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Islamic University of Gaza Faculty of Nursing. Chapter 7 Assessment of respiratory system. Anatomy of Respiratory System. Nasopharynx Larynx Trachea Bronchi Bronchioles Alveoli. Assessment of respiratory system cont. Subjective data: * you must ask about:-

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islamic university of gaza faculty of nursing
Islamic University of GazaFaculty of Nursing

Chapter 7

Assessment of respiratory system

anatomy of respiratory system
Anatomy of Respiratory System
  • Nasopharynx
  • Larynx
  • Trachea
  • Bronchi
  • Bronchioles
  • Alveoli
assessment of respiratory system cont
Assessment of respiratory system cont..

Subjective data:

* you must ask about:-

  • Coughing (productive, non productive)
  • Sputum (type & amount)
  • allergies, dyspnea or SOB (at rest or on exertion).
  • Chest pain, history of asthma, bronchitis, emphysema, tuberculosis.
  • Cyanosis, pallor.
  • Exposure to environmental inhalants (chemicals, fumes).
  • History of smoking (amount and length of time)

Respiratory tract extends from mouth/nose to alveoli

Upper airway filters airborne particles, humidifies and warms inspired gases

Lower airway serves for gas exchange

technique for respiratory exam
Technique for Respiratory Exam
  • Before beginning, if possible:
    • Quiet environment
    • Proper positioning (patient sitting for posterior thorax exam, supine for anterior thorax exam)
    • Expose skin for auscultation
    • Patient comfort, warm hands and diaphragm of stethoscope, be considerate of women (drape sheet to cover chest)
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
initial respiratory survey
Initial Respiratory Survey
  • Observe the patient’s breathing pattern
    • Rate (normal vs. increased/decreased)
    • Depth (shallow vs. deep)
    • Effort (any sign of accessory muscle use, inspect neck)
  • Assess the patient’s color
    • cyanosis
normal respiratory rates
Normal Respiratory Rates
  • Infant 30-60
  • Toddler 24-40
  • Preschooler 22-34
  • School-age child 18-30
  • Adolescent 12-16
  • Adult 16-20
assessment of respiratory system cont8
Assessment of respiratory system cont..
  • Inspection for Measurement and assessment of respiration patterns.
  • Assess the skin and overall symmetry and integrity of the thorax.
  • Assess thoracic configuration.
  • ** Client must be uncovered to the waist, and in sitting position without support.
  • * Observation of skin may give you knowledge about, nutritional status of the client.
  • * Anterior- posterior diameter of thorax in normal person less than the transverse diameter = (1 – 2).
  • * Assess for abnormality of configuration, e.g. pigeon chest, funnel chest, spinal deformities.
Assess ribs and inter spaces on respiration – may give you in formation about obstruction in air flow e.g. bulging of inter spaces on expiration may be from obstruction to air out flow “tumor, aneurysm, cardiac enlargement”

*Assess pattern of respiration:

