Respiratory Assessment

Question 1

Health History questions for respiratory assessment

Answer 1

• What brings you here today?
• Do you have a cough?
• Any shortness of breath
• Any chest pain with breathing?
• Any past history of respiratory infections or disease?
• Any family history of respiratory disease?
• Do you or have you ever smoked cigarettes or cigars?
• Are there any environmental conditions that affect breathing

Question 2

What are the steps to the respiratory assessment

Answer 2

1. Overall inspection
2. Posterior chest (palpation, percussion, auscultation)
3. Anterior chest (inspection, palpation, percussion, auscultation)

Question 3

Respiratory inspection

Answer 3

2. Note the client’s breathing – rate, rhythm, effort, use of any accessory muscles.
3. Inspect the posterior chest shape and configuration, noting:
   
   1. Spinous processes are in a straight line
   2. Thorax is symmetric with downward sloping ribs
   3. Scapulae are placed symmetrically.
4. Assess skin colour and condition of the anterior and posterior chest.
5. Inspect the anteroposterior to transverse diameter
   
   1. Anterior to posterior (front to back) should be half of transverse (1:2)
   2. In older adults, their anterior to posterior (front to back) might be bigger than regular adults (5:7 ratio)
6. Note development of neck and trapezius muscles (based on age)
7. Identify location of the lobes of the lungs

Question 4

Percussion Notes

Answer 4

• Resonance = Normal sound
• Hyperesonance = Air trapping (asthma)
• Tympany-Large air (large pneumothorax)
• Dullness = Solid mass (lung mass)
• Flatness = Empty (pneumonectomy)

Question 5

Posterior Chest palpation

Answer 5

• Chest expansion (checking for symmetry)
• Place hands at T9-T10 and ask person to take a deep breath (hands will expand out with the chest)

-Tactile fremitus (patient repeats “99” over and over as you feel for vibrations; Note symmetry of vibration and intensity)*Decreases as you go down (use base of the fingers)

• Palpate entire posterior chest wall using finger tips to detect:
• Tenderness
• Skin temperature and moisture
• Superficial lumps or masses
• Skin lesions