Week 3: Respiratory Assessment

Question 1

What are some challenges to the respiratory system?

Answer 1

• smoking
• first,second, and third hand smoke (third hand is through walls, clothes etc.
• E-cigarettes
• Vaping
• Environmental factors
• Home
• Occupational
• Travel

Question 2

subjective data: resp system examples

Answer 2

• cough? (if wet or dry, if wet what colour, if theres blood, amount of fluid, timing, consistency
• dyspnea (difficulty of breathing)?- SOB SOBOE (shortness of breath, shortness of breath on exhertion)
• chest pain?
• past medical history
• family histroy
• self-care activities
• allergies
• immunizations
• determinants of health

Question 3

Objective data: inspection resp system examples

Answer 3

-Chest shape

-Synosis: Blue things (fingers, toes, lips etc.)

-Palpation
> tenderness

• Extra assessments (if chest xray not possible)
• Chest excursion (expansion; 3-6cm)
• Tactile fremitus (vibration-“99”)
• Abnormal findings
• e.g., crepitus (air in subcutaneous tissue)

Hand in back thing

Question 4

Landmarks for auscultation (don’t have pictures so use slides to review)

Answer 4

• Suprasternal notch
• Angle of Lous (sternal angle)
• Costal angle
• Scapular, clavicular, axillary lines
• Cervical vertebra #7

Question 5

What pattern should auscultation be in?

Answer 5

Snake pattern

Question 6

What are the 3 normal lung sounds

Answer 6

• Bronchial
• Vesicular (most)
• Bronchovesicular

Question 7

What are some abnormal lung sounds?

Answer 7

• Diminished sounds
• absent sounds
• friction rub
• crackles
• wheezes

Question 8

What are some characteristics of bronchial sounds?

Answer 8

• Loud, hollow ‘tubular’ sounds
• high pitched
• considered abnormal if heard over peripheral lung fields
• Distinct pause between inspiration and expiration
• Inspiration to expiration ratio of 1:2 or 1:3.

Question 9

What are some characteristics of vesicular sounds?

Answer 9

• Soft, low pitched
• ‘rustling’ quality with inspiration
• even softer during expiration
• majority of lung sounds
• inspiration/expiratory ratio 3:1

Question 10

what are some characteristics of broncho-vesicular sounds?

Answer 10

• Normally heard in the mid-chest
• mixture of high pitch bronchial breath sounds heard near the trachea and the alveoli with the vesicular sound
• They have an inspiration to expiration ratio of 1:1.

Question 11

characteristics of abnormal sounds

Answer 11

• Fine crackles:
  > brief, discontinuous, popping lung sounds that are high-pitched – chf, atelectasis

-Coarse crackles:
also discontinuous, brief, popping lung sounds. Compared to fine crackles they are louder, lower in pitch and last longer - pneumonia

-Friction rub
>Low-pitched, short, grating sound from inflammation of pleural surface

• Wheeze
  >Musical sounds caused by narrowing of the airways – asthma, COPD

Question 12

Important developmental variations for infants

Answer 12

-Infants are obligatory nose breathers.

• Bronchovesicular sounds are heard
• Respirations are primarily abdominal.
• After the child is 2 the breathing shifts to intercostal.
• The respiratory rhythm is irregular.
• Apnea should never exceed 15 seconds.

Question 13

Pregnancy changes to resp system

Answer 13

• There is an increase in tidal volume to meet the fetus’ need for oxygen.
• Later in pregnancy, the diaphragm rises and the costal angle widens to accommodate the enlarging uterus

Question 14

Aging in older adults changes

Answer 14

With aging the lungs lose elasticity (compliance), respiratory strength decreases, cartilage loses flexibility and bone lose density.