o Example: if the cause is bacterial
ANATOMY & PHYSIOLOGY
INTERVIEW ASSESSMENT
 Cough
o Cough is a reflex that protects the
lungs from the accumulation of
secretions or inhalation of foreign
bodies.
o Cough reflex may be impaired by the
following
1. Weakness
2. Paralysis of the respiratory
muscle
3. Prolonged inactivity
4. presence of NGT or Nasal Gastric
Tube
o Nasal Gastric Tube – a tube
which is inserted via the nose,
going to the stomach for
feeding and for medication
administration purposes and
others.
5. depressed function of the
medullary centers in the brain due
to anesthesia or maybe brain
disorders.
o Coughing or the cough reflex
result from the irritation of the
mucous membrane anywhere in
the respiratory tract and it may
indicate serious pulmonary
disease or variety of problems,
including cardiac disease,
medication reaction, smoking and
GERD (Gastroesophageal reflux
disease)
Possible questions
 Do you have a cough?
 How long have you had it?
 Can you describe your cough?
 Are you coughing any mucous or phlegm?
 Has the amount of mucous changed?
 Has the consistency or thickness of
mucous changed?
 sputum production
o Sputum production is a reaction of
the lungs to any constantly
recurring irritant and its nature is
often indicative of its cause.
usually the sputum is purulent or
there’s a pus, it’s thick yellow,
green or rust colored.
o If its viral, it’s whitish, mucoid or
water.
o If the patient has bronchitis or
bronchiectasis, usually there is
gradual increase of sputum
overtime.
o If lung tumor, pink tinged mucoid
o If pulmonary edema, profuse,
frothy and pinkish
 shortness of breath
o Difficulty of breathing or adestria
o It is am indication of a respiratory or
cardiovascular problem
 Do you experience any shortness of
breath?
 How is it often?
 Is it only in the morning or all
throughout the day or only At night?
 chest pain with breathing
o Chest pain may be associated with
pulmonary or cardiac disease also
o pain which is associated with
pulmonary condition may be sharp,
stabbing or intermittent or may be
dull, aching and persistent
Take note! Lung disease does not always
cause thoracic pain because the lungs and
visceral pleura lack sensory nerves and they
are insensitive to pain stimuli. However, the
parietal pleura has rich blood supply of
sensory nerves that are stimulated by
inflammation and stretching of the
membrane
For pain you may ask:
 Do you feel pain anywhere in your chest?
 Where is the pain?
 How often do you experience the pain
and does the pain affect your breathing?
P - Precipitating and Aggravating
Q - Quality
R - Radiation and Location
S - Severity
T - Timing
 past history of respiratory infection
o We ask the client about history of
respiratory infection because the
current condition may be a sequela or
sequelae (the condition is a
consequence of previous diseases or
injury. There might be a connection
between the current condition and
the past.
 smoking history
o Smoking is associated with decreased
ciliary function of the lungs . Cilia or
hair like structures that sweep the
mucous
o Increased mucous production and
development of lung cancer and
chronic lung problems
o The pack year history helps quantifies
smoking history
Formula
 Years of smoking x number of packs
of smoke per day
 Years of smoking x stick smoke per
day / 20
 30 x 10/20
 environmental exposure
 self care behaviors
PHYSICAL ASSESSMENT
1) gather and assemble the needed
equipment and supplies*
2) introduce self and identify the client
3) explain the procedure and ask for
consent
4) assist the client to wear examination
gown if necessary and place in a position
appropriate to the procedure
5) provide privacy and expose only the
area(s)/part(s) to be assessed
6) do hand hygiene and don gloves if
necessary
POSTERIOR & LATERAL CHEST
1) Inspect for symmetry of the back and
scapulae
2) Inspect spine for mobility, structural
deformity, symmetry, and posture
3) Inspect skin color, hair distribution and
presence of lesions
 Note any bulges or retractions of the
costal interspaces on respiratory
movement
 Note the anteroposterior diameter in
relation to the lateral diameter of the
chest
4) Palpate the posterior chest, ribs, and
spine.
 Identify any areas of tenderness,
masses and inflammation
 Palpate the ribs for symmetry,
mobility and tenderness and the
spine for tenderness and vertebral
position*
5) Assess for symmetrical chest expansion.
6) Assess for tactile fremitus.
7) Percuss the entire lung fields
8) Assess diaphragmatic excursion
9) Auscultate the posterior lung fields.
10)Assess voice sounds.
ANTERIOR CHEST
1) Inspect for symmetry of the thorax, ribs,
and clavicles.
2) Inspect skin color, lesions, hair
distribution and note width of costal
angle
3) Assess the respiratory rate, depth and
symmetry
4) Palpate the anterior chest.
5) Assess for symmetrical chest expansion.
6) Assess tactile fremitus.
7) Percuss the anterior and lateral chest.
8) Auscultate the trachea and the anterior
and lateral lung fields.
9) Assess voice sounds.