Chapter 34:

Assessing the Respiratory System

Learning Outcomes:
1. Describe the anatomy, physiology, and functions of the respiratory
system.
a. Suggested Activity: Using anatomic models, demonstrate the
anatomy of the respiratory system.
2. Compare and contrast factors affecting respiration.
a. Suggested Activity: Have students identify factors that impact
respiration in their clinical patients.
3. Identify specific topics for consideration during a health history
interview of the patient with health problems involving the
respiratory system.
a. Suggested Activity: Have students complete respiratory
assessments on clinical patients.
4. Give examples of genetic disorders of the respiratory system.
5. Describe normal variations in assessment findings for the older
adult.
a. Suggested Activity: Have students identify assessment
changes associated with aging.
6. Identify abnormal findings that may indicate alterations in
respiratory function.

I. Anatomy, Physiology, and Functions of the Respiratory System

A. Events in respiration: ventilation, perfusion, diffusion
B. The upper respiratory system
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LeMone/Burke/Bauldoff/Gubrud, Instructor’s Resource Manual for Medical-Surgical Nursing, 6th Edition
Ch. 34: Assessing the Respiratory System
Page 1 of 6
 1. The nose and sinuses
a) Nose
(1) Nasal hairs filter air
(2) Mucus traps dust and bacteria, contains lysozyme that destroys bacteria
(3) Mucosal ciliated cells move accumulated mucus to pharynx to be swallowed
(4) Mucosa warms air
b) Paranasal sinuses
(1) Located in frontal, spheoid, ethmoid, and maxillary bones
(2) Lighten skull, assist in speech, produce mucus
c) Mouth: alternate airway
2. The pharynx
a) Nasopharynx: passageway for air
(1) Tonsil and adenoids: masses of lymphoid tissues
(a) Trap and destroy infectious agents entering with the air
(2) Eustachian tubes connect nasopharynx with middle ear
b) Oropharynx: passageway for air and food
(1) Behind oral cavity, from soft palate to hyoid bone
c) Laryngopharynx: passageway for air and food
(1) From hyoid bone to larynx
3. The larynx: passageway for air, routes food and air to proper passageways, contains
vocal cords
a) Inlet open for air, closes during swallowing
b) Framed by throid, cricoid, and epiglottis cartilages
c) Cough reflex to keep substances other than air out
4. The trachea
a) Begins at inferior larynx, descends anteriorly to the esophagus, enters mediastinum,
divides to become primary bronchi of lungs
b) Seromucous glands produce mucus
C. The lower respiratory system

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LeMone/Burke/Bauldoff/Gubrud, Instructor’s Resource Manual for Medical-Surgical Nursing, 6th Edition
Ch. 34: Assessing the Respiratory System
Page 2 of 6
 1. The lungs
a) Hilus: on mediastinal surface of each lung
(1) Where blood vessels enter and exit lungs
b) Stroma: elastic connective tissue
c) Left lung: smaller, has two lobes
d) Right lung: has three lobes
e) Vascular system:
(1) Pulmonary arteries: deliver blood for oxygenation
(a) Within lungs, branch in capillary network, surround alveoli
(2) Pulmonary veins: oxygenated blood to heart
(3) Bronchial arteries, bronchia and pulmonary veins: take blood to and from lungs
2. The pleura
a) Parietal pleura: lines thoracic wall and mediastinum
b) Visceral pleura: covers external lung surfaces
c) Pleural fluid: lubricating, serous fluid for lung movement
3. The bronchi and alveoli
a) Trachea divides into right and left primary bronchi
b) Bronchial tree: bronchi subdivide into smaller bronchi, into bronchioles, end in
terminal bronchioles
c) Terminal bronchioles branch into alveolar ducts, lead to alveolar sacs, to alveoli
d) Alveoli: location of oxygen and carbon dioxide exchange by simple diffusion
(1) Walls covered with layer of squamous epithelia cells over thin basement
membrane
(2) External surface covered with pulmonary capillaries
e) Alveoli cluster around alveolar sacs, open into atrium
4. The rib cage and intercostal muscles
a) 12 ribs, which articulate with the thoracic vertebrae
b) Sternum: manubrium, body, and xiphoid process
c) Intercostal spaces: spaces between ribs
d) Inspiratory muscles: intercostal muscles between ribs and diaphragm
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LeMone/Burke/Bauldoff/Gubrud, Instructor’s Resource Manual for Medical-Surgical Nursing, 6th Edition
Ch. 34: Assessing the Respiratory System
Page 3 of 6
II. Factors Affecting Respiration
A. Respiratory volume and capacity
1. Pulmonary function tests determine
a) Total lung capacity (TLC): volume at maximum inflation of lungs
(1) Calculated from: tidal volume (TV), inspiratory reserve volume (IRV), expiratory
reserve volume (ERV), residual volume (RV)
b) Vital capacity: amount that can be exhaled after maximal inspiration
(1) Calculated from: inspiratory capacity, functional residual capacity (FRC), forced
expiratory volume (FEV1), forced vital capacity (FVC), minute volume (MV)
B. Air pressures
1. Inspiration: diaphragm and intercostal muscles contract, create pressure gradient, air
fills lungs
2. Expiration: primarily passive process from elasticity of lungs when inspiratory
muscles relax
3. Intrapulmonary pressure: pressure within the alveoli, changes constantly with
inhalation and exhalation
4. Intrapleural pressure: within pleural space, also rises and falls with breathing, but is
always less than intrapulmonary pressure
5. Pressures necessary for breathing and to prevent lung collapse
C. Oxygen, carbon dioxide, and hydrogen ion concentrations
1. Rate and depth of respirations controlled by respiratory center in medulla oblongata
and pons of brain and chemoreceptors in medulla and carotid and aortic bodies
2. Respond to changes in oxygen, carbon dioxide, and hydrogen ion concentrations in
arterial blood
D. Airway resistance, lung compliance, and elasticity
1. Respiratory passageway resistance: from friction of gases moving, and by constriction
of passageways by mucus, infectious materials, and tumors
2. Lung compliance: depends on elasticity of lung tissue and flexibility of rib cage
E. Alveolar surface tension
1. Surface tension on liquid film of alveolar walls
2. Surfactant, produced by alveolar cells, reduces surface tension

