Respiratory assessment.pps.pdf

Assessment of respiratory system Prepared By: Dr./ Seham Mohamed Assist. Prof. of Medical Surgical Nursing Department  Out lines: Anatomic and physiologic overview Oxygen transport Gas exchange Characteristics of Norm...

Assessment of respiratory system Prepared By: Dr./ Seham Mohamed Assist. Prof. of Medical Surgical Nursing Department  Out lines: Anatomic and physiologic overview Oxygen transport Gas exchange Characteristics of Normal Breathing Sign of abnormal breathing Assessment of the respiratory system Diagnostic testes  Anatomic and physiologic overview The respiratory system is composed of the upper and lower respiratory tracts. Together, are responsible for ventilation (movement of air in and out of the airway and Oxygenation).  Anatomic and physiologic overview The upper tract, known as the upper airway, warms and filters inspired air so that the lower respiratory tract (the lungs) can accomplish gas exchange. Gas exchange involves delivering oxygen to the tissues through the bloodstream and expelling waste gases, such as carbon dioxide, during expiration.  Oxygen transport Cells are in close contact with capillaries, whose thin walls permit easy passage or exchange of Oxygen and Carbon Dioxide. Oxygen diffuses from the capillary, through the capillary wall to the interstitial fluid, and then through the membrane of tissue cells, where it can be used by the mitochondria for cellular respiration. The movement of Carbon Dioxide also occurs by diffusion and proceeds in the opposite direction, from cell to blood.  Gas exchange After these tissue capillary exchange, blood enters the systemic veins (where it called venous blood) and travels to the pulmonary circulation. The Oxygen concentration in the blood within the capillaries of the lungs is lower than it is in the lung’s air sacs, which are called alveoli. As a result of this concentration gradient, oxygen diffuses from the alveoli to the blood. Carbon Dioxide, which has a concentration in the blood higher than that in the alveoli, diffuses from the blood into the alveoli. Movement of air in and out of the airways called Ventilation  Gas exchange continually replenishes the Oxygen and removes the Carbon Dioxide from the airways in the lung. This whole process of gas exchange between the atmospheric air and the blood and between the blood and the cells of the body is called Respiration.  Components of health assessment: Health assessment Health history Physical examination History of present illness, Inspection Past, present medical Auscultation history Percussion Family history Palpation Social history  Characteristics of Normal Breathing ✓Normal rate and depth ✓Regular inhalation and exhalation pattern ✓Audible on each side of chest ✓Equal rise and fall of each side  Sign of Abnormal Breathing Rate slower than 8 per minute or faster than 24 per minute Pale or cyanotic skin Shallow or irregular Pursed lips  Assessment of the respiratory system: 1- Chief reason for seeking health care: Dyspnea Pain (quality, intensity, onset) Wheezing (is a high-pitched musical sound heard mainly on expiration) Hemoptysis The questions that should be asked When the symptoms started? How long it lasted? Assessment of the respiratory system cont: 2- History: Allergies Smoking history Nature of any cough (dry, productive) Sputum production Dyspnea Respiratory treatments or medications Last pulmonary tests e.g. chest radiograph. Occupation Exercise tolerance. Assessment of the respiratory system cont: - 3- Examination of the Chest and Lungs Inspection Observe the rate, rhythm, depth, and effort of breathing. Note whether the expiratory phase is prolonged. Observe the chest for asymmetry, deformity Note masses or scars that indicate trauma or surgery. Inspect related structure as skin, tongue, mouth, fingers, and nail beds. Patients with a bluish tint to their skin and mucous membranes are considered cyanotic. Clubbing of the fingers may signal long-term hypoxia Palpation Identify any areas of tenderness or deformity by palpating the ribs and sternum. Assess expansion and symmetry of the chest by placing hands on the patient's back, thumbs together at the midline, and ask them to breath deeply. Percussion The examiner uses percussion to: Determine whether or not the underlying tissues are filled with air, fluid, or solid material. Estimate the size and location of certain structures within the thorax (e.g. heart, liver, diaphragm) Percussion Posterior Chest Percuss from side to side and top to bottom. Omit the areas covered by the scapulae. Compare one side to the other looking for asymmetry. Note the location and quality of the percussion sounds hear. Find the level of the diaphragmatic dullness on both sides. Percussion Anterior Chest Percuss from side to side and top to bottom using the pattern shown in the illustration. Compare one side to the other looking for asymmetry. Note the location and quality of the percussion sounds hear. Auscultation Using the diaphragm of the stethoscope, listen to the movement of air through the airways during inspiration and expiration. Instruct the patient to take deep breaths through their mouth. Listen through the entire respiratory cycle because different sounds may be heard on inspiration and on others expiration. Auscultation is useful in assessing: The flow of air through the bronchial tree The presence of fluid or solid obstruction in the lung structure  The best position to listen to lung sounds is with the patient sitting