RESPIRATORY

1
RESPIRATORY

• Respiratory Assessment

2
Respiratory Assessment

• Visual Evaluation or Inspection (LOOK)
• Is the pt breathing comfortably?
• IE ratio normally 12
• Is the chest and abdomen moving in synchrony?
• Versus paradoxical breathing
• Is the chest expanding symmetrically?
• Is the patients skin color pink?
• Check nail beds, mucosa

3
Respiratory Assessment

• LISTEN w/o a stethoscope
• Upper Airway Obstruction
• Stridor
• Audible Secretion
• Patient unable to swallow or cough expectorate
• Audible wheezing
• Partial obstruction or narrowing of the larger
  airways

4
Respiratory Assessment

• FEEL
• Feel the patients chest for
• Symmetrical chest expansion
• Lower ribs should flare indicating use of
  diaphragm
• Tenderness or injury
• Trauma, surgery
• Missing ribs
• In the 1950s ribs were removed for lung
  resection

5
Respiratory Assessment

• Visual Cues of Respiratory Distress
• Abnormal breathing pattern
• Tachypnea
• gt 20 breaths per minute
• Paradoxical breathing pattern
• Seesaw pattern abdomen protrudes, chest retracts
  on inspiration
• Nasal flaring
• Orthopnea
• Intercostal retractions
• Pallor, grayish, or bluish skin color
• Clubbing of the digits

6
Respiratory Assessment

• Auditory Cues
• Adventitious lung sounds
• Rhonchi
• Partial obstruction of the larger airways
• Secretions, tumor external or internal
• Wheezing
• Bronchospasm (edema, secretions)
• Bronchoconstriction (decreased lumen diameter)
• Absent (fluid, foreign body)

7
Respiratory Assessment

• Other cues of Respiratory Distress
• Increased heartrate
• Increased blood pressure
• grunting
• Primarily premies and neonates
• Decreased mentation
• Combative, anxiousness, restlessness
• hallucination

8
Respiratory Assessment

• Reasons for Respiratory Distress
• (4) hypoxias
• Hypoxic hypoxia
• High altitude, pneumonia, ARDS, pneumothorax
• Hemic or anemic hypoxia
• hemorrhage
• Circulatory or stagnant hypoxia
• Cardiac arrest
• Histoxic hypoxia
• Cyanide poisoning

9
Respiratory Assessment

• Chief Complaint
• Dyspnea
• Subjective, i.e., pt feels SOB
• Hypoxemia (Objective)
• Physical measurement of reduced oxygen in the
  blood
• Pulse oximetry - SpO2
• ABG - PO2, SaO2

10
Respiratory Assessment

• Clinical thoughts
• What caused the SOB? How long?
• Smoking Hx? If so, PPY?
• Gradual (insidious) or sudden (acute)?
• What aggravates the SOB and what is done to
  alleviate it?
• Cough?
• NPC or productive
• Amount, color, odor, consistency
• Fever? Pain? Any meds taken?

11
Respiratory Assessment

• So now what? Recommendations
• Inductive thinking process to determine what
• Do nothing?
• Oxyen Rx?
• Bland aerosol Rx?
• Medicated aerosol Rx?
• Secretion Management?
• Intubate and mechanically ventilate--Nah, later