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Sem. A - PAM 1 > Respiratory Assessment > Flashcards

Respiratory Assessment Flashcards

(49 cards)

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1
Q

Important elements of physical Respiratory assessment are…

A

Inspection

Palpation

Percussion

Auscultation

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2
Q

Surface Anatomy/Landmarks

A
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3
Q

Anatomical Landmarks

A
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4
Q

Identifying Landmarks

A
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5
Q

Lobe Position - Anterior

A
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6
Q

Lobe Position - Posterior

A
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7
Q

Lobe Position - Left Lateral

A
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8
Q

Lobe Position - Right Lateral

A
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9
Q

Before physical examination clinicians must…

A

Explain their intentions and the examinations they wish to carry out.

Gain consent from the patient to carry out examinations.

Ensure the setting is appropriate/private, chaperones present if required, patient positioned comfortably.

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10
Q

History taking should include…

A

Signs & Symptoms

Risk Factors (eg. Smoking)

Pain

Timescale (duration)

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11
Q

Ensure there is a review of systems

A

Cardiovascular (CVS)

Respiratory (RS)

Gastrointestinal/Urinary (GI/GU)

Musculoskeletal (MSK)

Neurological (Neuro)

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12
Q

Inspection of the face & neck should include…

A

JACCO - Jaundice, Anaemia, Clubbing, Cyanosis, Oedema.

Trachea

Jugular Veins (distention?)

Accessory muscle use

Pallor

Cyanosis

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13
Q

Inspection of the Chest will include…

A

Shape of the chest

Symmetry

Scars

Audible sounds

Rate of breathing

Sputum production

Retraction/accessory muscle use

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14
Q

Examples of chest shapes

A
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15
Q

Inspection of the hands will include…

A

Cyanosis

Asterixis (tremor/flapping of the hand when the wrist is extended)

Tar staining

Skin turgor

Clubbing

Oedema

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16
Q

Causes of Clubbing include…

A

Congenital Heart Disease

Bacterial Endocarditis

Cirrhosis

Lung Disease

Chronic Infections

Inflammatory Bowel Disease

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17
Q

Palpation of the chest will include & identify…

A

Lumps/lesions

Skin temp./moisture

Chest expansion & symmetry

Identify areas of tenderness/deformity

Tactile Fremitus (Intensity of vibration palpated on chest wall)

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18
Q

Anterior palpation/fremitus sites

A
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19
Q

Posterior palpation/fremitus sites

A
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20
Q

Percussion identifies…

Study These Flashcards
A

Normal sound - Resonance

Abnormal sounds - Dull, Tympany & Hyperresonance

Useful identifying areas that are solid, fluid or air filled

‘Poor mans ultrasound!’

21
Q

Percussion technique…

Study These Flashcards
A

Hyperextend the middle finger of one hand & place the distal interphalangeal joint against the chest.

With the end of the opposite middle finger, and brisk movement of the wrist, strike the joint of the finger that is pressed against the chest.

