RESPIRATORY

SYSTEM
The structures of the respiratory system ( the airways, lungs, bony thorax,
respiatory muscles and central nervous system ) work together to deliver
oxygen to the bloodstream and remove excess carbon dioxide from the
body.
ANATOMY
ANATOMY

RIGHT LUNG: 3 lobes LEFT LUNG: 2 lobes

1. Upper 1. Upper
2. Middle 2. Lower
3. Lower

The lungs share space in the thoracic cavity with the heart
and great vessels, the trachea, esophagus and the bronchi.
The space between lungs is called mediastenum

THORAX
clavicle, sternum, scapula, 12 sets of ribs and 12 thoracic
vertebrae

Respiratory muscles
The diaphragm and the external intercostal muscles are the
primary muscles used in breath-ing. They contract when
the patient inhales and relax when the patient exhales.
Accessory inspiratory muscles include the trapezius,
sternocleidomastoid, and scalenes, which combine to
elevate the scapulae, clavicles, sternum, and upper ribs.
 RESPIRATORY LANDMARKS
You can use these landmarks to help describe the locations of your
assessment findings.
 ASSESSMENT

INSPECTION
CHEST-WALL ASYMMETY
RESPIRATORY RATE AND
PATTERN
ACCESSORY MUSCLE USE
MASSES OR SCARS
Respiratory rate and pattern
Adults: 12 to 20 breaths/minute
Infant: 40 breaths/minute
The respiratory pattern should be even, coordinated, and regular, with occasional sighs (long,
deep breaths).

Accessory muscle use

Observe the diaphragm and the intercostal muscles with breathing. Frequent use of accessory
muscles may indicate a respiratory problem, particularly when the patient purses his lips and flares his
nostrils when breathing.

PALPATION
Place your palm (or palms)
lightly over the
thorax. Palpate for tenderness,
alignment, bulging. and
retractions of the chest and
intercostal spaces.
Assess the patient for crepitus,
especially around drainage sItes.
Repeat this procedure on the
patient's back.
ADD A TITLECHECKING
SLIDE
FOR TACTILE
Use the pads of your fingers to
palpate the front and back of the
thorax. Pass your fingers over the
ribs and any scars, lumps,
lesions, or ulcerations. Note the
skin temperature, turgor, and
moisture. Also note tenderness
or subcutaneous crepitus. The
muscles should feel firm and
smooth.
FREMITUS
Use the pads of your fingers to
palpate the front and back of
the thorax. Pass your fingers
over the ribs and any scars,
lumps, lesions, or ulcerations.
Note the skin temperature,
turgor, and moisture. Also note
tenderness or subcutaneous
crepitus. The muscles should
feel firm and smooth.
EVALUATING CHEST
ASYMMETRY & EXPANSION
Place your hands on the front of the chest
wall with your thumbs touching each
other at the second intercostal space. As
the patient inhales deeply, watch your
thumbs. They should separate
simultaneously and equally to a distance
several centimeters away from the
sternum. Repeat the measurement at the
fifth intercostal space. The same
measurement may be made on the back
of the chest near the tenth rib. The
patient's chest may expand
asymmetrically if he has pleural effusion,
atelectasis, pneumonia, or
 ADD A TITLE SLIDE

PERCUSSION
Chest percussion
reveals the
boundaries of the
lungs and helps to
determine whether
the lungs are filled
with air or fluid or
solid material.
 ADD A TITLE SLIDE
PERCUSSION
Place your nondominant hand over the chest
wall, pressing firmly with your middle finger.

Position your dominant hand over your other

hand.

By flexing the wrist (not the elbow or upper arm)

of your dominant hand, tap the middle finger of
your nondominant hand with the middle finger
of your dominant hand (as shown). Follow the
standard percussion sequence over the front and
back chest walls.
 ADD A TITLE SLIDE
DIAPHRAGMATIC EXCURSION
Percussion is also used to assess diaphragmatic excursion (the distance the diaphragm moves between inhalation and
exhalation). Keep in mind that the diaphragm doesn't move as far in obese patients or patients with certain respiratory
disorders.

 Ask the patient to exhale.  Repeat on the

 Percuss the back on one side to opposite side
locate the upper edge of the of the back.
diaphragm, the point at which  Use a ruler or
normal lung resonance changes tape measure
to dullness. to determine
 Use a pen to mark the spot the distance
indicating the position of the between the
diaphragm at full expiration on pen marks. The
that side of the back. distance,
 Ask the patient to inhale as normally 1¼*
deeply as possible. to 2" (3 to 5
 Percuss the back when the cm), should be
patient has breathed in fully until equal on both
you locate the diaphragm. Use the right and
the pen to mark this spot as well. left sides
 ADD A TITLE SLIDE
AUSCULTATION
As air moves through bronchi, it creates sound waves that
travel to the chest wall. The sounds produced by breathing change
as air moves from larger airways to smaller airways.
Sounds also change if they pass through fluid, mucus, or
narrowed airways. Auscultation of these sounds helps you to
determine the condition of the alveoli and surrounding pleura.
Classify each sound you hear according to its intensity, location,
pitch, duration, and characteris-tic. Note whether the sound occurs
when the patient inhales, exhales, or both.
 ADD A TITLE SLIDE
AUSCULTATION SEQUENCE
ASSESSING VOICE SOUNDS
Assessing vocal fremitus
Ask the patient to repeat the words below while you listen.
Auscultate over an area where you heard abnormally located bronchial
breath sounds to check for abnormal voice sounds.
 If Ask the patient to say,  Ask the patient to say,  Ask the patient to whisper,
"ninety-nine." "E." "1,2,3"
 Over normal lung tissue,  Over normal lung tissue,  Over normal lung tissue, the
the words sound the sound is muffled. numbers will be almost
muffled.  Over consolidated lung indistinguishable.
 Over consolidated areas, tissue, it will sound like  Over consolidated lung tissue, the
the words sound the letter A numbers will be loud and clear.
unusually loud.

BRONCHOPHONY EGOPHONY WHISPERED PECTORILOQUY

LOCATION OF NORMAL BREATH SOUNDS
ABNORMAL FINDINGS
CHEST
DEFORMITIES
 ABNORMAL FINDINGS
ABNORMAL RESPIRATORY PATTERNS
 ABNORMAL FINDINGS: ABNORMAL BREATH
SOUNDS
ADVENTITIOUS BREATH SOUNDS

Other breath sounds, called adventitious sounds, are abnormal no matter

where you hear them in the lungs.
These sounds, which are superimposed on normal breath sounds, include
fine and coarse crackles, wheezes, rhonchi, stridor, and pleural friction
rub.

Stridor is a loud, high-pitched crowing sound, usually heard without a

stethoscope during auscultation. It's caused by upper airway obstruction.

Pleural friction rub is a low-pitched, grating, rubbing sound heard on

inspiration and expiration. It's caused by pleural inflammation.