RESPIRATORY

HEALTH ASSESSMENT OF

SYSTEM CARMEL GRACE B. GUAZON, RN

LOCATING FINDINGS ON THE CHEST

Describe chest findings in

two dimensions:
• Along the vertical axis
• The circumference of the
chest.
ANTERIOR RIBS & INTERCOSTAL
VERTICAL
SPACES AXIS.

Note special landmarks:

 2nd intercostal space for needle
insertion for tension pneumothorax.
ANTERIOR RIBS & INTERCOSTAL
VERTICAL
SPACES AXIS.
Note special landmarks:
 4th intercostal space for chest
tube insertion.
ANTERIOR RIBS & INTERCOSTAL
VERTICAL
SPACES AXIS.

Note special landmarks:

 T4 for the lower margin of an
endotracheal tube on a chest x-
ray.
POSTERIOR RIBS & INTERCOSTAL
VERTICAL
SPACES AXIS.
Note special landmarks:
 T7–T8 intercostal space landmark for
thoracentesis with needle insertion
immediately superior to the 8th rib.
Midsternal, midclavicular, and CHEST
anterior axillary lines. CIRCUMFERENCE
Anterior, midaxillary, and
posterior lines.
 CHEST
CIRCUMFERENCE

Vertebral and scapular lines.

 Lungs, Fissures, and Lobes.

The anterior lungs. The posterior lungs.

 Lungs, Fissures, and Lobes.

Right lung lobes Left lung lobes and fissures.

and fissures.
BREATHING.
 COMMON CONCERNING
SYMPTOMS.

Chest pain
Shortness of breath (dyspnea)
Wheezing
Cough
Blood-streaked sputum
(hemoptysis)
Daytime sleepiness or snoring
and disordered sleep
 CHEST PAIN.

To assess chest pain, you

must pursue a dual
investigation of both
thoracic and cardiac causes.
 CHEST PAIN.

ASSESSMENT:
• Ask patient: “Do you have any
discomfort or unpleasant feelings in
your chest?”
• Ask the patient to point to the location
of the pain in the chest.

 A clenched fist over the sternum

suggests angina pectoris;
 A finger pointing to a tender spot on the
chest wall suggests musculoskeletal
pain;
 A hand moving from the neck to the
epigastrium suggests heartburn.
 DYSPNEA & WHEEZING

Shortness of breath, or dyspnea,

is a painless but uncomfortable awareness of
breathing that is inappropriate to the level of
exertion.

ASSESSMENT:
• Ask patient: “Have you had any
difficulty breathing?”
• Find out if the symptom occurs at rest or
with exertion, and how much exertion
produces onset.
• Make every effort to determine its
severity based on the patient’s daily
activities.
 DYSPNEA & WHEEZING

Anxious patients may describe difficulty taking

a deep enough breath, a smothering sensation
with inability to get enough air, and paresthesias,
which are sensations of tingling or “pins and
needles” around the lips or in the
extremities.

Wheezes are musical respiratory sounds

that may be audible to the patient and to
others.
- Wheezing occurs in partial lower airway
obstruction from secretions and tissue
inflammation in asthma, or from a foreign
body.
 COUGH

Cough is a reflex response to stimuli that irritate

receptors in the larynx, trachea, or large bronchi.

ASSESSMENT:
• Establish the duration:
Is the cough acute, lasting
less than 3 weeks; subacute,
lasting 3 to 8 weeks; or
chronic, more than 8 weeks?
 COUGH
ASSESSMENT:
• Establish the duration:
Is the cough acute, lasting less than 3 weeks;
subacute, lasting 3 to 8 weeks; or chronic, more
than 8 weeks?

If Acute cough, consider the ff.:

-Viral URTI
-Pneumonia
-Asthma
-Foreign Body
-Smoking
-Medications (E.G. ACE Inhibitors)
 COUGH
ASSESSMENT:
• Establish the duration:
Is the cough acute, lasting less than 3 weeks;
subacute, lasting 3 to 8 weeks; or chronic, more
than 8 weeks?

