Term
| What are the functions of the respiratory system? |
|
Definition
Ventilation
diffusion and perfussion
Control of breathing |
|
|
Term
|
Definition
Movement of air into and out of the lungs
Inspiratory phase
Expiratory phase |
|
|
Term
|
Definition
| Slow, shallow breathing; causes CO2 to build up in the blood acidosis |
|
|
Term
|
Definition
| Rapid, deep breathing causes more CO2 to be blown off called alkalosis |
|
|
Term
| what is diffusion and perfussion |
|
Definition
| gas exchange across the aveolar-pulmonary capillary membrane |
|
|
Term
| control of breathing is influenced by |
|
Definition
| neural and chemical factors, medulla, pons, chemoreceptors in the carotid body. The stimulus of breathing is primarily due to the increase of CO2 |
|
|
Term
| Anatomical structures serve as |
|
Definition
| a reference point for pinpointing findings from the physical examination |
|
|
Term
| what are the two catorgories of anatomical structures that we use during a physical examination as reference points |
|
Definition
topographical landmarks
and reference lines |
|
|
Term
| what are 5 topographical landmarks |
|
Definition
1. nipples
2. manubrosternal juntion (angle of louis) where the 2nd rib articulates with the sternum
3.suprasternal notch
4.costal angle ( usually no more than 90 degrees, and ribs insert at approx. 45 degrees)
5. clavical |
|
|
Term
| What are on which 3 main points |
|
Definition
anterior chest
posterior chest
axilla |
|
|
Term
| What are the reference points on the anterior chest |
|
Definition
Midsternal line
midclavicular lines
anterior axillary lines |
|
|
Term
| What are the reference points on the Posterior chest |
|
Definition
Vertebral lines
midscapular lines |
|
|
Term
| What are the reference points on the axilla |
|
Definition
anterior axillary lines
posterior axillary lines
midaxillary lines |
|
|
Term
| Your lungs are symmetrical |
|
Definition
|
|
Term
| Our lungs are divided into lobes how many lobes does the left and right lung have |
|
Definition
| the right lung has 3 and the left lung has 2 |
|
|
Term
| What are the three primary muscles of respiration |
|
Definition
diaphram- divides chest from abdomen
external intercoastal muscles
Accessory muscles |
|
|
Term
| What does structures are considered in the upper airway |
|
Definition
| the nose, pharynx, larynx, intrathoracic trachea |
|
|
Term
| What is the function of the upper airway (3) |
|
Definition
| to conduct air to the lower airway; to filter in order to protect the lower airway; and to warm and humidify inspired air. |
|
|
Term
| What atructure are in the lower airway? |
|
Definition
| Trachea, Bronchi, Bronchioles |
|
|
Term
| What is the main function of the lower airway? |
|
Definition
Trachea splits into left and right mainstem bronchi which are further subdivided into bronchioles.
1. conduct air to the alveoli
2. clear mucociliary structures |
|
|
Term
| The alveoli acts as a functional unit to |
|
Definition
provide gas exchange
and to produce surfactant |
|
|
Term
| what is the difference between the right and left bronchus |
|
Definition
| the right bronchus is shorter wider, and more upright than the left |
|
|
Term
| The end of the lungs stop at which rib |
|
Definition
|
|
Term
| The horizontal fissure of the right lung runs in between which ribs |
|
Definition
|
|
Term
| To check patients respiratory history what 5 main catagories? |
|
Definition
chief complaint
past health history
family history
personal and social history
health promotion activites |
|
|
Term
| What are the two main chief complaints that deals with respiratory system? |
|
Definition
| cough and Dyspnea which is shortness of breath SOB |
|
|
Term
| What is usually typical for the onset description for coughing? |
|
Definition
| it can be either sudden or gradual |
|
|
Term
| what is usually the nature of coughing ? |
|
Definition
| dry, moist, hackling, barking |
|
|
Term
| what is the information we genrally get from the spuntum ( mucous coughed up from the lower airways of coughing) |
|
Definition
|
|
Term
| What is the usual severity for coughing ? |
|
Definition
|
|
Term
| What are the associated symptoms of coughing? |
|
Definition
| sneezing, dyspnea, fever, chills, congested gagging |
|
|
Term
| What usually brings coughing on? |
|
Definition
| anxiety, talking, activity |
|
|
Term
| What is used to treat coughing? |
|
Definition
|
|
Term
| What is the typical onset of Dyspnea? |
|
Definition
|
|
Term
