Respiratory Assessment Quiz

Respiratory Assessment

• Functions of the Respiratory System:

  • Ventilation (inspiration and exhalation)
  • Respiration (gas exchange)
  • Acid-base balance
  • Speech
  • Sense of smell
  • Fluid balance

• Ventilation:

  • Air moves in and out of the respiratory system
  • Inspiration and exhalation

• Respiration:

  • Gas exchange of oxygen and carbon dioxide at the alveolar level
  • Oxygenated blood transported to tissues (perfusion)
  • Deoxygenated blood returned to lungs for reoxygenation

• Acid-Base Balance:

  • Respiratory system involved in acid-base balance
  • Exchange of carbon dioxide for oxygen in the lungs
  • Renal system also plays a role (secreting bicarbonate)

• Speech:

  • Air movement through vocal cords allows for vocalization

• Sense of Smell:

  • Air movement through the nose enables detection of odors
  • Inability to smell can affect sense of taste

• Fluid Balance:

  • Water excreted as vapor during exhalation maintains fluid balance

Anatomy of the Respiratory System

• Head Region:

  • Adenoids
  • Eustachian tubes (connected to ears)
  • Tonsils
  • Pharynx

• Nasal Cavity:

  • Multiple chambers

• Upper Respiratory Tract:

  • Hyoid bone
  • Glottis
  • Cricoid cartilage
  • Air travels from nose through these structures to bronchi

• Lower Respiratory Tract:

  • Bronchi branch into smaller airways (treelike)
  • Alveoli location of gas exchange (arteries and veins facilitate exchange of oxygen and carbon dioxide)

Sinus Anatomy and Issues

• Sinuses: Frontal sinuses inflamed during sinus infections
• Pain: Pain across forehead due to excess mucus in sinuses (rigid cavity)

Key Structures for Palpation

• Epiglottis: Located at the top
• Hyoid Bone: Can be felt for self-assessment
• Trachea: Its ridges and cartilages can be felt moving down the neck
• True vocal cords: Responsible for sound production
• False vocal cords/vestibular folds: Holds true vocal cords in place, crucial for opening and closing during speaking

Physiology of the Respiratory System

• Inspiration: Diaphragm contracts, lowering it, expanding chest cavity, reducing pressure in lungs, air rushes in
• Expiration: Diaphragm relaxes, increasing pressure in lungs, air exits, passive process
• Respiration: Exchange of oxygen and carbon dioxide at the alveolar level
• Alveoli: Gas exchange occurs in alveolar ducts, alveolar sacs (lined with alveoli), and respiratory bronchioles
• Deoxygenated blood: From systemic system exchanged for oxygen in the alveoli.
• Oxygenated blood: Transported to body tissues via red blood cells.
• Carbon dioxide: Exhaled from the body

Dead Space

• Areas in respiratory tract where no gas exchange occurs
• Important in pulmonary function tests (PFTs) to measure air volume

Anatomy Review

• Right lung: Three lobes (upper, middle, and lower)
• Left lung: Two lobes

Mucus and Cilia

• Mucus layer Traps debris and particles
• Cilia (mucociliary layer) Sweeps away trapped particles and germs in the lungs
• Goblet cells Attack germs if present

Respiratory Structures

• Bronchioles divide into terminal branches
• Alveoli are tiny, highly vascularized structures for gas exchange

Pleural Space

• Parietal pleura: Outer layer lining the chest wall
• Visceral pleura: Inner layer directly covering the lungs

Factors that Exacerbate or Improve Symptoms

Current Medications

• Medications for asthma or COPD used daily

Allergies

• Allergies to grass, pollens, other environmental triggers
• Worsening of conditions due to pollution or air quality

Family and Occupational History

• Family history of COPD, genetic conditions like alpha-1 antitrypsin deficiency
• Occupational exposure to asbestos, chemicals, or other lung irritants

Social History

• Smoking history currently or previously?
• Travel history in different countries recently

Physical Examination

• Speech: Ability to speak in full sentences, clarity

• Clubbing of Fingers: Inspect for clubbing as a sign of chronic respiratory issues

• Mouth: Inspection for sores, bleeding, masses, or obstructions

• Mucosal Check: Pink, moist, cracked, sticky - possible dehydration

• Neck Assessment: Check for swelling, and lumps,

• Thorax Assessment: (Check for even expansion and listen to the lung sounds)

Patient History

• Chronic conditions like COPD may present at lower oxygen levels,
• Nurses need to understand expected readings

Vital Signs

• Rate, depth, and effort used to breathe
• Patients may alter their breathing if aware of observation.
• Anything above 20 breaths per minute is tachypnea and below 12 is bradypnea

Fingernail Assessment

• Normal shape, smooth, slightly curved

• Clubbing in chronic conditions(COPD, Tuberculosis).

• Results from oxygen deficiency, and develops slowly.

Physical Assessment

• Back Inspection: Look for abnormalities(scoliosis), lung field shortenings (kyphosis),lordosis
• Abdominal Issues (Hernia, aneurysms, etc) Reduced lung capacity

Palpation

• Trachea: Midline and nontender
• Crepitus: A sound like "snap, crackle, pop;’ similar to cereal; air escaping from the lungs, under the skin

Lung Auscultation

• Listen to lungs, have the patient say “99”
• Sound should be clear, not muffled
• Uneven sound could indicate respiratory issues

Percussion

• Percussion should be dull. Should not hear tympany or abnormal sounds.

Arterial Blood Gases (ABGs)

• pH, PaCO2, HCO3, PaO2 normal ranges
• COPD patients may have lower PaO2 levels around 88 to 89mmHg. This is still considered normal for them.

Oxygen Saturation

• Normal SpO2: 95-100%
• COPD patients may have lower SpO2 levels due to body adapting

Effects of Low Oxygen Saturation

• Symptoms like confusion, dizziness, sweating, and malaise.

COPD Progression

• Gradual worsening over time.
• Patient adapts to the lowered oxygen levels.

Methods

• Percutaneous biopsy: Tissue taken using a needle through the skin
• Open procedure: Involves surgically opening the chest to obtain lung tissue
• Lung wash: Fluid introduced into the lungs, then collected for lab analysis

Case Study Example

• Mr. Thomas, patient with COPD, smoking history, hypertension, etc.

Pulmonary Function Tests

• Measures lung capacity and function, via patient inhaling and exhaling into a tube. Helps evaluate lung volumes and volumes remaining after exhaling

Diagnostic Studies

• Bronchoscopy: Visualization of respiratory tract down to secondary bronchi
• Types: Flexible or rigid, used for specimen collection or endotracheal placement/removal of obstructions
• Thoracentesis: Removing fluid/air from pleural space for diagnostic or therapeutic reasons
• Lung Biopsy: Removing a small piece of lung tissue under a microscope for analysis

Types of Pneumonia

• Viral Pneumonia: Usually resolves within 10 days, typically not treated with antibiotics
• Bacterial Pneumonia: Treated with antibiotics
• Fungal Pneumonia: Treated with antifungal medications.

Diagnostic Studies (e.g. Chest X-rays)

• Chest X-rays: Identify lung, heart, or pleural cavity issues (like consolidation, enlarged heart, fluid buildup)..
• Pneumonia/TB Detection: X-rays detect pneumonia and TB nodules in lung tissue