22
Q

Anterior locations for Percussion/Auscultation

23
Q

Posterior locations for Percussion/Auscultation

24
Q

Method of Auscultation

Study These Flashcards
A

Listen over all lobes

Listen to at least 1 respiration on each region

Use the diaphragm of the Stethoscope

Note Intensity, Quality & Added sounds

25
Auscultation Tips!!
Where possible, do not listen through clothing. Ask the patient to take deep breaths through the mouth whilst auscultating. Ask the patient to cough a few times - helping to clear secretions. If you hear added breath sounds, try to determine where in the cycle it is heard, eg. expiratory wheeze on exhalation.
26
Sounds created in the larger airways...
Sounds from the trachea & main, lobar & segmental bronchi are transmitted throught the rest of the lungs. Air transmits sound ***POORLY*** *Fluid transmits sound **WELL***
27
Respiratory noises include...
Stridor Bronchial Vesicular Rales/Crackles Wheeze Crackles Rhonchi Pleural Rub
28
Normal Tracheal Respiration
Normal over the trachea and main bronchi, they are wide so air movement is fast. Inspiration & expiration are equal, there may be a small gap inbetween.
29
Normal breath sounds
Heard over the rest of the lungs/chest wall. Inspiration is louder. Expiration is quieter and shorter. No gap between.
30
Absent/Reduced breath sounds
Compare to other side of chest! Generalised decreased airflow (hypoventilation). Localised decreased airflow (mucus plug). Air in lung (emphysema). Increased distance between lung & stethoscope (effusion, pneumothorax, obesity).
31
Bronchial breathing
Normal heard over the trachea, but abnormal if heard in the rest of the lungs. Louder & harsher Inspiration followed by equal/longer expiration. May be a short gap between. Indicates consolidation (dense lung).
32
Crackles
Fine or Coarse. Snapping open of small airways. Air bubbling through fluid. Predominantly inspiratory. Normal if they clear with a cough.
33
Wheeze
Narrowed, partially obstructed airways. Lower airway obstruction. Predominantly expiratory. Short=mild. Long=severe. Can be localised or generalised.
34
Stridor
Higher pitched sound. Upper airway obstruction. Usually inspiratory. Croup, Epiglottis, Burns, FB, Tumour. Often easily audible at the mouth. DANGEROUS.
35
Pleural Friction Rub
2 inflamed pleural layers rubbing together. 'Creaking like old leather.' Inflammation spread from underlying lobe. Heard during inspiration & expiration. Often dominant during expiration. Often localised, eg. PE, Pneumonia.
36
Alternative terminology
Normal breath sounds-Tracheal, Vesicular Crackles-Crepitations(JRCALC), Creps, Rales Wheeze-Rhoncus, Rhonchi
37
Breath sounds associated with conditions
Pneumothorax-Decreased/Absent Consolidation-Bronchial, Crackles Pneumonia-Bronchial/Decreased, Crackles & ?Wheeze Pleural Effusion-Decreased/Absent Asthma-Prolonged expiration, ?Decreased, Wheeze Pulmonary Oedema-Decreased, Crackles, ?Wheeze Emphysema-Decreased air entry, Prolonged expiration
38
Special tests during Respiratory assessment include...
Broncophony: - normal - soft & muffled - abnormal - louder & clearer Egophony: - normal - prolonged 'eeee' - abnormal - 'e' changes to 'a' Whispered Pectoriloquy: - normal - whisper is muffled - abnormal - whisper is clearer Tactile Fremitus
39
Respiratory RED FLAGS
++ respiratory effort unable to speak wheeze/silent chest stridor RR \<10 RR \>29 reduced/absent breath sounds reduced SaO2 PF \<33% expected etCO2 \<45mmHg HR100+ or \<40 arrythmias pallor/cyanosis respiratory exhaustion reduced BP confusion/combative behaviour decreasing LOC/GCS
40
Pneumothorax
S&S: - sudden ons DIB - unilateral pleuritic pain - tachycardia/tachypnoea - ? unequal chest wall movement PN: ? hyper-resonant over affected area Ausc: ? reduced sounds over affected area Misc: - TVF - ? reduced/absent sounds - ? tracheal deviation
41
Consolidation/Pneumonia
S&S: - dyspneoa - pyrexial - cough (sputum) - pleuritic pain/myalgia - tachycardia PN: dull over airless area Ausc: - bronchial over affected area - late inspiratory crackles Misc: TVF increased over affected area
42
Indicator scores: Community Acquired Pneumonia(CAP)
new onset confusion +1 point RR \>30 +1 point systolic BP \<90mmHg & diastolic \<60mmHg +1 point pt age \>65 +1 point A+E mandatory if score \>2
43
Pleural Effusion
S&S: - ? tracheal deviation in large unilateral effusion - S&S of underlying cause PN: dull/flat over fluid Ausc: - decreased/absent - ? bronchial near top of large effusion Misc: - TVF decreased/absent - may increase near top of large effusion
44
Asthma
S&S: - dyspnoea - cough - unable to complete sentences PN: resonant/hyper-resonant Ausc: expiratory wheezes/crackles Misc: assess RR, PF, HR to differentiate between acute, severe & moderate
45
Chronic Bronchitis
S&S: - chronic productive cough - SOB - cyanosis PN: resonant Ausc: - coarse crackles on insp/exp - possible wheezes/rhonchi Misc: - Hx suggestive - Low SpO2 - TVF normal
46
COPD
S&S: - SOB - exacerbation of previously stable condition - accessory muscle use PN: diffusely hyper-resonant Ausc: - decreased/absent - possible crackles, wheezes & rhonchi Misc: - TVF decreased - measure capnography and SpO2
47
Risk factors for PE
Malignancy Immobilisation Obesity Recent surgery Recent trauma Hx of DVT/PE Pregnancy OCP Limb fracture
48
Indicator scores - PE
49
PRF?
Document: - air entry on each side - quality - added sounds - location simple diagrams work well Note: - obvious distress - position & use of accessory muscles - RR, depth, & adequacy(perfusion/cyanosis) - expansion symmetry - trachea - presence or absence of: added breath sounds percussion and palpation findings pain or bony tenderness & signs of injury location of any abnormality

Sem. A - PAM 1 (4 decks)

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