Week 10 - Respiratory, Breast, Lymphatic Flashcards
important landmarks
suprasternal notch, sternum, xiphoid process, sternal angle, costal angle
parietal pleura
lines chest cavity w/ lubricating fluid
acinus
a unit that contains bronchioles, alveolar ducts, alveolar sacs, and alveoli
– for gas exchange (perfusion)
what part of the brain controls breathing
brain stem: pons and medulla
stimulated by hypercapnia = CO2 in the blood
subjective data - respiratory
cough
- patterns, hemoptysis? Productive cough, worse in the morning, worse seasonally, etc
SOB
chest pain with breathing
history of respiratory infections
- flu, asthma, coughing, allergies, TB exposure
smoking - 1st and 2nd
environmental exposure
- work, home, history of, on CPAP, breathing machine, supplemental O2
self-care behaviors
- last TB test? Up to date on vaccines? Flu vaccine?
objective data - respiratory
Inspect the chest – shape and configuration
Notice the position the patient takes to breathe
Skin color and condition – signs of perfusion
How much work is the patient doing to breath?
inspect - respiratory effort
“Easy and regular” is normal
Tripoding
Pursed lip breathing
- prolongs the expiratory phase for those people with CO2 trapping
Tachypnea or gasping
- increased resp rate (normal adult RR 12 – 20, may or may not be related to WOB)
Retractions or bulging of interspaces
- intercostal, subcostal, substernal muscles in rib cage. More common in children or very thin adults
Accessory muscle use
- scalene, sternocleidomastoid, trapezius, pectoralis major
peripheral vs. central cyanosis
periphery can be cool to touch, pale/cyanotic due to ambient temp, fever
central is a more definitive sign of perfusion to end organs
palpation of the chest
Symmetrical chest expansion anteriorly and posteriorly - T9/T10
Lumps or masses
Skin temperature and moisture
Pain
Tactile fremitus – palpable vibration
auscultating
Normal Breath sounds:
B – Bronchial sounds over the trachea
BV – Bronchovesicular sounds over the bronchioles (branches off trachea)
V – Vesicular sounds over the alveoli (lungs)
adventitious breath sounds
note whether sounds are heard upon inspiration, expiration, or both
Crackles
- high pitched, short crackling popping sounds heard during inspiration that are not cleared by coughing. Commonly heard with congestive heart failure, pneumonia.
Pleural friction rub
- superficial sound that is course and low pitched. It has a grating quality like to pieces of leather being rubbed together. Sound is both inspiratory and expiratory. Commonly heard in pleuritis.
Wheeze
- high pitched musical squeaking sounds that occur usually on expiration but can occur on both inspiration and expiration. Commonly heard with asthma.
Stridor
- loud, harsh high pitched inspiratory crowing sound commonly heard with croup (swollen larynx and/or trachea) in children.
Decreased or absent breath sounds
– could indicate only a little or no air is moving in and out of the lung.
measurement of pulmonary function status
pulse oximeter
spirometry or peak flow
- patient take a deep breath in an blows out forcefully. A ball rises to the level of most pressure, best out of 3 is recorded (usually before and after inhalers)
pulmonary function tests
- the number of seconds it takes for the patient to exhale from total lung capacity to residual volume; a screening for airflow obstructions. Takes a deep breath a blows out forcefully (normal time for full expiration is 4 sec or less) – can be auscultated with stethoscope over sternum or a handheld spirometer.
low flow systems
nasal prongs 1-4L/min
face mask 6-10L/min
non re-breather 10-15L/min
surface anatomy of breasts
Location of breasts on chest wall
Axillary tail of Spence
Cooper’s ligaments
lymphatic system
Axillary nodes
Drainage patterns
More than 75% of lymph drains into axillary nodes
subjective data - breasts
Breast
Pain
- Pain or tenderness? When first noticed? Location? Sore to touch? Burning or pulling sensation? Is pain cyclic? Related to menstrual cycle? Related to a specific cause/activity?
Lump
- Lump or thickening? Location? When first noticed? Change since first noticed? Related to menstrual cycle? Changes in skin (redness, warmth, dimpling, swelling)? Ask about axilla area.
Discharge
- When first noticed? Colour? Consistency (thick or runny)? Odour? NOT a normal finding unless lactating
Rash
- When first noticed? Where did it start (nipple, areola, surrounding skin)?
Swelling
- Location? Related to menstrual period, pregnancy, breastfeeding? Change in bra size? MAY be a normal finding if related to menstrual cycle.
Trauma
- Resulted in swelling, lump, break in skin?
History of breast disease
- Type? How diagnosed? When? Treatment? Family history? Who? At what age?
Self-care behaviors – BSE, mammogram
objective data - breasts
Breasts - Inspect
- General appearance
- Skin
- Lymphatic drainage areas
- Nipple
Axillae - Inspect and palpate
- Skin
- Palpation technique
- Lymph nodes
