Respiratory Disorders

1
Respiratory Disorders

• Chapter 4

2
Anatomy Physiology

• Pulmonary System
• Ventilation
• Oxygenation

• Respiratory Tracts
• Upper warm, filter humidify air
• Nose
• Sinus
• Pharynx
• Larynx
• Lower
• Exchange of O2 and CO2
• Trachea lungs

3
The Evaluation Process

• History
• Acute/chronic
• Type of cough
• Shortness of breath?
• Pain with breathing
• Time of day
• Exacerbation with activity
• Allergies
• Medication

4
The Evaluation Process

• Inspection
• Shape of thoracic cavity
• Posture
• Breathing patterns
• Tachypnea rapid (gt24/min)
• Hyperpnea - deep
• Bradypnea slow (lt12/min)
• Hypopnea shallow/slow
• Orthopnea shortness when supine/prone

5
Abnormal Breathing Patterns
6
The Evaluation Process

• Palpation/Percussion
• Symmetry of chest during respiration T9/T10
• Tactile fremitus bilateral
• Percussion of thoracic cavity
• Posterior chest
• Right lateral thorax
• Left lateral thorax
• Anterior chest

7
Landmark Identification - Percussion

• Posterior chest
• Superior angle
• Spine
• Mid medial border
• Inferior angle
• Ribs 9-10
• All bilateral

• R/L Lateral Thorax
• Ribs 2-3
• Ribs 4-5
• Ribs 6-7
• Ribs 7-8
• All bilateral

8
Landmark Identification - Percussion

• Anterior Chest
• Superior to sternoclavicular jt.
• Ribs 2-3 (1-2 lateral to sternum)
• Ribs 4-5 (inferior to nipple/pec)
• Ribs 6-7 (middle of intercostal space)

9
Breath Sounds

• Intensity
• Pitch
• Quality
• Duration

10
Tips for Auscultation

• Use the diaphragm
• Listen to one full respiration at each location
• Follow the same pattern
• Compare side to side

11
Normal Bronchial Breath Sounds

• Heard over the trachea and larynx
• High-pitched
• Loud
• Inspiration lt expiration
• Harsh, hollow, and tubular

12
Normal Bronchovesicular Breath Sounds

• Posterior
• Heard between scapula
• Anterior
• Heard around Angle of Louis
• Medium-pitch
• Moderate amplitude
• Inspirationexpiration
• Mixed quality

13
Normal Vesicular

• Heard over peripheral lung fields
• Low-pitched
• Soft amplitude
• Inspiration gt expiration
• Sounds like rustling of leaves on a tree

14
Discontinuous, Fine Crackles

• Produced by inhaled air colliding with previously
  deflated airways. Airways suddenly pop open
• High-pitched (Sibilant)
• Heard mostly on inspiration
• Not cleared by coughing

15
Discontinuous, Course Crackles

• Produced by inhaled air colliding with secretion
  in trachea and large bronchi
• Loud, low-pitched (Sonorous)
• Start in inspiration and may be present in
  expiration
• May decrease with coughing or suction
• Clinical examples Pulmonary edema, pneumonia,
  pulmonary fibrosis

16
Continuous, Sibilant Wheeze

• Produced by air being squeezed through narrowed
  air passages
• High-pitched
• Musical quality
• Predominate in expiration, but may be heard in
  inspiration too
• Acute asthma
• Chronic emphysema

17
Continuous, Sonorous Wheeze

• Produced by airflow obstruction
• Low-pitched
• Snoring or moaning sounds
• More prominent on expiration
• May clear with coughing or suction
• Bronchitis
• Tumor in single bronchus

18
Stridor

• Caused by constriction of larynx, trachea, or
  upper airway obstruction
• High-pitched, crowing sound
• Heard on inspiration and louder in neck area
• Croup
• Foreign body
• Inhalation injury

19
Pathological Conditions

• Pneumonia
• Viral or bacterial pathogen
• S/S
• Dyspnea, wheeze, cough/bark, mucous
• Diagnosis
• Sputum culture
• Chest X-Ray
• Treatment
• Antibiotics, expectorant/cough suppressant

20
Pathological Conditions

• Influenza
• Viral infection
• S/S
• Contact with infected person
• Fever, body ache, cough, etc
• Precursor to pneumonia
• Diagnostics
• MD, blood tests,
• Treatments
• symptomatic

21
Pathological Conditions

• URI bacterial infection
• S/S
• fever, cough, body aches, runny nose, sore throat
• Diagnosis
• Symptoms persist for 7-10 days
• Dark nasal discharge
• Treatment
• Symptomatic, antibiotics, good hygiene

22
Pathological Conditions

• Spontaneous Pneumothorax/Hempthorax
• Air/gas trapped between chest wall and pleura
  causing lung to collapse
• Blood collects in pleural space due to direct
  trauma
• NOT TO BE CONFUSED WITH HAVING THE WIND KNOCKED
  OUT

23
Spontaneous Pneumothorax/Hempthorax

• S/S
• Dyspnea, cough w/chest pain, history of chest
  trauma
• Diagnosis
• Immediate referral, X-Ray,
• Tx aspiration of trapped air, drainage of blood
• RTP Decision recurrence can be 50,
  asymptomatic, clearance by MD