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63 Cards in this Set
- Front
- Back
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What four questions are you going to ask your pt during the HHx respiratory exam?
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1. Symptoms (cough/sputum/SOB)
2. Pain with breathing? Where? 3. Hx of illness or infection (COPD/Asthma/Emphysema/Pneumonia/TB) 4. Personal behaviors (Smoking/2nd hand/IZ) |
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Difficulty breathing = (vocabulary word)
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Dyspnea
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What are the four techniques of physical assessment in order?
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Inspection
Palpation Percussion Auscultation |
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What should your inspection assessment for respiratory consist of?
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Color of skin (cyanosis)
Shape and configuration of chest 1:2 ideal Costal Margin Positioning (Tripod?) Accessory Muscle use for breathing Intercostal space (retractions?) Respiratory Rate |
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If chest configuration is 2x2, what disease could the patient have?
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Emphysema or COPD
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What is a 2:2 chest called?
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Barrel Chest
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Why do you listen to lungs posteriorly?
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That is where you listen to the lower lungs - where all of the gunk is
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What's the importance of the trachea?
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Entry to respiratory system
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How should you palpate the trachea?
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Midline to sternal notch
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How does a deviated trachea present?
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No equal on each side center to midline
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Easy way to remember where the lungs end
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Bra line
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How do you palpate the anterior thorax? (2 ways)
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Symmetric expansion (wrap hands/thumbs together)
Tactile Fremitus - Use ulnar edge "99", start right above clavicle |
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What lobe of the lung are you listening to on the R axillary?
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Middle R lobe
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How do you percuss the anterior thorax?
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Use middle finger and tap twice with other two fingers of opposite hand
Start above clavicle and go side to side down intercostal space |
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What kind of sound should you hear when percussing the anterior thorax?
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Resonance - hollow
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How will normal percussion sound on a child?
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Louder - hyper resonance
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How you do auscultate the anterior thorax?
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Bronchial/Trachea
Bronchial/Vesticular Vesticular OR Above clavicle, intercostal space 2, intercostal space 4 |
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What is the ratio for bronchial/tracheal breathing?
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1:3 (inspiration/expiration
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What is the ration for bronchial/vesicular breathing?
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1:1 (inspiration = expiration)
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What is the ratio for vesicular breathing?
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3:1 (inspiration/expiration)
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What are adventious BS?
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Abnormal BS
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Hair Rubbing
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Fine Crackles
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Velcro
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Medium crackles
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Bubbling
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Coarse crackles
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Rhonchi/snore
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Sonorous Wheeze
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Musical sound
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Sibilant Wheeze
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Leather pants on leather couch
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Pleural rub
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Barking seal
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Stridor
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How can you distinguish between a pleural rub and a cardiac rub?
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Have pt hold breath - if you still hear it, it's cardiac
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What are the three ways to auscultate voice resonance?
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Bronchophony (99)
Egophony (EEE) Whispered Pectoriloquy (1-2-3) |
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What kind of sound do you want to hear on a bronchophony?
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Muffled sound - indistinguishable "99"
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What may the patient have if the bronchophony is clear?
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Pneumonia
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What kind of sound in a normal/abnormal egophony?
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Normal - EEE
Abnormal - AAA (bleeding goat) |
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What kind of sound is normal for a whispered pectoriloquy?
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Inaudible 1-2-3
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What could be the cause if you were a whispered pectoriloquy clearly?
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Secretions/Fluid
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What should you focus on for the posterior respiratory inspection?
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Signs of skin breakdown (ulcers)
Shape and configuration (scoliosis/kyphosis) Lesions RR AP:TD Diameter |
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How should you palpate the posterior thorax?
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1. Ask pt to hug themselves/elbows up - Wrap hands, thumbs in the center at bra line
2. Tactile Fremitus |
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Where do you hear the upper lobe posteriorly?
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Above the bra line (2, 4)
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Where do you hear the lower lobe posteriorly?
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Below the bra line (6)
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How do you percuss the posterior thorax?
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Side to side, assess symmetry
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What is a diaphragmatic excursion? When do you do it?
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Test for a collapsed lung
Inhale - Percuss - mark diaphragm Exhale - Percuss - mark diaphragm Measure the difference |
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Good hint for making sure you don't have your pt hold their breath for too long
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Mimic what you are asking them to do
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How should you auscultate the posterior thorax?
