Assessment of the Respiratory System Flashcards
Oxygen-Dissociation Curve:
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
Oxygen-Dissociation Curve: In tissues away from the source of O2
hemoglobin unloads or dissociates the oxygen molecule and delivers them to the tissues
The “unloading” depends on the tissues’ need for oxygen
Greater tissue need=
-curve shifts to right; hemoglobin will disassociate faster:
Increase tissue temperature
Increase tissue carbon dioxide concentration
Decrease pH (acidosis)
Metabolizing oxygen slowly=
-shift to left; prevents wasting of oxygen:
Decrease tissue temperature
Decrease tissue carbon dioxide concentration levels
Decreased glucose breakdown products
Higher tissue pH (alkalosis)
Respiratory & Aging Process:
Alveoli Lungs Pharynx & larynx Pulmonary vasculature Exercise tolerance Muscle strength Susceptibility of infections Chest wall
Alveoli aging:
Surface area decreases Diffusion capacity decreases Cough decreases Airways close early Bronchioles and alveolar ducts dilate
Lungs aging:
Residual volume increases
Vital capacity decreases
Efficiency of O2 decreases
Pharynx and larynx aging:
Muscles atrophy
Vocal cords become slack
Pulmonary vasculature aging:
Vascular resistance increases
Pulmonary capillary blood volume decreases
Hypoxia increases
Exercise tolerance:
Hypercarbia decreases
Muscle strength
decreases
Susceptibility of infection
effectiveness of cilia decrease
Immunoglobulin A decreases
Alveolar macrophages are altered
Chest wall aging
Anteroposterior diameter increases Thorax becomes shorter Progressive kyphoscoliosis occurs Chest wall compliance (elasticity) decreases Osteoporosis is possible Mobility of chest wall may decrease
Relevant Patient History:
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
Assessment of the Nose & Sinuses: External nose –
Deformities or tumors, polyps
Nares - symmetry of size and shape
Assessment of the Nose & Sinuses: Nasal cavity
Color, swelling, drainage, bleeding
Assessment of the Nose & Sinuses:Mucous membranes
Abnormalities
Normally appears redder than oral mucosa
Patients w/ allergic rhinitis = pale, engorged, and bluish gray
Assessment of the Nose & Sinuses: Septal deviation
common and appears as an S shape, tilting toward one side or the other
Assessment of the Nose & Sinuses: turbinates
swelling. exudate, and color in nasal mucosa
Assessment of thePharynx, Trachea, & Larynx :
- 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
Assessment of the Lungs & Thorax:
- 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
Lung sounds
Bronchial
Bronchovesicular
Vesicular
Adventitious sounds
Additional breath sounds superimposed on normal sounds, and they indicate pathologic changes in the lung
- Crackles (rales)
- Wheezes
- Rhonchi (lower pitch, coarse)
Other Indicators of Respiratory Adequacy:
- 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
Psychosocial Assessment:
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
Diagnostic Tests:
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)
Invasive Diagnostic Tests:
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
Lung Biopsy: Invasive
-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
