CHECKLIST 19: FOCUSED RESPIRATORY SYSTEM ASSESSMENT

Disclaimer: Always review and follow your hospital policy regarding this specific skill.

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.
Ensure patient’s privacy and dignity.
Assess ABCCS/suction/oxygen/safety.
Apply principles of asepsis and safety.
Check vital signs.
Complete necessary focused assessments.

RESPIRATION

This is the delivery of oxygen to the body and the elimination of carbon dioxide from the body. The normal range is between 12-20 bpm (beats per minute)

Below are some terms to remember about respiration:

Eupnea is normal respirations.
Tachypnea is an abnormally fast rate of breathing (more than 20 breaths per minute in adults).
Bradypnea is an abnormally slow rate of breathing (less than 12 breaths per minute in adults).
Orthopnea is shortness of breath that starts or get worse when the patient lies down. These patients normally sleep on more than one pillow.
Paroxysmal Nocturnal Dyspnea (PND) is shortness of breath that occurs once a patient has fallen asleep. The onset of PND is sudden.

INSPECTION

Inspection is a visual examination using the sense of sight. It is deliberate, purposeful, and systematic.

When inspecting the respiratory system you must look for:

Nasal flaring
Mouth vs nose breathing
Tracheal position
Signs of trauma to the respiratory system
Any use of accessory muscles
Configuration and symmetry of the chest
Respirations for rate (1 minute), depth, rhythm pattern
Colour of lips, face, hands, feet
O2 saturation with a pulse oximeter
Patients in respiratory distress may have an anxious expression, pursed lips, and/or nasal flaring.
Asymmetrical chest expansion may indicate conditions such as pneumothorax, rib fracture, severe pneumonia, or atelectasis.
With hypoxemia, cyanosis of the extremities or around the mouth may be noted.

These things can help healthcare professionals determine if a person is breathing well or in any respiratory distress.

AUSCULTATION

Auscultation is the process of listening to sounds produced within the body. This is mainly done by the assistance of a stethoscope to enhance these sounds.

For the respiratory system, the anterior and posterior of the lungs should be auscultated for breath sounds and adventitious sounds.

NB***

Auscultate anterior and posterior chest; White dots(numbers) indicate stethoscope placement for auscultation

Different breaths sounds may be heard when auscultating the lungs these are:

Normal Sounds:

Vesicular - Quiet low pitched with a longer inspiratory than expiratory phase. (Heard in most lung fields)

Bronchovesicular - Medium pitched with an equal inspiration and expiration phase.

Bronchial - Higher and louder than vesicular, the expiratory is longer than the inspiratory phase. This is usually heard around the 2nd and 3rd intercostal spaces anteriorly.

Tracheal - Loud and high pitched with an equal inspiratory and expiratory phase. Heard over the trachea.

Abnormal/Adventitious Sounds:

Fine crackles (rales) - may indicate asthma and chronic obstructive pulmonary disease (COPD).

Coarse crackles - may indicate pulmonary edema.

Wheezing - may indicate asthma, bronchitis, or emphysema.

Low-pitched wheezing (rhonchi) - may indicate pneumonia.

Pleural friction rub (creaking) - may indicate pleurisy.

NB***

Link to more in depth video showing complete breath sounds: https://www.youtube.com/watch?v=eWGxuwVk3gs

PALPATION

This is the use of touch to examine the body for any abnormalities. Finger-tips are used because of they are highly sensitive due to the high number of nerve endings.

When palpating you can determine: Texture, Pulsation, Temperature, Position, Size, Consistency and mobility of organs or masses. Palpation can also indicate discomfort or the presence of pain when pressure is applied.

With the respiratory system you should palpate:

Structures in the neck for any abnormalities
- The position of the trachea
- Subcutaneous emphysema
The Chest
- Palpate each side of the thorax individually to compare left and right

PERCUSSION

This is the tapping on the body using fingers to elicit sounds and determining whether the sound heard is appropriate for the organ being tapped. In the respiratory system percussion is used to help assess the underlying structures of the chest wall.

The usual sound is hollow or resonant

However, other sounds that can be heard are:

Tympanic sound: High pitched, heard if asthma or pneumothorax is present
Dull note: Medium in intensity and pitch. This is heard if atelectasis or consolidation is present
Flat note: Large pleural effusion

VIDEO SHOWING ASSESSMENT OF THE RESPIRATORY SYSTEM

Data source: Assessment Skill Checklists, 2014; Jarvis et al., 2014; Perry et al., 2014; Stephen et al., 2012; Wilson &

Giddens, 2013