Respiratory Assessment and Oxygenation

Respiratory Assessment

• Respiratory assessments are important for all patients, especially those with chronic respiratory conditions.
• Assess respiratory function every 8 hours.
• Pay attention to baseline respiratory function to detect subtle changes.
• Key symptoms to consider:
  • Chest pain
  • Shortness of breath (SOB)
  • Dyspnea
  • Cough
  • Sputum color changes

Oxygenation

• Oxygenation is vital to deliver oxygenated blood to tissues and remove waste.
• It supports intracranial function.

Lung Lobes

• The right mainstem bronchus is wider, straighter, and shorter than the left, making aspiration more likely on the right side.
• Lung airways branch out: bronchi → bronchioles → alveoli
• The lung has a double wall pleura:
  • Visceral wall - attached to the outer surface of the lung
  • Parietal wall - attached to the thoracic cavity and diaphragm
  • The liquid between the pleura minimizes friction during breathing.

Preliminary Findings

• Observe:
  • General appearance
  • Posture (sitting up or leaning forward)
  • Breathing pattern (rhythm, depth, quality, and pattern)
  • Sweating
  • Noisy breathing (wheezing, stridor)
• Assess Level of Consciousness (LOC):
  • Low LOC may indicate agitation or confusion due to hypoxia.
• Inspect:
  • Nails, skin, and lips for color
  • Skin and fingers for hypoxia, cyanosis, and pallor.
• Expected Findings:
  • Relaxed posture, no distress.
• Expected Variations:
  • Thoracic breathing is common in females, while abdominal/diaphragmatic breathing is common in males.
• Unexpected Findings:
  • Tripod position - Client leans forward with hands on knees, indicating difficulty breathing.
  • Abdominal and Intercostal Muscle Use - Ribs pulled in during breathing effort.
  • Muscle Retractions - Tugging of the supraclavicular and infraclavicular areas during respiratory distress.

Assessment

• Assess:
  • LOC and hypoxia
  • Respiratory rate (RR): Eupnea (normal RR), Tachypnea (increased RR), Bradypnea (decreased RR)
  • Pulse Oximetry (SpO2): Usually 95-100%
• Unexpected Findings:
  • Confusion, agitation, anxiety - Potential signs of hypoxia
  • Increased sighing - May indicate hyperventilation
  • Hyperventilating - Rapid, deep breathing

Respiratory Assessment

• Assess patients with chronic respiratory conditions and without separately.
• Consider normal baseline for the patient and note deviations.
• Observe general appearance, posture, breathing pattern, and skin for signs of respiratory distress.
• Check for chest pain, shortness of breath, dyspnea, cough, and sputum color changes.

Oxygenation

• Vital for delivering oxygenated blood to tissues and removing metabolic waste.
• Supports intracranial function.

Lung Lobes

• Right mainstem bronchus is wider, straighter, and shorter, increasing aspiration risk on the right side.
• Airways branch from bronchi to bronchioles to alveoli.
• Double wall pleural membrane:
  • Visceral wall attached to the lung surface.
  • Parietal wall attached to the thoracic cavity and diaphragm.
  • Fluid between the pleura reduces friction.

Preliminary Findings: Expected

• Relaxed posture with no distress.

Preliminary Findings: Expected Variations

• Breathing pattern: thoracic - female; abdominal/diaphragmatic - male.

Preliminary Findings: Unexpected

• Tripod position: leaning forward with hands on knees due to breathing difficulty.
• Abdominal & Intercostal Muscle Use: ribs pulled inwards during breathing effort.
• Muscle Retractions: tugging of supraclavicular and infraclavicular regions during respiratory distress.

Assessment: Unexpected

• Altered LOC: confusion, agitation, and anxiety due to hypoxia.
• Increased Sighing: may indicate hyperventilation.

Respiratory Rate (RR)

• Eupnea (normal breathing).
• Tachypnea (rapid breathing).
• Bradypnea (slow breathing).

Pulse Oximetry

• Normal range 95%-100%.