Ch. 12: Assessing the Respiratory System

What are the functions of the nose in the respiratory system?

Warms, humidifies, and filters the air

What is the oropharynx?

A hollow tube about 5 inches long located in the middle of the throat behind the mouth

What structures are part of the lower respiratory tract?

• Trachea

• Bronchi

• Bronchioles

• Alveoli

• Lungs

• Diaphragm

Which bronchus is more likely to receive an aspirated object and why?

Right bronchus; it is shorter, wider, and more vertical

How many lobes do the lungs have?

Right lung has 3 lobes; left lung has 2 lobes

What is the purpose of the diaphragm in respiration?

It's a dome-shaped muscle that supports breathing

Landmarks that help the nurse reference assessment findings

• Anterior thorax

• Posterior thorax

What does a pulse oximeter measure and what is the normal range?

SpO₂ (functional oxygen saturation); normal is 95–100%

What do arterial blood gases (ABGs) measure and where are they usually drawn from?

Oxygen and carbon dioxide levels; usually drawn from the radial artery

What is thoracentesis?

Needle insertion into the thoracic cavity to remove or analyze pleural fluid

What is a bronchoscopy?

 A procedure to visualize the larynx, trachea, and bronchial tree

What is the Mantoux test used for?

To detect infection with Mycobacterium tuberculosis

 Is SpO₂ of 88% acceptable for COPD patients?

Yes, but below 87% is concerning

Why is respiratory assessment critical for C3–C5 spinal injuries?

These vertebrae control the diaphragm; injury may impair breathing

What is asthma?

A reversible airway disease causing inflammation and bronchoconstriction

What is COPD?

A progressive, irreversible lung disease with inflammation and tissue destruction; smoking is the main cause

A hereditary disease with thick, sticky mucus blocking lungs and digestive organs

Cystic fibrosis

shortness of breath, difficulty breathing

Dyspnea

Difficulty breathing related to an inadequate cardiac output

Cardiac dyspnea

Difficulty breathing while lying down, relieved by sitting or standing

Orthopnea

Shortness of breath during sleep; often a sign of left heart failure

Paroxysmal nocturnal dyspnea

What is a key sign of respiratory distress during talking?

Difficulty speaking between breaths

What symptoms indicate asthma?

• Tachypnea

• Dyspnea

• Tachycardia

• Wheezing

• Coughing

Six Types of Coughs

• Sputum

• Hemoptysis

• Nonproductive

• Productive

• Hacking

• Chronic

Sputum

mucous

What is the difference between productive and nonproductive cough?

Productive has mucus. Nonproductive is dry with no sputum.

What is hemoptysis?

Blood in sputum

What is hacking cough?

persistent dry cough

What is a chronic cough?

Cough lasting longer than 8 weeks

What is pleuritic chest pain?

Pain from inflammation of lung pleura; SOB occurs even at rest

What is the patient position for respiratory assessment?

Sitting upright

Inspecting the Thoracic Cage Normal Findings

• AP-transverse ratio is approximately 1:2; costal angle less than 90 degrees

• Conical shape: smaller at the top and wider at the bottom;

• Symmetrical

• Skin color uniform

• Respiratory rate 12 to 20 breaths per minute

What does a barrel chest indicate?

AP-transverse ratio 1:1 and costal angle >90°; abnormal finding

What is pectus excavatum?

Funnel chest; depressed sternum

What is pectus carinatum?

Pigeon chest; protruding sternum

Abnormal Respiratory Rate & Rhythms

• Bradypnea

• Tachypnea

• Kussmaul Respirations

• Biot Respiration

• Cheyne-Stokes Respirations

• Apnea

Abnormal slow breathing, less than 12 breaths/minute

Bradypnea

Abnormal rapid breathing, more than 20 breaths/minute

Tachypnea

breaths that are abnormally deep, labored, and increased in rate

Kussmaul

irregular breathing of variable depth alternating with regular or irregular periods of apnea called ataxic breathing

Biot respiration

Gradual increase in depth of respirations, followed by gradual shallow breathing and then a period of apnea

Cheyne-Stokes Respirations

Absence of breathing

Apnea

White

• Poor circulation

• Lack of oxygen

• Pallor

Blue

• Cyanosis

• Lack of oxygen in the blood

• Respiratory infection

• Airway Obstruction

Red

• Vasodilation

• Infection

• High blood pressure

What is cyanosis?

A blue skin tone from lack of oxygen

Where do you auscultate lung sounds?

Anterior, posterior, and lateral chest, avoiding bone

Auscultating the lungs Three Normal Findings

• Bronchial: high-pitched

• Bronchovesicular: medium

• Vesicular: low-pitched

breath sounds are heard over the trachea and larger bronchi; high-pitched, hollow, tubular breath sounds

Bronchial sounds

breath sounds are heard over the right and left bronchi; medium-pitched sound

Bronchovesicular sounds

sounds are heard throughout the periphery of the lungs; low-pitched sound

Vesicular sounds

Five adventitious breath sounds

• Crackles

• Wheezes

• Rhonchi

• Stridor

• Pleural friction rub

Produced by air passing over retained airway secretions

Crackles

are soft, high-pitched sounds; sound like crunching, or a fine rubbing sound

Fine crackles

are louder, low-pitched lung sounds

Coarse crackles

Caused by narrowed passageways in the trachea-bronchial tree by secretions, inflammations. High-pitched, whistling, or musical sound.

Wheezes

louder, deeper, lower-pitched wheezes

Rhonchi

deep loud, harsh, leathery sound

Pleural friction rub

Upper airway, narrowing, or destruction. loudest over the trachea during inspiration; harsh, high pitched, crowing sound

Stridor

What should you do if adventitious sounds are heard?

Ask the patient to cough, then reassess

Normal Respiratory Rates by Age Group

• Infant: 30

• Toddler: 23–25

• School-age: 17–21

• Adolescent: 17–18 bpm

Signs of respiratory distress in children?

• Retractions

• Nasal flaring

• Grunting

• Pale or blue skin

• Altered consciousness

How does aging affect the respiratory system?

Decreased alveoli, elasticity, cough reflex, and immunity; bone structure thins

What is the S1 heart sound?

"Lub" — closing of the mitral and tricuspid valves; heard at apex.

What is the S2 heart sound?

"Dub" — closing of the aortic and pulmonic valves; heard at base.

What are S3 and S4 sounds associated with?

S3: heard after S2.

S4: heard before S1 and may indicate heart failure.

Types of heart murmurs?

Innocent (harmless) and pathological (from disease or age-related changes).

What characteristics are used to describe murmurs?

Intensity, timing, quality, pitch, and grade (I–VI)

How do you determine pitch of a murmur?

High/medium pitch: diaphragm

low pitch: bell of stethoscope

Bronchiectasis

expansion

Atlelectasis

Collapse of lungs

Alleviate muscle spasms in the airways of the lungs

Bronchodilator