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Health Assessment > Respiratory System Assessment > Flashcards

Respiratory System Assessment Flashcards

1
Q

Anterior Thoracic Landmarks

A

Suprasternal notch
Sternum
Sternal Angle (Angle of Louis)
Costal Angle

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2
Q

Posterior Thoracic Landmarks

A

Vertebra Prominens
Spinous Processes
Inferior Border of the Scapula
Twelfth Rib

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3
Q

Reference Lines

A 
Midsternal 
Midclavicular
Vertebral
scapular 
Axillary (Anterior, Posterior, mid)
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4
Q

Lung Borders

Anterior lung borders

A

Apex 3-4 cm above the inner third of the clavicles

base rests on the diaphragm at 6th rib mid clavicular line

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5
Q

Posterior lung border

A

apex of the lung at T7

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6
Q

Can you auscultate the right middle lobe ?

A

No

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7
Q

Left Anterior Lobes

A

Left lung: oblique fissure divides LUL from LLL

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8
Q

Functions of respiratory system

A

supply o2 to body’s cells
remove CO2 from the body as waste
maintain homeostasis (pH 7.35-7.45) through acid-base balance
maintain heat exchange

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9
Q

Hypercapnia

A

excess buildup of carbon dioxide in the blood

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10
Q

The buildup of carbon dioxide causes us to …..

quality of rate and depth of breath is stimulated by …

A

breathe

CO2 levels

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11
Q

biggest driver of our respiratory rate…

A

hypercapnia

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12
Q

where is the respiratory center ?

A

The brainstem, specifically the pons and medulla are the breathing centers

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13
Q

Should we be using neck muscles to breathe?

A

No, that would be abnormal

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14
Q

Expiration is a passive or active process?

A

Passive. Diaphragm relaxes.

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15
Q

Developmental consideration for the aging adult?

A

Our lungs become more rigid, less elastic and less like a balloon
decreased vital capacity (max expelled air)
increased residual volume (air in lung after expiration)
decreased number of alveoli and lung expansion, increases effort of breathing
decreased ability to cough
increased secretions
greater risk of postop atelectasis and infection
Lungs need to be compliant (expandable)

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16
Q

Subjective Data for Respiratory Assessment

A 
Cough
SOB
Orthopnea
Chest Pain w/breathing 
History of Respiratory infection 
trauma
surgery 
PMH
Environmental exposures 
social history
health promotion activity (vaccines, CXR, 
allergies
medication history
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17
Q

The more premature the neonate is, the more

A

they will struggle to respirate

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18
Q

After 28 days, a neonate becomes an

A

infant

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19
Q

what kind of growth and developmental changes could happen if there is respiratory problems?

A

Could see developmental changes in the brain

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20
Q

When inspecting what are you looking for?

A

Shape and symmetry
posture and position of breathing
LOC
effort of breathing

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21
Q

The anteroposterior (AP) to transverse diameter

A

AP should be less than transverse usually 1:2

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22
Q

If someone has a barrel chest, what could it possibly point to ?

A

Barrel chest: AP = transverse (COPD and hyperinflated lungs)

as people age they start developing more of a barrel chest, but for some it could be related to a disorder

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23
Q

What is the normal respiration rate ?

A

12-20 breaths a minute

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24
Q

Bradypnea

A

slower than 12 breaths per minute

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25
Q

Tachypnea

A

faster than 20 breaths per minute

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26
Q

Hyperventilation (hyperpnea)

A

faster than 20 breaths per minute, deep breathing

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27
Q

Cheyne-Stokes

A

varying periods of increasing depth interspersed with apnea

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28
Q

Kussmaul

A

rapid, deep, labored

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29
Q

Ataxic

A

significant disorganization with irregular and varying depths of respiration

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30
Q

When we think about respirations we think about

A

the rate and the quality, the depth

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31
Q

Increased metabolic demands such as intense exercise would render

A

increased respirations

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32
Q

What does increased work of breathing mean?

A

Effort is increased
Accessory muscle use
nasal flaring
pursed lip breathing

33
Q

When we palpate, what areas do we make sure to cover?

A

all areas of anterior and posterior chest

34
Q

What is tactile fremitus ?

A

technique assessing palpable vibrations within speech

“99” or blue moon

increased vibration occurs with consolidation (diffuse lobar pneumonia)
decreased vibration with air trapping in lungs due to obstruction

35
Q

Indirect percussion is used ………….

A

To assess for tones throughout lobes

36
Q

Diaphragmatic extension issue can point to

A

neurological issue

37
Q

Auscultation should be done where ?

A

Over all lobes both anterior and posterior

and lateral

38
Q

Most of the lungs sounds you are listening to are

A

vesicular

39
Q

Adventitious sounds

A

abnormal lung sounds

40
Q

are all adventitious sounds continuous ?

