RALES LUNG SOUNDS PLEURAL EFFUSION SKIN

Asymmetric movement may be associated with pleural disease, phrenic nerve damage, or pleural effusion.The anteroposterior diameter of the thorax may increase in COPD, leading to a “ barrel chest” appearance.When there is nail clubbing, the normal diamond-shaped “window” between the nail beds will not be seen.Place distal phalanges against each other so that both fingernails touch.

Nail bed feels spongy when pressed and springs back when released.

RALES LUNG SOUNDS PLEURAL EFFUSION SKIN

Lovibond angle ≥ 180°: angle between the base of the nail and its surrounding skin.Painless swelling of connective tissue in the distal phalanges.Hypertrophic osteoarthropathy : a syndrome (either hereditary or paraneoplastic ) that manifests with painful nail clubbing, synovial effusions, and periostitis.Fibrovascular proliferation in the region of the nail bed due to accumulation of megakaryocytes and platelets in digital vessels and subsequent local PDGF and VEGF release is suggested.Hereditary factors may predispose to clubbing.Definition: Nail clubbing is a physical finding characterized by painless swelling of the distal phalanges typically associated with chronic hypoxemia.Cyanosis: bluish discoloration of the skin and mucosa (due to deoxygenated hemoglobin ).Peripheral signs of respiratory dysfunction Tripod position: patients with emphysema and respiratory distress will lean forward while sitting, resting with their hands on their knees.Use of accessory muscles of respiration during inspiration.Obstructive breathing: prolonged exhalation.Ataxic breathing: irregular breathing in rhythm and depth.Common causes include: advanced heart failure, damage to respiratory centers (e.g., stroke, traumatic brain injuries, metabolic encephalopathies), and central sleep apnea.Results from a delay in detecting changes in ventilation and arterial carbon dioxide pressure.Cheyne-Stokes breathing: alternating periods of deep breathing followed by apnea.Common abnormal patterns of breathing include:.Inspiratory:expiratory ratio: The ratio of the inspiratory time to expiratory time during spontaneous breathing, which is normally 1:2.Hyperpnea: respiratory rate > 20/min, deep breathing.Respiratory rate 20/min, shallow breathing in adults.See also “ Normal vital signs at rest” for all age groups.

The following should be assessed: Breathing pattern

Rales lung sounds pleural effusion