If Subacute Cough, consider:

-Pertussis
-Acid Reflux
-Bacterial Sinusitis
-Asthma
 COUGH
ASSESSMENT:
• Establish the duration:
Is the cough acute, lasting less than 3 weeks;
subacute, lasting 3 to 8 weeks; or chronic, more
than 8 weeks?

If Chronic Cough, consider:

-Postnasal Drip
-Chronic Asthma
-Gastro-esophageal Reflux (GERD)
-Chronic Bronchitis
-Bronchiectasis
 COUGH
ASSESSMENT:
• Ask whether the cough is dry or
produces sputum, or phlegm.
 COUGH
ASSESSMENT:
• Ask the patient to describe the volume
of any sputum and its color, odor, and
consistency.
 COUGH
ASSESSMENT:
• The symptoms associated with a cough
often lead to its cause.
DROPLET VS. AIRBORNE
TRANSMISSION
 Hemoptysis.
Hemoptysis refers to blood coughed up
from the lower respiratory tract; it may vary
from blood-streaked sputum to frank blood.

ASSESSMENT:
• Ask the patient to quantify the volume
of blood produced, the setting and
activity, and any associated symptoms.
• NOTE: Blood originating in the
stomach is usually darker than blood
from the respiratory tract and may be
mixed with food particles.
 Daytime Sleepiness or Snoring and
Disordered Sleep.

ASSESSMENT:
• Patients may report excessive
daytime sleepiness and fatigue. Ask
about problems with snoring,
witnessed apneas (defined as
breathing cessation for ≥10
seconds), awakening with a
choking sensation, or morning
headache.
RESPIRATIONS

Eupnea refers to normal rate,

depth, and rhythm of respirations.
• Depth/tidal volume for an adult is
300 to 500 mL/min.
• Rhythm should be regular, with
signs every 15 minutes at rest.
• Respiration should be quiet and
relaxed unless the patient is
involved in vigorous activity.
NORMAL RESPIRATION RATES PER AGE
GROUP
RESPIRATIONS

Tachypnea (<20bpm)
CAUSES:
 Anxiety
 Fear
 Pain
 Compromised neurological
control of breathing
 Sepsis
 Fever
 Increased metabolism.
RESPIRATIONS

Bradypnea (>20bpm)
CAUSES:
 Excessive sedation
 Hypercapnea
 Compromised neurological
control of breathing
 Metabolic alkalosis
RESPIRATIONS

Rate and Depth.

■ SHALLOW RESPIRATION:
Decreased depth may be d/t:
 Habit
 Fatigue
 Metabolic alkalosis
 Ascites
 Restrictive lung disease
 Chest, abdominal, or pleuritic pain
 Neurological disorders.
 RESPIRATIONS

Rate and Depth.

■ INCREASED DEPTH:
Increased depth may be d/t:
 Hyperventilation with anxiety
 Metabolic acidosis
 Neurologic disorders
RESPIRATORY PATTERNS
RESPIRATORY PATTERNS
RESPIRATORY PATTERNS

It may be caused by damage to respiratory centers, or by physiological

abnormalities in congestive heart failure, and is also seen in newborns with
immature respiratory systems and in visitors new to high altitudes.
RESPIRATORY PATTERNS

Kussmaul breathing: Air hunger, or the rapid, deep, and labored breathing characteristic
of patients with acidosis (excess acidity of tissues).
RESPIRATORY PATTERNS

Associated with Head Trauma, Severe Brain Hypoxia, or Lack of Blood Flow to the
Brain.
RESPIRATORY PATTERNS

May also be characterized by irregular periods of apnea alternating with periods in

which four or five breaths of identical depth are taken.
Cause: INCREASED ICP
CHEST ASSESSMENT

NORMAL ADULT CHEST

CHEST ASSESSMENT

BARREL CHEST
CHEST ASSESSMENT

PECTUS EXCAVATUM
• Aka FUNNEL CHEST
• Cause: UNKNOWN, but could be
genetically inherited.
• More common in BOYS than in
girls.
CHEST ASSESSMENT

