Week 3: Respiratory Assessment Flashcards
right lung
Shorter and a little bit wider (space for the liver)
3 Lobes; Right Upper/Middle/Lower lobes
left lung
Narrow than the right but it is longer (space for the heart)
2 Lobes; Left Upper/Lower lobes
functions of the resp sys
- Supplies oxygen to the body for energy production
- Removes CO2 as waste products of energy reactions
- Maintains homeostasis (carbonic acid/base balance) of arterial blood
- Maintaining heat exchange
Hypercapnia
High CO2 retention in the blood
Hypoxemia/Hypoxia
Low O2 in the blood (measure with O2 sat. or arterial blood gas)
Symptoms are pallor, very bad is if they’re grey
Tachypnea
> 20 breaths/min for adults
Bradypnea
<10 breaths/min for adults
Apnea:
Not breathing for >5 seconds (ex., sleep apnea, “do you snore?”)
Diaphoresis
Very sweaty
sternal notch
Semicircle in the middle, aligns with the clavicle
Below it, where the manubrium/sternal body articulates = angle of louis/sternal angle
Sternal angle is where the 2nd rib is; use to landmark for heart
Upper Border/Apex
2-3cm above the inner third of the clavicle
Upper Border/Apex
2-3cm above the inner third of the clavicle
Lower Border/Base
Rests on the diaphragm; about 6th rib MCL (either side)
Reference Lines: for anterior lung landmarks
(MSL) Midsternal Line (down the middle)
(MCL) Midclavicular Line (down the middle of the clavicle)
(AAL) Anterior Axillary Line (on the front of the armpit down)
right lung lobes
Upper: From the clavicle to the 4th rib (MCL) and 5th rib (AAL) (it’s like a triangle)
Middle: From border of upper to the 6th rib (MCL)
Lower: From middle border to the 7th rib (AAL)
left lung lobes
Upper: From the clavicle to the 5th rib (AAL) and 6th rib (MCL)
Lower: From the upper border to the 7th rib (AAL)
posterior lung landmarks: vertebra prominens
The spinous process of C7; T1 is right below
Each of the Thoracic vertebrae have a rib; spinous processes align with them
Inferior angle of scapula aligns with T7/8
Apex of lungs = Superior border = T1-T3
Base of lungs = T10 on expiration (breathing out), T12 on inspiration (breathing in)
You cannot sense the right middle lobe here
posterior lung landmarks: reference lines
(SL) Scapular Line
(VL) Vertebral Line
posterior lung landmarks: lungs
Upper lung stretches from prominens to T3 VL and T4 SL
Lower lung is from T4 to T10/12
Subjective Data: Respiratory Health History
cough
SOB
chest pain with breathing
history of resp infection/lung diseases
smoking
environment/occupation
self care behaviours
objective data resp anterior side: inspection
Level of consciousness (alertness, in/out, awake, drowsy)
Facial expression (any difficulty breathing, pursed-lip breathing, pain)
Shape & configuration (normal vs. barrel chest [COPD])
Anterior-Posterior/Transverse Diameter (How wide you are vs. long)
Should be a ratio of 2 wide:1 long
Skin colour & nails (pallor, profile sign/capillary refill, shows perfusion)
Respiration Quality (depth, frequency, effortlessness, noise)
Use of Accessory muscles (Shoulder moving, using abdominals/obliques to breathe)
Indrawing:Lower chest movements inward while taking deep breathes, rest of chest moves out
Retraction: Intercostal muscles are sucked inward; indicates reduced air pressure in chest, upper airway/trachea area is partially blocked
Both signs of respiratory distress
Anterior side palpation
Any lumps, bumps, bruises, temperature, moisture, turgor (pinch sternum skin)
Symmetric Chest Expansion: Place hands along costal margins, thumbs pointed towards xiphoid process: pinch skin with thumbs and ask to breathe
Observe for any uneven movement
anterior side auscultation
Using the diaphragm, seated up ideally, not through the gown, inhale through mouth and exhale through nose, listen for complete cycles, apex to base, this is tiring
10 spots on front, do it bilaterally side to side
Start MCL at the clavicle, then to the 2nd ICS, 3rd ICS, 4th ICS, 5th ICS AAL (base)
posterior side inspection
Shape & configuration
Also check APTD (2:1)
Posture/Kyphosis (thoracic vertebrae arch outwards)
Skin colour & condition
