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The Respiratory System

The Respiratory System. Thorax and Lungs Rachel S. Natividad, RN, MSN, NP. Lobes and Landmarks. Performing the Assessment: Subjective Data. ROS -Ask about dyspnea, cough, chest pain (PQRST format) Short interview sessions if resp. distress / tiring easily. Inspection… …Always first!!!

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The Respiratory System

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  1. The Respiratory System Thorax and Lungs Rachel S. Natividad, RN, MSN, NP

  2. Lobes and Landmarks

  3. Performing the Assessment: Subjective Data • ROS -Ask about dyspnea, cough, chest pain (PQRST format) • Short interview sessions if resp. distress / tiring easily

  4. Inspection… …Always first!!! The moment you see the patient. What position is most comfortable for him? Does he appear relaxed, anxious, uncomfortable? Is he having any trouble breathing? Assessment begins…. Tripod Position

  5. Focused Assessment • Inspection-cont. • Color, Size and shape & symmetry of chest, any lesions or scars • Anterior Lateral Posterior

  6. Increased Anteroposterior:Transverse Diameter Altered size/shape:Barrel Chest 1:2 1:1

  7. Barrel Chest

  8. Fractured ribs/ flail chest Pneumothorax atelectasis paralysis of the diaphragm Spinal deformity Asymmetrical chest Scoliosis

  9. Intercostal Spaces and Muscles Retractions

  10. Focused Assessment Cont… • Resp. rate (per min.) and depth (shallow, even, deep) • Normal pattern of respiration – regular rhythm

  11. Relating to other systems… • Skin: cyanosis, pallor • Nails: Clubbing • Spongy nail matrix and nail angle of greater than 160 degrees

  12. Check for tenderness (normally nontender) Crepitus – SQ air pockets Tactile fremitus – increased with fluid accumulation Abnormal if tumor, fractured ribs, chest tubes, wound site, fluid Focused Assessment Cont.:Palpation

  13. Focused Assessment:Auscultation

  14. Normal Breath Sounds

  15. Continuous sounds Wheezes Sibilant Sonorous (Rhonchi) Discontinuous sounds Crackles (Rales) Fine Course *Atelectic crackles Stridor Pleural friction rub Adventitious/AbnormalBreath Sounds (T 11-2) p.132

  16. Wheezes (Continuous) Sibililant wheeze Heard 1st in expiration • high-pitched musical sounds • Partial blockage in airflow Sonorous wheeze (rhonchi) Heard primarily in expiration • low pitched – snoring, rattling sound • Air passes through large airways filled with fluid/ secretions

  17. Interpreting what you hear… • Is the sound is continuous or discontinuous? • Is the sound occur during inhalation or exhalation, or both?

  18. Crackles (Discontinuous) • FINE vs. COURSE • Caused by collapsed or fluid-filled alveoli popping open • usually heard in the lung bases during inhalation • Atelectic crackles • Sridor • Pleural friction rub – pericarditis

  19. Abnormal Breath Sounds • Diminished breathsounds • Absent breath sounds

  20. Assessment Guide: Gas Exchange • Respiratory • Rate: 18 resp/min • Depth: deep, even, shallow • Effort: labored, unlabored • Breath Sounds • Describe: clear, rhonchi, inspiratory/expiratory wheezes, crackles • Location: all lobes, throughout lung fields, LLL, RUL/RML, lower lobes bilat. • Cough: present/not present • Describe: productive, moist, nonproductive • Sputum: large amount, thick yellow; moderate pink frothy sputum, sml. Amt. thin clear sputum.

  21. Interventions in use: • Position, Turn, Cough, Deep breathe • O2 Method: nc, venti mask, rebreathing mask • Flow rate: 2L/min; 3l/min • Humidity: yes/no • Pulse Oximeter: continuous, spot monitoring • Incentive Spirometer: in use, n/a • Time used: 10 am, 11 am, 1 pm, 3 pm • Volume: 500 cc, 500 cc, 600 cc, 800 cc • Oropharyngeal Suctioning: Describe- moderate amount thick tan secretions • Med List: Albuterol inhaler, Prednisone, Theophylline

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