Week 2 - Pulmonary Exam Flashcards
(75 cards)
1
Q
What is the respiratory ROS question?
A
Any shortness of breath or cough?
2
Q
What 2 things is the Respiratory System responsible for?
A
- Ventilation
2. Respiration
3
Q
Define Ventilation
A
Getting air into and out of the lungs
4
Q
Respiration
A
Exchanging of air between the alveoli and the blood and between the blood and the tissues
5
Q
During what process does cough occur? Name 3 ways it can happen.
A
Ventilation; Tumors, infection, asthma
6
Q
During what process does alteration of blood gases (O2, CO2, pH) occur?
A
Respiration
7
Q
What 4 things do we observe in respiration?
A
- Rate
- Rhythm
- Depth
- Effort of breathing
8
Q
How do we assess respiration rate?
A
Count the number of breaths in 1 minute
9
Q
What 2 ways can we measure respiration rate?
A
- Visual inspection
2. Subtly listening over pt’s trachea with stethoscope head/neck or chest exam
10
Q
What is the normal breaths per minutes for an adult?
A
14-20 breaths per minute in a quiet, regular pattern
11
Q
Is an occasional sigh normal in respiration?
A
Yes
12
Q
How high can breaths per minute go in infants?
A
44 breaths per minute
13
Q
Go observe the picture on your phone about the different breathing patterns
A
GO LOOK
14
Q
Slow breathing may be secondary to what 3 things?
A
- Diabetic coma
- Increased intracranial pressure
- Drug-induced respiratory depression
15
Q
What is slow breathing called?
A
Bradypnea
16
Q
Rapid shallow breathing may be caused by what 3 things?
A
- Restrictive lung disease
- Elevated diaphragm
- Pleuritic chest pain
17
Q
What is rapid shallow breathing called?
A
Tachpnea
18
Q
What is Cheyne-Strokes Breathing?
A
Periods of deep breathing alternate with periods of apnea (no breathing)
19
Q
Where is Cheyne-Strokes Breathing often seen?
A
In children and aging people during sleep
20
Q
What 4 things could cause Cheyne-Strokes Breathing?
A
- Drug-induced respiratory depression
- HF
- Uremia
- Brain damage
21
Q
2 terms specifically seen in Cheyne-Strokes
A
- Hyperpnea
2. Apnea
22
Q
What happens in Obstructive Breathing?
A
Expiration prolonged because narrowed airways increase the resistance to air flow
23
Q
What 3 things can cause Obstructive Breathing?
A
- Chronic Bronchitis
- Asthma
- COPD
24
Q
What is Sighing Respiration?
A
Breathing punctuated by frequent sigghs
25
What should Sighing Respiration alert us to?
Possibility of hyperventilation syndrome
26
What is hyperventilation syndrome a common cause of?
Dyspnea and dizziness
27
What could cause Rapid Deep Breathing
1. Metabolic acidosis
2. Exercise
3. Anxiety
28
What 3 things should we consider in a comatose patient in Rapid Deep Breathing? What would these affect?
1. Hypoxia
2. Infarction
3. Hypoglycemia
Medulla or Pons
29
What is Kussmaul Breathing?
Deep breathing due to metabolic acidosis
30
Could Kussmaul Breathing be fast, normal in rate, or slow?
Yes
31
What is Ataxic Breathing?
Unpredictable irregularity in breathing
32
What is another name for Ataxic Breathing?
Blot's Breathing
33
Breaths could be what in Ataxic Breathing? (Blot's)
Shallow, deep, or stop for short periods
34
What 2 things could cause Ataxic (Blot's) Breathing? At what level?
1. Respiratory depression
2. Brain damage
Medullary level
35
Order for Pulmonary Exam
1. Inspect
2. Palpate
3. Percuss
4. Auscultate
5. Compare one side to another (see asymmetries)
6. Adjust the gown
36
How do we adjust the gown for men?
So that we can see the chest fully
37
How do we adjust the gown for women?
Cover the anterior chest when examining the back; when examining the chest, drape the gown over each half of the chest as you exam the other half
38
What do we inspect the patient for in the pulmonary exam?
Respiratory difficulty
39
Why do we assess color?
For cyanosis
40
What do we assess from midline position behind the patient?
1. Movement of chest
2. Abnormalities such as masses
3. Shape of chest
41
What does unilateral impairment or lagging in the chest indicate? From what?
Pleural disease from asbestosis or silicosis
42
What could also be a problem in unilateral impairment or lagging in the chest?
Phrenic nerve damage or trauma
43
What 3 things could abnormal retraction be caused by?
1. Upper airway obstruction
2. COPD
3. Severe asthma
44
What 4 things do we palpate the chest for?
1. Identify tender areas
2. Assess of observed abnormalities
3. Further assessment of chest expansion
4. Asses for Tactile Fremitus (TF)
45
What is Tactile Fremitus?