  • Normally: men and children – breathe diaphragmatically and Women breathe thoracically or costally.
  • Tachypnea: respiratory rate over than 20/m.
  • Bradypnea: respiratory rate less than 10/m.
  • * Palpation: palpate areas of chest especially areas of abnormalities.
  • If clients complains: all chest areas must palpated carefully for tenderness, bulges, or al movements
Assess thoracic expansion:
  • Anterior – put your hands over anterior-lateral chest and thumbs extended along costal margin pointing to xiphoid process.
  • Posterior—thumbs placed at level of 10th rib with palms placed on posterior-lateral chest.
  • ** By two ways – you feel amount of thoracic expansion during quiet and deep breathing, and symmetry of respiration between left and right hemi thoraces.
  • * Assessment of fremitus: which is vibration perceptible on palpation".
  • * In subcutaneous emphysema: you must palpate the tissue, audible cracking sounds are heard – these sounds are termed “Crepitations”.
Percussion of chest: to determine relative amounts of air, liquid, or solid material in the underlying lung, and to determine positions and boundaries of organs.
  • * Percussion done for posterior and anterior and lateral aspects of chest with all directions, and with about “5”cms intervals.
  • * Auscultation: To obtains information about the function of respiratory system & to detect any obstruction in the passages.
  • * Instruct the client to breathe through the mouth more deeply and slowly than in usual respiration before beginning
  • Auscultate all areas of chest for at least one complete respiration
auscultation cont
Auscultation cont..
  • 12 anterior locations
  • 14 posterior locations
  • Auscultate symmetrically
  • Should listen to at least 6 locations anteriorly and posteriorly
Breathe sounds: are analyzed according to pitch, intensity, quality, and relative duration of inspiratory and expiratory phases.
  • * Bronchial breathe sounds: are normally heard over the trachea, if heard over lung tissue – indicate pathologic condition, these sounds “high- pitched, loud sounds with decrease inspiratory and lengthened increase expiratory phases.
  • Absent or decreased breath sounds can occur in:
  • Foreign body – in pleural space.
  • Bronchial obstruction.
  • Shallow breathing.
  • Emphysema
normal breath sounds
Normal Breath Sounds
  • Tracheal
    • Very loud, high pitched sound
    • Inspiratory = Expiratory sound duration
    • Heard over trachea
  • Bronchial
    • Loud, high pitched sound
    • Expiratory sounds > Inspiratory sounds
    • Heard over manubrium of sternum
    • If heard in any other location suggestive of consolidation
Rale: is short, discrete, interrupted, crackling or bubbling sound that most commonly heard during inspiration “similar to sounds, produced by hairs being rolled between the fingers close to ear.”
  • * Important points when Auscultate rales:
  • low pitched, coarse rales, occurring early in inspiration means bronchitis “originate from bronchi”
  • Medium pitched rales in mid-inspiration means disease in small bronchi e.g. bronchiectasis.
  • High pitched, fine rales means disease affecting bronchioles and alveoli this occurs in late inspiration
* Rhonchi: are continuous sounds produced by movements of air through narrowed passages in the tracheal- bronchial tree "musical sounds heard in expiration".
  • Low pitched rhonchi“Sonorous rhonchi usually heard in early expiration originate in larger bronchi”
  • High pitched: “Sibilant rhonchi or wheezes” – in late expiration, this originates in small bronchioles.
  • Stridor
    • Inspiratory musical wheeze
    • Loudest over trachea
    • Suggests obstructed trachea or larynx
    • Medical emergency requiring immediate attention
    • Associated condition inhaled foreign body
  • * Pleural friction rub: is aloud dry, cracking or grating sound indicating of pleural irritation, heard over lateral and anterior lung in sitting position &not clear with coughing )
causes of decreased or absent breath sounds
Causes of Decreased or Absent Breath Sounds
  • Asthma
  • COPD
  • Pleural Effusion
  • Pneumothorax
  • Atelectasis

Common Respiratory Disorders

  • Pneumonia: Community-acquired pneumonia
  • Hospital-acquired pneumonia
  • Bacteria
  • Viruses
  • Mycoplasma
  • Fungi
  • Chemical
common respiratory disorders cont
Common Respiratory Disorders cont..
  • Pleural EffusionAccumulation of pleural fluid secondary to increased fluid formation
    • Increased capillary permeability
    • Deceased colloid osmotic pressure of the blood
    • Increased intrapleural negative pressure
    • Impaired lymphatic drainage
    • Increased pressure in the capillaries or lymphatics
common respiratory disorders cont21
Common Respiratory Disorders cont..
  • PneumothoraxSudden onset of pleuritic chest pain
    • Dyspnea, shortness of breath, increased work of breathing
  • Diagnostic test
    • CXR
  • Management
    • Oxygen
    • Possible placement of chest tube
common respiratory disorders cont22
Common Respiratory Disorders cont..
  • Pulmonary Embolism Part of a deep vein thrombosis that has traveled and lodged in the pulmonary arteries
  • Severity depends on the extent of occlusion
  • Mismatch of ventilation and perfusion
  • Testing ( pulmonary angiogram)
common respiratory disorders cont24
Common Respiratory Disorders cont..
  • COPD History
    • Exposure to risk factors, co-morbidities, current medical treatment (beta blockers)
  • Tests
    • Spirometry, ABGs
  • Management
    • Oxygen, education, drug therapy, nutrition, exercise, surgical intervention
common respiratory disorders cont25
Common Respiratory Disorders cont..
  • AsthmaA chronic inflammatory disease of the airways
  • Airway hyper responsiveness
  • Variable airway obstruction
  • Resolves spontaneously or after using a bronchodilator
  • Testing :
    • Spirometry
    • Pulmonary function testing
  • Management
    • Education, prevent exacerbation, optimize pharmacotherapy
common respiratory disorders cont26
Common Respiratory Disorders cont..
  • Acute Respiratory FailureA sudden and life–threatening deterioration in gas exchange
  • Type I – Acute hypoxemic respiratory failure
  • Type II - Acute hypercapnic respiratory failure
  • Type III – Combined hypoxemic and hypercapnic failure
  • Tests
    • ABGs, CXR, CT, thoracentesis
  • Management
    • Correction of gases, oxygen therapy
    • Reversal of any narcotics
    • Possible mechanical ventilation
the end
The end

Thank you