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Physical Assessment of the Respiratory System

بررسي دستگاه تنفس

Hajinezhad, Mohammad Esmaiel

History Physical problems Function problems Life style Smoking Family Hx Occupation hx Allergens / environment Recreational exposure Anxiety S&S

Hajinezhad, Mohammad Esmaiel

Inspection Normal chest

Slight retraction of intercostal spaces

2x as wide as deep Anterior/posterior

diameter 1:2

Hajinezhad, Mohammad Esmaiel

Inspection

Barrel chest D/t over inflation of

lungs anterior-posterior

diameter 2:2

Hajinezhad, Mohammad Esmaiel

Inspection Funnel chest

Depression of the lower portion of the sternum

Complications Heart damage Cardiac output

Nrs management Murmurs

Hajinezhad, Mohammad Esmaiel

Inspection Pigeon chest

Sternum protrudes outward

anterior-posterior diameter

Hajinezhad, Mohammad Esmaiel

Pigeon Chest

Hajinezhad, Mohammad Esmaiel

Inspection Scoliosis

Lateral curvature of thoracic spine

Assessment Shoulders elevated?

Complications Lung & heart damage Back problems Body image

Hajinezhad, Mohammad Esmaiel

Scoliosis

Hajinezhad, Mohammad Esmaiel

Scoliosis

Hajinezhad, Mohammad Esmaiel

Quiz? How many hours a day should a child

wear a brace for treating scoliosis?A. 8 hrB. 12 hrC. 23 hrD. 24 hrIt can be removed for 1 hour a day for

hygiene purposes

Hajinezhad, Mohammad Esmaiel

Inspection Kyphosis

AKA Hunchback

Abnormal curvature of the thoracic spine

Hajinezhad, Mohammad Esmaiel

Kyphosis

Hajinezhad, Mohammad Esmaiel

Inspection Lordosis

AKA Sway-back

Abnormal curvature of the lumbar spine

Hajinezhad, Mohammad Esmaiel

Lordosis

Hajinezhad, Mohammad Esmaiel

Inspection Uniform expansion

of the chest Pneumonia Pleural effusion Pneumothorax

Bulging intercostal spaces Obstruction Emphysema

Hajinezhad, Mohammad Esmaiel

Inspection Marked retraction of

intercostal spaces Blockage

Shoulder rise Accessory muscles Posture

Hajinezhad, Mohammad Esmaiel

Inspection: Breathing patterns Rate Eupnea

Normal 12-20 / min

Tachypnea rate Pnuemonia, pulm edema, acidosis, septicemia,

pain Bradypnea

rate ICP, drug OD

Hajinezhad, Mohammad Esmaiel

Inspection: Breathing patternsDepth Hyperpnea

depth

Hyperventilation depth & rate

Hypoventilation depth & rate

Hajinezhad, Mohammad Esmaiel

Inspection: Breathing patternsDepth Kussmaul's

rate & depth Assoc. with sever acidosis

Apneustic Prolonged gasping I following by short

Hajinezhad, Mohammad Esmaiel

Inspection: Breathing patternsRhythm Apnea

Not breathing

Cheyne-stokes Varying depth f/b apnea Death rattles Death rales

Hajinezhad, Mohammad Esmaiel

Inspection: Breathing patternsRhythm Biot’s

rate & depth w/ abrupt pauses Assoc w/ ICP

Hajinezhad, Mohammad Esmaiel

Inspection: Trachea

? Deviation Pleural effusion Tension pneumothorax Atelectasis

Color LOC Emotional state

Hajinezhad, Mohammad Esmaiel

Palpation TML

Tenderness (T) Masses (M) Lesions (L)

