The lower respiratory system includes what?
The trachea, bronchi and lungs
The primary function of the respiratory system is what?
To maintain normality of arterial blood gases (arterial pressure of oxygen and carbon dioxide)
To maintain normality of arterial blood gases what must be accomplished?
Alveolar ventilation, pulmonary perfusion, ventilation-perfusion matching and gas transfer across the alveolar-capillary membrane
Alveolar ventilation is achieved by what processes?
The cyclic process of air movement in and out of the lung (fancy talk for breathing)
During inspiration, the inspiratory muscles contracts and generates negative _________in the pleural space.
Pressure
What is Forced Expiratory Volume?
The volume exhaled in the first second of expiration
What is Forced vital capacity?
Maximal amount of air that can be exhaled after a maximal inhalation
What Physiologic abnormalities that can be measured by pulmonary function testing?
Decrease in gas transfer across alveolar-capillary membrane, restriction of lung size and obstruction to airflow
Describe Obstructive lung disease?
Reduced capacity to get air through the conducting airways and out of the lungs
Obstructive lung disease is often caused by what issues?
decrease in diameter of the airways (bronchospasm), a loss of their integrity (bronchomalacia), or a reduction in elastic recoil (emphysema)
Bronchspasm, Bronchomalacia and emphysemia all what type of lung disease?
Obstructive lung disease
Restrictive lung disease is defined as what?
Inability to get air into the lungs and maintain normal lung volumes
What type of lung disease reduces all the subdivisions of lung volumes without reducing airflow?
Restrictive lung disease
Patients with normal airway resistance have what value for FEV1/FVC?
> 75%.
What is the best indicator of overall lung function?
Arterial blood gas
The difference between the partial pressure of oxygen in the alveoli and arterial blood can be determined from what?
Arterial blood gas values
A normal A-a gradient can be approximated for sea-level, breathing room air by multiplying the age of the patient by what?
0.3
The presence of hypoxemia with a normal A-a gradient usually implies what?
Alveolar hypoventilation
What often causes aveolar hypoventilation?
sedative overdose
the A-a gradient will be significantly elevated under what conditions?
Hypoxemia secondary to a mismatching of ventilation and perfusion
Oxygen saturation is the ratio between what?
Actual amount of oxygen bound to hemoglobin and the potential amount of oxygen that could be bound
Where is a pulse oximeter placed on the patient?
Finger or earlobe
What does a pulse oximeter measure?
Estimates oxygen/hemoglobin saturation
What is a normal range for physiological pH?
7.35-7.45
What is a normal range for physiological PaCO2?
35-45 mmHg
What is a normal range for physiological PaO2?
90-100 mmHg
What is a normal range for physiological HCO3?
20-30 mmol/L
What is a normal range for Oxygen saturation?
> 89%
What is the Peak expiratory flow rate used to monitor?
Asthma and chronic bronchodilator therapy
What is the Green area of a peak flow meter?
>80% of expected or personal best
What does the yellow zone of a peak flow meter mean?
Moderate exacerbation 50-80% of best
What does the Red zone of a flow meter indicate?
Severe exacerbation, < 50% of predicted/personal best
What is the Peak expiratory flow rate measured in?
L/min during forced expiration
What does Peak flow monitor measure?
L/min during forced expiration, existence of airflow obstruction
What is the predicted value for Peak Expiratory Flow rate determined by in adults?
Height, Age and sex
What is the predicted value for Peak Expiratory Flow rate determined by in adolecscents?
Height
What value is used to monitor a patient's peak expiratory flow rate in chronic asthma?
Personal best value
When is a predicted value used for PEF?
New patients
What are the clinical signs of asthma?
Recurrent and episodic wheezes, Use of accessory muscles to breath, Tachypnea, Tachycardia, Decreased PFT's (FEV1, FEV1/FVC, PEF)
What are the symptoms of asthma?
Chest tightness/pressure anxiety, cough, dyspnea
What disease can be described as: recurrent inflammation episodes of widespread variable airflow obstruction, due to increased responsiveness to various stimuli?
