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NSG2317 - health assessment > Respiratory Assessment > Flashcards

Respiratory Assessment Flashcards

1
Q

costochondral junctions

A

point in which the ribs join their cartilage
–> NOT palpable

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2
Q

suprasternal notch

A

hollow U-shaped depression just above the sternum, in-between the clavicles

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3
Q

manubriosternal angle

A

the intersection between the manubrium and the sternum (bony ridge)
- a few centimeters down from
the manubrium

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4
Q

sternal angle (Angle of Louis)

A

articulation of the manubrium and the body of the sternum, continuous with the second rib

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5
Q

landmarks with the angle of Louis

A

a. landmark to start counting the
ribs
b. the site of which tracheal
bifurcation occurs (bronchus
splits into right and left bronchi)
c. landmark for the upper border
(base) of the atria

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6
Q

costal angle

A

the right and left costal margins
form an angle where they meet the xiphoid process (usually <90 degrees)
- angle > 90 decrees when the rib
cage is overinflated

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7
Q

vertebral prominens

A

C7 - the most bony projection felt at the base of the neck

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8
Q

spinous processes

A
  • align with their numbered ribs
    down to T4
  • after T4, spinous processes angle
    downwards from their vertebral
    bodies
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9
Q

lung borders: anterior chest

A

apex - 3-4cm above inner thrid of clavicles

base - rests on diaphragm at above the sixth rib in the midclavicular line

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10
Q

lung borders: posterior chest

A

apex - C7 spinous process

base - T10 –> T12 (deep inspiration)

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11
Q

properties of the right lung

A
  • shorter than the left lung (liver)
  • wider than the left lung (no heart)
  • 3 lobes
    1. Right Upper Lobe (RUL)
    2. Right Middle Lobe (RML)
    3. Right Lower Lobe (RLL)
  • responsible for 55% lung function
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12
Q

properties of the left lung

A
  • longer than the right lung (no
    liver)
  • narrower than the right lung
    (heart compresses the lung)
  • 2 lobes:
    1. Left Upper Lobe (LUL)
    2. Left Lower Lobe (LLL)
  • responsible for 45% of lung
    function
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13
Q

pleurae

A

two layers that form an envelope between the lungs and chest wall
a. visceral pleura - lines outside of
the lungs
b. parietal pleura - lines the inside
of the chest wall and
diaphragm

pleural cavity (space between the two pleura) contains serous fluid
- lubricates the lungs to allows
frictionless breathing
- creates a negative pressure
which holds the lungs in place

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14
Q

the trachea

A

lies anterior to the esophagus
- begins at the level of the cricoid
cartilage
- bifurcates at the level of the
angle of louis (anterior) or
T4/T5 (posteriorly)

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15
Q

the bronchi

A

transports air between the environment and the lung parenchyma
- functions to protect the alveoli
from particles inhaled (lined
with cilia and mucus secreting
goblet cells)

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16
Q

which bronchi is more likely to become obstructed?

A

the right bronchi –> it is shorter and straighter, allowing foreign objects to enter and obstruct it easier

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17
Q

what is considered the “dead space” of the lungs?

A

the trachea and the bronchi
- air present in these locations are
not directly involved in gas
exchange

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18
Q

acinus

A

the functional respiratory unit that consists of the:
1. bronchioles
2. alveolar ducts
3. alveolar sacs
4. the alveoli

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19
Q

hypercapnia

A

increased levels of carbon dioxide in the blood –> the major stimulus for breathing

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20
Q

hypoxemia

A

decreased levels of oxygen in the blood –> stimulus for breathing, although not as significant as hypercapnia

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21
Q

what mediates involuntary breathing?

A

the respiratory centre in the brainstem: the medulla and pons

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22
Q

Inspiration Process - Involuntary

A

ACTIVE - diaphragm flattens to open thoracic cavity while intercostal muscles move the ribcage up
–> creates a negative pressure
that draws air into the lungs

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23
Q

Expiration Process - Involuntary

A

PASSIVE - diaphragm relaxes (elasticity in thoracic cage and abdomen push it up), decreasing the thoracic cavity’s space, while the intercostal muscles relax, pulling the ribcage down and in to a more neutral position
–> creates a positive pressure
that pushes air out of the lungs

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24
Q

Forced Inspiration

A

accessory muscles in the neck pull up the sternum and ribcage
- sternomastoid, scalene, and
trapezius muscles

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25
Q

Forced Expiration

A

the abdominal muscles contract forcefully to push up the abdominal viscera against the diaphragm –> causes the diaphragm to move up and squeeze against the lungs

26
Q

what is the major muscle responsible for inspiration?

