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Physical Assessment > 4 - Respiratory > Flashcards

4 - Respiratory Flashcards

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1
Q

Respiration maintains adequate _____ ______ to tissues

A

oxygen supply

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2
Q

What does respiration do?

A
  • Removes carbon dioxide and metabolic wastes

- Maintains homeostasis or arterial blood

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3
Q

List & Describe the 2 processes of respiration

A

1) Ventilation - inspiration and expiration (gas moves in and out of lungs)
2) Diffusion - oxygen and carbon dioxide moves from areas high to low concentration (ex. alveoli - capillary - cells)

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4
Q

List 3 respiratory disorders

A
  • asthma
  • COPD
  • allergies
  • lung cancer
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5
Q

What are the 3 parts of the thoracic cavity?

A

1) Mediastinum
2) Right pleural cavity
3) Left pleural cavity

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6
Q

What does the mediastinum contain?

A
  • heart
  • arch of aorta
  • superior vena cava
  • lower esophagus
  • lower part of trachea
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7
Q

What does the right and left pleural cavity contain?

A

lungs

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8
Q

Right lung has __ lobes

A

3

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9
Q

Left lung has ___ lobes

A

2

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10
Q

What is the parietal pleura?

A

protects the chest wall and diaphragm

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11
Q

What is the visceral pleura?

A

protects the lungs

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12
Q

What protects most of the respiratory system

A

Thoracic cage

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13
Q

What does the thoracic cage consist of?

A
  • 12 thoracic vertebrae
  • 12 pairs of ribs
  • Sternum
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14
Q

Anterior Chest:

_____ (highest point of lung) is 2-4 cm above the inner 1/3 of clavicle

A

Apex

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15
Q

Anterior Chest:

_____ (lower border of lung) rests on diaphragm at ~ 6th rib in midclavicular line

A

Base

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16
Q

Lateral Chest:

Where is the apex?

A

Apex at axilla

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17
Q

Lateral Chest:

Where is the base?

A

Base extends to 7th or 8th rib

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18
Q

Posterior Chest:

Where is the apex?

A

Apex located at C7

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19
Q

Posterior Chest:

Where is the base?

A

Base located at T10 (inspiration expands lungs, with base dropping to T12)

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20
Q

What are some general respiratory assessment questions?

A
  • Chronic illnesses (ex. asthma, COPD, lung cancer)
  • Acute illnesses (pneumonia, chest injury)
  • Allergies
  • Medications (corticosteroids, inhalers)
  • Smoking history (current, past, frequency)
  • Home oxygen
  • Environment (air pollution, allergens, pets, air filter system, occupational, recent travel)
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21
Q

What kind of questions do you ask if someone comes in with cough, SOB or chest pain with breathing?

A

OLD CART

Onset
Location
Duration
Characteristics
Aggravates/Alleviates
Radiate
Treatment
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22
Q

What do you inspect when observing respirations?

A
  • Rate, Rhythm, Depth, Effort in Breathing
  • Audible breathing
  • Cyanosis
  • Nasal flaring
  • Chest expansion
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23
Q

