Auscultation: Breath sounds vary in intensity, volume, and duration, depending on the site along the tracheobronchoalveolar system. In the upper part of the respiratory tree, over the trachea, breath sounds should be bronchial, Over the bronchi, the bronchovesicular sounds are of a medium intensity while the vesicular sounds over the peripheral lung tissue are, softer in volume with a shorter expiratory phase (Jo & Laurie 2014). In abnormal findings, there is increased breath sounds over peripheral lung regions indicate consolidation, usually seen with pneumonia. Decreased, or softer, peripheral breath sounds can also be heard as a when there is bronchial obstruction or pleural effusion. (Jo & Laurie 2014) Palpation: In determining the respiratory
The contraction of the inspiratory muscles increases the volume of the thoracic cavity causing the pressure within the alveoli to decrease and air to flow into the alveoli. During resting inspiration, the diaphragm, the external intercostals and the parasternal intercostals contract to stimulate inspiration. During forced inspiration the scalene and the sternocleidomastoid muscles contract to further expand the thoracic cavity. The pectoralis minor muscles also play a minor role in forced inspiration. During quiet breathing, relaxation of these muscles causes the volume of the thoracic cavity to decrease, resulting in expiration. During a forced expiration, the compression of the chest cavity is increased by contraction of the internal intercostal muscles and various abdominal
Additionally, some of the general diagnostic and pulmonary function tests are distinct in emphysema in comparison to chronic bronchitis. In the case of R.S. the arterial blood gas (ABG) values are the following: pH=7.32, PaCO2= 60mm Hg, PaO2= 50 mm Hg, HCO3- = 80mEq/L. R.S.’s laboratory findings are indicative of chronic bronchitis, where the pH and PaO2 are decreased, whereas PaCO2 and HCO3- are increased, when compare to normal indices. Based on the arterial blood gas evaluation, the physician can deduce that the increased carbon dioxide is due to the airway obstruction displayed by the hypoventilation. Furthermore the excessive mucus production in chronic bronchitis hinders proper oxygenation leading to the hypoxia. On the other hand, in emphysema the arterial blood gas values would include a low to normal PaCO2 and only a slight decrease in PaO2 which tend to occur in the later disease stages.
Air then travels to the bronchioles which are narrow (bronchoconstriction) due to the natural defence in keeping irritants out of the airway, causing wheezing breath sounds.(Eldridge, 2016) The air then proceeds to the alveoli, which are weakened and damaged air sacs due to the progression of the disease, that are unable to efficiently move O2 into the blood stream and gas exchange CO2 to be expelled through exhale, causing hypoxemia, lethargy, dyspnoea and high CO2 reading. (“Lung conditions - chronic obstructive pulmonary disease (COPD),”
Healthy lung tissue is predominately soft, elastic connective tissue, designed to slide easily over the thorax with each breath. The lungs are covered with visceral pleura which glide fluidly over the parietal pleura of the thoracic cavity thanks to the serous secretion of pleural fluid (Marieb, 2006, p. 430). During inhalation, the lungs expand with air, similar to filling a balloon. The pliable latex of the balloon allows it to expand, just as the pliability of lungs and their components allows for expansion. During exhalation, the volume of air decrease causing a deflation, similar to letting air out of the balloon. However, unlike a balloon, the paired lungs are not filled with empty spaces; the bronchi enter the lungs and subdivide progressively smaller into bronchioles, a network of conducting passageways leading to the alveoli (Marieb, 2006, p. 433). Alveoli are small air sacs in the respiratory zone. The respiratory zone also consists of bronchioles and alveolar ducts, and is responsible for the exchange of oxygen and carbon dioxide (Marieb, 2006, p. 433).
Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored.
The ability to carry out and document a full respiratory and cardiovascular assessment is an essential skill. The severity of illness can be initially evaluated by inspection, palpation, percussion, and auscultation. During analysis, specific locations of symptoms can be identified using landmarks such as the midaxiallary, midclavicular, and, the midsternal line. Indicate anterior or posterior thorax, and use the midaxillary line location when applicable (Bickley & Szilagyi, 2013).
Person, A. & Mintz, M., (2006), Anatomy and Physiology of the Respiratory Tract, Disorders of the Respiratory Tract, pp. 11-17, New Jersey: Human Press Inc.
Unpleasant breathlessness that comes on suddenly or without expectation can be due to a serious underlying medical condition. Pneumonia can impact the very young and very old, asthma tends to affect young children, smokers are at greater risk of lung and heart disease and the elderly may develop heart failure. However, medical attention always needed by all these conditions as it can affect any age group and severe breathlessnes. There are short and long term causes of dyspnea. Sudden and unexpected breathlessness is most likely tend to be caused by one of the following health conditions. There is accumulating evidence that in many patients, dyspnea is multifactorial in causes, and that in most patients, there is no single, all-encompassing explanation for dyspnea.
