Week 7: Respiratory Assessment

Question 1

Parts of the upper respiratory tract (URT) (2) and lower respiratory tract (LRT) (5)

Answer 1

Upper respiratory tract: Nose and oropharynx
Lower respiratory tract: Trachea, lungs, pleura, thoracic cage, and diaphragm

Question 2

Lobes of the lungs: Anterior and posterior

Answer 2

Anterior:
- Right upper, middle, and lower lobes (RUL, RUM, RLL)
- Left upper and lower lobes (LUL, LLL)

Posterior:
- Right upper and lower lobes (RUL, RLL)
- Left upper and lower lobes (LUL, LLL)

Question 3

Diagnostic tools and what they do (6)

Answer 3

Pulse oximeter: Measures oxygen saturation level
Arterial blood gases: Measures levels of oxygen and carbon dioxide in the body. Can be drawn from radial, brachial, or femoral artery.
Thoracentesis: The collection of fluid from the pleural space of the thoracic cavity
Bronchoscopy: Direct visualization of the larynx, trachea, and bronchial tree
Lung biopsy: Removal of a small piece of lung tissue for analysis
Mantoux tuberculin skin test: TB test via the skin

Question 4

Mainstream vs sidestream smoke

Answer 4

Both forms of secondhand smoke
Mainstream smoke: Smoke exhaled by a smoker
Sidestream smoke: Smoke in the surrounding air from the lighted end of a tobacco product. Contains higher concentrations of carcinogens and is more toxic

Question 5

When the Pneumovax vaccine is recommended (3 populations)

Answer 5

Recommended for:
- All adults 65+
- Ages 2-64 with certain medical conditions
- Adults 19-64 who smoke cigarettes

Question 6

Breathing difficulties: Dyspnea

Answer 6

A general uncomfortable awareness of the act of breathing. Very subjective and broad

Question 7

Breathing difficulties: Cardiac dyspnea

Answer 7

Difficulty breathing related to inadequate cardiac output

Question 8

Breathing difficulties: Orthopnea

Answer 8

Difficulty breathing while lying in a supine position. Relieved when sitting or standing

Question 9

Breathing difficulties: Paroxysmal nocturnal dyspnea

Answer 9

Shortness of breath when asleep. Symptom of left ventricular heart failure

Question 10

Sputum vs hemoptysis

Answer 10

Sputum: Mucus
Hemoptysis: Sputum with blood

Question 11

Types of cough (4)

Answer 11

1. Nonproductive/dry cough: No sputum
2. Productive cough: Mucus produced and expectorated
3. Hacking cough: Persistent dry cough
4. Chronic cough: A cough lasting longer than 8 weeks

Question 12

Mapping the thoracic cage: Anterior, posterior, and lateral reference lines (3 each)

Answer 12

Anterior reference lines:
- Right midclavicular line
- Midsternal line
- Left midclavicular line

Posterior reference lines:
- Right scapular line
- Vertebral line
- Left scapular line

Lateral reference lines:
- Anterior axillary line
- Midaxilary line
- Posterior axillary line

Question 13

Aspects of inspection (5)

Answer 13

1. Size
2. Shape
3. Symmetry
4. Color
5. Respiratory rate and rhythm

Question 14

Abnormal inspection findings: Barrel chest

Answer 14

Anterior posterior-to-transverse ratio is 1:1, and the costal angle is greater than 90 degrees

Question 15

Abnormal inspection findings: Pectus excavatum (funnel chest)

Answer 15

A congenital deformity; sternum is abnormally depressed

Question 16

Abnormal inspection findings: Pectus carinatum (pigeon breast)

Answer 16

A deformity of the chest; the sternum protrudes out from the chest

Question 17

Abnormal inspection findings: Intercostal and accessory muscle retractions

Answer 17

May indicate problems with air movement; prolonged inspiratory phase may indicate upper airway obstruction; prolonged expiratory phase may indicate lower airway obstruction.

