Learning Objectives

• At the end of respiratory system assessment section, the

learner should be able to:
1- Apply knowledge of anatomy and physiology in conducting
physical examination related to respiratory system assessment.
2- Understand the different techniques employed in the physical
examination of respiratory system.
3- Differentiate between normal and abnormal respiratory system
conditions.
4- Document the respiratory system assessment findings
following designated format
 OUTLINE
Review of Respiratory System •
Obtaining Health History •
Assessment •
 Respiratory system
The respiratory system
Aim: deliver O2 to the bloodstream and
remove excess CO2 from the body.
 Mechanism of breathing
• At rest:
No air movement
 At Inhalation:
The diaphragm descend
Negative alveaolar pressure
Air moves into the lung
 At exhalation:
The diaphragm ascend
Positive alveaolar pressure
Air moves out of the lung
 health history .1
Chief complain
•Cough
•Sputum
•Chest pain
•Hemoptysis
•Dyspnea
•Wheeze
 Cough
• Cough is the most common symptom of
respiratory tract disease.
• Cough ( tussis) is a rapid expulsion of air from the
lungs, typically in order to clear the lung airways
of fluids, mucus, or other material.
• Productive or nonproductive i.e. with or without
sputum?
 Sputum
• Amount:
• Color:
Clear and white (excess normal mucus)
Yellow or green (infection)
Blood - stained sputum (hemoptysis)
• Consistency: watery or sticky
 Hemoptysis
• Hemoptysis: coughing up of blood or blood
stained sputum.
• Haematemesis: vomiting of blood
 Dyspnea
• difficult breathing or SOB
• orthopnea - SOB when lying down or/ supine
position
• This is commonly associated with compromised
cardiac function.
 Wheeze
• A whistling sound caused by bronchial
narrowing
• When does wheezing occur?
• Do you wheeze loudly enough for
others to hear it?
• What helps stop your wheezing?
 Past history
• Tuberculosis
• Allergy
• Surgery
 Family history
• Infection,
• TB,
• allergy,
• cancer,
• bronchial asthma
 Smoking
Ask also about
•age of starting,
•the type,
•number of cigarettes smoked currently
and in the past,
•passive smoking
 Assessment
C – chest wall
R – respiratory rate and pattern
A – Accessory muscle use
M – masses / scars
P – Paradoxical movement
 Chest- wall
abnormalities
• May be congenital or acquired
• May easily develop respiratory failure from a
respiratory tract infection
 Chest- wall abnormalities
1. Barrel chest:
• chest is round and bulging
2. Pigeon chest
protrusion of the sternum and ribs
 Chest- wall abnormalities
3. Funnel chest (pectus excavatum)
•depression of the lower part of the
sternum.
4. Thoracic kyphoscoliosis
•backward and lateral curvature of
the spinal column
 Respiratory Rate and
Pattern
Adults: 12 – 20 breaths / min
Infant : 12 – 40 b/min
Eupnea : quiet, rhythmic, and
effortless (12-18 breath / min)
Respiratory Pattern :
•Even
•Coordinated
•Regular
 Abnormal Respiratory Patterns
: Tachypnea
Rapid , shallow
.breath\minute 24 >

Bradypnea: (< 10breath\minute)

Hyperpnea :
•increased depth of breathing
•normal RR
Apnea – absence of breathing

Hypoventilation: Shallow & decrease

RR

Kussmaul respiration:
Rapid, deep breathing without pause
Cheyne-stokes respiration:
•breaths that gradually become faster
and deeper than normal , then slower,
and alternate periods of apnea
 Normal Breath sounds
A. Bronchial sounds - Heard over large airways •
B. Bronchiovesicular sounds - Heard upper intrascapular areas

.C. Vesicular sounds - Heard over peripheral lung fields

 Adventitious sounds
• Abnormal breath sounds
• Crackles
• Wheezes
• Rhonchi
• Stridor
• Pleural Friction rub
 DEFINITION CAUSE
Crackles/ Abnormal clicking, fluid Congestion of the
Crepitations / crackling or rattling lungs
Rales sound
 DEFINITION CAUSE
Wheezes whistling sound Constriction of bronchi
airways

Rhonchi snoring, gurgling, or rattle Secretions in the

soundlike quality bronchial airways

Stridor Loud, high pitch crowing Upper airway

sound obstruction

Friction rub rubbing sound heard on Pleural inflammation

inspiration and expiration
 Accessory Muscle use
• may indicate a respiratory problem and oxygen
hunger
 Paradoxical movement
• Abnormal collapse of
part of the chest wall
when the patient
inhales or
• Abnormal expansion
when exhales.
• Paradoxical chest
movement may
indicate a fractured
rib.
 Inspecting Related Structure
Skin color and nail beds

Cyanosis (bluish color) of the skin, nail beds, and

mucous membranes
1.Central
2.peripheral
Cyanosis
 Clubbing of fingers
• sign of long term hypoxia.
• angle is greater than or equal to 180 degrees.
CAUSES:
• Chest disease
• Heart diseases
• Gastrointestinal diseases:
• Familial clubbing
Clubbing of fingers