DOCSLIB.ORG

Respiratory Rate 4: Breathing Rhythm and Chest Movement

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Respiratory Rate 4: Breathing Rhythm and Chest Movement This article is open access and can be freely distributed Clinical Practice Keywords Respiratory rhythm/Vital signs/Patient deterioration Practical procedures This article has been Respiratory double-blind peer reviewed Respiratory rate 4: breathing rhythm and chest movement changing respiratory rate (RR) pulmonary disease, the respiratory rhythm Author Iain Wheatley is nurse consultant measurement is cited as an and chest movement change. These in acute and respiratory care, Frimley early indicator of patient deteri- changes are compensatory mechanisms as Health Foundation Trust. Aoration (Dougherty and Lister, a direct result of a chemical imbalance; and 2015), but there are other respiratory signs the primary cause may be mechanical, met- Abstract Breathing rhythm and chest that can be observed in conjunction with it. abolic or neurological. The changes result movement provide key information on a In normal breathing a fairly steady rate, in an increase or decrease in RR, depth of patient’s condition. The fourth article in inspiratory volume and depth of chest breathing and pattern of breathing. this six-part series on respiratory rate movement are maintained, with equal Changes in rhythm and chest move- expands on the procedure to measure expansion and symmetry. In the resting ments are made through feedback mecha- respiratory rate outlined in part 3 and state normal breathing is relaxed, regu- nisms to the central respiratory control provides a guide to the assessment of lating the gas exchange in the lungs to centres of the brain. A range of receptors respiratory rhythm and chest movement. maintain homoeostasis and balance pH provide information that is interpreted in changes and metabolism. the higher respiratory centre, modulating Citation Wheatley I (2018) Respiratory When there is an increased demand on RR and chest movement (Feldman and Del rate 4: breathing rhythm and chest the respiratory system from an acute epi- Negro, 2006); these receptors are: movement. Nursing Times; 114: 9, 49-50. sode, such as a chest infection, or long-term l Peripheral chemoreceptors found in the conditions, such as chronic obstructive carotid artery detect changes in PaO2 in the blood as well as PaCO2 and pH; Fig 1. Chest and abdominal movement l Central chemoreceptors in the ventral medullary surface of the medulla oblongata in the brain detect pH changes; A. Normal l Mechanoreceptors are stretch receptors located in the smooth muscle of the main airways and parenchyma. They respond to excessive stretching of the lung during inspiration and send signals to the apneustic centre of the pons B. Paralyzed (located in the brain stem); the pons controls inspiration and expiration. Respiratory rhythm and chest Source: Adapted from McCool and Tzelepis (2012) movement Normal Table 1. Breathing patterns In relaxed normal breathing the RR is 12-20 breaths per minute (bpm) (Royal Col- Pattern Condition Description lege of Physicians, 2017). Chest expansion on Eupnoea Normal breathing rate and pattern inspiration should be the same or similar on Tachypnoea Increased respiratory rate each breath. The chest wall is symmetrical, accessory (neck and shoulder) muscles are Bradypnoea Decreased respiratory rate not used, diaphragm muscles are func- Apnoea Absence of breathing tioning, and there is no paradoxical move- Hyperpnoea Increased depth and rate of breathing ment – the chest and abdomen move in the same direction on inspiration and expiration. Cheyne-Stokes Gradual increases and decreases in respirations with periods of apnoea Abnormal Biot’s Abnormal breathing pattern with groups/clusters of There are several reasons why respiratory rapid respiration of equal depth and regular apnoea rhythm and chest movement may change. periods Abnormality in respiratory rhythm may be Kussmaul’s Tachypnoea and hyperpnoea related to changes in the patient’s metabolic state; for example, a patient with diabetic Apneustic Prolonged inspiratory phase with a prolonged ketoacidosis may exhibit signs of rapid, deep expiratory phase PETER LAMB PETER breaths. Such breathing (often called Nursing Times [online] September 2018 / Vol 114 Issue 9 49 www.nursingtimes.net This article is open access and can be freely distributed Clinical Practice This article is funded by an unrestricted Practical procedures educational grant from PMD Solutions Table 2. position and observing the movement from Causes of abnormal respiratory rate the side gives the best view. Observation Respiratory changes Possible causes 3. Depth of chest movement – in normal Chest symmetry One side of the anterior l Unilateral consolidation tidal breathing the