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Year 1 HLB Respiratory > Respiratory System Examination > Flashcards

Respiratory System Examination Flashcards

1
Q

When conducting any clinical assessment what must be done to confirm the patient is the correct patient?

A
  • name - date of birth - hospital number
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2
Q

When meeting a patient what must you always do to ensure the patient knows who you are?

A
  • introduce yourself - tell the patient what you would like to do
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3
Q

What must you obtain from a patient before you do anything with them?

A
  • gain consent
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4
Q

What is the normal angle the bed should be set at when examining a patient for a respiratory examination?

A
  • 45 degrees
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5
Q

When examining a patient during a respiratory examination, do you conduct this from the left or the right of the patient?

A
  • always the right
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6
Q

The first step during a a respiratory examination is to observe the patient from the end of the bed, what are we looking for?

A
  • clinical signs of pathophysiology
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7
Q

The first step during a a respiratory examination is to observe the patient from the end of the bed, what are some simple signs to look for?

A
  • pale colour - anxious - pain/distressed - sweaty - cachectic (wasting of the body) - awareness - smell
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8
Q

When smelling a patient during a respiratory examination, what do ketones smell like?

A
  • sweet pear drops - sign of ketoacidosis
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9
Q

In addition to looking at the patient during a respiratory examination, other than the patient themselves, what else can be helpful?

A
  • look around the bed - pulse oximeter - cannula - nasal cannulation
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10
Q

What is cachexia?

A
  • extreme weight loss - muscle generally, but can be fat
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11
Q

What are 2 common examples where we may see cachexia?

A
  • cancer - COPD or pulmonary fibrosis
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12
Q

What is the best way to measure the patients respiratory rate, which can change if you tell them you are going to measure it?

A
  • after taking the patients pulse - dont tell them
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13
Q

What is the normal resting respiratory rate?

A
  • 12-16 breaths/minute
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14
Q

What is tachypnoea?

A
  • rapid breathing - normally >20 breathes/minute
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15
Q

What is dyspnoea?

A
  • slow breathing
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16
Q

What are the 2 main muscles used during normal breathing?

A
  • diaphragm - external intercostals
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17
Q

Will inspiration or expiration use more energy?

A
  • inspiration
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18
Q

What are the main accessory muscles used during respiration?

A
  • scalene - sternocleidomastoid - pectoralis minor and major - serratus anterior - latissimus dorsi
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19
Q

What groups of patients may excessively use their accessory muscles during respiration?

A
  • obstructive lung disease, air gets trapped - COPD - asthma
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20
Q

When might a healthy person use their accessory muscles during respiration?

A
  • during exercise
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21
Q

Why is pursed lips used during breathing?

A
  • helps control exhalation - ⬆️ control of breathing
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22
Q

What is the normal process of pursed lips breathing?

A
  • breathe in normally - purse lips and breathe out slower than normal
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23
Q

What patients may benefit from pursed lips breathing?

A
  • COPD - helps slow breathing and control breathlessness
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24
Q

What is the crico cartilage?

A
  • cartilage below thyroid cartilage - located at top of trachea
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25
Q

What is the crico-sternal distance?

A
  • distance between inferior border of crico cartilage and suprasternal notch
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26
Q

What is a normal crico-sternal distance?

A
  • 2-5cm
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27
Q

What may cause the crico-sternal distance to become shorter?

A
  • hyperventilation - COPD patients - emphysema
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28
Q

What is intercostal recession?

A
  • the intercostal muscles are sucked inwards
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29
Q

When might intercostal recession occur?

A
  • reduced pressure in the lungs - caused by a blockage in the airways
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30
Q

When observing the patient, why can it be useful to ask them breathe slower than normal?

A
  • observe any obvious pathophysiology - one lung expanding more than the other
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31
Q

What does congenital mean?

A
  • born with the condition/disease
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32
Q

What is an example of an acquired abnormality of the chest wall?

A
  • thoracic injury - kyphosis
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33
Q

What is kyphosis?

A
  • front to back curvature - think of the letter K
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34
Q

Is kyphosis an acquired or congenital chest wall abnormality?

A
  • both
  • acquired = elderly
  • congenital = kyphosis, scoliosis
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35
Q

Pectus excavatum is a congenital chest wall abnormality, what is it?

A
  • sternum and/or several ribs grow inwards
  • more common in males
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36
Q

Pectus carinatum is a congenital chest wall abnormality, what is it?

