HA Respiratory System

What question can you ask to open the conversation about the respiratory system?

"So tell me about your breathing"

Carina

Point at which the trachea bifurcates (divides) into the left and right mainstem bronchi.

Bronchial Bifurcation

Point where trachea splits into bronchi, denotes the switch from the upper to lower respiratory system

Manubrium of Sternum

top of sternum

suprasternal notch

hollow U-shaped depression just above the sternum, in between the clavicles

Sternal angle

horizontal ridge across front of sternum (at the bottom of the manubrium)

Body of sternum

middle portion of the sternum

Where do you place hands over sternum on CPR?

Body of sternum

Xyphoid Process

The lower part of the sternum that project downward to the point where the sternum meets the lower ribs.

Diaphragm

Large, flat muscle at the bottom of the chest cavity that helps with breathing

What is the bronchi bifurcation behind?

Sternal angle

Which lung has 3 lobes?

Right

Which lung has 2 lobes?

left

What are the 3 lobes of the right lung?

Upper, middle, lower

What are the 2 lobes of the left lung?

Upper, lower

What separates the upper/middle lobes in RL and upper/lower lobes in LL?

Horizontal Fissure

What separates the RML and the RLL?

Oblique Fissure

What are the lung auscultation fields?

RUL, RML, RLL, LUL, LLL

Midsternal Line

a vertical line down the middle of the sternum

Midclavicular line

imaginary vertical line bisecting the middle of the clavicle in each hemithorax

Anterior Axillary Line

a line that is parallel to the mid-axillary line and passes through the anterior axillary skinfold

Anterior Axillary Line

a line that is parallel to the mid-axillary line and passes through the anterior axillary skinfold

Midaxillary Line

An imaginary vertical line that starts at the middle of the axilla (armpit) and extends down the side of the chest.

Posterior Axillary Line

a line that is parallel to the mid-axillary line and passes through the posterior axillary skinfold

Scapular Line

extends through the inferior angle of the scapula when the arms are at the sides of the body

Vertebral Line

A line running vertically down through the spinous processes of the spine

Inferior Angle

bottom point of scapula

Accessory Muscles of Breathing

Sternocleidomastoid, scalenes, and pectoral is minor

Muscles of inspiration

External intercostals, diaphragm

Muscles of expiration

Passive typically, but if active internal intercostals, abdominals

Nasal Flaring

Widening of the nostrils, indicating that there is an airway obstruction.

What should you consider when treating older adults (resp. System only)?

Respiratory muscle strength declines @ 50, increased dyspnea with exertion even in daily life things, increased risk of pneumonia, decreased lung elasticity

Productive Cough

coughing up sputum or excessive mucus

Non-Productive Cough

dry cough

Hemoptysis

coughing up blood

purulent sputum

yellowish or greenish sputum (pus)

What age needs to get the Pneumonia vaccine?

65 and up unless they have immune issues then it would be younger

Pack Year

packs of day x number of years = pack year

What are some examples of environmental hazards for the respiratory system?

Smoke, chemical plants, hairdressing, military, welders, smog

What kinds of medications do we need to make note of when doing a system history?

Prescription, OTC and herbal (including herbal tea if they drink it frequently)

Dyspnea

difficulty breathing

Acute Dyspnea

Sudden onset of - anaphylaxis, pulmonary embolism, spontaneous pneumothorax, asthma, anxiety, etc.

Chronic Dyspnea

COPD, slowly progressing dyspnea

Wheezing

High pitched sound heard in the lungs with asthmatics or lung disease

Cough

sudden, noisy expulsion of air from the lungs, can also be caused by left-sided heart failure (cardiac cough)

Define Acute Cough

Less than 3 weeks

Define Semiacute cough

3-8 weeks

Define Chronic Cough

> 8 weeks

Breathing patterns

Rate, volume, rhythm, ease of effort

Hypercarbia

Increased carbon dioxide level in the bloodstream.

