The Respiratory System

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The Respiratory System

• Thorax and Lungs
• Rachel S. Natividad, RN, MSN, NP

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Lobes and Landmarks
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Performing the Assessment Subjective Data

• ROS -Ask about dyspnea, cough, chest pain (PQRST
  format)
• Short interview sessions if resp. distress /
  tiring easily

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Assessment begins.

• Inspection
• Always first!!!
• The moment you see the patient.
• What position is most comfortable for him?
• Does he appear relaxed, anxious, uncomfortable?
• Is he having any trouble breathing?

Tripod Position
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Focused Assessment

• Inspection-cont.
• Color, Size and shape symmetry of chest, any
  lesions or scars
• Anterior Lateral Posterior

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Altered size/shapeBarrel Chest

• Increased AnteroposteriorTransverse Diameter

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Barrel Chest
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Asymmetrical chest

• Fractured ribs/ flail chest
• Pneumothorax
• atelectasis
• paralysis of the diaphragm
• Spinal deformity

Scoliosis
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Intercostal Spaces and Muscles
Retractions
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Focused Assessment Cont

• Resp. rate (per min.) and depth (shallow, even,
  deep)
• Normal pattern of respiration regular rhythm

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Relating to other systems

• Skin cyanosis, pallor
• Nails Clubbing
• Spongy nail matrix and nail angle of greater than
  160 degrees

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Focused Assessment Cont.Palpation

• Check for tenderness
• (normally nontender)
• Crepitus SQ air pockets
• Tactile fremitus increased with fluid
  accumulation
• Abnormal if tumor,
• fractured ribs, chest
• tubes, wound site, fluid

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Focused AssessmentAuscultation
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Normal Breath Sounds
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Adventitious/AbnormalBreath Sounds (T 11-2) p.132

• Discontinuous sounds
• Crackles (Rales)
• Fine
• Course
• Atelectic crackles
• Stridor
• Pleural friction rub

• Continuous sounds
• Wheezes
• Sibilant
• Sonorous (Rhonchi)

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Wheezes (Continuous)

• Sibililant wheeze
• Heard 1st in expiration
• high-pitched musical sounds
• Partial blockage in airflow
• Sonorous wheeze (rhonchi)
• Heard primarily in expiration
• low pitched snoring, rattling sound
• Air passes through large airways filled with
  fluid/ secretions

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Interpreting what you hear

• Is the sound is continuous or discontinuous?
• Is the sound occur during inhalation or
  exhalation, or both?

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Crackles (Discontinuous)

• FINE vs. COURSE
• Caused by collapsed or fluid-filled alveoli
  popping open
• usually heard in the lung bases during
  inhalation
• Atelectic crackles
• Sridor
• Pleural friction rub pericarditis

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Abnormal Breath Sounds

• Diminished breath sounds
• Absent breath sounds

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Assessment Guide Gas Exchange

• Respiratory
• Rate 18 resp/min
• Depth deep, even, shallow
• Effort labored, unlabored
• Breath Sounds
• Describe clear, rhonchi, inspiratory/expiratory
  wheezes, crackles
• Location all lobes, throughout lung fields, LLL,
  RUL/RML, lower lobes bilat.
• Cough present/not present
• Describe productive, moist, nonproductive
• Sputum large amount, thick yellow moderate pink
  frothy sputum, sml. Amt. thin clear sputum.

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• Interventions in use
• Position, Turn, Cough, Deep breathe
• O2 Method nc, venti mask, rebreathing mask
• Flow rate 2L/min 3l/min
• Humidity yes/no
• Pulse Oximeter continuous, spot monitoring
• Incentive Spirometer in use, n/a
• Time used 10 am, 11 am, 1 pm, 3 pm
• Volume 500 cc, 500 cc, 600 cc, 800 cc
• Oropharyngeal Suctioning Describe- moderate
  amount thick tan secretions
• Med List Albuterol inhaler, Prednisone,
  Theophylline