Physical Assessment of the Respiratory System. Hajinezhad, Mohammad Esmaiel

Transcription

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2 Physical Assessment of the Respiratory System بررسي دستگاه تنفس

3 History Physical problems Function problems Life style Smoking Family Hx Occupation hx Allergens / environment Recreational exposure Anxiety S&S

4 Inspection Normal chest Slight retraction of intercostal spaces 2x as wide as deep Anterior/posterior diameter 1:2

5 Inspection Barrel chest D/t over inflation of lungs anterior-posterior diameter 2:2

6 Inspection Funnel chest Depression of the lower portion of the sternum Complications Heart damage Cardiac output Nrs management Murmurs

7 Inspection Pigeon chest Sternum protrudes outward anterior-posterior diameter

8 Pigeon Chest

9 Inspection Scoliosis Lateral curvature of thoracic spine Assessment Shoulders elevated? Complications Lung & heart damage Back problems Body image

10 Scoliosis

11 Scoliosis

12 Quiz? How many hours a day should a child wear a brace for treating scoliosis? A. 8 hr B. 12 hr C. 23 hr D. 24 hr It can be removed for 1 hour a day for hygiene purposes

13 Inspection Kyphosis AKA Hunchback Abnormal curvature of the thoracic spine

14 Kyphosis

15 Inspection Lordosis AKA Sway-back Abnormal curvature of the lumbar spine

16 Lordosis

17 Inspection Uniform expansion of the chest Pneumonia Pleural effusion Pneumothorax Bulging intercostal spaces Obstruction Emphysema

18 Inspection Marked retraction of intercostal spaces Blockage Shoulder rise Accessory muscles Posture

19 Inspection: Breathing patterns Rate Eupnea Normal / min Tachypnea rate Pnuemonia, pulm edema, acidosis, septicemia, pain Bradypnea rate ICP, drug OD

20 Inspection: Breathing patterns Depth Hyperpnea depth Hyperventilation depth & rate Hypoventilation depth & rate

21 Inspection: Breathing patterns Depth Kussmaul's rate & depth Assoc. with sever acidosis Apneustic Prolonged gasping I following by short

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

23 Inspection: Breathing patterns Rhythm Biot s rate & depth w/ abrupt pauses Assoc w/ ICP

24 Inspection: Trachea? Deviation Pleural effusion Tension pneumothorax Atelectasis Color LOC Emotional state

25 Palpation TML Tenderness (T) Masses (M) Lesions (L) Sinuses Palpate below eyebrow & Cheekbone Crepitus Subcutaneous emphysema Air leaks into the sub-c tissue

26 Percussion Rational To determine if underlying tissue is filled with air or solid material Procedure Pt sitting Tap starting at shoulder compare rt to lf

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

28 Auscultation Purpose Asses air flow through bronchial tree Procedure Diaphragm of stethoscope Superior inferior Compare rt to lf

29 Auscultation: Results Normal Vesicular Lung field Soft and low Bronchial Trachea & bronchi Hollow Bronchovesicular Mixed Between scapulae Side of sternum 1 st & 2 nd intercostal space

30 Auscultation: Results Adventitious Crackles Rales air bronchi with secretions Fine crackles Air suddenly reinflated Course Crackles Moist

31 Auscultation: Results Wheezes Sonorous wheezes Deep low pitched Snoring > E Caused by air narrowed passages D/t secretions Sibilant Wheezes High pitched Whistle-like I & E Caused by air narrowed passages D/t constriction Asthma

32 Auscultation: Results Pleural friction rub D/t inflammation of pleural space Grating, creaking I & E Best heard Anterior, Lower, lateral area

33 Auscultation: Results Stridor Crowing Partial obstruction of the larynx or trachea

34 Quiz? A child with difficulty breathing and a barking cough id displaying signs associated with which condition? A. Asthma B. Croup C. Cystic fibrosis D. Epiglottitis

35 Quiz? When assessing the lung sounds of a child with asthma, which sound are you most likely to hear? A. Murmurs B. Sonorous Wheezing C. Sibilant Wheezing D. Crackles E. Pleural friction rub

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

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

38 Dyspnea Definition SOB

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

40 Dyspnea Orthopnea Sit up to breath COPD CHF

41 Dyspnea Right ventricle If chronic airway resistance pressure Rt ventricle work Rt. Vent damage

42 Dyspnea Nrs Management Find cause Give O 2 HOB Communication KISS

43 Cough Definition To expel air from the lungs suddenly Irritation of mucous membrane

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

45 Cough Nrs management Assess Describe Directed Pain control Splinting Infection control Suppressants / Anti-tussives

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

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

48 Sputum Production Pink-tinged Lung CA TB Pink tinged, profuse, frothy Pulmonary edema Malodorous Lung abscess

49 Sputum Production Nrs Management Thick Hydrate water Nebulizer Humidifier TCDB No smoking Oral care Appetite

50 Do You Know????? What breath sound would you expect to head on a patient with increased sputum production? A. Vesicular B. Crackles C. Sonorous wheezes D. Sibilant wheezes

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

52 Chest pain Definition Cardiac or pulmonary

53 Chest pain Significance CA (late stage) Pneumonia Pulmonary embolism Pleurisy

54 Chest pain Pleurisy Inflammation of pleura Sharp with breath breath sounds

55 What????? What breath sound would you expect to hear on a patient suffering from pleurisy? A. Crackles B. Sonorous wheezes C. Sibilant wheezes D. Pleural Friction Rub

56 Chest pain Nrs Management Assess Analgesics OK, but Position for pain Affected side Splint

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

58 Clubbed fingers

59 Clubbed Finger Significance chronic hypoxia Nrs Management Marker

60 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?

61 Hemoptysis Definition Expectoration of blood from the respiratory tract

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

63 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

64 Hemoptysis Nrs Management Determine source Serious

65 Cyanosis Definition Bluish coloring of skin

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

67 Cyanosis O2 sat definition % of hemoglobin carrying oxygen compared to total # of hemoglobin

68 Cyanosis Normal Breath 100 O2 molecules 98 cross into blood Blood: 100 Hgb O2 SATS 98% No cyanosis

69 Cyanosis Hypoxia Breath 100 O2 molecules 75 cross into blood Blood: 100 Hgb O2 SATS 75% Cyanosis

70 Cyanosis Anemic and hypoxic Breath 100 O2 molecules 75 cross into blood Blood: 75 Hgb O2 SATS 100% No Cyanosis

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