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Respiratory A&P and
Assessment
PN 132
Objectives

Identify and define the parts and functions
of the upper and lower respiratory system

Define common terminology associated
with respiratory anatomy, physiology and
assessment

Identify components of a complete
respiratory assessment
Terminology
Airway Obstruction



Something blocks the airway
Prevents air from entering or leaving lungs
Anoxia


Absence of oxygen
Apnea



Absence of spontaneous respiration
SAS (sleep apnea)
Asphyxia


Impairment of ventilation and exchange of oxygen
and carbon dioxide
Terminology

Bradypnea
 Abnormally slow rate of respiration <10 bpm

Cyanosis


Dyspnea


Bluish discoloration of the skin caused by a lack of adequate oxygen
SOB, difficult breathing or labored breathing
Hyperventilation
 Abnormally rapid deep breathing
 Results in decreased levels of CO2 at cellular level

Hypoxia
 Decrease levels of oxygen in inspired gases, arterial blood, or
tissues
 Just short of anoxia
-
Terminology
Kussmaul Respirations


Deep and labored breathing
Respiratory Failure


Dangerously low level of oxygen (O2) in the blood
OR


Dangerously high level of carbon dioxide (CO2) in the
blood
Tachypnea
 Abnormally rapid rate of respiration
 > 20 respirations per minute
The Respiratory System
We cannot live without air.
 Millions of cells in our bodies need a
continuous supply of oxygen.

Respiratory System
Anatomy and Physiology
Respiratory Anatomy Video
http://www.youtube.com/watch?v=DCVIEMNPe1E
Structures of the Respiratory System

Upper Respiratory Tract





Nose Pharynx
Mouth
Larynx
Trachea
Lower Respiratory Tract
 Bronchial tree
 Lungs: alveolar ducts and alveoli
Upper Respiratory Tract
Lower Respiratory Tract
The Pleurae

Multilayered membranes
that are serous and moist
 Surround and protect each lung

Parietal Pleura: outer layer
of the pleura
 Lines the thoracic cavity and
forms the sac containing each
lung.

Visceral Pleura: inner layer
of pleura
 Closely surrounds the lung
tissue.
The Pleural Space

The space between the
folds of the pleural
membranes
 Contains lubricating




fluid
Prevents friction during
respiration.
Airtight vacuum
Contains negative
pressure
Keeps the lungs
inflated.
The Diaphragm

Muscle that separates
the thoracic cavity from
the abdomen
 Contracts and Relaxes

Phrenic nerve
 Stimulates diaphragm
to contract during
respiration.
External Respiration

BREATHING
 exchange of oxygen and
carbon dioxide

Occurs between the
lungs and the
environment
Internal Respiration
 Exchange of
oxygen and
carbon dioxide
○ cellular level
○ between the alveolus
and the alveolar
capillaries
CELLULAR
RESPIRATION
• Exchange of gases
within the cells of body
organs and tissues.
• Oxygen passes from the
bloodstream into the
tissue cells as carbon
dioxide passes from the
tissue cells back into
the blood stream.
Pulmonary Circulation
Superior Vena Cava
Pulmonary Arteries
Right Lung
Left Lung
Pulmonary Veins
Inferior Vena Cava
Aorta
Respiratory System Function

To exchange carbon
dioxide (CO2) and
oxygen (O2)

To make oxygen (O2)
available to the blood
stream
 So that it can be picked
up and used by the cells
of organs and tissues in
the body

To remove carbon
dioxide (CO2) waste
from the blood stream
Respiratory Assessment

The respiratory assessment is always
included in a patient’s physical exam.

