Respiratory Abnormalities
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Transcript of Respiratory Abnormalities
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511CHAPTER 26 Respiratory System
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TABLE 26-7 COMMON ASSESSMENT ABNORMALITIESRespiratory System
FINDING DESCRIPTION POSSIBLE ETIOLOGY AND SIGNIFICANCE*InspectionPursed-lip breathing Exhalation through mouth with lips pursed together to
slow exhalationCOPD, asthma; suggests breathlessnessStrategy taught to slow expiration, dyspnea
Tripod position; inability to lie flat
Learning forward with arms and elbows supported on overbed table
COPD, asthma in exacerbation, pulmonary edemaIndicates moderate to severe respiratory distress
Accessory muscle use; intercostal retractions
Neck and shoulder muscles used to assist breathing; muscles between ribs pull in during inspiration
COPD, asthma in exacerbation, secretion retentionIndicates severe respiratory distress, hypoxemia
Splinting Voluntary in tidal volume to pain on chest expansion Thoracic or abdominal incision; chest trauma, pleurisy AP diameter AP chest diameter equal to lateral; slope of ribs more
horizontal (90 degrees) to spineCOPD, asthma, cystic fibrosis; lung hyperinflation;
advanced ageTachypnea Rate >20 breaths/min; >25 breaths/min in elderly Fever, anxiety, hypoxemia, restrictive lung disease
Magnitude of above normal rate reflects increased work of breathing
Kussmaul respirations Regular, rapid, and deep respirations Metabolic acidosis; in rate aids body in CO2 excretionCyanosis Bluish color of skin best seen in lips and on the palpebral
conjunctiva (inside the lower eyelid)Reflects 5-6 g of hemoglobin not bound with oxygen; oxygen transfer in lungs, cardiac output; nonspecific, unreliable indicator
Finger clubbing Depth, bulk, sponginess of distal portion of finger (see eFig. 26-2 on the Evolve website for this chapter)
Chronic hypoxemia; cystic fibrosis, lung cancer, bronchiectasis
Abdominal paradox Inward (rather than normal outward) movement of abdomen during inspiration
Inefficient and ineffective breathing pattern; nonspecific indicator of severe respiratory distress
PalpationTracheal deviation Leftward or rightward movement of trachea from normal
midline positionNonspecific indicator of change in position of mediastinal
structures; medical emergency if caused by tension pneumothorax; trachea deviates to the side opposite the collapsed lung
Altered tactile fremitus Increase or decrease in vibrations In pneumonia, pulmonary edema; in pleural effusion, lung hyperinflation; absent in pneumothorax, atelectasis
Altered chest movement Unequal or equal but diminished movement of two sides of chest with inspiration
Unequal movement caused by atelectasis, pneumo-thorax, pleural effusion, splinting; equal but diminished movement caused by barrel chest, restrictive disease, neuromuscular disease
PercussionHyperresonance Loud, lower-pitched sound over areas that normally
produce a resonant soundLung hyperinflation (COPD), lung collapse (pneumothorax),
air trapping (asthma)Dullness Medium-pitched sound over areas that normally produce a
resonant sound Density (pneumonia, large atelectasis), fluid pleural
space (pleural effusion)
AuscultationFine crackles Series of short-duration, discontinuous, high-pitched sounds
heard just before the end of inspiration; result of rapid equalization of gas pressure when collapsed alveoli or termi nal bronchioles suddenly snap open; similar sound to that made by rolling hair between fingers just behind ear
Idiopathic pulmonary fibrosis, interstitial edema (early pulmonary edema), alveolar filling (pneumonia), loss of lung volume (atelectasis), early phase of heart failure
Coarse crackles Series of long-duration, discontinuous, low-pitched sounds caused by air passing through airway intermittently occluded by mucus, unstable bronchial wall, or fold of mucosa; evident on inspiration and, at times, expiration; similar sound to blowing through straw under water; increase in bubbling quality with more fluid
Heart failure, pulmonary edema, pneumonia with severe congestion, COPD
Rhonchi Continuous rumbling, snoring, or rattling sounds from obstruction of large airways with secretions; most prominent on expiration; change often evident after coughing or suctioning
COPD, cystic fibrosis, pneumonia, bronchiectasis
Wheezes Continuous high-pitched squeaking or musical sound caused by rapid vibration of bronchial walls; first evident on expira tion but possibly evident on inspiration as obstruction of airway increases; possibly audible without stethoscope
Bronchospasm (caused by asthma), airway obstruction (caused by foreign body, tumor), COPD
Stridor Continuous musical or crowing sound of constant pitch; result of partial obstruction of larynx or trachea
Croup, epiglottitis, vocal cord edema after extubation, foreign body
AP, Anterior-posterior; COPD, chronic obstructive pulmonary disease.*Limited to common etiologic factors. (Further discussion of conditions listed may be found in Chapters 27 through 29.)