Vibration felt on the chest when someone says "99
46
What 3 things might be occurring in DECREASED Tactile Fremitus? Due to what?
1. Neoplasm
2. Unilateral pleural effusion
3. Pneumothorax
Decreased transmission of low frequency sounds
47
What is seen in INCREASED Tactile Fremitus? Due to what?
1. Unilateral pneumonia
Increased transmission through consolidated tissue
48
What does Percussion do?
Sets chest wall and underlying tissues in motion producing a sound
49
What does percussion help establish about underlying tissues?
If they are:
1. Solid
2. Air-filled
3. Fluid filled
50
How far does Percussion penetrate? Does it help detect deep-seated lesions?
5-7cm; no
51
In reference to pitch, how does increased air sound?
Increased air = lower pitch
52
Which is lower in Percussion, R or L?
R (bigger air filled lung) is lower than L
53
Can we Percuss the diaphragm itself?
No; but can infer probably location from level of dullness
54
What are we identifying in diaphragmatic percussion?
Resonant lung tissue and duller structures below diaphragm
55
What does an abnormally high level suggest in diaphragmatic percussion?
Pleural effusion
56
Where do we see a high diaphragm?
1. Atelectasis
| 2. Phrenic nerve paralysis
57
What is the normal diaphragmatic excursion?
3-5.5cm
58
If abnormalities are suspected during Auscultation, what do we do?
Listen to sound of pt's spoken or whispered voice as transmitted through chest wall
59
Give the duration of sounds, intensity/pitch of expiratory sounds, and locations where head normally of Vesicular Breathing
1. Duration - inspiratory sounds longer than expiratory
2. Intensity - soft
3. Pitch - relatively low
4. Location - over most of both lungs
60
Give the duration of sounds, intensity/pitch of expiratory sounds, and locations where head normally of Broncho-Vesicular Breathing
1. Duration - I/E equal
2. Intesntiy - intermediate
3. Pitch - intermediate
4. Location - often in 1st or 2nd interspaces anteriorly between the scapulae
61
Give the duration of sounds, intensity/pitch of expiratory sounds, and locations where head normally of Bronchial Breathing?
1. Duration - E > I
2. Intensity - Loud
3. Pitch - Relatively high
4. Location - over manubrium (larger proximal airways)
62
Give the duration of sounds, intensity/pitch of expiratory sounds, and locations where head normally of Tracheal Breathing?
1. Duration - E=I
2. Intensity - very loud
3. Pitch - relatively high
4. Location - over trachea
63
Give the breath sounds, transmitted voice sounds, and tactile fremitus for a Normal, Air-filled lung
1. Breath Sounds - predominantly vesicular
2. Voice Sounds - muffled and indistinct, "ee" heard as "ee", whispers faint or not heard
3. TF - normal
64
Give the breath sounds, transmitted voice sounds, and tactile fremitus for a airless lung
1. Breath Sounds - bronchial or bronchovesicular
2. Voice Sounds - spoken louder, "ee" heard as "ay", whispers louder, clearer
3. TF - increased
65
2 causes of Crackles
1. Series of tiny explosions when small airways, deflated during expiration, pop open during inspiration
2. Air bubbles flowing through secreations or lightly closed airways during respiration
66
What 3 things do crackle explosions explain?
1. Late inspiratory crackles
2. Interstitial lung disease
3. Early HF
67
What is related to coarse crackles?
Air bubbles
68
What 7 adventitious sounds are possible?
1. Late inspiratory crackels
2. Early inspiratory crackles
3. Midinspiratory and expiratoy crackles
4. Wheezes and Rhonchi
5. Wheeze (Stridor)
6. Pleural Rub
7. Mediastinal crunch
69
What 2 things do we look for in Inspection of the Neck?
1. Contraction of accessory muscles
| 2. If trachea is midline
70
What 3 deformities of the chest are possible?
1. Pectus Excavatum (Funnel chest)
2. Barrel Chest
3. Pectus Carinatum (Pigeon Chest)
71
Another name for Pectus Excavatum
Funnel Chest
72
Another name for Pectus Carinatum
Pigeon Chest
73
Another name for Pectus Carinatum
Pigeon Chest
74
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Normal Pulmonary Findings for:
Percussion
Trachea
Breath Sounds
Adventitious Sounds
TF and Transmitted Vocie
```
1. Resonant
2. Midline
3. Vesicular
4. None
5. Normal
75
```
Conslidation Pulmonary Findings for:
Percussion
Trachea
Breath Sounds
Adventitious Sounds
TF and Transmitted Vocie
```
1. Dull over airless areas
2. Midline
3. Bronchial over involed area
4. Late inspiratory crackles over involved area
5. Increased TF w/ higher voice sounds
