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