Week 6 NR 302

NR302: Health Assessment - Week 6 - Respiratory Assessment

Overview

  • The respiratory assessment includes a thorough evaluation of the respiratory system.
  • Assessment techniques will differentiate between normal and abnormal findings.
  • Aging, health history, environmental, and developmental factors are important for thorough evaluations.
  • Documentation of findings must utilize appropriate terminology and technology.

Weekly Outcomes

  • Perform basic physical assessment techniques to assess the respiratory system.
  • Differentiate between normal and abnormal assessment findings in the respiratory system.
  • Explore physiological effects of aging on the respiratory system.
  • Associate health history findings with environmental and developmental influences on the respiratory system.
  • Identify educational opportunities for promoting respiratory health.
  • Document findings of respiratory assessments accurately.

Weekly Objectives

  • Describe steps involved in completing a respiratory assessment.
  • Discuss appropriate nursing techniques for respiratory system assessment.
  • Considerations include:
    • Cultural factors
    • Spiritual factors
    • Nutritional factors
      when gathering health history and performing assessments.

Thoracic Cage Anatomy

Anterior Thoracic Cage
  • Components:
    • Clavicle
    • 2nd intercostal space
    • Costal cartilage
    • Dome of the diaphragm
    • 7th intercostal space
  • Landmarks:
    • Suprasternal notch
    • Manubrium of sternum
    • Sternal angle (angle of Louis)
    • Body of sternum
    • Costochondral junction
    • Xiphoid process
    • Costal angle
    • Costal margin
Posterior Thoracic Cage
  • Components:
    • Clavicle
    • Scapula
    • Inferior angle of scapula
  • Landmarks:
    • Vertebra prominens of C7
    • Spinous process of T3
Reference Lines

  • Anterior Reference Lines:

    • Anterior axillary line
    • Midsternal line
    • Midclavicular line

  • Posterior Reference Lines:

    • Scapular line
    • Vertebral line

  • Lateral Reference Lines:

    • Anterior axillary line
    • Posterior axillary line
    • Midaxillary line

Lung Function

How Lungs Work
  • Lungs expand and contract to facilitate breathing:
    • Inhale: The future
    • Exhale: The past
    • Breathe: The present
Development across Lifespan
Infants and Children
  • Lung development begins in utero.
  • At 32 weeks, surfactant production starts, allowing lungs to function post-birth.
  • Increased vulnerability to environmental tobacco smoke (ETS) leading to:
    • Sudden infant death syndrome (SIDS)
    • Negative behavioral and cognitive outcomes
    • Higher adolescent smoking rates
Pregnant Women
  • Enlarging uterus impacts lung capacity.
  • Physiologic dyspnea is commonly experienced.
Aging Adults
  • Changes:
    • Decreased vital capacity
    • Increased residual volume due to structural changes.
  • Histologic changes reduce gas exchange efficiency.

Lung Diseases and Environmental Factors

Genetics and Environment
  • Lung Cancer:
    • 2nd most diagnosed cancer in both genders; leading cause of cancer death in the U.S.
  • Tuberculosis (TB):
    • Affects over 1/3 of the world population; considered a “social and migratory” disease requiring active treatment.
  • Asthma:
    • Most prevalent chronic disease in childhood leading to disparities especially in low-income populations.
    • Influenced by ethnic and environmental factors.
    • Types include:
    • Extrinsic/allergic (or pediatric-onset) asthma
    • Long-term exposure to traffic-related air pollution (TRAP).

Subjective Data Collection

  • Key Symptoms:
    • Cough
    • Shortness of breath
    • Chest pain related to breathing
    • History of respiratory infections
    • Smoking history
    • Environmental exposure

Patient-Centered Care

  • Screening Questions Include:
    • Last TB Skin Test
    • Last Chest X-ray study
    • Pneumonia vaccination history

Open-Ended Questions for Patient History

  • Explore environmental factors, exposures, and safety.
  • Example:
    • What would you ask your patient regarding potential inhalation of toxins?
Example Questions for Children
  • Inquiry about:
    • Frequent or severe colds
    • Family history of allergies
    • Current respiratory symptoms (cough/congestion)
  • Safety measures taken in the home to prevent inhalation of toxic substances.
  • Awareness of emergency care measures for choking.
Example Questions for Aging Adults
  • Assess symptoms such as:
    • Shortness of breath or fatigue during daily activities
    • Quantity of physical activity
  • Lung Function Questionnaire for patients with chronic conditions (COPD, lung cancer, TB).
  • Impact of illness on energy levels and daily life.