Sinuses Palpate below eyebrow &

Cheekbone Crepitus

Subcutaneous emphysema Air leaks into the sub-c

tissue

Hajinezhad, Mohammad Esmaiel

PercussionRational To determine if

underlying tissue is filled with air or solidmaterial

Procedure Pt sitting Tap starting at shoulder compare rt to lf

Hajinezhad, Mohammad Esmaiel

Percussion: results Resonance – drum like

Normal

Hyper-resonance Too much air Emphysema

Flatness / dull Fluid or solid Pleural effusion Pneumonia Tumor

Hajinezhad, Mohammad Esmaiel

AuscultationPurpose Asses air flow

through bronchial tree

Procedure Diaphragm of

stethoscope Superior inferior Compare rt to lf

Hajinezhad, Mohammad Esmaiel

Auscultation: ResultsNormal Vesicular

Lung field Soft and low

Bronchial Trachea & bronchi Hollow

Bronchovesicular Mixed Between scapulae Side of sternum 1st & 2nd intercostal space

Hajinezhad, Mohammad Esmaiel

Auscultation: ResultsAdventitious Crackles

Rales air bronchi with

secretions

Fine crackles Air suddenly

reinflated

Course Crackles Moist

Hajinezhad, Mohammad Esmaiel

Auscultation: Results Wheezes

Sonorous wheezes Deep low pitched Snoring > E Caused by air

narrowed passages D/t secretions

Sibilant Wheezes High pitched Whistle-like I & E Caused by air

narrowed passages D/t constriction

Asthma

Hajinezhad, Mohammad Esmaiel

Auscultation: Results Pleural friction rub

D/t inflammation of pleural space

Grating, creaking I & E Best heard

Anterior, Lower, lateral area

Hajinezhad, Mohammad Esmaiel

Auscultation: Results Stridor

Crowing Partial obstruction of

the larynx or trachea

Hajinezhad, Mohammad Esmaiel

Quiz? A child with difficulty breathing and a

“barking” cough id displaying signs associated with which condition?

A. AsthmaB. CroupC. Cystic fibrosisD. Epiglottitis

Hajinezhad, Mohammad Esmaiel

Quiz? When assessing the lung sounds of a

child with asthma, which sound are you most likely to hear?

A. MurmursB. Sonorous WheezingC. Sibilant WheezingD. CracklesE. Pleural friction rub

Hajinezhad, Mohammad Esmaiel

Early & late signs of hypoxia Anxiety Bradycardia Cyanosis Depressed

respirations Diaphoresis Disorientation Dyspnea

Restlessness Headache Agitation Poor judgment Retraction Tachycardia Tachypnea

Hajinezhad, Mohammad Esmaiel

Early & late signs of hypoxia Anxiety Bradycardia Cyanosis Depressed

respirations Diaphoresis Disorientation Dyspnea

Restlessness Headache Agitation Poor judgment Retraction Tachycardia Tachypnea

Hajinezhad, Mohammad Esmaiel

Dyspnea Definition

SOB ����������������� ��

Hajinezhad, Mohammad Esmaiel

Dyspnea Significance

Common with cardiac & resp. disease Sudden onset – healthy person

Pneumothorax

Sudden onset ill, post-op or injury Pulmonary emboli

Hajinezhad, Mohammad Esmaiel

Dyspnea Orthopnea

Sit up to breath COPD CHF

Hajinezhad, Mohammad Esmaiel

Dyspnea Right ventricle

If chronic airway resistance pressure Rt ventricle work Rt. Vent damage

Hajinezhad, Mohammad Esmaiel

Dyspnea Nrs Management

Find cause Give O2

HOB Communication

KISS

Hajinezhad, Mohammad Esmaiel

Cough Definition

To expel air from the lungs suddenly Irritation of mucous membrane

Hajinezhad, Mohammad Esmaiel

Cough Significance

Infection Irritants Protective mechanism Dry, irritating

URT

Cough + chest pain Pleural or musculoskeletal

Hajinezhad, Mohammad Esmaiel

Cough Nrs management

Assess Describe Directed Pain control

Splinting

Infection control Suppressants / Anti-tussives

Hajinezhad, Mohammad Esmaiel

Sputum ProductionDefinition Matter discharged

from resp. track that contains mucus and pus, blood, fibrin, or bacteria

Hajinezhad, Mohammad Esmaiel

Sputum ProductionSignificance Purulent

Thick, yellow/green Bacteria

Rusty Strep or staph

Thin, mucous Viral

Hajinezhad, Mohammad Esmaiel

Sputum Production Pink-tinged

Lung CA TB

Pink tinged, profuse, frothy Pulmonary edema

Malodorous Lung abscess

Hajinezhad, Mohammad Esmaiel

Sputum ProductionNrs Management Thick

Hydrate water Nebulizer Humidifier

TCDB No smoking Oral care Appetite

Hajinezhad, Mohammad Esmaiel

Do You Know?????What breath sound would you expect to

head on a patient with increased sputum production?

