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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?
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 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
 Infant
30 to 60 breaths per minute
 One year
20 to 40
“
 16 year
12 to 20
“
 Adult
12 to 20
“
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 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
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 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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