Have patient sit upright and use diaphragm end of stethoscope over bare skin

Have patient sit upright and use diaphragm end of

This preview shows page 5 - 7 out of 50 pages.

Have patient sit upright and use diaphragm end of stethoscope over bare skin Second intercostal space, midclavicular line o Airflow through larger conducting airways (structures still supported by cartilage) o Abnormal sounds heard best here = stridor and rhonchi Third intercostal space, anterior axillary line or fourth intercostal space, midaxillary line o Airflow through bronchioles; might also hear airflow into alveoli o Abnormal breath sounds heard best = wheezing Fifth-sixth intercostal space, posterior midscapular line o Airflow to alveoli (best location to hear alveolar airflow) o Abnormal sound heard here most commonly = rales (crackles) Three basic types of abnormal breath sounds (early indicators of impending r. distress): o Wheezing: high-pitched whistling sound best heard initially on exhalation (inspiration = more severe) Indication of swelling/constriction of inner lining of lower airways (bronchioles) Diffuse = primary indication for administration of beta2 agonist medication by metered-dose inhaler or small-volume nebulizer Usually heard in asthma, emphysema, chronic bronchitis; also in pneumonia, congestive heart failure, other conditions causing bronchoconstriction o Rhonchi: snoring/rattle noises; coarse crackles; quality of sound changes if person coughs/changes position Indicate obstruction of larger conducting airways by thick secretions of mucus Often heard in chronic bronchitis, emphysema, aspiration, pneumonia o Crackles (rales): bubbly/crackling sound heard during inhalation; does not change with coughing/movement Associated w fluid surrounding/filling alveoli/small bronchioles Posterior bases of lungs reveal crackles first (fluid pulled downward) Can indicate pulmonary edema or pneumonia Respiratory Distress Failing to breathe adequately can result in hypoxemia (low O2 in arterial blood) and hypercarbia (increased CO2 in bloodstream) o Hypoxia: reduced O2 to cells; cells begin to die/become irritable (function abnormally) Common findings of respiratory distress: o Subjective complaint of shortness of breath o Restlessness/anxiety o Tachycardia (early finding) or bradycardia (late finding)
Image of page 5
o Tachypnea o Pale, cool, clammy skin (early) or cyanosis (late) o Abnormal respiratory pattern o Wheezing, rhonchi, or crackles o Difficulty/inability to speak o Muscle retractions (difficulty inhaling through constricted airways or difficulty expanding lungs against poor compliance) o Altered mental status Anxiety/confusion (early) Aggressive or complacent behavior (late) Sleepiness (late) o Abdominal breathing (difficulty exhaling through constricted airways) o Excessive coughing o Tripod position (leaning forward, braced w arms and elbows locked, hands on knees) o Pulse oximetry < 94% Many complaints result from significant narrowing of lower airways from inflammation, swelling, or bronchoconstriction o Causes drastic increase in resistance to airflow in lower airways, making inhalation and
Image of page 6
Image of page 7

You've reached the end of your free preview.

Want to read all 50 pages?

  • Fall '19
  • Paul Palmiotto

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

Stuck? We have tutors online 24/7 who can help you get unstuck.
A+ icon
Ask Expert Tutors You can ask You can ask You can ask (will expire )
Answers in as fast as 15 minutes