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    Assessment of Respiratory System

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    Ibi Yulia Setyani
    The document provides guidance on assessing the respiratory system through inspection, palpation, percussion, and auscultation. It describes the techniques for examining breathing patterns, chest expansion, breath sounds, and adventitious sounds. Potential findings from the assessment are associated with various respiratory conditions.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Assessment of Respiratory System

    Uploaded by

    Ibi Yulia Setyani
    1K views18 pages
    The document provides guidance on assessing the respiratory system through inspection, palpation, percussion, and auscultation. It describes the techniques for examining breathing patterns, chest expansion, breath sounds, and adventitious sounds. Potential findings from the assessment are associated with various respiratory conditions.

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    The document provides guidance on assessing the respiratory system through inspection, palpation, percussion, and auscultation. It describes the techniques for examining breathing patterns, chest expansion, breath sounds, and adventitious sounds. Potential findings from the assessment are associated with various respiratory conditions.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    1K views18 pages

    Assessment of Respiratory System

    Uploaded by

    Ibi Yulia Setyani
    The document provides guidance on assessing the respiratory system through inspection, palpation, percussion, and auscultation. It describes the techniques for examining breathing patterns, chest expansion, breath sounds, and adventitious sounds. Potential findings from the assessment are associated with various respiratory conditions.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 18

    1

    2
    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)


    3
    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)

     Apply the four techniques; Inspection, Palpation, Percussion

    4
    and Auscultation
    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 16-20
    5
    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 out flow “tumor, aneurysm, cardiac
    enlargement”
    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 movements

    7
    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
    Crepitation
    8
    9
    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
     Auscultate symmetrically: Should listen to at least 6 locations anteriorly
    and posteriorly
    11
     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

    12
    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 of consolidation
    13
    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

    14
    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

    15
    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

    16
    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
     Associated conditions as pleural effusion, Pneumonothorax
    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

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