Physical Assessment of the Respiratory System

1. Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ

2. Inspection • Kyphosis • AKA • Hunchback • Abnormal curvature of the thoracic spine

3. Inspection • Lordosis • AKA • Sway-back • Abnormal curvature of the lumbar spine

4. 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

5. Inspection: Breathing patterns Depth • Hyperpnea • h depth • Hyperventilation • h depth & rate • Hypoventilation • i depth & rate

6. Inspection: Breathing patterns Rhythm • Apnea • Not breathing • Cheyne-stokes • Varying depth f/b apnea • Death rattles • Death rales

7. Percussion: results • Resonance – drum like • Normal • Hyper-resonance • Too much air • Emphysema • Flatness / dull • Fluid or solid • Pleural effusion • Pneumonia • Tumor

8. Auscultation Purpose • Asses air flow through bronchial tree Procedure • Diaphragm of stethoscope • Superior  inferior • Compare rt to lf

9. Quiz? • A child with difficulty breathing and a “barking” cough id displaying signs associated with which condition? • Asthma • Croup • Cystic fibrosis • Epiglottitis

10. 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

11. Early & late signs of hypoxia • Anxiety • Bradycardia • Cyanosis • Depressed respirations • Diaphoresis • Disorientation • Dyspnea • Restlessness • Headache • Agitation • Poor judgment • Retraction • Tachycardia • Tachypnea

12. which of the following as an early sign of hypoxia? • Restlessness, yawning & tachycardia • Dyspnea, confusion & bradycardia • Bradycardia, hypotension dyspnea • Dyspnea, restlessness, hypotension

13. Dyspnea • Definition • SOB • SOB, flat affect, BS x 4

14. Dyspnea • Significance • Common with cardiac & resp. disease • Sudden onset – healthy person  • Pneumothorax • Sudden onset ill, post-op or injury  • Pulmonary emboli

15. Dyspnea • Orthopnea • Sit up to breath • COPD • CHF

16. Dyspnea • Right ventricle • If chronic airway resistance  • hpressure  • Rt ventricle h work  • Rt. Vent damage

17. Dyspnea • Management • Find cause • Give O2 • HOB h • Communication

18. Cough • Definition • To expel air from the lungs suddenly • Irritation of mucous membrane

19. Cough • Significance • Infection • Irritants • Protective mechanism • Dry, irritating • URT • Cough + chest pain • Pleural or musculoskeletal

20. Cough • management • Assess • Describe • Directed • Pain control • Splinting • Infection control • Suppressants / Anti-tussives

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

22. Sputum Production Significance • Purulent • Thick, yellow/green • Bacteria • Rusty • Strep or staph • Thin, mucous • Viral

23. Sputum Production • Pink-tinged • Lung CA • TB • Pink tinged, profuse, frothy • Pulmonary edema • Malodorous • Lung abscess

24. Sputum Production Management • Thick • Hydrate • h water • Nebulizer • Humidifier • No smoking • Oral care • h Appetite

25. Obtaining a sputum specimen • Explain • From lungs • Sterile cup • Deep breath x 3  • Cough deeply • Expectorate • Best time for specimen collection? • AM

26. Chest pain Definition • Cardiac or pulmonary

27. Chest pain Significance • CA (late stage) • Pneumonia • Pulmonary embolism • Pleurisy

28. Chest pain • Pleurisy • Inflammation of pleura • Sharp with breath • i breath sounds

29. What????? What breath sound would you expect to hear on a patient suffering from pleurisy? • Crackles • Sonorous wheezes • Sibilant wheezes • Pleural Friction Rub

30. Chest pain Management • Assess • Analgesics OK, but… • Position for pain • Affected side • Splint

31. Clubbed fingers Definition • Sponginess of the nail bed • Loss of the nail bed angle • Finger tip is round and bulbous

32. Clubbed Finger Significance • chronic hypoxia

33. 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?

34. Hemoptysis Definition • Expectoration of blood from the respiratory tract

35. Hemoptysis Significance • Pulm or cardiac • Common causes • Pulm infection • CA of lungs • Pulm. Emboli • Pulm. Infarction • TB

36. 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

37. Hemoptysis Management • Determine source • Serious

38. Cyanosis Definition • Bluish coloring of skin

39. Cyanosis Significance • Very late indicator of hypoxia • Appears when O2 sats < 85% • NOT a reliable sign of hypoxia • Esp. with anemia

40. Cyanosis • O2 sat definition • % of hemoglobin carrying oxygen compared to total # of hemoglobin

41. Cyanosis • Normal Breath 100 O2 molecules  98 cross into blood Blood: 100 Hgb • O2 SATS • 98% • No cyanosis

42. Cyanosis • Hypoxia Breath 100 O2 molecules  75 cross into blood Blood: 100 Hgb • O2 SATS • 75% • Cyanosis

43. Cyanosis • Anemic and hypoxic Breath 100 O2 molecules  75 cross into blood Blood: 75 Hgb • O2 SATS • 100% • No Cyanosis

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