Objective Data Collection

  • Ensure respect and comfort during examinations.
  • Utilize techniques of inspection, palpation, percussion, and auscultation of the chest.
  • Required equipment:
    • Stethoscope
    • Alcohol wipe

Breath Sounds Evaluation

  • Assess presence and quality of normal breath sounds using a stethoscope:
    • Perform bilateral comparisons with full respiratory cycles.
    • Be aware of pacing background noise versus lung sounds.
Adventitious Lung Sounds
  • Definition:
    • Additional sounds typically not heard in healthy lungs.
  • Common classifications include:
    • Crackles (or rales)
    • Wheezes (or rhonchi)
  • Atelectatic Crackles:
    • Short, non-pathologic sounds occurring briefly.
More Adventitious Sounds Classifications

  • Discontinuous Sounds:

    • Fine crackles
    • Coarse crackles
    • Pleural friction rub

  • Continuous Sounds:

    • Sibilant wheeze
    • Sonorous rhonchi
    • Stridor

Measurement of Pulmonary Function

  • Forced Expiratory Time (FET):
    • Time taken to exhale from total lung capacity to residual volume.
    • Screening measure for airflow obstruction.
  • Spirometer:
    • Measures lung health; used in outpatient settings.
  • Pulse Oximeter:
    • Non-invasive method for estimating blood oxygen saturation (SpO2).
    • Normal SpO2 range is 97% to 98% for healthy individuals.
    • Contextual evaluation of SpO2 based on hemoglobin levels, acid-base balance, and ventilation status.
  • 6-Minute Walk Test (6MWT):
    • Simple, inexpensive, and safe clinical measure of functional status in older adults.

Developmental Competence in Infants and Children

Inspection Findings
  • Infants should exhibit:
    • Rounded thorax with equal anteroposterior (AP) to transverse diameter.
  • By age 6 years, the thorax reaches the mature ratio of 1:2.
  • Newborn's chest circumference typically between 30 to 36 cm, smaller than head circumference until age 2 years.
APGAR Scoring System
  • Used for assessing a newborn's transition to extrauterine life:
    • Criteria include:
    • Respiratory effort
    • Skin color (appearance)
    • Pulse rate
    • Grimace response (reflex)
    • Activity (tone)

Health Promotion and Education

Second-hand Smoke (SHS)
  • Mixture of sidestream and mainstream smoke along with multiple chemicals.
  • Mainstream smoke: Exhaled by the smoker.
  • Sidestream smoke: Produced at the burning end of a tobacco product.
  • Increased health risks associated with SHS include:
    • Lung cancer
    • Stroke
    • Low birthweight in pregnancies
    • SIDS and multiple comorbidities in children.

Abnormal Findings in Thorax Configurations

Thoracic Configurations
  • Barrel Chest: A condition characterized by an increased AP diameter.
  • Pectus Excavatum: A congenital defect causing a sunken chest.
  • Pectus Carinatum: A condition that leads to a protruding chest.
  • Scoliosis: Lateral curvature of the spine.
  • Kyphosis: Abnormal curvature causing hunching of the upper back.

Abnormal Respiration Patterns

  • Patterns include:
    • Bradypnea: Abnormally slow breathing.
    • Tachypnea: Rapid breathing.
    • Hypoventilation: Reduced breathing rate.
    • Hyperventilation: Excessively rapid breathing.
    • Cheyne-Stokes respiration: Periods of deep breathing followed by apnoea.
    • Biot respiration: Irregular patterns; can signal brain injury.
    • Chronic Obstructive Breathing: Associated with long-term respiratory conditions.

Diagnostic Clues for Chronic Dyspnea

  • Pulmonary: Related to alveolar, interstitial, obstruction of airflow, restrictive diseases, or vascular issues.
  • Cardiac: Related to arrhythmia, heart failure, or diseases affecting the pericardium or valves.
  • Gastrointestinal: Aspiration incidents.
  • Neuromuscular: Respiratory muscle weakness.
  • Psychological: Associated with anxiety.