Respiratory Care – Assessment & Diagnostics

Thoracic Physical Examination

• Vocal fremitus

  • ↑ with lung tissue consolidation: pneumonia, atelectasis (if airway patent)
  • ↓ with air/fluid separating lung from chest wall: pleural effusion, pneumothorax, COPD

• Percussion notes

  • Dull/soft (↑ tissue density): pleural thickening, atelectasis, consolidation
  • Hyper-resonant (↑ air): pneumothorax, emphysema

• Breath sounds

  • Bronchial over lung fields → suggests alveolar consolidation or atelectasis

• Wheeze characteristics

  • Caused by bronchospasm
  • High-pitched, expiratory, hallmark of bronchial asthma

• Whispered pectoriloquy (whisper transmission)

  • Markedly clear over consolidation & atelectasis

• Abnormal breathing pattern

  • Kussmaul’s respiration ↔ diabetic ketoacidosis (deep, rapid)

Basic Hematology & Immunology Values

• Hematocrit (Hct)

  • Healthy women: 38\% \text{–} 42\% (≈ option 38\%)

• Hemoglobin (Hb)

  • Men: 14 \text{–} 16\,g\%

• Red blood cell count (men)

  • ≈ 5{,}000{,}000/mm^3

• White blood cell (WBC) count

  • Normal total: 5{,}000 \text{–} 10{,}000/mm^3
  • Neutrophils: 60\% \text{–} 70\% of WBC (primary bacterial defense)
  • Eosinophils & basophils → activated by allergic / asthmatic reactions (eosinophils most noted)

• Platelets

  • Invasive procedures acceptable when ≥ 50{,}000/mm^3

Blood Chemistry

• Hyperglycemia associations: diabetes mellitus, myocardial infarction, thiazide/loop diuretics, acute infection
• Hyponatremia clinical signs: seizures, confusion, muscle twitching, abdominal cramps

Chest Radiography Basics

• Standard series: Posteroanterior (PA) + Lateral views
• Anteroposterior (AP) vs PA
  • AP: magnified heart, more distortion, hazier image, more extraneous shadows
• Lateral view
  • To visualize right lung & heart → left side of chest against cassette
• Decubitus view nomenclature
  • Right lateral decubitus = patient lying on right side (right side down)
• Mediastinal shift
  • Toward left: left upper-lobe atelectasis or fibrosis (volume loss)
  • Away from left: right-sided over-expansion/tumor/gas