Assessment of Respiratory SystemAssessment of Respiratory System

Anatomy of Respiratory SystemAnatomy of Respiratory System

•NasopharynxNasopharynx•LarynxLarynx•TracheaTrachea•BronchiBronchi•BronchiolesBronchioles•AlveoliAlveoli

Initial Respiratory SurveyInitial Respiratory Survey

Observe the patient’s breathing patternObserve the patient’s breathing pattern Rate (normal vs. increased/decreased) Rate (normal vs. increased/decreased) Depth (shallow vs. deep)Depth (shallow vs. deep) Effort (any sign of accessory muscle use, Effort (any sign of accessory muscle use,

inspect neck)inspect neck) Assess the patient’s colorAssess the patient’s color

cyanosiscyanosis

Normal Respiratory RatesNormal Respiratory Rates

Infant 30-60Infant 30-60 Toddler 24-40Toddler 24-40 Preschooler 22-34Preschooler 22-34 School-age child 18-30School-age child 18-30 Adolescent 12-16Adolescent 12-16 Adult 10-20Adult 10-20

SUBJECTIVE ASSESSMENTSUBJECTIVE ASSESSMENT

FeverFever Peripheral OedemaPeripheral Oedema SleepSleep Stress IncontinenceStress Incontinence Functional abilityFunctional ability Disease awarenessDisease awareness Previous physiotherapyPrevious physiotherapy Collateral from nursing staff/family.Collateral from nursing staff/family.

SUBJECTIVE ASSESSMENTSUBJECTIVE ASSESSMENT

Using the headings below, write some questions that you could use to Using the headings below, write some questions that you could use to find out or confirm the subjective information that you need to find out or confirm the subjective information that you need to know: know:

• Pain Pain • Exercise toleranceExercise tolerance• Wheeze Wheeze • Cough & sputum Cough & sputum • Sleep Sleep • Functional ability  Functional ability  • Disease awareness Disease awareness • Previous physiotherapy Previous physiotherapy 

Relevant HistoryRelevant History

Any chronic conditions Any chronic conditions Asthma, COPD, CHF, DMAsthma, COPD, CHF, DM

Exposure to new medicationExposure to new medication InhibitorInhibitor

Recent change in dietRecent change in diet Peanuts, StrawberriesPeanuts, Strawberries

Substance abuse/OverdoseSubstance abuse/Overdose Opioid abuse, ASA toxicity (aspirin) Opioid abuse, ASA toxicity (aspirin)

Prior DVT. Prior DVT. Recent trauma to chestRecent trauma to chest

OBJECTIVE ASSESSMENTOBJECTIVE ASSESSMENT

Observe ChartObserve Chart Drug KardexDrug Kardex General observationGeneral observation Oxygen therapyOxygen therapy Breathing patternBreathing pattern PalpationPalpation AuscultationAuscultation PercussionPercussion

CXR analysisCXR analysis Mobility Mobility Exercise toleranceExercise tolerance SpirometrySpirometry ABGABG Other investigationsOther investigations Standardised outcome Standardised outcome

measuresmeasures

InspectionInspection

Note the shape of the chest and the way it movesNote the shape of the chest and the way it moves Deformities or asymmetry Deformities or asymmetry

Increased AP diameter in COPD Increased AP diameter in COPD Abnormal retractions of interspaces during respiration Abnormal retractions of interspaces during respiration

Lower interspaces, supraclavicular in acute asthma Lower interspaces, supraclavicular in acute asthma exacerbationexacerbation

Impaired respiratory movement Impaired respiratory movement Flail Chest and paradoxical movement with rib Flail Chest and paradoxical movement with rib

fractures.fractures.

PercussionPercussion

Helps to identify if underlying tissues are air-Helps to identify if underlying tissues are air-filled, fluid-filled, or solidfilled, fluid-filled, or solid Hyperextend middle finger of either hand and Hyperextend middle finger of either hand and

press against chest wallpress against chest wall Strike with flexed middle finger of opposite Strike with flexed middle finger of opposite

hand hand Always percuss symmetrically on chest wallAlways percuss symmetrically on chest wall

Percussion NotesPercussion Notes

Flatness Flatness ThighThigh

Dullness Dullness LiverLiver

Resonance Resonance LungLung

Hyperresonance Hyperresonance NoneNone

Tympany Tympany Stomach, puffed cheek Stomach, puffed cheek

PercussionPercussion

Dullness replaces resonance when fluid or solid tissue Dullness replaces resonance when fluid or solid tissue replaces air containing lungreplaces air containing lung Pleural EffusionsPleural Effusions HemothoraxHemothorax TumorTumor

Unilateral Hyperresonance Unilateral Hyperresonance PneumothoraxPneumothorax

Generalized Hyperresonance Generalized Hyperresonance COPDCOPD

Breath SoundsBreath Sounds

NormalNormal TrachealTracheal BronchialBronchial BronchovesicularBronchovesicular VesicularVesicular

