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126 Cards in this Set
- Front
- Back
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Anatomy and Physiology: Chest: bones/cartilage
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Bone/cartilage - forms protective cage
Sternum/manubrium/xiphoid process Ribs/costal cartilages Thoracic vertebrae |
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Anatomy and Physiology: Chest: Muscles
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Muscles - assist in respiration
Diaphragm Intercostal |
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Anatomy and Physiology: Chest: Interior chest spaces
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Interior chest spaces - the site of lungs
Pleural cavities Mediastinum |
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Anatomy and Physiology: Lungs: How many
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Two lungs
Left lung has 2 lobes with a lingula Right lung 3 lobes |
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Anatomy and Physiology: Lungs: What do the lobes contain
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Blood vessels
Lymphatics Nerves Alveolar ducts Alveoli |
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Anatomy and Physiology: Tracheobronchial tree: Components
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Components
Trachea Right bronchus/three branches Left bronchus/two branches Bronchioles Acini/Alveoli |
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Anatomy and Physiology: Tracheobronchial tree: Function
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Function
Air transport Trap and dispose of foreign particles |
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The machines patients are placed on after intubation are called?
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VENTILATORS
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______ keeps body supplied with O2 and protects it from accumulation of CO2
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RESPIRATION keeps body supplied with O2 and protects it from accumulation of CO2
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Anatomy and Physiology: Chemical/Neurologic Control of Respiration: Three processes
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Ventilation
Diffusion/perfusion Circulatory system transport |
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Anatomy and Physiology: Anatomic Landmarks: Topographic markers
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Nipples
Manubriosternal junction Suprasternal notch Costal angles Vertebra prominens Clavicles |
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Anatomy and Physiology: Infants and Children
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Fetal lungs contain no air/gas exchange through placenta
At birth lungs adapt to postnatal function Chest circumference same as head circumference until 2 years old Chest wall thin/bony structures more prominent and yielding than in adult |
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Anatomy and Physiology: Pregnant Women
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Mechanical/biochemical factors lead to changes in respiratory function
Anatomic changes in chest Lower ribs flare Diaphragm rises above usual position Breathing done by diaphragm Increase in tidal volume |
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Anatomy and Physiology: Older Adult
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Barrel chest from loss of muscle strength in thorax and loss of lung resiliency
Skeletal changes of aging emphasize dorsal curve of thoracic spine Alveoli less elastic causing fatigue/dyspnea on exertion Decrease in vital capacity/increase in residual volume Mucous membranes drier |
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Related History: Present Problem: Coughing
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Onset
Nature Pattern Severity Associated symptoms Efforts to treat Medications |
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Related History: Present Problem: Shortness of breath (dyspnea)
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Onset
Pattern Severity Associated symptoms |
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Related History: Present Problem: Chest pain
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Onset/duration
Associated symptoms Efforts to treat Medications |
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Related History: Past Medical History
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Thoracic trauma or surgery, dates of hospitalization for pulmonary disorders
Use of O2/ventilation-assisting devices Chronic pulmonary diseases Chronic disorders Testing done in the past |
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Related History: Family History
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TB
Cystic fibrosis Emphysema Allergy Asthma Atopic dermatitis 50% likelihood to get asthma Malignancy |
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Related History: Personal/Social History
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Employment
Home environment Tobacco use Exposure to respiratory infections, flu, TB Nutritional status Regional/travel exposures Hobbies Use of alcohol/drugs Exercise tolerance |
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Related History: Infants/Children
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Low birth weight/prematurity
History of RSV Coughing/sudden onset SOB Possible aspiration of noxious substances Meconium aspiration Difficulty feeding Apneic episodes Use of apnea monitor/SIDS in sibling Possible gastroesophageal reflux Predictors for apnea in infants |
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Related History: Pregnant Women
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Weeks of gestation
Presence of multiple fetuses/polyhydramnios, other conditions where uterus displaces diaphragm Exercise type/energy expenditure Exposure to/frequency of respiratory infections Hx of flu/pneumococcal immunization |
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Related History: Older Adults
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Exposure to/frequency of respiratory infections
Hx of pneumococcal/flu vaccine Effects of weather on respiratory efforts/ infection occurrence Immobilization/sedentary habits Difficulty swallowing Possiblity of aspiration Altered activities from respiratory symptoms Focus On: Smoking history Cough Dyspnea on exertion/breathlessness Fatigue Weight changes Fever/night sweats |
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Exam & Findings: Inspection: Chest
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Shape/symmetry
