Podcast
Questions and Answers
Which part of the respiratory system includes the trachea and bronchi?
Which part of the respiratory system includes the trachea and bronchi?
What is the purpose of using the diaphragm of a stethoscope during auscultation?
What is the purpose of using the diaphragm of a stethoscope during auscultation?
What distinguishes an acute cough from a chronic cough?
What distinguishes an acute cough from a chronic cough?
Which of the following is a reason dyspnea might occur?
Which of the following is a reason dyspnea might occur?
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What is the significance of the ladder method in auscultation?
What is the significance of the ladder method in auscultation?
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What characteristic symptom might indicate the severity of a cough?
What characteristic symptom might indicate the severity of a cough?
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What factors may exacerbate dyspnea according to typical assessments?
What factors may exacerbate dyspnea according to typical assessments?
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What is the recommended approach when asking about associated manifestations of a cough?
What is the recommended approach when asking about associated manifestations of a cough?
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What is the normal respiratory rate for a healthy adult?
What is the normal respiratory rate for a healthy adult?
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Which condition is characterized by a depression in the lower part of the sternum?
Which condition is characterized by a depression in the lower part of the sternum?
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What does cyanosis indicate in a patient's assessment?
What does cyanosis indicate in a patient's assessment?
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Which respirational position is commonly seen in individuals with severe asthma or COPD?
Which respirational position is commonly seen in individuals with severe asthma or COPD?
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What is a key indicator of respiratory distress when observing breathing effort?
What is a key indicator of respiratory distress when observing breathing effort?
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Which adventitious sound is characteristic of bronchial airways narrowing and is often associated with asthma?
Which adventitious sound is characteristic of bronchial airways narrowing and is often associated with asthma?
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What does the term 'crepitus' refer to during a respiratory assessment?
What does the term 'crepitus' refer to during a respiratory assessment?
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What is the expected ratio of anteroposterior to lateral diameter of a healthy adult's thorax?
What is the expected ratio of anteroposterior to lateral diameter of a healthy adult's thorax?
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Which assessment tool measures the maximum volume of air expelled from the lungs during a vigorous exhalation?
Which assessment tool measures the maximum volume of air expelled from the lungs during a vigorous exhalation?
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Which lung sound is noted for its high-pitched, whistling quality and usually occurs on inspiration?
Which lung sound is noted for its high-pitched, whistling quality and usually occurs on inspiration?
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Study Notes
Upper and Lower Airways
- Upper airway: nose, pharynx, larynx, epiglottis
- Lower airway: trachea, bronchi, bronchioles
Auscultation Techniques
- Use diaphragm of stethoscope
- Patient breathes deeply through open mouth
- Listen to one full breath at each location
Ladder Method for Auscultation
- Anterior: 6 locations bilaterally (12 total)
- Posterior: 7 locations bilaterally (14 total)
- Assess diaphragmatic expansion for lung expansion.
Dyspnea (Air Hunger) Questions
- Onset: Exercise/rest, time of day, seasonal factors
- Location: Throat, neck, chest
- Duration: Gradual/sudden onset
- Characteristics: Ability to speak in full sentences
- Associated manifestations: Wheezing, cough, chest pain, nausea
- Relieving factors: Rest, positioning
- Exacerbating factors: Lying down
- Treatment: Depends on the cause (pulmonary, cardiac, inhaler, etc.)
Wheezes
- Partial obstruction of lower airways
- Causes: bronchoconstriction, edema, secretions, foreign body
Cough
- Acute cough: less than 3 weeks
- Chronic cough: over 8 weeks
Cough OLDCART
- Onset: When, recent illness (COVID, etc.), new medications
- Location: Throat or chest
- Duration: Constant, intermittent, time of day changes
- Characteristic symptoms: Wheezing, difficulty breathing, pain, productive/non-productive cough (color, consistency, amount)
- Associated manifestations: Shortness of breath, chest pain, wheezing
- Relieving/Exacerbating factors: What helps/hurts it, medications
- Treatment: Any actions taken
Past Medical History
- Prior lung problems/infections
- Chest surgery/biopsies/trauma
- Allergies
- TB skin tests
- Flu/COVID vaccines
- Pneumonia vaccine (over 65)
- Recent international travel (last 6 months)
Lifestyle and Habits
- Smoking history (duration, quitting date)
- Vaping
- Tobacco use
- Secondhand smoke exposure
- Environmental exposures (e.g., asbestos)
- Medications/drugs
- Oxygen use/other breathing treatments
Physical Assessment - Initial Inspection
- Observe respiratory rate, rhythm, depth, and effort
- Normal adult: 12-20 breaths/minute, regular rhythm
- Facial expression: relaxed, calm (hypoxia can cause anxiety/restlessness)
- Level of consciousness (LOC)
- Skin color, mucous membranes, nails (cyanosis indicates hypoxia, nail clubbing)
- Neck: accessory muscle use (SCM, scalenes, supraclavicular retraction)
Chest Deformities
- Normal: Wider than deep
- Funnel chest (Pectus excavatum): Depression in lower sternum
- Pigeon chest (Pectus carinatum): Increased AP diameter, sternum displaced anteriorly
- Barrel chest: Increased AP diameter (infancy, COPD)
Inspection (continued)
- Trachea position: Midline?
- Chest shape: AP diameter < lateral diameter (ideal 1:2 ratio)
- AP diameter increase with age/COPD
- Tripod position: severe asthma/COPD (sitting forward, lips pursed)
Respiratory Rate and Rhythm
- Normal: 12-20 breaths/minute (patient-dependent)
Palpation
- Areas of tenderness/abnormalities (skin, muscles, ribs)
- Muscle mass, bony defects, nodules, masses (evaluate tenderness)
- Lung expansion assessment (smooth, symmetrical expansion)
- Crepitus (subcutaneous emphysema): crackling sensation
Auscultation
- Listen for adventitious sounds, compare sides
- Listen to one full respiration at each spot
- Listen anteriorly and laterally
Lung Sounds
- Vesicular, bronchovesicular, bronchial, tracheal
Adventitious Lung Sounds
- Crackles (fine/coarse: change with position/coughing)
- Wheezes (narrowed airways): high-pitched, whistling, asthma, pulmonary diseases, silent chest requires immediate attention
- Rhonchi (variant of wheezes): may clear with coughing
- Stridor (upper airway narrowing): loud, high-pitched, whistling, crowing, barking, mainly inspiratory, urgent intervention,
- Pleural friction rub (inflammation/roughening of pleura): leathery sound
- Rales (fine crackles): pulmonary edema, pneumonia, atelectasis
Special Techniques
- Pulse oximetry (continuous/spot checks)
- Peak flow assessment (max air expelled, decreased in diseases)
- Regular monitoring: evaluate asthma treatment effectiveness
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Description
This quiz covers the anatomy of the upper and lower airways, techniques for auscultation, and assessments for dyspnea. Participants will explore the ladder method for auscultation and understand various factors associated with breathing difficulties. It's essential for students in healthcare or respiratory therapy fields.
