RESPIRATORY Flashcards
(40 cards)
1
Q
RESPIRATORY - RESP EXAM
A
- General inspection and close observation of hands
- Checking respiratory rate
- Assess position of trachea
- Palpate apex beat
- Percussion
- Auscultation
- Vocal resonance
2
Q
RESPIRATORY - GENERAL EXAM - CYANOSIS
A
- Cyanosis: bluish discolouration of the skin due to poor circulation (e.g. peripheral vasoconstriction secondary to hypovolaemia) or inadequate oxygenation of the blood (e.g. right-to-left cardiac shunting).
3
Q
RESPIRATORY - GENERAL EXAM - SHORTNESS OF BREATH
A
- Shortness of breath: signs may include nasal flaring, pursed lips. Asthma, lung cancer and COPD. The inability to speak in full sentences is an indicator of significant shortness of breath.
4
Q
RESPIRATORY - GENERAL EXAM - COUGH
A
- Cough: a productive cough can be associated with several respiratory pathologies including pneumonia, bronchiectasis, COPD and CF. A dry cough may suggest a diagnosis of asthma or interstitial lung disease.
5
Q
RESPIRATORY - GENERAL EXAM - WHEEZE
A
- Wheeze: a continuous, coarse, whistling sound produced in the respiratory airways during breathing. Wheeze is often associated with asthma, COPD and bronchiectasis.
6
Q
RESPIRATORY - GENERAL EXAM - PALLOR
A
- Pallor: a pale colour of the skin that can suggest underlying anaemia (e.g. haemorrhage/chronic disease) or poor perfusion (e.g. congestive cardiac failure). It should be noted that healthy individuals may have a pale complexion that mimics pallor.
7
Q
RESPIRATORY - GENERAL EXAM - OEDEMA
A
- Oedema: typically presents with swelling of the limbs (e.g. pedal oedema) or abdomen (i.e. ascites) and is often associated with right ventricular failure. Pulmonary oedema often occurs secondary to left ventricular failure.
8
Q
RESPIRATORY - GENERAL EXAM - CONJUNCTIVAL PALLOR
A
- Conjunctival pallor: suggestive of underlying anaemia. Ask the patient to gently pull down their lower eyelid to allow you to inspect the conjunctiva.
9
Q
RESPIRATORY - GENERAL EXAM - HANDS - COLOUR
A
- Colour: cyanosis of the hands may suggest underlying hypoxaemia.
10
Q
RESPIRATORY - GENERAL EXAM - HANDS - TAR STAINING
A
- Tar staining: caused by smoking, a significant risk factor for respiratory disease (e.g. COPD, lung cancer).
11
Q
RESPIRATORY - GENERAL EXAM - HANDS - SKIN CHANGES
A
- Skin changes: bruising and thinning of the skin can be associated with long-term steroid use (e.g. asthma, COPD, interstitial lung disease).
12
Q
RESPIRATORY - GENERAL EXAM - HANDS - JOINT SWELLING OR DEFORMITY
A
- Joint swelling or deformity: may be associated with rheumatoid arthritis which has several extra-articular manifestations that affect the respiratory system (e.g. pleural effusions/pulmonary fibrosis).
13
Q
RESPIRATORY - GENERAL EXAM - HANDS - FINGER CLUBBING
A
- Finger clubbing - lung cancer, interstitial lung disease, cystic fibrosis and bronchiectasis.
14
Q
RESPIRATORY - GENERAL EXAM - HANDS - TEMPERATURE
A
- Temp - Cool hands may suggest poor peripheral perfusion. Excessively warm and sweaty hands can be associated with CO2 retention
15
Q
RESPIRATORY - CHEST WALL DEFORMITY - ASYMMETRY
A
- Typically associated with pneumonectomy (e.g. lung cancer) and thoracoplasty (e.g. tuberculosis)
16
Q
RESPIRATORY - CHEST WALL DEFORMITY - PECTUS EXTAVATUM
A
- A caved-in or sucken appearance of the chest
17
Q
RESPIRATORY - CHEST WALL DEFORMITY - PECTUS CARNIATUM
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- Protrusion of the sternum and ribs
18
Q
RESPIRATORY - CHEST WALL DEFORMITY - HYPEREXPANSION
A
- “Barrel chest”
- Chest wall appears wider and taller than normal. Associated with chronic lung diseases such as asthma and COPD
19
Q
RESPIRATORY - RESPIRATORY RATE
A
- Whilst still palpating the radial pulse (but no longer counting it), assess the patient’s respiratory rate (palpation of the radial pulse at this stage purely to avoid making the patient aware you are directly observing their breathing, as this can itself alter the respiratory rate)
- Note any asymmetries in the expiratory and inspiratory phases of respiration (e.g. the expiratory phase is often prolonged in asthma exacerbations and in patients with COPD).
20
Q
RESPIRATORY - NORMAL RESPIRATORY RATE
A
- In healthy adults, the respiratory rate should be between 12-20 breaths per minute
21
Q
RESPIRATORY - ABNORMAL RESPIRATORY RATE
A
- A respiratory rate of fewer than 12 breaths per minute is referred to as bradypnoea (e.g. opiate overdose)
- A respiratory rate of more than 20 breaths per minute is referred to as tachypnoea (e.g. acute asthma)
22
Q
RESPIRATORY - POSITION OF TRACHEA
A
- Ensure patient’s neck musculature is relaxed by asking them to position their chin slightly downwards.
- Dip your index finger into the thorax beside the trachea.
