1. Assessment of Respiratory system
NUR 224
Assessment of
Respiratory system

2. Learning Objectives
At the end of respiratory system assessment section, the learner should be able to:
1- Apply knowledge of anatomy and physiology in conducting physical examination related to respiratory system assessment.
2- Understand the different techniques employed in the physical examination of respiratory system.
3- Differentiate between normal and abnormal respiratory system conditions.
4- Document the respiratory system assessment findings following designated format

3. OUTLINE Review of Respiratory System Obtaining Health History
Assessment

4. Respiratory system
The respiratory system Aim: deliver O2 to the bloodstream and remove excess CO2 from the body.

5. Review anatomy and physiology of Respiratory system

6. Mechanism of breathing
At rest:
No air movement
At Inhalation:
The diaphragm descend
Negative alveaolar pressure
Air moves into the lung
At exhalation:
The diaphragm ascend
Positive alveaolar pressure
Air moves out of the lung

7. 1. health history Cough Sputum Chest pain Hemoptysis Dyspnea Wheeze
Chief complain
Cough
Sputum
Chest pain
Hemoptysis
Dyspnea
Wheeze

8. Cough Cough is the most common symptom of respiratory tract disease.
Cough ( tussis) is a rapid expulsion of air from the lungs, typically in order to clear the lung airways of fluids, mucus, or other material.
Productive or nonproductive i.e. with or without sputum?

9. Sputum Amount: Color: Clear and white (excess normal mucus)
Yellow or green (infection)
Blood - stained sputum (hemoptysis)
Consistency: watery or sticky

10. Hemoptysis Hemoptysis: coughing up of blood or blood stained sputum.
Haematemesis: vomiting of blood

11. Dyspnea difficult breathing or SOB
orthopnea - SOB when lying down or/ supine position
This is commonly associated with compromised cardiac function.

12. Wheeze A whistling sound caused by bronchial narrowing
When does wheezing occur?
Do you wheeze loudly enough for others to hear it?
What helps stop your wheezing?

13. Past history
Tuberculosis
Allergy
Surgery

14. Family history
Infection,
TB,
allergy,
cancer,
bronchial asthma

15. Smoking Ask also about age of starting, the type,
number of cigarettes smoked currently and in the past,
passive smoking

16. Assessment
C – chest wall R – respiratory rate and pattern A – Accessory muscle use M – masses / scars P – Paradoxical movement

17. Chest- wall abnormalities
May be congenital or acquired
May easily develop respiratory failure from a respiratory tract infection

18. Chest- wall abnormalities
Barrel chest:
chest is round and bulging
2. Pigeon chest
protrusion of the sternum and ribs

19. Chest- wall abnormalities
3. Funnel chest (pectus excavatum)
depression of the lower part of the sternum.
4. Thoracic kyphoscoliosis
backward and lateral curvature of the spinal column

20. Respiratory Rate and Pattern
Adults: 12 – 20 breaths / min
Infant : 12 – 40 b/min
Eupnea : quiet, rhythmic, and effortless (12-18 breath / min)
Respiratory Pattern :
Even
Coordinated
Regular

21. Abnormal Respiratory Patterns
Tachypnea :
Rapid , shallow
> 24 breath\minute.
Bradypnea: (< 10breath\minute)
Hyperpnea :
increased depth of breathing
normal RR

22. Apnea – absence of breathing
Hypoventilation: Shallow & decrease RR
Kussmaul respiration:
Rapid, deep breathing without pause

23. Cheyne-stokes respiration:
breaths that gradually become faster and deeper than normal , then slower, and alternate periods of apnea

24. Normal Breath sounds A. Bronchial sounds - Heard over large airways
B. Bronchiovesicular sounds - Heard upper intrascapular areas
C. Vesicular sounds - Heard over peripheral lung fields.

25. Adventitious sounds Abnormal breath sounds Crackles Wheezes Rhonchi
Stridor
Pleural Friction rub

26. DEFINITION
CAUSE
Crackles/ Crepitations / Rales
Abnormal clicking, crackling or rattling sound
fluid Congestion of the lungs

27. DEFINITION
CAUSE
Wheezes
whistling sound
Constriction of bronchi airways
Rhonchi
snoring, gurgling, or rattle soundlike quality
Secretions in the bronchial airways
Stridor
Loud, high pitch crowing sound
Upper airway obstruction
Friction rub
rubbing sound heard on inspiration and expiration
Pleural inflammation

28. Accessory Muscle use
may indicate a respiratory problem and oxygen hunger

29. Paradoxical movement
Abnormal collapse of part of the chest wall when the patient inhales or
Abnormal expansion when exhales.
Paradoxical chest movement may indicate a fractured rib.

30. Inspecting Related Structure
Skin color and nail beds
Cyanosis (bluish color) of the skin, nail beds, and mucous membranes
Central
peripheral

32. Cyanosis

33. Clubbing of fingers sign of long term hypoxia.
angle is greater than or equal to 180 degrees.
CAUSES:
Chest disease
Heart diseases
Gastrointestinal diseases:
Familial clubbing

34. Clubbing of fingers