A
  • sternum and/or several ribs point outwards
  • more common in males
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37
Q

Hand examination is an important part of a respiratory examination, what are some basic things to look for or feel on the hands?

A
  • hot/cold temperatures
  • sweaty/clammy
  • peripheral cyanosis (blue colour)
  • White/pale (Raynauds Syndrome)
  • Capillary refil
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38
Q

Hand examination is an important part of a respiratory examination, when looking at nails what is clubbing?

A
  • finger tips swell like clubs
  • first look from side on
  • then feel for any swellings
  • the look for schmaroths window ⬇️
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39
Q

Hand examination is an important part of a respiratory examination, when looking at nails what can we commonly see due to smoking?

A
  • tar stains
40
Q

Hand examination is an important part of a respiratory examination, when looking at palms what is palmar erythema?

A
  • causes redness of palms - specifically at base of the thumb
41
Q

Hand examination is an important part of a respiratory examination, when looking at palms what is Dupuytrens contracture?

A
  • 1 or more fingers bend inwards
42
Q

What is the most common cause of clubbing?

A
  • lung cancer - accounts for 70%
43
Q

What does idiopathic mean?

A
  • no known cause of a disease
44
Q

In addition to lung cancer, what 2 other systems can cause clubbing?

A
  • cardiac - gastrointestinal
45
Q

Can chronic infections cause clubbing?

A
  • yes - empyema
46
Q

Hand examination is an important part of a respiratory examination, what is the retention flap assessment?

A
  • patients asked to hold hands out in front - palms face away and fingers apart - if CO2 build up wrists flap backwards and forwards
47
Q

Why does a build up of CO2 lead to flapping of the wrists?

A
  • CO2 affects motor centres in midbrain - specifically diencephalic - involved in motor coordination
48
Q

What are some common causes of a tremor in hand flapping?

A
  • B-2 agonist inhaler (salbutamol) - Parkinsons
49
Q

When conducting a respiratory examination, a basic cardiorespiratory examination must be conducted, what physiological parameters are required?

A
  • heart rate
  • respiratory rate
  • rhythm/strength
  • blood pressure
50
Q

What are the basic vital signs that need to be recorded?

A
  • heart rate
  • blood pressure
  • SaO2
  • temperature
  • pule rate
51
Q

What is the jugular venous pressure?

A
  • direct measure of the venous pressure
52
Q

What may cause an ⬆️ in jugular venous pressure?

A
  • ⬆️ in right atrium pressure
  • pulmonary hypertension
  • right heart failure
  • superior vena cava obstruction
53
Q

Why is the internal rather that the external vein used when assessing the jugular venous pressure?

A
  • internal has no obstructions
  • direct flow to the right atrium
54
Q

Where can the jugular venous pressure be measured?

A
  • between the 2 heads of sternocleiodmastoid muscle
  • patient sat at 45 degrees
  • measure from sternal angle to limit of venous pulse
55
Q

What is the abdominojugular test, when assessing jugular venous pressure?

A
  • pressing of the abdomen
  • ⬆️ blood flow back to heart
  • ⬆️ pressure = ⬆️ jugular venous pressure
  • normal is <3cm
56
Q

What happens to jugular venous pressure during inspiration or if the patient is lying flat?

A
  • it falls
57
Q

When conducting a respiratory examination, what can we look for in the eyes, specifcally the conjunctiva?

A
  • conjunctiva pallor (covering on inside of eyelids)
  • pale can be sign of aneamia
58
Q

What can we sometimes see on patients faces during a respiratory examination?

A
  • rash on the face
  • erythematosus (meaning red)
  • often butterfly shaped rash on face of patients
59
Q

When conducting a respiratory examination, what can we look for in the mouth?

A
  • telangiectasia - thread like veins
  • telos = “end”
  • angeion = “vessel”
  • ektasis “a stretching out, extension, dilation,”
  • mucous membranes can become blue (cyanosis)
60
Q

What is miosis in reference to the eyes?

A
  • meiosis = greek for ‘closing of the eyes’
  • small pupils (generally in one eye)
  • think m = mini pupils
61
Q

What is ptosis in reference to the eyes?

A
  • ptosis = ‘greek for fall’
  • falling of the eyelids
  • droopy eyelids
  • think P for pitching it up
62
Q

What is enophthalmos in reference to the eyes?

A
  • eyeballs sink into the head
63
Q

What is anhidrosis in reference to the eyes?

