Assessment of Respiratory System Flashcards

Assessment of Respiratory System: Fundamentals and Anatomy

  • Core Concepts

    • Anatomy and Physiology: Understanding the structure and function of the respiratory system.

    • Gas exchange, Ventilation, and Perfusion: The primary physiological processes of the lungs.

    • Health Promotion and Smoking Cessation: Strategies for lung health and harm reduction.

    • Physical Assessment: Techniques for evaluating respiratory status.

    • Oxygen Delivery Systems: Mechanisms for providing supplemental oxygen.

  • Upper Airway Structures

    • Nose and Sinuses:

      • Septum: Dividing wall of the nose.

      • Nares: The anterior and posterior openings.

      • Turbinates: Inferior, middle, and superior structures that increase surface area.

      • Paranasal Sinuses: Includes frontal and sphenoid sinuses.

    • Pharynx (Throat): A shared passageway for both the respiratory and gastrointestinal systems.

      • Nasopharynx: Contains the opening of the eustachian tube and adenoids (pharyngeal tonsils).

      • Oropharynx: Contains the palatine tonsils (faucial tonsils).

      • Laryngopharynx: The lower part of the throat.

    • Larynx ("Voice Box"):

      • Thyroid Cartilage: The largest cartilage structure.

      • Cricoid Cartilage: Located below the thyroid cartilage.

      • Vocal Cords: Includes both True and False vocal cords.

      • Glottis: The opening between the vocal cords.

      • Epiglottis: A flap that covers the glottis during swallowing.

      • Cricothyroid Membrane: A site for emergency airway access.

  • Lower Airway Structures

    • Trachea ("Wind Pipe"): Contains cartilaginous rings for structural support.

    • Carina: The junction where the trachea bifurcates.

    • Mainstem Bronchi: Right and left branches. The right bronchus is wider, shorter, and more vertical than the left. Issues with the right lung impair gas exchange to a greater degree than the left.

    • Bronchial Tree: Progresses from lobar to segmental and subsegmental bronchi, then to bronchioles.

    • Alveoli:

      • Terminal lung structures consisting of tiny sacs surrounded by capillaries.

      • The primary site of gas exchange.

      • Healthy adults have approximately 290×106290 \times 10^6 (290 million) alveoli.

      • Surface area is roughly equivalent to a tennis court.

    • Surfactant: A fatty protein lining the alveoli that reduces surface tension. Its absence leads to atelectasis.

    • Pleura:

      • Parietal: Lines the chest wall.

      • Visceral: Covers the lungs.

      • Pleural Cavity: The space between these layers.

Physiology of Respiration and Circulation

  • Atelectasis: This is the collapse or closure of alveoli resulting in reduced or absent gas exchange.

  • Pulmonary vs. Bronchial Circulation

    • Pulmonary Circulation:

      • Highly vascular capillary network.

      • Pathway: Right ventricle →\rightarrow pulmonary artery →\rightarrow arterioles →\rightarrow capillary networks meshed with alveoli.

      • Function: This is where gas exchange occurs.

    • Bronchial Circulation:

      • Carries oxygenated blood to the lung tissues themselves.

      • Part of the systemic circulation system.

      • Function: Does NOT participate in gas exchange.

Respiratory Assessment: History and Symptoms

  • Comprehensive History Factors

    • Smoking history, including vaping and calculated "pack years."

    • Drug use.

    • Complementary and integrative therapies.

    • Allergies.

    • Travel and geographic area of residence.

    • Family history and genetic risks.

    • Current health problems.

  • Symptoms of Current Health Problems

    • Cough.

    • Sputum production.

    • Chest pain.

    • Dyspnea (shortness of breath).

    • Orthopnea (difficulty breathing while lying flat).

  • Differential Diagnosis of Chest Pain

    • Cardiac Pain: Usually intense and "crushing"; may radiate to the arm, shoulder, or neck.

    • Pulmonary Pain: Varies depending on the cause; often feels like "rubbing"; may appear only during part of the respiratory cycle; not exacerbated by palpation.

Physical Assessment of the Respiratory System

  • Nose and Sinuses

    • External Appraisal: Deformities, shape, and size.

    • Internal Appraisal: Mucosa, septum (checking for deviation or perforation), and polyps.

    • Patency: Assess air movement by blocking one nare at a time.

  • Pharynx, Neck, Larynx, and Trachea

    • Pharynx: Evaluate soft palate, color, symmetry, drainage, and tonsils.

    • Neck: Inspect for appearance alterations, lymph nodes, and the use of accessory muscles.

    • Larynx: Assess for hoarseness.

    • Trachea: Palpate for position, mobility, tenderness, and masses. Tracheal deviation is always indicative of pathology.

  • Lungs and Thorax Assessment

    • Inspection: Check for symmetry, rate, rhythm, and depth of breaths. Observe for pursed-lip breathing or accessory muscle use. Evaluate the ratio of Anterior-Posterior (AP) vs. Lateral diameter.