The clinical manifestation one may see in patients with chronic bronchitis are chronic cough, weight loss, excessive sputum, and dyspnea. Chronic cough is from the body trying to expel the excessive mucus build up to return breathing back to normal. Dyspnea is from the thickening of the bronchial walls causing constriction, thereby altering the breathing pattern. This causes the body to use other surrounding muscles to help with breathing which can be exhausting. These patients ca...
When you think of the “land down under” you don’t really think of the kind of government they have. I chose to write about the Australian government because I really don’t hear much about Australia. It currently has a pretty interesting story to tell when it comes to their government. I became a bit interested in Australian politics when I saw a political animated cartoon on the internet that depicted Kevin Rudd, the last Prime Minister, on a news television show and it was quite humorous. I am going to give a quick history lesson on Australia then go into how the government formed and came to be. Then I will talk about the Australian constitution, the Australian arms of government, their federal system, political parties and Australia’s current Prime Minister.
The idea of the globalisation of Australian businesses, the process where businesses develop themselves internationally is one of the main issues in our current society. The concept of globalisation has occurred due to many factors, such as reduced trade barriers, a reduction in tariffs and quotas, new developments in technology and also new innovations in transportation technology. These factors that have caused globalisation can result in many consequences, both positive and negative. These consequences are free trade caused by a reduction in tariffs and environmental costs such as pollution caused by factories and greenhouse gasses causing global warming.
Nursing Diagnosis I for Patient R.M. is ineffective airway clearance related to retained secretions. This is evidenced by a weak unproductive cough and by both objective and subjective data. Objective data includes diagnosis of pneumonia, functional decline, and dyspnea. Subjective data include the patient’s complaints of feeling short of breath, even with assistance with basic ADLs. This is a crucial nursing diagnosis as pneumonia is a serious condition that is the eighth leading cause of death in the United States and the number one cause of death from infectious diseases (Lemon, & Burke, 2011). It is vital to keep the airway clear of the mucus that may be produced from the inflammatory response of pneumonia. This care plan is increasingly important because of R.M.'s state of functional decline; he is unable to perform ADL and to elicit a strong cough by himself due to his slouched posture. Respiratory infections and in this case, pneumonia, will further impair the airway (Lemon, & Burke, 2011). Because of the combination of pneumonia and R.M's other diagnoses of lifelong asthma, it is imperative that the nursing care plan of ineffective airway clearance be carried out. The first goal of this care plan was to have the patient breathe deeply and cough to remove secretions. It is important that the nurse help the patient deep breathe in an upright position; this is the best position for chest expansion, which promotes expansion and ventilation of all lung fields (Sparks and Taylor, 2011). It is also important the nurse teach the patient an easily performed cough technique and help mobilize the patient with ADL's. This helps the patient learn to cough and clear their airways without fatigue (Sparks a...
There are 2 types of breathing, costal and diaphragmatic breathing (Berman, 2015). Costal refers to the intercostal and accessory muscles while diaphragmatic refers to breathing using your diaphragm (Berman, 2015).It is important to understand the two different types of breathing because it is vital in the assessment of the patient. For example, if a patient is suing their accessory muscles to aid in breathing then we can safely assume that they are having breathing problems and use a focused assessment of their respiration. Assessing respiration is fairly straightforward. The patient’s respiration rate can be affected by anxiety so a useful to avoid this is to check pulse first and after you have finished that, while still holding their pulse point, check their respiration rate. Inconspicuous assessment avoids the patient changing their breathing because they know they are being assessed which patients can sometimes do subconsciously. Through textbooks and practical classes I have learned what to be aware of while assessing a patient’s respiratory rate. For example; their normal breathing pattern, if and how their health problems are affecting their breathing, any medications that could affect their respiratory rate and also the rate, depth, rhythm and quality of their breathing (Berman, 2015). The only problem I found while assessing respiration rate was I thought it seemed a bit invasive looking at the
While quiet breathing, external intercostal muscles contract, which causes the ribcage to expand and move up. The diaphragm then contracts and moves down. The volume of the chest cavity increases, the lungs expand and the pressure inside the lungs decreases. Air then flows into the lungs in response to the pressure gradient. Inspiration (inhalation or breathing in) is accomplished by increasing the space, therefore decreasing the
There are two articulators that combine in the production of a consonant : an active organ (articulator) which is a movable one that moves towards the second organ (articulator) which is a passive one (or unmovable one) to form a blockage in the passage of the airstream and cause an audible friction. This blockage may be complete or partial (Omar, 1997:132-135). Since, there is a complete blockage at some points in the vocal tract i.e. , the oral cavity, nasal articulation requires a free passage of airstream which is the nose (i.e., the nasal cavity) (Robins, 2014: 84). Consonants are articulated either with a total obstruction of the air passage or with a narrow oral passage so that the air 43 escapes with friction. Consonants are classified depending on the state of the glottis (the vocal cords) during their articulation, the place of articulation and the manner in which a sound is articulated (Al-Hattimi, 2010: 272 and Todd, 1987:14).