Learn how to do assessment of the respiratory system

1. Gerishon N. Chege
BScN, Advan dip A&E Nurs, KRCHN, KRPN
Kenyatta National Hospital Nursing Education Unit
Assessment of respiratory system
Higher Diploma In Accident And Emergency
Nursing 2015 Class

2. Anatomy of Respiratory System
The lung is a two cone-shaped, elastic structure suspended
within the thoracic cavity.
 Lung are paired, they are not complete symmetric, the right
lung contain three lobe, whereas the left lung contain only
two lobes.
 The apex of each lung extended slightly above the clavicle,
where the base is at the level of diaphragm
 The thoracic cavity contains the nasopharynx, larynx,
trachea, bronchi, bronchioles, alveoli.
 The thoracic cavity is lined by a thin, double- layered2

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5. Assessment of respiratory system
Subjective data: the nurse must ask the client about:-
 Coughing (productive, non productive)
 Sputum (type & amount)
 Allergies, dyspnea or SOB (at rest or on exertion).
 Chest pain, history of asthma, bronchitis, emphysema,
tuberculosis.
 Cyanosis, pallor.
 Exposure to environmental inhalants (chemicals,
fumes).
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6. Technique for Respiratory Exam
 Before beginning, if possible:
 Quiet environment
 Proper positioning (patient sitting for posterior thorax
exam, supine for anterior thorax exam)
 Expose skin for auscultation
 Patient comfort, warm hands and diaphragm of
stethoscope, be considerate of women (drape sheet to
cover chest)
 After that the nurse should apply the four
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7. Initial Respiratory Survey (Inspection)
 Observe the patient’s breathing pattern
 Rate (normal vs. increased/decreased)
 Depth (shallow vs. deep)
 Effort (any sign of accessory muscle use, inspect neck)
 Assess the patient’s color
 Cyanosis
 Normal Respiratory Rates
 Infant 30-60
 Toddler 24-40
 Preschooler 22-34
 School-age child 18-30
 Adolescent 12-16
 Adult 16-207

8. Inspection and assessment of respiration patterns
 Assess the skin and overall symmetry and integrity of
the thorax.
 Assess thoracic configuration.
 Client must be uncovered to the waist, and in sitting
position without support.
 Observation of skin may give you knowledge about
nutritional status of the client.
 Anterior- posterior diameter of thorax in normal person
less than the transverse diameter = (1:2).
 Assess for abnormality of configuration, e.g. pigeon
chest, funnel chest, spinal deformities.
 Assess ribs and inter spaces on respiration – may give
information about obstruction in air flow e.g. bulging of
inter spaces on expiration may be from obstruction to air

9. Assess pattern of respiration
 Normally: men and children – breathe
diaphragmatically and Women breathe thoracically
or costally.
 Tachypnea: respiratory rate over than 20/m for adult.
 Bradypnea: respiratory rate less than 10/m.
 Palpation: palpate areas of chest especially areas of
abnormalities.
 If clients complains: all chest areas must palpated
carefully for tenderness, bulges, or any movements9

10. Assess thoracic expansion:
 Anterior: put your hands over anterior-lateral chest
and thumbs extended along costal margin pointing
to xiphoid process.
 Posterior: thumbs placed at level of T 10 with palms
placed on posterior-lateral chest.
 By two ways you feel amount of thoracic expansion
during quiet and deep breathing, and symmetry of
respiration between left and right hemi thoraces.
 Assessment of fremitus: which is vibration
perceptible on palpation"
 In subcutaneous emphysema: you must palpate the
tissue, audible cracking sounds are heard – these
sounds are termed Crepitation10

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12. Percussion of chest:
 Done to determine relative amounts of air, liquid, or solid
material in the underlying lung, and to determine positions
and boundaries of organs.
 Percussion done for posterior and anterior and lateral
aspects of chest with all directions, and with about “5”cms
intervals.
Auscultation:
 To obtains information about the function of respiratory
system & to detect any obstruction in the passages.
 Instruct the client to breathe through the mouth more deeply
and slowly than in usual respiration and then to hold the
breath for a few seconds at the end of inspiration to increase
intrapleural pressure and reopen collapsed alveoli.
 Auscultate all areas of chest for at least one complete
respiration: 12 anterior locations and 14 posterior locations