PECTUS CARINATUM
• Aka PIGEON CHEST
• Cause:
-vitamin D deficiency in children
-growth spurt (11-14 yrs age)
• More common in BOYS than in
girls.
CLUBBING OF FINGERS

• also described as
Hypertrophic
Osteoarthropathy (HOA)
• painless soft tissue swelling
of the terminal phalanges
• enlargement increases
convexity of the nail
CLUBBING OF FINGERS

Diagnosis:
• Lovibond's profile sign
• Distal/interphalangeal
depth ratio
• Schamroth's sign
 RESPIRATORY
ABNORMAL FINDINGS:

SYSTEM
ASTHMA
Reactive airway disease causing inflammation and
airway obstruction because of increased reactiveness
to a variety of stimuli.

• Pallor or cyanosis caused • Crackles, rhonchi,

by hypoxia wheezes, decreased or
absent breath sounds
• Sits upright and leans • Early in disease:
forward expiratory wheezes
• Diaphoresis • Late in disease:
inspiratory and expiratory
wheezes
• Use of accessory muscles • Hyperresonance
• Chest tightness • Decreased tactile fremitus
• Dyspnea, respiratory rate
> 30/min
 BRONCHITIS
Excessive mucus production with recurrent,
persistent cough during 3 mo of the year for 2
consecutive years.
• Cyanosis (“blue • Changes in mental status
bloater”) related to hypoxia
• Productive cough with • Decreased tactile fremitus
copious amounts of
mucus
• Increased AP diameter • Hyperresonance at bases,
dullness over exudate
areas
• Increased use of
accessory muscles
• Cardiac enlargement
 EMPHYSEMA
Permanent enlargement of alveoli distal to terminal
bronchioles with destruction of alveolar wall.

• Thin with muscle • Pallor, ruddiness (pink

wasting puffer)
• May appear Anxious • Rapid, shallow
respiration
• Neck vein distension • Use of accessory
muscles
• Difficulty speaking • Distant heart sounds,
because of respiratory right-sided S3
distress
• Pursed-lip breathing • Tachycardia with
arrhythmias
• Increased AP • Hyperresonance at bases
diameter or in all lung fields
 LUNG CANCER
Malignant tumor of lung tissue.

• Decreased breath • Hemoptysis

sounds
• Thin as a result of • Change in respiratory
weight loss pattern
• Unexplained dyspnea • Wheezes
• Persistent dry or • Decreased breath sounds
productive cough over affected lung
• Blood-streaked, rust-
colored, or purulent
sputum
 PNEUMONIA
Infectious process of lung tissue. Clinical
manifestations vary depending on causative agent.

• Changes in mental • Pharyngitis

status related to
hypoxia or fever
• Pallor or flushing • Tachypnea
• Asymmetrical chest • Use of accessory
movement muscles
• Crackles, rhonchi • Dullness on percussion
• Diaphoretic or dry • Nailbed cyanosis
with poor turgor
 PNEUMOTHORAX
Complete or partial collapse of lung.

• Shallow, rapid • Dyspnea

respiration
• Absent breath • Complaint of chest pain
sounds with or without
hemoptysis
• tracheal shift away • severe respiratory
from affected lung distress
• Hyperresonance
 TUBERCULOSIS
Mycobacterial infection of lung.

• Clubbing (late sign) • Productive cough with

nonpurulent, blood-
streaked sputum.
• Fatigue • Hemoptysis.
• Persistent, long- • Chest tightness.
term, low-grade
fever
• Chills and night • dull chest pain
sweats
• Anorexia and weight • Dyspnea.
loss
Sample Documentation.
 1. What are Adventitious Breath Sounds?
2. Fill out the table:
ACTIVITY

ADVENTITIOUS DESCRIPTION ASSOCIATED

BREATH SOUND (expected sound to be CONDITIONS
heard upon
auscultation)