Part I: Nursing Assessment Respiratory System

Janet Duffey, RN, MS

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Structures and Functions of Respiratory System

• Structures

• Pulmonary functional unit

• Ciliated mucus membrane

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Anatomical Landmarks

Chest wall descriptors• Anterior landmarks

Midclavicular lines Midscapular lines

• Posterior landmarksMid-scapular lineMid-spinal line

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Structures and Functions of Respiratory System

• Upper Respiratory Tract• Lower Respiratory Tract

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Lower Airway Structures

Fig. 26-3. Structures of lower airways. 6

Atalectatsis: Collapsed Alveoli

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Respiratory Membrane

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Structures and Functions of Respiratory System

• Lower Respiratory Tract FactorsSurfactantBlood supply

• Chest Wall

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Structures and Functions of Respiratory System

• Physiology of RespirationVentilationCompliance Diffusion Oxygen-hemoglobin dissociation curve

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Oxygen-Hemoglobin Dissociation Curve

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Normal Arterial Blood GasesABG’s

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Physiology of RespirationMixed venous blood gasesOximetry

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Structures and Functions of Respiratory System

Table 26-3. Critical Values for Pao2 and Spo2 *.

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Respiratory Control

• Chemoreceptors• Mechanical receptors

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Respiratory Defense Mechanisms

Filtration of airMucociliary clearance systemCough reflexReflex bronchoconstrictionAlveolar macrophages

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Gerontologic Considerations: Aging Respiratory System

•Cumulative health alterations

•Decreased cough / gag reflex

•Diminished chest wall movement

•Slowed immune function

•Environmental exposures

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Assessment: Subjective DataPast health historyMedicationsSurgery or other treatments Functional health patternsHealth perception–health management

patternNutritional-metabolic patternElimination patternActivity-exercise pattern

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Functional Health Patterns (continued)

Sleep-rest patternCognitive-perceptual pattern Self-perception–self-concept patternRole-relationship patternSexuality-reproductive patternCoping–stress tolerance patternValues-belief pattern

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Assessment: Objective DataPhysical examinationNose Mouth and pharynxNeckThorax and lungs Inspection Palpation Percussion Auscultation

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Assessment: Thoracic Expansion

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Assessment: Percussion

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Auscultation Sequence

Listen for 1 breath cycle at each site

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Assessment: Percussion of Chest

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Posterior Percussion

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Normal Auscultation

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Physical Assessment of Respiratory System (normal)

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Diagnostic Studies

• Sputum Studies • Skin Tests • Endoscopic ExaminationsBronchoscopy

• CT scan

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Bronchoscopy

• NPO• Assure informed consent signed• Anxiety reduction• IV access• Hydration • Pre-op sedation• Post-op care

• Oxygen• Side-lying position• Re-orientation• Anxiety reduction• Evaluate for gag reflex

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Lung Biopsy

• Performed during bronchoscopy• Data on tumors or subcarinal lymph nodes• Risks

• Bleeding• Pneumothorax• Infection• Aspiration

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Diagnostic Studies: Thoracentesis

• Insertion of needle

• Floroscopicguidance

• Pleural space• Withdrawal of

fluid• Diagnostic • Palliative

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Functional Diagnostic Studies

• Pulmonary Function Tests • Exercise Testing Indications Role of nurse