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Respiratory System NRS 102

Respiratory System NRS 102. Denise Coffey MSN, RN. Respiratory Assessment. Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings. Anterior Thoracic Cage. Posterior. Reference Lines. Midsternal line Midclavicular line

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Respiratory System NRS 102

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  1. Respiratory SystemNRS 102 Denise Coffey MSN, RN

  2. Respiratory Assessment • Structure and Function • Subjective Data—Health History Questions • Objective Data—The Physical Exam • Abnormal Findings

  3. Anterior Thoracic Cage

  4. Posterior

  5. Reference Lines • Midsternal line • Midclavicular line • Scapular line • Vertebral line • Anterior, posterior, midaxillary lines

  6. Reference Lines Anterior

  7. Reference Lines Posterior

  8. Lateral

  9. Structure and Function • Thoracic cavity • Mediastinum defined • Lobes of the lungs • Anterior • Posterior • Lateral • Pleurae • Trachea and bronchial tree • Location of trachea and bronchi • Dead space

  10. Structures of the Respiratory System

  11. Mechanics of Respiration • Four functions of respiratory system • Changing chest size during respiration • Inspiration • Expiration • Control of respiration

  12. Mechanics of Respiration

  13. Subjective Data • What would you want to know?

  14. Subjective Data • Cough • Shortness of breath • Chest pain with breathing • History of respiratory infections • Smoking history • Environmental exposure • Self-care behaviors

  15. 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

  16. 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

  17. 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

  18. 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

  19. Objective Data- The Physical Exam Anterior Chest—Auscultate • Breath sounds • Abnormal breath sounds • Adventitious sounds

  20. Objective Data- The Physical Exam Anterior Chest—Auscultate • Breath sounds • Abnormal breath sounds

  21. Abnormal Breath Sounds • Rhonchi • Wheezes • Crackles • Stridor • Croup • Pleural friction rub

  22. Measurement of Pulmonary Function • Pulse ox • ABGs • Pulmonary Function Tests

  23. Documentation

  24. Documentation

  25. Abnormal Findings • Barrel chest • Scoliosis • Kyphosis

  26. Barrel Chest

  27. Scoliosis

  28. Kyphosis

  29. Congestive heart failure Pneumothorax Pneumocystis carinii pneumonia Tuberculosis Pulmonary embolism Acute respiratory distress syndrome (ARDS) Abnormal FindingsCommon Respiratory Conditions • Atelectasis • Lobar pneumonia • Bronchitis • Emphysema • Asthma (reactive airway disease) • Pleural effusion thickening

  30. Interventions • Ambulation • Incentive Spirometer ( IS) • Repositioning • Coughing and Deep Breathing • Medications • Education

  31. http://www.youtube.com/watch?v=NnuaHGW1cwU

  32. 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?

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