1. Respiratory System NRS 102
Denise Coffey MSN, RN

2. Respiratory Assessment
Structure and Function
Subjective Data—Health History Questions
Objective Data—The Physical Exam
Abnormal Findings

3. Anterior Thoracic Cage

4. Posterior

5. Reference Lines Midsternal line Midclavicular line Scapular line
Vertebral line
Anterior, posterior, midaxillary lines

6. Reference Lines Anterior

7. Reference Lines Posterior

8. Lateral

9. Structure and Function
Thoracic cavity
Mediastinum defined
Lobes of the lungs
Anterior
Posterior
Lateral
Pleurae
Trachea and bronchial tree
Location of trachea and bronchi
Dead space

10. Structures of the Respiratory System

11. Mechanics of Respiration
Four functions of respiratory system
Changing chest size during respiration
Inspiration
Expiration
Control of respiration

12. Mechanics of Respiration

13. Subjective Data
What would you want to know?

14. Subjective Data Cough Shortness of breath Chest pain with breathing
History of respiratory infections
Smoking history
Environmental exposure
Self-care behaviors

15. Objective Data- The Physical Exam
Preparation
Position
Draping
Timing during a complete examination
Cleaning stethoscope endpiece
Equipment needed
Stethoscope
Small ruler marked in centimeters
Marking pen
Alcohol swab

16. Objective Data- The Physical Exam
Posterior Chest—Inspect
Thoracic cage
Shape and configuration of chest wall
Anteroposterior/transverse diameter
Position of person
Skin color and condition

17. Objective Data- The Physical Exam
Posterior Chest—Palpate
Symmetric expansion
Tactile (or vocal) fremitus
Technique
Factors that affect normal intensity of tactile fremitus
Palpate the entire chest wall
Posterior Chest—Percuss
Predominant note over lung fields
Diaphragmatic excursion

18. Objective Data- The Physical Exam
Anterior Chest—Palpate
Symmetric chest expansion
Tactile fremitus
Palpate the anterior chest wall
Anterior Chest—Percuss
Predominant note over lung fields
Borders of cardiac dullness

19. Objective Data- The Physical Exam
Anterior Chest—Auscultate
Breath sounds
Abnormal breath sounds
Adventitious sounds

20. Objective Data- The Physical Exam
Anterior Chest—Auscultate
Breath sounds
Abnormal breath sounds

21. Abnormal Breath Sounds
Rhonchi
Wheezes
Crackles
Stridor
Croup
Pleural friction rub

22. Measurement of Pulmonary Function
Pulse ox
ABGs
Pulmonary Function Tests

23. Documentation

24. Documentation

25. Abnormal Findings
Barrel chest
Scoliosis
Kyphosis

26. Barrel Chest

27. Scoliosis

28. Kyphosis

29. Abnormal Findings Common Respiratory Conditions
Congestive heart failure
Pneumothorax
Pneumocystis carinii pneumonia
Tuberculosis
Pulmonary embolism
Acute respiratory distress syndrome (ARDS)
Atelectasis
Lobar pneumonia
Bronchitis
Emphysema
Asthma (reactive airway disease)
Pleural effusion thickening

30. Interventions Ambulation Incentive Spirometer ( IS) Repositioning
Coughing and Deep Breathing
Medications
Education

32. Case scenario
You are caring for Mrs. Brown, a 75-year-old retired school teacher who underwent repair of a right fractured femur. This is her first postoperative day on your clinical unit.
Upon auscultation of her posterior lung field bases, you hear a crackling noise upon inspiration. What is this sound, and what does it indicate?