Respiratory Assessment

ASSESSMENT
OF THE
RESPIRATORY
SYSTEM
1
2
INTRODUCTION
Correct diagnosis depends on an accurate health history
and a thorough physical examination. A respiratory
assessment can be done as part of a comprehensive physical
examination or as an examination itself.
The ability to carry out and document a full respiratory

assessment is an essential skill for all nurses.
3
INTRODUCTION
The elements included are: an initial assessment, history

taking, inspection, palpation, percussion and auscultation.
4
ANATOMY OF RESPIRATORY SYSTEM
5
ANATOMY AND PHYSIOLOGY OF
RESPIRATORY SYSTEM.
The respiratory system, which includes air passages,
pulmonary vessels, the lungs, and breathing muscles,
aids the body in the exchange of gases between the air
and blood, and between the blood and the body’s
billions of cells. Most of the organs of the respiratory
system help to distribute air but only the tiny, grape-
like alveoli and the alveolar ducts are responsible for
6actual gas exchange.
ANATOMY AND PHYSIOLOGY OF THE
RESPIRATORY SYSTEM
In addition to air distribution and gas exchange, the

respiratory system filters, warms, and humidifies the air
you breathe. Organs in the respiratory system also play a
role in speech and the sense of smell.
The respiratory system also helps the body maintain

homeostasis, or balance among the many elements of the
7
body’s internal environment.
CONT….
The respiratory system is divided into two main
components:
RESPIRATORY
SYSTEM
LOWER UPPER
RESPIRATORY RESPIRATORY
SYSTEM SYSTEM
8
CONT..
Upper respiratory tract:
Composed of the nose, the pharynx, and the larynx, the

organs of the upper respiratory tract are located outside the
chest cavity.
Nasal cavity: Inside the nose, the sticky mucous

membrane lining the nasal cavity traps dust particles, and
tiny hairs called cilia help move them to the nose to be
9 sneezed or blown out.
CONT..
Sinuses: These air-filled spaces along side the nose help

make the skull lighter.
Pharynx: Both food and air pass through the pharynx

before reaching their appropriate destinations. The
pharynx also plays a role in speech.
Larynx: The larynx is essential to human speech.
10
CONT..
Lower respiratory tract:
Composed of the trachea, the lungs, and all segments of

the bronchial tree (including the alveoli), the organs of the
lower respiratory tract are located inside the chest cavity.
Trachea: Located just below the larynx, the trachea is the

main airway to the lungs.
11
CONT….
Lungs: Together the lungs form one of the body’s largest
organs. They’re responsible for providing oxygen to
capillaries and exhaling carbon dioxide.
Bronchi: The bronchi branch from the trachea into each lung
and create the network of intricate passages that supply the
lungs with air.
Diaphragm: The diaphragm is the main respiratory muscle
that contracts and relaxes to allow air into the lungs.
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DEFINITION OF RESPIRATION
A process in living organisms involving the production of

energy, typically with the intake of oxygen and the release
of carbon dioxide from the oxidation of complex organic
substances.
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PURPOSE
The purpose of respiratory assessment is :

To ascertain the respiratory status of the patient and to
provide information related to other systems such as the

cardiovascular and neurological systems.
Breathing is usually the first vital sign to alter in the
deteriorating patient.
15
SUBJECTIVE DATA
A focused assessment of the respiratory system includes a

review for common or concerning symptoms including:
Cough—productive/nonproductive, hoarse, or barking;
Sputum characteristics—clear, purulent, bloody

(hemoptysis), rust colored, or pink and frothy
Dyspnea (shortness of breath) with or without activity,
wheezing, or stridor.
16
SUBJECTIVE DATA.
Chest pain—on inspiration, expiration, or with coughing and
location of pain.
 Ask about associated symptoms such as cold symptoms,
fever, night sweats, and fatigue.

For positive responses, ask when symptoms started (duration),
location, severity, setting, time of day, alleviating factors (what

helps), and aggravating factors (what makes it worse).
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SUBJECTIVE DATA
In addition, ask about smoking history, environmental
exposure, past medical and family history, and current

medications
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OBJECTIVE DATA
Visual inspection begins with observation of facial
expression, skin color, moisture, and temperature.

Skin should be warm and dry, and skin color should be
uniform and consistent with ethnicity.

Facial expression should be relaxed, without signs of
distress or apprehension.
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OBJECTIVE DATA
Observe nail beds, lips, mouth, ears, and conjunctiva for
oxygen saturation.
A bluish color indicates cyanosis and hypoxia.
Clubbing of the fingers may indicate chronic hypoxemia.
Observe the neck for contraction of the sternomastoid

muscles; any use of neck muscles to breathe signals
difficult breathing
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PALPATION
Using the palmar surface of the fingers, palpate the
anterior and posterior chest. It should be free of

tenderness, pain, or masses.
 A cracking sensation on palpation is crepitus, as minute
air collections are displaced with fingertip pressure, this

occurs when air from the lungs is introduced into the
subcutaneous space, usually with a pneumothorax
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PALPATION
Vocal fremitus is a vibration felt on the posterior chest
using the ulnar side of the hand.

Instruct the patient to say “99” to create vibrations, each
time the hands are moved from one area to another.

Solid areas of consolidation such as with pneumonia or
tumors will have increased
22
PALPATION
vibration; air-filled areas such as with chronic obstructive
pulmonary disease (COPD) or pneumothorax will have

less vibration.
23
PERCUSSION
Percussion is performed by placing the middle finger of
the non dominant hand against the chest wall.