    • Palpation: Assess chest expansion, tracheal position, tactile fremitus, crepitus, tenderness, and any physical abnormalities (masses, lesions).

    • Percussion: Used to determine pulmonary resonance and organ boundaries; sound helps differentiate between air, fluid, and solid tissue.

    • Auscultation:

      • Use a stethoscope and avoid bony prominences.

      • Listen to a full respiratory cycle.

      • Document sounds as normal, increased, diminished, or absent.

Characterizing Breath Sounds

  • Normal Breath Sounds

    • Bronchial (Tubular): Harsh, hollow sounds heard over the trachea and mainstem bronchi.

    • Bronchovesicular: Heard over the branching bronchi.

    • Vesicular: Soft, rustling sounds heard in lung tissue over small bronchioles.

  • Adventitious (Abnormal) Breath Sounds

    • Fine Crackles (Rales): Popping, discontinuous sounds; air moving into deflated airways; sounds like hair rolling between fingers.

    • Coarse Crackles: Low-pitched, rattling sounds caused by fluid/secretions in large airways; may change with coughing or suctioning.

    • Rhonchi: Lower-pitched, coarse, continuous snoring sounds arising from large airways.

    • Wheeze: Squeaky, musical sounds from air rushing through narrowed airways; does not clear with coughing.

    • Pleural Friction Rub: Loud, rough, grating sounds from inflamed pleural surfaces rubbing; associated with pain on inspiration.

    • Stridor: Continuous musical or crowing sound of constant pitch; indicates partial obstruction of the larynx or trachea (swelling, spasm, or mucus).

  • Other Clinical Indicators of Inadequacy

    • Pallor, ash-gray skin, or cyanosis.

    • Clubbing of the fingers.

    • Weight loss or loss of muscle mass.

    • Hypertrophy of neck and chest muscles.

    • Decreased physical endurance.

Psychosocial and Diagnostic Assessment

  • Psychosocial Assessment

    • Evaluate for anxiety, changes in roles or relationships, social isolation, and financial problems (unemployment/disability). Discuss coping mechanisms.

  • Laboratory and Imaging

    • Labs: Red blood count (RBC), Arterial Blood Gas (ABG), and Sputum specimens.

    • Imaging: Chest X-ray and Computed Tomography (CT).

  • Non-invasive Diagnostics

    • Pulse Oximetry: Measures oxygen saturation of hemoglobin (SpO2SpO_2).

      • 95−100%95-100\%: Normal.

      • 90%90\%: Intervention required.

      • 85%85\%: Tissues have difficulty oxygenating.

      • 75%75\%: Critical and life-threatening.

    • Capnometry/Capnography: Measures CO2 levels; more sensitive than pulse oximetry. Normal value is 35−45 mmHg35-45\,mmHg. Used to determine ROSC during CPR.

    • Pulmonary Function Tests (PFTs): Measure lung volumes, capacities, flow rates, and airway resistance.

    • Exercise Testing: Assesses the ability to perform Activities of Daily Living (ADLs).

  • Invasive Diagnostics

    • Bronchoscopy: Insertion of a tube (rigid or flexible) to view structures; involves sedation and may include bronchoalveolar lavage (BAL).

    • Thoracentesis: Needle aspiration of pleural fluid/air. Can be used for diagnosis or drug instillation. Requires post-procedure assessment for complications.

    • Lung Biopsy: Methods include transbronchial, percutaneous needle aspiration (TTNA), VATS (Video-Assisted Thoracoscopic Surgery), or open lung biopsy.

Health Promotion and Oxygen Therapy

  • Inhalation Irritants: Most common cause of chronic respiratory problems. Sources include cigarette smoke, secondhand/thirdhand smoke, vaping, and air pollution.

  • Smoking Cessation:

    • Utilize smoking cessation protocols and the "5A's."

    • Drug Therapies:

      • Over-the-counter: Nicotine patches, gums, lozenges.

      • Prescription: Nasal sprays/inhalers, Bupropion (reduces cravings/depression), and Varenicline (blocks nicotine receptors).

  • Vaping (EVALI): E-cigarette or vaping product use-associated lung injury. Can lead to ARDS, Hypersensitivity Pneumonitis, or Bronchiolitis obliterans. Up to 50%50\% of cases require ICU admission.

  • Oxygenation Overview

    • Hypoxemia: Low O2O_2 in the blood.

    • Hypoxia: Low O2O_2 in the tissues.

    • Indications: Respiratory disorders, cardiac issues, fever, sepsis, and anemia.

  • Oxygen Delivery Systems

    • Low Flow:

      • Nasal Cannula: 1−6 L/min1-6\,L/min.

      • Simple Facemask: 40−60%40-60\%, minimum 5 L/min5\,L/min.

      • Partial Rebreather: 60−75%60-75\% at 6−11 L/min6-11\,L/min.

      • Non-Rebreather: >90\% FiO_2 at 10−15 L/min10-15\,L/min.