upright; however, if the patient is acutely ill or unable to sit upright, turn them side to side in a lying position. Avoid listening over bones, such as the scapulae or clavicles or over the female breasts to ensure are hearing adequate sound transmission. Listen to sounds from side to side rather than down one side and then down the other side. This side-to-side pattern allows to compare sounds in symmetrical lung fields. Abnormal respiratory sounds: Crackles (Rales): crackles tend to sound like discontinuous clicking, rattling, or bubbling when the person inhales. Crackling breath sounds may sound wet or dry, and doctors might describe them as either fine or coarse. Abnormal respiratory sounds: Wheezing: Wheezing noises are high-pitched, continuous and may sound like a breathy whistle. Sometimes, wheezing can be loud enough to hear without a stethoscope. A squawk is a short version of a wheeze that occurs during inhalation.  Abnormal respiratory sounds: Rhonchi: Rhonchi are continuous, lower-pitched, rough sounds that many people compare to snoring. typically heard during both inhalation and exhalation. these sounds are caused by movement of fluid and secretions in larger airways (asthma, viral Upper Respiratory Infections). Rhonchi, unlike other sounds, may clear with coughing  Abnormal respiratory sounds: Stridor: Stridor is a harsh, high-pitched, wheeze-like sound. It occurs in people who have a blocked upper airway, usually when they are breathing in.  Each type of breath sound has specific causes: Crackles: Crackles commonly happen as a result of fluid accumulation in the lungs. Conditions such as pneumonia or left- sided heart failure may cause this buildup. Wheezing: Wheezing is a common symptom of conditions that narrow the small airways in the lungs, such as asthma and COPD.  Each type of breath sound hasspecific causes: Rhonchi: Rhonchi occur due to conditions that block airflow through the large airways, including the bronchi. There may also be inflammation and fluid in these airways. Conditions such as acute bronchitis and COPD may cause rhonchi. Stridor: Stridor occurs in people with an upper airway blockage. A blockage may occur if a person breathes in a foreign object, chemical, or other harmful substance. A traumatic neck or chest injury involving the upper airway could result in a blockage too. Stridor can also be a symptom of inflammatory conditions, such as tonsillitis, epiglottitis, or croup (laryngotracheitis).  Abnormalities in chest wall: Normal Adult chest The thorax in the normal adult is elliptical in shape and is narrower anterior to posterior than it is across the transverse axis. Abnormalities in chest wall: - Barrel chest is usually caused by lung conditions. When the lungs overfill with air, they push out the ribs, chest, bones in the upper back. Over time, barrel chest develops. The medical conditions that cause barrel chest as Asthma, COPD, emphysema, cystic lung fibrosis, but may also be present in the normal, older adult. - In Funnel chest (congenital): the depression of the sternum causes cardiac compression and lung capacity restriction. When severe, patients may experience shortness of breath.  Pigeon chest may be associated with disorders including heart disease, scoliosis, kyphosis and musculoskeletal defects. Thoracic kyphoscoliosis may be congenital or caused by poor posture in childhood, such as slouching, leaning back in chairs and carrying heavy schoolbags, can cause the ligaments and muscles that support the vertebrae to stretch. This can pull the thoracic vertebrae out of their normal position, resulting in kyphosis.  3- Diagnostic Test: Arterial blood gases It is an arterial blood sample to assess the degree to which the lungs are able to provide adequate oxygen and remove carbon dioxide pH (7.35-7.45) PaO2 (75-100 mmHg) PaCO2 (35-45 mmHg) HCO3 (22-26 mEq/L) Base excess/deficit (-4 to +2) SaO2 (95-100%)  3- Diagnostic Test… cont: Pulse oximetry Is a non-invasive method of continuously monitoring the oxygen saturation of hemoglobin. Sputum studies Sputum is obtained for study to identify pathological organisms. 3- Diagnostic Test… cont: Radiographic examination of the chest Radiographic examination of the chest includes chest X-ray studies, computed tomography, and angiographic studies of pulmonary vessels. Thoracentesis Thoracentesis is the aspiration of pleural fluid from the pleural cavity for diagnostic or therapeutic purposes by means of needle biopsy.  3- Diagnostic Test… cont: Lung, and lymph node biopsy It is an excision of tissue from a lung, or lymph nodes for microscopic examination. Endoscopic procedures Bronchoscopy is the direct inspection and examination of the larynx, trachea, and bronchi through either a flexible fiber-optic bronchoscope or a rigid bronchoscope  3- Diagnostic Test… cont: Thorascopy Thorascopy is a diagnostic procedure in which the pleural cavity is examined with endoscope  Pulmonary function test Tidal volume (TV): Volume of air inhaled and exhaled with each breath Expiratory reserve volume (ERV) Additional air that can be forcefully exhaled after normal exhalation is complete Inspiratory reserve volume ( IRV) Maximum volume of air that can be inhaled forcefully after normal inhalation  Pulmonary function test Residual volume (RV) Amount of air remaining in the lungs after forced expiration Total lung capacity (TLC) Maximum volume of air that lungs can contain Vital capacity ( VC) Maximum volume of air that can be exhaled after maximum inspiration