Physical Assessment of the Respiratory System

1. Physical Assessment of the Respiratory System Day 2A

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

3. The nurse is teaching a group of prenatal clients about the effects of cigarette smoke on fetal development. Which characteristic is associated with babies born to mothers who smoked during pregnancy? • Low birth weight • Large for gestational age • Preterm birth, but appropriate size for gestation • Growth retardation in weight and length

4. Inspection • Normal chest • Slight retraction of intercostal spaces • 2x as wide as deep • Anterior/posterior diameter • 1:2

5. Inspection • Barrel chest • D/t over inflation of lungs • anterior-posterior diameter • 2:2

6. Inspection • Funnel chest • Depression of the lower portion of the sternum • Complications • Heart damage • i Cardiac output • Nrs management • Murmurs

7. Inspection • Pigeon chest • Sternum protrudes outward • anterior-posterior diameter • h

8. Inspection • Scoliosis • Lateral curvature of thoracic spine • Assessment • Shoulders elevated? • Complications • Lung & heart damage • Back problems • Body image

9. Quiz? • How many hours a day should a child wear a brace for treating scoliosis? • 8 hr • 12 hr • 23 hr • 24 hr

10. Inspection • Kyphosis • AKA • Hunchback • Abnormal curvature of the thoracic spine

11. Inspection • Lordosis • AKA • Sway-back • Abnormal curvature of the lumbar spine

12. Inspection • Uniform expansion of the chest • Pneumonia • Pleural effusion • Pneumothorax • Bulging intercostal spaces • Obstruction • Emphysema

13. Inspection • Marked retraction of intercostal spaces • Blockage • Shoulder rise • Accessory muscles • Posture

14. Inspection: Breathing patterns Rate • Eupnea • Normal • 12-20 / min • Tachypnea • h rate • Pnuemonia, pulm edema, acidosis, septicemia, pain • Bradypnea • i rate • h ICP, drug OD

15. Inspection: Breathing patterns Depth • Hyperpnea • h depth • Hyperventilation • h depth & rate • Hypoventilation • i depth & rate

16. Inspection: Breathing patterns Depth • Kussmaul's • h rate & depth • Assoc. with sever acidosis • Apneustic • Prolonged gasping I following by short

17. Inspection: Breathing patterns Rhythm • Apnea • Not breathing • Cheyne-stokes • Varying depth f/b apnea • Death rattles • Death rales

18. Inspection: Breathing patterns Rhythm • Biot’s • h rate & depth w/ abrupt pauses • Assoc w/ h ICP

19. Inspection: • Trachea • ? Deviation • Pleural effusion • Tension pneumothorax • Atelectasis • Color • LOC • Emotional state

20. Palpation • TML • Tenderness (T) • Masses (M) • Lesions (L) • Sinuses • Palpate below eyebrow & Cheekbone • Crepitus • Subcutaneous emphysema • Air leaks into the sub-q tissue

21. Percussion Rational • To determine if underlying tissue is filled with air or solid material Procedure • Pt sitting • Tap starting at shoulder • compare rt to lf

22. Percussion: results • Resonance – drum like • Normal • Hyper-resonance • Too much air • Emphysema • Flatness / dull • Fluid or solid • Pleural effusion • Pneumonia • Tumor

23. Auscultation Purpose • Asses air flow through bronchial tree Procedure • Diaphragm of stethoscope • Superior  inferior • Compare rt to lf

24. Auscultation: Results Normal • Vesicular • Lung field • Soft and low • Bronchial • Trachea & bronchi • Hollow • Bronchovesicular • Mixed • Between scapulae • Side of sternum • 1st & 2nd intercostal space

25. Auscultation: Results Adventitious • Crackles • Rales • air  bronchi with secretions • Fine crackles • Air  suddenly reinflated • Course Crackles • Moist

26. Auscultation: Results • Wheezes • Sonorous wheezes • Deep low pitched • Snoring • > E • Caused by air  narrowed passages • D/t h secretions • Sibilant Wheezes • High pitched • Whistle-like • I & E • Caused by air  narrowed passages • D/t constriction • Asthma

27. Auscultation: Results • Pleural friction rub • D/t inflammation of pleural membranes • Grating, creaking • I & E • Best heard • Anterior, Lower, lateral area

28. Auscultation: Results • Stridor • Crowing • Partial obstruction of the larynx or trachea

29. Quiz? • A child with difficulty breathing and a “barking” cough id displaying signs associated with which condition? • Asthma • Croup • Cystic fibrosis • Epiglottitis

30. Quiz? • When assessing the lung sounds of a child with asthma, which sound are you most likely to hear? • Murmurs • Sonorous Wheezing • Sibilant Wheezing • Crackles • Pleural friction rub

31. Early & late signs of hypoxia • Anxiety • Bradycardia • Cyanosis • Depressed respirations • Diaphoresis • Disorientation • Dyspnea • Restlessness • Headache • Agitation • Poor judgment • Retraction • Tachycardia • Tachypnea

32. The nurse recognizes which of the following as an early sign of hypoxia? • Restlessness, yawning & tachycardia • Dyspnea, confusion & bradycardia • Bradycardia, hypotension dyspnea • Dyspnea, restlessness, hypotension

33. Dyspnea • Definition • SOB • SOB, flat affect, BS x 4

34. Dyspnea • Significance • Common with cardiac & resp. disease • Sudden onset – healthy person  • Pneumothorax • Sudden onset ill, post-op or injury  • Pulmonary emboli

35. Dyspnea • Orthopnea • Sit up to breath • COPD • CHF

36. Dyspnea • Right ventricle • If chronic airway resistance  • hpressure  • Rt ventricle h work  • Rt. Vent damage

37. Dyspnea • Nrs Management • Find cause • Give O2 • HOB h • Communication • KISS

38. Cough • Definition • To expel air from the lungs suddenly • Irritation of mucous membrane

39. Cough • Significance • Infection • Irritants • Protective mechanism • Dry, irritating • URT • Cough + chest pain • Pleural or musculoskeletal

40. Cough • Nrs management • Assess • Describe • Directed • Pain control • Splinting • Infection control • Suppressants / Anti-tussives

41. Sputum Production Definition • Matter discharged from resp. track that contains mucus and pus, blood, fibrin, or bacteria

42. Sputum Production Significance • Purulent • Thick, yellow/green • Bacteria • Rusty • Strep or staph • Thin, mucous • Viral

43. Sputum Production • Pink-tinged • Lung CA • TB • Pink tinged, profuse, frothy • Pulmonary edema • Malodorous • Lung abscess

44. Sputum Production Nrs Management • Thick • Hydrate • h water • Nebulizer • Humidifier • TCDB • No smoking • Oral care • h Appetite

45. Do You Know????? What breath sound would you expect to hear on a patient with increased sputum production? • Vesicular • Crackles • Sonorous wheezes • Sibilant wheezes

46. Obtaining a sputum specimen • Explain • From lungs • Sterile cup • Deep breath x 3  • Cough deeply • Expectorate • Best time for specimen collection? • AM

47. A nurse is to collect a sputum specimen for acid-fast bacillus (AFB) from a client. Whichaction should the nurse take first? • Ask client to cough sputum into container • Have the client take several deep breaths • Provide a appropriate specimen container • Assist with oral hygiene

48. Chest pain Definition • Cardiac or pulmonary

49. Chest pain Significance • CA (late stage) • Pneumonia • Pulmonary embolism • Pleurisy

50. Chest pain • Pleurisy • Inflammation of pleura • Sharp with breath • i breath sounds