1 oxygen

Canvas Resources

• YouTube videos on lung sounds (adventitious and normal - bronchial, bronchovesicular).

• Physical assessment overviews.

• Exemplars: RSV, COPD, Asthma (short overviews).

Venn Diagram

• For comparing similar illnesses.

• Similarities go in the center, differences on the outside.

• Example: Influenza and COVID.

• It can be used for any subject in the nursing program.

• Optional resource.

Templates

• Note-taking templates (optional).

• Available throughout the course.

Test Breakdown

• 50 questions.

• 65 minutes.

• Case study included.

• Medication questions (one drug calculation).

• Follow instructions exactly (number only, rounding).

• No units (e.g., mL).

• Failure to follow instructions will result in no credit.

• No anatomy of the lungs in the lecture due to time constraints.

• Video posted covering anatomy and physiology.

Readings

• Readings posted in Canvas.

• Readings in the syllabus are in red on PowerPoint slides under references.

Respiratory Assessment: Part 1

• Part 2 will cover RSV, COPD, and asthma.

Learning Outcomes

• Not explicitly reviewed in the lecture.

• Tracheostomy care and suctioning will not be on the test.

Focused Respiratory Assessment

• Blue underlined text on slides indicates a link (available in Canvas).

Video Demonstration

Patient assessment:

• Wash hands and introduce self.

• Ask about smoking history (cigarettes).

• Ask about history of lung problems (asthma, emphysema, bronchitis).

Inspection

• Respiratory rate and rhythm (normal limits, regular pattern).

• Depth of respirations.

• No retractions or bulging of interspaces.

• Posture (sitting up straight).

• Chest symmetry.

• Anterior-posterior (AP) to transverse ratio: Normal is 1:2.

• Posterior chest: Looking for abnormalities in shape.

• Chest shape should be like a cone.

Palpation

• Check for tenderness or pain.

• Assess skin color (pallor, cyanosis).

Chest Expansion

• Thumbs at the tenth rib on the posterior side.

• Observe symmetrical movement.

Auscultation

• Start at the trachea.

• Patient breathes deeper than normal through the mouth.

• Listen to a full breath in each location.

• Compare side to side as you move down the chest.

• Lateral: Listen in multiple places.

• Right side (3 lobes): 3 spots (triangle).

• Left side (2 lobes) listen in two places.

• Posterior: Listen starting at the apex, compare side to side, and go around the scapula.

Expected Breath Sounds

• Bronchial: Over the trachea.

• Bronchovesicular: Center near the sternum and upper back.

• Vesicular: Periphery of the lungs.

Health History

• Smoking History

• Packs per year calculation: (packs per day) x (number of years smoked).

• Example: 0.5 packs/day smoked for 10 years = 5 pack-year history.

Questions to Ask:

• Shortness of breath (triggers).

• History of lung problems (personal/family).

• Nasal passages.

• Allergies.

• Medications

  • Relevance to respiratory system.

  • Side effects (e.g., ACE inhibitors causing cough).

  • ACE inhibitors: End in "-pril" (e.g., Lisinopril).

• Exercise tolerance.

• Cough (productive/non-productive, sputum characteristics).

• Weight loss or gain.

• Environmental exposures (smoking, workplace hazards).

• Immunizations (COVID, pneumococcal, influenza).

• Sleeping position (orthopnea).

Vital Signs

• Respiratory rate: 12-20 breaths per minute (normal).

• Oxygen saturation (SpO2): 95-100% (normal).

• Heart rate: 60-100 bpm (normal).

• Blood pressure: 120/80 mmHg (normal).

• Temperature: 97.2-99°F (normal).

• Note: These values vary per patient.

Physical Assessment

Inspection

• Initial 60-second situational assessment (signs of respiratory distress).

• Posture, accessory muscle use, nasal flaring.

• Audible sounds (e.g., stridor).

• Nose: patency, congestion, drainage.

• Mouth: Color of the mouth (cyanosis, pallor).

• Mucous membranes.

• Tonsils: Swelling or inflammation.

• Trachea: Midline position (palpate if necessary).

AP and Transverse Diameter

• AP (Anterior-Posterior) vs. Transverse (side-to-side).

• Normal ratio: AP is 1, transverse is 2 (1:2).

• In COPD, the ratio may approach 1:1 due to hyperinflation of the lungs.

• Skin color: Pink, pale, cyanotic (blue in light skin, gray/white in dark skin).

Fingers

• Capillary refill.

• Clubbing (chronic lack of oxygen).

• Breathing Pattern: Observe rate and depth.

Abnormal Breathing Patterns

• Tachypnea (fast breathing).

• Kussmaul's breathing (diabetic ketoacidosis).

• Biot's breathing (brain injury).

Palpation

• Tracheal position (midline).

• Nodules, masses, or lumps.

• Crepitus (air in subcutaneous tissue – feels like Rice Krispies).

• Subcutaneous emphysema (air into tissue).

