Week 7: Respiratory Assessment Flashcards
Parts of the upper respiratory tract (URT) (2) and lower respiratory tract (LRT) (5)
Upper respiratory tract: Nose and oropharynx
Lower respiratory tract: Trachea, lungs, pleura, thoracic cage, and diaphragm
Lobes of the lungs: Anterior and posterior
Anterior:
- Right upper, middle, and lower lobes (RUL, RUM, RLL)
- Left upper and lower lobes (LUL, LLL)
Posterior:
- Right upper and lower lobes (RUL, RLL)
- Left upper and lower lobes (LUL, LLL)
Diagnostic tools and what they do (6)
Pulse oximeter: Measures oxygen saturation level
Arterial blood gases: Measures levels of oxygen and carbon dioxide in the body. Can be drawn from radial, brachial, or femoral artery.
Thoracentesis: The collection of fluid from the pleural space of the thoracic cavity
Bronchoscopy: Direct visualization of the larynx, trachea, and bronchial tree
Lung biopsy: Removal of a small piece of lung tissue for analysis
Mantoux tuberculin skin test: TB test via the skin
Mainstream vs sidestream smoke
Both forms of secondhand smoke
Mainstream smoke: Smoke exhaled by a smoker
Sidestream smoke: Smoke in the surrounding air from the lighted end of a tobacco product. Contains higher concentrations of carcinogens and is more toxic
When the Pneumovax vaccine is recommended (3 populations)
Recommended for:
- All adults 65+
- Ages 2-64 with certain medical conditions
- Adults 19-64 who smoke cigarettes
Breathing difficulties: Dyspnea
A general uncomfortable awareness of the act of breathing. Very subjective and broad
Breathing difficulties: Cardiac dyspnea
Difficulty breathing related to inadequate cardiac output
Breathing difficulties: Orthopnea
Difficulty breathing while lying in a supine position. Relieved when sitting or standing
Breathing difficulties: Paroxysmal nocturnal dyspnea
Shortness of breath when asleep. Symptom of left ventricular heart failure
Sputum vs hemoptysis
Sputum: Mucus
Hemoptysis: Sputum with blood
Types of cough (4)
- Nonproductive/dry cough: No sputum
- Productive cough: Mucus produced and expectorated
- Hacking cough: Persistent dry cough
- Chronic cough: A cough lasting longer than 8 weeks
Mapping the thoracic cage: Anterior, posterior, and lateral reference lines (3 each)
Anterior reference lines:
- Right midclavicular line
- Midsternal line
- Left midclavicular line
Posterior reference lines:
- Right scapular line
- Vertebral line
- Left scapular line
Lateral reference lines:
- Anterior axillary line
- Midaxilary line
- Posterior axillary line
Aspects of inspection (5)
- Size
- Shape
- Symmetry
- Color
- Respiratory rate and rhythm
Abnormal inspection findings: Barrel chest
Anterior posterior-to-transverse ratio is 1:1, and the costal angle is greater than 90 degrees
Abnormal inspection findings: Pectus excavatum (funnel chest)
A congenital deformity; sternum is abnormally depressed
Abnormal inspection findings: Pectus carinatum (pigeon breast)
A deformity of the chest; the sternum protrudes out from the chest
Abnormal inspection findings: Intercostal and accessory muscle retractions
May indicate problems with air movement; prolonged inspiratory phase may indicate upper airway obstruction; prolonged expiratory phase may indicate lower airway obstruction.
Abnormal respiratory rates and rhythms: Bradypnea
Abnormally slow breathing, less than 12 breaths/minute
Abnormal respiratory rates and rhythms: Tachypnea
Abnormally rapid breathing, more than 20 breaths/minute, usually shallow
Abnormal respiratory rates and rhythms: Kussmaul respirations
Abnormally rapid breathing, more than 20 breaths/minute, usually shallow
Abnormal respiratory rates and rhythms: Biot respirations
Irregular breathing of variable depth (usually shallow), alternating with regular or irregular periods of apnea (absence of breathing); also called ataxic breathing
Abnormal respiratory rates and rhythms: Cheyne-Stokes respirations
Gradual increase in depth of respirations, followed by gradual shallow breathing and then a period of apnea
Abnormal respiratory rates and rhythms: Apnea
Absence of breathing
Pursed lip breathing: Definition and implications
Definition: Breathing through the nose and exhaling through pursed lips
Implications: Common in individuals with COPD to reduce the work of breathing
Clubbing of nail plates: Definition and implications
Definition: Nailbeds soften and the nail forms a downward angle greater than 180
Implications: Chronic lack of oxygen or hypoxia
Aspects of palpation (4)
- Moisture
- Surface characteristics
- Temperature
- Tenderness
Crepitus: Definition and cause
Definition: A light crackling or popping feeling under the skin
Cause: Leakage of air into subQ tissue
Unique elements of palpation for the respiratory system (2)
Palpating for symmetrical expansion: To assess symmetrical expansion of the thoracic cage
Palpating tactile fremitus: To palpate voice sound vibrations through the bronchi
Implications of increased or decreased fremitus
Increased fremitus: May indicate increased density of the lung tissue; may be related to fluid or pathology in the lung that is changing the density or compressing the lung tissue, such as pneumonia
Decreased fremitus: may indicate the vibrations are obstructed with fluid (pleural effusion), decreased air movement (emphysema), obesity, or increased musculature.
Steps of percussion
- Explain the technique
- Have the pt sit on the side of the exam table
- Assess the anterior lungs via indirect percussion technique. Move from the apex to the base on each side.
- Assess the posterior lungs via indirect percussion technique. Move from the apex to the base on each side.
- Instruct pt to raise one arm and percuss the lateral lung fields via indirect percussion. Move from the apex to the base on each side.
- Document
Percussion sounds (3)
- Resonance: low-pitched, clear, hollow (healthy)
- Soft, muffled (heard over solid masses or areas of inc consolidation)
- Hyper-resonance: low-pitched, drum-like, accentuated (heard over hyper-inflated areas)
Auscultation: Normal findings (3)
- Bronchial breath sounds heard over trachea and larger bronchi; expiratory sounds are louder + longer than inspiratory sounds + have a pause. High-pitched, hollow, and tubular
- Bronchovesicular breath sounds heard over right and left bronchi; anteriorly over the mid-chest + between the scapula. Medium-pitched
- Vesicular breath sounds are heard throughout periphery; inspiration is longer and louder than expiration. Soft, low-pitched, rustling
Adventitious breath sounds: Crackles (rales)
Produced by air passing over retained airway secretions, heard at end of inspiration, may be cleared via coughing. Fine crackles are soft, high-pitched. Coarse crackles are louder, low-pitched (Velcro)
Adventitious breath sounds: Rhonchi (sonorous wheeze)
Louder, deeper, lower-pitched wheezes in the upper bronchi; may be related to obstruction of larger airways; commonly heard in expiration, sounds like snoring
Adventitious breath sounds: Wheeze
Caused by narrowed passageways by secretions, inflammation, obstruction, foreign body; high-pitched, whistling or musical sound
Adventitious breath sounds: Pleural friction rub
Caused by inflammation of pleurae that normally slide without friction; deep, harsh leathery sound heard during inspiration and expiration
Adventitious breath sounds: Stridor
Caused by upper airway narrowing or obstruction (loudest over trachea); harsh, high-pitched, crowing sound; sign of respiratory distress and medical emergency
