ASSESSMENT

PRESENTATION ON
RESPIRATORY SYSTEM
PRESENTED BY
BHAGYASHREE
MSC 1ST YR STUDENT

INTRODUCTION

Nurses who care for clients experiencing

respiratory disorder perform and interpret a
variety of assessment procedure .it discuss
history and physical assessment as well as
the diagnostic procedure used to plan care
of clients with respiratory disorders.

HISTORY TAKING
Biographical data
Current health
Chief complaint ,
clinical manifestations like
chest pain , dyspnea , cough, hemoptysis ,
sneezing , stidor, and complaint related to
nose and sinus. Note onset , duration ,
characteristics , severity of problem.

Clinical manifestation

Past medical history

Review the past health history of the client

and family members for data related to
upper and lower respiratory systems ,
which are common source of both acute and
chronic health problems. Assess client with
chronic conditions . for changes in their
ongoing respiratory manifestation , as these
changes provide clues to cause of the new
problems

Continue..

In addition to obtaining the data regarding

common diseases and vaccinations, ask the
client about the occurrence of tuberculosis ,
bronchitis , influenza , asthama and
pneumonia , and the frequency of lower
respiratory tract infections , after upper
respiratory tract infections. Determine the
existence of congenital problems , such as
cystic fibrosis , and premature birth history .
which can be associated with respiratory
complications in the adult client

Surgical history

Discuss the client history of any procedure

or surgery that pertains to the upper or
lower respiratory system , such as biopsies ,
or procedures to directly visualize the
structure.

Allergies

Question the client about the history of any

allergies and timing of manifestations to
help identify a possible allergic basis for the
condition . has the client been tested for
allergies ? when? Are medications
( including allergy shots ) taken
prophilactically or on as needed basis to
provide relief from manifestations

medications

Obtain detailed information regarding both

prescribed and over the counter
medications , including herbal and remedies
, because many products affect the
respiratory system the client may routinely
require antibiotics , bronchodilators , or
steroid for respiratory tract infection.

Dietary habits

Maintaining a nutritious diet is important for

clients with chronic respiratiory disease
which can result in decrease in lung
capacity and greater workload for the lungs
and cardiovascular system . the added
workload increases calorie , expenditure
and weight loss may occur

Social history

Respiratory status is affected by numerous factors

that may lead to acute problems or that may
affect the clients coping with chronic respiratory
problems . identify any environmental agent that
might be contributing to the clients condition .
ask specifically about the work environment and
hobbies , focus on exposure to dust , asbestos ,
beryllium , silica, and other toxins , or pollutants ,
farmer are exposed to airborne particles , such as
grain , dust , fertilizer , and animal dander .
hobbies may involve chemicals , dust , airborne
particles from grinding , soldering , or welding .

Family health history

Question the client about the family history

of respiratory diseases. Identify blood
relatives (in regard to genetically
transmitted diseases. ) and family members
(in regard to infectious conditions) who had
have asthma, cystic fibrosis , emphysema,
chronic obstructive pulmonary disease ,
(COPD), lung cancer , respiratory tract
infection , tuberculosis or allergies, list the
age and cause of death of each decreased
family member

PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

Hypoxia is a result of respiratory conditions

may precipitate subtle neurologic
alterations such as restlessness , fatigue ,
disorientation, and personality changes
.tachycardia usually accompanies
respiratory problems as the body attempts
to compensate for decreased oxygen
delivery . anorexia and weight loss are seen
in Many chronic respiratory conditions.

General assessment

Assess the client level of consciousnesss

and orientation note the skin and lip colour .
assess the nail colour , nail beds , and
presence of cubbing ,which occurs as
compensatory measure for chronic
hypoxia. The shamroth technique is useful
assessment for the presence of clubbing.

Nose and paranasal sinuses

External nose
Inspect and palpate the external nose for
deviations, from normal alignment , symmetry ,
colour, discharge , nasal flaring , lesions,, and
tenderness . the client should able to breath
quietly through the nose rather than breath through
mouth . check the nasal canals for petency by
asking the clients to occlude one naris with a finger
and breath through the open naris while closing the
mouth. Ask the client to tip the head back, and
inspect the outer nares, for crusting , bleeding , or
dryness , which should be absent.

Internal nose

Next inspect the vestibules with the

penlight while the clients head is tipped
back , normal findings include coarse hairs,
dark red nasal mucosa , clear passage
without discharge , and midline septum ,
further examination of the internal nose
requires the use of nasal speculum and is
not conducted unless indicated . inspection
may be hampered by nasal

Paranasal sinuses

Palpate and percuss the frontal and

maxillary sinuses to assess for swelling and
tenderness , which are normally absent .
palpate the frontal sinuses simultaneously
placing the thumbs above the eyes just
under the ridge of the eyes orbits , and
apply gentle pressure and palpate the
maxillary sinuses by using side of nose just
under the zygomatic bones, direct
percussion over the eyebrows .

Smell

The senses of taste and smell are closely related

smell is perceived mainly via the olfactory
nerves ,although the trigeminal nerves many
conditions can affect taste and smell , such as
viral infections , normal ageing , head injuries,
and local obstructions .smell impairement may
be 1. Hyposmia(a decrease in smell sensitivity )
or 2. Anosmia( bilateral and complete absence
of smell sensitivity ). Assess smell by having the
client identify various odours by testing each
nostrils separately.