inspiratory and expira- chest moves more with l Pneumothorax tory movement is fairly constant. Monitor normal tidal breaths l Pleural effusion for tachypnoea (>25bpm) or bradypnoea than the other l Fractured ribs (flail chest) (<12bpm) and assess whether the tidal breath l Blocked chest drain is very deep or shallow (RCP, 2017). l Partial diaphragm paralysis l Sputum plugging 4. Accessory muscle use – observe the Paradoxical chest Chest moves in opposite l Neuromuscular disorder patient from the front and note whether and abdominal direction to the l Spinal injury there is increased work of breathing at rest, movement abdomen during normal l Diaphragmatic paralysis which includes the use of the sternocleido- tidal breathing mastoid (neck), scalene (shoulder), pectoral and abdominal muscles (Tulaimat and Rapid and Tachypnoea and deep l Metabolic acidosis such as diabetic Trick, 2017). The patient may sit forward increased depth inspiratory breaths ketoacidosis (Kussmaul’s breathing) with their hands on their knees or resting of breathing or renal failure on a table to relieve respiratory muscles and l Sepsis increase inspiratory capacity. l After exercise Rapid and shallow Tachypnoea and shallow l Chest pain 5. Rhythm – breathing rhythm is usually depth of inspiratory breath l Abdominal pain constant and regular; a rhythm with breathing l Fractured ribs (pain) abnormally long pauses between breaths l Sleep-disordered breathing pattern or cessation of breaths and then rapid l Cerebral lesion breathing is abnormal (Table 1). l Shock l Anxiety/stress Conclusion l Medication It is important to observe RR and to Slow and Bradypnoea with deep l Brainstem lesion, impending death examine the rhythm of breathing and increased depth tidal breath, for l Damage to the pons (respiratory movement of the chest when conducting a of breathing example: centre in the brainstem that controls respiratory assessment. This observation l Apneustic breathing breathing) can aid rapid diagnosis and treatment par- l Cheyne-Stokes l Congestive heart failure, neurological ticularly in patients who are acutely ill. NT respirations insult (after, for example, a stroke) References l Biot’s respiration l Elevated intracranial pressure, for Dougherty L, Lister S (2015) The Royal Marsden example, meningitis Manual of Clinical Nursing Procedures. Oxford: l Sleep apnoea Wiley-Blackwell. Feldman JL, Del Negro CA (2006) Looking for Slow and shallow Bradypnoea with l Neuromuscular disorders inspiration: new perspectives on respiratory rhythm. depth of shallow tidal breath l Opioid toxicity Nature Reviews Neuroscience; 7: 3, 232-241. McCool FD, Tzelepis GE (2012) Dysfunction of the breathing l Hypopnoea (a partial blockage of diaphragm. New England Journal of Medicine; 366: the airway resulting in airflow 10, 932-942. Royal College of Physicians (2017) National Early reduction of >50% for ≥10 seconds) Warning Score (NEWS) 2. Bit.ly/NEWS2RCP l Hypothyroidism Tulaimat A, Trick WE (2017) DiapHRaGM: a mnemonic to describe the work of breathing in patients with respiratory faialure. PLoS One; 12: 7: e0179641. Kussmaul’s breathing) aims to reduce the RR. The key principles of chest observation Wheatley I (2018) Respiratory rate 3: how to take an accurate measurement. Nursing Times; 114: 7, 21-22. level of CO2 in the blood to maintain a normal are outlined below. It is important to have a pH and re-establish a homoeostatic state. clear view of the chest so the chest area Patients with chest pain may have rapid should be exposed. Protect the patient’s CLINICAL Respiratory rate series but shallow breaths because deep breaths dignity at all times by screening the bed. SERIES cause discomfort; in patients with rib frac- Part 1: Why measurement and recording tures adequate pain relief is paramount to 1. Chest symmetry – standing in front of are crucial Bit.ly/RespiratoryR1 restore a normal depth and rate of and facing the patient, observe whether Part 2: Anatomy and physiology of breathing breathing. Table 1 outlines common rhythm the movement of both sides of the anterior Bit.ly/RespiratoryR2 patterns, while Table 2 details key respira- chest is symmetrical. Part 3: How to take an accurate measurement tory changes and possible causes. Bit.lyRespiratoryR3 2. Chest and abdominal movement – the Part 4: Respiratory rhythms and chest The procedure chest and abdomen should move in the movement Observation of respiratory rhythm and same direction during a normal tidal breath Part 5: Respiratory rate and the deteriorating patient chest movement can be incorporated into (Fig 1) but it can be difficult to observe this. Part 6: Technology in respiratory assessment Wheatley’s (2018) procedure for assessing Positioning the patient in a semi-recumbent Nursing Times [online] September 2018 / Vol 114 Issue 9 50 www.nursingtimes.net.