• Associated with pneumothorax.

Lung Expansion

• Posterior: Hands at tenth rib, thumbs together.

• Chest should move symmetrically.

Tactile Fremitus

• Vibration felt on the chest wall.

• Use palms or sides of hands.

• Feel better around sternum/scapula (major bronchi).

• Patient says "99" in a deep, loud voice.

• Increased vibration: Pneumonia, tumor, mucus.

• Decreased vibration: Air in lungs (hyperinflation), pulmonary effusion.

• Absent vibration: Pneumothorax, atelectasis.

Auscultation

• Use stethoscope.

• Start at the top.

• Compare side to side.

• Patient takes deep breaths.

• Listen to full respiration (inhale and exhale).

• Anterior, posterior and lateral.

Classifications of Breath Sounds

• Normal

• Adventitious

Normal Breath Sounds

• Bronchial

  • location: Over the trachea.
    
    *Characteristics: Loud, high-pitched, hollow.

• Bronchovesicular

  • Location: 1st and 2nd intercostal spaces anteriorly, between scapulae posteriorly.

  • Characteristics: Moderate pitch.

• Vesicular

  • Location: Peripheral lung fields.

  • Characteristics: Low-pitched, rustling sound.

Adventitious Breath Sounds

• Wheezing, crackles, stridor, rhonchi, pleural friction rub, absent breath sounds.

Crackles (Rales)

*Location: Lower lobes (bases).

*Coarse Crackles:

* Loud, low-pitched, bubbling.

* Air moving through mucus.

* Inspiration or expiration.

* Does not clear with coughing.

* Sounds like blowing air through a straw in water.

*Fine Crackles:

* Short, high-pitched popping sounds before the end of inspiration.

* Does not clear with coughing.

* Sounds like rolling hair near the ear

Pleural Friction Rub

*Harsh, grating, or creaking.

*Inflamed pleural surfaces rubbing together.

*Inspiration, expiration, or both.

*Does not change with coughing.

Stridor

• Upper airway obstruction.

• Crowing sound (without stethoscope).

Wheezes

*Narrowed airways.

*High-pitched, musical sound.

*Typically on expiration, but can be on inspiration.

Rhonchi

• Lower-pitched, snoring sound.

• Heard during expiration (or inspiration).

• May clear with coughing.

Lab Work (Respiratory System)

Arterial Blood Gases (ABGs):

• Acid-base balance.

• Respiratory status.

Complete Blood Count (CBC):

• Hemoglobin (Hgb), Hematocrit (Hct) (anemia).

• White blood cell count (WBC) (infection).

Sputum Culture and Sensitivity:

• To find the type of infection.

Early and Late Signs of Inadequate Oxygenation

Early Signs

Cardiovascular (CV):

• Tachycardia (elevated heart rate).

• Hypertension (elevated blood pressure).

• Dysrhythmia (irregular heart rhythm).

Central Nervous System (CNS):

• Confusion, lethargy.

• Apprehension, restlessness, irritability.

Respiratory (Resp):

• Tachypnea (increased respiratory rate).

• Dyspnea on exertion (difficulty breathing with activity).

Other:

• Diaphoresis (sweating).

• Fatigue.

• Decreased urinary output.

Late Signs

Cardiovascular:

• Cool and clammy skin.

• Cyanosis (bluish skin discoloration).

• Dysrhythmia.

• Hypotension (decreased blood pressure).

Central Nervous System:

• Coma.

• Confusion/Lethargy.

• Combative.

Respiratory:

• Dyspnea at rest.

• Pauses for breath between sentences/words.

• Retractions (use of accessory muscles).

• Accessory muscle use (neck muscles).

Other

• Diaphoresis

• Fatigue

• Decreased urinary output

Diagnostic Studies

Noninvasive Oxygen Monitoring (Pulse Oximetry):

• Sites: Finger, toe, earlobe, forehead, nose.

Factors Affecting Accuracy:

• Cold extremities, skin temperature.

• Skin color.

• Nail polish.

• Anemia.

Arterial Blood Gases (ABGs)

• Identifies issues with gas exchange and acid-base balance.

Normal Values

• pH: 7.35 - 7.45

• CO2: 35 - 45

• Bicarb: 22 - 26

• Arterial Oxygen Level: 80 - 100

• Oxygen Saturation: 95 - 100\%
  Bronchoscopy: A procedure used to visualize and examine the airways and lungs, aiding in the diagnosis and treatment of respiratory conditions. used in post op to make sure there is a gag reflex lung biopsy- want to do a respiratory assessment every 4 hours after

• Post-Operative Care: Monitoring for signs of adequate oxygenation, ensuring patient comfort, and assessing for any respiratory complications following procedures.
  Thoracentesis- test to do while the patient is awake, they are numbed while a tube goes into their back to remove excess fluid from the pleural space, which can help improve lung function and oxygenation.
  Pulmonary function test- a diagnostic evaluation used