The Respiratory System
Current Symptoms: SOB, Difficulty breathing, Cough?
History: Asthma, Allergies, Bronchitis, COPD, Emphysema
Tell me about your tobacco/smoking history – do you or does anyone around you use tobacco? Do you vape?
Inspection
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Posture
o Erect, no tripod positioning.
Eyes
o Patient is in no apparent distress.
Nose
o Patient is a nasal breather. No nasal
flaring noted.
Mouth
o No presence circumoral cyanosis.
Lips
o No pursed lip breathing.
Mucus Membranes
o Mucus membranes are pink, moist, and
intact. No pale or dusky membranes
noted.
Neck
o No use of accessory muscles.
Chest
o Uniform venous pattern.
Breathing
o Chest rises and falls symmetrically with
inspiration and expiration.
Ribs
o No retractions, lifts/heaves.
Finger nail beds
o Pink, no clubbing, capillary refill < 3sec.
Costal Angle
o Costal Angle less than 90 degrees. No
barrel chest noted.
AP: Transverse Ratio
o 1:2
Respiratory rate
o Respiratory rate is 14 breaths per minute.
Respirations are easy, unlabored.
Instructions
Documentation
Begin your respiratory assessment by looking at the
patient’s eyes and move your way down the body.
Inspection
Patient in no apparent
distress. Respirations easy,
non-labored, nasal breathing
noted. No nasal flaring noted
or circumoral cyanosis noted.
No pursed lipped breathing.
Mucus membranes are pink,
moist, and intact. Neck
without use of accessory
muscles. Chest rises and falls
symmetrically with
inspiration and expiration.
No retractions, lifts, or heaves
noted. Costal Angle less than
90 degrees. AP: Transverse
ratio is 1:2. Symmetrical
venous pattern noted on the
chest. Respiratory rate is 14
breaths per minute.
Respirations are easy and
unlabored.
Palpation
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Presence or absence of masses or crepitus
Pain/Discomfort
Tactile Fremitus
Percussion
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Resonant throughout lung fields
Auscultation
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Lung sounds clear.
o 6 Anterior
o STOP in between so pt. can rest
o 6 Posterior
o 3 Right lateral
o 2 Left lateral
Presence or absence of adventitious sounds
Palpation
Palpation
With your hands, lightly press over the area of the
anterior and posterior thorax to assess for masses,
crepitus, or tenderness.
Tactile Fremitus – using the ulnar surface of your
hands, have the patient say “99” while you move your
hands down the patients anterior and posterior thorax
assessing for symmetry of vibrations. They should
decrease in the base of the lungs.
No masses or crepitus noted.
Patient denies
pain/discomfort. Tactile
fremitus is palpated
symmetrically bilaterally and
vibrations decrease in the
bases of the lungs.
Percussion
Percussion
Percussion is done indirectly and resonance is a
normal finding throughout the lung fields.
Lungs are resonant
throughout the lung fields.
Auscultation
Auscultation
Listen to the anterior/posterior/lateral lung fields. Be
sure to give clear instructions to your patient “take a
deep breath each time you feel my stethoscope move”.
Be sure to listen all the way through inspiration and
expiration. Break up anterior and posterior lung
sounds so patient has time to rest in between.
Lung sounds are clear. No
adventitious sounds
auscultated. No crackles,
wheezes, rhonchi, or rales
auscultated.
Documentation:
Patient in no apparent distress. Respiratory rate 14 breaths per minute. Respirations easy, non-labored, nasal breathing noted. No nasal flaring or
circumoral cyanosis noted. No pursed lipped breathing. Mucus membranes pink, moist, and intact. Neck without use of accessory muscles.
Chest rises and falls symmetrically with inspiration and expiration. No retractions, lifts, or heaves noted. Costal Angle less than 90 degrees.
AP: Transverse ratio is 1:2. Symmetrical venous pattern noted on the chest. No masses or crepitus noted. Denies pain/discomfort. Tactile
fremitus palpated symmetrically bilaterally and vibrations decrease in the bases of the lungs. Lungs are resonant throughout the lung fields. Lung
sounds clear, all lobes, anterior and posterior. No crackles, wheezes, rhonchi, or rales auscultated. (OR) No adventitious sounds auscultated.