Load more

Recommended publications
  • Respiratory Examination Cardiac Examination Is an Essential Part of the Respiratory Assessment and Vice Versa
    Respiratory examination Cardiac examination is an essential part of the respiratory assessment and vice versa. # Subject steps Pictures Notes Preparation: Pre-exam Checklist: A Very important. WIPE Be the one. 1 Wash your hands. Wash your hands in Introduce yourself to the patient, confirm front of the examiner or bring a sanitizer with 2 patient’s ID, explain the examination & you. take consent. Positioning of the patient and his/her (Position the patient in a 3 1 2 Privacy. 90 degree sitting position) and uncover Exposure. full exposure of the trunk. his/her upper body. 4 (if you could not, tell the examiner from the beginning). 3 4 Examination: General appearance: B (ABC2DEVs) Appearance: young, middle aged, or old, Begin by observing the and looks generally ill or well. patient's general health from the end of the bed. Observe the patient's general appearance (age, Around the bed I can't state of health, nutritional status and any other see any medications, obvious signs e.g. jaundice, cyanosis, O2 mask, or chest dyspnea). 1 tube(look at the lateral sides of chest wall), metered dose inhalers, and the presence of a sputum mug. 2 Body built: normal, thin, or obese The patient looks comfortable and he doesn't appear short of breath and he doesn't obviously use accessory muscles or any heard Connections: such as nasal cannula wheezes. To determine this, check for: (mention the medications), nasogastric Dyspnea: Assess the rate, depth, and regularity of the patient's 3 tube, oxygen mask, canals or nebulizer, breathing by counting the respiratory rate, range (16–25 breaths Holter monitor, I.V.
    [Show full text]
  • The Child with Altered Respiratory Status
    Path: K:/LWW-BOWDEN-09-0101/Application/LWW-BOWDEN-09-0101-016.3d Date: 3rd July 2009 Time: 16:31 User ID: muralir 1BlackLining Disabled CHAPTER 16 The Child With Altered Respiratory Status Do you remember the Diaz fam- Case History leave Lela, the baby sister, ily from Chapter 9, in which with Claudia’s mother, Selma, Jose has trouble taking his asthma medication, and head to the hospital. and in Chapter 4, in which Jose’s little sister, At the hospital the emergency department Lela, expresses her personality even as a new- nurse observes Jose sitting cross-legged and born? Jose is 4 years old and was diagnosed leaning forward on his hands. His mouth is with asthma this past fall, about 6 months ago. open and he is breathing hard with an easily Since that time Claudia, his mother, has audible inspiratory wheeze. He is using his noticed several factors that trigger his asthma subclavicular accessory muscles with each including getting sick, pollen, and cold air. breath. His respiratory rate is 32 breaths per One evening following a warm early-spring minute, his pulse is 112 beats per minutes, day, Jose is outside playing as the sun sets and and he is afebrile. Claudia explains that he the air cools. When he comes inside he was fine; he was outside running and playing, begins to cough. Claudia sets up his nebulizer and then came in and began coughing and and gives him a treatment of albuterol, which wheezing, and she gave him an albuterol lessens his coughing. Within an hour, Jose is treatment.
