Assessment of the Respiratory System (Process)

Question 1

Inspection of Respiratory System

Answer 1

• Observe the patient’s general appearance.
• Does the patient appear to be in any distress?
• Is the patient restless or anxious?
• Note the patient’s level of consciousness and orientation to person, place, and time.
• Alterations in oxygenation to body tissues can be a result of respiratory or cardiac distress and lead to altered mental status.
• Inspect the patient’s skin, mucous membranes, and general circulation, which can be a general indicator of the patient’s health status, as well as indicating problems with oxygenation. Pallor (lack of color) of skin and mucous membranes can indicate less than optimal oxygenation. Cyanosis (bluish discoloration) of these areas indicates decreased blood flow or poor blood oxygenation.
• Note any abnormalities in the structures of the chest. The adult chest contour is slightly convex, with no sternal depression.
• The anteroposterior diameter should be less than the transverse diameter. Kyphosis (curvature of the spine) contributes to the older person’s appearance of leaning forward and can limit respiratory ventilation.
• Barrel chest deformity may be a result of aging or COPD (chronic obstructive pulmonary disease).
• Note the contour of the intercostal spaces, which should be flat or depressed, and the movement of the chest, which should be symmetrical.
• Observe the respiratory rate, rhythm, and depth.
• Normally, respirations are quiet and non-labored, and occur at a rate of 12 to 20 times each minute in healthy adults.
• Note any flaring of the nostrils, muscular retractions

Question 2

Palpation of the Respiratory System

Answer 2

• Palpate the chest.
• Note skin temperature and color.
• Skin temperature in this area is typically the same as the rest of the body.
• Assess chest expansion (thoracic excursion), which should be symmetrical. Note the presence or absence of masses, edema, or tenderness on palpation.
• Palpate the point of maximal impulse (PMI). Note pulsations in any other area of the chest.
• Abnormal size or location of the PMI or the presence of vibrations can indicate heart failure, myocardial infarction, disease of the heart valves, or other cardiac diseases.
• Palpate the patient’s extremities.
• Assess skin temperature and color, pulses, and capillary refill.
• Note the presence or absence of edema, or tenderness on palpation. The presence of decreased skin temperature, pallor, cyanosis, decreased pulses, and prolonged capillary refill can indicate less than optimal cardiac function and oxygenation.
• The presence of edema an also indicate alterations in cardiovascular function.

Question 3

Auscultating the Respiratory System

Answer 3

• Auscultation of the lungs assesses air flow through the respiratory passages and lungs.
• Listen for normal and abnormal lung sounds.
• Normal breath sounds include vesicular (low-pitched, soft sounds heard over peripheral lung fields) bronchial sounds loud, high-pitched sounds heard primarily over the trachea and larynx), and medium-pitched blowing sounds heard over the major bronchi) sounds.
• Auscultate as the patient breathes slowly through an open mouth.
• Breathing through the nose can produce falsely abnormal breath sounds
• In addition to S1 and S2, listen for extra and abnormal heart sounds.
• Abnormal heart sounds occur as a result of alterations in the cardiovascular system that may lead to impaired oxygenation