| What is the severity of Dyspnea? |
|
Definition
|
|
Term
| What are the associated symptoms of Dyspnea? |
|
Definition
| night sweats, pain, chest pressure, discomfort, ankle edema, diaphoresis, cyanosis. |
|
|
Term
|
Definition
| position, time of day, exercise, allergens, emotions |
|
|
Term
| what has been tried to treat Dyspnea? |
|
Definition
| medications, inhalers, oxygen |
|
|
Term
| What 4 things do you ask with past health history? |
|
Definition
1. if they have had lung disease or breathing problems ( frequent sever colds, asthma, pneumonia, tuberculosis
2. Last PPD and or chest X-ray
3. allergies
4. medication use |
|
|
Term
| What are the 6 things included in the personal and social history? |
|
Definition
tabacco
alcohol
drugs
home enviroment
occupational enviroment
travel |
|
|
Term
| What equipment and techniques are used for a physical examination of the respiratory system? |
|
Definition
stethescope
inspection
palpation
percussion
auscultation |
|
|
Term
| What are the four main inspections you are going to be doing on the body? |
|
Definition
1. general
2. chest wall configuration
3. oxygenation ( cyanosis - blueish skin due to lack of oxygen)
4. respiratory effect |
|
|
Term
| what is included in the general assessment |
|
Definition
appearence
posture
breathing effect
trachea position ( midline) |
|
|
Term
| what do you look for in your inspection of the chest wall configuration |
|
Definition
form
symmetry
muscle development
anterior and posterior diameter
( which is approx. 1/2 transverse diameter 2:1)
costal angle should be no greater than 90 degrees |
|
|
Term
| when inspecting oxygenation( cyanosis) you examine |
|
Definition
| the nails, skin, and lips |
|
|
Term
| When inspecting the respiratory effect on the body you inspect the |
|
Definition
repiratory rate and depth
breathing pattern
chest expansion |
|
|
Term
| When you do palpation on the chest you check which two places |
|
Definition
| the trachea for position , and the chest wall for symmetry |
|
|
Term
| How do you perform a thoracic expansion (excursion)test on a patient |
|
Definition
- place both thumbs at about the 7th ribs posterly along the spinal process
-extend both fingers outward along chest wall
-have the person take a deep breath and observe for bilateral outward movement of the thumbs |
|
|
Term
| What are normal and abnormal readings for the Thoracic Expansion ( excursion) test |
|
Definition
Normal: bilateral, symetric expansion
abnormal: unilateral and unequal |
|
|
Term
| To perform a vocal ( tactile) Fremitus examination you do what ? |
|
Definition
- use your palmer or ulnar surface of your hand
- symetrically position hands over both sides of posteior chest
- have the person repeat 1,2,3 or 99 as you move from apices to bases |
|
|
Term
| What are normal and abnormal findings for the Vocal (tactile) Fremitus tests? |
|
Definition
normal : bilaterally, symetrically vibrates
decreased or absent: obstruction of transmission ( bronchitus, emphysema)
Increased: cosolation compression of lung tissue (pneumonia) |
|
|
Term
| What are the keys to auscultation of the repiratory system |
|
Definition
- auscultate in systematic manner
- compare one side to the other
- listen to one full respiration at each spot
- displace breast tissue to listen directly over chest wall
- DO NOT listen through gown, clothes ect. always listen to bare skin
- evaluate posterior , lateral, and anterior chest
- instruct person to sit upright and breathe in and out slowly through their mouth
- use diaphram side of stethoscope
- move from apices to bases |
|
|
Term
| What is the normal pitch, intesity,quality location, I to E relationship, of the bronchial |
|
Definition
| high, loud, blowing/hollow, trachea, I |
|
|
Term
| What is the normal pitch, intesity, location,quality I to E relationship, of the bronchovesicular |
|
Definition
| moderate, moderate, combination, E=I, between scapular, 1st and 2nd InterCoastal Space lateral to the sternum |
|
|
Term
| What is the normal pitch, intesity,quality, location, I to E relationship, of the vesicular |
|
Definition
| low, soft, gentle rustling/breeze, I>E,peripheral lung. |
|
|
Term
| How do we assess infants breathing |
|
Definition
measure chest circumference
usually 2-3 cm smaller than head circumference
- chest is round ( AP =transverse) |
|
|
Term
| What is common in neonates breathing |
|
Definition
-obligate nose breathers
