If I had to choose one focused assessment I’ve done more than any other, it would be respiratory (followed very closely by neurological assessments, which you can review here. Working in the MICU, so many of my patients were admitted with respiratory disorders. And now, working in the PACU, I am allllll about that airway. Show
In this article you’ll learn the basics of what goes into a respiratory assessment. Before you dive in, you might want to review Oxygenation Concepts for Nursing Students first. Ok, ready? Let’s do this! Listen to the below information on conducting a respiratory assessment in episode 237 of the Straight A Nursing podcast wherever you get your podcasts or straight from the website here. A general respiratory assessment is going to be heavily reliant on what you see and hear. Your assessment will also be guided by any underlying respiratory disorders and what is currently going on with the patient’s physiology and plan of care. For example, a patient with a chest tube will have assessments specific to that, and a patient with asthma is going to be assessed differently than a patient with congestive heart failure. So let’s go through a basic adult respiratory assessment step-by-step. Want to learn more about pediatric respiratory assessment? Here you go! Respiratory Assessment – ObservationThe first thing I do when I assess my patient’s respiratory status is observe. This lets you know immediately if the patient is having trouble so you can quickly intervene.
Respiratory Assessment – AuscultationThe next step in the respiratory assessment is to listen.
Assessment of voice soundsAnother way to assess pulmonary status is by listening to voice sounds. In healthy lungs, the organs are filled with air which does not transmit sound effectively. So, if you listen to your patient’s lungs and have them speak, it should be muffled. But when a substance is present that transmits sound more effectively (such as fluid or a solid mass), you’ll be able to hear the words more clearly. We assess for three types of voice sounds:
Assessing with palpationThe two key assessments you’ll conduct with your hands are for tactile fremitus and crepitus. Tactile fremitus (also called vocal fremitus) is pronounced vibration over areas of lung consolidation and diminished vibration in cases of hyperinflation or when fluid is present. To assess for tactile fremitus, place either your palms or ulnar sides of the hands on the posterior chest and ask the patient to say “ninety-nine” or “one-two-three.” Move the hands to the areas where you would normally place your stethoscope and compare the amount of vibration you feel from side-to-side. PROTIP: Ask the patient to cross his arms in front of his chest to displace the scapula for easier palpation. To assess for crepitus (also known as subcutaneous emphysema), you’ll simply palpate the chest wall. Crepitus feels like bubble wrap under the skin and is caused by air getting into the subcutaneous tissue. It’s common with chest tubes, chest trauma, pneumothorax, mechanical ventilation (barotrauma), pulmonary blebs, and tears in the airway. A key part of your chest tube assessment will be to determine if crepitus is present and if it is worsening or resolving. Something you’ll learn in the skills lab is to assess for symmetrical chest expansion by using your hands. Place your hands around the chest wall with thumbs at T9 or T10 and ask the patient to take a deep breath. Your hands should move symmetrically. What questions to ask the patientWhile the questions you ask your patient will be guided by their unique symptoms or disease pathology, some key questions to ask are:
I hope this helps you conduct a basic respiratory assessment. Please note that detailed assessments can vary based on each unique situation so always use your best judgment and clinical resources as guides. Want to learn more about the respiratory system? These articles should help! ____________________________________________________________ The information, including but not limited to, audio, video, text, and graphics contained on this website are for educational purposes only. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare provider’s scope of practice or any nursing school curriculum. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment. References: Abdallah, C. (2012). Acute epiglottitis: Trends, diagnosis and management. Saudi Journal of Anaesthesia, 6(3), 279–281. https://doi.org/10.4103/1658-354X.101222 American Nurse. (2011, January 11). Color awareness: A must for patient assessment. American Nurse. https://www.myamericannurse.com/color-awareness-a-must-for-patient-assessment/ Burcovschii, S., & Aboeed, A. (2022). Nail Clubbing. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK539713/ Kim, K., Byun, M., Lee, W., Cynn, H., Kwon, O., & Yi, C. (2012). Effects of breathing maneuver and sitting posture on muscle activity in inspiratory accessory muscles in patients with chronic obstructive pulmonary disease. Multidisciplinary Respiratory Medicine, 7(1), 9. https://doi.org/10.1186/2049-6958-7-9 Lippincott Nursing Center. (n.d.). Egophony, Bronchophony, and Whispered Pectoriloquy—Say What? https://nursingcenter.com/ncblog/january-2022/egophony-bronchophony,and-whispered-pectoriloquy Mauldin, A. (n.d.). Crepitus: What Is It, Causes, How It’s Assessed, and More | Osmosis. https://www.osmosis.org/answers/crepitus McGee, S. (n.d.). Accessory Muscle—An overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/accessory-muscle Modi, P., & Tolat, S. (2022). Vocal Fremitus. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK499838/ Mukerji, V. (1990). Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. In H. K. Walker, W. D. Hall, & J. W. Hurst (Eds.), Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.). Butterworths. http://www.ncbi.nlm.nih.gov/books/NBK213/ Physiopedia. (n.d.). Auscultation—Physiopedia. Retrieved June 27, 2022, from https://www.physio-pedia.com/Auscultation RNCEUS. (n.d.). Glossary. https://www.rnceus.com/resp/respgloss.html Sarkar, M., Mahesh, D. M., & Madabhavi, I. (2012). Digital clubbing. Lung India : Official Organ of Indian Chest Society, 29(4), 354–362. https://doi.org/10.4103/0970-2113.102824 Wilke, M. (n.d.). What is that morning cough all about? | Health24. Retrieved June 27, 2022, from https://www.news24.com/health24/medical/cough/news/what-is-that-morning-cough-all-about-20190602-2 Wisconsin Technical College System. (n.d.). 10.3 Respiratory Assessment – Nursing Skills. https://wtcs.pressbooks.pub/nursingskills/chapter/10-3-respiratory-assessment/ Zimlich, R. (2021, July 8). Rales vs Rhonchi: The Difference In These Lung Sounds. Healthline. https://www.healthline.com/health/rales-vs-rhonchi Which condition would the nurse associate with decreased breath sounds?Absent or decreased sounds can mean: Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion) Increased thickness of the chest wall. Over-inflation of a part of the lungs (emphysema can cause this)
Which process causes Hypoxemic respiratory failure?Type 1 respiratory failure occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia, and can be caused by alveolar hypoventilation, low atmospheric pressure/fraction of inspired oxygen, diffusion defect, ventilation/perfusion mismatch, and right-to-left shunt.
Which condition is an example of an indirect lung injury that increases the risk for developing ARDS?Conditions that cause indirect lung injury include: Sepsis (the body's overreaction to an infection that can damage multiple organ systems, including the lungs) Severe trauma to the body (head trauma, burns, multiple bone fractures) Massive blood transfusion.
Which diagnosis does the nurse expect based on the following respiratory assessment findings?Which diagnosis does the nurse expect based on the following respiratory assessment findings? These assessment findings indicate COPD. With pneumonia, pleural effusion, and pulmonary edema, percussion would be dull over the affected areas, not hyperresonant.
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