Week 3: Respiratory Assessment Flashcards
right lung
Shorter and a little bit wider (space for the liver)
3 Lobes; Right Upper/Middle/Lower lobes
left lung
Narrow than the right but it is longer (space for the heart)
2 Lobes; Left Upper/Lower lobes
functions of the resp sys
- Supplies oxygen to the body for energy production
- Removes CO2 as waste products of energy reactions
- Maintains homeostasis (carbonic acid/base balance) of arterial blood
- Maintaining heat exchange
Hypercapnia
High CO2 retention in the blood
Hypoxemia/Hypoxia
Low O2 in the blood (measure with O2 sat. or arterial blood gas)
Symptoms are pallor, very bad is if they’re grey
Tachypnea
> 20 breaths/min for adults
Bradypnea
<10 breaths/min for adults
Apnea:
Not breathing for >5 seconds (ex., sleep apnea, “do you snore?”)
Diaphoresis
Very sweaty
sternal notch
Semicircle in the middle, aligns with the clavicle
Below it, where the manubrium/sternal body articulates = angle of louis/sternal angle
Sternal angle is where the 2nd rib is; use to landmark for heart
Upper Border/Apex
2-3cm above the inner third of the clavicle
Upper Border/Apex
2-3cm above the inner third of the clavicle
Lower Border/Base
Rests on the diaphragm; about 6th rib MCL (either side)
Reference Lines: for anterior lung landmarks
(MSL) Midsternal Line (down the middle)
(MCL) Midclavicular Line (down the middle of the clavicle)
(AAL) Anterior Axillary Line (on the front of the armpit down)
right lung lobes
Upper: From the clavicle to the 4th rib (MCL) and 5th rib (AAL) (it’s like a triangle)
Middle: From border of upper to the 6th rib (MCL)
Lower: From middle border to the 7th rib (AAL)
left lung lobes
Upper: From the clavicle to the 5th rib (AAL) and 6th rib (MCL)
Lower: From the upper border to the 7th rib (AAL)
posterior lung landmarks: vertebra prominens
The spinous process of C7; T1 is right below
Each of the Thoracic vertebrae have a rib; spinous processes align with them
Inferior angle of scapula aligns with T7/8
Apex of lungs = Superior border = T1-T3
Base of lungs = T10 on expiration (breathing out), T12 on inspiration (breathing in)
You cannot sense the right middle lobe here
posterior lung landmarks: reference lines
(SL) Scapular Line
(VL) Vertebral Line
posterior lung landmarks: lungs
Upper lung stretches from prominens to T3 VL and T4 SL
Lower lung is from T4 to T10/12
Subjective Data: Respiratory Health History
cough
SOB
chest pain with breathing
history of resp infection/lung diseases
smoking
environment/occupation
self care behaviours
objective data resp anterior side: inspection
Level of consciousness (alertness, in/out, awake, drowsy)
Facial expression (any difficulty breathing, pursed-lip breathing, pain)
Shape & configuration (normal vs. barrel chest [COPD])
Anterior-Posterior/Transverse Diameter (How wide you are vs. long)
Should be a ratio of 2 wide:1 long
Skin colour & nails (pallor, profile sign/capillary refill, shows perfusion)
Respiration Quality (depth, frequency, effortlessness, noise)
Use of Accessory muscles (Shoulder moving, using abdominals/obliques to breathe)
Indrawing:Lower chest movements inward while taking deep breathes, rest of chest moves out
Retraction: Intercostal muscles are sucked inward; indicates reduced air pressure in chest, upper airway/trachea area is partially blocked
Both signs of respiratory distress
Anterior side palpation
Any lumps, bumps, bruises, temperature, moisture, turgor (pinch sternum skin)
Symmetric Chest Expansion: Place hands along costal margins, thumbs pointed towards xiphoid process: pinch skin with thumbs and ask to breathe
Observe for any uneven movement
anterior side auscultation
Using the diaphragm, seated up ideally, not through the gown, inhale through mouth and exhale through nose, listen for complete cycles, apex to base, this is tiring
10 spots on front, do it bilaterally side to side
Start MCL at the clavicle, then to the 2nd ICS, 3rd ICS, 4th ICS, 5th ICS AAL (base)
posterior side inspection
Shape & configuration
Also check APTD (2:1)
Posture/Kyphosis (thoracic vertebrae arch outwards)
Skin colour & condition
anterior side palpation
Any lumps/bumps/bruises, symmetry, tenderness
Symmetrical chest expansion: same as anterior, place hands on “posterolateral chest wall”, thumbs around T9-T10, pinch and watch for any uneven movement
Tactile Fremitus: Ask patient to repeat a phrase as you feel 10 zones on the back using the ball on your palm; obstruction = no vibrations
anterior side percussion
Use 10 fields on the back again; don’t do it on the bones; listen for resonance (normal)/hyperresonance (booming)/dullness (thuds)
auscultation
18 spots on back, also bilateral, moves in then out (to avoid scapulae)
Just above the scapulae (T1), T2, T3, T4, T5, T6 (moving out), T7, T8 (Posterior Axillary Line), T9 (right below)
breathing sounds: bronchial
Harsh and hollow sounding, in the trachea/larynx, loud
breathing sounds: broncho-vesicular
Mixed, less loud; between scapulae/sternal border/major bronchi (mid area)
breathing sounds: vesicular
Quiet, rustling sounds; in most of the lungs
adventitious breath sounds
Sounds not normally heard superimposed on normal sounds.
Where did you hear it (lobe), on both sides? Inhale/Exhale? Cleared?
Rales
Rales (Crackling): Literally sounds like crackling, can be cleared by coughing in atelectasis
Rhonchi (Wheeze): Sounds like squeaks, high/low pitches
Stridor: sounds like wheeze, airflow is disrupted
pleural friction rub
Pleural Friction Rub: Sounds like rubbing
Cheynes-Stokes Respiration
Like an apneic period; but breathing extremely slowly
Happens to infants/older adults during sleep
o2 saturation
SpO2: % of hemoglobin carrying oxygen
Normal = 92% for most, 88-92% for those with COPD
COPD is like trying to breathe through a straw; their drive to breathe is due to their low O2
For us, our drive to breathe is more to release CO2 from the blood