- Gently apply side pressure to locate the border of the trachea.
- Compare this space to the other side of the trachea using the same process.
23
Q
RESPIRATORY - WHY ASSESS THE POSITION OF THE TRACHEA?
A
- A difference in the amount of space between the sides suggests the presence of tracheal deviation
- Should be central in healthy individuals
- The trachea deviates away from tension pneumothorax and large pleural effusions
- The trachea deviates towards lobar collapse and pneumonectomy
24
Q
RESPIRATORY - ASSESSING CHEST EXPANSION
A
- Place your hands on the pateint’s chest, inferior to the nipples
- Wrap your fingers around either side of the chest
- Bring your thumbs together in the midline, so that they touch
- Ask the patient to take a deep breath in
- Observe the movement of your thumbs (in healthy individuals they should move symmetrically upwards/outwards during inspiration)
25
RESPIRATORY - ABNORMAL CHEST EXPANSION
- Reduced movement of one of your thumbs indicates reduced chest expansion on that side.
- **Symmetrical** - pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.
- **Asymmetrical** - pneumothorax, pneumonia and pleural effusion would all cause ipsilateral reduced chest expansion.
26
RESPIRATORY - PRECUSSION
- Place your non-dominant hand on the patient’s chest wall.
- Position your middle finger over the area you want to percuss, firmly pressed against the chest wall.
- With your dominant hand’s middle finger, strike the middle phalanx of your non-dominant hand’s middle finger using a swinging movement of the wrist.
- The striking finger should be removed quickly, otherwise, you may muffle the resulting percussion note.
27
RESPIRATORY - WHERE TO PERCUSS
- **Supraclavicular region**: lung apices, Infraclavicular region,
- **Chest wall**: percuss over 3-4 locations bilaterally, Axilla
28
RESPIRATORY - MEANING OF PERCUSSION SOUNDS
- **Resonant**: a normal finding
- **Dullness**: suggests increased tissue density (e.g. cardiac dullness, consolidation, tumour, lobar collapse).
- **Stony dullness**: typically caused by an underlying pleural effusion.
- **Hyper-resonance:** the opposite of dullness, suggestive of decreased tissue density (e.g. pneumothorax).
29
RESPIRATORY - AUSCULTATION
- Ask the patient to relax and breathe deeply in and out through their mouth (prolonged deep breathing should, however, be avoided).
- Position the diaphragm of the stethoscope over each of the relevant locations on the chest wall to ensure all lung regions have been assessed and listen to the breathing sounds during inspiration and expiration. Assess the quality and volume of breath sounds and note any added sounds.
- Auscultate each side of the chest at each location to allow for direct comparison and increased sensitivity at detecting local abnormalities.
30
RESPIRATORY - NORMAL BREATH SOUNDS
- **Vesicular**: the normal quality of breath sounds in healthy individuals.
31
RESPIRATORY - NORMAL BREATH SOUNDS - BRONCHOVESICULAR
- These are heard over the 1st and 2nd intercostal spaces and the interscapular area. The inspiratory and expiratory phases are roughly equal in length. They reflect a mixture of the pitch of the bronchial breath sounds heard near the trachea and the alveoli with the vesicular sound.
32
RESPIRATORY - NORMAL BREATH SOUNDS - BRONCHIAL
- These are normally heard over the manubrium. Expiratory phase is greater than inspiratory. The expiratory pitch is high and intensity is loud. Hollow, tubular sounds that are lower pitched.
- Heard in consolidation.
33
RESPIRATORY - NORMAL BREATH SOUNDS - TRACHEAL
- These sound are heard directly over the trachea. Inspiratory phase equals the expiratory phase. The sound is very loud and the pitch very high.
34
RESPIRATORY - VOLUME OF BREATH SOUNDS
- Quiet breath sounds: suggest reduced air entry into that region of the lung (e.g pleural effusion, pneumothorax).
35
RESPIRATORY - ABNORMAL BREATH SOUNDS - WHEEZE
- **Wheeze**: a continuous, coarse, whistling sound produced in the respiratory airways during breathing. Wheeze is often associated with asthma, COPD and bronchiectasis.
36
RESPIRATORY - ABNORMAL BREATH SOUNDS - STRIDOR
- **Stridor**: a high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways. Stridor has a wide range of causes, including foreign body inhalation (acute) and subglottic stenosis (chronic).
37
RESPIRATORY - ABNORMAL BREATH SOUNDS - COARSE CRACKLES
- **Coarse crackles:** discontinuous, brief, popping lung sounds typically associated with pneumonia, bronchiectasis and pulmonary oedema.
38
RESPIRATORY - ABNORMAL BREATH SOUNDS - FINE END-INSPIRATORY CRACKLES
- **Fine end-inspiratory crackles:** often described as sounding similar to the noise generated when separating velcro. Fine end-inspiratory crackles are associated with pulmonary fibrosis.
39
RESPIRATORY - VOCAL RESONANCE
- Ask Pt to say “99” repeatedly at the same volume and in the same tone.
- Auscultate all major regions of the anterior chest wall, comparing each side at each location with the opposite side of the stethoscope to cancel out heart beating sounds.
40
RESPIRATORY - ABNORMAL VOCAL RESONANCE
- Increased volume over an area suggests increased tissue density (e.g. consolidation, tumour, lobar collapse).
- Decreased volume over an area suggests the presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax).
- The presence of increased tissue density or fluid affects the volume at which the patient’s speech is transmitted to the diaphragm of the stethoscope.
