Pulm Assessment

Question 1

Dyspnea

Answer 1

Positional?
Paroxysmal nocturnal dyspnea? (cardiac)
Orthopnea? (cardiac)
Exertion?

Question 2

Chest Pain for Pulm

Answer 2

Distinguish from angina

MI has different descriptors –> doesn’t change with position

Question 3

Cough

Answer 3

Inflammation, pressure by tumor, smoking, allergies, heartburn, asthma and medications
example: ACE = stop if persistant cough

Question 4

Pectus excavatumn

Answer 4

Concave chest –> breastbone sunken in

Pushes heart in

Question 5

Barrel Chest

Answer 5

COPD
Lungs overfilled with air for long period of time
AP ratio

Question 6

Pectus carinatum

Answer 6

Abnormal development of rub cartilage causing the chest to be sunken
“Knee in chest”

Question 7

Respiratory Assessment

Answer 7

• Rate (1st thing to alert you!!)
• Rhythm
• Symmetry (rise and fall –> rib fractures)
• Quality of ventilatory movements (panting or deep? –> trying to keep alveoli open)
• Patient position (tri-pod)
• Accessory muscles (neck/abdominal for adults and intercostals/nasal flaring kids)
• Unequal chest wall movement (rib fractures/ pneumothorax)
• Pausing mid sentence to take a breathe?
• Chest tubes, central venous access (chest xray–>can get pneumo), artificial airway, NG tube (is it in the lungs?)

Question 8

What breathing rhythm is typical at EOL?

Answer 8

Cheyne-Stokes = varying periods of increasing depth interspersed with apnea

Question 9

Hyperventilation

Answer 9

Faster than 20 bpm, deep breathing

Question 10

Kussmal

Answer 10

Rapid, deep, labored = common during DKA = or too acidic

Question 11

Resp assessment: Palpation

Answer 11

Trachea = midline

Thoracid expansion = equal

Question 12

Vesicular

Answer 12

At the bases
No crackles/low pitch
Heard from beginning of inspiration to end of expiration

Question 13

Bronchovesicular

Answer 13

Heard over the 1st and 2nd intercostal spaces

Louder, over big conducting airways, between scapulae

Question 14

Absent of diminished lung sounds

Answer 14

Little to no flow to a particular portion of lung

Possibly collapsed lung

Question 15

Displaced bronchial

Answer 15

Normal bronchial sounds heard over the peripheral lung fluids instead of the trachea
Can indicate fluid in alveoli

Question 16

Crackles (rales)

Answer 16

Fluid in small airways/alveoli
Fine, medium, coarse
Probably pulmonary edema –> Fluid!

Question 17

Stridor

Answer 17

Loud, high-pitched sound heard during inspiration
In the upper airway
Ex: croup

Question 18

Rhonchi

Answer 18

Coarse, rumbling, low-pitched
Thick snot and secretions are the cause
Ex: PNA

Question 19

Wheezes

Answer 19

High-pitched, squeaking, whistling produced by airflow through narrowed small airways
Insp/exp wheezes
Ex: asthma (wheezes can get worse as the wheezes open)