A
  • lack of sweating
64
Q

When assessing lymphadenopathy what are the 5 steps? S.S.C.T.S

A
  • Size - Site - Consistency - Tenderness - Symmetry
65
Q

What is sarcoidosis?

A
  • collection of inflammatory cells
  • tend to be around hilar lumph nodes
  • granulomas can form
66
Q

What is tracheal deviation?

A
  • deviation of the trachea
67
Q

What is the apex beat?

A
  • tip of heart
68
Q

What examining the anterior and posterior thoracic chest, what are the 4 things to do and in what order?

A

1 - inspection visually

2 - palpation (feeling)

3 - percussion (tapping)

4 - auscultation (listening)

  • I.P.A.A
69
Q

Where is the maximum effect of the heart beat felt?

A
  • apex beat
70
Q

Where is best to hear the apex beat?

A
  • 5th intercostal space on mid clavicular line - count down from 2nd rib
71
Q

What can cause a displacement of the apex beat?

A
  • left ventricular hypertrophy
  • mediastinal shift
  • pneuomothroax
  • lymphadenopathy
  • cardiomegaly
72
Q

What may cause a right heave of the heart?

A
  • right ventricular hypertrophy - right heart failure - lung disease
73
Q

Where would you place the heel of your hand to assess the right side of the heart?

A
  • left parasternal area - in line with nipples or just below
74
Q

When palpating the lungs how should you place your hands on the anterior and posterior aspects of the chest?

A
  • thumbs should be at sternum - hands go under the pecs
75
Q

When percussing (tapping) the thoracic wall which finger is generally tapped?

A
  • middle finger
76
Q

What should percussion of normal lungs sound like?

A
  • low resonance/hollow sound
77
Q

What should percussion of lungs with a pleural effusion sound like?

A
  • dull on percussion
78
Q

When percussing the lungs what is hyper-resonance?

A
  • pneumothorax - increased air in thoracic cavity
79
Q

When percussing the heart and lungs how will they sound?

A
  • dull - they are thick tissue so little air
80
Q

Why does speaking cause changes in the sound when listening to the lungs?

A
  • vocal cords create vibrations - vibrations move down the trachea as well as up
81
Q

What number do we ask patients to say when listening to the lungs?

A
  • 99
82
Q

What is tactile vocal fremitus?

A
  • vibrations created from saying 99 - feel chest wall with hands
83
Q

What can cause ⬇️ tactile vocal fremitus?

A
  • vibrations do not vibrate as well
  • air/fluid in lungs
  • reduces lung density
84
Q

What can cause ⬆️ tactile vocal fremitus?

A
  • dense or inflamed tissue
85
Q

What are the bell and diaphragm of the stephascope?

A
  • diaphragm = larger round part - bell = small round part - both can be used for listening
86
Q

What are the 2 parts of the the second heart sound (P2) you can hear when listening to the lungs?

A
  • A2 = aortic valve is closing - P2 = pulmonary valve is closing
87
Q

What does vesicular mean when listening to the lungs?

A
  • normal breathing
88
Q

What is wheezing when listening to the lungs?

A
  • narrowing of the lungs - causes wheeze or whistling sound
89
Q

What are monophonic, polyphonic and no wheeze as forms of wheezing when listening to the lungs?

A
  • monophonic - one place in lungs (tumour) - polyphonic - multiple site in lungs (asthma, COPD) - no wheeze - silent lungs in asthma
90
Q

What is crackling when listening to the lungs?

A
  • ⬇️ compliance of the lungs - caused by fibrosis
91
Q

When describing the sounds of the lungs what do you need to report?

A
  • type of sound - location of sound - part of cycle (inspiration/expiration)
92
Q

What is bronchial breathing?

A
  • turbulent airflow in the lungs - listen by placing stethoscope on trachea
93
Q

What is pleural rub?

A
  • caused by pleurisy - inflammation of the pleural membranes
94
Q

What is pleural rub when listening to the lungs?

A
  • inflamed membranes rub together - sounds like walking on snow
95
Q

In patients with suspected swelling, where are the 2 most common places to assess oedema?

A
  • sacrum - lower limbs
96
Q

What is pitting?

A
  • pressure placed on skin to see if skin bounces back - if doesn’t then sign of oedema
97
Q

What is pitting oedema a sign of?

A
  • right heart failure - liver or kidney problems

Year 1 HLB Respiratory (25 decks)

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