    [Show full text]
  • Breathing Sounds – Determination of Extremely Low Spl
    MATEC Web of Conferences 217, 03001 (2018) https://doi.org/10.1051/matecconf/201821703001 ICVSSD 2018 BREATHING SOUNDS – DETERMINATION OF EXTREMELY LOW SPL M. Harun1*, R. Teoh Y. S1, M. ‘A. A. Ahmad, M. Mohd. Mokji1, You K. Y1, S. A. R. Syed Abu Bakar1, P. I. Khalid1, S. Z. Abd. Hamid1 and R. Arsat1 1 School of Electrical Engineering, Universiti Teknologi Malaysia, *Email: [email protected] Phone: +6075535358 ABSTRACT Breathing sound is an extremely low SPL that results from inspiration and expiration process in the lung. Breathing sound can be used to diagnose persons with complications with breathing. Also, the sound can indicate the effectiveness of treatment of lung disease such as asthma. The purpose of this study was to identify SPL of breathing sounds, over six one octave center frequencies from 63 Hz to 4000 Hz, from the recorded breathing sounds in .wav files. Breathing sounds of twenty participants with normal weight BMI had been recorded in an audiometry room. The breathing sound was acquired in two states: at rest and after a 300 meters walk. Matlab had been used to process the breathing sounds that are in .wav files to come up with SPL (in dB). It has been found out that the SPL of breathing sound of all participants are positive at frequencies 63 Hz and 125 Hz. On the other hand, the SPL are all negatives at frequency 1000 Hz, 2000 Hz and 4000 Hz. In conclusion, SPL of breathing sounds of the participants, at frequencies 250 Hz and 500 Hz that have both positive and negative values are viable to be studied further for physiological and medicinal clues.
    [Show full text]
  • Clinical Management of Severe Acute Respiratory Infections When Novel Coronavirus Is Suspected: What to Do and What Not to Do
    INTERIM GUIDANCE DOCUMENT Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do Introduction 2 Section 1. Early recognition and management 3 Section 2. Management of severe respiratory distress, hypoxemia and ARDS 6 Section 3. Management of septic shock 8 Section 4. Prevention of complications 9 References 10 Acknowledgements 12 Introduction The emergence of novel coronavirus in 2012 (see http://www.who.int/csr/disease/coronavirus_infections/en/index. html for the latest updates) has presented challenges for clinical management. Pneumonia has been the most common clinical presentation; five patients developed Acute Respira- tory Distress Syndrome (ARDS). Renal failure, pericarditis and disseminated intravascular coagulation (DIC) have also occurred. Our knowledge of the clinical features of coronavirus infection is limited and no virus-specific preven- tion or treatment (e.g. vaccine or antiviral drugs) is available. Thus, this interim guidance document aims to help clinicians with supportive management of patients who have acute respiratory failure and septic shock as a consequence of severe infection. Because other complications have been seen (renal failure, pericarditis, DIC, as above) clinicians should monitor for the development of these and other complications of severe infection and treat them according to local management guidelines. As all confirmed cases reported to date have occurred in adults, this document focuses on the care of adolescents and adults. Paediatric considerations will be added later. This document will be updated as more information becomes available and after the revised Surviving Sepsis Campaign Guidelines are published later this year (1). This document is for clinicians taking care of critically ill patients with severe acute respiratory infec- tion (SARI).
    [Show full text]
  • Initial Intake Information
    Appendix Initial Intake Information Date: Referred by: Address: Name: Sex: M ( ); F ( ). Age: Telephone: home-( work-( Address: Initial contact: Handshake: weak ); strong ( ). cold ); warm ( ). moist ); dry ( ). Grooming: ________; posture: Demeanor/attitude: Breathing mode: High chest shallow ( ); hyperpnea ( ). 307 308 APPENDIX Sighing: frequent ( ); occasional ( ); absent ( ). Occupation: Contact with: dust ( ); fibers (); paints ( ); solvents ( ); sprays ( ); detergents ( ). Other chemicals or airborne particles: Status: Married ( ); single ( ); divorced ( ); other: children: No. Boys ( ); No. Girls ( ). Physician(s) of record: Last medical examination: _________,199__ Diagnos(e)s: 'Ireatmentts): Medication(s): Do you now have, have you ever had, or has any family member related to you by blood (mother, father, sister, brother, familial grandparents or uncles and aunts) had: ( ) High blood pressure () Heart disease APPENDIX 309 ) Low blood pressure ) Angina ) Diabetes (insulin-dependent) ) Anemia ) Diabetes (non-insulin- ) Allergies dependent) ) Dermatitis ) Colitis ) Muscle spasms ) Gastritis ) Tingling in hands and/or feet ) Ulcer ) Fainting (syncope) ) Shortness of breath ) Dizziness (vertigo) ) Asthma ) Stroke ) Emphysema ) Headache ) Hyperventilation ) TMJlbruxism ) Mitral valve prolapse ) Chronic low backache ) Other heart murmur ) EB virus (mononucl.) ) Heart arrhythmia ) PMS ) Chronic vaginal yeast ) Chronic tiredness ) Cystitis ) Menstrual irregul. ) Raynaud's disease ) Tinnitus ) Chronic pain ) Hyperthyroid ) Eating disorder
