Respiratory Exam 3

Trachea location

Anterior to esophagus and splits into right and left main bronchi

Bronchi description

Below trachea, right bronchi is shorter and more vertical

What happens in the dead space in the respiratory system

Air is transported but no gas exchange

Function of thoracic cavity alveoli

Gas exchange

Path of air in respiratory system

Air passes through trachea, bronchi, bronchioles, alveolar sacs

Anatomy pathway of respiratory system

Trachea, bronchi, bronchi split into bronchioles, bronchioles have alveolar sacs at the end

Lobes in right lung

3

Lobes in left lung

2

Where does the apex extend to

Clavicle

Where does the base of the lung go to

Diaphragm

What is the plural membrane

Thin double layered serous membrane

What is breathing

Automatic act controlled by respiratory center in brain stem

What part of the brain stem initiates respiratory breathing

Medulla and pons

What is necessary of the brain stem for respiration

Nerve innervation, muscle excursion, and strength

What is the main muscle used for inspiration

Diaphragm

What happens to the diaphragm when breathing is triggered

The diaphragm contracts and flattens which pulls the lungs down

What kind of process is expiration

Passive

What should normal breathing be described as

Quiet, easy, and barely audible

What is dyspnea?

Difficulty breathing

What is orthopnea?

Multi breathing while laying flat

What is paroxysmal nocturnal dyspnea?

Shortness of breath that wakes someone up while sleeping

What is Cheyne-Stokes breathing?

Periods of deep breathing alternate with periods of no breathing

What is obstructive breathing?

Expiration prolonged due to narrowed airways

What is a sighing respiration?

Breathing punctuated by frequent size which suggests hyperventilation syndrome

What is rapid deep breathing?

A response to metabolic demand including exercise, altitude, sepsis, and anemia

What is ataxic breathing?

Periods of apnea that alternate with regular deep breaths which stop suddenly for short intervals

In what patient is ataxic breathing common?

Brain injury patients

How to palpate respiratory system

Palpate chest for tenderness, crepitus, then chest expansion

What should happen to examiners thumb when patient takes a deep breath

Examiner's thumbs move 5 to 10 centimeters apart symmetrically

Describe vesicular breath sounds

Inspiratory sounds lasts longer than expiratory, soft intensity, relatively low pitch, and is heard over most of both lungs

Describe broncho vesicular sounds

Inspiratory and expiratory sounds are about equal, intermediate intensity, intermediate pitch, often heard in 1st and 2nd intercostal spaces anteriorly and between the scapula

Describe bronchial sounds

Expiratory sounds last longer than inspiratory, loud intensity, high pitch, and heard over the manubrium

Describe tracheal sounds

Inspiratory and expiratory sounds are equal, very loud and intensity, relatively high pitch, heard over the trachea in the neck

Describe fine crackles

High pitched, soft crackling noises

Mechanism of fine crackles

Deflated small airways and alveoli will pop open during inspiration

Describe coarse crackles

Low pitched, moist, longer sounds similar to Velcro

Mechanism of coarse crackles

Air bubbles flow through secretions or narrowed airway

When do you hear crackles

Chronic respiratory disease

Describe wheezes

High pitched musical sounds heard mainly during inspiration

Mechanism of wheezing

Air passes through narrowed airways and creates sound similar to that of vibrating reed

When will you hear wheezing?

Asthma, bronchitis, emphysema

Describe rhonchi

Low pitched snoring or gurgling sound that may clear with coughing

Mechanism of rhonchi

Air flow passes around or through secretions

When would you hear rhonchi?

Pneumonia

Describe plural friction rub

Greeting or creaking sound similar to squeaking door

Mechanism of plural friction rub

Inflamed plural surfaces loose lubrication and rub together

When would you hear plural friction rub?

Pleuritis

Describe stridor

Loud, high pitched, crowing or honking in upper airway

Mechanism of stridor

Laryngeal or tracheal inflammation or spasm

What sounds do you expect in normal air filled lung?

Predominantly vesicular

What sound would you expect in lobar pneumonia?

Bronchial or bronchial vesicular over the involved area

Transmitted voice sounds for normal lungs

Spoken words muffled, “ee” heard as “ee”, and whispered words are faint

Transmitted voice sounds for lobar pneumonia

Spoken words are louder, “ee” heard as “ay”, and whispered words are louder

Describe abnormal bronchophony

Abnormal increase in the clarity and loudness of spoken words

Describe abnormal egophony

Change in voice sound when auscultating the lungs, where the spoken “ee” sound is heard as “ay”

Describe abnormal pectoriloquy

Whispered words are heard clearly and distinctly

Assessments for respiratory system

Chest X-ray, CBC, sputum sample, BNP, and CT