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Questions and Answers
A patient presents with labored breathing, using sternocleidomastoid muscles and exhibiting intercostal retractions. Which combination of preliminary assessment findings most closely aligns with these observations?
A patient presents with labored breathing, using sternocleidomastoid muscles and exhibiting intercostal retractions. Which combination of preliminary assessment findings most closely aligns with these observations?
- Relaxed posture, respiratory rate of 16 breaths/min, and absence of cyanosis.
- Support of own weight with arms, absence of accessory muscle use, and barrel chest.
- Strained breathing, accessory muscle use, and bulging of intercostal spaces. (correct)
- Absence of distress, normal level of consciousness, and bilateral chest wall expansion.
During a respiratory assessment, you notice the patient is leaning forward, supporting themselves with their arms on their knees. What could this posture indicate, and which additional assessment would be most relevant?
During a respiratory assessment, you notice the patient is leaning forward, supporting themselves with their arms on their knees. What could this posture indicate, and which additional assessment would be most relevant?
- Tripod position indicating respiratory distress; assess accessory muscle use and SpO2. (correct)
- Normal relaxed posture; check respiratory rate.
- Funnel chest; assess level of consciousness.
- Pigeon chest; check for pallor.
You are assessing a patient with a known history of COPD. Which of the following chest configurations and skin color changes would you MOST likely observe?
You are assessing a patient with a known history of COPD. Which of the following chest configurations and skin color changes would you MOST likely observe?
- Normal chest configuration and no skin color changes.
- Funnel chest and diaphoresis.
- Pigeon chest and pallor.
- Barrel chest and possible cyanosis. (correct)
What is the significance of observing intercostal retractions during a respiratory assessment, and what underlying physiological issue does it suggest?
What is the significance of observing intercostal retractions during a respiratory assessment, and what underlying physiological issue does it suggest?
You are called to assess a patient who appears drowsy and gives confused answers. Which of the following questions would BEST evaluate their respiratory status in relation to their level of consciousness?
You are called to assess a patient who appears drowsy and gives confused answers. Which of the following questions would BEST evaluate their respiratory status in relation to their level of consciousness?
During a scoliosis assessment, which of the following observations would raise concern for spinal asymmetry?
During a scoliosis assessment, which of the following observations would raise concern for spinal asymmetry?
A patient presents with a respiratory rate of 30 breaths per minute. Which of the following terms BEST describes this condition?
A patient presents with a respiratory rate of 30 breaths per minute. Which of the following terms BEST describes this condition?
Which of the following respiratory patterns is characterized by periods of deep breathing followed by gradual decrease in depth, and then a period of apnea?
Which of the following respiratory patterns is characterized by periods of deep breathing followed by gradual decrease in depth, and then a period of apnea?
When percussing the anterior chest, a dull sound is expected in which of the following areas?
When percussing the anterior chest, a dull sound is expected in which of the following areas?
During palpation of the anterior chest, what finding would MOST likely indicate subcutaneous air, potentially from a pneumothorax or trauma?
During palpation of the anterior chest, what finding would MOST likely indicate subcutaneous air, potentially from a pneumothorax or trauma?
Where are bronchovesicular breath sounds normally auscultated on the anterior chest?
Where are bronchovesicular breath sounds normally auscultated on the anterior chest?
During assessment of symmetric respiratory excursion on the posterior chest, what is the MOST appropriate placement of the examiner's hands?
During assessment of symmetric respiratory excursion on the posterior chest, what is the MOST appropriate placement of the examiner's hands?
When assessing vocal fremitus, increased vibrations would MOST likely be evident in a patient with which condition?
When assessing vocal fremitus, increased vibrations would MOST likely be evident in a patient with which condition?
Which percussion sound would you expect to predominate in a patient with significant air trapping due to emphysema?
Which percussion sound would you expect to predominate in a patient with significant air trapping due to emphysema?
Which description BEST characterizes the sound of wheezes?
Which description BEST characterizes the sound of wheezes?
Flashcards
Distress
Distress
Signs include sweating, strained and noisy breathing.
Position and effort
Position and effort
Relaxed posture, self-supporting weight with arms in lap or side.