Chest wall movement Superficial venous patterns Prominence of ribs AP vs. transverse diameter Sternal protrusion Spinal deviation |
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Exam & Findings: Inspection:Skin/nails/lips
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Cyanosis
Pallor Clubbing |
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Exam & Findings: Inspection: Lips
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Pursing
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Exam & Findings: Inspection: Nostrils
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Flaring
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Exam & Findings: Inspection: Breath
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Odor
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Exam & Findings: Inspection:Respiration
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Rate
Quality Pattern Count while palpating pulse Dyspnea Tachypnea Bradypnea Hyperpnea Hypopnea Orthopnea Apnea Paraoxsymal Nocturnal Dyspnea |
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Dyspnea
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x
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Tachypnea
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x
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Bradypnea
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x
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Hyperpnea
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x
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Hypopnea
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x
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Orthopnea
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x
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Apnea
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x
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Paraoxsymal Nocturnal
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x
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Dyspnea
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x
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Cheyne-Stokes
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can be normal during sleeping in young children and elderly, otherwise brain damage and drug induced respiratory depression
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Sighing
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x
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Air trapping
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x
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Kussmaul
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x
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Biot
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increased intercranial pressure, brain damage level of medulla and medication related
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Ataxic
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end stage
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Exam & Findings: Modes of Respiration: Thoracic (costal)
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Intercostal Muscle Use
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Exam & Findings: Modes of Respiration: Abdominal
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Diaphragm
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Exam & Findings: Modes of Respiration: Paradoxical
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Baby with severe distress
Flail Chest |
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Flail Chest
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3 or more ribs broken in 2 or more places
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Exam & Findings: Inspection: Obstruction
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Inspect for airway obstruction
Stridor Nostril flaring Cough Chest retraction Intercostal Supraclavicular |
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Exam & Findings: Inspection: Cough
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Paroxysmal
Barking Throat Clearing Moist Honking Nocturnal Early Morning Seasonal Non Productive Productive Clear/Mucoid Purulent Blood Streaked Malodorous |
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Paroxysmal Cough
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Pertusis, Chlamydia, FB
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Barking Cough
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Croup, LTB (Laryngeo Tracheal Bronchitis), Epiglottitis
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Throat Clearing Cough
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Allergy, PND (Post Nasal Drip) not Paroxysmal Nocturnal Dyspnea
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Moist Cough
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Pneumonia, Bronchitis
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Honking Cough
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Habit, Psychogenic
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Nocturnal Cough
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Asthma, PND, URI, GED (Gastro Esophigeal Reflux), Sinusitis
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Early Morning Cough
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Smoking, Sinusitis, Cystic Fibrosis
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Seasonal Cough
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Allergic
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Nonproductive Cough
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Viral/Allergic rhinnitis, Asthma, FB
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Productive Cough
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Asthma, Allergic rhinnitis, Smoking
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purulent cough
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CF, Bronchiectasis, Pneumonia
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Blood Streaked Cough
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TB, Diptheria, Nasopharyngeal irritation, Chronic FB, Pneumonia
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Malodorus Cough
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Sinusitis Chronic FB
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Exam & Findings: Palpation: Thoracic muscles/skeleton
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Pulsations
Tenderness Point tenderness Generalized or regional tenderness Bulges/depressions Unusual movement/positions Elasticity of rib cage |
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Exam & Findings: Palpation: Crepitus
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Feeling of bone movement on palpation
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Exam & Findings: Palpation: Friction Rub
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X