Individuals require more extensive datagathering
- chronic lung conditions
- allergic reactions
- trauma
- recent surgery, etc.
Lung Assessment
Lung Assessment


SUBJECTIVE
 What the patient tells
you
OBJECTIVE
 What you see and hear
Subjective Assessment

Ask the patient to describe any symptoms
he/she is experiencing
- shortness of breath
- difficulty breathing
- cough
- orthopnea
- pain with inspiration
- wheezing, etc.
Subjective Assessment

Data must include details such as
- onset
- duration
- precipitating factors
- measures that relieve the symptoms
- these may be medications, positioning,
oxygen, alternative measures, etc.
Subjective Assessment
 Cough
• If present, ask for details
○ Productive/Non-productive
○ Frequency/sound
• If productive, ask for
○ Color
○ Amount
○ Tenacity
• Use quotes from the patient whenever possible!
Productive and Non-Productive Cough
Objective Assessment
Observe the patient
-
Facial expressions when breathing
-
Chest movement
-
Quality of respirations
- rate, rhythm, depth

Normal Range = 12-20 breaths per
minute
Objective Assessment

Observe for
 - flaring nostrils
 - color of lips and nailbeds
 - anxiety on the patient’s face
 - skin color and turgor
 - equality of breathing on both lungs
 - retractions
 - Dyspnea
 - Orthopnea
Dyspnea and Orthopnea
Dyspnea = Difficulty Breathing
Flaring Nostrils
Lip Cyanosis
Cyanosis of the Nail Beds
Lung Auscultation
Auscultation
Listening for sounds
Auscultate ALL lung
fields
Both anteriorly and
posteriorly
Be sure to warm your stethoscope!!
Anterior and Posterior
Lung Auscultation
B = Bronchial
BV = Bronchial Vesicular
V = Vesicular
Lung Auscultation

The nurse notes the presence of any
adventitious sounds (abnormal breath sounds)
- wheezes
- crackles
- pleural friction rub
- absence of breath sounds
Normal Breath Sounds
Listen:
http://www.youtube.com/watch?v=-S8T2JhMrYM
Adventitious Breath Sounds
 Abnormal sounds superimposed on
breath sounds
○ Includes:
(“rales”)
 Sibilant Wheezes (“wheezes”)
 Sonorous Wheezes (“rhonchi”)
 Pleural Friction Rubs
 Crackles
Adventitious Breath Sounds
 Crackles:
- common on inspiration
- interrupted crackling/bubbling
sounds
- brief, not continuous
- can be fine, medium or coarse
Adventitious Breath Sounds
 Crackles
- Occurs when air is forced through respiratory
passages narrowed by fluid, mucous,
etc.
- Inflammation or infection of the small bronchi,
bronchioles, and alveoli
- To simulate the sound of Crackles
○ Take a few strands of hair between your fingers
○ Hold it up to your ear
○ Rub back and forth
Adventitious Breath Sounds
Wheezes:
Sibilant:
- Musical, high-pitched, whistling
sounds.
- Caused by rapid movement of air
through narrowed bronchioles.
- May occur during inspiration or
expiration
- The sound may consist of one or several notes
Adventitious Breath Sounds
 Wheezes
Sonorous:
- Low-pitched, loud, snoring
sounds.
- Can be heard at any point of
inspiration or expiration.
- May be continuous
Adventitious Breath Sounds
Listen…..
http://www.youtube.com/watch?v=_nPi4-ed_Y4#t=19
Adventitious Breath Sounds
Pleural Friction Rub
• Low-pitched grating or creaking sounds
○
Heard during both inspiration and expiration
○
Sound does not originate in the lungs

outside the lung fields

Inflamed pleural surfaces rubbing together
during respiration
 Usually indicates Pleurisy
Adventitious Breath Sounds

Pleural Friction Rub

This sound occurs
when inflamed
pleural surfaces rub
together during
respiration.
Listen…..
http://www.youtube.com/watch?v=t2QE0O_exAQ
Summary

Defined common terminology
associated with respiratory assessment
and diagnostic testing

Identified components of a complete
respiratory assessment

Identified methods for common
respiratory diagnostic testing
Assignment

Read/Review:
 PowerPoint Handout
 Student Handouts
 AHN – Chapter 9
○ Pp. 373-379
Next Class
Respiratory Diagnostics and Labs
 Understanding ABGs


Look Over
 AHN – Chapter 9
○ Pp. 379-384
QUESTIONS?