Chapter 29
Assessment
of the
Respiratory
System
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Chapter 29 Assessment of the Respiratory
System Learning Outcomes
1. Teach patients and family members about what
to expect during tests and procedures to assess
respiratory function and respiratory disease.
2. Use concepts of anatomy and appropriate
psychomotor skills to apply respiratory assessment
techniques correctly.
3. Perform a clinical respiratory assessment,
including health history, genetic risk, physical
assessment, and psychosocial assessment.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Chapter 29 Assessment of the Respiratory System
Learning Outcomes (Continued)
4. Distinguish between normal and abnormal
(adventitious) breath sounds.
5. Explain the respiratory changes associated with
aging.
6. Calculate the pack-year smoking history for the
patient who smokes or who has ever smoked
cigarettes.
7. Interpret arterial blood gas values to assess the
patient's respiratory status.
8. Explain nursing care needs for the patient after
bronchoscopy or open lung biopsy.
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Anatomy & Physiology Review
• Upper respiratory tract
• Lower respiratory tract
• Oxygen delivery and the oxygenhemoglobin dissociation curve
Figure 29-8
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Role of the Respiratory System
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Patient Health History
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Family and personal data
Smoking (pack-years)
Drug use
Allergies
Travel, geographic area of residence
Nutritional status
Cough, sputum production, chest pain,
dyspnea, PND, orthopnea
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Assessment of the
Nose & Sinuses
• External nose—deformities or tumors
• Nares—symmetry of size and shape
• Nasal cavity—color, swelling, drainage,
bleeding
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Assessment of the
Nose & Sinuses (cont’d)
• Mucous membranes—abnormalities
• Septal deviation
• Nasal polyps
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Assessment of the
Nose & Sinuses (cont’d)
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Assessment of the
Pharynx, Trachea, & Larynx
• Mouth
• Neck—symmetry, alignment, masses,
swelling, bruises, use of accessory neck
muscles for breathing
• Trachea—palpate for position, mobility,
tenderness, masses
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Assessment of the
Pharynx, Trachea, & Larynx (cont’d)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Assessment of the
Lungs & Thorax
• Inspect thorax with patient sitting up
• Observe chest, compare one side with the
other
• Work from the apex, move downward
toward base (from side to side)
• Rate, rhythm, depth of inspiration as well
as symmetry of chest movement
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Assessment of the
Lungs & Thorax (cont’d)
• Examine AP diameter with lateral diameter
• Distance between ribs (intercostal space)
• Palpate to assess respiratory movement,
symmetry
• Crepitus
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Assessment of the
Lungs & Thorax (cont’d)
• Diaphragmatic excursion
• Lung sounds Table 29-4
– Bronchial
– Bronchovesicular
– Vesicular
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Assessment of the
Lungs & Thorax (cont’d)
• Adventitious sounds Table 29-5
– Crackles
– Wheezes
– Rhonchi
– Pleural friction rub
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Assessment of the
Lungs & Thorax (cont’d)
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Assessment of the
Lungs & Thorax (cont’d)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Other Indicators of
Respiratory Adequacy
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Clubbing
Weight loss
Unevenly developed muscles
Skin and mucous membrane changes
General appearance
Endurance
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Psychosocial Assessment
• Stress may worsen some respiratory
problems
• Chronic respiratory disease may cause
changes in family roles, social isolation,
financial problems due to unemployment
or disability
• Discuss coping mechanisms, offer access to
support systems
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Study Chart 29-1
Changes in the Respiratory System
Related to Aging
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Alveoli
Lungs
Pharynx and Larynx
Pulmonary Vasculature
Exercise Tolerance
Muscle Strength
Susceptibility to Infection
Chest Wall
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Laboratory Tests
• Blood
• Sputum
• Standard chest x-rays, CT
• Pulse oximetry (noninvasive)
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Pulmonary Function Testing
• Noninvasive
• Evaluate lung function and breathing
problems
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Capnometry & Capnography
• Noninvasive
• Measure amount of carbon dioxide present
in exhaled air
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Other Noninvasive Testing
• Exercise testing
• Skin testing
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Invasive Diagnostic Tests
• Endoscopy
• Thoracentesis—aspiration of pleural fluid or
air from pleural space
– Stinging sensation and feeling of pressure
– Correct position
– Motionless patient
– Follow-up assessment for complications
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Position for Thoracentesis
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Lung Biopsy
• Invasive
• Obtain tissue to diagnose for cancer,
infection, inflammation or other lung
diseases
• May be performed in OR or radiology
department depending on the type of
biopsy done
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Lung Biopsy (cont’d)
• Follow-up care:
– Assess vital signs, breath sounds at least every
4 hours for 24 hours
– Assess for respiratory distress
– Report reduced/absent breath sounds
immediately
– Monitor for hemoptysis
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Question 1
Which of these is an expected outcome for
the older adult related to the natural aging
process of the respiratory system?
A. Tightening of the vocal cords
B. Decrease in the anteroposterior diameter
C. Decrease in respiratory muscle strength
D. Decrease in residual volume
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Answer: C
• Rationale: As a person ages, vocal cords become
slack, changing the quality and strength of the
voice, the anteroposterior diameter increases,
respiratory muscle strength decreases, and the
residual volume increases.
• (Source: Accessed August 1, 2011, from
http://www.nlm.nih.gov/medlineplus/ency/articl
e/004011.htm)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Question 2
Under normal physiologic conditions of tissue
perfusion, what percent of oxygen dissociates
from the hemoglobin molecule?
A. 25%
B. 50%
C. 75%
D. 100%
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• Answer: B
• Rationale: Oxygen dissociates with the
hemoglobin molecule based on the need for
oxygen to perfuse tissues. Under normal
conditions, 50% of hemoglobin molecules
completely dissociate their oxygen molecules
when blood perfuses tissues that have an oxygen
tension (concentration) of 26 mm Hg. This is
considered a “normal” point at which 50% of
hemoglobin molecules are no longer saturated
with oxygen. (See Figure 29-8.)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Question 3
Which is considered a main sign of lung
disease?
A. Dyspnea
B. Cough
C. Sputum production
D. Chest pain
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Answer: B
• Rationale: Cough is a main sign of lung disease.
Dyspnea (difficulty in breathing or
breathlessness) is a subjective perception and
varies among patients. A patient’s feeling of
dyspnea may not be consistent with the severity
of the presenting problem. Sputum production
may be associated with coughing and indicate an
acute or chronic lung condition. Chest pain can
occur with other health problems, as well as with
lung problems.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.