Asthma
What is the primary mechanism causing the hyperreactivity in asthma?
Persistent bronchial inflammation, which causes mucus hypertrophy
Airflow obstruction occurs during expiration or inhalation?
Expiration
Asthmatic wheezing is on the inhale or exhale?
Exhale
How is asthma severity determined?
Frequency of symptoms and lung function
What are common causes of Asthma?
Environmental chemicals or allergens, exercise, respiratory infections, strong odors, food, Cigarette smoke
Choosing a treatment for allergies is based on what?
Severity
Describe how to use a metered dose inhaler:
Sit up straight or stand and lift chin to open airway, Remove cap from mouthpiece and inspect for obstruction, Shake inhaler vigorously, Prime (if needed), Place inhaler 1-2 inches away from mouth, Breath in slowly, actuate inhaler, Hold breath for 10 sec
Chronic bronchitis is characterized by what?
inflammation and edema of the bronchiole with excessive mucus production and airway obstruction
Patients with chronic bronchitis have what symptom?
A persistent productive cough on most days >3 months/year for >2 consecutive years, cyanotic skin color
What are blue boaters?
People with chronic bronchitis
Emphysema is characterized by what?
Abnormal, permanent enlargement of airspaces distal to the bronchioles
Emphysema'sThis permanent enlargement of the airspaces is due to the destruction of what?
The alveolar walls
What happens in the lungs of Emphysema patients during expiration?
Elastic recoil decreases and bronchiolar collapse
(True/False) Patients frequently need to use accessory muscles to assist their breathing which usually has a long expiratory phase.
True
(True/False) Patients are usually cyanotic with emphysema.
False
What are "pink puffers"?
People with emphysema
Would a person with emphysema or Chronic Bronchitis have decreased breathing sounds?
Both
A barrel chest is indicative of what disease?
Emphysema
Obsesity is a characteristics of people with emphysema or chronic bronchitis?
Chronic bronchitis
Weight loss is a characteristics of people with emphysema or chronic bronchitis?
Emphysema
Tripod positioning is a characteristic of people with emphysema or chronic bronchitis?
Emphysema
What are the signs of COPD?
Decreased breath sounds, hypoxemia, C02 retention, Cyanosis, Decreased PFTs Crackles/rhonci
What are the symptoms of COPD?
Dyspnea, history of smoking, cough, sputum production, frequent respiratory infections
Is COPD reversible?
Not fully
What type of flow limitation is characteristic of COPD?
Expiratory primarily
Is COPD progressive?
Yes
What abnormal inflammatory response is normal for COPD?
Abnormal Inflammation due to noxious particles and gases
In COPD, what part of the lungs does chronic inflammation occur?
Parenchyma and pulmonary vasculature
Why does COPD progress?
Inflammatory cells produce chemical mediators that damage the lungs further and sustain neutrophilic inflammation
What happens in the trachea and bronchi of people with COPD?
Chronic inflammation leads to enlarged mucus secreting glands and increased number of goblet cells
In the small bronchi and bronchioles, chronic inflammation leads to what in patient with COPD?
repeated cycles of injury and repair, increasing its collagen / scar tissue, which narrows the lumen and causes fixed restriction
What is the FEV1/FVC for mild COPD?
<0.7
What is the FEV1/FVC for moderate COPD?
<0.7
What is the FEV1/FVC for severe COPD?
<0.7
What is the FEV1/FVC for very severe COPD?
<0.7
What is the FEV1 for mild COPD?
>80%
What is the FEV1 for moderate COPD?
>50-80%
What is the FEV1 for severe COPD?
>30-50%
What is the FEV1 for very severe COPD?
< 30%
Constitutional symptoms of COPD, a decrease in pulmonary function, and tachypnea are variably present during an exacerbation but the__________is usually unchanged.
Chest radiograph
What are the cardinal signs of an acute COPD exacerbation?
