This document outlines the assessment of the respiratory system. It discusses taking a patient history, including demographic data, current and past health issues, medications, and social history. A physical exam involves inspection, palpation, percussion and auscultation of the lungs, chest, and nose. Investigations and diagnostic tests include pulse oximetry, x-rays, CT scans, sputum cultures, and blood gases. The goal is to properly assess and diagnose any respiratory abnormalities or issues.

1. Assessment of respiratory system
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2. Learning outcomes
• At the end of this topic, student will be able
to:
• Perform assessment to the client with
respiratory problems
• Identify and report the abnormalities seen in
assessment.
• Identify the investigation and diagnostic
procedure performed to the client with
respiratory problems
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3. Topic contents
history
Physical examination
Investigation & diagnostic tests
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4. History
Biological and
demographic
data
Current health
Past health
history
Family health
history
Psychosocial
history
Review of
system
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5. 1. Biological and demographic data
Nama
Age
Gender
Living situations
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6. 2. Current health
• Clinical manifestations
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Non cardiac
chest pain
cough
Sputum
production
stridor
wheezing
hemoptysis Chest pain
sinuses

7. Noncardiac chest pain
• May associated with pulmonary, cardiac or
gastrointestinal problems.
• Determine the location, duration and intensity
of chest pain to provide early clues to the
cause.
• Pleuritic chest pain is commonly a
sharp,stabbing pain that occur at one site on
the chest wall and increase in chest wall
movement and deep breathing.
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8. Cont..
• Angina pectoris ( pain of the chest) is usually
described as an aching,heavy, squeezing
sensation with pressure or tightness in the
substernal area and radiate into the neck or
arm.
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9. Dyspnea
• ( Difficulty Breathing)- common manifestation
• Show as shortness of breath, suffocation,
tightness, being winded, being breathless
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10. cough
• Note when and how the cough began, how
long been present. Client may describe as:
Hacking,
dry,
hoarse,
congested,
barking,
wheezy
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11. Hemoptysis
• Refers to blood expectorated from the mouth.
• Causes of hemoptysis include chronic
bronchitis,bronchiectasis,pulmonary
tuberculosis,cystic fibrosis, upper airway
necrotizing granulomas, pulmonary embolism,
pneumonia, lung cancer and lung abscesses
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12. wheezing
• Sound produce when air
passes through partially
obstructed or narrowed
airway.
• May audible or may be heard
by stethoscope.
• Complain of chest tightness or
chest discomfort
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13. Stridor
• Name given to high-pitched sounds when air
passes through a partially obstructed or
narrowed airway.-
• Epiglottitis can cause stridor
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14. Nasal and sinus complaints
• May be allergy related and provoked by
pollen, fumes, smoke, animal dander or dust.
• A foul taste in mouth, unpleasant breath odor,
nasal obstruction and facial pain.
• Accompanied by headache.
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15. Symptoms analysis
• Onset
• Location
• Duration
• Characteristic/ client’s perception
• Aggravating and relieving factors
• Associated manifestations
• Timing
• Setting
• Severity
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16. Referred pain regions
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17. Past medical history
• Review client and family data related to the
upper and lower respiratory problem.
• Obtained data regarding common childhood
diseases and vaccinations
• Ask client about occurrence of
tuberculosis,bronchitis,influenza,asthma and
pneumonia
• Determine congenital problems such as cystic
fibrosis, premature birth history
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18. Surgical history
• Ask any history of surgical procedure that
pertains to upper and lower respiratory
system
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19. allergies
• Ask about history of allergies
• Ask about precipitating and aggravating
factors such foods, medications,
pollens,smoke,fume and dust.
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20. Medications
• Obtain information regarding medication that
they taken
• Many medication affect the respiratory
system.
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21. Dietary Habits
• Maintaining a nutritious diet is important for
clients with chronic respiratory disease.
• Chronic respiratory disease result in greater
workload for the lungs and increase caloric
expenditure and weight loss may occur.
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22. Social history
• Environment
• Work Environment
• Hobbies
• Occupations
• Nutrition
• Exercise
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23. Physical Examination
• Inspection
• Palpation
• Percussion
• Auscultation
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24. Inspection
• use of the naked eye. observes:
Nose-without flaring or discharge,nares
patent, mucosa pink and moist,sputum
midline
• Sinuses- Transilluminate
• Thorax- color,regular breathing,respirations
quiet. No retration, no use accessory muscle.
• Digits-clubbing absent,nail beds pink ,
immediate capillary refill on blanching
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Pigeon chestFunnel chest