    [Show full text]
  • PALS Helpful Hints 2015 Guidelines - December 2016 Mandatory Precourse Assessment at Least 70% Pass
    PALSPALS Helpful Helpful Hints Courtesy Hints are of CourtesyKey Medical of Resources, Key Medical Inc. Resources, www.cprclassroom.com Inc. PALS Helpful Hints 2015 Guidelines - December 2016 Mandatory precourse assessment at least 70% pass. Bring proof of completion to class. The PALS exam is 50 questions. Passing score is 84% or you may miss 8 questions. All AHA exams are now open resource, so you may use your books and/or handouts for the exam. For those persons taking PALS for the first time or updating/renewing with a current card, exam remediation is permitted should you miss more than 8 questions on the exam. Viewing the PALS book ahead of time with the online resources is very helpful. The American Heart Association link is www.heart.org/eccstudent has a pre-course self- assessment, supplementary written materials and videos. The code for these online resources is in the PALS Provider manual page ii. The code is PALS15. Basic Dysrhythmia knowledge is required. The exam has at least 5 strips to interpret. The course is a series of video segments then skills. The course materials well prepare you for the exam. Basic Dysrhythmias knowledge is required in relation to asystole, ventricular fibrillation, tachycardias in general and bradycardias in general. You do not need to know the ins and outs of each and every one. Tachycardias need to differentiate wide complex (ventricular tachycardia) and narrow complex (supraventricular tachycardia or SVT). Airway - child is grunting - immediate intervention. Airway - deteriorates after oral airway, next provide bag-mask ventilation. Airway - snoring with poor air entry bilaterally - reposition, oral airway.
    [Show full text]
  • Kuban State Medical University" of the Ministry of Healthcare of the Russian Federation
    Federal State Budgetary Educational Institution of Higher Education «Kuban State Medical University" of the Ministry of Healthcare of the Russian Federation. ФЕДЕРАЛЬНОЕ ГОСУДАРСТВЕННОЕ БЮДЖЕТНОЕ ОБРАЗОВАТЕЛЬНОЕ УЧРЕЖДЕНИЕ ВЫСШЕГО ОБРАЗОВАНИЯ «КУБАНСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ» МИНИСТЕРСТВА ЗДРАВООХРАНЕНИЯ РОССИЙСКОЙ ФЕДЕРАЦИИ (ФГБОУ ВО КубГМУ Минздрава России) Кафедра пропедевтики внутренних болезней Department of Propaedeutics of Internal Diseases BASIC CLINICAL SYNDROMES Guidelines for students of foreign (English) students of the 3rd year of medical university Krasnodar 2020 2 УДК 616-07:616-072 ББК 53.4 Compiled by the staff of the department of propaedeutics of internal diseases Federal State Budgetary Educational Institution of Higher Education «Kuban State Medical University" of the Ministry of Healthcare of the Russian Federation: assistant, candidate of medical sciences M.I. Bocharnikova; docent, c.m.s. I.V. Kryuchkova; assistent E.A. Kuznetsova; assistent, c.m.s. A.T. Nepso; assistent YU.A. Solodova; assistent D.I. Panchenko; docent, c.m.s. O.A. Shevchenko. Edited by the head of the department of propaedeutics of internal diseases FSBEI HE KubSMU of the Ministry of Healthcare of the Russian Federation docent A.Yu. Ionov. Guidelines "The main clinical syndromes." - Krasnodar, FSBEI HE KubSMU of the Ministry of Healthcare of the Russian Federation, 2019. – 120 p. Reviewers: Head of the Department of Faculty Therapy, FSBEI HE KubSMU of the Ministry of Health of Russia Professor L.N. Eliseeva Head of the Department
    [Show full text]
  • Why Is Respiratory Rate the Neglected Vital Sign? a Narrative Review Malcolm Elliott*
