1. Health assessment Respiratory system

2. Introduction Respiratory system ◦ Exchange of gases in the body ◦ Intake of oxygen and release of carbon dioxide Central nervous system ◦ Functions ◦ Maintains acid–base balance ◦ Maintains body fluids ◦ Assists with speech

3. Anatomy and Physiology Review Upper respiratory tract ◦ Nose, mouth, sinuses, pharynx, larynx, proximal trachea Lower respiratory tract ◦ Distal trachea, bronchi, lungs, pleural membranes, muscles of respiration, mediastinum Respiratory cycle

4. Anatomy of the respiratory system.

5. Anatomy and Physiology Review Thorax ◦ Closed cavity containing the structures needed for respiration ◦ Mediastinum ◦ Heart ◦ Trachea ◦ Esophagus ◦ Major blood vessels ◦ Pleural cavities continued on next slide

6. Anatomy and Physiology Review Thorax ◦ Thoracic cage ◦ Bones ◦ Cartilage ◦ Muscles of the thorax

7. Lower Respiratory Tract Trachea ◦ 16–20 rings of hyaline cartilage Bronchi ◦ Main bronchus enters each lung at the hilus. ◦ Terminal bronchioles less than 0.5 mm in diameter

8. Lower Respiratory Tract Lungs ◦ Cone-shaped, elastic, spongy, air-filled structures in pleural cavities ◦ Right lung has three lobes, left lung has two.

9. Lower Respiratory Tract Pleural membranes ◦ Thin, double-layered serous lining ◦ Surface tension created by fluid and negative pressure between membranes keeps lungs expanded. Mediastinum ◦ Middle section of thoracic cavity ◦ Surrounded by right and left pleural cavities

10. Landmarks Bony structures ◦ Sternum ◦ Angle of Louis ◦ Clavicles ◦ Ribs ◦ Vertebral column

11. Landmarks Horizontal and vertical lines ◦ Anterior, posterior, and lateral sections Division of the thorax ◦ Anterior ◦ Imaginary vertical lines ◦ Sternal ◦ Midclavicular ◦ Anterior axillary lines

12. Landmarks Division of the thorax ◦ Posterior ◦ Imaginary vertical lines ◦ Vertebral ◦ Scapular ◦ Posterior axillary continued on next slide

13. Landmarks Division of the thorax ◦ Lateral ◦ Imaginary vertical lines ◦ Anterior ◦ Posterior ◦ Midaxillary

14. Lines of the anterior thorax.

15. Lines of the posterior thorax.

16. Lines of the lateral thorax.

17. Lobes of the lungs: Posterior view.

18. Lobes of the lungs: Anterior view.

19. Lateral view of lobes of the left lung. continued on next slide

20. Lateral view of lobes of the right lung.

21. Special Considerations Age Developmental level Race Ethnicity Work history Living conditions Socioeconomic status Emotional wellness

22. Lifespan Considerations Infants and children ◦ Change from intrauterine to extrauterine breathing ◦ Use of abdominal muscles for breathing during infancy and early childhood ◦ Costal breathing expected after age 7 ◦ Smaller airways more prone to blockage continued on next slide

23. Lifespan Considerations The pregnant female ◦ Muscles and cartilage of the ribs relax. ◦ Inspiratory capacity increases. ◦ Expiratory reserve volume is decreased. ◦ Total lung capacity remains the same. ◦ Oxygen consumption can increase by 20% ◦ Mild respiratory alkalosis

24. Lifespan Considerations The older adult ◦ Decrease in respiratory efficiency ◦ Changes in respiratory depth ◦ Decrease in cough ability ◦ Increase in respiratory rate ◦ Anxiety and physical exertion can cause significant demands. ◦ Increased effect of infection

25. Psychosocial Considerations Exacerbation of respiratory problems ◦ Stress ◦ Anxiety ◦ Fatigue ◦ Pain Certain drugs used in the treatment of respiratory disorders may cause hands to tremble.