Progessive dyspnea, increased cough frequency and severity and increased sputum production
What are the three type of pneumonia?
Hospital acquired, Community acquired and Aspiration
What is Pneumonia?
Inflammation of the lungs
What are the risk factors for developing pneumonia?
Age, smoking, chronic bronchitis, chronic illness, recent upper respiratory infection, alcoholism,
What is the most common infectious cause of death in the United States?
Pneumonia
What are the symptoms of pneumonia?
Chills, progressive cough, rust coloered purulent sputum, pleuritic chest pain
Is chest percussion dulled during pneumonia?
Yes
Is pneumonia consolidated in a radiograph or disperse?
Consolidated
What are the risk factors for pneumonia?
Family member with multidrug resistant pathogen, hospitalization >2 days, nursing home residence, chronic dialysis, home infusion, home wound care
Do viruses usually cause pneumonia in a ICU inpatient?
No
What are the main causes of Inpatient ICU pneumonia?
Streptococcus pneumonia, Staphylococcus aureus, Legionella species, Haemophilus influenzae
What are the main causes of Inpatient non-ICU pneumonia?
Streptococcus pneumonia, Mycoplasma pneumonia, Chlamydophila pneumonia, Haemophilus influenza, Legionella species, Respiratory viruses
What is CURB-65?
Clinical prediction rule that predicts mortality in community-acquired pneumonia
What is CURB-65 used for?
Assessment of severity of pneumoni and action needed to be taken
Patients with scores of 0-1 for CURB-65 have what risk of death and need for hospitalization?
Low, no hospitalization
Patients with scores of 2 for CURB-65 have what risk of death and need for hospitalization?
Moderate, may need some hospitalization or close watch out-patient care
Patients with scores of 3-5 for CURB-65 have what risk of death and need for hospitalization?
High, ICU
Mucoid sputum indicates what type of lung infection?
Viral
Rust colored sputum indicates what type of lung infection?
Pneumococcal or tuberculosis
Pink frothy colored sputum indicates what type of lung infection?
Pulmonary edema
Profuse colorless colored sputum indicates what type of lung issue?
Carcinoma
Bloody colored sputum indicates what type of lung infection?
Pulmonary embolism, TB or tumor
Pink, blood tinged sputum indicates what type of lung issue?
Pneumococcal or staphylococcal pneumonia
Continuous cough indicates what?
Respiratory infection
Early morning cough indicates what?
chronic bronchitis, smoking
Productive cough indicates what?
chronic bronchitis, pneumonia
Dry hacking cough indicates what?
Viral infection, asthma, mycoplasma pneumonia, ACE inhibitors
Barking cough indicates what?
Croup
When dealing with a patient who has breathing difficulties, what should you assess?
Acute distress, nasal flaring, pursed lips, wheezing, cyanosis and accessory muscle use while breathing
What muscles are used for inhalation?
Scalenus, sternocleidomastoid, external intercostals
What muscles are used for exhalation?
Internal intercostals, obliques and rectus abdmoinus
What should be noted about the chest in a physical exam?
Anteroposterior diameter is less than the transverse diameter, rate, rhythm and depth of breathing, percussion of posterior chest, auscultate breath sounds
What is the definition of a barrel chest?
Chest's Anteroposterior diameter is greater than the transverse diameter
What is a barrel chest a sign of?
Air trapping, age and chronic emphysema
What constitutes tachypnea?
>20 breaths per minute
What constitutes Bradypnea?
>12 breaths per minute
What is Hyperpnea?
Hyperventilation
Why evaluate Percussion of the posterior chest?
Helps to evaluate the density of the underlying lung tissue to a depth of 5-7 cm
How do you evaluate percussion of lung tissue?
Listen for differences in volume and pitch comparing side-to-side
What are Adventitious sounds?
abnormal sounds heard apart from the normal sounds of inspiration and expiration
What are Crackles or rales caused by?
