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PCM II Midterm > Lower Respiratory Tract Exam > Flashcards

Lower Respiratory Tract Exam Flashcards

(47 cards)

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1
Q

What is considered to be a normal adult breathing rate?

A

quiet & regular @ respiratory rate of 14-20/min

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2
Q

What is bradypnea?

A

regular breathing rhythm but slower than normal rate (RR<14/min)

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3
Q

What is hyperpnea?

When is it normal?

A

increased depth of breathing & rate of respiration

normal during exercise

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4
Q

What is dyspnea?

A

feeling short of breath

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5
Q

Atelectasis

A

collapse of lung tissue that affects the alveoli from normal O2 absorption

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6
Q

Which 2 fingers do you use to percuss the lungs?

A

hyperextended middle finger of non-dominant hand & tapping finger of dominant hand

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7
Q

Where would you insert a needle for a thoracentesis?

A

2nd intercostal space & midclavicular line

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8
Q

Where would you insert a chest tube?

A

4th intercostal space @ mid axillary line (just superior to 5th rib to avoid neurovascular bundle)

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9
Q

Common chief complaints for lung exam

A 
cough
coughing &amp; spitting up blood
trouble breathing
wheezing 
swelling
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10
Q

What should be considered in HPI for cc related to lungs?

A

medications
exposure to cold/allergen that triggers asthma
allergic reaction (to meal)
pulmonary infection (cough)
recent surgery increases risk for pulmonary embolism
recent trauma (pneumothorax)

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11
Q

What are some associated symptom considerations for lung cc?

A

ENT: drainage from ear, otalgia (earache), tinnitis, epistaxis, nasal congestion, swollen lymph nodes, sore throad

Respiratory: chest pain, shortness of breath (asthma, pneumonia)

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12
Q

Constitutional associated symptom considerations

A

fever
sweats
chills
weight loss

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13
Q

PE of lower respiratory track

A

Inspection
Palpation
Percussion
Auscultation

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14
Q

Pulse oximetry

A

measures peripheral arterial oxygen saturation

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15
Q

End Tidal CO2

A

measures ventilation

non-invasive measurement of partial pressure of CO2 in inhaled breath over time

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16
Q

What is a normal PET CO2 reading?

A

35-40 mm Hg (represents normal partial pressure of CO2 in arterial blood)

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17
Q

What should you look for during inspection?

A

assess breathing rate, rhythm, depth & effort

skin color (cyanosis?)

trachea (is it midline)

hands (clubbing?)

shape of chest (deformity?)

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18
Q

What does cyanosis indicate?

A

hypoxia (can see @ nail bed)

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19
Q

What may tracheal deviation indicate?

Study These Flashcards
A

pneumothorax
pleural effusion
atelectasis
mass

20
Q

Pectus excavatum

Study These Flashcards
A

depression in lower portion of sternum that can compress heart & great vessels, cause murmurs

21
Q

Pectus carinatum

Study These Flashcards
A

sternum displaced anteriorly (increased AP diameter)

adj costal cartilages are depressed

22
Q

Barrel Chest

Study These Flashcards
A

increased AP diameter, seen in COPD

23
Q

Chronic Bronchitis

Study These Flashcards
A

daily productive cough for 3 months or more, in at least 2 consecutive years

assoc symptoms: overweight & cyanotic, elevated Hb, peripheral edema, wheezing

24
Q

Emphysema

Study These Flashcards
A

permanent enlargement & destruction of airspaces distal to terminal bronchiole

assoc symptoms: older & thin, severe dyspnea, quiet chest, lungs are hyperinflated w/ flat diaphragm

25
What may asymmetrical expansion of chest wall indicate?
pleural effusion
26
What may retraction of chest wall w/ breathing indicate?
severe asthma, COPD, upper airway obstruction
27
What may unilateral lagging of chest wall w/ breathing indicate?
pleural disease (asbesotsis, trauma, phrenic N damage)
28
Traumatic flail chest
multiple rib fractures may result in paradoxical movements of thorax injured area will cave INWARD w/ inspiration & move outward w/ expiration
29
What would use of accessory muscles for breathing indicate?
sign of respiratory distress seen in asthma, COPD, airway obstruction, viral illness
30
What should palpation in PE include?
palpate trachea areas of tenderness bruising or tenderness over ribs
31
How to examine if thoracic expansion is symmetrical
place thumbs @ level of 10th ribs, grab lateral to rib cage have pt inhale deeply & watch distance between thumbs as move apart during inspiration & feel for symmetry of rib cage
32
What do increased vibration sounds indicate? What do decreased/absent vibration sounds indicate?
pneumonia COPD or pleural changes (effusion, fibrosis, etc)
33
Dullness w/ percussion sounds
fluid or solid tissue replaces air-containing lung pleural accumulations or lobar pneumonia
34
Generalized hyperresonance w/ percussion sounds
indicates hyper-inflated lungs (chronic bronchitis or asthma)
35
Unilateral hyperresonance w/ percussion sounds
indicates large pneumothorax or large air filled bulb in lung
36
What is considered a normal lung percussion sound?
loud intensity, low pitch, long duration
37
What is considered a normal diaphragmatic excursion? What may abnormal indicate?
normal is 3-5.5 cm pleural effusion or is secondary to atelectasis/phrenic N paralysis
38
What should you use to auscultate the lungs?
use diaphragm of stethoscope compare both sides in ladder fashion (2 anterior & 4 posterior)
39
What are the most important techniques to assess airflow?
listen to sounds generated by breathing listen for any added sounds if abnormalities suspected, listen for vocal resonance
40
What are considered abnormal breath sounds?
stridor wheezes crackles
41
What are stridor sounds associated with?
usually heard on inspiration due to narrowing in upper airway croup, epiglottitis, upper airway foreign body, anaphylaxis
42
What is wheezing assoc w?
usually an expiratory sound caused by rapid airflow through narrowed bronchial airway reactive airway disease, asthma, COPD
43
What are crackles assoc w?
inspiratory sound caused by small airway closed during expiration & popping open during inspiration pneumonia, CHF, pulmonary fibrosis, asthma
44
When do you use an incentive spriometer?
to help w/ atelectasis (treatment & prevention) re-inflate lung after collapse of alveoli
45
Pulmonary Function test
non-invasive to show how well lungs are working diagnose obstructive v restrictive lung disorders
46
Spirometry (PFT)
measures lung function via amount & speed of air inhaled & exhaled
47
What should you evaluate on a chest X ray?
``` Adequate quality Airway Bones/soft tissue Cardiac size Diaphragms Effusions Fields/fissures Foreign body? Great vessels Gastric bubble Hilar masses ``` Impression-What are your overall findings?

PCM II Midterm (15 decks)

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