Thorax and lungs

Inspection
Palpation
Percussion
Auscultation

Characteristics of normal
breath sound
pitch

amplitude

duration

quality

Normal location

Bronchial (tracheal)

High

Loud

moderate

Moderate

Harsh
,hollow,tabular
mixed

Trachea and larynx

Bronchovesicular

Inspiration
< expiration
Inspiration =
expiration

vesicular

low

Soft

Inspiration>expirati
on

Rustling ,like sound Over peripheral

of wind in trees.
lung fields where
air follows through
smaller bronchioles
andalveoli.

Over major bronchi

where fewer
alveoli are located
posterior, between
scapulae,especially
on
right,anterior,aroun
d upper sternum in
first and
secondintercostal
spaces.

DIAGNOSTIC TESTING
Noninvasive tests

Diagnostic procedure facilitate the

assessment and diagnosis of client
trespiratory disorders . commonly available
diagnostic tests include pulmonary function
tests , arterial blood gas analysis , pulse
oximetry , ventilation perfusion scan ,x-ray
and sputum cultures .

Pulse oximetry

The pulse oxymeter passes a beam of light

through the tissue , and a sensor attached to
the finger tip , toe , or ear lobe measures ,
the amount of light absorbed by the oxygen ,
saturated haemoglobin . the oximeter then
gives a reading of percentage of
haemoglobin that is saturated with oxygen
(sao2) sao2 is closely correlated with the
saturations obtained from the pulse
oximeter it is greater than 70% .

Pulmonary function testing

Pulmonary function tests provide information about

respiratory fiunction by measuring lung volumes,
lung mechanics, and diffusion capabilities, of the
lungs, its performed in pulmonary function laboratory
can measure respiratory volumes, capacities . its
done outside the laboratory are modified to include
ventilation tests of forced expiratory volume , vital
capacity , and maximal voluntary ventilation
measures refers to the table pulmonary function test
(PFT) recording and results that indicate obstructive
and restrictive lung disease .

Comparing oxygen saturation to partial pressure of arterial

oxygen

Oxygen
saturatio
n(%)

Pao2(mm
Hg)

Clients
status

50

25

life
threatenin
g
hypoxemi
a

75

40

Moderate
hypoxemi
a

90

55

Mild
hypoxemi
a

Non invasive
Chest x ray
Ventilation perfusion scan
magnetic resonance imagning

Invasive test

Laboratory test
Sputum culture
An infectious process can lead to excessive
production of mucus commonly called
sputum assessment of sputum by bacteria ,
fungi, or cellular elements guides the
treatment of the underlying infections . if
possible sputum should be collected before
antimicrobial treatment is begun.

Nose and throat culture

The throat and nose normally contains

many organisms using a flexible sterile
cotton swab , cultures , of these areas are
taken to identify certain pathogens such as
streptococcus species , bordetella pertusis ,
cornybacterium diphtheria , haemophillus
influenza , or respiratory syncytial virus
(RSV) bacteria in the nose and throat can be
identified by culture during assessment of
the upper airway .

Arterial blood gases

The ABG analysis involves the use of arterial

rather than venous , blood to measure pao 2,
paco2 and PH directly. Bicarbonate
concentration (HCO3) and sao2 are calculated
as well . pao2 reflects the efficiency of gas
exchange , whereas paco2 reflects the
effectiveness of alveolar ventilation . the
acid base status of the body is indicated by
the PH of arterial blood . ABG analysis is
helpful in the assessment of the clients. Who

conclusion

summary

RECENT STUDIES

Respiratory function assessment

Abstract
Purpose of review- published research on neuromascular
respiratory failure has increased rapidly over the past
decade . progress in the management of respiratory
complications and preventive care have improved
outcomes and quality of life for many .in particular non
invasive positive pressure ventilation (NIPPV) is effective
in resolving respiratory failure , with a focus on non
duchenne muscular dystrophy investigating the impact
NIPPV has when it is introduced before diurnal respiratory
failure develops and evaluating a device to treat
insufficient cough the mechanical insufflators exsufflator .

Con..
Recent findings
Studies in children with congenital muscular dystrophies
and spinal mascular atrophies detected a high
prevalence of respiratory complications and confirmred
that respiratory failure can be predicted by
measurement of vital capacity . NIPPV is an established
Treatment that is effective in the long term management
of end stage diurnal respiratory failure additionally
recent studies showed improvement in symptoms ,
quality of life and prevention of respiratory complications
when it is introduced for nocturnal hypoventilation before
the development of diurnal respiratory failure .

BIBLIOGRAPHY

Joyce and Black Jane Hokanson, Hawks,

medical surgical nursing , clinical
management of positive outcomes ,8th edition
, volume 1 , New Delhi, Elsevier, 2012, page
no. 1526-1538.
Lewis, chintamani,textbook of medical surgical
nursing ,assessment and management of
clinical problems ,New Delhi ,india,
Elsevier,2011 pageno.506.
greekymedicas .com/respiratory history
www.rnceus.com/resp/resphx.html

THANK

TOU