Lower Respiratory DSA

Question 1

What is the rate of normal adult breathing?

Answer 1

RR = 14 - 20 bpm with quiet and regular rhythm

Question 2

What is Hypopnea?

Answer 2

Decreased depth (shallow) and rate (slow) of respiration

Question 3

What is bradypnea?

Answer 3

Regular rhythm BUT slower than normal rate (RR < 14/min)

Question 4

What is hyperpnea?

Answer 4

Increased depth (deep) of breathing and rate (fast) of respiration.

NORMAL IN EXERCISE

Question 5

What is dyspnea?

Answer 5

Feeling short of breath

Question 6

What is hypoxia?

Answer 6

Deficiency in the amount of O2 reaching the tissues.

Question 7

What is hypoxemia?

Answer 7

O2 deficiency in arterial blood.

Question 8

What is apnea?

Answer 8

No breathing.

Question 9

What is atelectasis?

Answer 9

Collapse of lung tissue that affects the alveoli from normal O2 absorption.

Question 10

What is the pleximeter finger? Plexor finger? How do they relate?

Answer 10

Pleximeter finger - hyperextended middle finger of non-dominant hand in percussion.

Plexor finger - “tapping” finger, dominant hand, for percussion.

Plexor finger is placed on pleximeter finger during percussion.

Question 11

Where is the Sternal Angle?

Answer 11

2nd rib joins sternum. (Angle of Louis)

Question 12

Where do you perform a needle thoracentesis (decompression)?

Answer 12

2nd intercostal space, midclavicular line.

Question 13

Where do you perform a chest tube insertion?

Answer 13

4th and 5th intercostal space, just anterior to the mid-axillary line.

5th intercostal space - just inferior to the nipple in a male or inframammary fold in a female.

Question 14

Where is the neurovascular bundle in relation to each rib?

Answer 14

Runs along the inferior margin of each rib.

Note: Place chest tubes/needles over superior margin of rib to avoid bundle.

Question 15

Please identify the following:
Otalgia
Tinnitis
Epistaxis
Rhinorrhea

Answer 15

Otalgia - Earache
Tinnitis - Ringing or buzzing in ears
Epistaxis - Nosebleed
Rhinorrhea - Runny nose

Question 16

What does a Pulse Oximeter measure? What is the mechanism?

Answer 16

Pulse Oximeter measures peripheral arterial oxygen saturation (SpO2).

Oxygenated hemoglobin - absorb infrared light and allow red light pass through

Deoxygenated hemoglobin - absorb red light and allow infrared light pass through

% Saturation = Red / Red + Blue

Question 17

What causes a bad Pulse Oximeter waveform?

Answer 17

• Improper placement
• Hypoperfusion
• Hypothermia
• Motion artifact

Question 18

What is the End Tidal CO2?

What are normal PETCO2 and PaCO2 values?

Answer 18

End Tidal CO2 - concentration of CO2 in exhaled air at the end of respiration. (PETCO2)

CO2 detected in exhaled air is produced by the body and delivered to the lungs by the blood — correlated with PaCO2.

Normal PETCO2 = 35-40 mmHg
Normal PaCOS = 35-45 mmHg

Question 19

What is Atelectasis?

What can help with prevention and treatment?

Answer 19

Atelectasis - Loss of lung volume due to collapse of lung tissue (alveoli).

Incentive Spirometer (IS) helps with prevention and treatment of Atelectasis.

Question 20

What is indicated by a patient using accessory muscles?

When can their use be seen?

Answer 20

Patients in respiratory distress.

Accessory muscles seen in:

• Asthmatics
• COPD
• Airway Obstruction
• Viral Illness (RSV)

Question 21

What is Cyanosis? What are the 2 types?

Answer 21

Cyanosis - bluish discoloration of skin and mucus membranes resulting from inadequate oxygenation of the blood.

Two types:

• Nail bed
• Perioral - seen around the mouth

Question 22

What are the causes of clubbing?

Answer 22

• Congenital heart disease
• Interstitial lung disease
• Bronchiectasis
• Pulmonary fibrosis
• Cystic fibrosis
• Lung abscess
• Malignancy (lung cancer)
• Inflammatory bowel disease

Question 23

What is Pectus Excavatum?

Answer 23

Pectus Excavatum “Funnel Chest”

Depression in lower portion of the sternum - can compress heart and great vessels, cause murmur.

Question 24

What is Pectus Carinatum?