Popping open of small airways and alveoli collapsed by fluid, exudate or lack of aeration during expiration
Crackles occur much more common during the ________than___________ phase of breathing.
Inspiratory than expiratory
Crackles are associate with what?
Inflammation or infection of the small bronchi, bronchioles and alveoli.
Crackles that don't clear after a cough may indicate what?
pulmonary edema, heart failure or acute respiratory distress syndrome (ARDS)
What is Rhonci?
Course rattling sound (like snoring) or gurgling noises during breathing
What is Rhonci usually caused by?
secretion in bronchial airways
Are Rhonci heard more on inhalation or exhalation?
Both
What are Rhonci noises caused by?
Air flow through thick mucous secretions in the larger air passages such as the bronchioles but may also be associated with smaller structures (alveoli)
Are Rhonci or Crackles indicative of a problem in the upper airways?
Rhonci
Are Rhonci or Crackles indicative of a problem in the lower airways?
Crackles
What is a wheeze?
is a continuous, coarse, high pitched whistling sound during breathing
What is the cause of wheezing?
Respiratory tree must be narrowed or obstructed, or airflow velocity must be heightened
The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to what?
The degree of airway obstruction
Bronchiolar disease usually causes wheezing that occurs in what phase of breathing?
Expiratory
The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is what?
Less than 50% of normal.
What type of lung issue produces a wheeze that is most likely to be heard throughout the chest via a stethoscope?
Diffuse processes
Does the pitch of a wheeze does reliably predict the degree of narrowing in the affected airway?
No
A friction rubbing sound in the lungs indicates what?
Loss of lubrication in the pleura
Define Bronchophony.
Abnormal transmission of sounds from the lungs
Define Egophony.
Increased resonance of voice sounds
Define Whispered Pectoriloquy
Increased loudness of whispering noted during auscultation.
Consolidation of pleural effusions can cause a wisper to sound like what?
More distinctive and clear
EE-EE-EE will sound like what is you have consolidation?
Ay
What percussion sound should you watch for?
Resonance, Hyperresonance and Dullness
What does Hyperresonance indicate?
Emphysema and pneumothorax
What does Dullness of the lungs indicate?
Pneumonia, pleural effusion and atelectasis
What is Resonance?
A long, low-pitched sound that can be heard over all the lung fields
What is Hyperresonance?
abnormally long, low-pitched sound heard with emphysema or pneumothroax
When does Dullness occur in the lungs?
Occurs with abnormal, dense tissue in the lungs, usually present with pneumonia, pleural effusion, and atelectasis
What isTachypnea?
Rapid breathing (> 20 breaths per minute)
What is Bradypnea?
Slow breathing (< 12 breaths per minute)
What is Hyperpnea (Kussmaul respirations)?
fast, deep breathing
What is Cheyne-Stokes respirations?
Irregular increase rhythm and decrease in depth (deep and fast, then slow and shallow) interrupted by regular episodes of apnea
What are the two types of mechanical ventilation?
Invasive positive pressure ventilation (IPPV) and Non-invasive positive pressure ventilation (NIPPV)
Mechnical ventilators are medical devices that are used to assist or replace _______respiration.
Spontaneous
Mechanical ventilation is primarily required for what type of patients?
Those unable to maintain adequate alveolar ventilation
Hypoxic respiratory failure is characterized by an inability to maintain adequate ______.
oxygenation
How is Hypoxic respiratory failure measured?
By the partial pressure of oxygen in the arterial blood (PaO2) or saturation of oxygen in arterial blood (SaO2)
Hypercapnic respiratory failure is defined by the inability to maintain adequate _______leading an increase in the partial pressure of carbon dioxide (PaCO2).
ventilation,
What type of lung disease is indicated by Hypoxic respiratory failure?
Pneumonia ARDS
What type of lung disease is indicated by Hypercapnic respiratory failure?
COPD, surgical procedures
What are the four indications for IPPV or NIPPV?
Hypoxic or Hypercapnic respiratory failure, protection against aspiration, relief of upper airway obstruction
The lower respiratory system includes what?
