1. Assessment of the Respiratory System
Chapter 29
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
Respiratory changes associated with aging

3. Role of the Respiratory System

4. 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

5. Assessment of the Nose & Sinuses
External nose—deformities or tumors
Nares—symmetry of size and shape
Nasal cavity—color, swelling, drainage, bleeding

6. Assessment of the Nose & Sinuses (cont’d)
Mucous membranes—abnormalities
Septal deviation
Turbinates

7. Assessment of the Nose & Sinuses (cont’d)
The paranasal sinuses.

8. 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

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

10. 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

11. Assessment of the Lungs & Thorax (cont’d)
Examine AP diameter with lateral diameter
Distance between ribs (intercostal space)
Palpate to assess respiratory movement, symmetry
Crepitus

12. Assessment of the Lungs & Thorax (cont’d)
Diaphragmatic excursion
Lung sounds
Bronchial
Bronchovesicular
Vesicular

13. Assessment of the Lungs & Thorax (cont’d)
Adventitious sounds
Crackles
Wheezes
Rhonchi
Pleural friction rub

14. Assessment of the Lungs & Thorax (cont’d)
Anterior and posterior chest landmarks.

15. Assessment of the Lungs & Thorax (cont’d)
Sequence for percussion and auscultation.

16. Other Indicators of Respiratory Adequacy
Clubbing
Weight loss
Unevenly developed muscles
Skin and mucous membrane changes
General appearance
Endurance

17. 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

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

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

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

21. Other Noninvasive Testing
Exercise testing
Skin testing

22. Invasive Diagnostic Tests
Endoscopy
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

23. Position for Thoracentesis

24. Lung Biopsy
Invasive
Obtain tissue for histologic analysis, culture, cytologic examination
May be performed in patient’s room

25. Lung Biopsy (cont’d) 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

26. Audience Response System Questions
Chapter 29
Audience Response System Questions 26

27. Question 1
Which of these is an expected outcome for the older adult related to the natural aging process of the respiratory system?
Tightening of the vocal cords
Decrease in the anteroposterior diameter
Decrease in respiratory muscle strength
Decrease in residual volume
Answer: C
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.
(Source: Accessed August 1, 2011, from

28. Question 2
Under normal physiologic conditions of tissue perfusion, what percent of oxygen dissociates 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 29-8.)

29. Question 3 Which is considered a main sign of lung disease? Dyspnea
Cough
Sputum production
Chest pain
Answer: B
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.