Week 4 Respiratory PP .pdf

Respiratory Assessment Landmarking Intercostal Spaces – Anterior Chest – Count Intercostal Spaces – Posterior Chest – top down Count bottom up Number of intercostal space = the number Find the 12th rib and count upward of rib above it....

Respiratory Assessment Landmarking Intercostal Spaces – Anterior Chest – Count Intercostal Spaces – Posterior Chest – top down Count bottom up Number of intercostal space = the number Find the 12th rib and count upward of rib above it. Inferior tip of scapula is normally at 7th Locate sternal notch rib or intercostal space 5cm below is the Angle of Louis (sternal T1 is site of first rib angle) 2nd intercostal space Landmarking Posterior Chest Landmarking Elsevier, 2019 Anterior chest landmarking Source: Morton DA, Foreman DB, Albertine KH: The big picture: Gross Anatomy from www.accessmedicine.com, McGraw Hill Lung Position Anterior/Posterior Anterior View of the Lung Posterior View of the Lung Lung Position – Lateral Right Later View of Lung Left Lateral View of Lung  Muscles of Respiration Diaphragm Inspiration – diaphragm contracts and descends , chest expands, abdominal contents are compressed, abdominal walls push out Expiration – diaphragm relaxes and rises passively Scalene Muscles (first 2 ribs) and Intercostal Muscles Inspiration - Expand the chest walls Expiration – chest wall recoils Accessory Muscles Sternocleidomastoid muscles, scalene, increased abdominal muscle use, intercostal indrawing, tracheal tug Review of PQRST – Symptom Assessment P– provocation/Palliative – what brings the symptom on and what makes it better? Systems for Q - what is the quality of the symptom, what does it feel like? Respiratory R – Where do you feel the symptom, and does it radiate elsewhere? System S – what is the severity of the symptom? Use a scale. T – Is there a particular time or setting where this occurs? What have you used to treat the symptom? Respiratory Dyspnea or shortness of breath Cough Review of Hemoptysis Chest pain System History of infections Smoking history Environmental exposures Activity tolerance Known lung disease Daytime sleepiness and disordered sleep Inspection Watch breathing rate rhythm depth effort Inspect both anterior and posterior chest Skin colour and condition Accessory muscle use https://www.physio-pedia.com/Diaphragmatic_Breathing_Exercises Any chest wall deformities Symmetrical chest rise and fall Anteroposterior/transverse diameter Position selected for breathing Inspection S/S of Acute Hypoxia Cyanosis/Pallor – peripheral or central Continued Anemia – pale and tired S/S of Chronic Hypoxia Club fingers Anemia S/S of Heart Failure Peripheral Edema JVD Palpation Palpate the entire chest wall anteriorly and posteriorly, identify any: Lumps, bumps or masses Areas of tenderness or bruising Respiratory expansion Tactile fremitus Percussion Not used all the time Can help to identify areas of consolidation Should be resonant Abnormal findings - Flat -dull - hyper-resonant - tympanic Technique Press the middle finger of the non- dominant hand, onto the patient’s skin Using the middle and ring finger of the dominant hand tap firmly between the 2nd and 3rd knuckle of the nondominant hand. Auscultation Done with the Diaphragm of the stethoscope Compare sides Listen for at least one full inspiration and expiration at each site Avoid listening over bone Abnormal Crackle or Rales Intermittent Breath Sounds: Fine crackles soft and higher pitched Coarse crackles low pitched and louder Adventitia Wheezes Rhonchi Stridor Rubs Special Tests Transmitted Breath Sounds Interpretation Egophony Positive Egophony Pt says eee while you listen with If you hear aaah instead of eee - stethoscope accumulation of fluid, scar tissue Bronchophony Positive Bronchophony Pt to say 99 99 can be clearly heard – indication of fluid or masses that transmit sound better Whispered Pectoriloquy Positive Whispered Pectoriloquy Pt whispers one two three Sounds are heard more distinctly rather than muffled over tissue abnormalities Normal vs. Normal Breath Sounds Tracheal Abnormal Vesicular Findings Bronchial Abnormal Breath Sounds Crackles (rales) Wheezes (rhonchi Stridor