Denise Coffey MSN, RN
Respiratory Assessment
 Structure and Function
 Subjective Data—Health History Questions
 Objective Data—The Physical Exam
 Abnormal Findings
Anterior Thoracic Cage
Slide 18-3
Posterior
Reference Lines
 Midsternal line
 Midclavicular line
 Scapular line
 Vertebral line
 Anterior, posterior,
midaxillary lines
Reference Lines Anterior
Reference Lines Posterior
Lateral
Structure and Function
 Thoracic cavity
 Mediastinum defined
 Trachea and bronchial
tree

Location of trachea and
bronchi

Dead space
 Lobes of the lungs

Anterior

Posterior

Lateral
 Pleurae
Structures of the Respiratory
System
Mechanics of Respiration
 Four functions of respiratory system
 Changing chest size during respiration
 Inspiration
 Expiration
 Control of respiration
Mechanics of Respiration
Subjective Data
 What would you want to know?
Subjective Data
 Cough
 Shortness of breath
 Chest pain with breathing
 History of respiratory infections
 Smoking history
 Environmental exposure
 Self-care behaviors
Objective Data- The Physical Exam
 Preparation
 Position
 Draping
 Timing during a complete examination
 Cleaning stethoscope endpiece
 Equipment needed
 Stethoscope
 Small ruler marked in centimeters
 Marking pen
 Alcohol swab
Objective Data- The Physical Exam
Posterior Chest—Inspect
 Thoracic cage
 Shape and configuration of chest wall
 Anteroposterior/transverse diameter
 Position of person
 Skin color and condition
Objective Data- The Physical Exam
Posterior Chest—Palpate
 Symmetric expansion
 Tactile (or vocal) fremitus
 Technique
 Factors that affect normal intensity of tactile fremitus
 Palpate the entire chest wall
Posterior Chest—Percuss
 Predominant note over lung fields
 Diaphragmatic excursion
Objective Data- The Physical Exam
Anterior Chest—Palpate
 Symmetric chest expansion
 Tactile fremitus
 Palpate the anterior chest wall
Anterior Chest—Percuss
 Predominant note over lung fields
 Borders of cardiac dullness
Objective Data- The Physical Exam
Anterior Chest—Auscultate
 Breath sounds
 Abnormal breath sounds
Objective Data- The Physical Exam
Anterior Chest—Auscultate
 Breath sounds
 Abnormal breath sounds
Expected Breath Sounds
 Breath sounds
 Technique
 Bronchial breath sounds—characteristics
 Bronchovesicular breath sounds—
characteristics
 Vesicular breath sounds—characteristics
Abnormal Breath Sounds
 Rhonchi
 Wheezes
 Crackles
 Stridor
 Croup
 Pleural friction rub
Listen
 http://www.youtube.com/watch?v=NnuaHGW1cwU
Measurement of Pulmonary Function
 Pulse ox
 ABGs
 Pulmonary Function Tests
Abnormal Findings
 Barrel chest
 Scoliosis
 Kyphosis
Barrel Chest
Scoliosis
Kyphosis
Abnormal Findings
Common Respiratory Conditions
 Atelectasis
 Lobar pneumonia
 Bronchitis
 Congestive heart


 Emphysema
 Asthma (reactive
airway disease)
 Pleural effusion thickening



failure
Pneumothorax
Pneumocystis carinii
pneumonia
Tuberculosis
Pulmonary embolism
Acute respiratory
distress syndrome
(ARDS)
Interventions
 Ambulation
 Incentive Spirometer ( IS)
 Repositioning
 Coughing and Deep Breathing
 Medications
 Education
Case scenario
 You are caring for Mrs. Brown, a 75-year-old retired
school teacher who underwent repair of a right
fractured femur. This is her first postoperative day on
your clinical unit.
 Upon auscultation of her posterior lung field bases,
you hear a crackling noise upon inspiration. What is
this sound, and what does it indicate?