LECTURE 3: Respiratory Assessment 🫁😫 Flashcards
(19 cards)
3 Components of respiration
- Ventilation
- breathing in & out - Diffusion
- gas exchange - Perfusion
- delivery of blood to a capillary bed
respiratory muscles
- pectoralis minor
- diaphragm
- internal intercostal
- external intercostal
- trapezius
- abdominal rectus
- sternocleidomastoid
visualization of accessory muscle use is a red flag
challenges to the respiratory system?
smoking
- first, second, and third hand smoke
- e-cigarettes
- vaping
environmental factors
- home
-occupational
-travel
respiratory assessment - subjective data:
OLDCARTSS
presence of cough?
- sputum? characteristics? (colour, texture, volume, blood)
- characteristics of cough (wet/dry)
dyspnea (difficulty breathing)
- SOB, shortness of breath
- SOBOE, shortness of breath on exertion
chest pain
- can be cardiac or respiratory
past medical history
family history
self-care activities (lifestyle)
allergies
immunizations
medications
respiratory assessment - objective data - inspection:
- must speak before inspection (subjective data)
shape of chest: - barrel chest
- pectus excavatum (funnel chest)
- pectus carinatum (pigeon breast)
- check for cyanosis (blue colouration)
respiratory assessment - objective data - palpation:
excursion:
- to see if both lungs are inhaling/exhaling symmetrically
- place hands on back & front, ask patient to inhale/exhale
chest tenderness:
- sternum, point tenderness (pain felt with pressure on specific area)
extra assessments:
- chest excursion (expansion)
- tactile remits (vibration)
abnormal findings:
- lumps/bumps
- crepitus (air in subcutaneous tissue)
respiratory assessment - objective data - auscultation (landmarks, flip card):
KNOW WHERE THEY ARE
- suprasternal notch
- angle of Louis (sternal angle)
- costal angle
- scapular, clavicular, axillary lines
- C7
auscultation: normal sounds
- bronchial
- vesicular
- broncho-vesicular
auscultation: abnormal sounds
- diminished/absent sounds
- friction rub
- crackles
- wheezes
bronchial sounds - description
- loud, hollow “tubular” sounds
- high pitched
- considered abnormal when heard over peripheral lung fields
- distinct pause between inspiration/expiration
- ratio of 1:2 or 1:3
vesicular sounds - description
- soft, low pitched
- “rustling” quality with inspiration
- even softer during expiration
- majority of lung sounds
- ratio of 3:1
broncho-vesicular sounds - description
- mixture of high-pitch bronchial sounds and low-pitched vesicular sounds
- normally heard in mid-chest
- ratio of 1:1
friction rub sounds - description
- low pitched, short, grating sound from inflammation of pleural surface
crackles sound - description
- brief, discontinuous, popping lung sounds that are high pitched
- occur when small air sacs fill with fluid
Fine vs. Coarse crackles
- coarse crackles are louder, lower pitch, and last longer than fine crackles
wheezes sound - description
- musical sounds caused by narrowing of airways
promoting respirations and oxygenation
- promote lung expansion
- promote removal of secretions (sputum)
- maintain patient airway
- promote adequate exchange of oxygen and carbon dioxide
developmental variations - infants:
- infants are obligatory nose breathers
- broncho-vesicular sounds are heard
- respirations are primarily abdominal
- after child is 2, breathing shifts to intercostal
- irregular respiratory rhythm
developmental variations - pregnancy
- there’s an increase in tidal volume to meed the fetus’ need for oxygen
- later, diaphragm rises and the costal angle widens to accommodate the enlarging uterus
developmental variations - elderly/older adults
- alveoli tend to fibrose with age resulting in decreased surface area for gas exchange
- lung capacity decreases due to muscle weakness and less elasticity
- there’s more “dead space”, trapped air, and less vital capacity
- often the thoracic spine curves, gives appearance of barrel chest
