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Nursing 6410 - Health Assessment > Respiratory Assessment > Flashcards

Respiratory Assessment Flashcards

(70 cards)

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1
Q

Where does the trachea split? And where can tracheal sounds be heard?

A

T4 vertebrae the trachea splits into the left and right bronchus. Breath sounds heard at bottom cervical spine.

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2
Q

Diaphragm

A

Moves down and pressure increases during inspiration and moves up and decreases pressure during expiration. Negative pressure during inspiration.

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3
Q

Right lobe of lungs

A

Contains three lobes contains right oblique fissure and horizontal fissure. Right upper, middle and lower lobe

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4
Q

Left lobe of lungs

A

Contains two lobes left upper and left lower with one oblique fissure separating the lobes.

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5
Q

Lower border of lungs

A

Normally found on T10, but during inspiration, moves down to T12

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6
Q

Pneumonia is most commonly found it what lobes?

A

Middle and lower

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7
Q

When documenting, be sure to indicate location of sounds.

A

Crackles heard at posterior axillary line at 6th ICS

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8
Q

HPI

A

Coughing - ACE?
Onset/duration - w/ fever could be infection (without fever could be foreign body, inhaled irrittant)
Nature of cough - frequency, regularity, pitch, loudness, quality, circumstances
Sputum production
Sputum character - bloody could be viral infection
Pattern - regular cough may be pertussis
Severity
Associated symptoms
Efforts to treat

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9
Q

HPI: SOB

A 
Onset/duration
Pattern
Position most comfortable, pillows used
Related to exercise, certain activities, time of day, eating 
Harder to inhale or exhale 
Severity 
Associated symptoms
Efforts to treat
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10
Q

HPI: Chest Pain

A 
Palpatable? Bone/Muscle 
Onset and duration - no radiation? constant  achiness? Fleeting, needle-like jab? Situated in shoulders
Associated symptoms
Effort to treat 
Medications (recreational?)
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11
Q

PMHx

A

Thoracic trauma or surgery, dates of hospitalization for pulmonary disorders
Use of CPAP, BiPAP or home oxygen
Chronic pulmonary diseases
Other chronic disorders
Testing
Immunization against Strep pneumoniae and influenza

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12
Q

FHx

A 
TB
CF
Emphysema (smokers)
Allergies, asthma, atopic dermatitis 
Malignancy (solid mass in lungs)
Bronchiecstaiss 
Bronchitis 
Clotting disorders
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13
Q

What increases clotting risk

A

Sedentary lifestyle
Birth control (women older than 35 should not be on birth control)
Smoking
Positive homon sign may be DVT

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14
Q

Personal and Social Hx

A 
Employment (landscaping, miner)
Home environment 
Tobacco or VAPOR use
Exposure to infections like TB or flu
Nutrition 
Use of herbal or other remedies 
Travel exposure
Hobbies
alcohol or drugs 
Exercise
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15
Q

What is walking pneumonia?

A

Patch pneumonia all over lungs

common in younger

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16
Q

Older Adults

A

Increased risk of exposure and frequency (Hx of vaccines)
Weather effects on respiratory efforts and infection occurrence
Immobilization and sedentary habits
Dysphagia
Altered activities from respiratory symptoms

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17
Q

What should be emphasized in older adults?

A 
Smoking hx
Cough 
Dyspnea on exertion 
Fatigue
Weight changes 
fever and night sweats
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18
Q

Infants and Children

A 
Low birth weight and prematurity
Coughing and sudden SOB (aspiraton)
Possible ingestion of aerosols/household cleaners
Apneic episodes
Swallowing dysfunction (GERD)
Hx of vaccienes
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19
Q

Sound travels best through what medium?