The tip of the middle finger on the dominant hand is
used to strike the distal phalanx of the middle finger

between the cuticle and the first joint.
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PERCUSSION
Percussion is helpful to determine the density of the
underlying lung tissue and identify the position of the

diaphragm during inspiration and expiration.
Percuss the posterior chest in each intercostal space,
avoiding the ribs and scapula, comparing one side with

the other using side to side ladder
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PERCUSSION
pattern, striking in each place twice .

Percussion sounds should be low-pitched, hollow, and
long in duration, or resonant.

In contrast, dullness occurs when fluid or solid tissue
replaces the normally air filled lung and are thud-like

with medium pitch and duration.
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PERCUSSION
Dull tones may indicate pneumonia, pleural effusion, or
atelectasis. Very loud, lower pitch, and longer percussion

sounds, hyper resonance, when unilateral may indicate
emphysema or pneumothorax
27
Figure 1: Percussion and auscultation pattern
for posterior chest.
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AUSCULTATION
Ask the patient to breathe slowly and deeply through
their open mouth.

Using the diaphragm of your stethoscope, listen in the
ladder pattern posterior and anterior, noting the breath

sounds
Listen in each area for at least one full breath. In the
person unable to sit up without help—percuss the upper

lung and ascultate the dependent lung on each side.
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AUSCULTATION
Vesicular breath sounds are soft and generated by
airflow of normal lungs.

 Bronchial breath sounds are normally heard over the
larger airways and trachea.

Bronchial breath sounds occurring over lateral or
posterior chest walls may indicate consolidation, as in

pneumonia.
30
AUSCULTATION
Auscultation of the lung is an important part of the

respiratory examination and is helpful in diagnosing various
respiratory disorders . Auscultation assesses airflow through
the trachea bronchial tree. It is important to distinguish
normal respiratory sounds from normal respiratory sounds
from abnormal ones for example crackles, wheezes and
pleural rub in order to make correct diagnosis . It is necessary
to understand the underlying
31
AUSCULTATION
pathophysiology of various lung sound generation for better

understanding of diseases processes.
Method of performing auscultation:

 Auscultation should be done in a quiet room, preferably
in sitting position . If patient cannot assume sitting

posture, roll the patient from one side to the other to
examine the back.
32
AUSCULTATION
 Always warm up the cold stethoscope by rubbing the
chest piece in your hands before placing it on naked

body. Auscultation should never be done through the
clothing.
 Ask the patient to take deep breath through the open
mouth.
 Using the diaphragm of the stethoscope, start
auscultation anteriorly at the apices, and move
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downward till no breath sound is appreciated.
AUSCULTATION
 Next listen to the back, starting the apices and moving
downward. At least one complete respiratory cycle

should be heard at each side.
 Always compare symmetrical points on each side.
 Listen for the quality of the breath sounds, the intensity
of the breath sounds and the presence of adventitious

sounds.
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Figure 2: Percussion and auscultation pattern
for anterior chest.
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36
CONCLUSION
A common misconception in clinical practice is that a respiratory

assessment involves just noting respiratory rate and pulse oximetry
readings. However, successful treatment of a patient with a
respiratory complaint is dependent on early detection of the
underlying problem. This may only be identified through a thorough
and systematic respiratory assessment that includes: an initial
assessment, inspection,
palpation, percussion, auscultation and carrying out pertinent further

investigations
37
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ASSESSMENT

The ability to carry out and document a full respiratory

The elements included are: an initial assessment, history

In addition to air distribution and gas exchange, the

The respiratory system also helps the body maintain

Composed of the nose, the pharynx, and the larynx, the

Nasal cavity: Inside the nose, the sticky mucous

Sinuses: These air-filled spaces along side the nose help

Pharynx: Both food and air pass through the pharynx

Larynx: The larynx is essential to human speech.

Composed of the trachea, the lungs, and all segments of

Trachea: Located just below the larynx, the trachea is the

A process in living organisms involving the production of

The purpose of respiratory assessment is :

provide information related to other systems such as the

A focused assessment of the respiratory system includes a

Sputum characteristics—clear, purulent, bloody

fever, night sweats, and fatigue.

location, severity, setting, time of day, alleviating factors (what

exposure, past medical and family history, and current

Visual inspection begins with observation of facial

expression, skin color, moisture, and temperature.

uniform and consistent with ethnicity.

Clubbing of the fingers may indicate chronic hypoxemia.

Observe the neck for contraction of the sternomastoid

anterior and posterior chest. It should be free of

air collections are displaced with fingertip pressure, this

using the ulnar side of the hand.

time the hands are moved from one area to another.

tumors will have increased

pulmonary disease (COPD) or pneumothorax will have

the non dominant hand against the chest wall.

used to strike the distal phalanx of the middle finger

underlying lung tissue and identify the position of the

avoiding the ribs and scapula, comparing one side with

pattern, striking in each place twice .

long in duration, or resonant.

replaces the normally air filled lung and are thud-like

atelectasis. Very loud, lower pitch, and longer percussion

their open mouth.

ladder pattern posterior and anterior, noting the breath

person unable to sit up without help—percuss the upper

airflow of normal lungs.

larger airways and trachea.

posterior chest walls may indicate consolidation, as in

Auscultation of the lung is an important part of the

pathophysiology of various lung sound generation for better

Method of performing auscultation:

in sitting position . If patient cannot assume sitting

chest piece in your hands before placing it on naked

downward. At least one complete respiratory cycle

 Listen for the quality of the breath sounds, the intensity

of the breath sounds and the presence of adventitious

A common misconception in clinical practice is that a respiratory

palpation, percussion, auscultation and carrying out pertinent further

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