This ppt is shared for the education purpose and knowledge about the respiratory system

2. Liaquat University of Medical & Health Sciences
Jamshoro
Sindh
College of Nursing JPMC Karachi.
Presented by
ZAHID ALI PHULPOTO
Subject
Health Assessment
Faculty
Mrs. Mustaqeema Begum
BSC’N 1st year Semester 1st
RESPIRATORY ASSESSMENT
Dated:13TH MAY 2016

3. OBJECTIVES
At the end of this presentation the participant will be able
to:
Introduction of Respiratory system.
Describe the Anatomy & Physiology of Respiratory system.
Assessment of the respiratory system.
Explain client preparation for assessment of the respiratory
system.
Describe the techniques required for assessment of the
respiratory system.
Differentiate normal from abnormal findings in physical
assessment.

4. INTRODUCTION
 The thorax is a closed cavity containing the structures
needed for respiration.
 The lungs are elastic, spongy, cone-shaped, and air-
filled structures on the left and right of the mediastinum.
 The thorax extends from the base of the neck to the
diaphragm and is surrounded by muscles and ribs.
 The thorax is divided into the mediastinum in which the
heart, trachea, esophagus, and major blood vessels are
located, and the right and left pleural cavities.

5. FUNTIONS
The primary responsibility of the respiratory
system is the exchange of gases in the body.
The intake of oxygen and release of carbon
dioxide take place with each respiratory cycle.
The central nervous system regulates the rate
and depth of each respiratory cycle.
The respiratory system helps maintain acid-base
balance, helps maintain body fluids, and assists
with speech.

6. ANATOMY &PHYSIOLOGY

7. ANATOMY AND PHYSIOLOGY
Lungs are symmetric
Lungs are divided into lobes
Right Lung=3 lobes
Left Lung=2 lobes
Primary muscles of respiratory
Diaphragm –divides chest from
abdomen
External intercostal muscles
Accessory muscles

8. ANATOMY AND PHYSIOLOGY
Upper Airway
Nose ,Pharynx ,Larynx
,intrathoracic trachea
Functions in respiration
Conduct air to lower airway
Filter to protect lower airway
Warm and humidify inspired air

9. ANATOMY AND
PHYSIOLOGY
Lower Airway
Trachea, bronchi, bronchioles
Functions in respiration
Conduct air to alveoli
Clear mucociliary structures
Alveoli
Functional unit
Gas exchange
Production of surfactant

10. LANDMARKS
Landmarks for
assessment of the thorax
include bony structures,
horizontal and vertical
lines, and the division of
the thorax.
The thorax is divided into
anterior and posterior
sections or anterior,
posterior, and lateral
sections.

11. LANDMARKS
The sternum, the first bony
landmark, is the flat line in
the midline of the thoracic
cavity.
The angle of Louis is a
bony ridge of the location
where the manubrium and
the body of the sternum join.
The clavicles are long,
slender bones that articulate
with the manubrium
medially and laterally form
the acrimony of the shoulder
joint.

12. GATHERING THE DATA
Respiratory health assessment includes
gathering subjective and objective data.
Subjective data is gathered during the client
interview and includes data about illness,
symptoms, family history, treatment,
developmental considerations, behaviors, and
the environment.
The focused interview guides physical
assessment of the respiratory system.

13. 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).
History of smoking (amount and length of time)

14. 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)

15. After that the nurse should apply the four
techniques
Inspection Palpation
Percussion Auscultation

16. 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
Adult 16-20

17. 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).

18. INSPECTION AND ASSESSMENT OF
RESPIRATION PATTERNS
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 out flow “tumor,
aneurysm, cardiac enlargement”

20. PALPATE CHEST
EXPANSION/EXCURSION
Posterior- place hands along outer edge of
costal margin with thumbs toward middle of
spine
Have patient take a deep breath
Should observe yours hands moving equally
far apart.

21. DIAPHRAGMATIC EXCURSION
Distance between deep inspiration and
full expiration.
Normally ranges from 3-6 cm
Exhale and hold, percuss and mark
location of diaphragm: change dull-
resonance
Deep inspiration and hold it, percuss +
mark change again

22. PALPATION

25. PALPATION
TACTILE FREMITUS
 Is vibration felt by palpation. Place your open
palms against the upper portion of the anterior
chest, making sure that the fingers do not touch
the chest.
Ask the patient to repeat the phrase “ninety-
nine” or another resonant phrase while you
systematically move your palms over the chest
from the central airways to each lung’s
periphery.

26. PALPATION

27. PERCUSSION OF CHEST:

28. 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.

30. 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
Auscultate symmetrically: Should listen to at
least 6 locations interiorly and posteriorly

31. ANTERIOR CHEST

32. POSTERIOR CHEST

36. NORMAL BREATH SOUNDS
Bronchial-
heard over trachea and larynx. High pitch,
loud, harsh. Inspiration < expiration
Bronchovesicular-
heard over major bronchi. Moderate pitch
and loudness. Inspiration=expiration
Vesicular-
heard over lung fields. Low pitch, soft
sound. Inspiration>expiration

37. ADVENTITIOUS SOUNDS
Crackles-
Rub hair between fingers cracking/popping
sound. Secondary to fluid in airway or to
opening of collapsed alveoli in atelectasis.
Wheezes-
Continuous musical and high pitched, due
to constricted bronchi.
Rhonchi-
Lower pitched, coarse, snoring, due to thick
secretions.
Pleural friction rub-
Rough, grating, inflamed surfaces, as in
pleurisy.

38. REFERENCES
 Respiratory assessment Picture Image on
MedicineNet.com. www.medicinenet.com ›
home › image collection az list.
 www.news-medical.net/health/What-are-
respiratory system. aspx
 www.ncbi.nlm.nih.gov/pubmed/17067937.
 SideServe (2016). Respiratory physically
Examination