Respirtatory System Flashcards
4 HISTORY TAKING
Current Symptoms
Past History
Family History
Lifestyle and Health Practices
A clenched fist over the sternum (Levine sign) →
angina pectoris
a finger pointing to a tender spot on the chest wall →
musculoskeletal pain
a hand moving from the neck to the epigastrium →
heartburn
problems with snoring, witnessed apneas (defined as breathing cessation for ≥10 seconds), awakening with a choking sensation, or morning headache.
obstructive sleep apnea
EQUIPMENT
Examination gown anddrapes
Mask
Gloves
Stethoscope
Light source
Skin marker
Centimeter ruler
Palpate for fremitus, using the ball or ulnar edge of one
hand while the client says “_____”.
ninety-nine
Palpate for chest expansion. Place hands on the posterior
chest wall with your thumbs at the level of ___
T9 or T10,
is the most
important examination
technique for assessing air
ow through the
tracheobronchial tree
Auscultation
The most commonly heard adventitious sounds
crackles
rhonchi
wheezes
*Stridor
*rubs
Normal Sounds
egophony
bronchophony
Whisper Pectoriloquy
ask the client to repeatthe letter “E”
Egophony
ask the client to repeat the phrase “ninety-nine.”
Bronchophony
ask the client to whisper the phrase “one-two-three” or “ninety-nine.”
whisper pectoriloquy.
INSPECTION Note the following in the respiratory system
▪ Tracheal deviation
▪ Chest wall deformities
▪ Kyphosis
▪ Scoliosis
▪ Barrel Chest
▪ Pectus excavatum
▪ Pectus carinatum
curvature of the spine (anterior/posterior)
Khyposis
curvature of the spine (lateral)
Scoliosis
Increased anterior/posterior chest wall.
▪ Barrel Chest
Abnormal spinal curvature and , vertebral rotation deform chest. Distortion of the underlying lungs interpretation of lung findings are difficult
Thoracic Kyphoscoliosis
Normal Adult
The lateral diameter of the thorax in the normal adult is greater than its AP diameter which is
0.7 up to 0.9 increases with age
Note depression in the lower portion of the sternum.
Compression of the heart and greater vessels may cause murmurs.
Funnel Chest (Pectus Excavatum)
the sternum is displaced anteriorly. increasing the AP diameter.
Costal cartilages adjacent and protruding sternum are depressed.
Pigeon Chest (Pectus Carinatum)
SIGNS
OF RESPIRATORY DISTRESS
▪Tachypneic (>25/bpm)
▪Cyanosis (hypoxia) or pallor (heart failure)
▪ Pursed-lip breathing
▪ Accessory muscle use
▪ Diaphragmatic paradox
▪ Intercostal indrawing
2 Chronic Obstructive Pulmonary Disease
Pink Puffer (Emphysema Dominant)
Blue Bloater (Bronchitis Dominant)
Accessory muscles of
ventilation:
- scalene
- sternocleidomastoid
- pectoralis major
- trapezius
- external intercostals.
when the chest expands during inhalation and the abdomen is drawn inwards and then during exhalation the abdomen is pushed outwards
Paradoxical Breathing
Inspiratory Sound longer than expiratory sound
soft and relatively low.
over both lungs
Vesicular
inspiratory and expiratory are almost equal.
intermediate
2nd interspaces anterior between the scapula
Bronchovesicular
Expiratory sounds last longer than the inspiratory ones.
loud
relatively high
over the manubrium
Bronchial
inspiratory and expiratory sound are almost equal.
very loud
relatively high
over the trachea in the neck
Tracheal
Discontinuous
Intermittent, nonmusical, and brief
like dots in time
Crackles
louder, lower in pitch
350Hz
15-30ms
Coarse Crackles
soft, high-pitched
650Hz
5-10ms
fine crackles
Continuous
Sinusoidal, musical, prolonged
like a dash in time
Wheezes and Rhonchi
relatively high-pitched
>400Hz with hissing/shrill >80ms
Wheezes
relatively low-pitched 150-200Hz
with snoring quality >80ms
Rhonchi
is a continuous, high-frequency, high-pitched musical sound produced during airflow through a narrowing in the upper respiratory tract.
Stridor
is a discontinuous low frequency: grating sound that arises from inflammation and roughening of the Visceral pleura as it slides against the parietal pleura.
A pleural rub
