respiratory system

Question 1

control of respirations

Answer 1

Breathing is controlled by brainstem
Change in CO2 or O2 levels in our blood influence our breathing

Question 2

subjective data - cough

Answer 2

if they have one for how long
is it a productive cough
- are they coughing anything up, if so what does it look like

Question 3

orthopnea

Answer 3

the inability to sleep lying down, have to sit up to effectively breathe while sleeping

Question 4

subjective data - pain

Answer 4

can have chest pain while breathing because of a lung issue
do they have a history of respiratory illness of problems that could be causing the pain

Question 5

subjective data - smoking habits

Answer 5

smoking can lead to cancer
- 2nd most common cancer, and most common cause of cancer related death

Question 6

subjective data - environment and ADLs

Answer 6

are there any environmental hazards
- can they effectively and safely perform ADLs and live at home

Question 7

order for objective data

Answer 7

Inspect, palpate, percuss, auscultate (Posterior chest then anterior chest)

Question 8

colors of sputum meanings

Answer 8

blood - pneumonia or TB
yellow or green - some kind of bacterial infection
pink frothy - pulmonary edema
white or clear - typically a viral infection

Question 9

inspection of the posterior chest - inspection

Answer 9

skin color
- is it pale of cyanotic (hypoxic)
skeletal deformities?
- the the spine okay (kyphosis: hunchback, scoliosis: lateral curvature)

Question 10

inspection of the posterior chest - palpation

Answer 10

Symmetric chest expansion 🡪 confirm by using hands
Tactile (or vocal) fremitus 🡪 using hands to assess for palpable vibrations
- assess as you would a thrill (have them say 99 or blue moon and feel for vibrations)

Question 11

posterior chest - how to percuss

Answer 11

place two fingers between the intercostal spaces then tap those fingers with the other hand and assess by listening for sounds

Question 12

the types of sounds for percussion

Answer 12

Normal resonance = low-pitched, clear, hollow sound
Hyperresonance = low-pitched, booming sound
Dull sound = “thud” sound

Question 13

auscultation of the posterior chest lung fields

Answer 13

use the diaphragm of the stethoscope
- always listen to both sides
- each time you place it you have them take a deep breath in and out and listen for all of the inspiration and expiration

Question 14

how is anterior the same as posterior

Answer 14

you inspect, palpate, percuss, and auscultate looking for the same things just in different places

Question 15

listening to adventitious lung sounds

Answer 15

• listen with the diaphragm of the stethoscope
• it is best heard when directly on the skin

Question 16

abnormal sounds - crackle

Answer 16

• typically shows there is fluid in the lungs, typically heard on inspiration like a popping sounds like the sound rice Krispies make
  fine crackles (rales)
  coarse crackles

Question 17

abnormal sounds - wheeze

Answer 17

High-pitched
Low-pitched (rhonchi)
- is typically on expiration, every once in a while on inspiration

Question 18

abnormal sounds - stridor

Answer 18

a high pitch sound on inspiration

Question 19

barrel chest

Answer 19

have a wider than normal chest for their size

Question 20

pectus excavatum versus carinatum

Answer 20

excavatum - depression in the sternum
carinatum - protrusion in the sternum

Question 21

scoliosis

Answer 21

lateral curvature of the back

Question 22

kyphosis

Answer 22

outward curvature of the back
humpback

Question 23

tachypnea versus bradypnea

Answer 23

tachypnea - fast respirations typically 24 or more
bradypnea - slow respirations less than 10

Question 24

hyperventilation versus hypoventilation

Answer 24

hyper - increased rate and depth of respirations
hypo - shallow, irregular, and decreased depth

Question 25

cheyne-stokes versus biot

Answer 25

cheyne stokes - a cycle of a regular breath, then one with an increase in depth, then one with a decrease in depth, then followed by apnea, then it restarts biot - like cheyne-stokes but has an irregular pattern

Question 26

abnormal findings: common respiratory conditions

Answer 26

Atelectasis Lobar Pneumonia Pneumothorax Pleural effusion (fluid) or thickening Heart Failure Asthma (Reactive airway disease) Acute or chronic bronchitis Emphysema Pneumocystis jiroveci (P. carinii) pneumonia Tuberculosis Pulmonary embolism Acute respiratory distress syndrome (ARDS) Lung cancer COVID-19 Viral Pneumonia

Question 27

lobar pneumonia manifestations

Answer 27

Manifestations: Fever, cough (productive), pleuritic chest pain, SOB, fatigue, altered LOC, confusion

Question 28

assessment findings for lobar pneumonia

Answer 28

Assessment findings: - when the alveoli become filled with bacteria tachypnea, cyanosis, hypotension decreased chest expansion and tactile fremitus to affected side Crackles (rales)

Question 29

sputum for lobar pneumonia

Answer 29

purulent, green or yellow, may be slightly bloody

Question 30

what is lobar pneumonia

Answer 30

when the Alveoli become filled with bacteria

Question 31

what is pleural effusion

Answer 31

Excess fluid in intrapleural space

Question 32

manifestations of pleural effusion

Answer 32

Manifestations: sharp chest pains

Question 33

assessment findings of pleural effusion

Answer 33

Assessment findings: dry cough, increased RR, cyanosis decreased or absent tactile fremitus dull sounds when percussed crackles, pleural rub

Question 34

what is emphysema/COPD

Answer 34

Destruction of pulmonary connective tissue; increased airway resistance, especially on expiration.

Question 35

assessment findings for emphysema and COPD

Answer 35

Assessment findings: Barrel chest, signs of respiratory distress, tripod positioning, SOB on exertion May have muffled heart sounds Wheezes heard in lungs

Question 36

what else is common with emphysema and COPD

Answer 36

tripod positioning for easier breathing intercostal retractions

Question 37

what is heart failure

Answer 37

Pump failure leading to increased vascular congestion.

Question 38

assessment findings for heart failure

Answer 38

Assessment findings: Tachypnea, SOB with exertion, orthopnea Pulmonary edema - pink frothy sputum Crackles at base of lungs

Question 39

summary checklist: thorax and lung examination

Answer 39

Inspection - Thoracic cage, respirations, skin color, and condition - A person’s facial expression, and LOC Palpation - Confirm symmetric expansion and tactile fremitus - Detection of any lumps, masses, or tenderness Percussion - Lung fields and estimate diaphragmatic excursion Auscultation - Assess breath sounds and note any abnormal/adventitious breath sounds - Perform bronchophony, whispered pectoriloquy, or egophony as needed