AbnormalAbnormal Absent/DecreasedAbsent/Decreased BronchialBronchial

Adventitious Adventitious Crackles (Rales)Crackles (Rales) WheezeWheeze RhonchiRhonchi StridorStridor Pleural RubPleural Rub

Causes of Decreased or Absent Causes of Decreased or Absent Breath SoundsBreath Sounds

AsthmaAsthma COPDCOPD Pleural EffusionPleural Effusion PneumothoraxPneumothorax AtelectasisAtelectasis

Common Respiratory DisordersCommon Respiratory Disorders

PneumoniaPneumonia

Community-acquired pneumoniaCommunity-acquired pneumonia Hospital-acquired pneumonia Hospital-acquired pneumonia BacteriaBacteria Viruses Viruses Mycoplasma Mycoplasma Fungi Fungi Chemical Chemical

PneumoniaPneumonia is an inflammatory response to the uncontrolled is an inflammatory response to the uncontrolled multiplication of microorganisms invading the multiplication of microorganisms invading the

lower respiratory tract.lower respiratory tract.

PneumoniaPneumonia

StudiesStudies CXR, sputum culture, bronchoalveolar lavage CXR, sputum culture, bronchoalveolar lavage

Management Management Antibiotics, oxygen, pulmonary toilet Antibiotics, oxygen, pulmonary toilet

Supportive careSupportive care Nutrition, hydration, restNutrition, hydration, rest

PreventionPrevention Pneumococcal and influenza vaccinesPneumococcal and influenza vaccines

Pleural EffusionPleural Effusion

Accumulation of pleural fluid secondary to increased Accumulation of pleural fluid secondary to increased fluid formation fluid formation Increased capillary permeability Increased capillary permeability Deceased colloid osmotic pressure of the blood Deceased colloid osmotic pressure of the blood Increased intrapleural negative pressure Increased intrapleural negative pressure Impaired lymphatic drainage Impaired lymphatic drainage Increased pressure in the capillaries or lymphaticsIncreased pressure in the capillaries or lymphatics

Assessment of Pleural FluidAssessment of Pleural Fluid

H/P finding H/P finding Shortness of breath, chest painShortness of breath, chest pain Tachypnea, hypoxemia, pleural rub Tachypnea, hypoxemia, pleural rub

Diagnostic studiesDiagnostic studies CXR – lateral decubitus CXR – lateral decubitus ThoracentesisThoracentesis

PneumothoraxPneumothorax

Sudden onset of pleuritic chest painSudden onset of pleuritic chest pain Dyspnea, shortness of breath, increased work of Dyspnea, shortness of breath, increased work of

breathing breathing Diagnostic testDiagnostic test

CXR CXR ManagementManagement

Oxygen Oxygen Possible placement of chest tubePossible placement of chest tube

Pulmonary EmbolismPulmonary Embolism

Part of a deep vein thrombosis that has traveled Part of a deep vein thrombosis that has traveled and lodged in the pulmonary arteriesand lodged in the pulmonary arteries

Severity depends on the extent of occlusionSeverity depends on the extent of occlusion Mismatch of ventilation and perfusion Mismatch of ventilation and perfusion Testing Testing

A pulmonary angiogramA pulmonary angiogram Management Management

Anticoagulation Anticoagulation

COPDCOPD

History History Exposure to risk factors, co-morbidities, Exposure to risk factors, co-morbidities,

current medical treatment (beta blockers)current medical treatment (beta blockers) Tests Tests

Spirometry, ABGsSpirometry, ABGs Management Management

Oxygen, education, drug therapy, nutrition, Oxygen, education, drug therapy, nutrition, exercise, surgical interventionexercise, surgical intervention

AsthmaAsthma

A chronic inflammatory disease of the airwaysA chronic inflammatory disease of the airways Airway hyper responsivenessAirway hyper responsiveness Variable airway obstruction Variable airway obstruction Resolves spontaneously or after using a Resolves spontaneously or after using a

bronchodilatorbronchodilator

AsthmaAsthma

Testing Testing Spirometry Spirometry Pulmonary function testingPulmonary function testing

ManagementManagement Education, prevent exacerbation, optimize Education, prevent exacerbation, optimize

pharmacotherapypharmacotherapy

Acute Respiratory FailureAcute Respiratory Failure

A sudden and life–threatening deterioration in A sudden and life–threatening deterioration in gas exchangegas exchange

Type I – Acute hypoxemic respiratory failure Type I – Acute hypoxemic respiratory failure Type II - Acute hypercapnic respiratory failureType II - Acute hypercapnic respiratory failure Type III – Combined hypoxemic and Type III – Combined hypoxemic and

hypercapnic failurehypercapnic failure

Acute Respiratory FailureAcute Respiratory Failure

Tests Tests ABGs, CXR, CT, thoracentesisABGs, CXR, CT, thoracentesis

ManagementManagement Correction of gases, oxygen therapy Correction of gases, oxygen therapy Reversal of any narcoticsReversal of any narcotics Possible mechanical ventilationPossible mechanical ventilation