Week 9 Flashcards
Where are the anterior thoracic landmarks
Sternum
-notch
-manubrium
-body
-xiphoid
What are the reference lines for the back
-left scapular line
-vertebral line
-right scapular line
What are the reference lines for the anterior side
-midsternal line
-midclavicular line
-anterior axillary line
What are the references lines for the side
-posterior axillary line
-midaxillary line
-anterior axillary line
Subjective data: resp
S: signs and symptoms
(Tell me what brought you in here today)
A: Allergies
(Medications and environmental)
M: medications
(Correct use of respiratory medications)
P: past medical, surgical, family Hx
(Respiratory infections/conditions, smoking history, environmental exposure or occupational exposures, influenza and pneumococcal vaccine)
L: last meal
(Tell me about your food and drink choices over the last week (or month))
E: Events
(Leading up to)
Focused subjective data: resp
- cough with or without sputum
- shortness of breath or dyspnea
- SOBOE
- chest pain with breathing
- orthopnea
- wheezing or tightness in chest
- change in functional ability
Inspection: Resp
- what is the position/posture of the pt
- facial expression and signs of distress
- pursed lips or nasal flaring
- LOC - GCS
- skin colour: pink, cyanosis, pallor, grey
- resp. Rate
- check for clubbing
- which muscles are doing the work
- any retractions
- audible respirations
- thoracic cage: shape and configuration
- spinous process midline
- scapulae symmetrical - AP diameter: approx half of transverse diameter
What is a barrel chest
AP equal to transverse diameter
- horizontal ribs
What is a funnel chest (pectus exacvatum)
Sunken sternum
- noticeable on inspiration
Palpation for Resp
- finger pads above the scapula
- move side to side - ending at base of lung
- laterally to mid axillary line
- same for anterior
Posterior chest: Palpation tactile fremitus
Tactile (or vocal) fremitus: “99”
Resonance
- low- pitched, clear, hollow sound (healthy lung)
Hyper-resonance
- lower pitched booming sound (too much air present e.g emphysema)
Dull note
- soft, muffled thud (abnormal density in lung e.g tumour, pleural effusion, pneumonia)
Percussion: Diaphragmatic excursion
- pt exhales and holds
- percussion in ICS down scapular line
- mark level of lung tissue on deep exhalation at last resonant note (sound changes from resonant to dull)
- repeat after pt breathes deeply and holds
- difference should equal and bilateral, measuring 1-2 rib spaces
Auscultation: anterior and posterior
- top down, alternating sides
- do not listen through clothing
- full breath in each location
- intensity, quality, duration or inspiration/expiration
- Tracheal
- Bronchial
3: Bronchovesicular
4: vesicular
Auscultation Resp
Bronchial and tracheal
- inspiration will be slightly SHORTER than expiration
Bronchovesicular
- inspiration and expiration will be EQUAL
Vesicular
- inspiration will be slightly GREATER than expiration
Abnormal lung sounds
Adventitious
- added sounds
Crackles/rales
- excessive mucous, fluid filled alveoli
Wheeze
- narrowed bronchioles
Rhonchi
- louder resulting from secretions moving around narrowed airways
Stridor
- partially obstructed airway (foreign object or laryngeal spasm)
What is Whispered Pectoriloquy
Ask the pt to whisper a sentence of words such as “one-two-three” and listen with a stethoscope
Normally only faint sounds are heard, however over areas of tissue abnormalities the whispered sounds will be clear and distinct
What is Bronchophomy
Ask the pt to say 99 in a normal voice. Listen to the chest with a stethoscope
The expected finding is that words will be in distinct. Bronchophony is present if sounds can be heard clearly
What is Egophony
While listening to the chest with a stethoscope, ask the pt to say the vowel e
Over normal lung tissues the same e as in beet will be heard if the tissue is consolidated the e sound will change to a nasal a as in say
Considerations of older adults: resp
- decrease resp strength
- loss of lung flexibility
- smaller breaths
- thorax more rounded
- costal cartilage is calcified
- may need to increase rate
- alveoli more rigid
- more difficult to meet O2 demands during times of exertion
- decreased function of cilia leads to pooling
-secretions
-weaker muscles lesions strength of cough
-risk of pneumonia - assess management of chronic conditions
