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Resp ClinSkills
Respiratory Clinical Skills- Danielle Bennett, 1/14
| Question | Answer |
|---|---|
| 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
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