Comprehensive Respiratory System Assessment and Pathophysiology

What are adventitious breath sounds?

Abnormal breath sounds heard during auscultation.

What is apnea?

The absence of breathing.

What is atelectasis?

Collapse of alveoli or lung tissue, reducing gas exchange.

What is bradypnea?

An abnormally slow respiratory rate.

What is bronchophony?

Increased clarity of spoken words heard through the lungs, suggesting lung consolidation.

What are Cheyne-Stokes respirations?

A cyclic breathing pattern with periods of apnea followed by gradually increasing and decreasing respirations.

What is consolidation?

Lung tissue that has become solid due to fluid, infection, or other material replacing air.

What are crackles?

Popping sounds caused by air moving through fluid or collapsed alveoli reopening.

What is crepitus?

A crackling sensation or sound caused by air trapped under the skin.

What is cyanosis?

A bluish discoloration of the skin or mucous membranes caused by decreased oxygenation.

What is dyspnea?

Difficulty or discomfort with breathing; shortness of breath.

What is egophony?

A change in the sound of the patient's voice ('E' heard as 'A') that suggests lung consolidation.

What is grunting?

An abnormal breathing sound produced during exhalation to help keep alveoli open.

What is hemoptysis?

Coughing up blood from the respiratory tract.

What is hyperresonance?

A loud, booming percussion sound that suggests excess air in the lungs, such as with emphysema or pneumothorax.

What is hyperventilation?

Breathing faster or deeper than needed, causing excessive loss of carbon dioxide.

What is hypoventilation?

Breathing too slowly or too shallowly, leading to inadequate ventilation.

What is hypoxia?

A decrease in oxygen available to body tissues.

What is nasal flaring?

Widening of the nostrils during breathing, indicating increased work of breathing.

What is orthopnea?

Shortness of breath that occurs when lying flat and improves when sitting up.

What is resonance?

A low-pitched, hollow percussion sound heard over normal, air-filled lung tissue.

What are retractions?

Inward pulling of the chest wall during inspiration due to increased work of breathing.

What are rhonchi?

Low-pitched, snoring breath sounds caused by secretions in the larger airways.

What is stridor?

A harsh, high-pitched sound caused by upper airway obstruction.

What is tachypnea?

An abnormally rapid respiratory rate.

What is tactile fremitus?

Vibrations felt on the chest wall when the patient speaks.

What is the tripod position?

A position in which the patient leans forward with the arms supported to improve breathing.

What are wheezes?

High-pitched, musical breath sounds caused by narrowed airways.

What are the six objectives of the respiratory assessment?

Perform inspection, palpation, and auscultation; differentiate normal from abnormal findings; describe respiratory anatomy and function; discuss oxygenation, breathing, and gas exchange; describe common nursing procedures; differentiate oxygen delivery devices.

What major structures make up the respiratory system?

The lungs, bronchi, trachea, and thoracic structures involved in airflow and gas exchange.

What happens during inspiration (inhalation)?

The diaphragm contracts and moves downward, the intercostal muscles lift the rib cage, thoracic volume increases, and negative pressure draws air into the lungs.

What happens during expiration (exhalation)?

The diaphragm relaxes and moves upward, the rib cage falls, thoracic volume decreases, pressure rises, and air is pushed out of the lungs.

How do inspiration and expiration allow ventilation?

Coordinated muscle movement changes thoracic pressure and volume, allowing air to move into and out of the lungs efficiently.

What safety measures should be completed before beginning a respiratory assessment?

Perform hand hygiene, check for isolation precautions, introduce yourself, verify two patient identifiers, explain the procedure, maintain privacy, use aseptic technique, and check vital signs.

What equipment is needed for a respiratory assessment?

Examination gown and drape, gloves, stethoscope, light source, mask, skin marker, and metric ruler.

What respiratory symptoms should be included in the subjective history?

Cough, hemoptysis, shortness of breath, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, chest pain with breathing, respiratory infections, smoking history, environmental exposures, vaccination history, home safety, and activity level.

What is paroxysmal nocturnal dyspnea (PND)?

Episodes of sudden shortness of breath that awaken a person from sleep.

Why is smoking history important during a respiratory assessment?

It helps identify risk factors for respiratory disease and guides further assessment.

Why should environmental exposures be assessed?

They may contribute to respiratory disease or worsen existing lung conditions.

Why are TB testing, chest X-rays, and flu/pneumonia vaccinations included in the respiratory history?

They help assess previous respiratory disease, infection risk, and preventive care.

Why is activity level assessed during the respiratory history?

It helps determine how respiratory symptoms affect functional ability and exercise tolerance.

Why is childproofing the home included in the respiratory history?

It helps identify potential respiratory safety hazards, especially in homes with children.

What should be inspected on the posterior chest?

Thoracic shape and configuration, patient position, skin color and condition, and respiratory pattern.

What respiratory patterns should be assessed during inspection?

Tachypnea, bradypnea, hyperventilation, hypoventilation, Kussmaul respirations, and Cheyne-Stokes respirations.

What are Kussmaul respirations?

Deep, rapid, continuous respirations associated with metabolic acidosis, especially diabetic ketoacidosis (DKA), as the body attempts to eliminate carbon dioxide.

What do Kussmaul respirations indicate?

Metabolic acidosis, especially diabetic ketoacidosis (DKA).

What are the characteristics of Kussmaul respirations?

Deep, rapid, labored, continuous breathing often described as 'air hunger.'

What is the clinical pearl for Kussmaul respirations?

If Kussmaul respirations are present, check the patient's blood glucose and metabolic panel.

What do Cheyne-Stokes respirations indicate?

