Chapter 17
Assessment of Respiratory
Function
Overview of the Respiratory System
Two tracts:
o Upper respiratory tract warms and filters air
o Lower respiratory tract (the lungs) accomplishes
gas exchange
Together they deliver oxygen to and expel carbon
dioxide from the body
Works in conjunction with the circulatory system
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The Respiratory System
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Structures of the Upper Respiratory Tract
#1
 Nose: passageway for air to pass to and from the lungs (Figure
17-1)
 Paranasal Sinuses (Figure 17-2)
o Frontal
o Ethmoid
o Sphenoid
o Maxillary
 Pharynx, Tonsils, Adenoids
o Nasal
o Oral
o Laryngeal
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Structures of the Upper Respiratory Tract
#2
Larynx
o Epiglottis
o Glottis
o Thyroid cartilage
o Cricoid cartilage
o Arytenoid cartilages
o Vocal cords
Trachea
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Question #1
Is the following statement true or false?
The only function of the larynx is vocalization.
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Answer to Question #1
False
Rationale: Another name for the larynx is the voice
box, and a primary function is to create vocal sounds.
The larynx also serves as a barrier to foreign
substances entering the lower respiratory tract and
facilitates coughing.
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Structures of the Lower Respiratory Tract
#1
Two lungs, five lobes
o Left: upper and lower
o Right: upper, middle, and lower
Pleura
Mediastinum
Bronchi and bronchioles
Alveoli
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Structures of the Lower Respiratory Tract
#2
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Functions of the Respiratory System #1
Oxygen transport
Respiration
Ventilation
o Air pressure variances
o Airway resistance
o Compliance
o Lung volumes and capacities (Table 17-1)
Pulmonary diffusion and perfusion
Ventilation and perfusion balance and imbalance
(Chart 17-2)
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Functions of the Respiratory System #2
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Functions of the Respiratory System #3
Gas Exchanges
o Partial pressure of gases
o Oxyhemoglobin dissociation curve
o Carbon dioxide transport
o Neurologic control of ventilation
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Gas Exchange and Respiratory Function
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Question #2
Which groups of receptors assist in the brain’s control
of the respiratory system?
A. Chemoreceptors
B. Mechanoreceptors
C. Proprioceptors
D. All of the above
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Answer to Question #2
D. All of the above
Rationale: Chemoreceptors located in the medulla
respond to chemical changes in the cerebrospinal fluid
and work to maintain balance through increased or
decreased respiratory rate. Mechanoreceptors are
located in the lungs and respond to changes in
resistance by altering inflation of the lungs.
Proprioceptors are in the muscles and chest wall and
respond to body movements to stimulate breathing.
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Comprehensive Respiratory Assessment
#1
Health history
Presenting problems and associated symptoms
o Onset
o Location
o Duration
o Aggravating factors
o Associated signs/symptoms
o Impact on activities of daily living
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Comprehensive Respiratory Assessment
#2
Past health, social and family history
o Childhood illnesses
o Immunizations
o Diet and exercise
o Risk factors/genetics
o Charts 17-6 and 17-7
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Physical Assessment #1
 General appearance may give clues to respiratory status
o Clubbing of the fingers
o Skin color (cyanosis)
 Routine examination of the upper airway structures
o Penlight
 Assessment of the lower respiratory structures
o Inspection, palpation, percussion, auscultation
o Chart 17-10
o Table 17-3
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Physical Assessment #2
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Physical Assessment #3
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Physical Assessment #4
Auscultation
o Anterior, posterior, and lateral thorax
o Normal, adventitious, and voice sounds
 Tables 17-5 and 17-6
o Sequence
 Similar to percussion
 Apices to bases to midaxillary lines
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Assessment Findings
Percussion note (resonant, hyperresonant, dull/flat)
Tracheal position (midline vs. shifted)
Breath sounds (vesicular, bronchial, decreased to
absent)
Adventitious sounds (crackles, wheezes, rhonchi,
pleural rub)
Tactile fremitus and transmitted voice sounds
Table 17-7
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Diagnostic Evaluation #1
Pulmonary function tests (Table 17-8)
Arterial blood gases
Venous blood gas studies
Pulse oximetry
End-tidal carbon dioxide
Cultures
Sputum studies
Imaging studies
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Diagnostic Evaluation #2
Fluoroscopic studies
Radioisotope procedures (lung scans)
Endoscopic procedures
Thoracentesis
Biopsies
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Question #3
Is the following statement true or false?
Sputum samples are best collected immediately
before bed.
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Answer to Question #3
False
Rationale: Sputum samples are used to diagnose
infectious processes and evidence of malignant cells.
The ideal time to obtain a sputum specimen is early in
the morning before the patient has had anything to
eat or drink. The patient should clear the nose and
throat, then rinse the mouth to avoid contamination
of the sample. The patient should be instructed to
take a few deep breaths, cough, and expectorate
sputum into a sterile container.
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