Assessment of respiratory system

able to:
Revise knowledge of anatomy and physiology
Obtain health history

about respiratory system
Demonstrate physical examination
Differentiate between normal and abnormal findings

Position/Lighting/Draping
2 Inspection
2.1 Chest wall deformities
2.2 Signs of

respiratory distress
3 Palpation
4 Percussion
5 Ausculation
5.1 Vocal fremitus (not usually done)

to the alveoli and includes not only the air-conducting passages

also but the blood supply
The primary purpose of the respiratory system is gas exchange, which involves the transfer of oxygen and carbon dioxide between the atmosphere and the blood.
The respiratory system is divided into two parts: the upper respiratory tract and the
lower respiratory tract

upper respiratory tract includes

alveoli
With the exception of the right and left main-stem

bronchi, all lower airway structures are contained within the lungs.

and lower)
the left lung into two lobes (upper

and lower)
The structures of the chest wall
(ribs, pleura, muscles of respiration) are also essential

lungs) and expiration (movement of air out of the
lungs). Air

moves in and out of the lungs because intrathoracic
pressure changes in relation to pressure at the airway opening.
Contraction of the diaphragm and intercostal and scalene muscles
increases chest dimensions, thereby decreasing intrathoracic
pressure. Gas flows from an area of higher pressure (atmospheric)
to one of lower pressure (intrathoracic)

posterior, (c) right lateral and (d) left lateral.
(UL, upper lobe;

ML, middle lobe; LL, lower lobe).

Ul
ml

a

b

ll

ul

ll

ul

ll

ml

The patient's hands should remain at their sides.
When the

back is examined the patient is usually asked to move their arms forward (hug themself position) so that the scapulae are not in the way of examining the upper lung fields.
Lighting - adjusted so that it is ideal.
Draping - the chest should be fully exposed. Exposure time should be minimized.

mnemonic IPPA:
Inspection
Palpation
Percussion
Auscultation

ppd X # years
exposure to smoke
history of attempts

to quit, methods, results
sedentary lifestyle, immobilization
age
environmental exposure
Dust, chemicals, asbestos, air pollution
obesity
family history

Pattern
activities, time of day, weather
Severity
effect on ADLs
Wheezing
Associated

symptoms
Treatment and effectiveness

production

other systems
Family Health History
Tuberculosis
Emphysema
Lung Cancer
Allergies
Asthma

Past Health History

- curvature of the spine - anterior-posterior
Scoliosis - curvature

of the spine - lateral
Barrel chest - chest wall increased anterior-posterior; normal in children; typical of hyperinflation seen in COPD
Pectus excavatum
Pectus carinatum

- seen in COPD (used to increase end expiratory pressure)

Accessory muscle use (scalene muscles)
Diaphragmatic paradox - the diaphragm moves opposite of the normal direction on inspiration; suspect flail segment in trauma
Intercostal indrawing

breathing
.

‘blue bloater’
showing ascites
from marked cor
pulmonale.

palms against the upper portion of the anterior chest, making

sure that the fingers do not touch the chest. Ask the patient to repeat the phrase “ninety-nine” or another resonant phrase while you systematically move your palms over the chest from the central airways to each lung’s periphery.You should feel vibration of equally intensity on both sides of the chest. Examine the posterior thorax in a similar manner. The fremitus should be felt more strongly in the upper chest with little or no fremitus being felt in the lower chest

of the clavicles for disease in the lung apices


Percussion over

the anterior chest.

and out slowly and deeply through the mouth.
Begin at

the apex of each lung and zigzag downward between intercostal spaces . Listen with the diaphragm portion of the stethoscope.

(2nd-4th intercostal spaces either side of the sternum anteriorly and

3rd-6th intercostal spaces along the vertebrae posteriorly). The sounds are described as tubular and harsh. Also known as tracheal breath sounds.
Bronchovesicular: Heard over the major bronchi below the clavicles in the upper of the chest anteriorly. Bronchovesicular sounds heard over the peripheral lung denote pathology. The sounds are described as medium-pitched and continuous throughout inspiration and expiration.
Vesicular: Heard over the peripheral lung. Described as soft and low- pitched. Best heard on inspiration.
Diminished: Heard with shallow breathing; normal in obese patients with excessive adipose tissue and during pregnancy. Can also indicate an obstructed airway, partial or total lung collapse, or chronic lung disease.

a normal voice.
Palpate using the ball of your hand.

You should feel the vibrations transmitted through the airways to the lung.
Increased tactile fremitus suggests consolidation of the underlying lung tissues