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Exam & Findings: Palpation: Thoracic Expansion
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X
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Exam & Findings: Palpation: Tactile Fremitus
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Vibration felt while speaking
Compare side to side Increased with pneumonia/ consolidation Decreased with pneumothorax, and emphysema. Use the palm or ulnar aspect of the hand to palpate. Have the patient say 99 or 1,2,3 compare bilaterally determine if the same. Incre with consolidation, fluid and decreased processes that block transmission of sound waves - pus, solid (Decr: Atelectasis, emphysema, effusion, pneumothorax) (Incr: Pneumonia) |
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Exam & Findings: Palpation: Position of Trachea
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Compare to suprasternal notch
Tracheal Tug: Usually trachea descends slighty during inspiration. Tug is felt during heart beat, consider with arotic aneurysm, of dilated aorta. AKA as Olivers sign Chin up palpate trachea for tug or pull |
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Exam & Findings: Percussion:
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Percuss chest
Anterior Lateral Posterior Compare tones bilaterally |
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Exam & Findings: Percussion: Percussion tone indicators for lungs: Resonance
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Low Pitch, Peripheral, Normal
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Exam & Findings: Percussion: Percussion tone indicators for lungs: Dullness
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Over Solid (mass, consolidation, liver)
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Exam & Findings: Percussion: Percussion tone indicators for lungs:Tympany/hyperresonace
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High Pitch, Over Air Filled Regions
(Pneumothorax, emphysema) |
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Exam & Findings: Auscultation: Breath sounds: Vesicular
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Low Soft, Heard at the periphery
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Exam & Findings: Auscultation: Breath sounds: Broncho-vesicular
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Moderate Pitch, Over Bronchi
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Exam & Findings: Auscultation: Breath sounds: Bronchial/Tracheal
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High Pitch, Loud, Over Trachea
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Exam & Findings: Auscultation: Breath sounds:Adventitious breath sounds
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Crackles
Fine Medium Coarse Rhonchi Wheezes Friction rub Mediastinal crunch Stridor |
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Vocal resonance
_______ over consolidation/fluid. |
Vocal resonance
INCREASES over consolidation/fluid. |
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Vocal resonance ______ over air
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Vocal Resonance DECREASES over air
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Bronchophony
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Clearity and loudness of the spoken word (99)
Increased transmission of spoken word to the periphery. 99 or blue moon Supposed to be muffled when reaches perephery. Signifies consolidation |
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Whispered Pectoriloquy
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Increased transmission of whispered words
Say 1,2,3 softly can hear over consolidation not hear normally |
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Egophony
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E becomes A
Supposed to hear E over consolidation hear A |
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Hamman’s Signs:
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Crunching, crackling sound in synchrony with heart beat. Means air in mediastinum (pneumomediastinum). Just to let you know if you hear about it.
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Exam & Findings: Sputum
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Describe
Color Consistency Odor |
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Exam & Findings: Infants
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Exam approach similar to adults
Percussion is less reliable Thoracic cage size compared to head size Acrocyanosis is common and normal Cyanosis of hands and feet Respiratory rate varies between 40-60 Coughing rare/sneezing frequent Primarily diaphragmatic breathing, gradual use of intercostal muscles Localization of breath sounds may be difficult Crackles/rhonchi may not be problematic in neonatal hours Stridor/retractions/grunting/flaring indicate problems |
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Exam & Findings: Children
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Thoracic muscles for breathing by 6/7 years
Respiratory rate varies, reaches adult rates at about 17 years Roundness of chest that persists past 2nd year may indicate a pulmonary problem The younger the infant/toddler, the more difficult to evaluate wheezing Breath sounds Broncho-vesicular sounds may predominate |
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Exam & Findings: Pregnant Women
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Dyspnea common with expected normal physiologic changes
Vital capacity/tidal volume increases Ventilation increases by deeper/more frequent breathing |
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Exam & Findings: Older Adults
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Chest expansion decreased
Increased bony prominences Kyphosis with flattening of lumbar curve Increased AP diameter Hyperresonance common |
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Clinical Diagnostics: CXR
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Gold standard
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Clinical Diagnostics: Sputum
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Not very useful - wait long for results, difficult to get good sample. Reserve for consultants, not recommended for screening. (Acid fast bacilli-TB)
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Clinical Diagnostics: Spirometry - FEV1
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Vital capacity, FEV1, Useful for staging severity of asthma attacks and good for home monitoring.
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Clinical Diagnostics: ABG
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In house test, Alveolar vs Arterial comparison. Shows how well lungs and heart are functioning.