Question 18

Abnormal respiratory rates and rhythms: Bradypnea

Answer 18

Abnormally slow breathing, less than 12 breaths/minute

Question 19

Abnormal respiratory rates and rhythms: Tachypnea

Answer 19

Abnormally rapid breathing, more than 20 breaths/minute, usually shallow

Question 20

Abnormal respiratory rates and rhythms: Kussmaul respirations

Answer 20

Abnormally rapid breathing, more than 20 breaths/minute, usually shallow

Question 21

Abnormal respiratory rates and rhythms: Biot respirations

Answer 21

Irregular breathing of variable depth (usually shallow), alternating with regular or irregular periods of apnea (absence of breathing); also called ataxic breathing

Question 22

Abnormal respiratory rates and rhythms: Cheyne-Stokes respirations

Answer 22

Gradual increase in depth of respirations, followed by gradual shallow breathing and then a period of apnea

Question 23

Abnormal respiratory rates and rhythms: Apnea

Answer 23

Absence of breathing

Question 24

Pursed lip breathing: Definition and implications

Answer 24

Definition: Breathing through the nose and exhaling through pursed lips
Implications: Common in individuals with COPD to reduce the work of breathing

Question 25

Clubbing of nail plates: Definition and implications

Answer 25

Definition: Nailbeds soften and the nail forms a downward angle greater than 180 Implications: Chronic lack of oxygen or hypoxia

Question 26

Aspects of palpation (4)

Answer 26

1. Moisture 2. Surface characteristics 3. Temperature 4. Tenderness

Question 27

Crepitus: Definition and cause

Answer 27

Definition: A light crackling or popping feeling under the skin Cause: Leakage of air into subQ tissue

Question 28

Unique elements of palpation for the respiratory system (2)

Answer 28

Palpating for symmetrical expansion: To assess symmetrical expansion of the thoracic cage Palpating tactile fremitus: To palpate voice sound vibrations through the bronchi

Question 29

Implications of increased or decreased fremitus

Answer 29

Increased fremitus: May indicate increased density of the lung tissue; may be related to fluid or pathology in the lung that is changing the density or compressing the lung tissue, such as pneumonia Decreased fremitus: may indicate the vibrations are obstructed with fluid (pleural effusion), decreased air movement (emphysema), obesity, or increased musculature.

Question 30

Steps of percussion

Answer 30

1. Explain the technique 2. Have the pt sit on the side of the exam table 3. Assess the anterior lungs via indirect percussion technique. Move from the apex to the base on each side. 4. Assess the posterior lungs via indirect percussion technique. Move from the apex to the base on each side. 5. Instruct pt to raise one arm and percuss the lateral lung fields via indirect percussion. Move from the apex to the base on each side. 6. Document

Question 31

Percussion sounds (3)

Answer 31

1. Resonance: low-pitched, clear, hollow (healthy) 2. Soft, muffled (heard over solid masses or areas of inc consolidation) 3. Hyper-resonance: low-pitched, drum-like, accentuated (heard over hyper-inflated areas)

Question 32

Auscultation: Normal findings (3)

Answer 32

1. Bronchial breath sounds heard over trachea and larger bronchi; expiratory sounds are louder + longer than inspiratory sounds + have a pause. High-pitched, hollow, and tubular 2. Bronchovesicular breath sounds heard over right and left bronchi; anteriorly over the mid-chest + between the scapula. Medium-pitched 3. Vesicular breath sounds are heard throughout periphery; inspiration is longer and louder than expiration. Soft, low-pitched, rustling

Question 33

Adventitious breath sounds: Crackles (rales)

Answer 33

Produced by air passing over retained airway secretions, heard at end of inspiration, may be cleared via coughing. Fine crackles are soft, high-pitched. Coarse crackles are louder, low-pitched (Velcro)

Question 34

Adventitious breath sounds: Rhonchi (sonorous wheeze)

Answer 34

Louder, deeper, lower-pitched wheezes in the upper bronchi; may be related to obstruction of larger airways; commonly heard in expiration, sounds like snoring

Question 35

Adventitious breath sounds: Wheeze

Answer 35

Caused by narrowed passageways by secretions, inflammation, obstruction, foreign body; high-pitched, whistling or musical sound

Question 36

Adventitious breath sounds: Pleural friction rub

Answer 36

Caused by inflammation of pleurae that normally slide without friction; deep, harsh leathery sound heard during inspiration and expiration

Question 37

Adventitious breath sounds: Stridor

Answer 37

Caused by upper airway narrowing or obstruction (loudest over trachea); harsh, high-pitched, crowing sound; sign of respiratory distress and medical emergency