Module 10- Respiratory

Question 1

what are costochondral junctions? Are they palpable?

Answer 1

Points at which the ribs join their cartilages. They are not palpable

Question 2

how far down can you palpate the ribs?

Answer 2

can palpate easily until the 10th rib

Question 3

what is the respiratory health history for older adults?

Answer 3

-Pain
◦Fatigue
◦Smoking
◦Dyspnea
◦Wheezing
◦Allergies
◦Health risks
◦Medications
-Cough
-Shortness of breath
-Chest pain with breathing
-History of respiratory infections
-Smoking history
-Environmental exposure
-Self-care behaviours

Question 4

what is the difference in a normal chest and barrel chest?

Answer 4

normal chest- ribs have a downward slope

barrel chest- ribs are horizontal and it is usually caused by aging and chronic lung disease

Question 5

what is scoliosis and kyphosis?

Answer 5

scoliosis- a lateral s-shaped curvature of spine

kyphosis- exaggerated posterior curvature of thoracic spine (hunch back)

Question 6

what are developmental considerations for older adults?

Answer 6

• Lungs more rigid and harder to inflate
• Decrease in vital capacity and alveoli
• Increased SOBOE (on exertion) and post-op complication risk
• Round, barrel-shaped thoracic cage and kyphosis
• Chest expansion somewhat decreased

Question 7

what are developmental considerations for pregnant women?

Answer 7

• Enlarging uterus elevates diaphragm 4cm
• Decreases vertical diameter of thoracic cage is offset by increase in horizontal diameter
• Increase in estrogen relaxes thoracic cage ligaments
• Fetus increases maternal oxygen demands, which are met by an increased tidal volume (deeper breathing)
• Mom experiences increased awareness of need to breathe (normal).

Question 8

what are the developmental considerations for infants and children?

Answer 8

• Flexibility in sequence of the exam
• Crying enhances palpation of tactile fremitus
• Thoracic cage soft and flexible
• Apgar scoring system
• Sternal or intercostal retractions indicates distress
• Respiratory rate and pattern
• On auscultation, localization of breath sounds more difficult
• Percussion of limited use in newborns

Question 9

what are the three breathing techniques?

Answer 9

1. Cascade cough
2. Huff cough
3. Quad cough

Question 10

what is apart of the mediastinum?

Answer 10

esophagus, trachea, heart, and great vessels

Question 11

how many lobes does each lung have?

Answer 11

right lung has 3 lobes

left lung has 2 lobes

Question 12

what is the visceral pleura?

Answer 12

lines outside of lungs and is continuous with parietal pleura which lines inside of chest wall and diaphragm

Question 13

what compromises lung expansion?

Answer 13

costodiaphragmatic recess (this is when pleurae extend approx 3cm below level of the lungs)

Question 14

what are signs that indicate oxygenation problems?

Answer 14

• reduced mental awareness
• nasal flaring
• somnolence
• cyanosis

Question 15

what does atrophy mean? and how does this relate to older adults?

Answer 15

Atrophy means reduction in size. Chest movement normally declines as you age

Question 16

what can cause blocked vibrations (tactile/vocal fremitus) from reaching chest wall?

Answer 16

accumulation of mucous, collapse of lung tissue are a few examples

Question 17

what does bronchophony and whispered pectoriloquy mean?

Answer 17

sound becomes clear and distinct when abnormalities such as asthma, pneumonia, lung tumours etc are present when performing tactile fremitus

Question 18

what is the cascade cough?

Answer 18

slow, deep breath and it holds for 2 seconds while contracting expiratory muscles. Patient then opens mouth and performs a series of coughs throughout exhalation (coughing at a progressively low lung volumes)

Question 19

what is the huff cough?

Answer 19

stimulates natural cough reflex which is effective for clearing central airways. Patient exhales and says “huff” and able to inhale more air

Question 20

what is the quad cough?

Answer 20

used for patients without abdominal muscle control. Patient breathes out-nurse pushes in and upward on abdominal muscles toward diaphragm causing a cough

Question 21

what is pursed-lip breathing?

Answer 21

involves deep inspiration and prolonged expansion through pursed lips and to prevent alveolar collapse

Question 22

what is diaphragmatic breathing?

Answer 22

more difficult and requires relaxed patient while taking deep inspirations

Question 23

what are the four major functions of the respiratory system?

Answer 23

1. supplying O2 to body for energy production
2. removing CO2 as a waste product of energy rxns
3. maintaining homeostasis of arterial blood (acid-base balance)
4. Maintaining heat exchange (less important in humans)

Question 24

what is resonance and hyper-resonance? Which is abnormal?

Answer 24

Resonance- low-pitched, clear, hollow sound (predominates in healthy lung tissue of adults)
Hyper-resonance- abnormal and is lower pitched, booming

Question 25

what are the three normal breath sounds in adults and older children?

Answer 25

1. Bronchial 2. Bronchovesicular 3. Vesicular

Question 26

what is bronchial?

Answer 26

high pitch, loud amplitude, inspire is less than expire. Quality= harsh/hollow normal location= Trachea/larynx

Question 27

what is bronchovesicular?

Answer 27

moderate pitch, moderate amplitude, inspire=expire. Mixed quality and located over major bronchi

Question 28

what is vesicular?

Answer 28

low pitch, soft amplitude, inspire is greater than expire, quality is rustling trees and over peripheral lung fields

Question 29

what is abnormal with breath sounds?

Answer 29

decreased or absent breath sounds (emphysema) or increased breath sounds (pneumonia)

Question 30

what is normal for O2 saturations?

Answer 30

97-98%. If its abnormal then less than 93%

Question 31

what is sputum and how can you collect it?

Answer 31

its mucous produced by cells of lungs, bronchi, and trachea. You collect it by having patient cough into container by suction.

Question 32

if you're healthy, how much sputum is normal?

Answer 32

minimal sputum