Week 8: Respiratory Flashcards
Chest Anatomy
- Lungs composed of right and left lung: Right lung composed of 3 lobes upper, middle, lower while Left has upper and lower.
Anterior: Apex of the lungs are 3cm above inner clavice with a base on diaphram of 6th rib. Anterior chest almost all upper and midde lobes. Landmarks used to describe chest
Posterior: apex at C7 and base near T10- posterior lungs composed of lower lobes mainly. Deep expiration base extends T12
During inspiration: increase chest size, increase A-P , diaphram contract and descend
Expiration: diaphram relax, air flow out
Anterior Important Lung Landmarks
- Supersternal Notch: jugular notch
- Sternal notch/manusternal sternal angle which is continous with the second rib and boarder of the atria ( bifurcation of bronchi)
- Sternum
- Intercostal spaces
- Costal angle 90 degrees or less
- Thoracic cage is narrow at top, 12 ribs and 12 thoracic vertebrae. The anteior side has first 7 ribs attaching to sternum via costal cartilages
- 8-12 attach via extra cartilage
Anterior Lobes
Landmarks to find lung lobes
- Anterior chest upper and middle lobes
- Apex rests 4cm above clavicle with base midaxillary around 8th rib.
Lateral Lobes
Posterior Landmarkings and Lobes
- Vertbrae prominse of spinous process at base of neck. C7 and T 1 can be found at neck base.
- Apex of lung at C7 and base is near T10
- Vertbare of C7
- Count spinous process down
- Inferior scapula Rib 7/8
- 12th rib
- All lower lobes lungs
Reference Lines
- Midsternal
- Midclavicular
- Scapular
- Veterbal
- Midaxillary Anterior/Posterior
Respirations
Triggered due to brain stem, hypercapnia ( Co2) in blood and Hypoxemia (low o2) trigger inspiration.
- Inspiration: contraction of diaphram, size increases, increase AP diameter
- Expiration: passive air flow out
- Tidal Volume: how much air is inhale during relaxed breath 500ml.
Respiratiom Pathlogies
- Eupnea (normal)
- Dyspnea (difficulty breathing)
- Orthopena ( trouble when supine)
- Bradypena ( Breathinng is less than 10)
- tachypena (Breating rate is greater)
- Apena ( no breath)
- Hypercapnia ( increased co2)
- Hyoxemia ( decreased O2)
- Hypoventilation slow shallow due to co2 build up
- Hyperventilation rapid and deep breaths
Acute Assessment
Acute SOB
- Immediate assessments pursued lips nasal flares
- Ascultation
- Oxygen may be given
- Elevated head bed
- Pt remain stable: tripoid for asucltation
- Priotitize subjective data
Subjective Collection
- Cought (sputum)
- SOB
- Chest pain: assume cardiac until proven
- Orthopena
- Tightness
- Smoke/Vape
- Enviornment
- Family/Personal History
- Allergies
- OPQRSTUV
Main questions to ask
- Cough
- SOB: resp rate, oxygen saturation, pulse, BP, ascultation
Cluster paitents who exibit SOB–> ask essential questions, intervene and assess - Smoking
- History resp.
Objective Assessment
IPPA
- Preparation include drapping, position seated, privacy
- Hygine
Conditions
- Bronchitis
- Orthopena ( cant breath supine)
- Dyspnea (SOB)
- Epunea (normal breath)
- Cyanosis (blue peripheral and central)
- Pallor (white)
- erythema (redness)
- Jaundice
- Crepitus (crackling sense)
- Edema
- Hypoxia
- Clubbing
- Scoliosis/Kryphosis
- COPD
- Emphysema ( aveoli loose elastic)
- Tachypena/Bradypena Tachy rate > 24 and Brady < 10
- Adventious sound
General Inspection
- Posture
- Facial expression
- Pursued lips nasal flares
- LOC, GCS
- skin color (pink, cyanosis, pallor, grey)
- Resp rate rythum (10-20)
- Chest and Back shape configuration
- O2 sat
- Clubbing
- Muscles bulging, accessory muscle?
- Retractions
Chest Posterior Inspection
- Inspection: Thoracic cage note shape and configuration
- Normal finings: spinous process mideline, straight, eliptcal shape, scapulae symmetrical, shoulders symmetry. AP diameter half of the tranverse
- Symmetry of chest rise and fall/peripheral cyanosis, signs of distress, muscle movement, lesions, retractions
Posterior Palpation
- Palpation for emphysema, crepitus, tenderness, lesions, masses, lumps
- Chest symmetrical expansion and expiration
- Soft/Firm
- Distended
- Tactile Fermitus: air transmitted vibrations acoss, should be equal.
Posterior Perucssions
- Determines pressce of fluid or air
- Begin at apex move side to side, bilaterally compare
Sounds:
Resonace (soft, hollow sound in healthy tissue air filled) heard in between spaces and above apex )
Tymapny ( hollowed organs)
Dullness ( solid) Across scapula
Posterior Chest Ascultation
All Lower lobes
- Pressece and quality of breath sounds
- Pt tripoid psoiton and arms crossed head down
- One full respiration each location, compare top down, left to right compare bilaterally
- No clothing
- Note intesnity, qualiity, duration, inspiration and expiration
–> Larger airways are louder while smaller are softer
Landmark at lung apex go top-down left to right
Ascultation Sounds
Vesicular Sounds: Common across majority of lung tissues, soft, low ruslting sounds during inspiration and expiration. Low pitch, soft, louder during inspration, overal pi tissue
Bronchivesicular: Moderate pitch and amplitude. mixed quality and found over major bronchi in 1st 2nd sternal rib
Bronchial/Trachelar: Higher and louder, expiration louder, harsh hollowed sound. Trahcea and larynx
