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Respiratory Assessment
Components of Upper Airway
Anatomy of the Thorax
Trachea
Lungs
Diaphragm
Pleura
- Parietal
- Visceral
Mediastinum or interpleural space
Bronchi
- Right
- Left
Alveloli
Lobes
Right lung has three lobes
Left lung has two lobes
Thoracic Lines
Muscles
External intercostal muscles
Accessory muscles
Basic Clinical Assessment
Patient History
Inspection
Palpation
Percussion
Auscultation
Patient’s Respiratory History
Cough
Sputum production
Dyspnea
______
Chest pain
Wheezing
Subjective Questioning
Are you having any trouble breathing?
Do you have chest pain with breathing?
Do you have a cough?
Are you ever short of breath?
Do you have problems breathing at night?
Do you have any allergies?
Do you smoke now or have you ever smoked?
What kind of work did you do/did you do?
Do you have a personal family hx of asthma, TB, lung CA, emphysema, or any other lung diseases?
Considerations In Infants
Respiratory distress
Cyanosis
Apnea
SIDS in siblings
Exposure to ______
Hx of prematurity or mechanical ventilation
Night cough
Swollen lymph nodes
Sore throat or facial swelling
Considerations in Older Adults
Annual ______
Recent changes in activity tolerance
Change in number of pillows used at HS
Significant weight change
Night sweats
Hand or leg swelling
Inspection
Patient Sitting
Examine anterior and posterior chest
Assess front, back and sides of chest
- Scars
- Wounds
- Lesions
Symmetry of chest wall movement
Inspiratory/expiratory cycles
Respiratory pattern and breathing rhythm
Other Considerations
Sternocleidomastoid muscle
Posture
Scoliosis
______
Level of Consciousness (LOC)
Confusion
02 therapy
Respiratory Rates
Infant30 to 60 breaths per minute
One year20 to 40“
16 year12 to 20“
Adult12 to 20“
Abnormal Breathing Patterns
Tachypnea
Hyperpnea or Hyperventilation
Kussmal breathing
Bradypnea
Cheyne-Stokes
Ataxia
Normal Inspection Findings
Side to side symmetric chest shape
Anterior-posterior diameter < transverse diameter
Normal chest shape, with no visible deformities
No muscle retractions when breathing
Quiet, unlabored respirations without use of accessory muscles
A regular respiratory rhythm
Skin color that matches the rest of the body's complexion
A respiratory rate of 12-20 in an adult
Palpation
Identify chest movement symmetry
Chest skeletal abnormalities
Tenderness
Skin temperature changes
Swelling and/or masses
Trachea Placement
Symmetry of Chest Expansion
______
Normal Findings on Palpation
Normal chest size and shape
Warm, dry skin
No tender spots
Symmetrical chest expansion
Tactile fremitus over the mainstem bronchi in front and between the scapulae in the back of the chest
Percussion
Produces sounds by tapping on the patient’s chest wall
Sets chest wall and underlying tissues into motion
Helps determine whether underlying tissues are filled with air, fluid, or solid material
Work from Top Down
Auscultation
Listening to the sounds of the chest
Breath sounds transmitted through the chest wall and through the diaphragm
Assesses airflow through the tracheobronchial tree
Not through clothing!
______breaths through mouth
- Increases the duration, intensity, and thus detectability of any abnormal breath sounds that might be present
Have the patient cough a few times prior to beginning auscultation.
- Clears airway secretions and opens small atelectatic (i.e. collapsed) areas at the lung bases.
If the patient cannot sit up, auscultation can be performed while the patient is lying on their side.
For those with respiratory conditions, start at posterior bases.
Normal…Breath Sounds
Chest Auscultation
Listen for the sounds of normal breathing
Listen for adventitious (added) sounds
Anterior, Posterior, and Sides
- Modify based on pt
Adventitious Breath
Sounds
Wheezing
Crackles/Rales
Stridor
Pleural Friction Rub
Documentation Example
Anterior and posterior thorax appears symmetrical in a sitting and lying position. Respirations at 16, regular and effortless through nose. Breathing audible 1” from nose. No retractions, accessory muscle use, masses, nasal flaring, or visible superficial veins visible. Chest rise and fall of 1in. AP<T. No crepitus, masses, tenderness upon palpation. Thoracic expansion of <2 cm. Costal angle <90 degrees. Angle of ribs < 45 degrees. Breath sounds clear bilaterally in all lobes. No advantageous sounds. No assistive devices used. O2 stats 99% on room air.------John Smith ADNS Chippewa Valley Technical College
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