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NR 302 Week 6-Edapt-Respiratory
Health Assessment I (NR-302)
Chamberlain University
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NR 302-Edapt Week 6
Respiratory System
Introduction to Respiratory System The lungs are the most vulnerable internal organ. They have constant exposure to particles, chemicals, and infectious agents (Forum of International Respiratory Societies, 2021). The five most common causes of severe illness and death are respiratory diseases. Education, training, and increased awareness can reduce the burden respiratory diseases have across the world. Abnormal Breath Sounds Sibilant Rhonchi, a high-pitched, squeaky wheeze produced by narrowed airways. Fine crackles, course crackles, and sonorous rhonchi are caused by fluid in the airways. Fremitus is a vibration felt through the chest wall. An ulceration is an open wound, and a cyst is a fluid-filled pocket under the skin. Crepitus the feel of crackling, little pockets of air. Breath Sounds Bronchovesicular breath sounds are heard in the sternal area anteriorly and the mid–scapula area posteriorly. Vesicular sounds are heard over the peripheral lung fields, including the left lower lobe, and bronchial sounds are heard over the trachea. Lung Lobes
The examiner places the stethoscope along the anterior axillary line at the 5th intercostal space to hear the crackles. Lifestyle
Occupation
Respiratory illnesses and diseases account for a large portion of all occupational disease related deaths. These include “allergies, asthma, influenza, pneumoconioses, tuberculosis, obliterative bronchiolitis, chronic obstructive pulmonary disease (COPD), silicosis, and mesothelioma” (NIOSH, 2017). Hobbies
There are hobbies that expose people to paints, glues, dust, and chemical agents through inhalation. Exposures to these materials can irritate the lungs. Pets
Pet dander, microscopic pieces of skin shed by animals with fur or feathers, can cause reactions in people who are allergic to these triggers. Bird Fancier’s Lung, a type of hypersensitivity pneumonitis, can be caused by breathing in particles from birds or bird droppings. Smoking or Illicit Drug Use
Smoking is the primary cause of lung cancer and contributes to 80-90% of lung cancer deaths (American Lung Association, 2020). If exposed to second-hand smoke, non-smokers have a 20-30% greater chance of developing lung cancer (American Lung Association, 2020). Damage to the lungs can be caused by inhaling various illicit drugs or by aspiration during unconsciousness. Vaping can also cause significant lung damage. Exercise
Regular exercise can increase the strength and function of the lungs. Lifestyle Choices and Respiratory Health Occupation, Smoking, And Exercise; these are lifestyle choices that impact respiratory health. Preparing to Assess the Respiratory System
Respiratory Assessment: Inspection Normal Abnormal Respiratory Rhythm Regular with equal pauses between breaths
Uneven, irregular pauses or breaths
Respiratory Rate 12-20 breaths per minute
<12 or >
Respiratory Depth It may vary by clients.
Deep or shallow at a rapid or slow rate Respiratory Effort Effortless; no accessory muscle use
Labored; visible accessory muscle use; nasal flaring
Posture Relaxed Tripod position: sitting, leaning forward with arms braced against knees, chair, or bed Chest movement Symmetrical Asymmetrical Shape and configuration of the chest wall
Symmetrical Asymmetrical; may be due to skeletal deformities
Chest Diameter Anteroposterior diameter less than transverse
Anteroposterior diameter greater than or equal to transverse
Skin color Consistent with their normal tone
Cyanosis (blue tone) or pallor (pale tone) Respiratory Assessment: Palpation Expansion
By placing your hands on the posterior lateral chest, you can feel the rise and fall of the rib cage when the client takes a deep breath. This should be symmetrical, and the client should not feel pain during chest expansion. Fremitus
Fremitus are vibrations felt through the chest wall. To assess for fremitus, ask the client to say “99” or “blue moon” and palpate the posterior chest from one side to the other. Vibrations should be symmetrical.
