Respiratory System: Alternate Assignment Week 2
Chamberlain College of Nursing
NR 509 Advanced Physical Assessment
... [Show More] Body System
This week involved assessment of the respiratory system, which will be the topic of discussion for this assignment. In addition to providing the body with oxygen and expelling carbon dioxide, the respiratory system plays a key role in homeostasis by contributing to pH balance, temperature control, and disease prevention. These topics will be further discussed throughout this paper among the following sections: pathophysiology, subjective data collection, objective data collection, examination procedures, special population considerations, disease processes, and conclusion.
Physiology of the Body System
The respiratory system is comprised of several organs and is usually viewed as two tracts: the upper and lower respiratory tracts. The upper respiratory tract includes the nose and nasal cavity, sinuses, and pharynx. These structures are often referred to as conducting organs, the function of which is to move air throughout into and out of the system. The upper respiratory structures do not perform gas exchange, they play the role of warming and moistening the air entering the body, as well as filtering out potentially infectious or harmful particles and debris. The larynx is most well-known as the "voice box", but also serves as the gateway to the lungs, letting air in and out and sealing shut to prevent aspiration and choking. From the larynx, the trachea provides structure to support the airway and ultimately divides into the main stem bronchi in the lower respiratory tract. Each bronchi leads to the main organs of the respiratory system: the lungs. The lungs are divided into lobes with the right lung having three lobes and left lung having two to allow room for the heart. Each lung is comprised of alveoli, alveolar ducts, and alveolar sacs which are responsible for performing gas exchange (McCance, Huether, Brashers, & Rote, 2013). Though the lungs are often the sole organ credited with respiration, all of these structures must function together to effectively complete each step in the cycle of respiration.
Respiratory Subjective Data
Subjective data is information reported by the patient and is taken at face value without interpretation or bias. Common symptoms associated with respiratory complaints include cough, difficulty breathing, production of phlegm or sputum, chest pain, sinus pressure, and wheezing. Relevant health history inquires would include onset of symptoms, known triggers, duration and severity of symptoms, exacerbating factors, and alleviating factors. It is also important to note medications taken, history of respiratory illness, possible exposure to illness, international travel, family history of respiratory illness, smoking status, secondhand smoke exposure, drug use, general medical history, and possible environmental allergy or toxin exposure.
Objective Data / Normal Physical Examination Findings
Objective data is collected by the examiner during the physical assessment through visual inspection, auscultation, percussion, and palpation. Inspection is the first step in the assessment process and involves visually observing for any signs and symptoms which are apparent to the naked eye. Auscultation is done next, when appropriate, such as when examining the abdomen or assessing lung fields, and employees the use of a stethoscope with which the examiner listens for audible normal and abnormal sounds for the specific body system. Percussion uses light to firm taps to illicit sounds over areas which may accumulate air or fluid, and palpation is performed with the examiner’s hands to assess for pain or possible swelling or growths based upon how the palpated area feels. Objective data for the respiratory system would be collected by obtaining vital signs particularly pulse oximetry, respiratory rate, depth, rhythm and effort. Visual inspection of the nasal should also be performed to assess for swelling, discharge, or redness, as well as visualization of the pharynx to assess for visual changes, swelling, drainage or growths. Palpation of the sinuses and lymphatic structures of the neck should be done to assess for pain or swelling. Visual inspection of the chest should reveal a chest that is wider than it is deep; barrel chest indicates compensation for long-term respiratory difficulties. Auscultation of the lungs should be performed anteriorly and posteriorly in all lobe fields, followed by percussion in all fields, which may reveal fluid in areas if the resultant sound is dull rather than resonant. The provider should also take note of the use of accessory muscles during resting respiration as this indicates a higher degree of respiratory difficulty. Normal findings for respiratory assessment would include relaxed posture without tripod stature. Nasal passages patent, septum midline, turbinates non-edematous, mucosa pink and moist. Pharynx pink, moist, non-edematous. Respiratory rate 10-18 breaths per minute, regular rate, no accessory muscle use. Pulse ox 94-100% on room air. No cyanosis noted. Anteroposterior diameter less than transverse diameter. Chest expansion symmetric. Bronchovesicular sounds noted anterior and posterior. Vesicular sounds noted to all lobes. No adventitious sounds auscultated. Tactile fremitus present and equal bilaterally. Percussion resonant all fields (Jarvis, 2016).
Physical Assessment Procedures for Special Populations
When performing physical assessments, it important to note that there are specific times when adaptations to the assessment process may need to occur. When assessing infants, pregnant women, and geriatric individuals, special considerations must be observed based upon the needs of these patients. For infant patients, the child needs to be undressed except for the diaper which may be left in place until the examination warrants removal. Also, the parent should remain in the room and the examiner should address questions, explanations, and education to the parent rather than the patient. Respiratory examination in the infant reveals abdominal breathing that is often irregular corresponding with increased breaths during respiration, which is a normal finding in infants. Newborns my exhibit acrocyanosis, a bluish discoloration of the hands and feet, which is usually a temporary, benign condition requiring no treatment. Pulse oximetry should be performed to ensure that peripheral oxygenation is not compromised, and parents should be reassured that the condition should resolve with time (Das & Miati, 2013). Percussion is often not used in infants as it is not particularly productive of relevant results, but palpation of the position of the liver is helpful to assess for lungs which may be hyperexpanded.
