Respiratory System Assessment

Question 1

First Impressions

Answer 1

Position?
Colour: cyanosis (peripheral/central)
Audible noise: wheeze, high pitch noises
Rate, rhythm and depth

Question 2

What do high pitched noises indicate

Answer 2

issues with the upper respiratory tract

Question 3

What do low pitched noises indicate

Answer 3

issues with the lower respiratory tract

Question 4

What can snoring sounds indicate

Answer 4

soft tissue of larynx being relaxed.

Question 5

Inspection

Answer 5

Chest wall movement: equal rise and fall, symmetry, subcostal recession and accessory muscle use

Scars: indicate previous surgery, check mid axillary for evidence of previous chest drains

Deformity: scoliosis, kyphosis, pectus carinatum and barrel chest

Question 6

Inspection

Answer 6

Trachea: should lie deep in the middle of the sternal notch.

Chest expansion: hands on patients chest with your fingers laterally and touching the midline. Ask patient to take a deep breath, thumbs should move apart equally.

Question 7

Percussion

Answer 7

Assessing the resonance of the lungs
Hyperresonance = high pitched
Hyporesonance = low pitched
patient should lie supine when percussing the chest and sit upright when percussing the back

place middle finer in the intercostal space and strike this finger with your other middle finger

compare each side

Question 8

Fine Crackles (Rales)

Answer 8

brief and discontinuous
high pitched popping sound
can be heard during inspiration and expiration

can be a sign of early bronchitis or late pneumonia or congestive heart failure

auscultated at the lungs base

sounds like wood burning

Question 9

Course crackles

Answer 9

low pitched popping noise
“bubbling” sound quality
louder and longer than fine crackles

heard in: bronchitis, pneumonia and severe pulmonary oedema

heard during inspiration and expiration

Question 10

Wheeze

Answer 10

Expiratory

narrowing of airways

continuous

high or low pitch

heard throughout the chest wall

Question 11

Stridor

Answer 11

high pitched and whistling sound

heard during inspiration

often heard in: croup, upper airway narrowing after intubation and foreign body aspirations, tumours, peritonsillar abscesses, retropharyngeal abscess and airway oedema

narrowed or obstructed airway

best heard in the upper airway or without a stethoscope

Question 12

Rhonchi

Answer 12

continuous

inspiration and expiration

lower in pitch than wheezes

often due to copious secretions in airways or bronchi

snoring, gurgling or rumbling

heard best in the centre of the chest

Question 13

Pleural Rub

Answer 13

inflammation of pleural surfaces

low pitched grating noise “treading on snow”

can be found in: consolidation, pulmonary embolism, uremia and other inflammatory conditions

Question 14

What does a peak flow monitor measure?

Answer 14

maximum force of air expelled following deep inhalation

Question 15

How to measure peak expiratory flow step by step

Answer 15

1. explain procedure and gain consent
2. position pt upright
3. insert a clean mouthpiece and ensure needle gauge is on 0.
4. pt should hold the metre horizontally
5. ask pt to take full inspiration through their mouth
6. ask pt to blow into metre
7. take note of reading
8. repeat twice more and record best reading

Question 16

Different types of oxygen mask

Answer 16

Simple: spontaneously breathing patients, 5-10L/min, delivery rate of 28%, transparent for visual checks, white valve

Adult nebuliser: graduated drug cup for guidance on how much drug is in the nebuliser. Aerosolises the drug

Non re-breath: high concentration oxygen, transparent, soft seals for comfort, 10-15L/min, inflated before putting on patient