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Resp ClinSkills

Respiratory Clinical Skills- Danielle Bennett, 1/14

Muscles of inspiration Diaphragm and External intercoastal muscles
Muscles of expirations Internal intercostal muscles
Accessory muscles of respiration SCM and trapezius
Accessory muscles are used when there are Pulmonary problems and compromise but also due to exercise
Lungs are enclosed in a Serous membrane
The trachea splits at which level T4 (nipple line)
Three spaces of the interior chest Mediastinum, right and left pleural cavities
Lobes in the right lung 3
Lobes in the left lung 2 and a lingula
Trachea divides into Left and right bronchi
The (Right/left) bronchus is wider, shorter, and more vertically placed making it more susceptible to aspiration of foreign bodies Right
Lungs fully develop at what age 8
Chest of the newborn is generally __ Round
Chest wall of an infant compared to an adult Infants chest wall is thinner and body structures are more prominent
Anatomic changes in the chest in early pregnancy Lower ribs flare and diaphragm rises above usual position to increase movement. Minute ventilation increases while respiratory rate stays the same
Older adults are prone to barrel chest from Loss of muscle strength in thorax and diaphragm and loss of lung resiliency
Common chief complaints Cough, Shortness of breath, and chest pain
Most important question regarding cough Is it productive?
A patient under 6 should never have I cough that is Productive
Chest pain is usually non-cardiac when Constant ache lasting all day, Pain stays in one location, Made worse with pressure on the precordium, Very short sharp pain lasting 1-2 seconds, Located in the shoulders or between the scapula in the back
Immunizations relevant to Past respiratory history DTaP, influenze, Strep pneumo
Pack years= Pack per day x Number of years smoking
History for Older Adults emphasizes Smoking history, Cough, Dyspnea, Fatigue, Weight changes, Fever and night sweats
Pectus Carninatum Sternum protrudes outward
Pectus excavatum Lower sternum indents in
Barrel Chest Thoracic ratio close to 1 (normal is .7)
Retractions Chest wall seems to cave in at the sternum, between the ribs, at the suprasternal notch, above the clavicles and at the lowest costal margins, suggests an obstruction
Paradoxic breathing On inspiration, the lower thorax is drawn in and on expiration, the opposite occurs. (opposite chest movements in breathing)
Kussmaul Deep and rapib breathing, associated with metabolic acidosis
Cheyne-Stokes Regular pattern of breathing with intervals of apnea followed by crescendo/decrescendo sequences, occurs with brain damage at the cerebral level or drugs
Biot Irregular respirations varying in depth with intervals of apnea, no repetitive pattern, Can mean increased ICP, drugs, or brain damage at the level of the medulla
Ataxic Significant disorganization with irregular and varying depths of respiration
Grunting is an indication that the body is trying to keep air in the lungs so they will stay open
Nose flaring The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breath
Crepitus Crackly or crinkly sensation, can be palpated and heard, indicates air in the subcutaneous tissue (infection or rupture)
Sympathetic innervation of lungs T2-7
Hyperresonace in the lungs indicates Hyperinflation (ex. emphysemea)
Dullness in the lungs indicates Diminished air exchange (ex. Pneumonia)
Vesicular breath sounds Low-pitched, low-intensity sounds heard over healthy lung tissue
Bronchovesicular breath sounds Heard over the major branchi nd are typically moderate in pitch and intensity
Bronchial breath sounds Highest in pitch and intensity, ordinarily heard only over the trachea
Amphoric breath sounds Breathing that resembles the noise made by blowing across the mouth of a bottle, most often herad with a large, relatively stiff-walled pulmonary cavity or a tension pneumothorax with bronchopleural fistula
Cavernous breath sounds Sounding as if coming from a cavern, Commonly heard over a pulmonary cavity in which the wall is rigid
Crackles in breath sounds Abnormal respiratory sound heard more often during INSPIRATION and characterized by discrete discontinuous sounds (COPD, influenze, congestive heart failure, pulmonary edema)
Rhonchi Deeper, more rumbling, more pronounced during EXPIRATION, more likely to be prolongs and continuous and less discrete than crackles, Indicative of an obstruction
Wheeze Continuous, high pitched, musical sound heard during INSPIRATION AND EXPIRATION
Friction Rub Occurs outside the respiratory tree, Dry grating low pitched sound heard in both EXPIRATION AND INSPIRATION, Caused by inflamed pleura
Mediastinal crunch (Hamman sign) Found with midastinal emphysema, variety of sounds
Respiration in infants 40-60 respirations per minute
Periodic breathing A sequence of relatively vigorous respiratory efforts followed by apnea of as long as 10 to 15 seconds, common in infants
Paradoxic breathing The chest wall collapses as the abdomen distends on inspiration, common in infants
Stridor High-pitched, piercing sound most often heard during inspiration, reslut of an obstruction high in the respiratory tree (usually croup)
In pregnancy, Dyspnea is Common and normal
Children under 5 with a productive cough need to be evaluated for Cystic fibrosis
Tracheomalacia Lack of rigidity or floppiness of the trachea or airway
Bronciolitis Bronchiolar inflammation leading to hyperinflation of the lungs occurring most often in infants younger than 6 months
At greatest risk for COPD? Smokers
Emphysema Condition in which the lungs lose elasticity and alveoli enlarge in a way that disrupts function (hyperresonance)
Chronic Bronchitis Large airway inflammation, usually a result of chronic irritant exposure; More commonly a problem for patients over 40
Asthma Small airways obstruction due to inflammation and hyperreactive airways
Atelectasis Incomplete expansion of the lung at birth or the collapse of the lung at any age
Bronchitis Inflammation of the large airways
Pleurisy Inflammatory process involving the visceral and parietal pleura which becomes edamatous and fibrous
Pneumonia Inflammatory response of the bronchioles and alveoli to an infective agent, Lung consolidation causes dyspnea, tachypnea and crackles
Influenza Viral infection of the lung, Normally an upper respiratory infection but due to alteration in the epithelial barrier, the infected host is more susceptible to secondary bacterial infections
Pneumothorax Presence of air or gas in the pleural cavity, tension pneumothorax is a medical emergency and can cause tracheal deviation
Sleep Apnea Spontaneous absence of breathing and oxygenation during sleep; Obesity, maxillomandibular abnormalities, macroglossia, CNS defect
Pulmonary embolism Emblolic occlusion of the pulmonary arteries, difficult to diagnose
Created by: mcasto