physical assessment of the respiratory system professorb dr m.abd elaziz
TRANSCRIPT
![Page 1: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/1.jpg)
Physical Assessment of the Respiratory System
PROFESSORB DRM.ABD ELAZIZ
![Page 2: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/2.jpg)
Inspection
• Kyphosis– AKA
• Hunchback
– Abnormal curvature of the thoracic spine
![Page 3: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/3.jpg)
Inspection
• Lordosis– AKA
• Sway-back
– Abnormal curvature of the lumbar spine
![Page 4: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/4.jpg)
Inspection: Breathing patterns
Rate• Eupnea– Normal– 12-20 / min
• Tachypnea– rate– Pnuemonia, pulm edema, acidosis, septicemia, pain
• Bradypnea– rate– ICP, drug OD
![Page 5: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/5.jpg)
Inspection: Breathing patterns
Depth• Hyperpnea– depth
• Hyperventilation– depth & rate
• Hypoventilation– depth & rate
![Page 6: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/6.jpg)
Inspection: Breathing patterns
Rhythm• Apnea– Not breathing
• Cheyne-stokes– Varying depth f/b apnea– Death rattles– Death rales
![Page 7: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/7.jpg)
Percussion: results
• Resonance – drum like– Normal
• Hyper-resonance– Too much air– Emphysema
• Flatness / dull– Fluid or solid– Pleural effusion– Pneumonia– Tumor
![Page 8: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/8.jpg)
Auscultation
Purpose• Asses air flow through
bronchial treeProcedure• Diaphragm of
stethoscope• Superior inferior• Compare rt to lf
![Page 9: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/9.jpg)
Quiz?
• A child with difficulty breathing and a “barking” cough id displaying signs associated with which condition?
A. AsthmaB. CroupC. Cystic fibrosisD. Epiglottitis
![Page 10: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/10.jpg)
Quiz?
• When assessing the lung sounds of a child with asthma, which sound are you most likely to hear?
A. MurmursB. Sibilant WheezingC. CracklesD. Pleural friction rub
![Page 11: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/11.jpg)
Early & late signs of hypoxia
• Anxiety• Bradycardia• Cyanosis• Depressed respirations• Diaphoresis• Disorientation• Dyspnea
• Restlessness• Headache• Agitation• Poor judgment• Retraction• Tachycardia• Tachypnea
![Page 12: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/12.jpg)
which of the following as an early sign of hypoxia?
A. Restlessness, yawning & tachycardiaB. Dyspnea, confusion & bradycardiaC. Bradycardia, hypotension dyspneaD. Dyspnea, restlessness, hypotension
![Page 13: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/13.jpg)
Dyspnea
• Definition– SOB
–SOB, flat affect, BS x 4
![Page 14: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/14.jpg)
Dyspnea
• Significance– Common with cardiac & resp. disease– Sudden onset – healthy person • Pneumothorax
– Sudden onset ill, post-op or injury • Pulmonary emboli
![Page 15: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/15.jpg)
Dyspnea
• Orthopnea– Sit up to breath• COPD• CHF
![Page 16: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/16.jpg)
Dyspnea
• Right ventricle– If chronic airway resistance – pressure – Rt ventricle work – Rt. Vent damage
![Page 17: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/17.jpg)
Dyspnea
• Management– Find cause– Give O2
– HOB – Communication
![Page 18: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/18.jpg)
Cough
• Definition– To expel air from the lungs suddenly– Irritation of mucous membrane
![Page 19: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/19.jpg)
Cough
• Significance– Infection– Irritants– Protective mechanism– Dry, irritating• URT
– Cough + chest pain• Pleural or musculoskeletal
![Page 20: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/20.jpg)
Cough
• management– Assess– Describe – Directed – Pain control• Splinting
– Infection control– Suppressants / Anti-tussives
![Page 21: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/21.jpg)
Sputum Production
Definition• Matter discharged
from resp. track that contains mucus and pus, blood, fibrin, or bacteria
![Page 22: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/22.jpg)
Sputum Production
Significance• Purulent– Thick, yellow/green – Bacteria
• Rusty – Strep or staph
• Thin, mucous – Viral
![Page 23: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/23.jpg)
Sputum Production
• Pink-tinged– Lung CA– TB
• Pink tinged, profuse, frothy– Pulmonary edema
• Malodorous– Lung abscess
![Page 24: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/24.jpg)
Sputum Production
Management• Thick– Hydrate
• water• Nebulizer• Humidifier
• No smoking• Oral care• Appetite
![Page 25: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/25.jpg)
Obtaining a sputum specimen
• Explain– From lungs
• Sterile cup• Deep breath x 3 • Cough deeply• Expectorate • Best time for
specimen collection?– AM
![Page 26: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/26.jpg)
Chest pain
Definition• Cardiac or pulmonary
![Page 27: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/27.jpg)
Chest pain
Significance• CA (late stage)• Pneumonia• Pulmonary embolism• Pleurisy
![Page 28: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/28.jpg)
Chest pain
• Pleurisy– Inflammation of pleura– Sharp with breath– breath sounds
![Page 29: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/29.jpg)
What?????