Accessory muscles
Accessory muscles
Muscles aiding breathing include sternocleidomastoid, trapezius, and abdominal muscles.
Level of consciousness
Level of consciousness
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Thoracic cage inspection
Thoracic cage inspection
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Scoliosis Technique
Scoliosis Technique
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Kyphosis
Kyphosis
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Lordosis
Lordosis
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Respiratory Patterns
Respiratory Patterns
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Tachypnea
Tachypnea
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Bradypnea
Bradypnea
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Cheyne-Stokes Respiration
Cheyne-Stokes Respiration
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Palpate for Fremitus
Palpate for Fremitus
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Adventitious Breath Sounds
Adventitious Breath Sounds
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Auscultation Technique
Auscultation Technique
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Study Notes
Preliminary Assessment
- Distress: Sweating, strained, noisy breathing
- Position and Effort: Relaxed posture, supporting own weight with arms in lap or on side
- Retractions/Bulging: Intercostal spaces may retract or bulge
- Accessory Muscles: Sternocleidomastoid, trapezius, and abdominal muscles may be used
- Level of Consciousness: Assessed by questioning and facial expression inspection; Include a question about breathing problems.
- Hypoxia Assessment: Skin color, diaphoresis, pallor, and cyanosis are checked
- Respiratory Rate: Checked
- Pulse Oximetry: Performed
Chest Inspection
- Thoracic Cage: Slope of ribs (45˚ angle), bilateral chest wall expansion, and presence of barrel chest, funnel chest (pectus excavatum), pigeon chest (pectus carinatum), kyphosis, scoliosis, and lordosis are observed
- Scoliosis Technique: Patient stands in front, leans forward; assess scapulae, ribs, and hips for symmetry to check for curvature
- Costal angle width: Measured
- Rib cage geometry (AP diameter): Measured to estimate lateral diameter ratio; 1:2 ratio is ideal
Anterior Chest Inspection
- Respiratory Patterns: Abnormal patterns include tachypnea (rate > 20/min), bradypnea (rate < 12/min), apnea, hyperpnea, hyperventilation, hypoventilation, Cheyne-Stokes, ataxic (Biot's) or Kussmaul’s breaths are noted
- Costal angle: Measured.
Palpation
- Palpation Technique: Tenderness, masses, sinus tracts, and crepitus (grating) are assessed using palm and rotary motions
- Areas to Palpate: 1-1,2-2,3-3,4-4 (lateral and below boob), 3-3, 4-4 (between middle of boobs); 5-5 (lateral and under boobs) are palpated for tenderness, masses, and crepitus.
- Symmetrical Respiratory Excursion: Checking for symmetry in the respiratory movements on the posterior and lateral chest
- Rotary Motion: Using finger pads, the chest is palpated in a rotary motion
Percussion
- Areas to Percuss: 1-1 (slightly above clavicle), 2-2 (above boob), 3-3 (middle boob), 4-4 (between middle of boobs), 5-5 (lateral and under boobs); areas over the heart (precordium), are percussed for quality and character
- Sound Assessment: Resonance (air-filled), dull (fluid filled), and hyper-resonant (hyper-inflated) sounds are evaluated
Auscultation
- Areas to Auscultate: 1-1,2-2,3-3,4-4,5-5,6-6,7-7,8-8,9-9 are auscultated
- Normal Breath Sounds: Vesicular (soft, low pitched over lungs), and bronchovesicular (moderately pitched between posterior scapula)
- Decreased or Absent Sounds: Obstruction of the bronchial tree may cause this
- Adventitious Breath Sounds: Crackles/rales (air traveling through vessels with abnormal moisture), wheezes (high pitched sound from air constricted airways), rhonchi (coarse rattling from constricted airways), and friction rubs (crackling or grating when inflamed pleural surfaces rub together) are identified
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Description
This assessment focuses on identifying signs of respiratory distress through observation and basic measurement techniques, including chest wall expansion, muscle use, skin color, and respiratory rate. Key elements involve observing posture, breathing effort, and thoracic cage structure to identify abnormalities.
