Respiratory/Thorax/Lungs Flashcards
ABC of cardiac/pulmonary
airway, breathing, circulation
anterior thoracic landmarks
suprasternal notch, sternum, costal angle
posterior thoracic landmarks
spinous processes
inferior border of scapula
twelfth rib
upper lobes posterior landmarks
between c7 and t3
right lung is [shorter/narrower] and left lung is [shorter/narrower]
left lung is longer and narrower (2 lobes) - heart
right lung is shorter and wider (3 lobes) - liver
upper lobes are best heard on [posterior/anterior] chest
anterior
right middle lobe is best heard
anterior into mid axillary line – can’t hear posterior
lower lobes are best heard [anterior/posterior]
posterior
which lung has a middle lobe
right
respiratory hx
dx of concern
COPD, asthma, chronic bronchitis, lung cancer
respiratory hx
sx of concern
cough, dyspnea, chest pain with breathing
behavioral/lifestyle factors
- smoking history (incl vaping), medications, self-care behaviors
- environmental exposure, occupational exposure
sequence these:
- percussion
- auscultation
- inspection
- palpation
- inspection
- palpation
- percussion (used occasionally)
- auscultation
Complete whole sequence on front or back, then repeat. Order isn’t as important here as it is in GI.
t/f: auscultation is fine over the clothing
false, should be performed directly on the skin
inspection elements
- ease/effort
- dyspnea, orthopnea
- chest movement and accessory muscle
- sputum
- skin color (natural light)
Qualities of breathing
- rate (tachypnea, bradypnea, apnea)
- volume (hyper/hypoventilation)
- depth (deep, normal, shallow)
- rhythm (regular, pauses)
- ease (labored, unlabored)
breathing pattern with pneumonia, pulmonary edema, acidosis, septicemia, pain
tachypnea
breathing pattern with ICP, drug OD, alkalosis, benzos/alcohol
bradypnea
hyperventilation vs. tachypnea
tachypnea is shallow. hyperventilation increases depth and rate >22
hypoventilation vs bradypnea
bradypnea not always shallow. hypoventilation is depth and rate decreased <10.
not breathing
apnea
breathing pattern
with variable rate and depth. Regular-irregular rhythm cycles slow and shallow to deep and fast. Period of apnea. (crescendo and decrescendo)
Cheyne-Stokes: mostly dying – can be accompanied by death rattles/rales. But also TBI, altitude sickness, heart failure.
breathing pattern
rate and depth can be variable. Irregular. Increased rate and depth with abrupt pauses.
Biot’s: head injury, trauma, stroke in medulla oblongata, prolonged opioid use
breathing pattern
Regular but abnormally deep and increased in rate. Labored and using accessory muscles.
Kussmaul: DKA, exercise, metabolic acidosis, renal failure.
this is a type of hyperventilation
markers of respiratory effort
labored/unlabored, retractions, nares flaring, pursed lip breathing
kyphosis
abnormal anterior spine curvature
scoliosis
abnormal lateral spine curvature
spinal damage above this landmark can cause failure of spontaneous respiration
c5
palpation assessment points
- tenderness
- temperature
- skin integrity
- position of trachea
- symmetrical expansion
normal breath sounds
sounds near the sternum and between the scapulae
- moderate pitch and intensity
- occur equally over inspiration and expiration
broncho-vesicular sounds
normal breath sounds
hear around the trachea, high pitched and harsh with a long, loud expiration
bronchial sounds
normal breath sounds
vesicular sounds
audible over anterior, soft breezy quality during inspiration
adventitious breath sounds
crackling or popping sounds of varying intensity, not caused by cough
crackles
adventitious breath sounds
low, coarse, gurgling, louder sounds. may be altered or cleared by coughing. may have a moaning or snoring quality. heard at end of inhale and beginning of exhale.
rhonchi (gurgles)
adventitious breath sounds
breath sound caused by air passing through fluid or mucus
crackles
adventitious breath sounds
breath sound caused by air passing through narrowed air passages due to secretions, swelling, or tumors
rhonchi (gurgles)
whistling sound, could be musical, moaning, sonorous
wheeze
squeaking or grating heard in lateral lung fields during inspiration and expiration
pleural friction rub
caused by air passing through a constricted bronchus due to asthma, secretions, swelling, or tumors
wheeze
caused by the rubbing together of inflamed pleural surfaces
pleural friction rub
crowing noise heard during inspiration
stridor – obstruction or swelling (croup)
dullness to percussion, crackles, increased tactile fremitus suggest
consolidation
dullness to percussion, decreased breath sounds, decreased tactile fremitus suggest
pleural effusion
