Week 3: Respiratory Assessment

Question 1

Ventilation

Answer 1

air going in and air going out

Question 2

Diffusion

Answer 2

gas exchange at the capillaries

Question 3

Perfusion

Answer 3

blood flow to the tissues and organs

Question 4

Respiratory Muscles

Answer 4

breathing is effortless

Question 5

Challenges to the Respiratory System

Answer 5

Smoking
-first, second, third hand smoke
-e-cigs
-vaping

Environmental Factors
-home
-occupation
-travel

Question 6

Subjective Data

Answer 6

Cough?
Dyspnea? - SOB SOBOE
Chest pain?
Past medical history
Family history
Self-care activities
Allergies
Immunizations
SDoH

Question 7

Objective Data: Inspection

Answer 7

general survey

Question 8

Objective Data: Palpation

Answer 8

Chest tenderness
-Sternum, paravertebral muscles, point tenderness

“Extra” assessments (If chest x-ray not possible)
-Chest excursion (expansion; 3-6cm)
- Tactile fremitus (vibration - “99”)

Abnormal findings
-E.g., Crepitus (air in subcutaneous tissue)

Question 9

Landmarks for Auscultation

Answer 9

-Suprasternal notch
-Angle of Louis (sternal angle)
-Costal angle
-Scapular, clavicular, axillary lines
-Cervical vertebra #7

Question 10

Auscultation: Normal Sounds

Answer 10

Bronchial
-loud, hollow ‘tubular’ sounds
-high pitched
considered abnormal if heard over peripheral lung fields
-distinct pause between inspiration and expiration, ratio of 1:2 or 1:3

Vesicular (most common)
-soft, low pitched
-‘rustling’ quality with inspiration
-even softer during expiration
-inspiration/expiration ratio 3:1

Bronchovesicular
-normally hear in the mid-chest
-mixture of bronchial sounds near trachea and vesicular sounds near the alveoli
-inspiration/expiration ratio 1:1

Question 11

Auscultation: Abnormal/Adventitious Sounds

Answer 11

Diminished sounds

Absent sounds

Friction rub
-low pitched, short, granting sound form inflammation of pleural surface

Crackles
-caused by fluid or mucus in the lungs
-fine crackles are brief, discontinuous, popping lung sounds that are high-pitched - chf, atelectasis
-coarse crackles also discontinuous, brief, popping lung sounds. compared to fine, they are louder, lower in pitch and last longer - pneumonia

Wheezes
-musical sounds caused by narrowing of the airways - asthma, COPD

Question 12

Promoting Respiration

Answer 12

-promote lung expansion
-prevent statis of secretions
-maintain patent airway
-promote adequate exchange of oxygen and carbon dioxide

Question 13

Developmental Variations: Infants

Answer 13

-are obligatory nose breathers
-bronchovesicular sounds are hear
-respirations are primary abdominal
-after the is 2 the breathing shifts to intercostal
-the respiratory rhythm is irregular
-apnea should never exceed 15 seconds

Question 14

Developmental Variations: Pregnancy

Answer 14

-there is an increase in tidal volume to meet the fetus’ need for oxygen
-later in pregnancy, the diaphragm rises and the costal angle widen to accommodate the enlarging uterus