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45 Cards in this Set
- Front
- Back
- 3rd side (hint)
INSPECT 7 points |
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Assess respirations
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Tachypnea
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persistent respiratory rate approaching 25 breaths/min.
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Bradypnea
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a rate slower than 12 breaths/min.
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Hyperpnea
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deep breathing.
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Kussmaul breathing
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deep, usually rapid breathing associated with metabolic acidosis.
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Hypopnea
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abnormally shallow respirations.
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Cheyne-Stokes respiration
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regular breathing with intervals of apnea followed by crescendo–decrescendo breathing.
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Biot respiration
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irregular breathing that varies in depth and is interrupted irregularly by intervals of apnea.
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Observe chest wall movement during respiration, noting three characteristics.
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Inspect four peripheral areas |
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Chest palpation: 4 points
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1. Thoracic muscles, skeleton |
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crepitus
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(a crackly or crinkly sensation)
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pleural friction rub
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(a palpable, grating vibration)
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Evaluate thoracic expansion
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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.
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costal margin, xiphoid process
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The costal margin is the lower edge of the chest (thorax) formed by the bottom edge of the rib cage.
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Assess tactile fremitus
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palpable vibration of the chest wall during speaking. Fremitus should be symmetrical.
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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”.
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trachea
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Palpate for tracheal shift: place finger in sternal notch and slip to each side. Should be midline. |
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Percuss the chest
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diaphragmatic excursion: 7 steps |
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Auscultate the chest |
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Normal breath sound pitch and intensity |
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Auscultate for vocal resonance |
patient repeats numbers or words: bronchophony, pectoriloquy, egophony |
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Bronchophony |
spoken words sound clearer and louder on auscultation. |
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pectoriloquy
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even a whisper can be heard clearly.
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egophony
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voice intensity increases and has a nasal quality.
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Crackles |
usually heard during inspiration as discrete discontinuous sounds. They may be high-pitched and sibilant or low-pitched and sonorous. |
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Rhonchi
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deeper than crackles and more rumbling, more pronounced on expiration, more prolonged and continuous, and less discrete.
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Wheezes
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continuous, high-pitched, musical sounds almost like a whistle. They are heard during inspiration or expiration.
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friction rub
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dry, crackly, grating, low-pitched sound heard on expiration and inspiration.
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mediastinal crunch |
a variety of noises—loud crackles, clicks, and gurgles—that are synchronous with the heartbeat. |
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Pleural Effusion
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Consolidation
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Emphysema
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Pneumothorax
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Mucous Plug (With Collapse)
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Crackles: early insp, fine |
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Crackles: early insp, coarse
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Crackles: late insp, fine
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Crackles: Mid-inspiratory and expiratory, coarse |
Bronchiectasis, which can be secondary to the following:
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Describe any cough
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If coughing produces sputum
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peak expiratory flow rate
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maximum air flow achieved during forced expiration (use a peak flow meter).
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Stridor
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Loud, rough, continuous, high-pitched sound, pronounced during inspiration; it indicates proximal airway obstruction. loudest over the trachea.
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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
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