Resp

Front 1

INSPECT 7 points

Back 1

1. size and shape
2. symmetry.
3. thoracic landmarks: costal angle, angle of the ribs, and intercostal spaces.
4. color: cyanosis or pallor?
5. supernumerary nipples.
6. superficial venous patterns (cardio)
7. prominence of the ribs (nutrition)
   

Front 2

Assess respirations

Back 2

1. Rate
2. Rhythm

Front 3

Tachypnea

Back 3

persistent respiratory rate approaching 25 breaths/min.

Front 4

Bradypnea

Back 4

a rate slower than 12 breaths/min.

Front 5

Hyperpnea

Back 5

deep breathing.

Front 6

Kussmaul breathing

Back 6

deep, usually rapid breathing associated with metabolic acidosis.

Front 7

Hypopnea

Back 7

abnormally shallow respirations.

Front 8

Cheyne-Stokes respiration

Back 8

regular breathing with intervals of apnea followed by crescendo–decrescendo breathing.

Front 9

Biot respiration

Back 9

irregular breathing that varies in depth and is interrupted irregularly by intervals of apnea.

Front 10

Observe chest wall movement during respiration, noting three characteristics.

Back 10

1. inspect for symmetry. Expansion should be symmetrical.
2. check for use of accessory muscles
3. look for bulging or retractions
   

Front 11

Inspect four peripheral areas

Back 11

1. inspect the lips and nails for cyanosis
2. observe the lips for pursing.
3. check the fingers for clubbing.
4. inspect for nostril flaring.
   

Front 12

Chest palpation: 4 points

Back 12

1. thoracic muscles and skeleton
   
2. thoracic expansion
   
3. tactile fremitus
   
4. examine the trachea
   

Front 13

1. Thoracic muscles, skeleton

Back 13

• pulsations, tender areas, bulges, depressions, masses, and unusual movement or positions.
• bilateral symmetry, some rib cage elasticity, relative inflexibility of the sternum and xiphoid, and a rigid thoracic spine
• crepitus (a crackly or crinkly sensation)
  

Front 14

crepitus

Back 14

(a crackly or crinkly sensation)

Front 15

pleural friction rub

Back 15

(a palpable, grating vibration)

Front 16

Evaluate thoracic expansion

Back 16

place thumbs at the tenth rib and watch for them to diverge during quiet and deep breathing. Then face the patient and repeat this action with your thumbs along the costal margin and xiphoid process. Your thumbs should move symmetrically.

Front 17

costal margin, xiphoid process

Back 17

The costal margin is the lower edge of the chest (thorax) formed by the bottom edge of the rib cage.

Front 18

Assess tactile fremitus

Back 18

palpable vibration of the chest wall during speaking. Fremitus should be symmetrical.

• decreased or absent: COPD, obstruction, PE, or pneumo T
  
• Increased: lobular pneumonia if no bronchus obstruction
  

Hint 18

Systematically palpate the front, back, and sides of the chest with a light, firm touch and feel for chest wall vibration when the patient repeats numbers or words, such as “99”, “Mickey Mouse”.

Front 19

trachea

Back 19

Palpate for tracheal shift: place finger in sternal notch and slip to each side. Should be midline.

Front 20

Percuss the chest

Back 20

1. posterior chest (10)
   
2. lateral chest, (4, 5)
   
3. anterior chest (
4. diaphragmatic excursion
   

Front 21

diaphragmatic excursion: 7 steps

Back 21

1. patient inhales deeply and hold their breath.
2. percuss down thescapular line to the lower border, where resonance changes to dullness.
3. mark point
4. patient takes a few breaths, full exhale, hold breath.
5. percuss up from the first point and mark where the tone changes from dullness to resonance.
6. repeat these actions on the other side.
7. measure the distance between the marks on each side. Excursion usually ranges from 3 to 5 cm.

Front 22

Auscultate the chest

Back 22

• posterior: head bent arms folded
• lateral chest: arms up.
• anterior: shoulders back
  

Front 23

Normal breath sound pitch and intensity

Back 23

1. Vesicular sounds: low, over healthy lung tissue
2. Bronchovesicular: moderate, over bronchi.
3. Bronchial: highest, over the trachea only
   

Front 24

Auscultate for vocal resonance

Back 24

patient repeats numbers or words:

bronchophony, pectoriloquy, egophony

Front 25

Bronchophony

Back 25

spoken words sound clearer and louder on auscultation.

Front 26

pectoriloquy

Back 26

even a whisper can be heard clearly.

Front 27

egophony

Back 27

voice intensity increases and has a nasal quality.

Front 28

Crackles

Back 28

usually heard during inspiration as discrete discontinuous sounds. They may be high-pitched and sibilant or low-pitched and sonorous.

Front 29

Rhonchi

Back 29

deeper than crackles and more rumbling, more pronounced on expiration, more prolonged and continuous, and less discrete.

Front 30

Wheezes

Back 30

continuous, high-pitched, musical sounds almost like a whistle. They are heard during inspiration or expiration.

Front 31

friction rub

Back 31

dry, crackly, grating, low-pitched sound heard on expiration and inspiration.

Front 32

mediastinal crunch

Back 32

a variety of noises—loud crackles, clicks, and gurgles—that are synchronous with the heartbeat.

Front 33

Pleural Effusion

Back 33

• contralateral trach deviat'n
• decreased fremitus
• dull to percussion
• decreased breath sounds

Front 34

Consolidation

Back 34

• N trachea
• increased fremitus
• dull to percussion
• decreased breath sounds
• pectoriloquy

Front 35

Emphysema

Back 35

• N trachea
• decreased fremitus
• hyperresonant percussion
• crackles on auscultation

Front 36

Pneumothorax

Back 36

• contralateral trach deviation
• decreased fremitus
• hyperresonant percussion
• decreased breath sounds
  

Front 37

Mucous Plug (With Collapse)

Back 37

• ipsilateral trach deviation
• decreased fremitus
• dull percussion
• decreased breath sounds

Front 38

Crackles: early insp, fine

Back 38

• Usual interstitial pneumonia
• Desquamative interstitial pneumonia
• Sarcoidosis
• Miliary tuberculosis
• Allergic alveolitis
• Asbestosis

Front 39

Crackles: early insp, coarse

Back 39

• Chronic bronchitis
• COPD
  

Front 40

Crackles: late insp, fine

Back 40

• Atelectasis
• Asthma
• CHF
• Pulmonary edema
• Pneumonia/Consolidation
• Scleroderma
  

Front 41

Crackles: Mid-inspiratory and expiratory, coarse

Back 41

Bronchiectasis, which can be secondary to the following:

• Necrotizing pneumonia
• Environmental exposures
• Cystic fibrosis
• A-1 antitrypsin disorder

Front 42

Describe any cough

Back 42

• moisture
• onset, frequency, regularity
• pitch, loudness
• postural influences
• quality.
  

Front 43

If coughing produces sputum

Back 43

• color
• clarity
• consistency
• amount
• timing
• blood or pus?
  

Front 44

peak expiratory flow rate

Back 44

maximum air flow achieved during forced expiration (use a peak flow meter).

Front 45

Stridor

Back 45

Loud, rough, continuous, high-pitched sound, pronounced during inspiration; it indicates proximal airway obstruction. loudest over the trachea.

Hint 45

This is commonly a medical emergency and should be recognized early. Diagnoses that may present with stridor include epiglottitis, vocal cord dysfunction, croup, and airway edema