A. VesicularB. CracklesC. Sonorous wheezesD. Sibilant wheezes

Hajinezhad, Mohammad Esmaiel

Obtaining a sputum specimen Explain

From lungs Sterile cup Deep breath x 3 Cough deeply Expectorate Best time for

specimen collection? AM

Hajinezhad, Mohammad Esmaiel

Chest painDefinition Cardiac or

pulmonary

Hajinezhad, Mohammad Esmaiel

Chest painSignificance CA (late stage) Pneumonia Pulmonary embolism Pleurisy

Hajinezhad, Mohammad Esmaiel

Chest pain Pleurisy

Inflammation of pleura

Sharp with breath breath sounds

Hajinezhad, Mohammad Esmaiel

What?????What breath sound would you expect to

hear on a patient suffering from pleurisy?

A. CracklesB. Sonorous wheezesC. Sibilant wheezesD. Pleural Friction Rub

Hajinezhad, Mohammad Esmaiel

Chest painNrs Management Assess Analgesics OK,

but… Position for pain

Affected side Splint

Hajinezhad, Mohammad Esmaiel

Clubbed fingersDefinition Sponginess of the

nail bed Loss of the nail bed

angle Finger tip is round

and bulbous

Hajinezhad, Mohammad Esmaiel

Clubbed fingers

Hajinezhad, Mohammad Esmaiel

Clubbed FingerSignificance chronic hypoxiaNrs Management Marker

Hajinezhad, Mohammad Esmaiel

Mr. Caveman:

Mr. Caveman enters the ER unconscious following an Automobile accident. The paramedics report that his O2 sats are 86%. You note that Mr. Caveman has clubbed fingers. What does this tell you?

Hajinezhad, Mohammad Esmaiel

HemoptysisDefinition Expectoration of

blood from the respiratory tract

Hajinezhad, Mohammad Esmaiel

HemoptysisSignificance Pulm or cardiac Common causes

Pulm infection CA of lungs Pulm. Emboli Pulm. Infarction TB

Hajinezhad, Mohammad Esmaiel

Hemoptysis Hemoptysis

Definition? Coughed up blood

From? Pulm hemorrhage

Description Pink, red, mixed with

sputum

Blood pH Alkaline blood

Hematemesis Definition?

Vomited blood

From? Stomach / GI

Description “Coffee ground”

Blood ph Acidic blood

Hajinezhad, Mohammad Esmaiel

HemoptysisNrs Management Determine source Serious

Hajinezhad, Mohammad Esmaiel

CyanosisDefinition Bluish coloring of

skin

Hajinezhad, Mohammad Esmaiel

CyanosisSignificance Very late indicator of

hypoxia Appears when O2

sats < 85% NOT a reliable sign

of hypoxia Esp. with anemia

Hajinezhad, Mohammad Esmaiel

Cyanosis O2 sat definition

% of hemoglobin carrying oxygen compared to total # of hemoglobin

Hajinezhad, Mohammad Esmaiel

Cyanosis NormalBreath 100 O2 molecules 98 cross into blood

Blood: 100 Hgb O2 SATS

98% No cyanosis

Hajinezhad, Mohammad Esmaiel

Cyanosis HypoxiaBreath 100 O2 molecules 75 cross into blood

Blood: 100 Hgb O2 SATS

75% Cyanosis

Hajinezhad, Mohammad Esmaiel

Cyanosis Anemic and hypoxicBreath 100 O2 molecules 75 cross into blood

Blood: 75 Hgb O2 SATS

100% No Cyanosis

Hajinezhad, Mohammad Esmaiel

CyanosisNrs. Management Know color of Pt. skin Assess color of tongue

& lips Fingernail polish African-American Vasoconstriction (cold

weather) peripheral cyanosis

Hajinezhad, Mohammad Esmaiel