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100 Cards in this Set
- Front
- Back
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Pursed-lip breathing |
Exhalation through mouth with lips pursed together to slow exhalation |
COPD, asthma, strategy taught to slow expiration, decrease dyspnea |
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Tripod position; inability to lie flat |
Leaning forward with arms and elbows supported on overbed table |
COPD, asthma in exacerbation, pulmonary edema, indicates moderate to severe respiratory distress |
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Accessory muscle use; intercostal retractions |
Neck and shoulder muscles used to assist breathing; muscles between ribs pull in during inspiration |
COPD, asthma in exacerbation, secretion retention. Indicates severe respiratory distress, hypoxemia |
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Splinting |
Voluntary ⬇️ in tidal volume to ⬇️ pain on chest expansion |
Thoracic or abdominal incision, chest trauma, pleurisy |
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⬆️AP diameter |
AP chest diameter = to lateral; slope of ribs more horizontal(90 degrees) to spine |
COPD, asthma, cystic fibrosis, lung hyperinflation, advanced age |
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Tachypnea |
Rate greater than 20 breaths/min, greater than 25 breaths/min in older adults |
Fever, anxiety, hypoxemia, restrictive lung disease, ⬆️ above normal rate reflects increased work of breathing |
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Kussmaul respirations |
Regular, rapid, and deep respirations |
Metabolic acidosis, increases CO2 excretion |
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Cyanosis |
Bluish color of skin best seen in lips and on the palpebral conjunctiva |
Reflects 5-6 g of hemoglobin not bound with 02. ⬇️ transfer in lungs, ⬇️ cardiac output. Nonspecific, unreliable indicator |
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Finger clubbing |
⬆️ depth, bulk, sponginess of distal portion of finger |
Chronic hypoxemia, cystic fibrosis, lung cancer, bronchiectasis |
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Abdominal paradox |
Inward movement of abdomen during inspiration |
Inefficient and ineffective breathing pattern. Nonspecific indicator of severe respiratory distress |
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Tracheal Deviation |
Leftward or rightward movement of trachea from normal midline position |
Medical emergency if caused by tension pneumothorax. Trachea deviates to the side opposite the collapsed lung |
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Altered Tactile Fremitus |
⬆️or⬇️ in vibrations |
⬆️ in pneumonia, pulmonary edema, ⬇️ in pleural effusion, lung hyperinflation. Absent in pneumothorax, atelectasis. |
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Altered Chest Movement |
Unequal or equal but diminished movement of 2 sides of chest with inspiration |
Unequal movement caused by atelectasis, pneumothorax, pleural effusion, splinting. Equal but diminished movement caused by barrel chest, restrictive disease, neuromuscular disease |
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Hyperresonance |
Loud, lower-pitched sound over areas that normally produce a resonant sound |
Lung hyperinflation (COPD), lung collapse (pneumothorax), air trapping (asthma) |
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Dullness |
Medium-pitched sound over areas that normally produce a resonant sound |
⬆️ Density (pneumonia, large atelectasis), ⬆️ fluid in pleural space (pleural effusion) |
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Fine Crackles |
Series of short-duration, discontinuous, high-pitched sounds heard just before the end of inspiration. Result of rapid equalization of gas pressure when collapsed alveoli or terminal bronchioles suddenly snap open. |
Idiopathic pulmonary fibrosis, interstitial edema, alveolar filling (pneumonia), loss of lung volume (atelectasis), early phase of heart failure |
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Course Crackles |
Series of long-duration, discontinuous, low pitched sounds caused by air passing through airway intermittently occluded by mucus, unstable bronchial wall, or fold of mucosa. Evident on inspiration and, at times, expiration. |
Heart failure, pulmonary edema, pneumonia with severe congestion, COPD |
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Rhonci |
Continuous rumbling, snoring, or rattling sounds from obstruction of large airways with secretions. Most prominent on expiration. Change often evident after coughing or suctioning |
COPD, cystic fibrosis, pneumonia, bronchiectasis |
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Stridor |
Continuous musical or crowing sound of constant pitch. Result of partial obstruction of larynx or trachea |
Croup, epiglottitis, vocal cord edema after extubation, foreign body |
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Absent Breath Sounds |
No sound evident over entire lung or area of lung |
Pleural effusion, mainstem bronchi obstruction, large atelectasis, pneumonectomy, lobectomy |
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Hering-Breuer Reflex |
Prevents over distention of lungs |
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Respiratory Defense Mechanisms |
Filtration of air, mucociliary clearance system, cough reflex, reflex bronchconstriction, alveolar macrophages |
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What can impair ciliary action? |
Dehydration, smoking, inhalation of high O2 concentrations, infection, drugs |
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Alveolar macrophages are responsible for what? |
Rapidly phagoytize inhales foreign particles, move debris to level of bronchioles for removal by cilia or lymphatic system. Smoking impairs |
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What are the 3 main effects of aging on respiratory |
Alterations in structure Defense mechanism Respiratory control |
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What is the most important risk factor for COPD and Lung Cancer? |
Smoking. Quantify by packs/years |
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What patient may awaken with chest tightness, wheezing or coughing? |
