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Physical Assessment of the Respiratory System
PROFESSORB DRM.ABD ELAZIZ
Inspection
• Kyphosis– AKA
• Hunchback
– Abnormal curvature of the thoracic spine
Inspection
• Lordosis– AKA
• Sway-back
– Abnormal curvature of the lumbar spine
Inspection: Breathing patterns
Rate• Eupnea– Normal– 12-20 / min
• Tachypnea– rate– Pnuemonia, pulm edema, acidosis, septicemia, pain
• Bradypnea– rate– ICP, drug OD
Inspection: Breathing patterns
Depth• Hyperpnea– depth
• Hyperventilation– depth & rate
• Hypoventilation– depth & rate
Inspection: Breathing patterns
Rhythm• Apnea– Not breathing
• Cheyne-stokes– Varying depth f/b apnea– Death rattles– Death rales
Percussion: results
• Resonance – drum like– Normal
• Hyper-resonance– Too much air– Emphysema
• Flatness / dull– Fluid or solid– Pleural effusion– Pneumonia– Tumor
Auscultation
Purpose• Asses air flow through
bronchial treeProcedure• Diaphragm of
stethoscope• Superior inferior• Compare rt to lf
Quiz?
• A child with difficulty breathing and a “barking” cough id displaying signs associated with which condition?
A. AsthmaB. CroupC. Cystic fibrosisD. Epiglottitis
Quiz?
• When assessing the lung sounds of a child with asthma, which sound are you most likely to hear?
A. MurmursB. Sibilant WheezingC. CracklesD. Pleural friction rub
Early & late signs of hypoxia
• Anxiety• Bradycardia• Cyanosis• Depressed respirations• Diaphoresis• Disorientation• Dyspnea
• Restlessness• Headache• Agitation• Poor judgment• Retraction• Tachycardia• Tachypnea
which of the following as an early sign of hypoxia?
A. Restlessness, yawning & tachycardiaB. Dyspnea, confusion & bradycardiaC. Bradycardia, hypotension dyspneaD. Dyspnea, restlessness, hypotension
Dyspnea
• Definition– SOB
–SOB, flat affect, BS x 4
Dyspnea
• Significance– Common with cardiac & resp. disease– Sudden onset – healthy person • Pneumothorax
– Sudden onset ill, post-op or injury • Pulmonary emboli
Dyspnea
• Orthopnea– Sit up to breath• COPD• CHF
Dyspnea
• Right ventricle– If chronic airway resistance – pressure – Rt ventricle work – Rt. Vent damage
Dyspnea
• Management– Find cause– Give O2
– HOB – Communication
Cough
• Definition– To expel air from the lungs suddenly– Irritation of mucous membrane
Cough
• Significance– Infection– Irritants– Protective mechanism– Dry, irritating• URT
– Cough + chest pain• Pleural or musculoskeletal
Cough
• management– Assess– Describe – Directed – Pain control• Splinting
– Infection control– Suppressants / Anti-tussives
Sputum Production
Definition• Matter discharged
from resp. track that contains mucus and pus, blood, fibrin, or bacteria
Sputum Production
Significance• Purulent– Thick, yellow/green – Bacteria
• Rusty – Strep or staph
• Thin, mucous – Viral
Sputum Production
• Pink-tinged– Lung CA– TB
• Pink tinged, profuse, frothy– Pulmonary edema
• Malodorous– Lung abscess
Sputum Production
Management• Thick– Hydrate
• water• Nebulizer• Humidifier
• No smoking• Oral care• Appetite
Obtaining a sputum specimen
• Explain– From lungs
• Sterile cup• Deep breath x 3 • Cough deeply• Expectorate • Best time for
specimen collection?– AM
Chest pain
Definition• Cardiac or pulmonary
Chest pain
Significance• CA (late stage)• Pneumonia• Pulmonary embolism• Pleurisy
Chest pain
• Pleurisy– Inflammation of pleura– Sharp with breath– breath sounds
What?????
What breath sound would you expect to hear on a patient suffering from pleurisy?
A. CracklesB. Sonorous wheezesC. Sibilant wheezesD. Pleural Friction Rub
Chest pain
Management• Assess• Analgesics OK, but…• Position for pain– Affected side– Splint
Clubbed fingers
Definition• Sponginess of the nail
bed • Loss of the nail bed
angle• Finger tip is round and
bulbous
Clubbed Finger
Significance• chronic hypoxia
Mr. Caveman:
Mr. Caveman enters the ER unconscious following an Automobile accident. The paramedics report that his O2 sats are 86%. You note that Mr. Caveman has clubbed fingers. What does this tell you?
Hemoptysis
Definition• Expectoration of
blood from the respiratory tract
Hemoptysis
Significance• Pulm or cardiac• Common causes– Pulm infection– CA of lungs– Pulm. Emboli– Pulm. Infarction– TB
Hemoptysis
• Hemoptysis– Definition?
• Coughed up blood
– From?• Pulm hemorrhage
– Description• Pink, red, mixed with
sputum
– Blood pH• Alkaline blood
• Hematemesis– Definition?
• Vomited blood
– From?• Stomach / GI
– Description• “Coffee ground”
– Blood ph• Acidic blood
Hemoptysis
Management• Determine source• Serious
Cyanosis
Definition• Bluish coloring of skin
Cyanosis
Significance• Very late indicator of
hypoxia• Appears when O2 sats
< 85%• NOT a reliable sign of
hypoxia– Esp. with anemia
Cyanosis
• O2 sat definition– % of hemoglobin
carrying oxygen compared to total # of hemoglobin
Cyanosis
• NormalBreath 100 O2 molecules 98 cross into blood
Blood: 100 Hgb• O2 SATS– 98%– No cyanosis
Cyanosis
• HypoxiaBreath 100 O2 molecules 75 cross into blood
Blood: 100 Hgb• O2 SATS– 75%– Cyanosis
Cyanosis
• Anemic and hypoxicBreath 100 O2 molecules 75 cross into blood
Blood: 75 Hgb• O2 SATS– 100% – No Cyanosis
Cyanosis
Management• Know color of Pt. skin• Assess color of tongue &
lips• Fingernail polish• African-American• Vasoconstriction (cold
weather) peripheral cyanosis