Bradypnea

A

slow breathing

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24
Q

Tachypnea

A

rapid breathing

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25
Hyperpnea
rapid deep breathing
26
Apnea
no breathing
27
Kussmaul
deep breathing
28
Biot
unpredictable irregular breathing
29
Cheyne-Stokes
deep breathing alternating with apnea
30
What do you inspect when observing anterior and posterior chest?
- Skin, color, and condition - Size, shape and symmetry of the chest wall - lateral/anteroposterior diameter - vertebral column alignment - Position the patient takes to breath (ex. sit leaning forward) - Abnormal retraction
31
What do you do when palpating the anterior and posterior chest?
- Assess any observed abnormalities during inspection - Identify areas of tenderness - Assess respiratory excursion (lung expansion) - Assess tactile fremitus (transmission of vibrations from larynx to chest surface)
32
How do you palpate for respiratory excursion (lung expansion) ?
- Place hands on back at level T9 or T10 - Thumbs ~ 1" apart - Pinch a small fold of skin between thumbs - Relax hands - Ask patient to take a deep breath - As patient inhales deeply, your thumbs should move apart (lungs expanding) symmetrically
33
How do you palpate for tactile fremitus (transmission of vibrations from larynx to chest surface) ?
- Ball of both hands - Over intercostal spaces - Patient repeats "99" or "1-1-1" - Compare sides for symmetry - Palpable vibrations transmitted through the bronchopulmonary tree to the chest well
34
What is percussion?
Tapping sets the chest wall and underlying tissues in motion producing - Audible sounds - Palpable vibrations
35
What does percussion allow for?
The determination of whether underlying tissues are: - Air-filled (hyper-resonant/tympanic) - Fluid filled (dull) - Solid mass (dull/flat)
36
What is auscultation used for?
to assess air flow through the tracheobronchial tree
37
What does auscultation involve?
- Listening to sounds generated by breathing - Listening for any adventitious (added) sounds - Listen to sounds of patients' spoken or whispered voice
38
What are some adventitious sounds?
- crackles/rales - wheezing - rhonchi - friction rub
39
What are breath sounds described in terms of?
- location - ratio of inspiration to expiration - intensity - pitch
40
What do crackles/rales sound like?
-Short, popping inspiration and/or expiration
41
Mechanism of crackles/rales?
Air forced through bronchi narrowed by fluid/mucus/pus
42
Conditions that cause crackles/rales?
- Infection - Inflammation - Heart failure
43
What do wheezes sound like?
High-pitched, musical inspiration and/or expiration
44
Mechanism of wheezes?
airway narrowing
45
Conditions that cause wheezes?
- Asthma - COPD - Bronchitis
46
What does stridor sound like?
-High-pitched, musical | INSPIRATION ONLY
47
Mechanism of stridor?
Mechanical obstruction at trachea/upper airway
48
Conditions that cause stridor?
- Tumor | - Pneumonia
49
What does Friction Rub sound like?
Deep, harsh, grating/creaking | Mostly INSPIRATION
50
Mechanism of Friction Rub?
Inflamed pleural surfaces lose normal lubricating fluid
51
Conditions that cause Friction Rub?
Pleuritis | Pneumonia
52
What would indicate Bronchophony ?
Patient says "99" and it is louder and clearer
53
What would indicate egophony ?
Patient says "EE" and it comes outs E to A ??? WTF
54
What is whispered pectoriloquy?
Whisper "99" and it comes out louder and clearer
55
__________: - Percussion is dull over airless area - Bronchial breath sound - Late inspiratory crackles - Increased tactile fremitus
Consolidation
56
______: - Percussion is diffusely hyperresonant - Decreased/absent breath sounds - May have wheezes, crackles, rhonchi - Decreased tactile fremitus
COPD
57
______ ________: - Percussion is resonant - Vesicular breath sounds - May have scattered crackles, wheezes, rhonchi - Normal tactile fremitus
Chronic bronchitis
58
What is spirometry?
A tool used to objectively assess airflow obstruction and stage severity of pulmonary disease - Measures the total volume of air a patient can expel from the lungs after maximal inhalation - Gold standard for diagnosing asthma and COPD - Monitoring progression/control
59
How long should a short-acting beta agonist be withheld prior to spirometry test?
6 hours
60
How long should an anticholinergic be withheld prior to spirometry test?
6 hours
61
How long should a long-acting beta agonist be withheld prior to spirometry test?
12-24 hours
62
How long should a long-acting anticholinergic be withheld prior to spirometry test?
24 hours
63
What are some spirometry indications?
- Significant occupational exposure to respiratory irritants - Smokers of > 20 pack years - Recurrent or chronic respiratory symptoms - Family history of respiratory disease - Assess/monitor bronchodilator therapy - Adverse reactions to drugs (ex. amiodarone)
64
PFTs
pulmonary function tests
65
What are some spirometry relative contraindications?
- recent surgery (within 4 weeks) - aneurysm (cerebral, thoracic, abdominal) - recent eye surgery - recent stroke - severe uncontrolled hypertension - pneumothorax - unstable cardiac status - MI within last month - Active TB, Hepatitis B, Hemoptysis or oral bleeding (cross infection concerns)
66
What is FVC ?
Forced vital capacity: | -Total volume of air that can be forcibly exhaled in one breath after full inspiration (L)
67
What is FEV1 ?
Forced expiratory volume in 1 second: | -Volume of air expired in first second during maximal expiratory effort (L)
68
What is PEF ?
Peak expiratory flow: | -Maximal flow speed achieved during forced expiration after full inspiration (L/min)
69
What is FEV1/FVC ratio ?
Proportion of forced vital capacity exhaled in the first second (%, post bronchodilator)
70
How is asthma diagnosed?
FEV1/FVC ratio < LLN and > 12% increase in FEV1 (and minimum > 200 mL for adults) post-bronchodilator (or after course of controlled therapy)
71
How is COPD diagnosed?
FEV1/FVC < 0.7 AND Mild: FEV1 > 80% predicted Mod: 50% < FEV1 < 80% predicted Sev: 30% < FEV < 50% predicted Very Sev: FEV1 < 30% predicted *All values post-bronchodilator
72
For asthma, when do you need to repeat spirometry?
every 1-2 years afterward
73
What indicates a loss of asthma control?
FEV1 < 90% of personal best
74
T or F: Long-term lung function often declines over time, even in well-controlled patients
true
75
When do you redo spirometry in COPD?
spirometry at 1-2 year intervals after diagnosis can help chart rate of lung function decline
76
What can establish presence of a complicated exacerbation?
FEV1 < 50% predicted
77
LLN
lower limit of normal (for age, sex, height, ethnicity); typically 0.8 - 0.9 for age 6-17 and 0.75-0.8 for adults
78
see diagnostic flow diagram and cases !!!
okay

Physical Assessment (6 decks)

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