Quiz 2 Study Guide
Respiratory objective
Review the anatomy and physiology of the respiratory system
Two lungs
o Apex of the lung is the top, and sits 2-4 cm above inner third of
the clavicle
o Lower border of lung crosses 6th rib at MCL and 8th rib at MAL
o Lungs descend into chest cavity upon inspiration.
Right lung
o 3 lobes (RUL, RML, RLL)
Left lung
o 2 lobes (LUL, LLL)
Trachea and Major Bronchi
o Breath sounds are harsher pitched in the trachea
o Trachea L & R main bronchi lobar segmental bronchi
alveoli
Breathing
o Primary muscle of breathing is the diaphragm
o Controlled by the brainstem
o Diaphragm contracts, descends in the chest, and expands the
thoracic cavity, compresses abdominal contents.
o As thorax expands, intrathoracic pressure decreases
o Oxygen diffuses into pulmonary capillaries as CO2 exchanges
from blood into the alveoli
Procure a history and physical of the patient with respiratory disorder
Symptoms that warrant prompt medical intervention
o Inability to speak in full sentences, use of accessory muscles,
cyanosis, evidence of low oxygen, or pulsus paradoxes
Many symptoms are associated with CV diseases
SOB
o Ask: Have you had difficulty breathing?
o Does symptom occur at rest or exertion?
o How much exertion produces onset?
o How many steps or flights of stairs can the patient climb before
pausing?
o What about carrying bags of groceries? (daily activities)
o Has it affected their lifestyle?
o Elicit timing and setting of symptoms, relieving and aggravating
factors
o Anxious patients: pins and needles around lips or extremities
o Wheezes are musical sounds made by respiration
, Occurs in partial lower airway obstruction from secretions
and tissue inflammation in asthma or from foreign body
Cough
o Ranges from trivial to ominous
Can signal left sided HF
Most common cause of ACUTE is URI.
Also consider bronchitis, pneumonia, LSHF, asthma, foreign
body, smoking, ACE inhibitor therapy, pertussis, acid
reflux, bacterial sinusitis, and asthma can cause SUBACUTE
CHRONIC is seen in postnasal drip, asthma, GERD, chronic
bronchitis, or bronchiectasis
o Establish duration (acute = < 3 weeks, subacute = 3-8 weeks,
chronic = more than 8 weeks)
o Dry or productive?
o Volume of sputum?
Mucoid sputum is translucent, white, or gray and seen in
viral infections and CF.
Purulent sputum seen in bacterial pneumonia
Foul smelling = lung abscess or CF
Large volumes seen in bronchiectasis and lung abscess
o Hemoptysis?
Most commonly bronchitis, malignancy or CF
Can sometimes be coughed out from GI tract, or
nasopharynx
o Chest pain?
Myocardium = angina pectoris, MI, myocarditis
Pericardium = pericarditis
Aorta = aortic dissection
Trachea and large bronchi = bronchitis
Parietal pleura = pericarditis, pneum., pneumothorax,
Pleural eff., PE, connective tissue disease
Chest wall including skin = costochondritis, herpes zoster
Esophagus = GERD, esoph. Spasm., esoph tear
Neck, gallbladder and stomach = cervical arthritis, biliary
colic, gastritis
o Always ask patient if they have any discomfort or unpleasant
feelings in their chest!
o Lung tissue has no pain fibers
Examination
Inspection:
Start by assessing for tachypnea (>25 breaths/min)
Cyanosis or pallor
o Cyanosis in lips, tongue, or oral mucosa signal hypoxia
Respiratory objective
Review the anatomy and physiology of the respiratory system
Two lungs
o Apex of the lung is the top, and sits 2-4 cm above inner third of
the clavicle
o Lower border of lung crosses 6th rib at MCL and 8th rib at MAL
o Lungs descend into chest cavity upon inspiration.
Right lung
o 3 lobes (RUL, RML, RLL)
Left lung
o 2 lobes (LUL, LLL)
Trachea and Major Bronchi
o Breath sounds are harsher pitched in the trachea
o Trachea L & R main bronchi lobar segmental bronchi
alveoli
Breathing
o Primary muscle of breathing is the diaphragm
o Controlled by the brainstem
o Diaphragm contracts, descends in the chest, and expands the
thoracic cavity, compresses abdominal contents.
o As thorax expands, intrathoracic pressure decreases
o Oxygen diffuses into pulmonary capillaries as CO2 exchanges
from blood into the alveoli
Procure a history and physical of the patient with respiratory disorder
Symptoms that warrant prompt medical intervention
o Inability to speak in full sentences, use of accessory muscles,
cyanosis, evidence of low oxygen, or pulsus paradoxes
Many symptoms are associated with CV diseases
SOB
o Ask: Have you had difficulty breathing?
o Does symptom occur at rest or exertion?
o How much exertion produces onset?
o How many steps or flights of stairs can the patient climb before
pausing?
o What about carrying bags of groceries? (daily activities)
o Has it affected their lifestyle?
o Elicit timing and setting of symptoms, relieving and aggravating
factors
o Anxious patients: pins and needles around lips or extremities
o Wheezes are musical sounds made by respiration
, Occurs in partial lower airway obstruction from secretions
and tissue inflammation in asthma or from foreign body
Cough
o Ranges from trivial to ominous
Can signal left sided HF
Most common cause of ACUTE is URI.
Also consider bronchitis, pneumonia, LSHF, asthma, foreign
body, smoking, ACE inhibitor therapy, pertussis, acid
reflux, bacterial sinusitis, and asthma can cause SUBACUTE
CHRONIC is seen in postnasal drip, asthma, GERD, chronic
bronchitis, or bronchiectasis
o Establish duration (acute = < 3 weeks, subacute = 3-8 weeks,
chronic = more than 8 weeks)
o Dry or productive?
o Volume of sputum?
Mucoid sputum is translucent, white, or gray and seen in
viral infections and CF.
Purulent sputum seen in bacterial pneumonia
Foul smelling = lung abscess or CF
Large volumes seen in bronchiectasis and lung abscess
o Hemoptysis?
Most commonly bronchitis, malignancy or CF
Can sometimes be coughed out from GI tract, or
nasopharynx
o Chest pain?
Myocardium = angina pectoris, MI, myocarditis
Pericardium = pericarditis
Aorta = aortic dissection
Trachea and large bronchi = bronchitis
Parietal pleura = pericarditis, pneum., pneumothorax,
Pleural eff., PE, connective tissue disease
Chest wall including skin = costochondritis, herpes zoster
Esophagus = GERD, esoph. Spasm., esoph tear
Neck, gallbladder and stomach = cervical arthritis, biliary
colic, gastritis
o Always ask patient if they have any discomfort or unpleasant
feelings in their chest!
o Lung tissue has no pain fibers
Examination
Inspection:
Start by assessing for tachypnea (>25 breaths/min)
Cyanosis or pallor
o Cyanosis in lips, tongue, or oral mucosa signal hypoxia
