Assessment of the Respiratory System

Question 1

Oxygen-Dissociation Curve:

Answer 1

When blood passes through lung alveoli, oxygen concentration is greater, oxygen diffuses from alveoli into RBC’s

Then oxygen rich blood is pumped out into systemic circulation

Question 2

Oxygen-Dissociation Curve: In tissues away from the source of O2

Answer 2

hemoglobin unloads or dissociates the oxygen molecule and delivers them to the tissues

The “unloading” depends on the tissues’ need for oxygen

Question 3

Greater tissue need=

Answer 3

-curve shifts to right; hemoglobin will disassociate faster:
Increase tissue temperature
Increase tissue carbon dioxide concentration
Decrease pH (acidosis)

Question 4

Metabolizing oxygen slowly=

Answer 4

-shift to left; prevents wasting of oxygen:
Decrease tissue temperature
Decrease tissue carbon dioxide concentration levels
Decreased glucose breakdown products
Higher tissue pH (alkalosis)

Question 5

Respiratory & Aging Process:

Answer 5

Alveoli
Lungs
Pharynx & larynx
Pulmonary vasculature
Exercise tolerance
Muscle strength
Susceptibility of infections
Chest wall

Question 6

Alveoli aging:

Answer 6

Surface area decreases
Diffusion capacity decreases
Cough decreases
Airways close early
Bronchioles and alveolar ducts dilate

Question 7

Lungs aging:

Answer 7

Residual volume increases
Vital capacity decreases
Efficiency of O2 decreases

Question 8

Pharynx and larynx aging:

Answer 8

Muscles atrophy

Vocal cords become slack

Question 9

Pulmonary vasculature aging:

Answer 9

Vascular resistance increases
Pulmonary capillary blood volume decreases
Hypoxia increases

Question 10

Exercise tolerance:

Answer 10

Hypercarbia decreases

Question 11

Muscle strength

Answer 11

decreases

Question 12

Susceptibility of infection

Answer 12

effectiveness of cilia decrease
Immunoglobulin A decreases
Alveolar macrophages are altered

Question 13

Chest wall aging

Answer 13

Anteroposterior diameter increases 
Thorax becomes shorter
Progressive kyphoscoliosis occurs 
Chest wall compliance (elasticity) decreases 
Osteoporosis is possible
Mobility of chest wall may decrease

Question 14

Relevant Patient History:

Answer 14

Family and personal data
Smoking (pack-years)
Drug use
Allergies/ Irritants
Travel, geographic area of residence
Nutritional status
Cough, sputum production, chest pain, dyspnea, PND, orthopnea

Question 15

Assessment of the Nose & Sinuses: External nose –

Answer 15

Deformities or tumors, polyps

Nares - symmetry of size and shape

Question 16

Assessment of the Nose & Sinuses: Nasal cavity

Answer 16

Color, swelling, drainage, bleeding

Question 17

Assessment of the Nose & Sinuses:Mucous membranes

Answer 17

Abnormalities
Normally appears redder than oral mucosa
Patients w/ allergic rhinitis = pale, engorged, and bluish gray

Question 18

Assessment of the Nose & Sinuses: Septal deviation

Answer 18

common and appears as an S shape, tilting toward one side or the other

Question 19

Assessment of the Nose & Sinuses: turbinates

Answer 19

swelling. exudate, and color in nasal mucosa

Question 20

Assessment of thePharynx, Trachea, & Larynx :

Answer 20

• Begins w/Mouth
• Posterior pharynx
• Neck – Symmetry, alignment, masses, swelling, bruises, use of accessory neck muscles for breathing
• Trachea – Palpate for position, mobility, tenderness, masses

Question 21

Assessment of the Lungs & Thorax:

Answer 21

• Inspect thorax with patient sitting up
• Observe chest, compare one side with the other
• Work from the apex, move downward toward base (from side to side)
• Rate, rhythm, depth of inspiration as well as symmetry of chest movement
• Examine AP diameter with lateral diameter
• Distance between ribs (intercostal space)
• Palpate to assess respiratory movement, symmetry
• Crepitus

Question 22

Lung sounds

Answer 22

Bronchial
Bronchovesicular
Vesicular

Question 23

Adventitious sounds

Answer 23

Additional breath sounds superimposed on normal sounds, and they indicate pathologic changes in the lung

• Crackles (rales)
• Wheezes
• Rhonchi (lower pitch, coarse)

Question 24

Other Indicators of Respiratory Adequacy:

Answer 24

• Cyanosis
• Clubbing of fingers
• Weight loss
• Unevenly developed muscles
• Skin and mucous membrane changes
• General appearance
• Tripod position
• Activity tolerance – shortness of breath with 10-20 steps

Question 25

Psychosocial Assessment:

Answer 25

Stress may worsen some respiratory problems

Chronic respiratory disease may cause changes in family roles, social isolation, financial problems due to unemployment or disability

Discuss coping mechanisms, offer access to support systems

Question 26

Diagnostic Tests:

Answer 26

Blood
Sputum
TB skin test
Standard chest x-rays, digital chest radiography, CT
Ventilation and perfusion scan
Pulse oximetry (noninvasive)
Exercise testing
Pulmonary function test (PFTs)

Question 27

Invasive Diagnostic Tests:

Answer 27

Bronchoscopy

Thoracentesis – Aspiration of pleural fluid or air from pleural space:

• Stinging sensation and feeling of pressure
• Correct position
• Motionless patient
• Follow-up assessment for complications

Question 28

Lung Biopsy: Invasive

Answer 28

-Obtain tissue for histologic analysis, culture, cytologic examination
-May be performed in patient’s room?
-Follow-up care:
Assess vital signs, breath sounds at least every 4 hours for 24 hours
Assess for respiratory distress
Report reduced/absent breath sounds immediately
Monitor for hemoptysis