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14.  Breathe sounds: are analyzed according to pitch,
intensity, quality, and relative duration of inspiratory and
expiratory phases.
 Bronchial breathe sounds: are normally heard over
manubrium of sternum
 If heard over lung tissue – indicate pathologic condition,
these sounds “high-pitched loud sounds with decrease
inspiratory and lengthened increase expiratory phases.
 Absent or decreased breath sounds can occur in:
 Foreign body.
 Bronchial obstruction.
 Shallow breathing.
 Emphysema
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15. Breath Sounds
 Normal breath sounds are distinguished by their
location over a specific area of the lung and are
identified as tracheal, vesicular, bronchovesicular, and
bronchial (tubular) breath sounds as the next:
1. Tracheal
 Very loud, high pitched sound
 Inspiratory = Expiratory sound duration
 Heard over trachea in the neck
2. Bronchial
 Loud, high pitched sound
 Expiratory sounds > Inspiratory sounds
 Heard over manubrium of sternum
 If heard in any other location suggestive of15

16. 3. Bronchovesicular
 Intermediate intensity, intermediate pitch
 Inspiratory = Expiratory sound duration
 Heard best 1st and 2nd ICS anteriorly, and between
scapula posteriorly
 If heard in any other location suggestive of
consolidation
4. Vesicular
 Soft, low pitched sound
 Inspiratory > Expiratory sounds
 Major normal breath sound, heard over most of lungs
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17. Adventitious Breath Sounds
 An abnormal condition that affects the bronchial tree and
alveoli may produce adventitious (abnrmal= addtional)
sounds. Adventitious sounds are divided into two
categories: discrete, noncontinuous sounds (crackles) and
continuous musical sounds (wheezes) as the next:
1. Crackles (Rales)
 Discontinuous, intermittent, nonmusical, brief sounds.
Heard more commonly with inspiration
 Classified as fine or coarse
 Its may associated with Prolonged recumbency
 Crackles caused by air moving through secretions and
collapsed alveoli and associated with the following
conditions: pulmonary edema, early CHF, and pnumonia
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18. 2. Wheeze
 Continuous, high pitched, musical sound, longer than
crackles
 Whistle quality, heard during expiration, however, can
be heard on inspiration
 Produced when air flows through narrowed airways
 Associated conditions: asthma, chronic bronchitis, and
COPD
3. Rhonchi
 Similar to wheezes (subtype of wheeze)
 Low pitched, snoring quality, continuous, musical
sounds
 Implies obstruction of larger airways by secretions
 Associated condition: acute bronchitis
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19. 4. Stridor
 Inspiratory musical wheeze
 Loudest over trachea
 Suggests obstructed trachea or larynx
 Medical emergency requiring immediate attention
 Associated condition
 inhaled foreign body
5. Pleural Friction Rub
 Pleural friction rubs are specific examples of crackles.
Discontinuous or continuous brushing sounds
 It is a loud dry, cracking or grating sound indicating of pleural
irritation, heard over lateral and anterior lung in sitting
position that heard during both inspiratory and expiratory
phases
 Occurs when pleural surfaces are inflamed and rub against
each other

20. Medical conditions associated with decreased or
absent of breath sounds
 Asthma
 COPD
 Pleural Effusion: fluid accumulating within the pleural
space
 Pneumothorax: caused by accumulation of air or gas in
the pleural space.
 ARDS( adult respiratory distress syndrome)
 Atelectasis : is defined as a state in which the lung, in
whole or in part, is collapsed or without air entery
Five Main Symptoms of Respiratory Disease
 Cough Sputum Pain
 Breathlessness Wheeze

21. THANK YOU VERY MUCH
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