Respiratory Assessment Case Study with Lung Sounds!!

I have found what has to be the BEST case study for respiratory assessment!! It even has lung sounds (really really juicy ones too)

Trouble is - no answers

So I figure we can all have a go. You don't have to answer every question - you need only have a go at one or two or none and just lurk. You don't have to get 100% - in fact it might be good for the newer people to omit something or have something not quite right so that someone else can pick up on something too. Play devils advocate if you will.

There is no wrong answers just some that will be more right than others.

When enough people have had a turn at answering I will post answers that I have researched and validated.
Sweetie, you forgot the link!!!

That is what I get for posting after night dutyhttp://mtsu32.mtsu.edu:11019/cases/shipp.html

Quote from gwenith That is what I get for posting after night dutyhttp://mtsu32.mtsu.edu:11019/cases/shipp.html

Quote from gwenith That is what I get for posting after night dutyhttp://mtsu32.mtsu.edu:11019/cases/shipp.html

Do you think he might be barrel chested?

Quote from gwenithDo you think he might be barrel chested?

Here are a couple of good resources on COPDhttp://www.emedicine.com/EMERG/topic99.htmhttp://www.hypertension-consult.com/...k/51_COPD1.htmhttp://www.aaaai.org/aadmc/resdigest/buist.pdfhttp://www.rcpe.ac.uk/publications/a..._statement.pdfhttp://www.merck.com/mrkshared/mm_ge...sec10/ch78.jspBlue bloater/pink puffers Deadful names and classifications but great memonics.Blue bloaters have a poor respiratory drive.Features include:dyspnoea is quite mildthe patient is often obeselarge volumes of sputum are producedinfective exacerbationspatient often oedematousmay develop cor pulmonalePink puffers have a good respiratory drive.Features include:purse-lip breathing with intense dyspnoeapatient is often thin and elderlylittle sputum producedoedema and overt heart failure are rare complicationsInvestigations:blood gases are near normal until pre-terminallythere is very severe airways obstructiontotal lung capacity is increasedreduction in transfer factor

I LIKE this one - it takes a running hit at the Blue Bloater/Pink Puffer classification which IS correct as those terms have been superceded but they still remain good memonicsThere are no specific findings on examination, although signs of hyperinflation of the chest are highly suggestive of emphysema. These include a barrel shaped chest (increased antero-posterior diameter), use of accessory muscles of respiration, reduction of the cricosternal distance, tracheal tug, paradoxical indrawing of the lower ribs on inspiration (Hoover's sign), intercostal recession, hollowing out of the supraclavicular fossae, pursed lip breathing and reduced expansion. In addition the patient may have hyperresonant lung fields, prolongation of expiration, especially forced expiration >5s, and audible wheeze. None of these signs are specific to COPD and do not correlate very well with the severity of the disease which emphasises the need for objective assessment. Their presence, however, should alert the physician to the possible diagnosis of COPD.As the disease progresses, signs of right ventricular dysfunction may develop (Cor pulmonale) because of the effects chronic hypoxaemia and hypercapnia which include peripheral oedema, raised jugular venous pressure, hepatic congestion, and the presence of metabolic flapping tremor. Despite the widely held belief that these signs are due to right ventricular failure, the pathophysiology cor pulmonale is likely to be due to altered renal function giving rise to salt and water retention rather than cardiac dysfunction secondary to pulmonary hypertension.

I'm going to have to try this at work. Those wav files take about 10 minutes each to download for me. Hard to see his hands but the nailbeds look like they are bluish too. He looks pretty bony. I'm betting he has poor appetite and weight loss history as well.

I agree with Aimee, the nailbeds and the lips are somewhat bluish, in addition to the orthopneic positioning, facial grimacing, pursed-lip breathing, sternal retractions.OK, I'm playing. Here goes:Inspection/auscultation:Because he's losing consciousness AEB his inability to follow simple commands and his inability to talk, I would think he might need intubation before this gets much worse. The right lung has crackles at the top and expiratory wheezes that worsen throughout the mid and lower sections. Overall, the right lung sounds "tight" and constricted. The absence of sputum, the high WBC, and the rising temp seem to indicate pneumonia and possible atelectasis going on there.The left lung sounds somewhat better till you get to the apex of the heart, where there's a noise that might be (and here I'm really going out on a limb but here goes) pulmonary stenosis. So this guy is having an exacerbation of a chronic condition, I'm still thinking a bacterial infection versus a viral type.If this were an actual patient, I'd be on the phone to get Respiratory and trying a nonrebreather till we got ABGs and intubation equipment setup. That high, irregular heart rate is scary. I have to wonder how the heck his EKG is showing NSR (which means his HR is regular and 60 BPM or less) according to the problem. Like, Dude, where's my monitor? So I'm ignoring the EKG results--they're inconsistent with the patient's condition. I'd put our staff on alert for possible Code, with the crash cart outside the door. Because You Never Know.And that's as far as I got because shoot! hafta get hubby off to work....This is a fascinating thread! Just what I needed today!

Here are a couple of lung sounds sites to help those who need a brush up on this skill.http://www.lumen.luc.edu/lumen/MedEd...d/a-sounds.htm(Unfortunately the first two recordings don't seem to work but the rest on that site do)This site shows lung sound measurementhttp://www.ymec.com/hp/signal2/lung2.htmThis site has links to both the rale repository and the University of Loyolahttp://www.rnceus.com/resp/respabn.html

Angie is the only one to have had a crack at the lung sounds and what she said is pretty darn good. However because the inspiratory/expiratory noise that is heard is low pitched and not high pitched I would opt for calling it rhonchi and not a wheeze. Anyone want to add an opinion???Don't be shy - you can disagree, agree whatever!!! There is no right or wrong here.