Chapter objectives: At the end of this chapter, the learner will:
Chapter objectives: At the end of this chapter, the learner will:
- Conduct a health history pertaining to the respiratory system.
- Identify anatomic landmarks in identifying underlying structures and the location of physical findings.
- Inspect the thorax for pattern of respiration, skin, symmetry, and use of accessory muscles.
- Auscultate the anterior and posterior thorax for normal breath sounds and adventitious sounds.
- Describe the findings using correct terminology.
- Document the findings of the respiratory exam.
I. Overview of the Respiratory System
The assessment of the respiratory system includes assessing the thorax, lungs, ventilatory function and oxygenation of the body. Focused assessment techniques will be applied intensively in this system: inspect level of consciousness, agitation, skin color, clubbing fingers, shortness of breath, use of accessory muscles, position and alignment of the spine ; auscultate breathing sounds; palpate position of the trachea, subcutaneous emphysema; percuss to assess the underlying structure of the chest.
II. Anatomy and Physiology
Identifying thoracic landmarks is essential to the systematic examination of the respiratory system. Click the link below to review anatomy and physiology of the respiratory system. You will need to apply your knowledge in the assessment process.
III. Medical Terminology
Important terms to know and understand:
| Adventitious sounds | abnormal breath sounds |
| Atelectasis | incomplete expansion or collapse of a part of the lungs |
| Bradypnea | slow rate of breathing |
| Cheyen-Stokes Respirations | gradual increase and then gradual decrease in depth of respiration followed a period of apnea |
| Crackles | crackling sounds made as air moves through wet secretions in the lungs |
| Crepitus | a grating sound or sensation under the skin around the lungs, or in the joints |
| Cyanosis | bluish coloring of the skin |
| Dyspnea | difficult or labored breathing |
| Hemoptysis | sputum containing blood |
| Hyperventilation | condition in which there is more than the normal amount of air entering and leaving lungs |
| Hypoventilation | decreased rate or depth of air movement into the lungs |
| Hypoxia | inadequate amount of oxygen available to the cells |
| Nasal Flaring | nostrils widen while breathing indicates difficulty in breathing |
| Pneumothorax | air in the pleural space |
| Stridor | harsh, high-pitched sound usually heard on inspiration when upper airway become narrowed |
| Tachypnea | rapid rate of breathing |
| Wheezes | high-pitched, musical noise that sounds like a squeak |
IV. Step by Step Assessment
Safety considerations:
- Perform hand hygiene.
- Check room for contact precautions.
- Introduce yourself to patient.
- Confirm patient ID using two patient identifiers (e.g., name and date of birth).
- Explain process to patient.
- Be organized and systematic in your assessment.
- Use appropriate listening and questioning skills.
- Listen and attend to patient cues.