Crepitus/Discomfort
Palpating the anterior and posterior chest allows you to note any areas of skin concerns, discomfort, or abnormal sensations such as crepitus. Crepitus is a crackling sensation under the skin caused by pockets of air. Normal Respiratory Sounds Bronchovesicular Breath Sounds Breath sounds that are medium in loudness and pitch where inspiration equals expiration and are heard next to the sternum, between the scapulae, on the anterior thorax and posterior thorax Bronchial Breath Sounds Loud, high-pitched breath sounds with the inspiration shorter than expiration that are heard just above the clavicles on each side of the sternum, between the scapulae, and over the manubrium on the anterior thorax. Bronchial breath sounds may be called tracheal breath sounds Vesicular Breath Sounds Soft, low-pitched breath sounds where the inspiration is longer than the expiration and that are heard in all other areas of the lungs Respiratory Assessment: Auscultation When you auscultate the respiratory sounds, use the diaphragm of your stethoscope. You may begin anteriorly or posteriorly. Progress side to side by comparing breath sounds and moving downward. Listen for one full respiration (inhalation and expiration) in each location. Listen for normal breath sounds and any abnormal sounds. Monitor the client for shortness of breath during the assessment. Respiratory Assessment: Auscultation Abnormals Adventitious sounds are abnormal breath sounds. If adventitious sounds are heard, it is important to assess: o their loudness o timing in the respiratory cycle o location on the chest wall o persistence of the pattern from breath to breath o whether or not the sounds clear after a cough or a few deep breaths Diminished or absent – Reduced intensity or no breath sounds that occur due to weak sound generation or impaired transmission
cities offer “pollution advisories” to warn those with lung disease about high air particulate levels. Occupation adds to the impact on lung health. For example, individuals living in the Appalachian areas of West Virginia may have a higher risk of obtaining tuberculosis, emphysema, and black lung disease due to close living conditions and coal mining. In the Western United States, high levels of dust and wind can increase the risk of coccidioidomycosis in families who spend time in parks, especially in rural and undeveloped desert areas.
Risk Factors There are non-modifiable and modifiable risk factors associated with the potential of developing chronic respiratory disease. Non-modifiable risk factors include age and congenital deformities. Regardless of risk factors, anyone can lessen their potential for and the severity of a chronic condition by controlling the known modifiable risk factors. Modifiable risk factors associated with chronic respiratory diseases include: unhealthy diet and physical inactivity tobacco use indoor and outdoor air pollution allergens occupational exposure co-morbid conditions Health Education Prevention, detection, treatment, and education are important in promoting respiratory health. Potential educational opportunities will arise during interaction with a client when assessing the respiratory system. Respiratory Inspection Part Of the Lung Is Obstructed Or Collapsed. Auscultation Technique When you auscultate the respiratory sounds, use the diaphragm of your stethoscope. You may begin anteriorly or posteriorly. Progress side to side by comparing breath sounds and moving downward. Listen for one full respiration (inhalation and expiration) in each location. Listen for normal breath sounds and any abnormal sounds.
Monitor the client for shortness of breath during the assessment.
Nursing Application: Respiratory System
Pathology of Respiratory System
COPD mainly involves bronchitis and emphysema, though other respiratory conditions such as asthma or pneumonia can worsen symptoms.
Risk Factors of the Respiratory System
Modifiable risk factors are cigarette smoking (active/passive) and occupational exposure to dust and chemicals.
Non-modifiable developmental risk factors are severe respiratory infections as a child, alpha-1 antitrypsin deficiency, and being over the age of 40.
Assessment-COPD Limited Chest Expansion, Anteroposterior to Transverse Diameter 1:1, Rhonchi, And Rapid, Shallow Respirations. Respirations less than 12, asymmetrical chest expansion, crepitus, stridor, and anteroposterior diameter greater than transverse diameter are not expected findings for a person with COPD. Medical Diagnosis: Moderate COPD Nursing Diagnosis: ☑Ineffective Airway Clearance ☑Impaired Gas Exchange ☑Imbalanced Nutrition: Less Than Body Requirements ☑Deficient Knowledge: Smoking and COPD Treatment The two main goals of chronic obstructive pulmonary disease (COPD) treatment are to reduce symptoms and decrease the risk of long-term complications. Treatment is used to relieve airflow obstruction, improve activity tolerance, improve health status, prevent progression of the disease, prevent or treat exacerbations, and reduce mortality. Pulmonary rehabilitation focuses on respiratory exercises, breathing techniques, and overall health support. Medication therapy is determined based on the client’s history of exacerbation amounts and severity. In addition, questions about the impact of COPD on a client’s life also determine treatment strategies. Planning
Alpha-1 antitrypsin deficiency is inherited in an autosomal codominant pattern. This means that both parents would either need to be carriers, or have alpha-1 antitrypsin deficiency for a child to be a carrier or have the condition, irrespective of gender. If the gene is present, there is a risk that it impacts health, especially based on lifestyle choices.
Client Education
- Remove caps from the inhaler and spacer. Shake the inhaler vigorously three or four times.
- Exhale to empty the lungs.
- Insert the mouthpiece of the inhaler into the non-mouthpiece end of the spacer.
- Place the mouthpiece into your mouth, over the tongue, and seal your lips tightly around the mouthpiece.
- Press down firmly on the canister to release one dose of medication.
- Inhale slowly and deeply.
- Hold your breath for 5 to 10 seconds.
- Remove the spacer from your mouth and exhale.
NR 302 Week 6-Edapt-Respiratory
Course: Health Assessment I (NR-302)
University: Chamberlain University
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