-periodic breathing is common: sequence of rigerous breathing followed by apnea for 10-15 seconds is common; only concerned when it is prolonged or cyanosis occurs
- breathing is diaphramatic and abdomen |
|
|
Term
| What are signs of compromise for neonates |
|
Definition
-stridor ( crowning)
-grunting
-central cyanosis
-flaring of the nostrils |
|
|
Term
| infants and younf children with breathing |
|
Definition
- roundness of chest is persistant for two years
- chest walls are usually thinner than adults
- breathing sounds may be louder and more bronchial than adults
- bronchovesicular sounds may be heard throughout the chest |
|
|
Term
| Pregnancys effect on breathing |
|
Definition
- costal angle increases to 105 degrees during the third semester
- dyspnea and orthopnea(trouble breathing lating down) are common
- breathes more deeply
- |
|
|
Term
| older adults and breathing |
|
Definition
- chest expansion often decreases
- bony prominences are usually marked
- AP diameter increases in respect to transverse diameter but not 1:1 |
|
|
Term
|
Definition
| absense os spontaneous respiration |
|
|
Term
|
Definition
| not equal anteroposterior- to - transverse diameter and that ribs are horizontal instead of normal ageing and also with chronic emphysema and asthma as a result of hyperinflation of lungs |
|
|
Term
|
Definition
| abnormally low rate of breathing ( less than 12 respirations/minute) |
|
|
Term
|
Definition
| increase in the intesity and the clarity of vocal resonance that may result from an increase in lung tissue density, such as the consulation of pneamonia |
|
|
Term
|
Definition
| normal sound heard with a stethescope over the main airway of the lungs, especially the trachea |
|
|
Term
| bronchovesicular breath sounds |
|
Definition
| normal sounds that occurs between the sounds of the bronchial tubes and those of the aveoli, or a combo of the two sounds |
|
|
Term
|
Definition
| common, abnormal respiratory sounds consisting of bubbling noises heard suring auscultation of chest during inspiration, fine- popping sounds produced by air entering distal bronchioles or alveoli that contain serous secretions ( congestive heart failure, pneumonia, early TB), coarse-originate in larger bronchi or trachea and have a lower pitch, cant be cleared by coughing |
|
|
Term
|
Definition
| crackle of a consolidated area of a lung in pneumonia, course crackling sensation palpable over the skin surface, occurs in subQ emphysema when air escapes from the lungs and enters the subQ tissue, as after open thoracic injury or surgery |
|
|
Term
|
Definition
| blueish discoloration of the skin and mucous membranes cause by an excess of dehydrated henoglobin in the blood |
|
|
Term
|
Definition
| pattern of inspiration/expiration in which most of the ventilatory work is done with the diaphram ( males normally do this, few females do) |
|
|
Term
|
Definition
| distressful subjective sensation of uncomfortable breathing that may be caused by many disorder, including some heart and respiratory conditions, strenious exercise or anxiety |
|
|
Term
|
Definition
| change in the voice sound of a patient with pleural effusion of pnemonia as heard on ausculation( hear A-A-A sound when patient says E-E-E) |
|
|
Term
|
Definition
| dry, grating sound heard during auscultation. It is a normal finding when heard over the liver and splenic areas. A friction rub auscultated over the pericardial area is suggested of pericarditis; a rub over the pleural area may be a sign of lung disease |
|
|
Term
|
Definition
| coughing up of blood from the respiratory tract |
|
|
Term
|
Definition
| exaggerated deep, rapid, or labored respiration, normal with exercise |
|
|
Term
|
Definition
| lower-pitched, booming sound found when too much air is present as in emphysema or pneumothorax |
|
|
Term
|
Definition
| abnormal condition in which person must sit or stand to breathe deeply or comfortably |
|
|
Term
|
Definition
| "pigeon breast", congenital structural defect characterized by a prominant anterior projection of the xiphoid and the lower part of the sternum by a lengthening of the coastal cartilages, may cause cardiorespiratory complications |
|
|
Term
|
Definition
| "funnel chest"; skeltal abnormalty of the chest characterized by a depressed sternum, usually doesnt interfere with breathing |
|
|
Term
|
Definition
| echo or other sound- hollow, clear produced by percussion over healthy lungs |
|
|
Term
|
Definition
