Assessing the Respiratory System

Upper respiratory tract

Nose, oropharynx

Lower respiratory tract

Trachea, bronchi, bronchioles, alveoli

Anterior thorax

Part of the chest that houses the lungs and heart

Posterior thorax

Back part of the chest, including the rib cage and structures behind the lungs

Diagnostics

Pulse oximeter, arterial blood gases, thoracentesis, bronchoscopy, lung biopsy, mantoux tuberculin skin test

Past medical history

Pulmonary disease, acute or chronic respiratory infections

Psychosocial health history

Occupation, exposure to environmental pollutants, smoking, second hand smoke

Cough health history

Acute or chronic, productive or nonproductive

Breathing health history

Past shortness of breath

Pulmonary disease

Group of disorders affecting the lungs, leading to breathing difficulties and reduced oxygen exchange

Dyspnea

Shortness of breath

Pulmonary embolism

Blood clot in the lung arteries

Orthopnea

Difficulty breathing when lying flat, often relieved by sitting up

Paroxysmal nocturnal dyspnea

Sudden episode of breathing difficulty that occurs during sleep

Pleuritic chest pain

Sharp, stabbing pain in the chest that worsens with breathing, coughing, or sneezing, often associated with inflammation of the pleura

Muscle retractions

Inward movement of muscles between the ribs or in the neck during breathing, indicating respiratory distress

Productive cough

Produces mucus or phlegm

Nonproductive cough

Does not produce mucus or phlegm

Anterior reference lines

Right and left midclavicular lines, midsternal line

Posterior reference lines

Right and left scapular lines, vertebral line

Lateral reference lines

Anterior and posterior axillary lines, midaxillary line

Bronchial breath sounds

Heard over the trachea and larger bronchi; expiratory sounds are louder and last longer than inspiratory sounds and have a pause between them; high-pitched, hollow, tubular breath sounds

Vesicular breath sounds

Heard throughout the periphery of the lungs; inspiration is longer and louder than expiration; soft, low-pitched, rustling sounds

Bronchovesicular breath sounds

Heard over the right and left bronchi; anteriorly over the mid-chest and between the scapula posteriorly; medium-pitched sounds

Inspecting the thoracic cage normal findings

AP-transverse ratio is approximately 1:2, conical shape, symmetrical, uniform skin color, respiratory rate 12-20 breaths per minute

Inspecting the thoracic cage abnormal findings

AP-transverse ratio is approximately 1:1, pectus excavatum or carinatum, muscle retractions, abnormal respirations, abnormal skin color, clubbing of nail plates

Barrel chest

AP-transverse ratio is 1:1; associated with chronic lung diseases, chronic emphysema, COPD

Nail clubbing

Enlargement of fingers and toes due to hypoxia

Pectus excavatum

Sunken chest a depression in the sternum

Pectus carinatum

Protrusion of the sternum

Palpating the thorax normal findings

Skin dry, surface smooth and uniform, warm skin, no tenderness

Palpating the thorax abnormal findings

Excessive moisture, irregular surface, temp cool or clammy, tenderness, crepitus 

Crepitus

Popping, grating or crunching caused by air trapped in skin

Palpating for symmetrical expansion normal findings

Thumbs move apart symmetrically

Palpating for symmetrical expansion abnormal findings

Asymmetrical expansion indicates decreased air movement in that side of the lung

Palpating for tactile femitus normal findings

Vibrations felt equally on both sides of the lungs

Palpating for tactile fremitus abnormal findings

Palpable vibrations not felt equally on both sides

Tactile fremitus

Evaluates vibrations produced by speech and felt on the chest wall, used to detect lung abnormalities

Auscultating the lungs normal findings

Bronchial, bronchovesicular sounds, and vesicular sounds

Auscultating the lungs abnormal findings

Adventitious sounds, diminished breath sounds, pleural friction rub

Adventitious sounds

Crackles, wheezes, rhonchi, stridor, and pleural friction rub

Diminished breath sounds

Reduced intensity of normal lung sounds; possible obstruction or abnormality in lung function

Crackles

Short, popping sounds heard during inspiration or expiration, indicates fluid in the airways

Wheezes

High-pitched sounds produced during expiration, often due to narrowed airways or asthma

Stridor

High-pitched wheezing caused by disrupted airflow, often indicative of an upper airway obstruction

Pleural friction rub

Grating sound produced by rubbing of inflamed pleural surfaces during breathing, often indicating pleuritis.

Auscultating bronchophony normal findings

Words become less distinct as you move to the lower chest

Auscultating bronchophony abnormal findings

Word is clearly auscultated with an increase in sound and intensity

Pneumonia

Infection of lung tissue, alveoli in the affected areas fill with fluid

Chronic obstructive pulmonary disease (COPD)

Lung disease that obstructs airflow and makes breathing difficult, often caused by long-term exposure to irritants

Chronic emphysema

Lung disease that causes permanent destruction of the alveoli

Rhonchi

Caused by obstruction of airways, often compared to a snore or a rumbling sound

Metabolic acidosis

Increase blood acidity due to excess production of acids or loss of bicarbonate

Increased fremitus

Occurs with compression or consolidation of lung tissue (pneumonia)

Decreased fremitus

Occurs when anything obstructs transmission of vibrations (obstructed bronchus, pleural effusion, pneumothorax, emphysema)

Signs of shortness of breath

Labored breathing, difficulty talking between breaths, tripoding, pursed lip breathing

Cheyne-Stokes respiration

Breathing pattern characterized by alternating periods of deep, rapid breathing and episodes of shallow or absent breathing, often associated with heart failure or brain injury