The trachea, bronchi and lungs
The primary function of the respiratory system is what?
To maintain normality of arterial blood gases (arterial pressure of oxygen and carbon dioxide)
To maintain normality of arterial blood gases what must be accomplished?
Alveolar ventilation, pulmonary perfusion, ventilation-perfusion matching and gas transfer across the alveolar-capillary membrane
Alveolar ventilation is achieved by what processes?
The cyclic process of air movement in and out of the lung (fancy talk for breathing)
During inspiration, the inspiratory muscles contracts and generates negative _________in the pleural space.
Pressure
What is Forced Expiratory Volume?
The volume exhaled in the first second of expiration
What is Forced vital capacity?
Maximal amount of air that can be exhaled after a maximal inhalation
What Physiologic abnormalities that can be measured by pulmonary function testing?
Decrease in gas transfer across alveolar-capillary membrane, restriction of lung size and obstruction to airflow
Describe Obstructive lung disease?
Reduced capacity to get air through the conducting airways and out of the lungs
Obstructive lung disease is often caused by what issues?
decrease in diameter of the airways (bronchospasm), a loss of their integrity (bronchomalacia), or a reduction in elastic recoil (emphysema)
Bronchspasm, Bronchomalacia and emphysemia all what type of lung disease?
Obstructive lung disease
Restrictive lung disease is defined as what?
Inability to get air into the lungs and maintain normal lung volumes
What type of lung disease reduces all the subdivisions of lung volumes without reducing airflow?
Restrictive lung disease
Patients with normal airway resistance have what value for FEV1/FVC?
> 75%.
What is the best indicator of overall lung function?
Arterial blood gas
The difference between the partial pressure of oxygen in the alveoli and arterial blood can be determined from what?
Arterial blood gas values
A normal A-a gradient can be approximated for sea-level, breathing room air by multiplying the age of the patient by what?
0.3
The presence of hypoxemia with a normal A-a gradient usually implies what?
Alveolar hypoventilation
What often causes aveolar hypoventilation?
sedative overdose
the A-a gradient will be significantly elevated under what conditions?
Hypoxemia secondary to a mismatching of ventilation and perfusion
Oxygen saturation is the ratio between what?
Actual amount of oxygen bound to hemoglobin and the potential amount of oxygen that could be bound
Where is a pulse oximeter placed on the patient?
Finger or earlobe
What does a pulse oximeter measure?
Estimates oxygen/hemoglobin saturation
What is a normal range for physiological pH?
7.35-7.45
What is a normal range for physiological PaCO2?
35-45 mmHg
What is a normal range for physiological PaO2?
90-100 mmHg
What is a normal range for physiological HCO3?
20-30 mmol/L
What is a normal range for Oxygen saturation?
> 89%
What is the Peak expiratory flow rate used to monitor?
Asthma and chronic bronchodilator therapy
What is the Green area of a peak flow meter?
>80% of expected or personal best
What does the yellow zone of a peak flow meter mean?
Moderate exacerbation 50-80% of best
What does the Red zone of a flow meter indicate?
Severe exacerbation, < 50% of predicted/personal best
What is the Peak expiratory flow rate measured in?
L/min during forced expiration
What does Peak flow monitor measure?
L/min during forced expiration, existence of airflow obstruction
What is the predicted value for Peak Expiratory Flow rate determined by in adults?
Height, Age and sex
What is the predicted value for Peak Expiratory Flow rate determined by in adolecscents?
Height
What value is used to monitor a patient's peak expiratory flow rate in chronic asthma?
Personal best value
When is a predicted value used for PEF?
New patients
What are the clinical signs of asthma?
Recurrent and episodic wheezes, Use of accessory muscles to breath, Tachypnea, Tachycardia, Decreased PFT's (FEV1, FEV1/FVC, PEF)
What are the symptoms of asthma?
Chest tightness/pressure anxiety, cough, dyspnea
What disease can be described as: recurrent inflammation episodes of widespread variable airflow obstruction, due to increased responsiveness to various stimuli?