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LeMone/Burke/Bauldoff/Gubrud, Instructor’s Resource Manual for Medical-Surgical Nursing, 6th Edition
Ch. 34: Assessing the Respiratory System
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III. Oxygen and Carbon Dioxide Transport
A. Arterial blood gases reflect gas exchange function of alveoli
B. Oxygen transport and unloading
1. Blood carries oxygen in dissolved state (1–2%) and combined with hemoglobin (99%)
2. Hemoglobin: made of 4 polypeptide chains, each bound to iron-containing heme
group
3. Oxygen affinity to hemoglobin affected by: temperature, blood pH, PO2, PCO2, serum
concentration of 2,3-DPG
4. Blood dissociates from hemoglobin in capillaries, diffuses into cells
C. Carbon dioxide transport
1. CO2: product of cell metabolism
2. CO2 transported in blood to lungs as bicarbonate ions in plasma, dissolved in plasma,
and bound to hemoglobin
3. Amount of CO2 transported in blood depends on oxygenation of blood

IV. Assessing Respiratory Function

A. Diagnostic tests
1. Arterial blood gases (ABGs), biopsy of the lung, bronchoscopy, chest x-ray, CT scan
of the thorax, MRI of the thorax, pulmonary angiography, pulmonary ventilation
scan, pulse oximetry, positron emission tomography (PET), sputum studies,
thoracentesis
2. Nurse explains procedure, assesses medication use that may affect test, supports
patients, documents, monitors results
B. Genetic considerations
1. Family history of emphysema, asthma, cystic fibrosis, lung cancer
C. Health assessment interview
1. Analyze manifestations: onset, characteristics, course, severity, precipitating and
relieving factors, and associated symptoms
2. History of allergies, asthma, bronchitis, emphysema, pneumonia, tuberculosis,
congestive heart failure, surgery or trauma to the respiratory structures, chronic
illnesses, self treatment of manifestations
3. Lifestyle, environmental and occupation factors

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LeMone/Burke/Bauldoff/Gubrud, Instructor’s Resource Manual for Medical-Surgical Nursing, 6th Edition
Ch. 34: Assessing the Respiratory System
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 D. Physical assessment
1. Nasal inspection
a) Size, shape, color, nasal cavity health, ability to smell
2. Sinus assessment
a) Comfortable to palpation
3. Thoracic assessment
a) Respiratory rate, anteroposterior diameter/transverse diameter ratio, intercostal
retraction or bulging, chest expansion, trachea position, lung sounds, diaphragmatic
excursion
4. Breath sound assessment
a) Auscultate for sounds, crackles, wheezes, friction rubs

V. Chapter Highlights
A. Correct structure and function of the respiratory system is vital to
ventilation, resulting in oxygenation of all body tissues.
B. Manifestations of dysfunction, injury, and disorders affecting the
respiratory system may be detected during a general health assessment as
well as during a focused respiratory system assessment.
C. Normal anatomy, physiology, and functions of the upper and lower
respiratory systems are the basis for assessment.
D. Both general health and focused pulmonary system assessments can detect
dysfunction, injury, and disorders.
E. Assessment of the pulmonary system includes diagnostic tests, genetic
considerations, a health interview, and a physical assessment.

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LeMone/Burke/Bauldoff/Gubrud, Instructor’s Resource Manual for Medical-Surgical Nursing, 6th Edition
Ch. 34: Assessing the Respiratory System
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