Respiratory

Fine crackles

high-pitched short popping on inspiration; air popping open deflated airways

Ex: Restrictive (pneumonia); Obstructive (asthma)

Coarse crackles

louder, low-pitched bubbling sounds; air colliding with secretions in trachea/bronchi

Ex: pulmonary edema, pneumonia

Pleural Friction Rub

superficial, course, low-pitched grating sound; inflamed pleura rubbing together

Ex: pleuritis

Wheeze

contiuous musical sounds caused by narrowed airways

Ex: acute asthma, chronic emphysema

Rhonchi

low-pitched wheezing or snoring sounds; airflow obstruction

Ex: bronchitis, single bronchus tumor

Stridor

harsh, high-pitched inspiratory sound caused by upper-airway obstruction

Ex: croup *LIFE THREATENING*

Resonance

low-pitched, clear, hallow; healthy air-filled tissue

Ex: normal adult lungs

Hyperresonance

excess trapped air

Ex: emphysema, pneumothorax

Dullness

air replaced by fluid or solid mass

Ex: consolidation, pleural effusion

Tympany

air-filled hollow structures

Ex: stomach or bowel (not normal in lung fields)

4 pathways: Hypoxemic - Lung/Air failure

most common; low blood oxygen; causes lung/heart disease, depressant meds, high altitude

4 pathways: Circulatory - Pump/Pipe failure

plenty of O2, but blocked delivery; causes congestive heart failure, vessel disease, blood clots

4 pathways: Anemic - Transport failure

insufficient RBCs to carry oxygen; caused by low RBC production

4 pathways: Histotoxic - Utilization failure

plenty of O2 arrives but tissues cannot use it; caused by cyanide poisoning

Hypoxemia caused by

Ventilation and perfusion mismatch

Asthma

chronic inflammatory disorder of airway — airway narrows, inflammation, increased mucus production

Pleural Effusion

excess fluid collection in pleural space compressing lungs

Pneumothorax

Free air in pleural space, causing lung collapse

Acute Bronchitis

inflammation of the bronchial tubes, often due to infection, leading to coughing and respiratory discomfort

Chronic Bronchitis

type of COPD, results in excessive mucus production

Emphysema

Destruction of pulmonary connective tissue, permanently enlarging air sacs and increasing resistance

Pulmonary Embolism

DVT travels upward and occludes pulmonary arteries, causing ischemia

Heart Failure

Pump failure causes backward pressure into pulmonary circulation

Inspection & Palpation - Plueral Effusion

• asymmetric expansion

• tracheal shift AWAY from affected side

Inspection & Palpation - Pneumothorax

• unequal expansion

• tracheal shift to unaffected side

Inspection & Palpation - Chronic Bronchitis

• hacking, productive cough, cyanosis, possible finger clubbing

Inspection & Palpation - Emphysema

• barrel chest, accessory muscle use, tachypnea, severe SOB

Inspection & Palpation - Pulmonary Embolism

• Apprehensive, mental status changes, cyanosis, hemoptysis

• Diaphoresis, hypotension

Inspection & Palpation - Heart Failure

• orthopnea, paroxysmal nocturnal, dyspnea, ankle edema

Percussion & Auscultation - Pleural Effusion

Percussion: Dull

Breath sounds decreased

Percussion & Auscultation - Pneumothorax

Percussion: hyper resonant

Breath sounds decreased, no adventitious sounds

Percussion & Auscultation - Chronic Bronchitis

Percussion: Resonant

Crackles over deflated areas

Percussion & Auscultation - Emphysema

Percussion: Hyperresonant

decreased breath sounds, muffled heart sounds

Percussion & Auscultation - Pulmonary Embolism

Accentuated S2, Crackles, wheezes

Percussion & Auscultation - Heart Failure

Percussion: Resonant, S3 gallop

Crackles

dyspnea

shortness of breath

tachypnea

rapid, shallow breathing

• above 20 breaths/min

bradypnea

abnormally slow breathing

• below 12 breaths/min

apnea

temporary absence of breathing

orthopnea

difficulty breathing while laying flat

paroxysmal nocturnal dysnpea (PND)

sudden shortness of breath that awakens someone from sleep

consolidation

lung tissue becomes dense because air spaces fill with fluid or inflammatory material

bronchial breath sounds

loud, high-pitched, hollow sounds; expiration lasts longer than inspiration

bronchiovesicular sounds

medium-pitched sounds with approximately equal inspiration and expiration

vesicular sounds

soft, low-pitched, rustling sounds; inspiration lasts longer than expiration

pectus excavatum

sunken or inward-depression sternum; funnel chestp

pectus carinatum

forrward-protruding sternum; pigeon chest

Cheyne-Stokes Respirations

breathing periods last 30-45 seconds, with periods of apnea

eupnea

normal, regular breathing

Kussamaul Respirations

very deep, rapid respirations

Atelectasis

collapse of some or all of lung

Lobar Pneumonia

an infection that affects one or more lobes of the lungs