Asthma
What is the primary mechanism causing the hyperreactivity in asthma?
Persistent bronchial inflammation, which causes mucus hypertrophy
Airflow obstruction occurs during expiration or inhalation?
Expiration
Asthmatic wheezing is on the inhale or exhale?
Exhale
How is asthma severity determined?
Frequency of symptoms and lung function
What are common causes of Asthma?
Environmental chemicals or allergens, exercise, respiratory infections, strong odors, food, Cigarette smoke
Choosing a treatment for allergies is based on what?
Severity
Describe how to use a metered dose inhaler:
Sit up straight or stand and lift chin to open airway, Remove cap from mouthpiece and inspect for obstruction, Shake inhaler vigorously, Prime (if needed), Place inhaler 1-2 inches away from mouth, Breath in slowly, actuate inhaler, Hold breath for 10 sec
Chronic bronchitis is characterized by what?
inflammation and edema of the bronchiole with excessive mucus production and airway obstruction
Patients with chronic bronchitis have what symptom?
A persistent productive cough on most days >3 months/year for >2 consecutive years, cyanotic skin color
What are blue boaters?
People with chronic bronchitis
Emphysema is characterized by what?
Abnormal, permanent enlargement of airspaces distal to the bronchioles
Emphysema'sThis permanent enlargement of the airspaces is due to the destruction of what?
The alveolar walls
What happens in the lungs of Emphysema patients during expiration?
Elastic recoil decreases and bronchiolar collapse
(True/False) Patients frequently need to use accessory muscles to assist their breathing which usually has a long expiratory phase.
True
(True/False) Patients are usually cyanotic with emphysema.
False
What are "pink puffers"?
People with emphysema
Would a person with emphysema or Chronic Bronchitis have decreased breathing sounds?
Both
A barrel chest is indicative of what disease?
Emphysema
Obsesity is a characteristics of people with emphysema or chronic bronchitis?
Chronic bronchitis
Weight loss is a characteristics of people with emphysema or chronic bronchitis?
Emphysema
Tripod positioning is a characteristic of people with emphysema or chronic bronchitis?
Emphysema
What are the signs of COPD?
Decreased breath sounds, hypoxemia, C02 retention, Cyanosis, Decreased PFTs Crackles/rhonci
What are the symptoms of COPD?
Dyspnea, history of smoking, cough, sputum production, frequent respiratory infections
Is COPD reversible?
Not fully
What type of flow limitation is characteristic of COPD?
Expiratory primarily
Is COPD progressive?
Yes
What abnormal inflammatory response is normal for COPD?
Abnormal Inflammation due to noxious particles and gases
In COPD, what part of the lungs does chronic inflammation occur?
Parenchyma and pulmonary vasculature
Why does COPD progress?
Inflammatory cells produce chemical mediators that damage the lungs further and sustain neutrophilic inflammation
What happens in the trachea and bronchi of people with COPD?
Chronic inflammation leads to enlarged mucus secreting glands and increased number of goblet cells
In the small bronchi and bronchioles, chronic inflammation leads to what in patient with COPD?
repeated cycles of injury and repair, increasing its collagen / scar tissue, which narrows the lumen and causes fixed restriction
What is the FEV1/FVC for mild COPD?
<0.7
What is the FEV1/FVC for moderate COPD?
<0.7
What is the FEV1/FVC for severe COPD?
<0.7
What is the FEV1/FVC for very severe COPD?
<0.7
What is the FEV1 for mild COPD?
>80%
What is the FEV1 for moderate COPD?
>50-80%
What is the FEV1 for severe COPD?
>30-50%
What is the FEV1 for very severe COPD?
< 30%
Constitutional symptoms of COPD, a decrease in pulmonary function, and tachypnea are variably present during an exacerbation but the__________is usually unchanged.
Chest radiograph
What are the cardinal signs of an acute COPD exacerbation?