Patient with COPD or Asthma |
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Patient tells you they sleep on several pillows... |
May have cardiovascular disease and suffer from orthopnea |
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What symptoms might a patient with sleep apnea experience? |
Snoring, insomnia, abrupt awakenings, daytime drowsiness, early morning headaches |
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What would you want to test your patient for if they complain of night sweats? |
TB |
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What might you see in patient with hypoxia? |
Neuro symptoms: apprehension, restlessness, irritability, memory change. This will interfere with ability to learn and retain info- make sure caregiver is present for teaching |
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What problems can cause chest pain? |
Cardiac involvement Fractured ribs Pleurisy Costochondritis |
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What is a shotty node? |
Small, mobile non tender node. It is ok |
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What type of nose would indicate disease? |
Tender, hard or fixed |
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When inspecting lungs why are you looking for? |
Shape, symmetry. Rate, depth and rhythm of breath. 12-20 breaths or 16-25 in older adults |
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Define Kussmaul breathimg |
Rapid and deep. Noted with metabolic acidosis |
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What is cheyne-stokes? |
Alternating periods of apnea and deep breathing. Rapid. |
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What is Biot's? |
Irregular with apnea every 4-5 cycles. |
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What are abnormal breath sounds? |
Bronchial or bronchvesicular sounds heard in peripheral lung fields |
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What are adventitious sounds? |
Extra breath sounds that are abnormal. Crackles, rhonci, wheezes and plural friction rub. |
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When assessing skin, what is a late sign of hypoxemia? |
Cyanosis. In darker skin: observe conjunctival, lips, palms and under tongue. |
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What causes cyanosis? |
Hypoxemia or decreased cardiac output |
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Why type of pain might someone feel with fractured rib? |
Sharp local associated with breathing |
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What is clubbing evidence of? |
Long standing hypoxemia |
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Trachea deviates to what side with collapsed lung ? |
Opposite side. |
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How serious is tracheal deviation because of tension pneumothorax ? |
Medical emergency |
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When checking chest expansion, what are the landmarks for anterior and posterior? |
Anterior- diaphragm Posterior- 10th rib 1 inch is normal |
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If your patient has unequal chest expansion, what could be the problem? |
Limited air entry, atelectasis or pneumothorax |
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When might you find increased fremitus? |
Occurs because of lungs filling with fluid. (Pneumonia, lung tumors and above pleural effusion) |
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Why might you find with inspection of COPD? |
Barrel chest, cyanosis, tripod position, use of accessory muscles |
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Asthma in exacerbation might look like what? |
Prolonged expiration, tripod position, pursed lips. Decreased movement on palpation and hyperresonance on percussion. |
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What might you find with pneumonia patient on assessment? |
Tachypnea, use of accessory muscles, duskiness or cyanosis. Increased fremitus over affected area. Dull on percussion |
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Pulmonary edema might look like what on inspection? |
Tachypnea, labored respirations, cyanosis |
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What is pleurisy and describe the pain? |
Inflammation of plurae which impairs their lubricating function. Pain is sharp, localized, stabbing associated with deep breathing or movement |
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Pleural effusion might look like what on inspection? |
Tachypnea, use of accessory muscles. Increased movement and increased fremitus above effusion. |
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When listening to lungs what do you want to note? |
Pitch , duration of sound, presence of adventitious sounds |
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Describe normal breath sounds |
Vesicular- soft Bronchovesicular- medium pitch Bronchial- loud, high pitched |
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Always do what with sputum specimen? |
Observe for color, volume, blood and viscosity |
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What does a positive TB test indicate? |
Person has been exposed to antigen |
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Purpose of bronchoscopy? |
Diagnosis, biopsy, specimen collection or assess changes. Can also be used to suction mucous plugs, lavage the lungs or remove foreign objects |
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How may a lung biopsy be performed? |
Transbronchially, transthoracic needle aspiration (TTNA), VATS, open lung biopsy |
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Purpose of lung biopsy |
To obtain tissues, cells or secretions for evaluation |
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What is done to differentiate between infection and rejection in lung transplant recipients? |
Combination of transbronchial lung biopsy and BAL |
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What is bronchoalveolar lavage (BAL)? |
Small amounts of sterile saline injected through scope and withdrawn and examined for cells |
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How do you achieve good pulmonary hygiene? |
