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The Respiratory System

The Respiratory System. Jean M. Wilson, BSN, RN, CCE. Assessment of the Chest and Lungs. Equipment needed: Tape measure Stethoscope Blanket or drape Ruler. A & P. Position of the Patient:

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The Respiratory System

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  1. The Respiratory System Jean M. Wilson, BSN, RN, CCE

  2. Assessment of the Chest and Lungs • Equipment needed: Tape measure Stethoscope Blanket or drape Ruler

  3. A & P • Position of the Patient: Sitting = best; Allows for inspection of both the back and the chest for: the 3 S’s Size Shape Symmetry

  4. Landmarks • Landmarks: Clavicle Trachea Intercostal spaces (ICS) Midclavicular lines Axillary lines

  5. Landmarks Continued Midsternal line Sternum Xiphoid process

  6. Anterior Chest • Lungs: Right upper lobe Left upper lobe Right middle lobe Left lower lobe Right lower lobe

  7. Posterior Chest • Vertebral line • Right and left lobes • Scapula • Scapula line

  8. Assesessment • Anteroposterior Diameter = half of the transverse diameter • Unexpected findings: Barrel chest Pigeon chest Funnel chest Deviations

  9. Assessment • Assess the patient’s; Lips: color, pursed lips Nails: clubbing, cyanosis Nares: flaring Oxygen saturation Breath: odor Patients overall color

  10. Respirations • Expected: Rhythm and pattern: even & easy with no distress Repiration rate: 12-20 breaths per minute Ratio of HR/RR: 1 to 4

  11. Respirations • Unexpected: Shortness of Breath (SOB) Tachypnea Orthopnea Use of accessory muscles Retractions

  12. Patterns of Respirations • Normal: regular 12-20 per minute • Bradypnea: slow, < 12 • Tachypena: fast, > 20 • Hyperpnea (hyperventilation) faster, >20 and deep • Sighing: sigh/deep breath

  13. Patterns of Respirations • Air trapping: increase difference in the air getting out • Cheyne Stokes: increase in depth with periods of apnea • Kussmauls: rapid, deep, and labored • Biots: apnea and disorganized breathing

  14. Patterns of Respirations • Ataxic: irregular, with varying depths

  15. Listening • Two types of breath sounds; normal and abnormal • Normal are called; bronchial, bronchial vesicular, and vesicular • Abnormal are also called; adventitious

  16. Listening • Review the proper use of the stethoscope

  17. Normal Breath Sounds • Bronchial: trachea, anterior only, and high pitch • Bronchovesicular: main bronchus, anterior and posterior, medium pitch • Vesicular: heard over most of the lung fields, bases, low pitch

  18. Adventicious Breath Sounds • Crackles: fine, medium, and coarse Fine: not cleared by coughing, heard at the end of inspiration Medium: lower, moist, heard during inspiration, not cleared by cough Coarse: loud, bubbly, heard on inspiration, can be cleared by coughing

  19. Adventicious Breath Sounds • Wheezes: musical note, squeaky, heard on inspiration or expiration • Rhonci: sunorous wheeze, loud, low, inspiration or expiration, coughing may clear, due to mucous accumulation • Stridor: bark, no air exchange • Pleural friction rub: rubbing, dry, grating sound, inspiration or expiration, anterior

  20. Abnormalities • Pulsations • Tenderness • Bulges • Depressions • Unusual movement • Unusual positions

  21. Thoracic Expansion • Stand behind the patient • Place palms lightly on patient’s back with thumbs at the 10th rib • Have patient breathe & watch thumbs with each breath • Symmetric expantions should be seen • Repeat anteriorly under the xiphoid process

  22. Trachea • Midline • Palpate gently with index finger about suprasternal notch • A slight deviation to the right is normal • Should be non-tender • Pulsations = abnormal

  23. Chest Percussion • Direct: • Indirect: • Percuss all areas anteriorly and posteriorly

  24. Percussion Tones • Resonant: low pitch, hollow, loud, long • Flat: soft, extremely dull, short, high pitch • Dull: medium, medium-high pitch, thudlike • Tympanic: loud, high pitch, drumlike • Hyperresonant: very loud, very low pitch, long, booming sound

  25. Vocal Resonance • Have patient recite numbers or words as you listen to all lung fields (99) • Muffled sound should be heard

  26. Abnormalities • Cancer • Infections: upper respiratory, sputum production • Asthma • Chronic Obstructive Pulmonary Disease (COPD)

  27. Abnormalities Continued • Emphysema • Pneumonai • Barrel Chest • Productive (sputum)/non-productive coughing • Long expirations

  28. Cough Descriptions • Dry • Moist • Non-productive • Productive: assess sputum color; yellow, green, rust, clear, purrulent, blood streaked, thick(viscous) or thin

  29. Coughs • Assess: Onset Frequency Regularity; certain time of day or activities Postural changes Smoker/non-smoker Environmental/work related issues

  30. References Schilling, J. A. et al (2007). Health assessment made incredibly visual! Philadelphia: Lippincott, Williams, & Williams.

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