Progessive dyspnea, increased cough frequency and severity and increased sputum production
What are the three type of pneumonia?
Hospital acquired, Community acquired and Aspiration
What is Pneumonia?
Inflammation of the lungs
What are the risk factors for developing pneumonia?
Age, smoking, chronic bronchitis, chronic illness, recent upper respiratory infection, alcoholism,
What is the most common infectious cause of death in the United States?
Pneumonia
What are the symptoms of pneumonia?
Chills, progressive cough, rust coloered purulent sputum, pleuritic chest pain
Is chest percussion dulled during pneumonia?
Yes
Is pneumonia consolidated in a radiograph or disperse?
Consolidated
What are the risk factors for pneumonia?
Family member with multidrug resistant pathogen, hospitalization >2 days, nursing home residence, chronic dialysis, home infusion, home wound care
Do viruses usually cause pneumonia in a ICU inpatient?
No
What are the main causes of Inpatient ICU pneumonia?
Streptococcus pneumonia, Staphylococcus aureus, Legionella species, Haemophilus influenzae
What are the main causes of Inpatient non-ICU pneumonia?
Streptococcus pneumonia, Mycoplasma pneumonia, Chlamydophila pneumonia, Haemophilus influenza, Legionella species, Respiratory viruses
What is CURB-65?
Clinical prediction rule that predicts mortality in community-acquired pneumonia
What is CURB-65 used for?
Assessment of severity of pneumoni and action needed to be taken
Patients with scores of 0-1 for CURB-65 have what risk of death and need for hospitalization?
Low, no hospitalization
Patients with scores of 2 for CURB-65 have what risk of death and need for hospitalization?
Moderate, may need some hospitalization or close watch out-patient care
Patients with scores of 3-5 for CURB-65 have what risk of death and need for hospitalization?
High, ICU
Mucoid sputum indicates what type of lung infection?
Viral
Rust colored sputum indicates what type of lung infection?
Pneumococcal or tuberculosis
Pink frothy colored sputum indicates what type of lung infection?
Pulmonary edema
Profuse colorless colored sputum indicates what type of lung issue?
Carcinoma
Bloody colored sputum indicates what type of lung infection?
Pulmonary embolism, TB or tumor
Pink, blood tinged sputum indicates what type of lung issue?
Pneumococcal or staphylococcal pneumonia
Continuous cough indicates what?
Respiratory infection
Early morning cough indicates what?
chronic bronchitis, smoking
Productive cough indicates what?
chronic bronchitis, pneumonia
Dry hacking cough indicates what?
Viral infection, asthma, mycoplasma pneumonia, ACE inhibitors
Barking cough indicates what?
Croup
When dealing with a patient who has breathing difficulties, what should you assess?
Acute distress, nasal flaring, pursed lips, wheezing, cyanosis and accessory muscle use while breathing
What muscles are used for inhalation?
Scalenus, sternocleidomastoid, external intercostals
What muscles are used for exhalation?
Internal intercostals, obliques and rectus abdmoinus
What should be noted about the chest in a physical exam?
Anteroposterior diameter is less than the transverse diameter, rate, rhythm and depth of breathing, percussion of posterior chest, auscultate breath sounds
What is the definition of a barrel chest?
Chest's Anteroposterior diameter is greater than the transverse diameter
What is a barrel chest a sign of?
Air trapping, age and chronic emphysema
What constitutes tachypnea?
>20 breaths per minute
What constitutes Bradypnea?
>12 breaths per minute
What is Hyperpnea?
Hyperventilation
Why evaluate Percussion of the posterior chest?
Helps to evaluate the density of the underlying lung tissue to a depth of 5-7 cm
How do you evaluate percussion of lung tissue?
Listen for differences in volume and pitch comparing side-to-side
What are Adventitious sounds?
abnormal sounds heard apart from the normal sounds of inspiration and expiration
What are Crackles or rales caused by?