Orthopnea

difficulty breathing when lying down

Hypoxemia

deficient amount of oxygen in the blood (leads to cyanosis)

What type of check do we always do when assessing the lungs?

Check bilaterally

Inspection of the thorax and lungs includes

Observe rate, rhythm, depth, and effort; note facial expressions and LOC; assess skin color; observe thorax shape; compare findings bilaterally

Barrel chest

a condition characterized by increased anterior-posterior chest diameter caused by increased functional residual capacity due to air trapping from small airway collapse. A barrel chest is frequently seen in patients with chronic obstructive diseases, such as chronic bronchitis and emphysema.

Pectus carinatum

a chest that protrudes like the keel of a ship (pigeon chest)

Pectus Excavatum

a chest that is hollowed out

Scoliosis

lateral curvature of the spine

Kyphosis

hunchback

Adventitious Breath Sounds

Abnormal breath sounds such as wheezing, stridor, rhonchi, and crackles.

What should you do if a patient has a lot of chest hair before you auscultate lung sounds?

Press more firmly or wet the hair

Tactile fremitus

a tremulous vibration of the chest wall during speaking that is palpable on physical examination

How do you check for tactile fremitus using palpation?

Place ball or ulnar surface of hand on either side of the vertebral column and ask patient to say "99" or "1 on 1" and move your hands inferiorly and feel for vibrations

What percussion sounds should the lungs make?

Resonance, loud, low, long

Normal Breath Sounds

vesicular, bronchovesicular, bronchial, tracheal

Vesicular breath sounds

Breath sounds with longer inspiratory sounds, soft, low pitched expiratory sounds, and heard over most of the lungs

Broncho-vesicular Breath Sounds

Equal in inspiration and expiration for duration, intermediate sound and intermediate pitch on expiration, often in the 1st and 2nd intercostal spaces or between scapulae

Bronchial Breath Sounds

Expiratory lasts longer than inspiratory in duration, loud and relatively high pitched expiratory sounds, heard over the manubrium if heard at all

Tracheal

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

Crackles (Rales)

fine, crackling sounds made as air moves through wet secretions in the lungs, intermittent, non musical, and brief

Fine Crackles in lungs

Soft, high-pitched, very brief (5-10 msec)

Coarse Crackles in lungs

Somewhat louder, lower in pitch, brief (20-30 msec)

Wheezes

continuous high-pitched whistling sounds produced during breathing

Rhonchi

Rattling noise of mucous in the lungs, > or = 250 msec, musical, prolonged (but not necessarily persisting throughout the respiratory cycle) < or = 200 Hz with snoring quality

Stridor

Audible, high pitched sound heard during inspiration

What could help fix Rhonchi?

Coughing

Semi-Fowler's Position

30-45 degrees - helps oxygenation

High-Fowler's Position

Full 90 degree angle sitting - helps oxygenation

If a patient can't ambulate, how often should you check breath sounds?

Every 2 hours

Tripod Position

Sit upright, leaning on arms or elbows, can indicate respiratory distress

How should you handle interventions for respiratory patients who are fatigued?

Cluster them

Atelectasis

Diminished lung volume, shrinks down and sticks. Immobility is a risk factor

Incentive Spirometer

a resistive breathing device that helps patients exercise their breathing muscles

Who should use an incentive spirometer?

Post operative patients

Pain management

Obese patients

Patients on bedrest

What is the benefit of using an incentive spirometer?

Helps keep up lung strength

How often should an incentive spirometer be used?

Every 15 minutes while awake

What does an incentive spirometer help prevent?

pneumonia

Normal Range for pulse oximetry?

97-100%

Where can a pulse oximeter be placed?

finger, toe, earlobe

What affects the accuracy of a pulse oximeter?

Poor perfusion, hypotension, dyshemoglobinemias, nail polish, cold extremities

Dyshemoglobinemias

disorders in which the hemoglobin is functionally altered and prevented from carrying oxygen

What health promotion technique should you use with tobacco cessation?

Ask, Advise, Assess, Assist, Arrange