A

the diaphragm

27
Q

Health History Points (7)

A
  1. cough
  2. shortness of breath
  3. chest pain with breathing
  4. history of respiratory infections
  5. smoking history
  6. environmental exposure
  7. self care behaviour
28
Q

Sputum Colours

A

white/ clear - viral infection
green/ yellow - bacterial infection
red/ pink and frothy - blood (hemopytosis)

29
Q

Physical Exam Points

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
30
Q

Physical Exam: Inspection

A
  1. LOC
  2. Facial Expressions
  3. Position taken to breathe
  4. Development of Accessory Muscles
  5. Shape and Configuration of chest wall
  6. Respiration Quality
  7. Skin Colour and Condition
31
Q

Kyphosis

A

C-shaped curve of the spine anterior to posterior (typically seen as a hump of the neck)
–> alters chest wall, decreases
thoracic cavity space for lung
inflation

32
Q

Barrel Chest

A

increased anterior-posterior chest diameter caused by increased functional residual capacity
- permanent hyperextension of
the chest due to the
hyperinflation of the lungs
Seen in patients with chronic obstructive diseases
- chronic bronchitis
- emphysema

33
Q

Scoliosis

A

S-shaped curve of the spine left to right, hips and shoulders not level
–> alters chest wall, decreases
thoracic cavity space for lung
inflation

34
Q

Normal Chest Wall Configuration

A

chest wall is symmetric, without deformity
- distance from the front to the
back of the chest is less than
the size of the chest side to side
- oval shaped thoracic cavity

35
Q

Respiratory Patterns (4)

A
  1. Eupnea (normal breathing)
  2. Hyperventilation
  3. Cheyene-Stokes
  4. Biot
36
Q

Eupnea

A

rhythmic breathing, predictable, evenly spaced, each inspiration is the same depth

37
Q

Hyperventilation

A

rhythmic breathing, increased rate and depth

Causes:
- acute pain
- activation of the SNS (exercise,
stress)
- ketoacidosis

38
Q

Cheyene-Stokes

A

rhythmic breathing (regular pattern), alternating periods of hypercapnia and apnea

Causes:
- dying - regions of the brain are
dying, less oxygen needed
- brain injury
- intoxication
- increased intercranial pressure

39
Q

Biot

A

IRREGULAR, unpredictable breathing, periods of breathing and apnea

Cause:
- respiratory depression
- brain injury at the level of the
medulla
- meningitis (spinal) - compresses
brainstem

40
Q

Physical Exam: Palpation

A
  1. Chest Expansion
  2. Tactile Fremitus
41
Q

Palpation: Chest Expansion

A

Anterior - place hands on anterolateral wall with thumbs along the costal margins pointing towards the zyphoid process
–> limitations in chest expansion
is easier to detect anteriorly due
to its increased range of motion

Posterior - place hands on posteriolateral wall with thumbs at the level of T9-10, slide thumbs medially to pinch a small fold of skin

42
Q

Palpation: Tactile Fremitus

A

Anterior - start palpation over the ling apices in the supraclavicular areas
–> compare vibrations from side to side (working down) as patient says “ninety-nine”

Posterior - start palpation over the lung apices

palpate skin for lumps, masses, temperature, moisture or otherwise at the same time

43
Q

Where is tactile fremitus most prominent?

A

between the scapulae and around the sternum (where the bronchi are closest to the chest wall

44
Q

Physical Exam: Percussion

A

start at the apices and percuss both sides of the chest, into the intercostal spaces to make a side to side comparison
–> ensure resonance over lung
fields bilaterally

45
Q

Resonance

A

low-pitched, clear, hollow sound that predominates in healthy lung tissue
–> dampened by the scapulae
and visceral organs (including
liver below the right lung)

46
Q

Physical Exam: Auscultation

A

start at the lung apices and auscultate both sides of the chest, into the intercostal spaces, and laterally to the side of the chest to make comparisons
–> listen for adventitious sounds
–> ensure vesicular breath
sounds are bilateral

47
Q

Normal Pulmonary Sounds

A
  1. Bronchial Sounds
  2. Bronchovesicular Sounds
  3. Vesicular Sounds
48
Q

Abnormal (Adventitious) Pulmonary Sounds

A
  1. Crackles (fine and course)
  2. Stridor
  3. Wheezing
  4. Pleural Friction Rub
49
Q

