respiratory system Flashcards
control of respirations
Breathing is controlled by brainstem
Change in CO2 or O2 levels in our blood influence our breathing
subjective data - cough
if they have one for how long
is it a productive cough
- are they coughing anything up, if so what does it look like
orthopnea
the inability to sleep lying down, have to sit up to effectively breathe while sleeping
subjective data - pain
can have chest pain while breathing because of a lung issue
do they have a history of respiratory illness of problems that could be causing the pain
subjective data - smoking habits
smoking can lead to cancer
- 2nd most common cancer, and most common cause of cancer related death
subjective data - environment and ADLs
are there any environmental hazards
- can they effectively and safely perform ADLs and live at home
order for objective data
Inspect, palpate, percuss, auscultate (Posterior chest then anterior chest)
colors of sputum meanings
blood - pneumonia or TB
yellow or green - some kind of bacterial infection
pink frothy - pulmonary edema
white or clear - typically a viral infection
inspection of the posterior chest - inspection
skin color
- is it pale of cyanotic (hypoxic)
skeletal deformities?
- the the spine okay (kyphosis: hunchback, scoliosis: lateral curvature)
inspection of the posterior chest - palpation
Symmetric chest expansion 🡪 confirm by using hands
Tactile (or vocal) fremitus 🡪 using hands to assess for palpable vibrations
- assess as you would a thrill (have them say 99 or blue moon and feel for vibrations)
posterior chest - how to percuss
place two fingers between the intercostal spaces then tap those fingers with the other hand and assess by listening for sounds
the types of sounds for percussion
Normal resonance = low-pitched, clear, hollow sound
Hyperresonance = low-pitched, booming sound
Dull sound = “thud” sound
auscultation of the posterior chest lung fields
use the diaphragm of the stethoscope
- always listen to both sides
- each time you place it you have them take a deep breath in and out and listen for all of the inspiration and expiration
how is anterior the same as posterior
you inspect, palpate, percuss, and auscultate looking for the same things just in different places
listening to adventitious lung sounds
- listen with the diaphragm of the stethoscope
- it is best heard when directly on the skin
abnormal sounds - crackle
- typically shows there is fluid in the lungs, typically heard on inspiration like a popping sounds like the sound rice Krispies make
fine crackles (rales)
coarse crackles
abnormal sounds - wheeze
High-pitched
Low-pitched (rhonchi)
- is typically on expiration, every once in a while on inspiration
abnormal sounds - stridor
a high pitch sound on inspiration
barrel chest
have a wider than normal chest for their size
pectus excavatum versus carinatum
excavatum - depression in the sternum
carinatum - protrusion in the sternum
scoliosis
lateral curvature of the back
kyphosis
outward curvature of the back
humpback
tachypnea versus bradypnea
tachypnea - fast respirations typically 24 or more
bradypnea - slow respirations less than 10
hyperventilation versus hypoventilation
hyper - increased rate and depth of respirations
hypo - shallow, irregular, and decreased depth
cheyne-stokes versus biot
cheyne stokes - a cycle of a regular breath, then one with an increase in depth, then one with a decrease in depth, then followed by apnea, then it restarts
biot - like cheyne-stokes but has an irregular pattern
abnormal findings: common respiratory conditions
Atelectasis
Lobar Pneumonia
Pneumothorax
Pleural effusion (fluid) or thickening
Heart Failure
Asthma (Reactive airway disease)
Acute or chronic bronchitis
Emphysema
Pneumocystis jiroveci (P. carinii) pneumonia
Tuberculosis
Pulmonary embolism
Acute respiratory distress syndrome (ARDS)
Lung cancer
COVID-19 Viral Pneumonia
lobar pneumonia manifestations
Manifestations: Fever, cough (productive), pleuritic chest pain, SOB, fatigue, altered LOC, confusion
assessment findings for lobar pneumonia
Assessment findings:
tachypnea, cyanosis, hypotension
decreased chest expansion and tactile fremitus to affected side
Crackles (rales)
sputum for lobar pneumonia
purulent, green or yellow, may be slightly bloody
what is lobar pneumonia
when the Alveoli become filled with bacteria
what is pleural effusion
Excess fluid in intrapleural space
manifestations of pleural effusion
Manifestations: sharp chest pains
assessment findings of pleural effusion
Assessment findings:
dry cough, increased RR, cyanosis
decreased or absent tactile fremitus
dull sounds when percussed
crackles, pleural rub
what is emphysema/COPD
Destruction of pulmonary connective tissue; increased airway resistance, especially on expiration.
assessment findings for emphysema and COPD
Assessment findings:
Barrel chest, signs of respiratory distress, tripod positioning, SOB on exertion
May have muffled heart sounds
Wheezes heard in lungs
what else is common with emphysema and COPD
tripod positioning for easier breathing
intercostal retractions
what is heart failure
Pump failure leading to increased vascular congestion.
assessment findings for heart failure
Assessment findings:
Tachypnea, SOB with exertion, orthopnea
Pulmonary edema - pink frothy sputum
Crackles at base of lungs
summary checklist: thorax and lung examination
Inspection
- Thoracic cage, respirations, skin color, and condition
- A person’s facial expression, and LOC
Palpation
- Confirm symmetric expansion and tactile fremitus
- Detection of any lumps, masses, or tenderness
Percussion
- Lung fields and estimate diaphragmatic excursion
Auscultation
- Assess breath sounds and note any abnormal/adventitious breath sounds
- Perform bronchophony, whispered pectoriloquy, or egophony as needed
