Nursing Assessment of the Respiratory System

Nursing Assessment of the Respiratory System
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  • 0:04 The Respiratory System
  • 0:54 Inspection
  • 1:52 Palpation and Percussion
  • 3:40 Auscultation
  • 4:33 Documentation
  • 5:13 Lesson Summary
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Lesson Transcript
Instructor: Kaitlin Baker

Kaitlin has taught nursing students and has a master's degree in nursing leaderhsip, as well as a bachelor's degree in English literature.

This lesson examines a nursing approach to respiratory assessment. We will review the respiratory system's structure and function and describe how to perform a history and physical focusing on this system, making use of subjective data, objective data, and documentation of the assessment process.

The Respiratory System

You are a new nurse excited to get started in your new job in the emergency room. The first patient of the day is a young man in his late 20s, who is complaining of shortness of breath. For a second you freeze. You try to think back to nursing school and where to start with a respiratory assessment.

The respiratory system's purpose is supplying oxygen to and removing carbon dioxide from the body. To this end, your patient must be able to perform the actions of inspiration (breathing in) and expiration (breathing out).

Normal breathing should be quiet and require little effort. The respiratory rate in a healthy adult patient ranges from 12-20 breaths per minute at rest. The oxygen saturation (a measure of how much oxygen is in the blood) should be above 92.

Inspection

After taking a thorough family history and reviewing your patient's current medications, ask your patient about his energy level, ability to perform activities, smoking status, vaccination status, and current symptoms, such as chest pain, shortness of breath, or wheezing.

Objective Data: Physical Examination

Looking at your patient and observing him as he breathes is the first step. Take note of the rate, rhythm (should be regular), depth, and effort of breathing (should be easy with minimal effort).

Look at the chest's shape: a normal-shaped chest is wider than it is deep; however, older adults or those with chronic obstructive pulmonary disorder (COPD) may develop a barrel chest (measures longer front to back than side to side).

Look at the color of the mucus membranes of the mouth, skin, and nail beds.

Additionally, take note of the patient's mental status, as diminished mental functioning may be a sign of hypoxia (too little oxygen in the blood).

Palpation and Percussion

The second step involves putting hands on the patient to feel whether their respiratory anatomy is normal or abnormal.

Testing chest expansion involves placing your hands palm down on your patient's back with your thumbs at the level of the 10th ribs on each side and your fingers spread. Ask him to breathe deeply; your hands should move symmetrically.

Feel for tactile fremitus (vibrations from the lungs that you can feel through the skin). Ask your patient to say ninety-nine with your palms on his back. You should feel an even, slight vibration. Increased fremitus in a certain area suggests consolidation, an area of concentrated liquid, in the lung, as in pneumonia. Decreased fremitus suggests an obstruction to air flow.

You may also feel for crepitus, a course, crackling sensation that suggests air trapped under the skin. This may happen after trauma or surgery.

The percussion step involves using the middle finger of your dominant hand to firmly and quickly tap the middle finger of your nondominant hand against your patient's chest. This creates vibrations that help you determine whether the underlying tissues are healthy. The following sounds give you clues:

  • Flatness - A short, soft, high-pitched sound, similar to how it would sound if you tapped your thigh. This indicates fluid.
  • Dullness - A thud-like sound. This also suggests fluid.
  • Resonance - A loud, hollow sound. This indicates air and is a healthy sound to hear over the lungs.
  • Hyperresonance - A very loud, lower-pitched round, similar to what you would hear over the stomach. This suggests the lung is hyper-inflated.
  • Tympany - A high-pitched, drum-like sound. This suggests excess air.

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