| abnormal sound heard on auscultation of an airway obstructed by thick secretions, muscular spasms, neoplasm, or external pressure, more pronounced during expiration |
|
|
Term
|
Definition
| material coughed up from the lungs and exporcated through the mouth; contains mucous, cell debris, microorganisms, and maybe pus or blood, amount color, and constittes important in diagnosising illness like TB, pneumonia, lung cancer and pneumonconioses |
|
|
Term
|
Definition
| abnormal, high pitched musical sound caused by an obstruction in the tracheaor larynx; usually heard during inspiration, may indicate glottic edema, asthma, diptheria, laryngospasm |
|
|
Term
| tactile (vocal ) Fremitus |
|
Definition
| tremulus vibration of the chest wall during speaking that is palpable on a physical exam; increased in pneumonia, decreased or absent during COPD, obstruction pleural diffusion, or pneumothorax |
|
|
Term
|
Definition
| expansion of the thoracic cavity |
|
|
Term
|
Definition
| loud, high pitched musical sound percussed over the upper gastric area |
|
|
Term
|
Definition
| normal sounds of rustling heard from a stethescope over the lung perphery; higher pitch during inspiration, fades rapidly during expiration |
|
|
Term
|
Definition
| form of conchus, characterized by a high pitched or low pitched musical quality; caused by a high velocity flow of air through a narrowed airway; heard during inspiration and expiration. |
|
|
Term
|
Definition
| asking patient to whisper " 1,2,3, while auscultating, normally faint and muffled, abnormal is able to hear clearly with stethescope |
|
|
Term
| what is the characteristics of a chief complaint of wheezing |
|
Definition
| high pitch, continuous it sounds polyphonic predominatly in expiration but can be in inspiration as well. as squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling; secretions, or tumors; from acute asthma, or chronic emphysema |
|
|
Term
| What are the characteristics of the chief complaint about pain with breathing |
|
Definition
| chestt pain of thoracic cavity occurs with muscles soreness from coughing or from inflammation of pleura overlaping pneumonia |
|
|
Term
|
Definition
| loud, bubbling and gurgling sound that starts in early inspiration and may be present in expiration; may decrease somewhat by suctioning or coughing but will reappear shortly, sounds like openeing a velcro fastener. |
|
|
Term
|
Definition
| discontinuous, high-pitched, short crackling popping sounds heard during inspiration that are not clear by coughing; you can stimulate this sound by rolling a piece of hair by your ears. |
|
|
Term
| What is a focused health history for a person who has a coughing complaint |
|
Definition
- how often so you cough?At any special time of the day or is it just arising? does coughing wake you up at night?
- do you cough up any phlegm or spuntum? how much, what color is it?
- do you cough up any blood? does this look like streaks or frank blood? DOes the spuntum have a foul odor?
- how would you describe you coughing " hackling, dry , barking, hoarse, congested, bubbled"
- does the cough seem to come with any activity, position ( lying), fever, congested, fever, anxiety
- doe the activity make it better or worse
- what treatment have you tried, prescriptions or over the counter medications, vaporizer, rest, position change.
- does the cough bring on anything: chest pain, ear pain? is it tiring, are you concerned about it? |
|
|
Term
| What is a focused health history for a patient who is short of breath |
|
Definition
ever had any shortness of breath , or hard- breathing spells? what brings it on? how sever is it? how long does it last?
- is it affected by position such as laying down
- occurs at any specific time of the day?
- shortness of breath episodes associated with night sweats?
- cough, chest pain, or bluish aroung the lips or nails, wheexing sound?
- episode seem to be related to food, pollen, dust, animals, seasons, or emotions
- What do you do in a hard - breathing attack? take a special posiiton, or used purse- lip breathing? use any oxygen inhalers or medication?
- how does the shotness of breath effect your work or home activities/ getting better or worse or staying about the same? |
|
|
Term
| What is a focused health history of someone who has a chest pain while brathing? |
|
Definition
please point to the exact location
- when did it start, constant or does it come and go
- describe the pain, burning, dtabbing
-brought on by respiratory infection, coughing , or trama.
