Nursing 2220 The Respiratory System Nursing Assessment (Auscultation) By Ginger VanDenBerg

Respiratory & Auscultation Course Objectives Discuss upper and lower respiratory anatomy Discuss ventilation versus oxygenation Identify nursing auscultation assessment of the respiratory system Define assessment of normal versus abnormal respiratory sounds

Respiratory Anatomy Overview Upper Respiratory System -Nasal Cavity -Oral Cavity -Pharnyx

Respiratory Anatomy Overview Lower Respiratory System -Larnyx (Opening of the trachea) -Trachea (Windpipe) -Lungs (right/left) -Bronchus (divides into right/left) Upper & Lower Respiratory anatomy is consider to be the CONDUCTING portion No Gas Exchange Occurs

Respiratory Anatomy Overview Terminal Bronchioles (<1mm diameter Alveolar Ducts Alveolar Sacs -Actual units of gaseous exchange in lungs Respiratory bronchioles to alveoli is consider to be the Respiratory Portion Gas Exchange does occur

Structures of the upper airway include all of the following except? POP Quiz Structures of the upper airway include all of the following except? Nasal Cavity Oral Cavity Pharnyx Larnyx

Nursing Auscultation Assessment Place the diaphragm of your stethoscope over the posterior chest between the ribs Ask patient to take slow – deep breaths Listen to an entire inspiration & expiration cycle at each position Compare the sounds in one region to sounds in the same region on the opposite side Anterior follows same pattern as posterior, with attention to the lower lobes for increased secretions

Normal Breath Sounds Posterior Thorax Posterior Thorax Sounds Bronchovesicular – medium pitched blowing sounds, between the scapulae. Equal inspiratory & expiratory phases Vesicular- heard over the lung periphery, smaller airways, soft & low pitched. Inspiratory phase is about 3x longer than expiratory phase

Normal Breath Sounds Anterior Thorax Anterior Thorax Sounds Bronchovesicular & vesicular sounds-are heard above & below the clavicles and along the lung periphery Bronchial-loud, high pitched, hollow sound, heard over the trachea, expiration last longer than inspiration

POP Quiz During auscultation the nurse compares lung sounds on one side of the body to lung sounds in the same field on the opposite of the body? True False

Abnormal Breath Sounds (Adventitious) Crackles-heard in dependent lobes, lung bases, sudden reinflation of alveoli. Bowl of rice krispies Ronchi-heard over trachea & bronchi, caused by muscular spasm, fluid or mucus in larger airways, turbulent sound Wheezes-heard over all lung fields, high-velocity airflow through narrow bronchus Pleural friction rub-heard over anterior lung surface, parietal pleura rubbing against visceral pleura

The following lungs sounds are considered to be advantitious except? Final POP Quiz The following lungs sounds are considered to be advantitious except? Crackles Ronchi Vescular Wheezes

The End Questions and Answers Please referred to the our assigned discussion board for questions and answers

References Nursing Assessing Lung Sounds (n.d.). Retrieved from http://www.barcharts.com/Inventory/Navision/97815722276133. Potter, P. A., Perry, A. G., Stocker, P. A. & Hall, A. (2010). Basic Nursing (7th ed.), St. Louis, MO: Elsevier Health Science. Respiratory System (n.d.). Retrieved from http://www.medical/exam-essentials.com/respiratory-system- diagram.html.