Respiratory System Flashcards
Order of assessment for Respiratory
INSPECTION
PALPATION
PERCUSSION (advanced)
AUSCULTATION
Inspection
Shape and configuration
spinous process should appear in a straight line posterior, scapulae should be symmetric
Thorax is symmetric with an elliptical shape and downward sloping ribs about 45 degrees relative to the spine
Abnormalities – scoliosis and kyphosis
Inspection
AP diameter
AP diameter should be less than the transverse diameter about 0.7
abnormalities eg..Pigeon chest (pectus carinatum) cartilage and ribs don’t form properly and chest becomes pushed outward
or Barrel-chest – AP diameter = transverse diameter with hyperinflation of the lungs
Neck and trapezius muscles should be developed normally for age
-Muscles can be hypertrophied in COPD
Note the position the person takes to breathe
Should be relaxed posture and the ability to support ones own weight with arms comfortably at sides
Tripod position is abnormal and can be seen in COPD, person leans forward with arms braced against knees
Inspection
Assess skin: color, condition, lesions.
Color should be consistent with genetic background
Check nail beds, lips, & mucous membranes
Cyanosis is abnormal and occurs with tissue hypoxia
Tachypnea
24 per minute
rapid, shallow
Normal response to fear, anxiety, exercise
Abnormal with respiratory insufficiency, pneumonia, alkalosis, lesions in the pons
Bradypnea
<10 per minute
Slow, Regular rate
Drug induced respiratory depression of the medulla, Increased ICP, diabetic coma
Orthopnea
shortness of breath when laying flat
sign of heart failure but can occur with lung disease and obesity
Dyspnea
-harder to breath
-shortness of breath
Paroxysmal nocturnal dyspnea
occurs at night, awaking with Shortness of Breath and needing to sit up to feel comfort
Caused by OSA, heart failure, lung diseases
Periodic or Cheyne-Stokes respirations
abnormal breathing pattern that can occur while awake but usually when asleep.
It is a period of fast, shallow breathing followed by slow heavier breathing followed by moments of apnea (absence of breathing
Common in infants and older adults
Can signal pathology such as heart failure, renal failure, drug OD
Biot’s (irregular Cheyne-Stokes)
The pattern is very irregular
Occurs with head trauma, brain abscess, encephalitis
Fremitus
is a palpable vibration
“99” or “blue moon”
sounds generated from the larynx and transmitted through patent bronchi and lung parenchyma to the chest wall where you feel them as vibrations
Pneumothorax
collapsed lung
Rhonchal Fremitus
Vibration felt when inhaled air passed through thick secretions in the larger bronchi (felt anteriorly)
Pleural Friction Fremitus
Inflammation of the parietal or visceral pleura
-feels like 2 pieces of leather grating together
Crepitus
Coarse, crackling ~over skin surface
Occurs when air escapes from lungs and enters subcutaneous tissue
subcutaneous emphysema
occurs with open thoracic injury or surgery
Hyperresonance
too much air
– lower pitched booming sound
Found with pneumothorax or emphysema
Bronchial Sounds
high pitch, loud amplitude,
inspiration is shorter than expiration
Sounds harsh, hollow or tubular
Heard over trachea and larynx
Bronchovesicular
pitch is moderate, amplitude is moderate,
inspiration = expiration
Quality is mixed
Heard over major bronchi, posterior between scapulae closer to spinal column
Vesicular
low pitch, soft amplitude,
inspiration is longer than expiration
Rustling sound like wind in the trees
Heard over peripheral lung fields
Crackles (rales)
Crackles are discontinuous popping sounds heard over inspiration
Wheeze (rhonchi)
Wheezes are continuous musical sounds heard mainly over expiration.
Atelectatic crackles-
short popping sounds. Only for few breaths
not pathologic.
This occurs when sections are alveoli are closed and when they take a deep breath, they pop them open, making crackle noise.
They disappear with a cough or a few deep breaths.
Pleural friction rub sound
Very superficial sound that is coarse, low pitched, grating quality, sounds like crackles but very close to the ear
Caused when pleurae become inflamed and lose their normal lubricating fluid
Occurs with pleuritic, accompanies by pain
Stridor sound