Answer 24

Pectus Carinatum “Pigeon Chest”

Sternum displaced anteriorly (increased AP diameter), adjacent costal cartilages depressed.

Question 25

How does AP diameter change in Barrel Chest? Which clinical condition is associated with Barrel Chest?

Answer 25

Increased AP Diameter COPD is associated with Barrel Chest

Question 26

What is the difference between a “Blue Bloated” and “Pink Puffer?”

Answer 26

Blue Bloater - Chronic bronchitis - daily productive cough; overweight and cyanotic, elevated hemoglobin, peripheral edema, rhonchi and wheezing. Pink Puffer - Emphysema - permanent enlargement and destruction of airspaces; older and thin, severe dyspnea, quiet chest.

Question 27

How do you perform Thoracic Expansion?

Answer 27

1. Place thumbs at level of 10th ribs posteriorly, slide medially to created a loose fold of skin on each side b/t thumb and spine. 2. Ask patient to INHALE DEEPLY, watch distance between thumbs MOVE APART during inspiration and feel for range/symmetry of rib cage.

Question 28

What is Tactile Fremitus? How do we assess Tactile Fremitus? What is indicated by decreased/absent fremitus? Increased fremitus?

Answer 28

Tacticle Fremitus - palpable vibration transmitted through the bronchopulmonary tree to the chest wall as the patient speaks. Assessment - Use ball or ulnar surface of hands. Perform on both sides at same time. Ask patient to say 99 or 1-1-1. Decreased/Absent - COPD, pleural effusion, fibrosis, pneumothorax, thick chest wall Increased - Pneumonia

Question 29

How do you perform a Diaphragmatic Excursion? What is indicated by Diaphragmatic Excursion asymmetry?

Answer 29

1. Patient exhale completely and hold. 2. Percuss for level of diaphragm and mark with a pen. 3. Patient breathes normally for a few breaths. 4. Patient inhales completely and holds it. 5. Percuss for level of diaphragm and mark with a pen. 6. Distance between the two is the Diaphragmatic Excursion. Normal = 3-5.5 cm Asymmetry indicates pleural effusion.

Question 30

What are the 4 types of normal breath sounds? Where are they typically heard?

Answer 30

Typical Breath Sounds: 1. Tracheal - best heard over trachea in neck 2. Bronchial - over trachea 3. Bronchovesicular - over main bronchi 4. Vesicular - Over lesser bronchi, bronchioles, and lobes

Question 31

What is Stridor? What are the common causes?

Answer 31

High pitched wheeze entirely or predominantly inspiratory. Louder in neck than over chest wall. Causes: - Croup - Epiglottitis - Upper airway foreign body - Anaphylaxis

Question 32

What is Wheezing? What are the common causes?

Answer 32

Continuous; musical quality and prolonged (not necessarily entire cycle) Wheezing is relatively high pitched, musical, hissing or shrill quality. Common Causes: - Reactive Airway Disease (RAD) - Asthma - COPD

Question 33

What are Crackles (Rales)? What are their common causes?

Answer 33

Discontinuous; intermittent, non-musical and brief. Two Types: - Fine Crackles: soft, high pitched, very brief. - Coarse Crackles: louder, lower in pitch, brief. Common Causes: - Pneumonia - Congestive Heart Failure - Atelectasis - Pulmonary Fibrosis - COPD - Asthma

Question 34

What is Bronchophony? Whispered Pectoriloquy? Egophony?

Answer 34

Bronchophony - spoken words become louder during auscultation. Whispered pectoriloquy - whispered words louder and clearer during auscultation. Egophony - when patient says “ee” it sounds like “A” during auscultation - which is nasal and localized. THESE ARE ABNORMAL - Distinctness increases with lung consolidation.

Question 35

What are the characteristics of Vesicular breath sounds?

Answer 35

Soft and low pitched. Heard through inspiration and 1/3 expiration Heard over most of lungs (parenchyma)

Question 36

What are the characteristics of Bronchovesicular breath sounds?

Answer 36

Intermediate in intensity and pitch EQUALLY in inspiration & expiration Heard best in 1st & 2nd interspaces anteriorly and between the scapulae

Question 37

What are the characteristics of Bronchial breath sounds?

Answer 37

Loud and high pitched MOSTLY expiratory with some inspiratory Heard best over manubrium

Question 38

What are the characteristics of Tracheal breath sounds?

Answer 38

Very loud and high pitched EQUALLY in inspiration & expiration Heard best over trachea in neck