Chapter 27
Assessment of the
Respiratory System
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Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Concepts
The priority concept for this chapter is
GAS EXCHANGE
The interrelated concept for this chapter is
PERFUSION
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Respiratory System
Uses ventilation to provide body with
atmospheric oxygen
Gas exchange (see Chapter 2)
Perfusion (see Chapter 2)
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Anatomy and Physiology Review
Upper respiratory tract
Nose, sinuses, pharynx, larynx
Lungs
Lower respiratory tract
Trachea, two mainstem bronchi, lobar, segmental,
and subsegmental bronchi; bronchioles; alveolar
ducts; alveoli
Alveolar air sacs
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Respiratory Changes
Associated with Aging
Heredity
Lifetime exposure to environmental pollutants
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Health Promotion and Maintenance
Minimize exposure to inhalation irritants
Home, occupation, work exposures
Smoking cessation (including hookah, water
pipe, “vaping”)
Limit or cease exposure to secondhand and
thirdhand smoke
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Assessment: Noticing and Interpreting
Family and personal data (including genetic
risk)
Smoking (pack-years)
Drug use (prescribed and illicit)
Allergies
Travel, geographic area of residence
Veterans: location of deployments
Current health problems
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Physical Assessment:
Nose and Sinuses
External nose—deformities or tumors
Nares—symmetry of size and shape
Nasal cavity—color, swelling, drainage,
bleeding
Mucous membranes—color, other
abnormalities
Septum—bleeding, perforation, deviation
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Assessment of the
Nose and Sinuses (Cont.)
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Physical Assessment:
Pharynx, Trachea, and Larynx
Mouth
Posterior pharynx
Neck—symmetry, alignment, masses,
swelling, bruises, use of accessory neck
muscles for breathing; lymph nodes
Trachea—palpate for position, mobility,
tenderness, masses
Larynx—voice abnormality; hoarseness
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Physical Assessment:
Pharynx, Trachea, and Larynx (Cont.)
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Physical Assessment:
Lungs and Thorax
Inspect thorax with patient sitting up
Observe chest, compare one side with the
other
Work from the apex, move downward toward
base (from side to side)
Rate, rhythm, depth of inspiration as well as
symmetry of chest movement
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Physical Assessment:
Lungs and Thorax (Cont.)
Examine AP diameter with lateral diameter
Distance between ribs (intercostal space)
Palpate to assess respiratory movement,
symmetry, for tenderness and tactile fremitus,
crepitus
Percussion for pulmonary resonance, organ
boundaries, diaphragmatic excursion
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Physical Assessment:
Lungs and Thorax (Cont.)
Lung sounds
Bronchial
Bronchovesicular
Vesicular
Adventitious sounds
Crackles
Wheezes
Rhonchus
Pleural friction rub
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Physical Assessment:
Lungs and Thorax (Cont.)
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Other Indicators of
Respiratory Adequacy
Skin and mucous membrane changes
General appearance
Endurance
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Psychosocial Assessment
Anxiety
Stress
Coping mechanisms
Roles and relationships may be affected
Finances, unemployment, disability may be
factors
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Diagnostic Assessment
Laboratory assessment
RBC
ABG
Sputum
Imaging assessment
x-rays
CT
Other noninvasive diagnostic assessments
Pulse oximetry
Capnometry and capnography
PFTs
Exercise testing
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Invasive Diagnostic Assessment
Endoscopic examinations
Bronchoscopy
Thoracentesis
Lung biopsy
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Chapter 27
Audience Response System Questions
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Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Question 1
Which assessment finding for an older adult
patient does the nurse ascribe to the natural
aging process?
A. Tightening of the vocal cords
B. Decrease in residual volume
C. Decrease in the anteroposterior diameter
D. Decrease in respiratory muscle strength
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Question 2
The nurse knows that under normal physiologic
conditions of tissue perfusion, a patient will
have what percent of oxygen dissociate from
the hemoglobin molecule?
A. 25%
B. 50%
C. 75%
D. 100%
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Question 3
Which assessment finding does the nurse
interpret that is associated most closely
with lung disease?
A. Cough
B. Dyspnea
C. Chest pain
D. Sputum production
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