Bronchial Sounds

A

heard over the trachea and larynx
- heard better on expiration

50
Q

Bronchovesicular Sounds

A

heard at major bronchi, between scapulae
- heard equally on inspiration and
expiration

51
Q

Vesicular Sounds

A

heard over lung fields
- heard more on inspiration

52
Q

Asthma

A

allergic hypersensitivity to inhaled allergens –> bronchospasm, inflammation, edema, secretion of mucus in airways

Exam:
- tactile fremitus decreased
- resonant to hyper-resonant
- adventitious bilateral wheezing
on expiration
- diminished air movement,
difficult exhaling
- tachycardia, tachypnea
- dyspnea, accessory muscles

53
Q

Bronchitis

A

proliferation of mucous glands in the passageways, excessive mucous secretion

Exam:
- productive cough
- thick mucoid sputum
- tactile fremitus normal
- resonance over lungs
- crackles over deflated regions

54
Q

Emphysema

A

destruction of pulmonary connective tissue = enlargement of air sacs and rupture of alveolar walls, increased resistance on expiration results in lung hyperinflation

Exam:
- barrel chest
- tripod position
- tachypnea, tachycardia
- decreased tactile fremitus
(hyper-inflation of lungs)
- hyper-resonant
- prolonged expiration (airway
resistance)
- muffled heart sounds (hyper-
inflation)

55
Q

Lobar Pneumonia

A

Infection in lung parenchyma leaves alveolar membrane edematous and porous = RBCs and WBCs fill alveoli air space

Exam:
- tachypnea, tachycardia
- chest expansion decreased on
affected size
- tactile fremitus normal if
unobstructed
- no resonance, dull over affected
area (fluid filled, not air)
- decreased or absent breath
sounds over affected area
- adventitious crackles

56
Q

Atelectasis

A

collapsed alveoli (or an entire lung) due to:
a. an airway obstruction (foreign
body, mucoid, tumor
b. compression of the lung
c. lack of surfactant

Exam:
- tactile fremitus decreased or
absent
- trachea might shift towards
affected side
- dull over area of collapse
- vesicular sounds decreased or
absent over affected area
- fine crackles of bronchus is
unobstructive

57
Q

Pulmonary Embolism

A

undissolved thrombi lodges in heart to occlude pulmonary vessels

Exam:
- ischemia downstream, hypoxia,
cyanosis
- decreased CO (occlusion)
- tachypnea, tachycardia
- sputum with blood
- hypotension (from dec CO)
- crackles, wheeze

58
Q

Pleural Effusion

A

collection of excess fluid in the intrapleural space, compression of overlying lung tissue

Exam:
- tachypnea, tachycardia
- dyspnea
- decreased tactile fremitus
- tracheal shift away from affected
side
- no resonance, dull
- breath sounds decreased or
absent

59
Q

Heart Failure

A

pump failure with increasing pressure of cardiac overload resulting in pulmonary congestion

Exam:
- tachypnea, tachycardia
- skin moist, clammy
- tactile fremitus normal (lungs
still inflated)
- resonant (lungs still inflated)
- crackles at lung bases
- paroxysmal nocturnal dyspnea
- orthopnea ^^
- SOB on exertion

60
Q

Indications of Respiratory Difficulty

A
  • intercostal retractions
  • nasal flaring
  • pursed lip breathing
  • accessory muscle use
  • tripod sitting
61
Q

Older Adult Considerations: Health History (pul)

A
  1. Any SOBE?
    • decreased vital capacity
    • decreased gas exchange = dec
      energy, fatigue
  2. Usual amounts of physical activity
    • older adults are less able to
      perform activates bc of fatigue,
      SOBE
    • people who are sedentary are at
      greater risk for respiratory
      issues
  3. Positive history of respiratory conditions
  4. Chest pain with breathing
    • could indicate a broken rib that
      has punctured a lung (after
      falling)
62
Q

Older Adult Considerations: Physical Exam

A
  1. costal cartilages become calcified - dec mobility of thorax
  2. decrease in elastic properties of the lungs - less distensible and lessens their ability to contract and recoil
  3. lung bases become less ventilated - inc SOBE
  4. Kyphosis - hunched spine, decreased thoracic cavity space

NSG2317 - health assessment (18 decks)

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