Chapter 29

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Chapter 29

Assessment of the Respiratory System

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Anatomy and Physiology Review

Upper respiratory tract Lower respiratory tract Lungs Accessory muscles of respiration Respiratory changes associated with aging

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Functions of the Respiratory System

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Respiratory Membrane

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Respiratory Mucosa

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Role of the Respiratory System

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Patient History Collect history of patient data on family, personal,

smoking, drug use, allergies, travel, place of residence, dietary history, occupational history, and socioeconomic level.

Pack-years of smoking—number of packs smoked per day multiplied by the number of years the patient has smoked.

Assess current health problems such as cough, sputum production, chest pain, and dyspnea.

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Patient History (Cont’d)

Drug use Allergies Travel and geographic area of residence Nutritional status Cough, sputum production, chest pain,

dyspnea, PND, orthopnea

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Physical Assessment

Assessment of the nose and sinuses

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Physical Assessment (Cont’d)

Assessment of the pharynx, trachea, and larynx

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Physical Assessment (Cont’d)

Assessment of the lungs and thorax

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Physical Assessment (Cont’d)

Assessment of the lungs and thorax

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Other Indicators of Respiratory Adequacy

Clubbing Weight loss Unevenly developed muscles Skin and mucous membrane changes General appearance Endurance

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Psychosocial Assessment

Some respiratory problems may be worsened by stress.

Chronic respiratory disease may cause changes in family roles, social isolation, and financial problems due to unemployment or disability.

Discuss coping mechanisms and offer access to support systems.

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Laboratory Tests

Blood tests Sputum tests Radiographic examinations including

standard chest x-rays, digital chest radiography, CT

Ventilation and perfusion scanning Pulse oximetry

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Pulmonary Function Testing

These tests evaluate lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation.

Patient preparation. Procedure for performing tests at the

bedside.

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Other Testing and Follow-Up Care

Exercise testing Skin testing

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Other Invasive Diagnostic Tests

Endoscopic examinations Thoracentesis—aspiration of pleural fluid

or air from the pleural space: Patient preparation for stinging sensation and

feeling of pressure Correct position Motionless patient Follow-up assessment for complications

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Thoracentesis

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Lung Biopsy

Performed to obtain tissue for histologic analysis, culture, or cytologic examination.

Patient preparation. May be performed in patient’s room.

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Lung Biopsy (Cont’d)

Follow-up care: Assess vital signs and breath sounds at least

every 4 hr for 24 hr. Assess for respiratory distress. Report reduced or absent breath sounds

immediately. Monitor for hemoptysis.