Respiratory Physical Exam Flashcards
Adult physical exam: What are the four things you assess and in what order?
observe pattern of breathing, inspect (extrapulmonary signs of pulm, disease), palpate, percussion, auscultate
A normal respiratory rate in an adult?
12-20
Why is it important for you as the FNP to inspect for extrapulmonary signs of pulmonary disease?
directs your exam, gives you more details about what is going on with the patient
What areas of the patient are you going to palpate during a respiratory exam?
Trachea (is it deviated?) posterior chest wall (fremitus during spoken words?), anterior chest wall (cardiac impulse)
What are you assessing for during the percussion portion of the adult resp exam?
identify any dull areas or consolidation
In an adult, the primary muscle of respiration is?
Diaphragm, with chest/abdominal wall expands simultaneously
Normal breathing: is 12-20rr, symmetrical chest expansion, and what sounds should you hear over periphery of the chest wall?
vesicular (gentle, rustling heard throughout inspiration – fades in expiration)
Concerning the rate of an adult patient, if their respiratory rate goes up - what is this called and what do you expect to happen to
their tidal volume?
tachypnea; decreased Tidal Volume
What is the physiological cause of cyanosis in patients?
increased amounts of UNSATURATED HgB in capillary blood
A patient presents to the clinic with anemia. The patient appears very short of breath. What are two indicators of hypoxemia that would not be accurate/present in this patient? To determine the extent of hypoxemia in this patient, what labs or studies would you
order?
Answer: pulse ox and cyanosis; order hgb/hct (see their blood levels and extent of anemia); ABG (to assess degree of hypoxemia);
(Patients who have anemia do not develop cyanosis until the oxygen saturation (also called SaO2) falls below normal hemoglobin levels. Patients with
lower hemoglobin or anemia say with hemoglobin of 6 g/dL, the saturation has to drop as low as 60% before cyanosis becomes clinically apparent)
A patient presents to your clinic with hx of polycythemia. The patient appears cyanotic but there is no apparent respiratory distress noted (sitting comfortably, respirations even and unlabored, AAOX4). What do you suspect is going on?
This is a normal finding in this patient. (Polycythemia vera is a slow-growing blood cancer in which your bone marrow makes too many red blood cells – increased hemoglobin concentration; therefore, minimal dips in O2 will appear cyanotic in these patients)
When a patient displays an increased work of breathing, you would expect them to be using accessory muscles. However, a patient at
rest who is using accessory muscles - what is this a sign of?
Sign of significant pulmonary impairment
If a patient’s chest expands but the abdomen collapse on inspiration - what could be the physiological cause?
weakness of diaphragm (neuromuscular diseases)
A patient presents with unilateral volume loss on the right side when inspecting their CXR film. What could be the cause?
pleural effusion, atelectasis, empyema
You are assessing a patient and note hyperresonance on percussion. What do you suspect could be the cause?
Hyperresonant sounds may be heard when percussing lungs hyperinflated with air (COPD, acute asthma attack). An area of hyperresonance on one side of the chest may indicate a pneumothorax.