Week 9 - Respiratory Assessment Flashcards
Anatomy of Upper Airway (4)
- Mouth & oropharynx
- Nose & nasopharynx (better filtration)
- Pharynx
- Larynx
Anatomy of Lower Airway (4)
- Trachea
- Carina
- Bronchi
- Terminal Bronchioles (slows down air flow, smaller diameter)
Anatomy of Acinus (4)
- Respiratory Bronchioles
- Alveolar ducts
- Alveolar sacs
- Alveoli
Type I Alveolar cells
responsible for structure
Type II Alveolar cells
responsible for surfactant
Alveolar Macrophages
keepin’ clean
3 Types of Pleura
- Visceral Pleura
- Parietal Pleura
- Pleural Space
Four Major Functions of the Respiratory System
- Supply oxygen to the body
- Remove carbon dioxide
- Maintain homeostasis (acid-base balance)
- Maintain heat exchange
Hypoventilation
increases CO2 in the blood
Hyperventilation
decreases CO2 in the blood
Properties of respiration control (3)
- Normally involuntary
- Mediated by the respiratory center in the brain stem
- Breathing patterns change in response to varying levels of CO2 AND O2 in the blood
Stimulus to Breathe
- Normal stimulus to breathe in most people is an increase in CO2 or hypercapnia
- A decrease in O2 (hypoxemia) also increases respirations, but less effective than hypercapnia
Hypercapnia
increase in CO2 in bloodstream
Hypoxemia
decrease in O2 in bloodstream
Landmarks of the Thoracic Cage (4)
- Sternum
- 12 pairs of ribs
- 12 thoracic vertebrae
- Diaphragm
Landmarks of Anterior chest (7)
- Ribs 2, 4, 5, 6
- Suprasternal notch
- Manubrium of sternum
- Angle of Louis
- Body of sternum
- Xiphoid process
- Costal angle
Landmarks of Posterior chest (6)
- T1
- C7 (vertebra prominens)
- T3
- Inferior angle of scapula
- T10 and T12
- 12th rib
Anterior Reference Lines (3)
- Anterior axillary line
- Midclavicular line
- Midsternal line
Posterior Reference Lines (2)
- Scapular line
2. Vertebral line
Axillary Reference Lines (3)
- Anterior axillary line
- Midaxillary line
- Posterior axillary line
Areas of lung assessment
- Mediastinum (middle of thoracic cage) location of hear
- Right pleural cavity
- Left pleural cavity
- Right lung has 3 lobes, left lung only has 2
- Posterior chest is all lower lobes
- Anterior chest is mostly upper lobes
- Lateral sides we can see all 3 lobes, only place we hear the mid lobe (right side)
Considerations for Infants and Children (3)
- Surfactant not present until 32w gestation
- Smaller size of the respiratory system
○ Nasal passages
○ Diameter of airway
○ Distance between structures - Immune system immaturity
Considerations for Pregnancy (3)
- Decreased space for lung expansion
- Increased circumference of thoracic cage
- Increased O2 demand
Considerations for Aging Adults (4)
- Costal cartilage calcification (stiff)
- Decreased respiratory muscle strength
- Decreased elasticity within the lungs (more rigid, harder to inflate)
- Increase in small airway closure
Components of Subjective Respiratory Assessment (7)
- Cough
- Productive? - coughing anything up
- Hemoptysis - blood - SOB (Dyspnea)
- Chest pain with breathing
- Past history of respiratory infections
- Smoking history
- Environmental exposure
- Self care behaviours
Hemoptysis
Blood in cough
Components of Inspection (8)
- Skin colour and condition
- Nail beds (cap refill less than 2s), clubbing
- Thoracic cage: shape and configuration, costal angle is 90, less deep than wide
- Respirations: rate, rhythm, depth, pattern
- Work Of Breathing, persons position and facial expression, extra muscles
- LOC
- Signs of distress
- Sputum
Signs of respiratory distress (10)
- Increased WOB
- Sudden onset of SOB
- Gasping
- Colour changes around lips and nail beds
- Increasing RR
- Decreasing oxygen saturation
- Changes in LOC
- Tracheal tugging
- Retractions/indrawing
- Nasal flaring
Barrel chest
(Unexpected Configurations of thoracic cage)
Depth of chest is wider or equal to width of chest
Scoliosis
(Unexpected Configurations of thoracic cage)
S-shape in spine
Kyphosis
(Unexpected Configurations of thoracic cage)
Curvature in spine (old person hunch)
Pectus excavatum
(Unexpected Configurations of thoracic cage)
Sunken sternum
Pectus carinatum
(Unexpected Configurations of thoracic cage)
Protruded sternum
Components of Palpation
Check anterior, posterior & lateral chest for symmetry
Tactile Fremitus (vibrations in the chest wall) - say “99” or “blue moon” for resonance
Pleural Effusion
Fluid in the lungs
Decreased fremitus on palpation
Pneumothorax
Collapsed lung
Decreased fremitus on palpation
Pneumonia
Consolidation of lung tissue (alveoli fill with pus)
Increased fremitus on palpation
Dullness in percussion
Crepitus
Sounds like bubble-wrap, air enters subcut. tissue
Percussion notes
- Resonance (should predominate)
- Hyperresonance (too much air)
- Dullness (abnormal density in lungs, pneumonia)
- Tympany (abdominal area)
Expected breath sounds (Auscultation)
- Bronchial (tracheal) = insipration < expiration
- Bronchovesicular: insipration = expiration
- Vesicular: insipration > expiration, hear it everywhere
Adventitious Breath Sounds (Auscultation)
- Crackles
- Wheezes
- Rubs
- Stridor
Crackles
Adventitious Breath Sounds (Auscultation)
Fine = sounds like hair rubbing together Coarse = sounds like velcro
Wheezes
Adventitious Breath Sounds (Auscultation)
Inspiratory and Expiratory
Rubs
Pleural friction rub (inflamed, unlubricated pleura)
Sounds like leather
Stridor
Narrowing of upper airway, sounds like a whale or dolphin
Abnormal/unexpected breath sounds
- Diminished, decreased or absent sounds
- Increased sounds
Bronchophony
Tests for consolidation (pneumonia)
Say “99”
Expected: hear sound but can’t tell what’s been said
Unexpected: you can hear “99” on auscultation
Egophony
Tests for consolidation (pneumonia)
Say “eeeee”
Expected: hear “eeeee”
Unexpected: you “aaaaaa” on auscultation
Whispered Pectoriloquy
Tests for consolidation (pneumonia)
Whisper “1, 2, 3”
Expected: hear faintly, muddled, inaudible
Unexpected: hear it clearly and distinctly
