Assessment Week 4: Respiratory Assessment Fundamentals

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Questions and Answers

What is a potential sign of acute hypoxia that can be observed during inspection?

Anemia

Peripheral edema

Cyanosis (correct)

Clubbing of fingers

Which of the following is NOT a component included in the inspection of the respiratory system?

Skin color and condition

Accessory muscle use

Breathing rate

Access to oxygen (correct)

What does the presence of clubbed fingers typically indicate?

Chronic hypoxia (correct)

High fever

Heart failure

Acute infection

In the palpation process, what is NOT typically assessed?

Skin temperature Signup and view all the answers

Which percussion finding suggests abnormal lung consolidation?

Flat sound Signup and view all the answers

What aspect of breathing should be monitored during the inspection of the respiratory system?

Breathing effort Signup and view all the answers

Which of the following is a typical sign of chronic hypoxia?

Anemia Signup and view all the answers

When inspecting the chest, what should show healthy respiratory function regarding chest movement?

Minimal accessory muscle use Signup and view all the answers

During inspection, which finding might indicate congestive heart failure?

Peripheral edema Signup and view all the answers

Which is the correct technique for performing percussion on the chest?

Tapping firmly with the dominant hand Signup and view all the answers

Which intercostal space corresponds to the inferior tip of the scapula?

7th intercostal space Signup and view all the answers

During inspiration, what action does the diaphragm take?

It contracts and descends Signup and view all the answers

What is the purpose of the scalene muscles during respiration?

They help expand the chest walls during inspiration Signup and view all the answers

What is the correct method to identify the 2nd intercostal space?

Locate the sternal notch and count 5cm down Signup and view all the answers

Which of the following muscles is classified as an accessory muscle of respiration?

Sternocleidomastoid Signup and view all the answers

How does the chest wall behave during expiration?

It recoils to expel air from the lungs Signup and view all the answers

Which aspect of the PQRST symptom assessment relates to what makes a symptom feel better?

P - provocation/Palliative Signup and view all the answers

What is typically found at the 1st intercostal space?

T1 rib Signup and view all the answers

When counting intercostal spaces on the anterior chest, which landmark would you locate first?

Sternal notch Signup and view all the answers

Which muscles primarily carry out the contraction and expansion of the rib cage?

Diaphragm and intercostal muscles Signup and view all the answers

What is the primary purpose of auscultation in a clinical assessment?

To evaluate breath sounds Signup and view all the answers

Which type of breath sound is characterized by a soft, higher pitch?

Fine crackles Signup and view all the answers

What does positive egophony indicate when a patient says 'eee'?

Accumulation of fluid or scar tissue Signup and view all the answers

Which of the following breath sounds are intermittent and indicate possible lung disease?

Crackles Signup and view all the answers

What is the correct technique during auscultation regarding the comparison of sides?

Compare each sound with the corresponding side Signup and view all the answers

What is the interpretation of a positive bronchophony test?

99 heard clearly indicating fluid or mass Signup and view all the answers

Which abnormal breath sound is typically low pitched and can be louder than crackles?

Rhonchi Signup and view all the answers

What is the definition of whispered pectoriloquy?

Patient whispers and sounds are clearer Signup and view all the answers

Which breath sound is continuous and often indicates narrowed airways?

Wheezes Signup and view all the answers

Listening over bones during auscultation can lead to which of the following?

Inaccurate assessment of breath sounds Signup and view all the answers

Study Notes

Respiratory Assessment Landmarking

Intercostal spaces identified by counting ribs; anterior chest counts top down, posterior counts bottom up.
The 12th rib serves as a reference point; the inferior tip of the scapula normally aligns with the 7th rib or intercostal space.
Sternal notch located at the top of the sternum; the Angle of Louis is 5cm below it, at the 2nd intercostal space.
T1 indicates the site of the first rib.

Lung Position

Anterior lung position covers the upper front portion of the chest, while the posterior view encompasses the back upper regions.
The right lung may be differentiated from the left based on anatomical features in lateral views.

Muscles of Respiration

Diaphragm: Essential for inspiration by contracting and descending, allowing chest expansion, and compressing abdominal contents. During expiration, it relaxes and rises passively.
Scalene and Intercostal Muscles: Assist in chest wall expansion during inspiration and recoil during expiration.
Accessory Muscles: Include sternocleidomastoid, scalene, and increased abdominal muscle use, involved in forced inspiration or expiration.

Symptom Assessment (PQRST)

P: Provocation/Palliative - factors that trigger or alleviate symptoms.
Q: Quality - description of the symptom feel.
R: Region/Radiation - location and potential spread of symptoms.
S: Severity - subjective severity rating on a scale.
T: Timing - specific time or context when symptoms arise.

Common Respiratory Symptoms

Dyspnea (shortness of breath) and cough are primary concerns.
Hemoptysis (coughing up blood) and chest pain warrant further examination.
History of infections, smoking, environmental exposures, and known lung diseases inform risk assessment.
Daytime sleepiness and sleep disorders may relate to respiratory health.

Inspection

Observe breathing for rate, rhythm, depth, and effort.
Examine the anterior and posterior chest for skin color, condition, accessory muscle use, and chest deformities.
Assess chest symmetry and diameter; note the patient's breathing position.

Signs of Hypoxia

Acute Hypoxia: May present as cyanosis or pallor; patients may exhibit signs of anemia.
Chronic Hypoxia: Characterized by clubbing of fingers and persistent fatigue.
Heart Failure Indicators: Peripheral edema and jugular venous distension (JVD).

Palpation

Palpate the chest to identify lumps, tenderness, bruising, respiratory expansion, and tactile fremitus.

Percussion

Not routinely used but useful for identifying areas of consolidation in the lungs.
Normal percussion is resonant; abnormal findings include flat, dull, hyper-resonant, or tympanic sounds.
Technique involves applying pressure with the non-dominant middle finger and tapping with the dominant hand.

Auscultation

Use the diaphragm of the stethoscope, comparing sounds on both sides.
Listen for at least one full breath cycle at each site, avoiding bony areas.

Abnormal Breath Sounds

Crackles (Rales): Intermittent fine or coarse sounds, indicating fluid in the airways.
Wheezes: High-pitched sounds indicate narrowed airways.
Rhonchi: Low-pitched, snoring sounds suggest mucus in larger airways.
Stridor: A harsh sound indicating upper airway obstruction.
Rubs: Pleuritic sounds from friction between inflamed pleural layers.

Special Tests

Egophony: Positive if 'eee' sounds like 'aaa', indicating fluid accumulation or scar tissue.
Bronchophony: Positive if '99' can be heard clearly, suggesting denser lung tissue due to fluid or masses.
Whispered Pectoriloquy: Positive if whispered sounds are heard distinctly, indicating tissue abnormalities affecting sound transmission.

Normal vs. Abnormal Breath Sounds

Normal breath sounds include tracheal, bronchial, and vesicular.
Abnormal findings consist of crackles, wheezes, and stridor, which indicate underlying respiratory conditions.

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Description

This quiz focuses on the essential techniques for assessing respiratory landmarks, particularly the intercostal spaces in both the anterior and posterior chest. You'll learn how to count intercostal spaces accurately and identify anatomical references such as the sternal notch and the angle of Louis. Test your understanding and enhance your clinical skills in respiratory assessments.