respiratory procedures exam 1

chs 16 and 17

what is interviewing

the process of gathering relevant information from a patient, which is an essential element which involves establishing rapport

What is the purpose of the patient interview

It provides unique information because it represents the pts perspective, and it allows healthcare providers to obtain information essential for making a diagnosis. It also helps monitor changes in the pts symptoms and response to therapy.

  What are different spaces in which a patient introduction and interview are conducted in?

social and personal space

what is social space

Introductions are done from a social space of 4-12 ft from the pt

what is personal space

After an introduction is made, it is usually appropriate to begin the interview from what is referred to as [personal space, 2-4 ft from the pt.

What  are the various types of positional dyspnea?

dyspnea

orthopnea

platypnea

trepopnea

Dyspnea

a general term describing the sensation of breathing discomfort(only pt can describe and cannot be observed by a medical professional)

Orthopnea

dyspnea triggered by reclining. It commonly occurs in pts with CHF, mitral valve disease, bilateral diaphragm paralysis, and superior vena cava syndrome.

Platypnea

dyspnea triggered by assuming the upright position. It occurs in conditions such as pneumonectomy, during hypovolemia, in lower cervical spinal injury, and in some pts with chronic liver disease.

Trepopnea

dyspnea that occurs when a pt with unilateral lung disease lies with the affected side in the dependent position.

What scale do we use to quantify dyspnea?

Modified borg dysypnea scale

what does 0-1 indicate on the Modified borg dysypnea scale

none

what does 2-4 indicate on the Modified borg dysypnea scale

slight

what does 5-7 indicate on the Modified borg dysypnea scale

moderate

what does 8-9 indicate on the Modified borg dysypnea scale

moderately severe

what does 10 indicate on the Modified borg dysypnea scale

severe

What is mucus from the tracheobronchial tree that has been contaminated by oral secretions referred to as

sputum

What is mucus from the tracheobronchial tree that has not been contaminated by oral secretions referred to as

phlegm

Purulent

sputum containing pus cells , suggesting a bacterial infection

Fetid

sputum that is foul-smelling

Angina

a common cause of non-pleuritic chest pain brought on by exertion or stress and is associated with coronary artery occlusion

why is it important to be aware of angina in the patient assessment

other common causes of non-pleuritic chest pain include gastroesophageal reflux, esophageal spasm, chest wall pain, and gallbladder disease

Past medical history

shows past childhood diseases and development; hospitalizations, surgeries, injuries, accidents, and major illnesses; allergies; and medications

Family History

familial disease history, marital history, and family relationships

Social/ Environmental History

education; military experience; occupational history; religious and social activities; alcohol and cigarette consumption; living arrangements; hobbies and recreations; satisfaction with and stresses of life situation, finances, and relationships; recent travel or other events that may affect health

what are the level of sensorium

confused

delirious

lethargic

obtunded

stuporous

comatose

Sensorium

used when evaluating a pts cognitive functioning and level of consciousness. Different levels of consciousness include Confused, delirious, lethargic, obtunded, stuporous, and comatose

Confused

The patient exhibits slight decrease of consciousness, has slow mental responses, has decreased or dulled perception, has incoherent thoughts

Delirious

the patient is easily agitated, is irritable, exhibits hallucinations

Lethargic

the patient is sleepy, arouses easily, responds appropriately when aroused

Obtunded

the patient awakens only with difficulty, responds appropriately when aroused

Stuporous

the patient does not awaken completely, has decreased mental and physical activity, responds to pain and exhibits deep tendon reflexes, responds slowly to verbal stimuli

Comatose

the patient is unconscious, does not respond to stimuli, does not move voluntarily, exhibits possible signs of upper motor neuron dysfunction such as Babinski reflex or hyperreflexia, loses reflexes with deep or prolonged coma

Hyperthermia

elevated body temperature

what symptoms are associated with hyperthermia

from disease or from normal strenuous activities; pts heart rate and respiratory rate have increased heart and breathing rates due to increased metabolism, increased O2 consumption and CO2 production

Hypothermia

body temperature below normal

what are the symptoms associated with hypothermia

prolonged exposure to the cold may cause hypothermia; it may cause slow and shallow respiratory rate and a reduced pulse rate due to the reduction of O2 consumption and CO2 production

what is the normal range for systolic blood pressure in the adult patient

less than or equal to 120

what is the normal range for diastolic blood pressure in the adult patient

less than or equal to 20

Systolic pressure

the peak force exerted in the major arteries during contraction of the left ventricle

Diastolic pressure

the force of the major arteries remaining after relaxation of the ventricles

What is the advantage of pursed lip breathing for the COPD patient

Breathing through pursed lips during exhalation creates resistance to flow. The increased resistance creates a slight back pressure in the small airways during exhalation. This back pressure prevents premature airway collapse and allows more complete emptying of the lung.

What is the importance of AP diameter?

It usually increases with age, but it can increase prematurely in pts with COPD

With what disease process will an increased AP diameter be noted?

diseases such as COPD and emphysema

what are the different breathing patterns

agonal breathing

apnea

apneustic breathing

asthmatic breathing

ataxic breathing

biot respiration

central neurologic hyperventilation

Cheyenne-stokes respiration

paradoxical breathing

periodic breathing

kussmaul

Agonal breathing

intermittent prolonged gasps

when will agonal breathing occur

preterminal brain stem reflex

Apnea

no breathing

when will Apnea occur

cardiac arrest, narcotic overdose, severe brain trauma

Apneustic breathing

deep, gasping inspiration with brief, partial expiration

when will Apneustic breathing occur

damage to upper medulla or pons caused by stroke or trauma. Sometimes observed with hypoglycemic coma or profound hypoxemia.

