Unit 5. Respiratory System PDF

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UNIT 5: RESPIRATORY PHYSICAL EXAM COMPONENTS 

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Inspect the chest; front and back, noting thoracic landmarks. o Size and shape (________ ________ compared with the lateral diameter) o Symmetry o Color o Superficial venous patterns o Prominence of ribs Evaluate respirations. _____________ Rhythm or pattern Note any audible sounds with respiration.

PHYSICAL EXAM CONTINUED… 

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Palpate the chest. o _______ _________ o Sensations such as crepitus, grating vibrations o ________ _________ Perform direct or indirect percussion on the chest, comparing sides. o __________ excursion o Percussion tone intensity, pitch, duration, and quality Auscultate the chest with the stethoscope diaphragm, from apex to base; comparing sides. o Intensity, pitch, duration, and quality of breath sounds o Adventitious breath sounds (crackles, rhonchi, wheezes, friction rubs) o Vocal ____________

UNIT 5: RESPIRATORY

UNIT 5: RESPIRATORY

UNIT 5: RESPIRATORY HISTORY OF PRESENT ILLNESS   

_______________ Shortness of breath Chest pain

PAST MEDICAL HISTORY 

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Thoracic trauma or surgery, hospitalization for pulmonary disorders Oxygen or ventilation-assisted devices Chronic pulmonary diseases Other chronic disorders _____________________

PERSONAL AND SOCIAL HISTORIES          

Employment Home environment Nutritional status Exercise tolerance Hobbies Regional/travel exposures Use of complementary/alternative therapies _______________________ Use of alcohol/drugs Exposure to respiratory infections, ______________, tuberculosis

HISTORY FOR INFANTS AND CHILDREN       

Prematurity; low birth weight; steroids Immunization Bronchiolitis ___________________ Swallowing dysfunction Sudden-onset cough or difficulty breathing Apnea

HISTORY FOR PREGNANT PATIENTS AND OLDER ADULTS PREGNANT PATIENTS  Weeks of gestation  Multiple fetuses/polyhydramnios/other conditions  Exercise type and energy expenditure  Respiratory infections; influenza immunization OLDER ADULTS  Respiratory infections  Oxygen therapy  Effects of weather  Immobilization

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Swallowing issues, choking, coughing Change in ADL Signs/symptoms of chronic respiratory diseases

PHYSICAL EXAM: INSPECTION CHEST  Shape and symmetry  Chest wall movement  Superficial venous patterns  Prominence of ribs  Anteroposterior versus transverse diameter  Sternal protrusion; spinal deviation RESPIRATION  Rate  __________  Pattern COUNT RATE WHILE PALPATING PULSE!!! INSPECT THE CHEST WALL DURING RESPIRATION.  Symmetry  Retractions

UNIT 5: RESPIRATORY PERIPHERAL CLUES MAY SUGGEST PULMONARY OR CARDIAC DIFFICULTIES.  Fingers  Breath  Skin, nails, and lips  Nose

PHYSICAL EXAM: PALPATION      

Thoracic muscles/skeleton Crepitus Friction rub Thoracic expansion ________________________ Note the position of the trachea.

BRONCHOVESICULAR  Heard over the major bronchi; moderate in pitch and intensity BRONCHIAL  Highest in pitch and _____________  Ordinarily heard only over the trachea BOTH BRONCHOVESICULAR AND BRONCHIAL  Abnormal if heard over peripheral lung tissue

AUSCULTATING BREATH SOUNDS CONTINUED… ADVENTITIOUS BREATH SOUNDS  Crackles (formerly called rales) o Fine or Coarse  Rhonchi (sonorous wheezes)  Wheezes (sibilant wheeze)  _____________________________ VOCAL RESONANCE  Voice transmits sounds through lung fields, heard with the stethoscope.  Auditory changes o Bronchophony, pectoriloquy, ________________

PHYSICAL EXAM: PERCUSSION    

Percuss chest Measure diaphragmatic excursion Percussion tone indicators for lungs Percussion notes

PHYSICAL EXAM: AUSCULTATING BREATH SOUNDS VESICULAR  Low-pitched, low-intensity; heard over _______________ lung tissue

CRACKLES VS RHONCHI CRACKLES  Discontinuous sounds  Often bilaterally  Heard most often on inspiration  DO NOT CLEAR WITH COUGHING

UNIT 5: RESPIRATORY RHONCHI  Continuous sounds  May be unilateral or bilateral  Heard most often on expiration  CLEARS or CHANGES with COUGHING

UNIT 5: RESPIRATORY DIAGNOSTIC TESTS     

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Chest x-ray Pulse oximeter ________________________ PFT’s ABG’s

Roundness of chest persisting past second year may indicate pulmonary problem

AUSCULTATE THE CHEST.  Stridor: high-pitched, piercing sound most often heard during inspiration W ORK OF BREATHING: AN INFANT’S EFFORT TO BREATHE

CHILDREN  Thoracic (intercostal) musculature for respiration occurs by 6 or 7 years.  Variable respiratory rate, decreasing with age, reaching adult rates at 17 years

Marked bony prominences, kyphosis, increased anteroposterior diameter

CHEST/RESPIRATORY ABNORMALITIES

PHYSICAL EXAM: INFANTS & CHILDREN INFANTS INSPECTION  Chest expansion for asymmetry  Respiratory rate varies between ___ and ____ respirations per minute.

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Breath sounds o Bronchovesicular sounds may predominate.

PHYSICAL EXAM: PREGNANT PATIENTS AND OLDER ADULTS PREGNANT PATIENTS  Structural and ventilatory changes  Dyspnea  Deeper breathing OLDER ADULTS  Decreased chest expansion, muscle weakness, physical disability, sedentary lifestyle, rib articulation calcification

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Asthma Atelectasis Bronchitis Pleurisy Pleural effusion Empyema Lung abscess Pneumonia Influenza Tuberculosis Pneumothorax Hemothorax Lung cancer Pulmonary embolism Epiglottitis Cardiac Disorders leading to respiratory symptoms: Angina, MI Endocarditis, Pericarditis Cardiac Tamponade Cor Pulmonale Heart Defects Rheumatic Fever Aneurysm Heart Failure

UNIT 5: RESPIRATORY ABNORMALITIES IN INFANTS, CHILDREN, AND ADOLESCENTS       

Diaphragmatic hernia Tracheomalacia Chronic lung disease Cystic fibrosis Bronchiolitis Croup (laryngotracheal bronchitis) Asthma

ABNORMALITIES IN OLDER ADULTS    

Chronic obstructive pulmonary disease (COPD) Emphysema Bronchiectasis Chronic bronchitis...