- isit associated with fever , deep breathing, unequal chest inflation
- what have you done to treat it / medications or heat applicants |
|
|
Term
| what is the definition for ineffective breathing patterns |
|
Definition
| inspiration or expiration that does not provide adequate ventilation |
|
|
Term
| what are the defining characteristics of ineffective breathing patterns |
|
Definition
| alternation in depth of breathing, altered chest excursion, assumption of three point ; bradypnea; decreased exspiratory pressure; decreased minute ventilation, decreased vital capacity, dyspnea; increased anterior-posterior diameter, nasal flaring, orthopnea; prolonged expiration phase; pursed-lip breathing; trachyapnea; use of axillary muscles to breathe. |
|
|
Term
| what are the related to factors of ineffective breathing patterns |
|
Definition
| anxiety, body position, bony deformity, chest wall deformity, cognitive impairment, fatigue, hyperventilation; hyperventilation syndrome, muscoskeletal impairment, neurological immaturity, neuromuscular disfunction, obesity, pain, perception impairment , respiratory muscle fatigue, spinal cord injury. |
|
|
Term
| what are the normal palpatory findings when doing a respiratory assessment |
|
Definition
symetrical chest expansion
tactile fremitus present and equal bilaterally, diminishing toward periphery. No lumps masses or tenderness. |
|
|
Term
| What are the normal findings for an ispection of the lung |
|
Definition
anteroposterior less than the transferse diameter
relaxed posture
normal musculature
rate 10-18 breaths per minute
regular no cyanosis or pallor |
|
|
Term
| why is the right lung shorter than the left lung |
|
Definition
| because the liver is pushing it up |
|
|
Term
| what are the two fissures called for the right lung |
|
Definition
| the horizontal fissure right oblique fissure |
|
|
Term
| the posterior chest is composed of mostly -- lobe |
|
Definition
|
|
Term
| laterally lungs extend from the -- to the -- |
|
Definition
|
|
Term
| the anterior chest contains mostly --- |
|
Definition
|
|
Term
| visceral pleaura lines the |
|
Definition
|
|
Term
| the pariental pleura lines the |
|
Definition
| inside of the chest wall and diaphram |
|
|
Term
| the trachea is anterior or posterior to the esophagus |
|
Definition
|
|
Term
| The right main bronchus it ---- than the left |
|
Definition
| shorter wider and more vertical |
|
|
Term
|
Definition
| a functional respiratory unit that consists of the bronchiloes alveolar ducts, and the alveoli |
|
|
Term
| the diaphram -- during inspiration |
|
Definition
|
|
Term
| some aging facts about old people lungs |
|
Definition
decreased vital capacity
increased risidual volume
less elastic properties
lungs are more rigid and harder to inflate |
|
|
Term
| a cough that is continuous thoughout the day is said to be |
|
Definition
|
|
Term
| afternoon/ evening cough usually related to |
|
Definition
| may reflect exposure to irratants in the enviroment |
|
|
Term
| a night time cough could be |
|
Definition
|
|
Term
| early morning cough can be related to |
|
Definition
| chronic bronchial inflamation of smokers |
|
|
Term
| describe colors of septum |
|
Definition
white or clear- cold, bronchitis, viral infection
yellow or green- bacterial infection
rust colored- TB, pneumonia,
pink, frothy- pulmonary edema, |
|
|
Term
| how many points do you palpatate with tactile fremitus |
|
Definition
| 2 sets of 5 on each side starting at the top of the back and go down to the 8th rib |
|
|
Term
| what is the normal range findings for the tactile fremitus test |
|
Definition
you do this between the scapula and around the sternum, sites where major bronchios are closest to the chest wall
the fremitus decreases as you move down away from bronchioloes
- it is greater over a thin chest
vibrations should feel the same on both sides
-should feel alittle stonger on the right side because it is closer to the bronchial bifurcation
-low pitch generates more fremitus than a high pitch |
|
|
Term
| how do you use the fingers to palpate the chest wall |
|
Definition
note any areas of tenderness
note skin temp and moisture
to detect any lumps or masses
-and explore skin lesions you found whiole inspecting |
|
|
Term
| you should hear -- sound over the lungs and -- sound over the scapula and -- sound over the liver |
|
Definition
resonance(hollow)
flat
dull |
|
|
Term
|
Definition
shows there is to much air in the lungs
emphysema |
|
|
Term
| how many points do you auscultate at |
|
Definition
| two sets of nine with 8 and 9 doind a circle |
|
|
Term
| bronchial sounds are located |
|
Definition
|
|
Term
| bronchovesicular sounds are located |
|
Definition
| over major bronchi, where fewer alveoli are located, posterior: between scapulae especially on the right. Anterior: around upper sternum in 1st and 2nd intercoastal space |
|
|
Term
| vesicaular sounds located pg429 |
|
Definition
| over peripheral lungs where air flows through bronchioles and alveoli |
|
|
Term
| do you check facial expressions and level of consciousness during inspection of the chest |
|
Definition
|
|
Term
| should you allow the child to play with your stethescope to become comfortable with your exam |
|
Definition
|
|
Term
| when is it best to measure a babys breathing |
|
Definition
|
|
Term
|
Definition
AP diameter = transverse until age 6
chest circumference is 30-36 2 cm smaller than their head
chest wall is thin with little musculature
diaphram main muscle used because intercoatal muscles are undeveloped
thoracic cage soft and flexible
infant obligate nose breather for 3 months
no nose flares
normal rate of breathing 30-40
bronchovesicular sounds are normally heard louder than adults till age 5
breath sounds louder and harsher |
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|
