Respiratory Clinical Skills- Danielle Bennett, 1/14
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| Muscles of inspiration | Diaphragm and External intercoastal muscles
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| Muscles of expirations | Internal intercostal muscles
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| Accessory muscles of respiration | SCM and trapezius
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| Accessory muscles are used when there are | Pulmonary problems and compromise but also due to exercise
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| Lungs are enclosed in a | Serous membrane
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| The trachea splits at which level | T4 (nipple line)
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| Three spaces of the interior chest | Mediastinum, right and left pleural cavities
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| Lobes in the right lung | 3
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| Lobes in the left lung | 2 and a lingula
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| Trachea divides into | Left and right bronchi
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| The (Right/left) bronchus is wider, shorter, and more vertically placed making it more susceptible to aspiration of foreign bodies | Right
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| Lungs fully develop at what age | 8
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| Chest of the newborn is generally __ | Round
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| Chest wall of an infant compared to an adult | Infants chest wall is thinner and body structures are more prominent
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| 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
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| Older adults are prone to barrel chest from | Loss of muscle strength in thorax and diaphragm and loss of lung resiliency
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| Common chief complaints | Cough, Shortness of breath, and chest pain
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| Most important question regarding cough | Is it productive?
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| A patient under 6 should never have I cough that is | Productive
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| 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
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| Immunizations relevant to Past respiratory history | DTaP, influenze, Strep pneumo
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| Pack years= | Pack per day x Number of years smoking
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| History for Older Adults emphasizes | Smoking history, Cough, Dyspnea, Fatigue, Weight changes, Fever and night sweats
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| Pectus Carninatum | Sternum protrudes outward
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| Pectus excavatum | Lower sternum indents in
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| Barrel Chest | Thoracic ratio close to 1 (normal is .7)
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| 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
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| Paradoxic breathing | On inspiration, the lower thorax is drawn in and on expiration, the opposite occurs. (opposite chest movements in breathing)
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| Kussmaul | Deep and rapib breathing, associated with metabolic acidosis
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| 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
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| 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
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| Ataxic | Significant disorganization with irregular and varying depths of respiration
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| Grunting is an indication that the body is | trying to keep air in the lungs so they will stay open
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| Nose flaring | The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breath
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| Crepitus | Crackly or crinkly sensation, can be palpated and heard, indicates air in the subcutaneous tissue (infection or rupture)
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| Sympathetic innervation of lungs | T2-7
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| Hyperresonace in the lungs indicates | Hyperinflation (ex. emphysemea)
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| Dullness in the lungs indicates | Diminished air exchange (ex. Pneumonia)
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| Vesicular breath sounds | Low-pitched, low-intensity sounds heard over healthy lung tissue
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| Bronchovesicular breath sounds | Heard over the major branchi nd are typically moderate in pitch and intensity
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| Bronchial breath sounds | Highest in pitch and intensity, ordinarily heard only over the trachea
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| 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
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| Cavernous breath sounds | Sounding as if coming from a cavern, Commonly heard over a pulmonary cavity in which the wall is rigid
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| 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)
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| Rhonchi | Deeper, more rumbling, more pronounced during EXPIRATION, more likely to be prolongs and continuous and less discrete than crackles, Indicative of an obstruction
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| Wheeze | Continuous, high pitched, musical sound heard during INSPIRATION AND EXPIRATION
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| Friction Rub | Occurs outside the respiratory tree, Dry grating low pitched sound heard in both EXPIRATION AND INSPIRATION, Caused by inflamed pleura
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| Mediastinal crunch (Hamman sign) | Found with midastinal emphysema, variety of sounds
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| Respiration in infants | 40-60 respirations per minute
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| Periodic breathing | A sequence of relatively vigorous respiratory efforts followed by apnea of as long as 10 to 15 seconds, common in infants
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| Paradoxic breathing | The chest wall collapses as the abdomen distends on inspiration, common in infants
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| Stridor | High-pitched, piercing sound most often heard during inspiration, reslut of an obstruction high in the respiratory tree (usually croup)
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| In pregnancy, Dyspnea is | Common and normal
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| Children under 5 with a productive cough need to be evaluated for | Cystic fibrosis
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| Tracheomalacia | Lack of rigidity or floppiness of the trachea or airway
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| Bronciolitis | Bronchiolar inflammation leading to hyperinflation of the lungs occurring most often in infants younger than 6 months
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| At greatest risk for COPD? | Smokers
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| Emphysema | Condition in which the lungs lose elasticity and alveoli enlarge in a way that disrupts function (hyperresonance)
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| Chronic Bronchitis | Large airway inflammation, usually a result of chronic irritant exposure; More commonly a problem for patients over 40
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| Asthma | Small airways obstruction due to inflammation and hyperreactive airways
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| Atelectasis | Incomplete expansion of the lung at birth or the collapse of the lung at any age
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| Bronchitis | Inflammation of the large airways
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| Pleurisy | Inflammatory process involving the visceral and parietal pleura which becomes edamatous and fibrous
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| Pneumonia | Inflammatory response of the bronchioles and alveoli to an infective agent, Lung consolidation causes dyspnea, tachypnea and crackles
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| 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
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| Pneumothorax | Presence of air or gas in the pleural cavity, tension pneumothorax is a medical emergency and can cause tracheal deviation
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| Sleep Apnea | Spontaneous absence of breathing and oxygenation during sleep; Obesity, maxillomandibular abnormalities, macroglossia, CNS defect
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| Pulmonary embolism | Emblolic occlusion of the pulmonary arteries, difficult to diagnose
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