    Elliott. Int Arch Nurs Health Care 2016, 2:050 Volume 2 | Issue 3 International Archives of ISSN: 2469-5823 Nursing and Health Care Review: Open Access Why is Respiratory Rate the Neglected Vital Sign? A Narrative Review Malcolm Elliott* School of Health, Charles Darwin University, Melbourne, Australia *Corresponding author: Malcolm Elliott, RN, PhD, Lecturer, School of Health, Charles Darwin University, Melbourne, Australia, E-mail: [email protected] Early identification of this change allows prompt intervention and Abstract thus reduces the risk of organ failure and death [10]. Tachypnoea Respiratory rate assessment is essential for detecting acute changes for example is one of the most significant predictors of in-hospital in a patient’s condition. Despite this, research has shown that it is the cardiac arrest and admission to intensive care [11]. The ability to most neglected vital sign in clinical practice. This literature review identify a deteriorating patient is also essential for avoiding poor identified three key reasons for this: inadequate knowledge regarding clinical outcomes and to ensure the effective intervention of rapid respiratory rate assessment; nurses’ perception of patient acuity; and lack of time. These factors suggest poor understanding of the response teams [12]. importance of respiratory rate as a vital sign. Despite its clinical importance, respiratory rate has consistently Although respiratory rate assessment is commonly neglected been the least frequently measured vital sign [13-15]. An audit of 211 in clinical practice, only three studies have explored the reasons adult post-operative patients in five Australian hospitals for example for this. It is not known what is taught at the undergraduate level found only 17% of medical records had complete documentation of regarding respiratory rate assessment.
    [Show full text]
  • EMS Quick Study Guide NOTICE: You DO NOT Have the Right to Reprint Or Resell This Publication
    Presents The EMS Quick Study Guide NOTICE: You DO NOT Have the Right to Reprint or Resell this Publication. You Also MAY NOT Give Away, Sell or Share the Content Herein. If you purchased this book/ebook from anywhere other than http://www.ems-safety.com , you have a pirated copy. Please help stop Internet crime by reporting this to: [email protected] © Copyright The EMS Professional ALL RIGHTS RESERVED. No part of this publication may be reproduced or transmitted in any form whatsoever, electronic, or mechanical, including photocopying, recording, or by any informational storage or retrieval system without the expressed written, dated and signed permission from the author. DISCLAIMER AND/OR LEGAL NOTICES: The information presented herein represents the views of the author as of the date of publication. Because of the rate with which conditions change, the author reserves the right to alter and update this information based on the new conditions. The publication is for informational purposes only. While every attempt has been made to verify the information provided in this publication, neither the author nor its affiliates/partners assume any responsibility for errors, inaccuracies or omissions. Any slights of people or organizations are unintentional. If advice concerning medical, legal or related matters is needed, the services of a fully qualified professional should be sought. You should be aware of any laws/practices or local policies which govern emergency care or other pre hospital care practices in your country and state.
    [Show full text]
  • Chest and Lung Examination
    Chest and Lung Examination Statement of Goals Understand and perform a complete examination of the normal chest and lungs. Learning Objectives A. Locate the bony landmarks of the normal chest: • Ribs and costal margin, numbering ribs and interspaces • Clavicle • Sternum, sternal angle and suprasternal notch • Scapula B. Define the vertical "lines" used to designate chest wall locations. Use the bony landmarks and conventional vertical "lines" when describing a specific area of the chest wall. • Midsternal line • Midclavicular line • Anterior, mid and posterior axillary lines • Scapular line • Vertebral line C. Describe the location of the trachea, mainstem bronchi, lobes of the lungs and pleurae with respect to the surface anatomy of the chest. D. Prepare for an effective and comfortable examination of the chest and lungs by positioning and draping the patient. Communicate with the patient during the exam to enlist the patient’s cooperation. E. Describe and perform inspection of the chest including the following: • Rate, rhythm, depth, and effort of breathing • Shape and movement of the chest F. Describe and perform palpation of the chest including the following: • Identify tender areas • Chest expansion • Tactile fremitus G. Describe and perform percussion of the chest, distinguishing a dull sound (below the diaphragm) from a resonant sound (over normal lung.) Use percussion to demonstrate symmetric resonance of the lung fields and to measure diaphragmatic excursion. H. Describe and perform auscultation of the lungs including the following: • Symmetric examination of the lung fields, posterior and anterior. • Normal breath sounds (vesicular, bronchovesicular, bronchial and tracheal), their usual locations and their characteristics. I. Define terms for three common adventitious lung sounds: • Wheezes are high pitched, continuous hissing or whistling sounds.
