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Physical Assessment of the Respiratory System. PROFESSORB DR M.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

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inspection
Inspection
  • Kyphosis
    • AKA
      • Hunchback
    • Abnormal curvature of the thoracic spine
inspection1
Inspection
  • Lordosis
    • AKA
      • Sway-back
    • Abnormal curvature of the lumbar spine
inspection breathing patterns
Inspection: Breathing patterns

Rate

  • Eupnea
    • Normal
    • 12-20 / min
  • Tachypnea
    • h rate
    • Pnuemonia, pulm edema, acidosis, septicemia, pain
  • Bradypnea
    • i rate
    • h ICP, drug OD
inspection breathing patterns1
Inspection: Breathing patterns

Depth

  • Hyperpnea
    • h depth
  • Hyperventilation
    • h depth & rate
  • Hypoventilation
    • i depth & rate
inspection breathing patterns2
Inspection: Breathing patterns

Rhythm

  • Apnea
    • Not breathing
  • Cheyne-stokes
    • Varying depth f/b apnea
    • Death rattles
    • Death rales
percussion results
Percussion: results
  • Resonance – drum like
    • Normal
  • Hyper-resonance
    • Too much air
    • Emphysema
  • Flatness / dull
    • Fluid or solid
    • Pleural effusion
    • Pneumonia
    • Tumor
auscultation
Auscultation

Purpose

  • Asses air flow through bronchial tree

Procedure

  • Diaphragm of stethoscope
  • Superior  inferior
  • Compare rt to lf
slide9
Quiz?
  • A child with difficulty breathing and a “barking” cough id displaying signs associated with which condition?
  • Asthma
  • Croup
  • Cystic fibrosis
  • Epiglottitis
slide10
Quiz?
  • When assessing the lung sounds of a child with asthma, which sound are you most likely to hear?
  • Murmurs
  • Sibilant Wheezing
  • Crackles
  • Pleural friction rub
early late signs of hypoxia
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
which of the following as an early sign of hypoxia?
  • Restlessness, yawning & tachycardia
  • Dyspnea, confusion & bradycardia
  • Bradycardia, hypotension dyspnea
  • Dyspnea, restlessness, hypotension
dyspnea
Dyspnea
  • Definition
    • SOB
    • SOB, flat affect, BS x 4
dyspnea1
Dyspnea
  • Significance
    • Common with cardiac & resp. disease
    • Sudden onset – healthy person 
      • Pneumothorax
    • Sudden onset ill, post-op or injury 
      • Pulmonary emboli
dyspnea2
Dyspnea
  • Orthopnea
    • Sit up to breath
      • COPD
      • CHF
dyspnea3
Dyspnea
  • Right ventricle
    • If chronic airway resistance 
    • hpressure 
    • Rt ventricle h work 
    • Rt. Vent damage
dyspnea4
Dyspnea
  • Management
    • Find cause
    • Give O2
    • HOB h
    • Communication
cough
Cough
  • Definition
    • To expel air from the lungs suddenly
    • Irritation of mucous membrane
cough1
Cough
  • Significance
    • Infection
    • Irritants
    • Protective mechanism
    • Dry, irritating
      • URT
    • Cough + chest pain
      • Pleural or musculoskeletal
cough2
Cough
  • management
    • Assess
    • Describe
    • Directed
    • Pain control
      • Splinting
    • Infection control
    • Suppressants / Anti-tussives
sputum production
Sputum Production

Definition

  • Matter discharged from resp. track that contains mucus and pus, blood, fibrin, or bacteria
sputum production1
Sputum Production

Significance

  • Purulent
    • Thick, yellow/green
    • Bacteria
  • Rusty
    • Strep or staph
  • Thin, mucous
    • Viral
sputum production2
Sputum Production
  • Pink-tinged
    • Lung CA
    • TB
  • Pink tinged, profuse, frothy
    • Pulmonary edema
  • Malodorous
    • Lung abscess
sputum production3
Sputum Production

Management

  • Thick
    • Hydrate
      • h water
      • Nebulizer
      • Humidifier
  • No smoking
  • Oral care
  • h Appetite
obtaining a sputum specimen
Obtaining a sputum specimen
  • Explain
    • From lungs
  • Sterile cup
  • Deep breath x 3 
  • Cough deeply
  • Expectorate
  • Best time for specimen collection?
    • AM
chest pain
Chest pain

Definition

  • Cardiac or pulmonary
chest pain1
Chest pain

Significance

  • CA (late stage)
  • Pneumonia
  • Pulmonary embolism
  • Pleurisy
chest pain2
Chest pain
  • Pleurisy
    • Inflammation of pleura
    • Sharp with breath
    • i breath sounds
slide29
What?????

What breath sound would you expect to hear on a patient suffering from pleurisy?

  • Crackles
  • Sonorous wheezes
  • Sibilant wheezes
  • Pleural Friction Rub
chest pain3
Chest pain

Management

  • Assess
  • Analgesics OK, but…
  • Position for pain
    • Affected side
    • Splint
clubbed fingers
Clubbed fingers

Definition

  • Sponginess of the nail bed
  • Loss of the nail bed angle
  • Finger tip is round and bulbous
clubbed finger
Clubbed Finger

Significance

  • chronic hypoxia
mr caveman
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
Hemoptysis

Definition

  • Expectoration of blood from the respiratory tract
hemoptysis1
Hemoptysis

Significance

  • Pulm or cardiac
  • Common causes
    • Pulm infection
    • CA of lungs
    • Pulm. Emboli
    • Pulm. Infarction
    • TB
hemoptysis2
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
hemoptysis3
Hemoptysis

Management

  • Determine source
  • Serious
cyanosis
Cyanosis

Definition

  • Bluish coloring of skin
cyanosis1
Cyanosis

Significance

  • Very late indicator of hypoxia
  • Appears when O2 sats < 85%
  • NOT a reliable sign of hypoxia
    • Esp. with anemia
cyanosis2
Cyanosis
  • O2 sat definition
    • % of hemoglobin carrying oxygen compared to total # of hemoglobin
cyanosis3
Cyanosis
  • Normal

Breath 100 O2 molecules  98 cross into blood

Blood: 100 Hgb

  • O2 SATS
    • 98%
    • No cyanosis
cyanosis4
Cyanosis
  • Hypoxia

Breath 100 O2 molecules  75 cross into blood

Blood: 100 Hgb

  • O2 SATS
    • 75%
    • Cyanosis
cyanosis5
Cyanosis
  • Anemic and hypoxic

Breath 100 O2 molecules  75 cross into blood

Blood: 75 Hgb

  • O2 SATS
    • 100%
    • No Cyanosis
cyanosis6
Cyanosis

Management

  • Know color of Pt. skin
  • Assess color of tongue & lips
  • Fingernail polish
  • African-American
  • Vasoconstriction (cold weather)  peripheral cyanosis