A

No some are continuous and some are discontinuous

41
Q

rhonchi

A

coarse sounds, low pitched, rattling sounds

42
Q

Wheezing

A

musical noise

43
Q

stridor

A

high pitched, piercing sound heard during inspiration

indicative of upper airway obstruction - EMERGENCY

44
Q

Discontinuous sounds

A

Crackles (rales) - formed by fluid in airway- heard during inspiration; not cleared by coughing. May be course or fine; sounds like a velcro fastener

Friction Rub - dry, crackly, grating, low-pitched sound heard during inspiration and expiration

45
Q

Continuous sounds include

A

wheezing, rhonchi and stridor

46
Q

Auscultating voice sounds; sounds should be heard clearly as in speech. True or false?

A

False. The transmitted sound should be muffled

If there is something fluidy, sound is going to travel through that fluid and can be a clue to further examination

47
Q

What is bronchophony?

A

Ask client to say 99 - normal sound should be muffled

clear sound indicates lung density

48
Q

Whispered pectoriloquy

A

The good sound is poor

49
Q

Newborns breathe through their

A

nose

50
Q

Is cough normal in a newborn?

A

No - cough is rare in newborn and considered a problem

51
Q

Tuberculosis can cause shortness of breath…. True or false

A

True

52
Q

Clinical signs of hypoxia ?

A 
Restlessness, agitation 
Confusion
tachypnea
tachycardia
dyspnea
53
Q

Is pulse oximeter everything to assessment?

A

No, it’s an important piece of assessment but its not the be all end all
The pulse ox does not tell you what patients pulmonary status, only their oxygen binding capacity.

54
Q

What are the borders of the lungs on the right axillary side ?

A

Right upper lobe extends from the peak of the axilla to the 4th-5th rib.
Right middle lobe extends forward to the sixth rib.
Right lower lobe extends from the 3rd rib to the eighth rib.

55
Q

What are the borders of the lungs on the left axillary side?

A

Left upper lobe extends from the peak of axilla to 5th rib. Right lower lobe extends to the eighth rib.

56
Q

Cellular demands drive _____________

A

breathing pattern

57
Q

What brings upon forced inspiration ?

A

Respiratory distress and excercise

58
Q

What happens during forced expiration ?

A

The accessory muscles of respiration such as the intercostals, external obliques and abdominal rectus contract forcefully to squeeze the lungs

59
Q

Cyanosis occurs with __________________

A

tissue hypoxia

60
Q

Hemithorax …………

A

one side of the chest

61
Q

What is kyphosis ?

A

An excessive outward curvature of the spine that causes hunching

62
Q

Someone is barrel chested…. what would you expect their AP: transverse ratio to be ?

A

Equal or 1:1

The ribs would look horizontal and the chest appears like its held in continuous inspiration

63
Q

Normal adult respiratory rate

A

12-20 respirations per minute

64
Q

During inspection, you should check the nails, skin, lips and mucous membranes for ……………..

A

cyanosis or pallor, which would indicate hypoxia (the tissues are not being adequately perfused with oxygen)

65
Q

Normal Rate of breathing

A

12-20 breaths per minute

66
Q

Tachypnea

A

Slower than 20 breaths per minute

67
Q

What is crepitus ?

A

A crackling sound

68
Q

Tactile fremitus - decreased vibrations sounds would indicate

A

air being trapped in lungs due to obstruction

69
Q

Tactile Fremitus - increased vibration sounds would indicate

A

consolidation (trapping of fluid within airspace of lungs)

as occurs in diffuse lobar pneumonia

70
Q

Normal diaphragmatic excursion result

A

Diaphragmatic excursion should result in distance between two marks of diaphragm when expiring and inspiring of 3-5 cm

71
Q

What are the three breath sounds ?

A

Bronchial (Tracheal)
Bronchiovesicular
Vesicular

72
Q

Bronchial sounds

A

Inspiratory sound < expiratory sound
High pitched, hollow and tubular
heard over the trachea

73
Q

Bronchiovesicular

A

Inspiratory sounds = expiratory sounds
moderate pitch
heard over main bronchus (between scapulae and upper sternum)

74
Q

Vesicular sounds

A

low pitched
heard over healthy lung tissue where air flows through small passages
Inspiratory sounds > expiratory

75
Q

Unequal symmetric expansion of chest indicates what possible conditions ?

A

Marked atelectasis, lobar pneumonia, pleural effusion, with thoracic trauma, such as fractured ribs; or with pneumothorax
pain accompanies deep breathing when the pleura are inflamed

76
Q

Decreased fremitus would indicate

A

some kind of obstruction to the transmission of vibrations. This can occur with obstructed bronchus. pleural effusion, or thickening, pneumothorax or emphysema

77
Q

Increased fremitus would indicate

A

conditions that increase the density of lung tissue( thereby making it a better conducting medium for vibrations (consolidations

78
Q

For percussion, What does hyperresonance indicate ?

A

A lower pitched booming sound found when too much air is present such as in emphysema and pneumothorax.

79
Q

for percussion, what does a dull note indicate ?

A

Signals abnormal density in the lungs, such as in pleural effusion, pneumonia, atelectasis or tumor

Health Assessment (11 decks)

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