Respiratory System Flashcards
What is the pleura and what are the two types?
Pleurae is a thin, slippery envelope between the lungs and chest wall - it is filled with fluid that helps prevent friction throughout inspiration/expiration
- Visceral pleura - hugs the lungs and their surfaces
- Parietal pleura - lines the chest wall and diaphragm
What are the four broad functions of the respiratory system?
- Supplying oxygen to the body (inspiration)
- Removing carbon dioxide as a waste product (expiration)
- Maintaining homeostasis of arterial blood
- Maintaining heat exchange
How do we perform cluster care for patients exhibiting SOB?
Only ask/prioritize the essential questions and remember that you may need to intervene while assessing (elevating the head of bed, O2, medications, positioning, and calling for help)
What key things are we looking for during a general inspection?
- position/posture of the patient
- facial expression
- pursed lips and nasal flaring
- LOC
- skin colour: pink, cyanosis, pallor, grey
- respiratory rate
- O2 sat
- Shamroth test/clubbing
- Retractions
- audible respirations
What is being assessed during a posterior chest inspection?
- Shape and configuration of the thoracic cage
- Symmetry of scapulae and spine
- Anteroposterior/transverse diameter (AP diameter should be approx. half of transverse diameter)
- Inspect skin colour, lesions, masses, etc.
What could be indicated by the AP diameter being equal to the transverse diameter?
What about the AP diameter being extremely small compared to transverse diameter?
Barrel chest & funnel chest
Describe how to complete a posterior chest palpation assessment
- test for symmetrical expansion
- assess for tenderness, lesions, masses, lumps, or crepitus
- test for tactile remits (pt. says “99”)
What are the differences between resonance, hyper resonance, and dull note?
- Resonance is low pitched, clear, hollow sounding lungs (healthy)
- Hyper resonance is lower-pitched, booming sound from too much air being present (unhealthy, emphysema)
- Dull note is soft, muffled thud from abnormal density in the lungs (unhealthy, tumour, pleural effusion, pneumonia)
What is diaphragmatic excursion?
A measurement of distance between the base of the lungs on inspiration and expiration as the diaphragm recoils
First begin with the exhale measurement and then the inhale measurement. Should be equal bilaterally and measure about 3-5cm
What are the three different regions we auscultate? Describe their sound characteristics and whether inspiration is >, =, or < expiration
- Bronchial - loud, high-pitched sounds (I<E)
- Bronchovesicular - over major bronchi (I = E)
- Vesicular - soft, low-pitched (I>E)
What is being assessed during an anterior chest inspection?
- shape and configuration of thoracic cage
- symmetry of chest
- quality of respirations
- retractions and use of accessory muscles
- skin, colour, lesions, masses
Describe how to complete a posterior chest palpation assessment
- test for symmetrical chest expansion
- palpate for tenderness, masses, lesions, etc.
- complete tactile fremitus - however, note that it will be decreased over breast tissue and the heart
When auscultating, at what anatomical point do you cease auscultation?
Work through anterior and lateral lung fields until you reach the 6th ICS or when breath sounds are absent
What are adventitious sounds?
Added/extra lung sounds
What are crackles or rales?
Excess mucous; fluid filled alveoli
What are wheezes?
Narrowed bronchioles
What are ronchi?
Course wheezes and louder resulting from secretions moving around narrowed airways
What is stridor?
Partially obstructed airway (foreign object or laryngeal spasm)
Describe a FULL respiratory assessment
Inspection
- posterior shape/configuration
- anterior shape/configuration
- pursed lips/nasal flaring
- skin colour: cyanosis, pink, pallor
- retractions
- clubbing
- resp. rate
- O2 sat
- position/posture
- AP < TD
Palpation
- anterior/posterior symmetrical chest expansion
- palpate for tenderness, masses, lesions, or lumps
Auscultation
- auscultate posterior, anterior, and lateral sites (bronchial, bronchovesicular, and vesicular) with full resp. cycle for each site
What are some considerations for older adult populations?
- decreased respiratory strength
- smaller breaths
- increased resp. rate
- alveoli more rigid
- difficulty meeting O2 demands during times of exertion
- weaker chest and lung muscles
- higher risk of pneumonia
What is hypercapnia and hypoxemia? Which is more effective for respiration?
Hypercapnia is an increase of carbon dioxide in the blood, whereas hypoxemia is a decrease of oxygen in the blood. Hypercapnia is the normal and most effective stimulus for respiration
What is hemoptysis?
Coughing up blood
What is orthopnea?
Difficulty breathing in the supine position
What is paroxysmal nocturnal dyspnea?
Awakening from sleep with shortness of breath and needing to be upright to achieve comfort
What is hyper-resonance and a dull note when percussing the lungs?
Hyper-resonance is a lower-pitched, booming sound when too much air is present
A dull note is soft, muddled thuds when there is abnormal density in the lungs
Which breath sound has the highest pitch? Lowest pitch?
Bronchial is the highest and vesicular is the lowest