26. Palpation
• Nose-nontender without masses
or lesions.
• Sinuses- nontender, no swelling
or bogginess
• Trechea- midline and mobile
without crepitus
• Thorax- chest wall symmetrical,
smooth, no
lumps,masses,tendernes,crepitus
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27. Percussion
• Resonant-low-pitched,hollow( healty lung
tissue)
• Tympany-high-pitched,hollow,drum-like(
stamoch)
• Flat-high-pitched,soft ( bone)
• Dull-medium-pitched( heart, liver)
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29. Auscultation
• Provides critical assessment data
• Compares the right side and left side
• Listen for fully respiratory cycle ( inspiration
and expiration)
• listen for breath sound
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30. Normal auscultation
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Bronchial
( tracheal)
Broncho
-vesicular
Vesicular
Pitch
High
moderate
low
Amplitude
Loud
moderate
soft
Duration
Inspiration
<Expiration
Inspiration=
expiration
Inspiration
>expiration
Quality
Harsh/hollow,
tubular
Mixed
Rustling like
sound of wind
in tree
Normal
location
Trechea/
Larynx
Over major
bronchi
where fewer
alveoli are
located,
Over
peripheral
lung fields
where air
flows through
smaller
bronchioles
and alveoli

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32. INVESTIGATION AND DIAGNOSTIC
TEST
• I. test to evaluate respiratory functions
• II. test to evaluate anatomic functions
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33. Noninvasive test
• Includes
• Pulse Oximetry
• Pulmonary function testing
• Chest X-Ray
• Ventilation- perfusion scan
• Computed Tomograpy ( CT Scan) And
Magnetic Resonance Imaging (MRI)
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34. Pulse Oximetry
• Passes a beam of light through the tissue.
• A sensor attached to the finger tip,toe or ear
lobe measure the amount of light absorbed by
the oxygen-saturated hemoglobin.
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35. Pulmonary function test
• Can measure respiratory volumes and
capacities
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36. Chest X-Ray
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• Provide information about the chest,be able
to illustrate graphically the cause of
respiratory dysfunction

37. Ventilation-perfusion scan
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• Used to assess lung ventilation and lung
perfusion
• Used to confirm pulmonary
embolism,pulmonary
infarction,emphysema,fibrosis and
bronchiectasis

38. Ventilation-perfusion scan
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39. Computed Tomograpy And Magnetic
Resonance Imaging
• Provide more sophisticated tomography
• CT scan helpful in identifying peripheral (
pleural) or mediastinal disorders.
• Special tecniques can be used
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41. Invasive tests
• Includes
• Laryngoscopy
• Bronchoscopy
• Thoracentesis and pleural fluid analysis
• biopsy
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42. laryngoscopy
• Visual examination of the larynx
• Used to diagnosis laryngeal papilomas,
nodules, polyps or cancer
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43. Bronchoscopy
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• For diagnostic and therapeutic uses.
• It permits visualization of the larynx,trachea
and bronchi.
• To detect tumor,inflammation,strictures.
• Obtain tissue biopsies

44. Bronchoscopes
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45. Thoracentesis and pleural fluid
analysis
• Involves insertion of a needle into the pleural
space for removal of pleural fluid or air
• Therapeutically relieve pain or shortness of
breath caused by pleural pressure.
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47. Biopsy
• Requires a surgical excision of tissue.
• Examined for abnormal cellular structure (
cancer cell) or infection.
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49. Laboratory tests
• Includes
• Sputum culture
• Nose and throat cultures
• Arterial blood gases (ABGs)
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50. Sputum culture
• Infectious process lead to excessive
production of mucus ( sputum)
• Should be collected before antimicrobial
treatment begun
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51. Nose and throat cultures
• Used sterile cotton swab
• Use to identify certain
pathogens such as
streptococcus, bordetella
pertusis,corynebacterium
diphtheria act..
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52. Arterial blood gases ( ABGs)
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• Involves the use of arterial rather than venous
• Blood to measure PaO2,(partial pressure of
oxygen in the blood) PaCO2 (partial pressure of
corbon dioxide in the blood). and PH
• Also calculated bicarbonate concentration (
HCO3) and SPO2

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54. Conclusion
• The nurse involvement in a general respiratory
assessment includes a variety of interventions.
The nurse must obtain specific history data,
including information about smoking history
and other environmental hazards. The physical
examination includes the assessment
techniques of inspection, palpation,
percussion, and auscultation
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55. Thank you
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