NCM 112 – Day 2 10/26/2020

PHYSICAL ASSESSMENT OF RESPIRATORY SYSTEM

The Hands
Clubbing
-commonly cause by respiratory disease (but NOT emphysema or chronic bronchitis)
-compensatory measure; body develops collateral circulation to area with impaired circulation
to provide oxygen; from 160 angle to 180
-occasionally, clubbing is associated with hypertrophic pulmonary osteoarthropathy (HPO)
distal phalanx {cancer in lungs}
of each finger → characterized by periosteal inflammation at distal ends of long bones, wrists, ankles,
is rounded metacarpals and metatarsals
and bulbous; → swelling and tenderness over wrists and other involved areas
nail plate is Due to TISSUE HYPOXIA
more convex;
proximal nail Nursing Priority: Maintain a patent airway
fold, when Possible Nursing Dx for cancer in lungs:
palpated, -Impaired gas exchange related to Removal of lung tissue, altered oxygen supply.
feels spongy -Ineffective Airway Clearance May be related to : Increased amount or viscosity of
or floating secretions, Restricted chest movement, pain, Fatigue, weakness
-Acute Pain May be related to: Surgical incision, tissue trauma, and disruption of
intercostals nerves, Presence of chest tube, Cancer invasion of pleura, chest wall
-Fear/Anxiety may be related to: Situational crises, Threat to or change in health status,
Perceived threat of death.

Staining
 staining of fingers - sign of cigarette smoking (caused by tar, not nicotine)
Wasting and weakness
Atropy of cells or tissues; pt commonly verbalizes labored breathing
Pulse rate
Compensation of blood to tissues;
Flapping tremor (asterixis) - unreliable sign
 ask patient to dorsiflex wrists and spread out fingers, with arms outstretched
*dorsiflexion can lead to muscle spasm*
 flapping tremor may occur with severe carbon dioxide retention (severe chronic airflow
limitation); elevated CO2 -> blood pH acidifies -> increased pH

The Face
Droopy eyelid

Eyes
 Horner's syndrome (constricted pupil, partial ptosis and loss of sweating which can be due
to apical lung tumour compressing sympathetic nerves in neck)

Nose
 polyps? (associated with asthma)
 engorged turbinates? (various allergic conditions); rhinitis = irritation of mucus
membrane
 deviated septum? (nasal obstruction)
Ex: -smell often attributed by olfactory nerve (1) and trigeminal nerve (5)
Chronic
Rhinitis H1 - allergic reactions;
H2 - found in stomach

Mouth and tongue
 look for central cyanosis
 evidence of upper respiratory tract infection (a r eddened pharynx and tonsillar enlargement

with or without a coating of pus)

 ● broken tooth - may predispose to lung abscess or pneumonia
 SINUSITIS is indicated by tenderness over the sinuses on palpation
 SOME patients with obstructive sleep apnoea will be obese with a receding chin, a small
pharynx and a short thick neck

The Trachea
→ causes of tracheal displacement:
 toward the side of the lung lesion
upper lobe collapse
upper lobe fibrosis
pneumonectomy
upper mediastinal masses, such as retrosternal goitre
→ tracheal tug (finger resting on trachea feels it move inferiorly with each
inspiration) is a sign of gross overexpansion of the chest because of
airflow obstruction

The Chest
Inspection
 Shape and symmetry of chest
 i. Barrel shaped
-anteroposterior (AP) diameter is increased compared with lateral diameter
 -causes: hyperinflation due to asthma, emphysema