NR 509 Week 4: Respiratory System Assessment

Introduction to Respiratory System Assessment

The respiratory system assessment is a vital part of a comprehensive physical examination. It involves evaluating the function and structure of the lungs and airways to identify respiratory conditions. Understanding the anatomy and physiology of the respiratory system is essential for performing an accurate assessment.

Components of Respiratory System Assessment

A thorough respiratory assessment includes several key components:

1. Inspection: Observing the chest for symmetry, shape, and any visible abnormalities.
2. Palpation: Feeling for tenderness, masses, and chest expansion.
3. Percussion: Assessing the underlying structures by tapping on the chest.
4. Auscultation: Listening to breath sounds to identify normal and abnormal respiratory sounds.

Conducting the Respiratory Examination

The respiratory examination is performed systematically, starting with inspection and progressing through palpation, percussion, and auscultation:

1. Inspection: Observe the chest for any deformities, asymmetry, or use of accessory muscles for breathing. Note the respiratory rate, rhythm, and effort. Look for signs of respiratory distress, such as cyanosis, nasal flaring, or intercostal retractions.
2. Palpation: Palpate the chest wall to assess for tenderness, masses, or crepitus. Check for symmetrical chest expansion by placing your hands on the patient’s back with your thumbs at the midline and asking the patient to take a deep breath. Feel for tactile fremitus, which is the vibration felt when the patient speaks, indicating air movement through the lungs.
3. Percussion: Percuss the chest to assess the underlying structures. Resonant sounds indicate normal, air-filled lungs, while dullness may suggest consolidation, pleural effusion, or a mass. Hyperresonance can indicate pneumothorax or emphysema.
4. Auscultation: Use a stethoscope to listen to breath sounds in all lung fields. Normal breath sounds include vesicular, bronchial, and bronchovesicular sounds. Abnormal sounds, or adventitious sounds, include crackles (rales), wheezes, rhonchi, and pleural friction rubs. Note the intensity, pitch, and duration of these sounds.

Common Respiratory Conditions and Their Assessment

Understanding the presentation and assessment findings associated with common respiratory conditions is essential for accurate diagnosis and management:

1. Asthma: A chronic inflammatory disease of the airways, asthma presents with wheezing, shortness of breath, chest tightness, and coughing. On examination, listen for wheezes and assess for signs of respiratory distress.
2. Chronic Obstructive Pulmonary Disease (COPD): A progressive disease characterized by airflow limitation, COPD includes chronic bronchitis and emphysema. Symptoms include chronic cough, sputum production, and dyspnea. Physical examination findings may include decreased breath sounds, wheezes, and prolonged expiratory phase.
3. Pneumonia: An infection of the lung parenchyma, pneumonia presents with fever, cough, and dyspnea. On examination, look for signs of consolidation such as dullness to percussion, increased tactile fremitus, and bronchial breath sounds. Crackles may also be heard.
4. Pleural Effusion: The accumulation of fluid in the pleural space, pleural effusion presents with dyspnea and pleuritic chest pain. Examination findings include decreased or absent breath sounds, dullness to percussion, and decreased tactile fremitus over the affected area.
5. Pneumothorax: The presence of air in the pleural space, pneumothorax presents with sudden onset of dyspnea and pleuritic chest pain. Examination findings include decreased breath sounds, hyperresonance to percussion, and decreased tactile fremitus on the affected side.

Conclusion

The respiratory system assessment is a crucial component of patient care, helping to identify and manage respiratory conditions. By conducting a thorough and systematic examination, healthcare providers can accurately diagnose and treat respiratory conditions, improving patient outcomes and quality of life.