Nursing Science V: Respiratory Assessment

Learning Outcomes

• Understand nursing assessment for the lower respiratory system.
• Identify abnormal breath sounds and their associated medical conditions.
• Recognize five main symptoms of respiratory disease.

Subjective Data

• Assess signs and symptoms of Shortness of Breath (SOB) through specific questions during patient interviews.
• Inquire about:
  • Coughing (productive vs. non-productive).
  • Type and amount of sputum.
  • Allergies, dyspnea or SOB (rest and exertion).
  • Chest pain, and history of respiratory conditions (asthma, bronchitis, emphysema, tuberculosis).
  • Cyanosis and pallor.
  • Exposure to environmental inhalants.
  • Smoking history (amount and duration).

Initial Respiratory Survey (Inspection)

• Observe breathing pattern:
  • Rate: normal vs. increased/decreased.
  • Depth: shallow vs. deep.
  • Effort: any accessory muscle use, inspect neck.
• Assess skin color, checking for cyanosis.

Normal Respiratory Rates

• Infant: 30-60 breaths/min
• Toddler: 24-40 breaths/min
• Preschooler: 22-34 breaths/min
• School-age child: 18-30 breaths/min
• Adolescent: 12-16 breaths/min
• Adult: 16-20 breaths/min

Inspection and Assessment of Respiration Patterns

• Look for abnormalities in chest configuration (e.g., pigeon chest, funnel chest).
• Check for rib and interspace abnormalities during breathing, which may indicate airflow obstruction.
• Assess respiration patterns:
  • Tachypnea: >20 breaths/min (adults).
  • Bradypnea: <10 breaths/min.
• Palpate chest areas for tenderness or bulges as needed.

Abnormal Breath Sounds

• Crackles (Rales): Commonly heard during inspiration, associated with conditions like pulmonary edema.
• Wheeze: Continuous high-pitched sound, heard mainly during expiration but can occur during inspiration.
• Rhonchi: Low-pitched, snoring sounds, a subtype of wheeze.
• Stridor: Loudest inspiratory wheeze, best heard over the trachea.
• Pleural Friction Rub: Continuous brushing sound, indicative of pleural inflammation.

Arterial Blood Gas (ABG) Components

• Key components for interpretation:
  • pH
  • Partial pressure of carbon dioxide (PaCO₂)
  • Bicarbonate (HCO₃)
• Other components: Partial pressure of oxygen (PaO₂) and oxygen saturation (SaO₂).

Pulse Oximetry (SpO₂)

• Measure respiratory status.
• Normal SpO₂ range: 95-100%.

Bronchoscopy

• Procedure to visualize the airway and collect specimens by inserting a tube into the airway.

Flexible Bronchoscopy

• Utilizes a bronchoscope for viewing the respiratory system.
• Provides real-time images on a monitor during the procedure.

Indications for Flexible Bronchoscopy

• Minor treatments include:
  • Removing blockages from airways.
  • Draining an abscess or fluid from the lungs.
  • Widening narrowed airways.

Indications for Rigid Bronchoscopy

• Primarily used for foreign object removal from the airway.