Concerning pregnant women, physical assessment is performed as it would be for non-pregnant adults. It is important, however, for the examiner to understand the mechanical and biochemical changes, due to hormonal alterations, which effect patterns, function, and gas exchange during pregnancy (LoMauro & Aliverti, 2015). As the woman progresses through pregnancy, she does not usually experience notable changes in spirometry. Lung volume and expansion, however, undergoes a dramatic alteration, decreasing by up to 40% as the woman nears term, due to expansion of the uterus and subsequent displacement of the diaphragm. As a result, many women have increased respiratory rate during late pregnancy as a compensatory mechanism to the decrease in volume (LoMauro & Aliverti, 2015). Pregnant women are also at increased risk for development of influenza, so the provider should take the time to educate about the need for vaccination against influenza and also about the signs and symptoms of influenza and the need to seek immediate care if the condition is suspected (Bödeker, Betsch, & Wichmann, 2015).
Finally, when assessing geriatric populations, the physical assessment is parallel to that of other adults but often also includes considerations and assessment for activities of daily living. Geriatric patients who have a long history of unhealthy behaviors such as smoking are at an increased risk for development of respiratory conditions such as COPD and lung cancer. Assessment for these and other chronic lung conditions includes inspection for chest wall changes such as development of barrel chest, decreased oxygenation revealed by low pulse oximetry, increased respiratory rate, chronic cough, and adventitious or decreased lung sounds. Asthma should also be considered as a possible contributing factor to respiratory difficulties in elderly populations. Radiological studies and pulmonary function testing will likely be needed to confirm diagnosis (Scichilone et al., 2015). Thorough medical history as well as complete list of current medications is also essential when determining diagnosis and treatment for respiratory conditions.
Disease Process Associated with the Respiratory System: Asthma
Asthma is the most prevalent chronic condition effecting children under the age of 17 and is non-discriminatory, occurring in males and females of all races. Often attributed to both genetic and environmental factor, asthma effects the ability of the lungs to function properly, resulting in decreased ventilatory movement and hypoxia. In people who have asthma, the airways are often either chronically inflamed or may suddenly become edematous when exposed to a triggering substance. When exacerbation occurs, the hyperactive airway responds to the insulting substance by over-production of mucous and increased swelling. This reaction causes the airway to narrow, decreasing movement of air through the passageways and resultant hypoxia (Asthma, n.d.). It is important to note that although asthma is most prevalent among children and young adults, it may develop later in life and should not be discounted as the cause of respiratory difficulty in elderly populations. Providers should be cautious when diagnosing geriatric patients with respiratory symptoms as asthma may be misdiagnosed and therefore mistreated (Scichilone et al, 2015).
Expected Abnormal Physical Examination Findings Associated with Asthma
Individuals with asthma often present with complain of cough, chest tightness without chest pain, shortness of breath, activity intolerance, and wheezing. Thorough medical history, onset, severity, and duration of symptoms, as well as familial history should be collected to assess for contributing factors and support diagnosis. Upon examination, observation of the skin should be performed as skin conditions such as eczema are often a related finding. Inspection of the nasal passages is also performed, and inflamed turbinates and mucous membranes are often an indication of a hyperreactive state. Audible wheezing may be heard without auscultation. Nonetheless, auscultation of the lungs is performed to further assess for adventitious lung sounds and accompanied by percussion to assess for other possible respiratory problems, such as pneumonia, which may have similar symptoms but need different treatments. Radiology studies and pulmonary function tests should be completed to confirm diagnosis and determine severity of the condition before treatment can begin (Asthma, n.d.).
Key Points
It seems ironic that respiration is required for living but is also something that we tend to give no thought to on a regular basis. Normal respiratory function is involuntary, quiet, and relatively effortless whereas acute respiratory problems often bring about swift response by the patient as well as the provider. Understanding the physiology of the respiratory system and the related assessment factors for all populations is a vital part of providing thorough medical care for patients. Combining subjective and objective information with knowledge of disease process symptoms and treatments allows the provider to skillfully examine, diagnose, and treat with confidence and accuracy.
References
Asthma. (n.d.). Retrieved from https://www.nhlbi.nih.gov/health-topics/asthma
Beachey, W. (2018). Respiratory care anatomy and physiology: foundations for clinical practice (4th ed.). New York, NY: Elsevier Health Sciences.
Bödeker, B., Betsch, C., & Wichmann, O. (2015). Skewed risk perceptions in pregnant women: the case of influenza vaccination. BMC public health, 16, 1308. doi:10.1186/s12889-015- 2621-5
Das, S., & Maiti, A. (2013). Acrocyanosis: an overview. Indian journal of dermatology, 58(6),
417-20.
Jarvis, C. (2016). Physical examination & health assessment (7th ed.). St. Louis, MO: Elsevier
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The
biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
Scichilone, N., Ventura, M. T., Bonini, M., Braido, F., Bucca, C., Caminati, M.,… (2015). Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly. Clinical and molecular allergy : CMA, 13(1), 7. doi:10.1186/s12948-015- 0016-x
LoMauro, A., & Aliverti, A. (2015). Respiratory physiology of pregnancy: Physiology masterclass. Breathe, 11(4), 297–301. http://doi.org/10.1183/20734735.008615 [Show Less]