Popping open of small airways and alveoli collapsed by fluid, exudate or lack of aeration during expiration
Crackles occur much more common during the ________than___________ phase of breathing.
Inspiratory than expiratory
Crackles are associate with what?
Inflammation or infection of the small bronchi, bronchioles and alveoli.
Crackles that don't clear after a cough may indicate what?
pulmonary edema, heart failure or acute respiratory distress syndrome (ARDS)
What is Rhonci?
Course rattling sound (like snoring) or gurgling noises during breathing
What is Rhonci usually caused by?
secretion in bronchial airways
Are Rhonci heard more on inhalation or exhalation?
Both
What are Rhonci noises caused by?
Air flow through thick mucous secretions in the larger air passages such as the bronchioles but may also be associated with smaller structures (alveoli)
Are Rhonci or Crackles indicative of a problem in the upper airways?
Rhonci
Are Rhonci or Crackles indicative of a problem in the lower airways?
Crackles
What is a wheeze?
is a continuous, coarse, high pitched whistling sound during breathing
What is the cause of wheezing?
Respiratory tree must be narrowed or obstructed, or airflow velocity must be heightened
The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to what?
The degree of airway obstruction
Bronchiolar disease usually causes wheezing that occurs in what phase of breathing?
Expiratory
The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is what?
Less than 50% of normal.
What type of lung issue produces a wheeze that is most likely to be heard throughout the chest via a stethoscope?
Diffuse processes
Does the pitch of a wheeze does reliably predict the degree of narrowing in the affected airway?
No
A friction rubbing sound in the lungs indicates what?
Loss of lubrication in the pleura
Define Bronchophony.
Abnormal transmission of sounds from the lungs
Define Egophony.
Increased resonance of voice sounds
Define Whispered Pectoriloquy
Increased loudness of whispering noted during auscultation.
Consolidation of pleural effusions can cause a wisper to sound like what?
More distinctive and clear
EE-EE-EE will sound like what is you have consolidation?
Ay
What percussion sound should you watch for?
Resonance, Hyperresonance and Dullness
What does Hyperresonance indicate?
Emphysema and pneumothorax
What does Dullness of the lungs indicate?
Pneumonia, pleural effusion and atelectasis
What is Resonance?
A long, low-pitched sound that can be heard over all the lung fields
What is Hyperresonance?
abnormally long, low-pitched sound heard with emphysema or pneumothroax
When does Dullness occur in the lungs?
Occurs with abnormal, dense tissue in the lungs, usually present with pneumonia, pleural effusion, and atelectasis
What isTachypnea?
Rapid breathing (> 20 breaths per minute)
What is Bradypnea?
Slow breathing (< 12 breaths per minute)
What is Hyperpnea (Kussmaul respirations)?
fast, deep breathing
What is Cheyne-Stokes respirations?
Irregular increase rhythm and decrease in depth (deep and fast, then slow and shallow) interrupted by regular episodes of apnea
What are the two types of mechanical ventilation?
Invasive positive pressure ventilation (IPPV) and Non-invasive positive pressure ventilation (NIPPV)
Mechnical ventilators are medical devices that are used to assist or replace _______respiration.
Spontaneous
Mechanical ventilation is primarily required for what type of patients?
Those unable to maintain adequate alveolar ventilation
Hypoxic respiratory failure is characterized by an inability to maintain adequate ______.
oxygenation
How is Hypoxic respiratory failure measured?
By the partial pressure of oxygen in the arterial blood (PaO2) or saturation of oxygen in arterial blood (SaO2)
Hypercapnic respiratory failure is defined by the inability to maintain adequate _______leading an increase in the partial pressure of carbon dioxide (PaCO2).
ventilation,
What type of lung disease is indicated by Hypoxic respiratory failure?
Pneumonia ARDS
What type of lung disease is indicated by Hypercapnic respiratory failure?
COPD, surgical procedures
What are the four indications for IPPV or NIPPV?
Hypoxic or Hypercapnic respiratory failure, protection against aspiration, relief of upper airway obstruction