1. Assessment of the Respiratory System
Chapter 27
Assessment of the
Respiratory System

2. Anatomy & Physiology Review
Upper respiratory tract
Lower respiratory tract
Lungs
Accessory muscles of respiration
Oxygen delivery and the oxygen-hemoglobin dissociation curve

3. Role of the Respiratory System

4. Relevant Patient History
Family and personal data
Smoking (pack-years)
Drug use
Allergies
Travel, geographic area of residence
Nutritional status
Cough, sputum production, chest pain, dyspnea, PND, orthopnea
PND, Paroxysmal nocturnal dyspnea.

5. Assessment of the Nose & Sinuses
External nose – Deformities or tumors
Nares – Symmetry of size and shape
Nasal cavity – Color, swelling, drainage, bleeding
Mucous membranes – Abnormalities
Septal deviation
Turbinates

6. Assessment of the Nose & Sinuses (Cont.)
The paranasal sinuses.

7. Assessment of the Pharynx, Trachea, & Larynx
Mouth
Posterior pharynx
Neck – Symmetry, alignment, masses, swelling, bruises, use of accessory neck muscles for breathing
Trachea – Palpate for position, mobility, tenderness, masses

8. Assessment of the Pharynx, Trachea, & Larynx (Cont.)
Left: Structures of the larynx.
Right: Detail of the glottis (two vocal folds and the intervening space, the rima glottidis).

9. Assessment of the Lungs & Thorax
Inspect thorax with patient sitting up
Observe chest, compare one side with the other
Work from the apex, move downward toward base (from side to side)
Rate, rhythm, depth of inspiration as well as symmetry of chest movement

10. Assessment of the Lungs & Thorax (Cont.)
Examine AP diameter with lateral diameter
Distance between ribs (intercostal space)
Palpate to assess respiratory movement, symmetry
Crepitus
AP, Anteroposterior.

11. Assessment of the Lungs & Thorax (Cont.)
Diaphragmatic excursion
Lung sounds
Bronchial
Bronchovesicular
Vesicular
Adventitious sounds
Crackles
Wheezes
Rhonchi
Pleural friction rub

12. Assessment of the Lungs & Thorax (Cont.)
Sequence for percussion and auscultation.

13. Other Indicators of Respiratory Adequacy
Clubbing of fingers
Weight loss
Unevenly developed muscles
Skin and mucous membrane changes
General appearance
Activity tolerance

14. Psychosocial Assessment
Stress may worsen some respiratory problems
Chronic respiratory disease may cause changes in family roles, social isolation, financial problems due to unemployment or disability
Discuss coping mechanisms, offer access to support systems

15. Laboratory Tests Blood Sputum
Standard chest x-rays, digital chest radiography, CT
Ventilation and perfusion scan
Pulse oximetry (noninvasive)
CT, Computed tomography.

16. Pulmonary Function Testing
Noninvasive
Evaluate lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, distribution of ventilation

17. Capnometry & Capnography
Noninvasive
Measure amount of carbon dioxide present in exhaled air
Normal pressure of PETCO2 is between 20 and 40 mm Hg

18. Other Noninvasive Testing
Exercise testing
Skin testing

19. Invasive Diagnostic Tests
Bronchoscopy
Thoracentesis – Aspiration of pleural fluid or air from pleural space
Stinging sensation and feeling of pressure
Correct position
Motionless patient
Follow-up assessment for complications

20. Lung Biopsy
Invasive
Obtain tissue for histologic analysis, culture, cytologic examination
May be performed in patient’s room
Follow-up care:
Assess vital signs, breath sounds at least every 4 hours for 24 hours
Assess for respiratory distress
Report reduced/absent breath sounds immediately
Monitor for hemoptysis

21. Audience Response System Questions
Chapter 27
Audience Response System Questions 21

22. Question 1
The nurse understands that the expected assessment for the older adult related to the natural aging process of the respiratory system includes which finding?
Tightening of the vocal cords
Decrease in residual volume
Decrease in the anteroposterior diameter
Decrease in respiratory muscle strength
Answer: D
Rationale: As a person ages, vocal cords become slack, changing the quality and strength of the voice; the anteroposterior diameter increases; respiratory muscle strength decreases; and the residual volume increases.

23. Question 2
The nurse knows that under normal physiologic conditions of tissue perfusion, a patient will have what percent of oxygen dissociate from the hemoglobin molecule?
25%
50%
75%
100%
Answer: B
Rationale: Oxygen dissociates with the hemoglobin molecule based on the need for oxygen to perfuse tissues. Under normal conditions, 50% of hemoglobin molecules completely dissociate their oxygen molecules when blood perfuses tissues that have an oxygen tension (concentration) of 26 mm Hg. This is considered a “normal” point at which 50% of hemoglobin molecules are no longer saturated with oxygen. (See Figure 27-8.)

24. Question 3
The nurse understands which symptom to be a hallmark subjective sign of lung disease?
Cough
Dyspnea
Chest pain
Sputum production
Answer: A
Rationale: Cough is a main sign of lung disease. Dyspnea (difficulty in breathing or breathlessness) is a subjective perception and varies among patients. A patient’s feeling of dyspnea may not be consistent with the severity of the presenting problem. Sputum production may be associated with coughing and indicate an acute or chronic lung condition. Chest pain can occur with other health problems, as well as with lung problems.