Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 29 Assessment of the Respiratory System

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Anatomy and Physiology Review  Upper respiratory tract  Lower respiratory tract  Lungs  Accessory muscles of respiration  Respiratory changes associated with aging

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 Functions of the Respiratory System

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Respiratory Membrane

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 Respiratory Mucosa

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 Role of the Respiratory System

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 Patient History  Collect history of patient data on family, personal, smoking, drug use, allergies, travel, place of residence, dietary history, occupational history, and socioeconomic level.  Pack-years of smoking—number of packs smoked per day multiplied by the number of years the patient has smoked.  Assess current health problems such as cough, sputum production, chest pain, and dyspnea.

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Patient History (Cont’d)  Drug use  Allergies  Travel and geographic area of residence  Nutritional status  Cough, sputum production, chest pain, dyspnea, PND, orthopnea

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 Physical Assessment  Assessment of the nose and sinuses

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10 Physical Assessment (Cont’d)  Assessment of the pharynx, trachea, and larynx

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Physical Assessment (Cont’d)  Assessment of the lungs and thorax

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 Physical Assessment (Cont’d)  Assessment of the lungs and thorax

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Other Indicators of Respiratory Adequacy  Clubbing  Weight loss  Unevenly developed muscles  Skin and mucous membrane changes  General appearance  Endurance

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 Psychosocial Assessment  Some respiratory problems may be worsened by stress.  Chronic respiratory disease may cause changes in family roles, social isolation, and financial problems due to unemployment or disability.  Discuss coping mechanisms and offer access to support systems.

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 Laboratory Tests  Blood tests  Sputum tests  Radiographic examinations including standard chest x-rays, digital chest radiography, CT  Ventilation and perfusion scanning  Pulse oximetry

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 Pulmonary Function Testing  These tests evaluate lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation.  Patient preparation.  Procedure for performing tests at the bedside.

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17 Other Testing and Follow-Up Care  Exercise testing  Skin testing

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 Other Invasive Diagnostic Tests  Endoscopic examinations  Thoracentesis—aspiration of pleural fluid or air from the pleural space:  Patient preparation for stinging sensation and feeling of pressure  Correct position  Motionless patient  Follow-up assessment for complications

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 Thoracentesis

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20 Lung Biopsy  Performed to obtain tissue for histologic analysis, culture, or cytologic examination.  Patient preparation.  May be performed in patient’s room.

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 Lung Biopsy (Cont’d)  Follow-up care:  Assess vital signs and breath sounds at least every 4 hr for 24 hr.  Assess for respiratory distress.  Report reduced or absent breath sounds immediately.  Monitor for hemoptysis.