Asthmatic breathing

prolonged exhalation with recruitment of abdominal muscles

when will Asthmatic breathing occur

obstruction to airflow out of the lungs

Ataxic breathing

completely irregular breathing pattern with variable periods of apnea

when will Ataxic breathing occur

damage to the medulla

Biot respiration

chaotic breathing pattern characterized by frequent irregularity in both rate and tidal volume that eventually deteriorates to agonal breathing and terminal apnea

when will Biot respiration occur

damage to the medulla or pons caused by stroke or trauma; severe intracranial hypertension.

Central neurogenic hyperventilation

persistent hyperventilation

when will Central neurogenic hyperventilation occur

midbrain and upper pons damage associated with head trauma, severe brain hypoxia or ischemia

Cheyenne-stokes respiration

an irregular type of breathing, increases and decreases in depth and rate with periods of apnea

when will Cheyenne-stokes respiration occur

most often caused by severe damage to bilateral cerebral hemispheres and basal ganglia, seen in pts with congestive heart failure owing to increased circulation time and various types of encephalopathy

Kussmaul breathing

deep and fast respirations

when will Kussmaul breathing occur

metabolic acidosis

Paradoxical breathing

- abdominal: abdominal wall moves inward in inspiration and outward on expiration ; Chest: part or all of the chest wall moves in with inhalation and out with exhalation

when will Paradoxical breathing occur

abdonimal- diaphragmatic fatigue or paralysis; chest- typically observed in chest trauma with multiple rib or sternal fractures. Also found in pts with high spinal cord injury with paralysis of intercostal muscles.

Periodic breathing

breathing oscillates between periods of rapid, deep breathing and slow, shallow breathing without pro-longed periods of apnea

when will Periodic breathing occur

same as Cheyenne stokes, most often caused by severe damage to bilateral cerebral hemispheres and basal ganglia, seen in pts with congestive heart failure owing to increased circulation time and various types of encephalopathy

chest palpation

the art of touching the chest wall to evaluate underlying structure and function.

When will there be an increase in tactile fremitus

when the lung becomes consolidated, as in pneumonia(filled with inflammatory exudate).

When will there be a decrease in tactile fremitus

when fluid or air collects in the pleural space(pleural effusion or pneumothoraces)

Subcutaneous emphysema

fine air bubbles collecting in subcutaneous tissues, producing a crackling sound and sensation when palpating.

what can cause subcutaneous emphysema

a lung rupture, which often causes air to leak into the subcutaneous tissues of the chest and neck

Chest percussion

the art of tapping the chest wall to evaluate underlying structure and function.

When will there be an increase in resonance

When the percussion note is louder, deeper, and more resonant, it is said to be hyper-tympanic.

When will there be a decrease in resonance

Percussion over normal lung fields produces an easily heard, moderately low-pitched resonate sound described as tympanic.

Vascular breath sounds

- are heard over normal lung parenchyma and are characterized by a soft, muffled sound quality that is lower both in pitch and intensity than bronchovesicular breath sounds. These sounds are heard primarily during inhalation with an exhalation component that is 1/3 the duration of inhalation.

Adventitious breath sounds

additional sounds or vibrations produced by air movement through diseased airways

what are the various types of breath sounds

bronchial

diminished

wheezes

stridor

course crackles/ ronchi

fine crackles

pleural friction rub

Bronchial breath sounds

- abnormal is heard over peripheral lung regions, replacing normal vesicular sounds

when are Bronchial breath sounds heard

when lung tissue density increases

Diminished breath sounds

quieter than normal breath sounds

when are diminished breath sounds heard

occur when sound intensity at the site of generation(larger airways) is reduced due to shallow or slow breathing or when sound transmission through the lung or chest wall is decreased(COPD or asthma)

Wheezes

high-pitched qual musical sound

when are Wheezes heard

consistent with airway obstruction; monophonic _______indicates one airway is affected, polyphonic_________ indicates many airways are involved

Stridor

loud pitched sound associated with upper airway obstruction

when are Stridor breath sounds heard

, heard primarily over the larynx and trachea during inhalation; upper airway compromised;

Course crackles/Ronchi-

airflow moves secretions or fluid in airways

when are coarse crackles/ronchi heard

usually clears when pt coughs or upper airway is suctioned

Fine crackles

air moving through fluid-filled airways(that cannot be cleared with coughing

when are Fine crackles heard

sudden opening of collapsed small airways during inhalation

Pleural friction rub

creaking or grating sound

when is Pleural friction rub heard

by inflamed pleural spaces creating friction, not affected by coughing; intensity may increase with deep breathing

What characteristic of wheezing indicates improvement in airway obstruction after providing bronchodilator therapy?

It is useful to monitor the pitch and duration of wheezing improved expiratory flow is associated with a decrease in the pitch and length of the wheezing.

when will a pleural friction rub occur during the breathing cycle

heard during inspiration and is usually localized to a discreet site on the chest wall

what creates the S1 sound

created by closure of AV valve

what creates the S2 sound

created by closure of semilunar valves

What might decrease the intensity of the heart sounds?

Both cardiac and extracardiac abnormalities may reduce the intensity and heart sounds

What key components should be included in the inspection of the extremities?

clubbing of the fingers

cyanosis

pedal edema

capillary refill

peripheral skin temperature

Clubbing

the painless enlargement of the terminal phalanges of the fingers and toes associated with numerous cardiopulmonary and other diseases

what does clubbing indicate

infiltrative or interstitial lung disease, bronchiectasis, various cancers, congenital heart disease, severe liver failure, and inflammatory bowel disease.