    • High Flow:

      • High Flow Nasal Cannula: 30−60 L/min30-60\,L/min; can be heated and humidified.

      • Venturi Mask: Most accurate concentration; uses an adaptor to pull in room air.

    • NPPV (Noninvasive Positive-Pressure Ventilation):

      • CPAP: Continuous positive pressure to keep alveoli open.

      • BiPAP: Two pressure levels (inspiratory and expiratory) to improve tidal volume and relieve dyspnea.

  • Hazards of Oxygen: Combustion, oxygen toxicity, absorptive atelectasis, drying of membranes, and infection.

Assessment of Respiratory System: Fundamentals and Anatomy

  • Core Concepts

    • Anatomy and Physiology: Understanding the complex structure and function of the respiratory system is crucial for assessing respiratory health. The respiratory system is involved in gas exchange, metabolism, and maintaining homeostasis.

    • Gas Exchange, Ventilation, and Perfusion: These primary physiological processes of the lungs are essential for the effective transport of oxygen and carbon dioxide. Gas exchange occurs in the alveoli, where oxygen is absorbed and carbon dioxide is expelled.

    • Health Promotion and Smoking Cessation: Developing strategies for promoting lung health is vital. Effective harm reduction techniques include educating patients on smoking cessation, understanding the harmful effects of tobacco, and providing resources to help quit.

    • Physical Assessment: Involves systematic techniques for evaluating respiratory status, including inspection, palpation, percussion, and auscultation, which provide insights into respiratory function and potential pathologies.

    • Oxygen Delivery Systems: Knowledge of various mechanisms for providing supplemental oxygen, including low and high flow systems, is crucial for managing patients with respiratory distress or failure.

  • Upper Airway Structures

    • Nose and Sinuses:

      • Septum: The dividing wall of the nose, important for airflow efficiency. Deviations can cause obstructive symptoms.

      • Nares: The anterior and posterior openings that allow air to enter the nasal cavity; responsible for filtration and humidification of inspired air.

      • Turbinates: Inferior, middle, and superior structures that increase the surface area for air interaction, playing a role in warming and humidifying incoming air.

      • Paranasal Sinuses: Consists of the frontal, sphenoid, maxillary, and ethmoid sinuses, which reduce skull weight and enhance resonance of speech.

    • Pharynx (Throat): A shared passageway for both the respiratory and gastrointestinal systems, facilitating the movement of air and food.

      • Nasopharynx: Houses the opening of the eustachian tube and adenoids; significant in immunity and drainage.

      • Oropharynx: Contains the palatine tonsils, important in immune response; also contributes to speech and swallowing.

      • Laryngopharynx: The lower part leading to the esophagus and larynx; critical junction for airway and digestive tract separation.

    • Larynx ("Voice Box"):

      • Thyroid Cartilage: The largest cartilage structure, often referred to as the Adam's apple; it protects the vocal cords.

      • Cricoid Cartilage: Provides structural integrity to the larynx, located below the thyroid cartilage, playing a role in airway patency.

      • Vocal Cords: Comprises true and false vocal cords; essential for phonation and protecting the airway.

      • Glottis: The opening between the vocal cords; critical in sound production and preventing aspiration.

      • Epiglottis: A flap that covers the glottis during swallowing, preventing food from entering the trachea; key for safe swallowing.

      • Cricothyroid Membrane: A potential site for emergency airway access; important in emergency medicine.

  • Lower Airway Structures

    • Trachea ("Wind Pipe"): An important passageway for air, supported by C-shaped cartilaginous rings to maintain openness, ensuring unimpeded airflow.

    • Carina: The anatomical junction where the trachea bifurcates into right and left mainstem bronchi; highly sensitive area for cough reflex activation.

    • Mainstem Bronchi: Right and left branches of the trachea. The right bronchus is wider, shorter, and more vertical, making aspirated objects more likely to lodge there; understanding its anatomy aids in clinical assessments.

    • Bronchial Tree: A hierarchical structure that includes lobar, segmental, and subsegmental bronchi, branching into bronchioles, facilitating air conduction to alveoli.

    • Alveoli:

      • Terminal lung structures consisting of tiny, thin-walled sacs surrounded by capillaries; critical site for gas exchange due to their vast total surface area of approximately 290×106290 \times 10^6 (290 million) alveoli, equivalent to a tennis court.

      • The presence of surfactant, a fatty protein lining the alveoli, reduces surface tension, preventing collapse (atelectasis) during exhalation; understanding surfactant function is critical in respiratory evaluations.

    • Surfactant: Its absence can lead to conditions like atelectasis, highlighting its importance in respiratory health.

    • Pleura:

      • Parietal Pleura: Lines the chest wall, playing a role in the mechanics of breathing.

      • Visceral Pleura: Covers the lungs and facilitates smooth movement during respiration.

      • Pleural Cavity: The space between these layers, containing pleural fluid that reduces friction during lung expansion and contraction.