or midbrain tegmentum.
Respiratory failure, hemodynamics shock, fever, sepsis, metabolic disarray, and psychiatric disease
Apneustic breathing
Prolonged pause at the end of respiration, lateral tegmentum of the lower half of the pons
Cluster breathing
Periodic respirations that are irregular in frequency and amplitude with variable pauses between clusters of breaths, lower pontine tegmental lesion.
Ataxic breathing
Is irregular in both rate and tidal volume, suggests damage to medulla
Eupnea
Normal pattern
Bradypnea respirations
Slow respirations <10 breaths/min; CVA diabetic coma, increased ICP, metabolic disorder, opioid overdose, sleep
Tachypnea respirations
Fast, shallow respirations >24 breaths/min; anxiety, exercise, fever, shock
Hyperpnea respirations
Deep, regular at a normal rate; diabetic ketoacidosis, emotional stress
Kussmaul respirations
Regular, rapid, deep respirations; diabetic ketoacidosis, exercise, metabolic acidosis, renal failure
Hypopnea respirations
Shallow, regular respirations at a normal rate; anxiety asthma, hyperventilation, obesity, pneumonia, pulmonary edema, sedatives, shock, tonsillitis
Ataxic respirations
Irregular, disorganized, varying depth; CVA, medullary, brain trauma
Biot respirations
Irregular, disorganized with periods of apnea; brain trauma, CNS disorder, CVA, opioid overdose, spinal meningitis
Cheyne-Stokes respirations
Increasing depth followed by apnea; altitude sickness, brain stem injury, CO poisoning, CHF, CVA, increasing ICP, metabolic encephalopathy, uremia
Air trapping respirations
Increasing expiratory difficulty; asthma, bronchiolitis obliterans syndrome, chronic bronchitis, emphysema
Obstructive respirations
Prolonged expirations; asthma, COPD
Sighing respirations
Regular breathing with frequent deep breaths; anxiety, asthma, fatigue, hyperventilation syndrome
Apneustic respirations
Prolonged inspiration and expiration; brain stem lesion, CVA, brain stem injury
Atonal respirations
Occasional reflex driven gasps; anoxia, cardiac arrest, cerebral ischemia, hypoxia
Apnea respirations
Absence of breathing; CVA, brain trauma, deceased