A

Solid > liquids > gas
Solid objects (mucus, phlegm or others) in the lungs allow for enhanced sounds
Lower sound means only air

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20
Q

Observing Respirations

A

Inspect chest wall for movement
Symmetry
Retractions = concave at sternum, between ribs and suprasternal notch, above clavicles and lowest costal margins (using accessory muscles)
Suggestive of obstruction to inspiration

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21
Q

Tripodding

A

Leaning forward, uses sternocleidomastoid and clavicles to support breathing

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22
Q

Paradoxic breathing

A

On inspiration, lower thorax is drawn in, and on expiration, the opposite occurs

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23
Q

Inspection

A 
Shape and symmetry 
Chest wall movement
Superficial venous patterns
Prominence of ribs
Anteroposterior vs transverse diameter (Barrel chest)
Sternal protrusion (pidgeon chest)
Spinal deviation (scoliosis)
Funnel chest (pectus excavatum)
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24
Q

Inspection of peripheries

A 
Clubbing
Odor on breath
Cyanosis or pallor of skin, nails and lips
Pursed lip breathing 
Flaring of nostrils (more so in infants)
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25
Inspection of Respiration
Rate Quality Pattern Count rate
26
Palpation
``` Pulsations Tenderness bulges and depressions Masses Unusual movement or positions Elasticity of rib cage Immovability of sternum Ridgidity of thoracic spine Crepitus ```
27
Thoracic Expansion
Look for loss of symmetry in the movement of the thumbs suggest a problem on one or both sides
28
Tactile Fremitus
Palpable vibrations of the chest wall that results from speech or other verbalizations Use balls of hand and go side to side. Increased vibrations means obstruction in lungs. Easier posterioryl and underarm Check for pleurisy
29
Respiratory excursion
Thumbs connected on posterior to see thumb movement
30
Tracheal deviation
Take a deep breath. Is the trachea midline? Thyroid enlargement or pleural effusion Pneumothorax Tumors
31
Percussion
Percuss anterior, posterior and lateral Compare tones bilaterally Measure diaphragmatic excursion (3-5cm) Usually higher in right lobe because of liver Dullness over lungs may be tumor or phlegm
32
Percussion sounds
Palpate with hand hyperextended to use finger tips instead of finger pads Resonance is normal and hyperressonance is normal in lower lobes of lungs Dullness means obstruction
33
Anterior percussion sounds
Flatness over heavy muscles and bones Resonance over lungs Dullness over cardiac, liver Tympany over stomach
34
Percuss for diagphragmatic excursion
T10-T12 is diaphragm Measure distance diaphragm travels during inspirational hold and expirational hold Should be between 2-4cm
35
Auscultation
``` Intensity Pitch Quality Duration use diaphragm ```
36
What are breath sounds
Length of inspiration vs expiration wheezes, crackles Should be same on both sides
37
Vesicular breath sounds
3:1 (adults) | Low=pitched, low-intensity heard in healthy lungs
38
Bronchovesicular
1:1 (Children) Heard over major bronchi and are typically moderate in pitch and intensity Middle of lungs
39
Bronchial/trachial
Highest in pitch and intensity | Heard over trachea (1:1)
40
When are bronchovesicular and bronchial considered abnormal?
When heard over peripheral lung tissue of adults
41
Adventitious breath sounds
``` Crackles (formerly called rales) more common on inspiration POS for pneumonia Discontinuous sound heard on inspiration Fine: high pitched, short in duration Coarse: low pitched, longer in duration ```
42
Rhonchi (snorous weezes)
deeper, rumbling, pronounced on expiration, prolonged continuous Airway obstructed by secretions, muscular spasm, new growth or external pressure Expiratory wheeze = asthma
43
Wheezes
Continuous, high-pitched, musical sound (almost whistle) heard on inspiration and expiration High-velocity air flow through narrow or obstructed airway Bronchospasm, or acute or chronic bronchitis
44
Friction Rub
Pleural inflammation Outside respiratory tree Dry, crackle, grating, low-pitched, heard on both inspiraiton and expiration Caused by inflammed, roughened surfaces rubbing together Friction rub of heart is continuous
45
Equal breath sounds
may be a sign of infiltration or obstruction
46
Patterns of Respiration
Tachypnea - restrictive lung dx, pain, sepsis, obesity, anxiety, fever (faster than 20 breaths/min) Bradypnea - CNS depression, tissue damage, diabetic coma (<12 breaths per min)
