Mechanism Of Breathing And Observation And Palpation

Question 1

Other than the ribs, what structure surround the lungs?

Answer 1

Visceral pleura - type of serous membrane, sits directly outside lungs
Parietal pleura - further outside
Pleural cavity - in between visceral and pleural

Question 2

Pressures
Atmospheric pressure -
Intrapulmonary pressure -
Intrapleural pressure -

Answer 2

Atmospheric - 760mmHg
Intra - 760mmHG **therefore compliment each other
Intrapleural - in pleural cavity - 750mmHg

MmHg - mercury

Question 3

Mechanism of breathing
Describe what happens during inspiration (just vol and pressure changes) -

Answer 3

Pressures are balanced (760mmHg)
Intrapulmonary volume increases (due to constriction of diaphragm, as it moves down, and external intercostal muscles )
Rib cage rises and thoracic cavity volume increases
Intrapulmonary pressure decreases to 759mmHg, therefore difference of -1mmHg
Therefore, air will flow into lungs from area of high pressure to area of low pressure

Question 4

Mechanism of breathing
Describe expiration (just vol and pressure changes) -

Answer 4

External intercostals relax and diaphragm moves up
Rib cage descends and thoracic cavity volume decreases
Intrapulmonary volume decreases and Intrapulmonary pressure increases to 761mmHg, therefore difference of +1mmHg
Therefore air flows out, down its pressure gradient

Question 5

What is COPD?

Answer 5

It is irreversible
Lung condition characterised by chronic respiratory symptoms (dyspnoea, sputum production and exacerbations)
Symptoms causes by airway abnormalities (bronchitis) and or the alveoli (emphysema) that result in persistent and often progressive limitation of airflow and lung hyperinflation
The inflammation caused means structural changes occur to both small and large airways and alveoli, meaning it is hard to get air out of lungs

Question 6

What is COPD a combination of?

Answer 6

Chronic bronchitis
Asthma
Emphysema

Question 7

COPD
Chronic bronchitis, what is it?

Answer 7

Chronic inflammation causes narrowing of bronchi
Inflammation causes more mucus production
Thick mucus causes more inflammation and infection
Causes increase in WOB
Narrowing of airways can cause wheezing

Question 8

COPD
Emphysema, what is it?

Answer 8

Inflammation causes proteases to destroy elastin and connective tissue which reduces normal elastic recoil
Alveoli become over expanded
Some sacs rupture reducing the surface area
Airways become floppy and collapse trapping gas in the alveoli on exhalation

Question 9

COPD
Chronic asthma, what is it?

Answer 9

Airway inflammation in response to stimulus (cold air, pollution etc)
Bronchoconstriction of smooth muscle
Often reversible expect when becomes chronic (fixed airway)

Question 10

COPD
Clinical features of chronic bronchitis -

Answer 10

Over production of mucous
Increased WOB at rest and upon exertion
Wheezing
Cough
Fatigue
Activity limitation

Question 11

COPD
Clinical features of emphysema -

Answer 11

SOBAR and SOBOE
Cough
Not usually characterised by mucous production
Fatigue
Activity limitation

Question 12

COPD
Clinical features of chronic asthma -

Answer 12

Wheezing
SOB
Dry cough (nocturnal)
Tight chest

Question 13

Function of respiratory system -
The four stages of respiration -

Answer 13

Supply the body with oxygen taken from atmospheric air and to dispose of CO2 aka respiration
4 stages -
Ventilation (respiratory system)
External respiration (respiratory system)
Gas transport (CVS)
Internal respiration (simple diffusion)

Question 14

Stages of respiration
1) ventilation -
2) external respiration -

Answer 14

1) movement of air in and out of the lungs
Breathing is the process we use to achieve ventilation

2) diffusion of O2 from lungs to blood and CO2 from blood to lungs

Question 15

Stages of respiration
3) gas transport -
4) internal respiration -

Answer 15

3) transportation of O2 and CO2 to/from the lungs via the cardiovascular system

4) movement of O2 from blood to cells and CO2 from cells to blood

Question 16

Ventilation -

Answer 16

Process of moving gas in and out of the lungs/alveoli, achieved by rhythmical changes in the volume of the thoracic cavity

Question 17

What must change in order for ventilation to be able to occur?