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Clinical Diagnostics: EKG
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Cardiac
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Clinical Disorders & PE: Asthma
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Accessory Muscle Use
Tight Cough Long Expiratory Phase Decreased Fremitus Hyper-resonant Wheezing |
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Clinical Disorders & PE: Atelectasis
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Decreased Motion Affected Side
Decreased Fremitus Dull Percussion Diminished lung sounds Crackles Related to non use, bedridden, rib fracture |
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Clinical Disorders & PE: Bronchiectasis
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Cough with Purelent Sputum
Strong Fremitus Dull Crackles/Rhonci |
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Clinical Disorders & PE: Bronchitis
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Rasping Cough with Mucoid Sputum
Moderate to Strong Fremitus Localized Crackles Rhonci that clear |
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Clinical Disorders & PE: Emphysema
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Barrel Chest
Accessory Muscle Use Weak Fremitus Hyperresonant Decreased Excursion Crackles, Mild Wheezing, Rhonci, prolonged expiratory phase |
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Clinical Disorders & PE: Pleural Effusion
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Weak Fremitus
Dull Percussion Diminished lung sounds Friction Rub Increased bronchophony Outside of the lung tissue in the thoracic cavity |
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Clinical Disorders & PE:Pneumonia
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Fever
Cough Productive Green/Yellow Strong Fremitus Crackles Rhonci that may or may not clear Increased bronchophony |
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Clinical Disorders & PE:Pneumothorax
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Absent Fremitus
Hyperresonant Diminished lung sounds Kids Increased Decreased bronchophony Outside the lung in the thoracic cavity |
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Clinical Disorders & PE:Fibrosis
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Decreased Expansion
Dull Diminished lung Sounds Crackles Increased bronchophony Post surgery, scarring, following an inflammatory process (connective tissue disorders), pneumonia and in TB |
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Common Abnormalities Treatment: Asthma (RAD)
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Bronchodilators
Steroids |
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Common Abnormalities Treatment: Atelectasis
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Increased pulmonary toilet
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Common Abnormalities Treatment: Bronchitis
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+/- Antibiotics
Bronchodilators +/- CXR |
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Common Abnormalities Treatment: Pleurisy
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Investigate cause
NSAIDs Follow up |
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Common Abnormalities Treatment: Pleural effusion
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Investigate cause
May hide underlying process-reevaluate Thoracentisis |
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Common Abnormalities Treatment: Empyema
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Pulmonary Toilet
Teaching +/- Bronchodilators +/- Antibiotics |
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Common Abnormalities Treatment: Lung abscess
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Investigate cause
Thorocentisis/ Culture |
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Common Abnormalities Treatment: Influenza
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Pulmonary Toilet
Bronchodilators |
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Common Abnormalities Treatment: Pneumonia
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Antibiotics
Bronchodilators Follow Up |
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Common
Abnormalities Treatment: Tuberculosis |
High Suspision
Skin Test CXR Long Term Antibiotics |
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Common Abnormalities Treatment: Pneumothorax
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<20% monitor
>20% Chest Tube |
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Common Abnormalities Treatment: Hemothorax
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Chest Tube
Autotransfuser Blood Transfusion |
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Common Abnormalities Treatment:Lung cancer
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XXX
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Common Abnormalities Treatment: Cor pulmonale (CHF)
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Diuretic
Investigate Cause |
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Common Abnormalities Treatment: Pulmonary hypertension
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Investigate Cause
Transplant |
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Common Abnormalities: Children and Adolescents: Cystic fibrosis
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Diagnosis
Prevent Complications CF: is a autosomal recessive disorder of the exocrine glands involving the lungs, pancrease and sweat glands. Cough with excessive sputum in kids under 5 is hallmark symptom. Very salty sweat. 10% of CF dxd in adulthood. |
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Common Abnormalities: Children and Adolescents: Epiglottis
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Rare
Children Early Intubation |
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Common Abnormalities: Children and Adolescents: Bronchiolitis
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Bronchodilators
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Common Abnormalities: Children and Adolescents: Croup
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Steroids
Raceimic Epinephrine Neb |
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Common Abnormalities: Children and Adolescents: Tracheomalacia
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Teaching
Associated with GERD Floopy airway, noisy breathing (stridor). Self limiting disease, will grow out of it. |
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What two vaccinations have changed the way we treat peds patients with fevers and/or stridor?
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Humophelus Influenza (H Flu) and Pneumoccal
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Common Abnormalities: Older Adults: COPD/Emphysema
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Smoking Cessation
+/- Bronchodilators Leukotriene Inhibitors Prevent Complications |
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Common Abnormalities: Older Adults: Bronchiectasis
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Smoking Cessation
Pulmonary Toilet Bronchodilators Prevent Complications |
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Common Abnormalities: Older Adults: Chronic bronchitis
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Smoking Cessation
Pulmonary Toilet Low dose antibiotics |