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Above clavicle, 2, 4, 6, axillary
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CTA =
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Clear to auscultation
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Abnormalities in anterior chest configuration
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Barrel chest
Pectus Excavatum (funnel chest) OUT Pectus Carnivatum (Pigeon Chest IN |
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Abnormalities in chest configuration
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Kyphosis
Scoliosis |
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Asthma Reactive Airway Disease (chronic hyper reactive condition)
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I: Increase RR, SOB, audible wheeze, use of accessory muscles, cyanosis, labored/prolonged breathing
Pal: Tactile Fremitus decrease, tachycardia Per: Resonant to hyper-resonant A: Diminished BS, Prolonged expiration, wheezing upon expiration |
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I: Increase RR, SOB, audible wheeze, use of accessory muscles, cyanosis, labored/prolonged breathing
Pal: Tactile Fremitus decrease, tachycardia Per: Resonant to hyper-resonant A: Diminished BS, Prolonged expiration, wheezing upon expiration |
Asthma
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Tactile Fremitus =
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Palpation testing for vibration (99)
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Bronchitis (inflammation of bronchial tree)
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I: Hacking, rasping cough, productive thick sputum, if chronic = dyspnea, fatigue, cyanosis, clubbing
Pal: Normal Tactile Fremitus Per: Resonant A: Crackles over deflated areas, wheeze. Chronic = prolonged expiration |
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I: Hacking, rasping cough, productive thick sputum, if chronic = dyspnea, fatigue, cyanosis, clubbing
Pal: Normal Tactile Fremitus Per: Resonant A: Crackles over deflated areas, wheeze. Chronic = prolonged expiration |
Bronchitis
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Emphysema (obstruction of alveoli)
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I: Barrel chest 1:1/2:2, use of accessory muscles, tripod, SOB on exertion, respiratory distress, tachypnea
Pal: Decreased tactile fremitus and check expansion Per: Hyper-Resonant, decreased diaphragmatic excursion A: Diminished BS, prolonged expiration, muffled heart sounds secondary to overdistention of lungs, occasional wheeze |
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I: Barrel chest 1:1/2:2, use of accessory muscles, tripod, SOB on exertion, respiratory distress, tachypnea
Pal: Decreased tactile fremitus and check expansion Per: Hyper-Resonant, decreased diaphragmatic excursion A: Diminished BS, prolonged expiration, muffled heart sounds secondary to overdistention of lungs, occasional wheeze |
Emphysema
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Pneumonia (infection of alveoli)
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I: Increased RR, lag on expansion on affected side - Children: sternal retraction and nasal flaring
Pal: Decreased chest expansion on affected side Per: Dull over lobar consolidation A: BS louder, increased clarity in bronchophony, egophony, and whispered pectoriloquy. Crackles fine to medium |
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I: Increased RR, lag on expansion on affected side - Children: sternal retraction and nasal flaring
Pal: Decreased chest expansion on affected side Per: Dull over lobar consolidation A: BS louder, increased clarity in bronchophony, egophony, and whispered pectoriloquy. Crackles fine to medium |
Pneumonia
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Atelectasis (obstruction of airflow)
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I: cough, lag expansion on affected side, increased RR and pulse, cyanosis
Pal: Decreased chest expansion on affected side, diminished or absent tactile fremitus, tracheal shift Per: Dull over area or hyper-resonant A: Diminished BS/absent, diminished/absent voice sounds, fine crackles |
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I: cough, lag expansion on affected side, increased RR and pulse, cyanosis
Pal: Decreased chest expansion on affected side, diminished or absent tactile fremitus, tracheal shift toward affected side Per: Dull over area or hyper-resonant A: Diminished BS/absent, diminished/absent voice sounds, fine crackles |
Atelectasis
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Pleural Effusion (fluid in pleural space)
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I: Increased RR, dry cough, tachycardia, cyanosis, abdominal distention
Pal: Decreased tactile fremitus, tracheal shift, chest expansion decreased on affected side Per: Dull to flat, no diaphragmatic excursion on affected side A: Diminished/absent BS, diminished/absent voice sounds, bronchial BS over compression along with voice sounds (bronchophony, egophony, whispered pectoriloquy) |
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I: Increased RR, dry cough, tachycardia, cyanosis, abdominal distention
Pal: Decreased tactile fremitus, tracheal shift, chest expansion decreased on affected side Per: Dull to flat, no diaphragmatic excursion on affected side A: Diminished/absent BS, diminished/absent voice sounds, bronchial BS over compression along with voice sounds (bronchophony, egophony, whispered pectoriloquy) |
Pleural Effusion (fluid in pleural space)
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Pneumothorax (collapse of lung)
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I: Unequal chest expansion, tachypnea, cyanosis, apprehension, bulging interspaces
Pal: Decreased/absent tactile fremitus, tracheal shift, diminished chest expansion of affected side, tachycardia, decreased BP Per: Hyper-resonant, Decreased diaphragmatic excursion A: Diminished/absent BS and voice sounds |
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I: Unequal chest expansion, tachypnea, cyanosis, apprehension, bulging interspaces
Pal: Decreased/absent tactile fremitus, tracheal shift, diminished chest expansion of affected side, tachycardia, decreased BP Per: Hyper-resonant, Decreased diaphragmatic excursion A: Diminished/absent BS and voice sounds |
Pneumothorax
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Congestive Heart Failure (Edema around alveoli)
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I: Increased RR, SOB on exertion, orthopnea (SOB when laying flat), nocturia, ankle edema, pallor
Pal: Moist, clammy skin, normal tactile fremitus Per: Resonant A: Normal vesicular, crackles at bases |
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I: Increased RR, SOB on exertion, orthopnea (SOB when laying flat), nocturia, ankle edema, pallor
Pal: Moist, clammy skin, normal tactile fremitus Per: Resonant A: Normal vesicular, crackles at bases |
Congestive Heart Failure
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