what are costochondral junctions? Are they palpable?
Points at which the ribs join their cartilages. They are not palpable
how far down can you palpate the ribs?
can palpate easily until the 10th rib
what is the respiratory health history for older adults?
-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
what is the difference in a normal chest and barrel chest?
normal chest- ribs have a downward slope
barrel chest- ribs are horizontal and it is usually caused by aging and chronic lung disease
what is scoliosis and kyphosis?
scoliosis- a lateral s-shaped curvature of spine
kyphosis- exaggerated posterior curvature of thoracic spine (hunch back)
what are developmental considerations for older adults?
- 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
what are developmental considerations for pregnant women?
- 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).
what are the developmental considerations for infants and children?
- 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
what are the three breathing techniques?
- Cascade cough
- Huff cough
- Quad cough
what is apart of the mediastinum?
esophagus, trachea, heart, and great vessels
how many lobes does each lung have?
right lung has 3 lobes
left lung has 2 lobes
what is the visceral pleura?
lines outside of lungs and is continuous with parietal pleura which lines inside of chest wall and diaphragm
what compromises lung expansion?
costodiaphragmatic recess (this is when pleurae extend approx 3cm below level of the lungs)
what are signs that indicate oxygenation problems?
- reduced mental awareness
- nasal flaring
what does atrophy mean? and how does this relate to older adults?
Atrophy means reduction in size. Chest movement normally declines as you age
what can cause blocked vibrations (tactile/vocal fremitus) from reaching chest wall?
accumulation of mucous, collapse of lung tissue are a few examples
what does bronchophony and whispered pectoriloquy mean?
sound becomes clear and distinct when abnormalities such as asthma, pneumonia, lung tumours etc are present when performing tactile fremitus
what is the cascade cough?
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)
what is the huff cough?
stimulates natural cough reflex which is effective for clearing central airways. Patient exhales and says “huff” and able to inhale more air
what is the quad cough?
used for patients without abdominal muscle control. Patient breathes out-nurse pushes in and upward on abdominal muscles toward diaphragm causing a cough
what is pursed-lip breathing?
involves deep inspiration and prolonged expansion through pursed lips and to prevent alveolar collapse
what is diaphragmatic breathing?
more difficult and requires relaxed patient while taking deep inspirations
what are the four major functions of the respiratory system?
- supplying O2 to body for energy production
- removing CO2 as a waste product of energy rxns
- maintaining homeostasis of arterial blood (acid-base balance)
- Maintaining heat exchange (less important in humans)
what is resonance and hyper-resonance? Which is abnormal?
Resonance- low-pitched, clear, hollow sound (predominates in healthy lung tissue of adults)
Hyper-resonance- abnormal and is lower pitched, booming
what are the three normal breath sounds in adults and older children?
what is bronchial?
high pitch, loud amplitude, inspire is less than expire. Quality= harsh/hollow
normal location= Trachea/larynx
what is bronchovesicular?
moderate pitch, moderate amplitude, inspire=expire. Mixed quality and located over major bronchi
what is vesicular?
low pitch, soft amplitude, inspire is greater than expire, quality is rustling trees and over peripheral lung fields
what is abnormal with breath sounds?
decreased or absent breath sounds (emphysema) or increased breath sounds (pneumonia)
what is normal for O2 saturations?
97-98%. If its abnormal then less than 93%
what is sputum and how can you collect it?
its mucous produced by cells of lungs, bronchi, and trachea. You collect it by having patient cough into container by suction.
if you’re healthy, how much sputum is normal?