They are commonly associated with neurologic disorders, heart failure, and end-of-life breathing patterns.

What are the characteristics of Cheyne-Stokes respirations?

A crescendo-decrescendo breathing pattern followed by a period of apnea that repeats cyclically.

What is the clinical pearl for Cheyne-Stokes respirations?

Unlike Kussmaul respirations, Cheyne-Stokes respirations are periodic and predictable.

What should be palpated on the posterior chest?

Symmetric chest expansion and tactile fremitus.

What should be assessed during percussion of the posterior chest?

Resonance, hyperresonance, dullness, and diaphragmatic excursion.

What does a resonant percussion sound indicate?

Normal, air-filled lung tissue.

What does hyperresonance indicate?

Excess air in the lungs, commonly seen with emphysema or pneumothorax.

Why is hyperresonance considered abnormal in adults?

It indicates air trapping or air leakage within the lungs.

What does dullness on percussion indicate?

Increased lung density caused by fluid or solid tissue replacing air.

What conditions commonly cause dullness to percussion?

Pneumonia (consolidation), pleural effusion, and tumors.

Why is dullness an important assessment finding?

It suggests that normal air-filled lung tissue has been replaced by fluid or solid tissue.

What is diaphragmatic excursion?

The movement of the diaphragm during breathing measured by percussion.

How is diaphragmatic excursion assessed?

Percuss downward after full exhalation and again after full inhalation, then measure the distance between the two marks.

What is the normal diaphragmatic excursion?

3-5 cm in most adults and 7-8 cm in athletes.

What should be auscultated on the posterior chest?

Normal breath sounds, abnormal breath sounds, adventitious sounds, and voice sounds.

What are the three normal breath sounds?

Bronchial, bronchovesicular, and vesicular breath sounds.

What abnormal breath sound findings should be identified?

Decreased or absent breath sounds and increased breath sounds.

What are the four adventitious breath sounds?

Crackles, wheezes, rhonchi, and stridor.

What voice sounds may be assessed if lung abnormalities are suspected?

Bronchophony, egophony, and whispered pectoriloquy.

What causes crackles?

Air moving through fluid or the reopening of collapsed alveoli.

What causes wheezes?

Narrowing of the airways.

What causes rhonchi?

Secretions in the larger airways.

What causes stridor?

Upper airway obstruction.

What should be inspected on the anterior chest?

Shape and configuration, facial expression, level of consciousness, skin color and condition, quality of respirations, and use of accessory muscles or retractions.

What should be palpated on the anterior chest?

Symmetric chest expansion, tactile fremitus, and pain.

What should be percussed during the anterior chest assessment?

The anterior lung fields.

What should be auscultated during the anterior chest assessment?

Anterior lung sounds to identify normal and abnormal findings.

What are pulmonary function tests (PFTs)?

Tests that measure lung volumes, capacities, and airflow to evaluate obstructive and restrictive lung disorders.

What is the purpose of a chest X-ray?

To evaluate the lungs, heart size, ribs, and thoracic structures for infection, fluid, masses, or consolidation.

What is the purpose of a CT scan of the chest?

To provide detailed cross-sectional images for identifying tumors, pulmonary embolism, interstitial lung disease, or other abnormalities.

What is bronchoscopy?

A procedure that allows direct visualization of the airways for diagnosis, biopsy, suctioning, or foreign body removal.

What does clubbing of the nails indicate?

Chronic hypoxia or chronic lung disease, resulting in a nail angle of about 180°.

What should be done if assessment findings are inconsistent?

Validate the data to resolve discrepancies or inconsistencies.

Why should assessment findings be verified?

To ensure the data are reliable and accurate.

What should be included when documenting a respiratory assessment?

Assessment findings according to facility policy, including use of COLDSPA and SBAR when appropriate.

What does COLDSPA stand for?

Character, Onset, Location, Duration, Severity, Pattern, and Associated factors.

What does SBAR stand for?

Situation, Background, Assessment, and Recommendation.

What respiratory changes commonly occur in older adults?

Dyspnea with activity, decreased ability to cough effectively, reduced thoracic expansion, and fatigue with deep breathing.

Why may chest pain from pleuritis be absent in older adults?

Age-related changes may make pleuritic chest pain less noticeable.

What spinal curvature is common in older adults and can affect breathing?

Kyphosis.

How should thoracic expansion appear in older adults?

It may be decreased but should remain symmetric.

Why may older adults have difficulty taking deep breaths?

Age-related respiratory changes can make deep breathing difficult and cause them to fatigue easily.

What may cause costochondral tenderness in older adults?

Rib fractures, especially in patients with osteoporosis.

What are the categories used when analyzing respiratory assessment data?

Selected client concerns, opportunities to improve health, risk for client concerns, actual client concerns, collaborative problems, risk for complications (RC), and medical problems.

What position is commonly used for a patient in respiratory distress?

High Fowler's position.

What finding on a respiratory assessment should be reported immediately if heard on only one side?

Audible wheezing on one side of the lung.

What are the four thoracic deformities discussed in this lecture?

Kyphosis, scoliosis, pectus excavatum, and barrel chest (COPD).

How does kyphosis affect breathing?

The forward curvature compresses the lungs, reducing chest expansion and causing shallow breathing.

How does scoliosis affect breathing?

The lateral curvature of the spine causes asymmetric lung expansion.

How does pectus excavatum affect breathing?

The sunken sternum compresses mediastinal structures, reducing lung capacity and exercise tolerance.

How does a barrel chest affect breathing?

Overexpansion of the chest traps air, making exhalation difficult.

How do thoracic deformities affect chest expansion?

They limit chest wall movement, reducing lung expansion and causing shallow or inefficient breathing.