Answer 17

The dimensions of the thorax:
Vertical, transverse and intero-posterior diameter increases during inspiration

Vertical, transverse and intern-posterior diameter reduces during expiration

Question 18

Inspiration
Pump handle movement -

Answer 18

Anterior ends of ribs 2-5 rise with the sternum
This increases the anterior posterior diameter of the thorax
Sternum moves in superior and anterior direction
Look for this when watching chest movement, and can palpate this

Question 19

Inspiration
Bucket handle movement -

Answer 19

The upward and outward movement of the shaft of the ribs
The anterior ends of ribs 8-10 move in an upward and outward direction
This increases the transverse diameter of the thorax
Look and palpate this

Question 20

Inspiration
The role of the abdomen -

Answer 20

Very close relationship between abdomen and diaphragm
A distended abdomen inhibits diaphragmatic movement
Eg late stages of pregnancy this may happen
This restricts lung volumes and increases the work of breathing

*aways palpate abdomen movement during breathing as well

Question 21

Work of breathing -

Answer 21

The total expenditure of energy (effort) necessary to accomplish the act of the breathing

Question 22

What is the main muscle of inspiration ?

Answer 22

Diaphragm

Question 23

Difference in diaphragm movement between quiet and deep inspiration -

Answer 23

Quiet - diaphragm descends approx 1-2cm from T8-9

Deep - diaphragm can descend up to 0cm
Any further movement is prevented by compression of abdominal organs

Question 24

Normal expiration -

Answer 24

Expiration is normally passive
Diaphragm and external intercostals relax
Lungs simply deflate as a result of their elastic recoil
Elastic recoil - natural tendency of lungs to rebound back to their resting state when stretched

Elastin and elastic fibres in the connective tissue of the lungs helps with this elastic recoil

Question 25

Forced exhalation Coughing and sneezing -

Answer 25

Achieved by contraction of internal intercostals and abdominal muscles Abdominal muscles contract causing abdominal contents to push up against the diaphragm Vertical diameter of thorax rapidly reduces

Question 26

Forced exhalation Vigorous exercise - What if forcing and you’re not exercising?

Answer 26

Expiration also becomes forced Using abdominal muscles during exhalation when not vigorously exercising is a sign of respiratory distress

Question 27

What is normal respiratory rate?

Answer 27

12-20 breaths per minute

Question 28

What can potentially cause someone’s respiratory rate to reduce?

Answer 28

Brain injury/drug overdoses As they effect breathing centre in the brain

Question 29

Observation What are potential signs of respiratory dysfunction?

Answer 29

Tracheal tug No bucket handle movement or pump handle movement Pursed lip breathing Backwards movement of abdomen Elevation of SG to aid inspiration - therefore trying to use accessory muscles Active expiration - abdominals working Fixing Tremors as may be a sign of increased CO2

Question 30

What are we feeling for when we palpate chest expansion?

Answer 30

Areas of tenderness (widespread or local) Skin temperature changes - hot/cold/clammy/sweaty Scars Response to touch Swelling or masses Crackles/tactile fermitus indicating sputum (feels like vibrations when palpating) Surgical emphysema - air gets trapped in subcutaneous area under skin Chest movement reflects chest expansion - should be equal on both sides. If not, can be an indication of pneumonia Distended abdomen

Question 32

Palpation position Apical (front) - Lateral costal - Abdomen - Posterior -

Answer 32

Apical - hand across sternum Hand anterior either side of sternum Lateral - both hands either side of chest, on lower ribs Both hands on one side (anterior and posterior) Abdomen - flat hand on upper abdomen just below xiphoid process Feel for movement and any distention Posterior - fingers hold the sides of the chest and thumbs rest lightly on each side of spine Looking for symmetrical separation of the thumbs

Question 33

What is surgical emphysema ?

Answer 33

Air leaked into the subcutaneous tissue of chest, neck or face Characterised crackling on touch Patients appear swollen, palpation feels like bubble wrap Can happen after stab wound for eg.

Question 34

List the order in which ventilation occurs -

Answer 34

Respiratory centre of brain sends a message to breath Muscles of inspiration contract Diaphragm contracts and flattens Ribs swing up and out Causes changes in pressures and air is sucked in Equilibrium is reached and air stops Brain stops sending a message Diaphragm relaxes and moves upwards Ribs move in and down Lungs deflate via elastic recoil