Pulmonary Assessment Flashcards
(39 cards)
Six Symptoms to be aware of:
- Cough
- Sputum
- Hemoptysis
- Chest Pain
- Dyspnea
- Smoking History
Cough should be characterized by…
- time of day
- Productive/Nonproductive
- Related to any exacerbating factor (running in cold weather)
Sputum should be described as…
Amount, color, consistency and odor
Ex: 1 cup a day of yellow foul smelling sputum
If someone is experiencing hemoptysis while experiencing coughing and vomiting, what must you do?
Distinguish whether it is gastric or cardio/pulmonary
When someone is experiencing chest pain, it is characterized into what categories? How do you distinguish if it is cardiac?
Categories: pleuropulmonary (PE, pneuomothorax, pleurisy), cardiovascular or neuromuscular
If you can touch it or manipulate it, it is NOT cardiac.
If a patient is experiencing dyspnea, what should you do?
Quantify it. Use clinical reasoning. Use dyspnea scale.
Example:
* A patient who usually runs 5 miles a day who then notices dyspnea after running one mile a day may have new disease.
* A patient who usually can run up two flights of stairs who then notices dyspnea after walking up one flight of stairs may have new disease.
How do you document Smoking History?
You want to convert smoking history into “pack-years smoked”
Where 1 pack-year = 20 cigarettes/day for 1 year.
Example: Smoked between the years of 1991 to 1998 & smoked 2 packs per day
[8] x [2] = 16 pack-year
When observing a patient what should you look at?
- Clubbing (chronic tissue hypoxia; pulmonary disease)
- Skin (cyanosis; fingers and lips)
- Posture/position (Forward bend - COPD = Professional or Tripod position
How does a tripod sitting position help with COPD patients?
Improves length-tension ratio of diaphragm
Allows better use of accessory muscles (pectorals) to elevate anterior chest; Mechanical advantage for ventilation.
How long should the respiratory rate be taken?
30 seconds
Normal ratio of inspiration to expiration
I:E Ratio can be 1:1-1:2
Expiration is generally longer than inspiration
Respiratory Rate Classifications
Normal: 12-20
Tachypnea: increased respiratory rate with shallow breathing pattern >20
Bradypnea: <10
Normal Breathing Pattern
Synchronous upward and outward motion of the abdomen and upper chest
Abdominal-paradox breathing pattern
Upward and outward motion of the upper-chest and inward motion of the abdomen [hyperinflation of the lungs]
Upper chest-paradox breathing pattern
Upward and outward motion of the abdomen and inward motion of the chest [spinal cord injury – have diaphragm but not upper chest innervation]
Excessive accessory breathing pattern
Muscle use-Excessive upper-chest motion with increased use of the SCM and scalene muscles. Signifies increased work of breathing and respiratory distress. Dome is compromised, diaphragm is down, the only way now is for muscles.
Cheyne-Stokes breathing pattern
A breathing pattern characterized by a period of apnea, followed by gradually increasing depth and frequency of respirations; associated with critically ill patients. Usually happens after something critical. Increase depth and speed to a point then decrease depth and speed, similar to a crescendo and decrescendo.
Apnea breathing pattern
A pattern in which there is an absence of breathing.
Breathing Patterns and Restrictive lung Disease
Don’t try to change patterns of people with restrictive lung disease as it will not work.
Note breathing patterns as normal and expected or abnormal and unexpected.
Tracheal Positioning
Should be in the midline - may deviate contralateral direction due to:
Pneumothorax or ipsilateral direction - negative pressure pulls the trachea towards this side. Will hear no breath sounds if collapsed lung; Emergency situation.
What are two types of sternal deformities?
Pectus Carinatum (Pigeon)
Pectus Excavatum (Funnel)
What level does the trachea bifuracate?
Lecel of T4 and Sternal Notch
What level is the inferior angle of the scapula at?
7th-8th rib/interspace
How do you palpate chest wall expansion? What are you looking for?
- Place hands at the base of the rib cage with thumbs equidistant from the xiphoid process or lower ribs.
- Asl patient to take slow, deep breaths and observe for any asymmetric motion of your hands
- Provides information about symmetry of chest movement, Look for asymmetry