Bronchodilators Coughing Deep breathing |
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Video assisted thoracic surgery is used for what? |
View and biopsy lesions in the pleura or peripheral lung |
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Percutaneous transthoracic needle aspiration (TTNA) involves what and what is the risk? |
Needle through chest wall with CT guidance. Risk of pneumothorax, chest X-ray is ordered after TTNA. |
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What is a thoracentesis? How is patient positioned? |
Large bore needle through chest wall. Can obtain specimens, remove pleural fluid, or instill medication. Patient sits upright with elbows on table and feet supported. Lidocaine subcutaneously. Chest tube may be needed for further drainage |
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What do Pulmonary function tests (PFTs) measure? What are they used for? |
Lung volume and airflow. Diagnose pulmonary disease, monitor progression, evaluate disability and assess response to bronchodilators. |
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Home spirometry used to monitor whom? |
People with asthma, cystic fibrosis, COPD, and before and after thoracic surgeries |
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What is the name of the home spirometry device? |
Peak flow meter |
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Patient has <40 PaO2 and <75 SpO2. What does this mean? |
Inadequate perfusion. Tissue hypoxia and cardiac dysrhythmias can be expected. |
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Define tidal volume |
Volume of air inhaled and exhaled with each breath. Only a small proportion of total capacity of lungs. 0.5 L |
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What is total lung capacity (TLC)? |
6.0 L |
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What is acute bronchitis? |
Inflammation of bronchi in lower respiratory tract |
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Discharge that is malodorous and purulent could be...? |
Foreign body |
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What is the most common symptom of acute bronchitis? |
Cough- can last 3 weeks |
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Symptoms of acute bronchitis? |
Cough, headache, fever, malaise,hoarseness, myalgia, dyspnea, chest pain. Adventitious breath sounds may be heard on expiration |
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Bronchitis treatment |
Supportive. Cough suppressants, bronchodilator or steroid. Abx not helpful |
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What is Pertussis? What causes it? |
Highly contagious respiratory tract infection. Caused by gram-negative bacillus. |
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Describe symptoms of Pertussis |
1st stage: mild uri, low or no fever, runny nose, watery eyes, mild, non productive cough 2nd stage: paroxysms of coughing, whooping sound, vomiting can occur, cough more frequent at night, cough can last 6-10 weeks |
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How do you treat Pertussis? |
Antibiotics. Usually macrolides(erythromycin) Do not use cough suppressant |
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How do organisms that cause pneumonia reach the lungs? |
🔹Aspiration of normal flora from nasopharynx or oropharynx 🔹inhalation of microbes (mycoplasma pneumoniae) 🔹hematogenous spread from primary infection somewhere else in body |
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Pneumonia can be caused by... |
Bacteria, viruses , mycoplasma organisms, fungi, parasites, chemicals |
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What is CAP? |
Community acquired pneumonia |
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Hospitalization for CAP depends on what? |
Age, vital signs, mental status, comorbidities. Use PORT severity index or CURB-65 scale |
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Upon examination of nasal passageway you see watery discharge. This could be from what? |
Secondary to allergies or cerebrospinal fluid |
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How is Pneumonia treated? |
Empiric antibiotic therapy should be started asap - (door to dose= 4 hrs) macrolide or doxycycline Sputum specimen should be obtained first |
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What could cause bloody discharge from nose? |
Trauma or dryness |
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Thick mucous from nose indicates what? |
Infection |
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When inspecting the mouth why would you want to stimulate and what is responsible for the desired response? |
Gag reflex. Cranial nerves 9 and 10 |
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When assessing neck, why order do you palpate nodes? |
Around ears to base of skull and then those under mandible to midline |
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Signs and symptoms of pneumonia |
Cough, fever, shaking chills, dyspnea, tachypnea, pleuritic chest pain Cough may or may not be productive Sputum may be different colors |
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What might be the only finding in an older patient with pneumonia? |
Confusion or stupor Possibly hypothermia instead of fever |
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What is the leading cause of death in patients with severe pneumonia? |
Acute respiratory failure |
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What diagnostic tests might you expect for patient with pneumonia? |
X-ray, sputum culture, ABGs, complete blood count, WBCs with differential |
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Pulmonary embolism most common symptom |
Dyspnea |
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Most sensitive and specific test for PE? |
Pulmonary angiography |
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COPD risk factors |
Smoking, occupational chemicals, dusts, air pollution, infections,heredity , aging , a1 antitrypsin deficiency |
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Main characteristic of COPD |
Inability to expire air |
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