What breath sound would you expect to hear on a patient suffering from pleurisy?
A. CracklesB. Sonorous wheezesC. Sibilant wheezesD. Pleural Friction Rub
![Page 30: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/30.jpg)
Chest pain
Management• Assess• Analgesics OK, but…• Position for pain– Affected side– Splint
![Page 31: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/31.jpg)
Clubbed fingers
Definition• Sponginess of the nail
bed • Loss of the nail bed
angle• Finger tip is round and
bulbous
![Page 32: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/32.jpg)
Clubbed Finger
Significance• chronic hypoxia
![Page 33: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/33.jpg)
Mr. Caveman:
Mr. Caveman enters the ER unconscious following an Automobile accident. The paramedics report that his O2 sats are 86%. You note that Mr. Caveman has clubbed fingers. What does this tell you?
![Page 34: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/34.jpg)
Hemoptysis
Definition• Expectoration of
blood from the respiratory tract
![Page 35: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/35.jpg)
Hemoptysis
Significance• Pulm or cardiac• Common causes– Pulm infection– CA of lungs– Pulm. Emboli– Pulm. Infarction– TB
![Page 36: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/36.jpg)
Hemoptysis
• Hemoptysis– Definition?
• Coughed up blood
– From?• Pulm hemorrhage
– Description• Pink, red, mixed with
sputum
– Blood pH• Alkaline blood
• Hematemesis– Definition?
• Vomited blood
– From?• Stomach / GI
– Description• “Coffee ground”
– Blood ph• Acidic blood
![Page 37: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/37.jpg)
Hemoptysis
Management• Determine source• Serious
![Page 38: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/38.jpg)
Cyanosis
Definition• Bluish coloring of skin
![Page 39: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/39.jpg)
Cyanosis
Significance• Very late indicator of
hypoxia• Appears when O2 sats
< 85%• NOT a reliable sign of
hypoxia– Esp. with anemia
![Page 40: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/40.jpg)
Cyanosis
• O2 sat definition– % of hemoglobin
carrying oxygen compared to total # of hemoglobin
![Page 41: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/41.jpg)
Cyanosis
• NormalBreath 100 O2 molecules 98 cross into blood
Blood: 100 Hgb• O2 SATS– 98%– No cyanosis
![Page 42: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/42.jpg)
Cyanosis
• HypoxiaBreath 100 O2 molecules 75 cross into blood
Blood: 100 Hgb• O2 SATS– 75%– Cyanosis
![Page 43: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/43.jpg)
Cyanosis
• Anemic and hypoxicBreath 100 O2 molecules 75 cross into blood
Blood: 75 Hgb• O2 SATS– 100% – No Cyanosis
![Page 44: Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ](https://reader036.vdocuments.us/reader036/viewer/2022062712/56649c7d5503460f94931a01/html5/thumbnails/44.jpg)
Cyanosis
Management• Know color of Pt. skin• Assess color of tongue &
lips• Fingernail polish• African-American• Vasoconstriction (cold
weather) peripheral cyanosis