47
Hyperpnea
Metabolic acidosis, pain, anxiety, hypoxia or hypoglycemia if comatose >20 breaths per min, deep breathing Hypopnea - shallow breaths
48
Kussmaul
DKA | Rapid, deep, labored
49
Cheyne-Stokes
CHF, Kidney failure, CNS damage, normal in sleep and elderly and children Periods of increasing depth with apnea
50
Biot's
Severe CNS damage | Irregularly interspread periods of apnea in a disorganized sequence of breaths
51
Adventitious Breath Sounds
Fine Crackles - discontinuous, heard during inspiration Medium Crackles - moist sound heard mid inspiration Coarse - loud and bubbly Rhonchi - loud, low, coarse sounds during both phases
52
Vocal Sounds
Egophony - say "eee" same as bronchophony Bronchophony - stethescope over consolidated area (say a phrase to listen for muffles) Non-muffled sound is obstruction Whispered Pectoriloquy - whisper instead
53
Vocal Resonance
Diminishes and loses intensity when there is loss of tissue in respiratory tree (barrel chest of emphysema) Classify as bronchophony, pectoriloquy and egophony
54
Peak Flow
Deep breath in and forced expiration to test asthma Measured by age/gender and height Find expected, measured and actual peak flow This check expiratory volume
55
A&P of Respiratory
Sternum, manubrium, xiphoid process, costal cartilage, 12 pairs of ribs and 12 thoracic vertebrae Ribs 11 and 12 are floating ribs Lung apex is found about 4cm above first rib
56
Increased AP diameter in adults d/t
loss of muscle strength in thorax and diaphragm loss of lung resiliency - trapped air can lead to inflation of lungs Air trapping = prolonged but ineffcient expiratory effort dorsal curve of thoracic spine stiffening, decreased expansion of chest wall
57
Dry cough
nonproductive? | Could be cardiac problem, allergeis, GERD, with pharyngeal irritation
58
Pain from Cocaine
Acute, severe? | Can cause tachycardia, HTN, coronary artery spasm (with infarction) and pneumothorax
59
Causes of tachypnea
broken rib or pleurisy | liver enlargement, abdominal ascites
60
Causes of bradypnea
neurological/electrolyte imbalance infection irritative pneumonia cardiorespiratory fitness
61
Depth and rate of breathing increases with
``` acidosis CNS lesions (pons) anxiety aspirin poisoning Hypoxemia Pain ```
62
Depth and rate of breathing DECREASES with
``` metabolic alkalosis CNS lesions (cerebrum) Myasthenia gravis Narcotic overdose Obesity (extreme) ```
63
Chest asymmetry
Unequal expansion and respiratory compromise D/t collapsed lung, extrapleural fluid or air or mass Unilateral or bilateral bulging caused by obstruction Prolonged exp c bulging could be airway outflow obstruction or compression d/t tumor,aneurysm,enlarged heart Costal angle widens above 90 degrees
64
Retractions in chest
Usually an inspirational obstruction Muscles pull back in an effort overcome blockage on inspiration. Obstruction high in the respiratory tree; breathing is characterized as stridor Paradoxic breathing causes abdomen to be drawn in during inspiration d/t to weakened diaphragm, OAD, or during sleep
65
Foreign body in bronchus (usually right side)
Causes unilateral retraction, but suprasternal notch is not involved. Retraction of lower chest occurs with asthma and bronchiolitis
66
Airway Patent or Obstructed
Obstructed when there is inspiratory stridor, hoarse cry or cough, flaring of nostrils, retraction at suprastern Severely when: stridor is both insp and exp, cough is barking, retractions also involve subcostal and intercostal spaces, cyanosis is obvious
67
When obstruction is above the glottis
``` Stridor tends to be quieter Voice is muffled Swallowing is difficult Cough is not a factor Head and neck awkwardly positioned to preserve airway. Could be an abscess ```
68
Obstruction below glottis
``` stidor tends to be loud and raspy voice is hoarse swallowing is not affected cough is harsh, barking positioning of head is not a factor ```
69
Hyperresonance of lungs
pneumothorax, emphysema, asthma
70
Expected findings in lungs
On inspection - symmetry, absence of retractions Palpation - Midline to trachea without tug, symmetric, unaccentuated tactile fremitus Percussion - range of 3-5cm, resonant and symmetric percussion notes Auscultation - absence of adventitious breath sounds Vesicular breath sounds, except for bronchovesicular sounds beside the sternum, or in areas of larger bronchi

Nursing 6410 - Health Assessment (16 decks)

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