    [Show full text]
  • Physical Examination of the Adult Patient with Respiratory Diseases: Inspection and Palpation
    Eur Respir J, 1995, 8, 1584–1593 Copyright ERS Journals Ltd 1995 DOI: 10.1183/09031936.95.08091584 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 SERIES 'CHEST PHYSICAL EXAMINATION' Edited by J.C. Yernault Physical examination of the adult patient with respiratory diseases: inspection and palpation B. Maitre, T. Similowski, J-P. Derenne Physical examination of the adult patient with respiratory diseases: inspection and pal- Service de Pneumologie et de Réanimation, pation. B. Maitre, T. Similowski, J-P. Derenne. ©ERS Journals Ltd 1995. Groupe Hospitalier Pitié-Salpêtrière, Paris, ABSTRACT: Inspection of the thorax identifies the breathing position adopted by France. the patient, the shape of the thorax, the dynamics of respiration (breathing pat- tern, symmetry of expansion, mechanics and synchrony of rib cage and abdominal Correspondence: T. Similowski movements). Inspection of the neck adds useful information, particularly with Service de Pneumologie et de Réanimation respect to the dynamics of breathing. Palpation ascertains the signs suggested by Groupe Hospitalier Pitié-Salpêtrière inspection with respect to the mechanics of breathing. It also assesses the state of 47-83 Bd de l'Hôpital 75651 Paris Cedex 13 the pleura and pulmonary parenchyma by studying the tactile fremitus. It inte- France grates extrarespiratory signs, such as enlarged lymph nodes or breast abnorma- lities. Extrathoracic respiratory signs should also be systematically looked for, Keywords: Clinical examination including cyanosis, finger deformation, pulsus paradoxus, and pursed lips breath- inspection ing. palpation Interobserver agreement about respiratory signs has repeatedly been studied, and respiratory system generally found to be low, as are clinical-functional correlations.
    [Show full text]
  • Adapting to Changes in Breathing When You Have ALS
    Adapting to Changes in Breathing When You Have ALS I ALS Sec 1 O_REV_FINAL.indd 1 4/1 /17 3:04 PM I ALS Sec 10_REV_FINAL.indd 2 4/1/17 3:04 PM ADAPTING TO CHANGES IN BREATHING WHEN YOU HAVE ALS Lee Guion, MA, RRT, RCP, FAARC The Forbes Norris ALS Research and Treatment Center, An ALS Association Certified Treatment Center of Excellence and Connie Paladenech, RRT, RCP, FAARC Wake Forest Baptist Health ALS Center, An ALS Association Certified Treatment Center of Excellence ALS Sec 10_REV_FINAL.indd 1 4/1/17 3:04 PM A note to the reader: The ALS Association has developed the Living with ALS resource guides for informational and educational purposes only. The information contained in these guides is not intended to replace personalized medical assessment and management of ALS. Your doctor and other qualified health care providers must be consulted before beginning any treatment. Living with ALS Adapting to Changes in Breathing When You Have ALS Copyright © 2017 by The ALS Association. All rights reserved. ALS Sec 10_REV_FINAL.indd 2 4/1/17 3:04 PM TABLE OF CONTENTS INTRODUCTION . 10-4 HOW THE LUNGS WORK . 10-4 MEASURING LUNG FUNCTION . 10-4 SYMPTOMS OF LUNG MUSCLE WEAKNESS . 10-7 MAXIMIZING LUNG FUNCTION . 10-8 BI-LEVEL POSITIVE AIRWAY PRESSURE (BI-LEVEL PAP) BREATHING . 10-10 ADDITIONAL BREATHING ASSISTANCE DEVICE OPTIONS . 10-14 CHALLENGES TO NONINVASIVE MECHANICAL ASSISTED BREATHING . 10-16 DIAPHRAGM PACING SYSTEM (DPS) . 10-17 A WORD ABOUT OXYGEN . 10-18 ADVANCED DECISION MAKING ABOUT RESPIRATORY SUPPORT . 10-19 SUMMARY STATEMENT .
    [Show full text]