Physical Assessment of the Respiratory System PROFESSORB DR M.ABD ELAZIZ

Inspection Kyphosis – AKA Hunchback – Abnormal curvature of the thoracic spine

Inspection Lordosis – AKA Sway-back – Abnormal curvature of the lumbar spine

Inspection: Breathing patterns Rate Eupnea – Normal – / min Tachypnea –  rate – Pnuemonia, pulm edema, acidosis, septicemia, pain Bradypnea –  rate –  ICP, drug OD

Inspection: Breathing patterns Depth Hyperpnea –  depth Hyperventilation –  depth & rate Hypoventilation –  depth & rate

Inspection: Breathing patterns Rhythm Apnea – Not breathing Cheyne-stokes – Varying depth f/b apnea – Death rattles – Death rales

Percussion: results Resonance – drum like – Normal Hyper-resonance – Too much air – Emphysema Flatness / dull – Fluid or solid – Pleural effusion – Pneumonia – Tumor

Auscultation Purpose Asses air flow through bronchial tree Procedure Diaphragm of stethoscope Superior  inferior Compare rt to lf

Quiz? A child with difficulty breathing and a “ barking ” cough id displaying signs associated with which condition? A.Asthma B.Croup C.Cystic fibrosis D.Epiglottitis

Quiz? When assessing the lung sounds of a child with asthma, which sound are you most likely to hear? A.Murmurs B.Sibilant Wheezing C.Crackles D.Pleural friction rub

Early & late signs of hypoxia Anxiety Bradycardia Cyanosis Depressed respirations Diaphoresis Disorientation Dyspnea Restlessness Headache Agitation Poor judgment Retraction Tachycardia Tachypnea

which of the following as an early sign of hypoxia? A.Restlessness, yawning & tachycardia B.Dyspnea, confusion & bradycardia C.Bradycardia, hypotension dyspnea D.Dyspnea, restlessness, hypotension

Dyspnea Definition – SOB – SOB, flat affect, BS x 4

Dyspnea Significance – Common with cardiac & resp. disease – Sudden onset – healthy person  Pneumothorax – Sudden onset ill, post-op or injury  Pulmonary emboli

Dyspnea Orthopnea – Sit up to breath COPD CHF

Dyspnea Right ventricle – If chronic airway resistance  –  pressure  – Rt ventricle  work  – Rt. Vent damage

Dyspnea Management – Find cause – Give O 2 – HOB  – Communication

Cough Definition – To expel air from the lungs suddenly – Irritation of mucous membrane

Cough Significance – Infection – Irritants – Protective mechanism – Dry, irritating URT – Cough + chest pain Pleural or musculoskeletal

Cough management – Assess – Describe – Directed – Pain control Splinting – Infection control – Suppressants / Anti-tussives

Sputum Production Definition Matter discharged from resp. track that contains mucus and pus, blood, fibrin, or bacteria

Sputum Production Significance Purulent – Thick, yellow/green – Bacteria Rusty – Strep or staph Thin, mucous – Viral

Sputum Production Pink-tinged – Lung CA – TB Pink tinged, profuse, frothy – Pulmonary edema Malodorous – Lung abscess

Sputum Production Management Thick – Hydrate  water Nebulizer Humidifier No smoking Oral care  Appetite

Obtaining a sputum specimen Explain – From lungs Sterile cup Deep breath x 3  Cough deeply Expectorate Best time for specimen collection? – AM

Chest pain Definition Cardiac or pulmonary

Chest pain Significance CA (late stage) Pneumonia Pulmonary embolism Pleurisy

Chest pain Pleurisy – Inflammation of pleura – Sharp with breath –  breath sounds

What????? What breath sound would you expect to hear on a patient suffering from pleurisy? A.Crackles B.Sonorous wheezes C.Sibilant wheezes D.Pleural Friction Rub

Chest pain Management Assess Analgesics OK, but … Position for pain – Affected side – Splint

Clubbed fingers Definition Sponginess of the nail bed Loss of the nail bed angle Finger tip is round and bulbous

Clubbed Finger Significance chronic hypoxia

Mr. Caveman: Mr. Caveman enters the ER unconscious following an Automobile accident. The paramedics report that his O2 sats are 86%. You note that Mr. Caveman has clubbed fingers. What does this tell you?

Hemoptysis Definition Expectoration of blood from the respiratory tract

Hemoptysis Significance Pulm or cardiac Common causes – Pulm infection – CA of lungs – Pulm. Emboli – Pulm. Infarction – TB

Hemoptysis – Definition? Coughed up blood – From? Pulm hemorrhage – Description Pink, red, mixed with sputum – Blood pH Alkaline blood Hematemesis – Definition? Vomited blood – From? Stomach / GI – Description “ Coffee ground ” – Blood ph Acidic blood

Hemoptysis Management Determine source Serious

Cyanosis Definition Bluish coloring of skin

Cyanosis Significance Very late indicator of hypoxia Appears when O2 sats < 85% NOT a reliable sign of hypoxia – Esp. with anemia

Cyanosis O2 sat definition – % of hemoglobin carrying oxygen compared to total # of hemoglobin

Cyanosis Normal Breath 100 O2 molecules  98 cross into blood Blood: 100 Hgb O2 SATS – 98% – No cyanosis

Cyanosis Hypoxia Breath 100 O2 molecules  75 cross into blood Blood: 100 Hgb O2 SATS – 75% – Cyanosis

Cyanosis Anemic and hypoxic Breath 100 O2 molecules  75 cross into blood Blood: 75 Hgb O2 SATS – 100% – No Cyanosis

Cyanosis Management Know color of Pt. skin Assess color of tongue & lips Fingernail polish African-American Vasoconstriction (cold weather)  peripheral cyanosis