Physical Assessment of the Respiratory System

PROFESSORB DRM.ABD ELAZIZ

Inspection

• Kyphosis– AKA

• Hunchback

– Abnormal curvature of the thoracic spine

Inspection

• Lordosis– AKA

• Sway-back

– Abnormal curvature of the lumbar spine

Inspection: Breathing patterns

Rate• Eupnea– Normal– 12-20 / min

• Tachypnea– rate– Pnuemonia, pulm edema, acidosis, septicemia, pain

• Bradypnea– rate– ICP, drug OD

Inspection: Breathing patterns

Depth• Hyperpnea– depth

• Hyperventilation– depth & rate

• Hypoventilation– depth & rate

Inspection: Breathing patterns

Rhythm• Apnea– Not breathing

• Cheyne-stokes– Varying depth f/b apnea– Death rattles– Death rales

Percussion: results

• Resonance – drum like– Normal

• Hyper-resonance– Too much air– Emphysema

• Flatness / dull– Fluid or solid– Pleural effusion– Pneumonia– Tumor

Auscultation

Purpose• Asses air flow through

bronchial treeProcedure• Diaphragm of

stethoscope• Superior inferior• Compare rt to lf

Quiz?

• A child with difficulty breathing and a “barking” cough id displaying signs associated with which condition?

A. AsthmaB. CroupC. Cystic fibrosisD. Epiglottitis

Quiz?

• When assessing the lung sounds of a child with asthma, which sound are you most likely to hear?

A. MurmursB. Sibilant WheezingC. CracklesD. Pleural friction rub

Early & late signs of hypoxia

• Anxiety• Bradycardia• Cyanosis• Depressed respirations• Diaphoresis• Disorientation• Dyspnea

• Restlessness• Headache• Agitation• Poor judgment• Retraction• Tachycardia• Tachypnea

which of the following as an early sign of hypoxia?

A. Restlessness, yawning & tachycardiaB. Dyspnea, confusion & bradycardiaC. Bradycardia, hypotension dyspneaD. Dyspnea, restlessness, hypotension

Dyspnea

• Definition– SOB

–SOB, flat affect, BS x 4

Dyspnea

• Significance– Common with cardiac & resp. disease– Sudden onset – healthy person • Pneumothorax

– Sudden onset ill, post-op or injury • Pulmonary emboli

Dyspnea

• Orthopnea– Sit up to breath• COPD• CHF

Dyspnea

• Right ventricle– If chronic airway resistance – pressure – Rt ventricle work – Rt. Vent damage

Dyspnea

• Management– Find cause– Give O2

– HOB – Communication

Cough

• Definition– To expel air from the lungs suddenly– Irritation of mucous membrane

Cough

• Significance– Infection– Irritants– Protective mechanism– Dry, irritating• URT

– Cough + chest pain• Pleural or musculoskeletal

Cough

• management– Assess– Describe – Directed – Pain control• Splinting

– Infection control– Suppressants / Anti-tussives

Sputum Production

Definition• Matter discharged

from resp. track that contains mucus and pus, blood, fibrin, or bacteria

Sputum Production

Significance• Purulent– Thick, yellow/green – Bacteria

• Rusty – Strep or staph

• Thin, mucous – Viral

Sputum Production

• Pink-tinged– Lung CA– TB

• Pink tinged, profuse, frothy– Pulmonary edema

• Malodorous– Lung abscess

Sputum Production

Management• Thick– Hydrate

• water• Nebulizer• Humidifier

• No smoking• Oral care• Appetite

Obtaining a sputum specimen

• Explain– From lungs

• Sterile cup• Deep breath x 3 • Cough deeply• Expectorate • Best time for

specimen collection?– AM

Chest pain

Definition• Cardiac or pulmonary

Chest pain

Significance• CA (late stage)• Pneumonia• Pulmonary embolism• Pleurisy

Chest pain

• Pleurisy– Inflammation of pleura– Sharp with breath– breath sounds

What?????

What breath sound would you expect to hear on a patient suffering from pleurisy?

A. CracklesB. Sonorous wheezesC. Sibilant wheezesD. Pleural Friction Rub

Chest pain

Management• Assess• Analgesics OK, but…• Position for pain– Affected side– Splint

Clubbed fingers

Definition• Sponginess of the nail

bed • Loss of the nail bed

angle• Finger tip is round and

bulbous

Clubbed Finger

Significance• chronic hypoxia

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?

Hemoptysis

Definition• Expectoration of

blood from the respiratory tract

Hemoptysis

Significance• Pulm or cardiac• Common causes– Pulm infection– CA of lungs– Pulm. Emboli– Pulm. Infarction– TB

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

Hemoptysis

Management• Determine source• Serious

Cyanosis

Definition• Bluish coloring of skin

Cyanosis

Significance• Very late indicator of

hypoxia• Appears when O2 sats

< 85%• NOT a reliable sign of

hypoxia– Esp. with anemia

Cyanosis

• O2 sat definition– % of hemoglobin

carrying oxygen compared to total # of hemoglobin

Cyanosis

• NormalBreath 100 O2 molecules 98 cross into blood

Blood: 100 Hgb• O2 SATS– 98%– No cyanosis

Cyanosis

• HypoxiaBreath 100 O2 molecules 75 cross into blood

Blood: 100 Hgb• O2 SATS– 75%– Cyanosis

Cyanosis

• Anemic and hypoxicBreath 100 O2 molecules 75 cross into blood

Blood: 75 Hgb• O2 SATS– 100% – No Cyanosis

Cyanosis

Management• Know color of Pt. skin• Assess color of tongue &

lips• Fingernail polish• African-American• Vasoconstriction (cold

weather) peripheral cyanosis