26. Cultural and Environmental Considerations Race Ethnicity Presence of allergens Socioeconomic status Incidence of respiratory diseases Geography and environment ◦ Temperature, moisture, altitude, and pollution

27. Focused Interview Consider patient's ability to participate ◦ If patient is experiencing dyspnea, cyanosis, difficulty with speech, or anxiety, attention must focus on relief of symptoms and restoration of oxygenation.

28. Focused Interview Focused interview questions ◦ General ◦ Illness or infection ◦ Symptoms, pain, behaviors ◦ Age ◦ Infants and children ◦ The pregnant female ◦ The older adult ◦ Environment

29. Assessment Techniques Inspection Palpation Percussion Auscultation

30. Assessment Techniques Observation of skin color Inspection of the anterior and posterior thorax ◦ Symmetry ◦ Configuration ◦ Respiratory rate

31. Assessment Techniques Palpation of the posterior thorax ◦ Ribs ◦ Intercostal spaces ◦ Respiratory expansion ◦ Tactile fremitus

32. Patient positioned and gowned for assessment.

33. Pattern for palpating the posterior thorax.

34. Palpation for respiratory expansion.

35. Palpation for tactile fremitus using metacarpophalangeal joint area.

36. Assessment Techniques Percussion of the posterior thorax ◦ Lungs ◦ Diaphragmatic excursion

37. Pattern for percussion: Posterior thorax.

38. Diaphragmatic movement, percussion. continued on next slide

39. Diaphragmatic movement, measurement.

40. Assessment Techniques Auscultation of the posterior thorax for sounds ◦ Tracheal ◦ Bronchial ◦ Bronchovesicular ◦ Vesicular

41. Pattern for auscultation: Posterior thorax.

42. Normal Breath Sounds

43. Adventitious Breath Sounds

44. Assessment Techniques Auscultation of voice sounds ◦ Bronchophony ◦ Egophony ◦ Whispered pectoriloquy Palpation of the anterior thorax

45. Assessment Techniques Palpation of the anterior thorax ◦ Sternum ◦ Ribs ◦ Intercostal spaces

46. Palpation of the anterior thorax.

47. Palpation for respiratory expansion: Anterior view.

48. Palpation for tactile fremitus: Anterior thorax.

49. Pattern for percussion: Anterior thorax. continued on next slide

50. Pattern for percussion: Left lateral thorax.

51. Auscultatory sounds: Anterior thorax.

52. Normal and Abnormal Respiratory Rates and Patterns continued on next slide

53. (continued) Normal and Abnormal Respiratory Rates and Patterns continued on next slide

54. (continued) Normal and Abnormal Respiratory Rates and Patterns

55. Normal Chest Configurations continued on next slide

56. (continued) Normal Chest Configurations continued on next slide

57. (continued) Normal Chest Configurations

58. Abnormal Chest Configurations continued on next slide

59. (continued) Abnormal Chest Configurations continued on next slide

60. (continued) Abnormal Chest Configurations continued on next slide

61. (continued) Abnormal Chest Configurations

62. Abnormal Findings Respiratory disorders ◦ Asthma ◦ Chronic hyperreactive condition ◦ Atelectasis ◦ Obstruction of airflow ◦ Bronchitis ◦ Inflammation of the tracheobronchial tree

63. Asthma.

64. Atelectasis.

65. Chronic bronchitis.

66. Abnormal Findings Respiratory disorders ◦ Emphysema (obstruction of the alveoli) ◦ Pneumonia (infection if the alveoli) ◦ Pleural effusion (fluid in the pleural space)

67. Emphysema.

68. Lobar pneumonia.

69. Pleural effusion.

70. Abnormal Findings Respiratory disorders ◦ Pneumothorax (collapse of the lung) ◦ Congestive heart failure (edema around the alveoli) ◦ Valley fever

71. Pneumothorax.

72. Left heart failure.