Assessment of respiratory

Function
Main symptoms of pulmonary diseases
Risk factors for respiratory disease
Smoking( the single most important contributor to
lung disease).
Exposure to second hand smoking
Personal history of lung disease
Genetic and family history of lung disease
Allergens and environmental pollutants
Occupational exposure
Symptoms of lungs disease
Cough
Sputum products
 Dyspnea
Cyanosis
Chest pain
1. Cough
The most common symptom of lung disease is the
cough.
The cough is a normal defense mechanism of the
lungs that protects them from foreign bodies and
excessive secretions.
When a patient complains of cough ask the
following:
Can you describe your cough? Do you smoke?
How long have you had a cough? is the cough worse in
any position? What relieves the cough?
Descriptors of coughing
Description / possible causes:
Dry
Viral infections, tumor, allergy, anxiety
Chronic, productive
Chronic bronchitis, abscess, bacterial pneumonia,
tuberculosis
2. Sputum products
Sputum should be described according to color and
consistency
Uninfected sputum is ordorless, colorless, and mucus
and transparent(mucoid)
Infected sputum contains pus.
Hemoptysis
Hemoptysis is the sputum with blood or is a coughing
of blood.
Clots of blood are indicative of a cavity lung lesion, a
tumor of the lung or pulmonary embolism
hemoptysis
Ask the following questions;
Do you smoke, if yes, what and how much?
Did the coughing of blood occurred suddenly?
Is the sputum tinged with blood or are there actual
blood clots?
Have you ever had tuberclosis?
Do you take any blood thinners?
Have you had night sweats, short of breath.
Appearance of sputum
White or clear mucoid = bronchitis, or viral
infections
Yellow green purulent = bacterial infection, chronic
bronchitis
Rust color = pneumonia or tuberculosis
Foul color = lung abscess
Bloody cough = pulmonary emboli, TB, bleeding
disorders, cardiac problems.
Characteristics between Hemoptysis and
Hematemesis
Feature hemoptysis hematemesis
Symptoms coughing Nausea and vomiting
Past history History of History of
cardiopulmonary gastrointestinal
disease disease
Color Bright red Dark red, brown, or
coffee ground
Manifestation Mixed with pus Mixed with food
Associated dyspnea nausea
symptoms
3. Dyspnea
The subjective sensation of “shortness of breath” is dyspnea.

Ask the following questions;

How long have you had shortness of breath? Did the
shortness of breath occur suddenly?
Is shortness of breath constant?
Does the shortness of breath occur with exercise?, at rest?, or
lying flat?
What makes the shortness of breath worse?
How many blocks can you walk without becoming short of
breath?
4. Cyanosis
The discoloration of the lips and nail beds of a
patients .
Inadequate gas exchange in the lungs that results in a
significant reduction in arterial oxygenation.
Where is the cyanosis present?
How long has the cyanosis been present
Are you aware of any lung problem, heart problem,
blood problem?
Is there associated shortness of breath? Cough? Or
bleeding?
5. Chest pain
Chest pain relates to pulmonary disease generally
results from involvement of the chest wall or parietal
pleura.
Nerves are abundant in this area
Pleural pain is a common symptom of inflammation of
the parietal pleura.
It described as sharp stabbing pain during inspiration
May be localized on one side
Although pain occurs in pulmonary diseases, yet it is a
cardinal symptom of cardaic disease.
Physical examination of the chest
General assessment
Inspection of the facial expression
Is the patient in acute distress?
Is there any nose flare? or pursed lip breathing?
Are there any audible signs of breathing such as
strider or wheezing?( relates to obstruction of air flow)
Is there cyanosis present?
Assess the respiratory rate
The normal adult breathes 12-20 breath per minute.
Bradypnea: is an abnormal slowing of respiration
Tachypnea: is an abnormal increase of breathing
Apnea: is the temporary cessation of breathing
Hyperpnea: is an abnormal increased depth of
breathing.
General inspection
Inspection of the patient’s posture
Patients with obstruction usually clasp the sides of the
bed and use the arms, shoulder and neck muscles to
aid respiration.
Is the patient breathing aided by the action of the
accessory muscles?(early signs of airway obstruction)
Accessory muscles include trapezius and
sternocleidomastoid).
Inspect the hands
General observations
Observe the hands and note your findings:
Colour: cyanosis of the hands may suggest underlying
hypoxaemia.
Tar staining: caused by smoking, a significant risk
factor for respiratory disease (e.g. COPD, lung cancer).
Skin changes: bruising and thinning of the skin can
be associated with long-term steroid use (e.g. asthma,
COPD, interstitial lung disease).
Inspect the hands
Finger clubbing
Is clubbing present? this is associated with:
Chronic pulmonary disease
Chronic hepatic fibrosis
In some individuals clubbing may be inherited
without any pathological process
Fine tremor
Assess for the presence of a fine tremor
Nail clubning
Inspection face, neck and chest
Inspect the face for any signs relevant to the
respiratory system
Eyes (Conjunctival pallor)
Mouth (Central cyanosis and Oral candidiasis, a
fungal infection commonly associated with steroid
inhaler use
Inspection of the neck (Jugular venous pressure )
 Chest closely inspect the chest wall
for scars and other abnormalities such chest wall
deformities.
Inspect the configuration
A configuration of the chest may indicate chronic
lung disease.
An increase in the anterio-posterior diameter is seen
in Advanced obstructive pulmonary disease.
A flail chest is a chest configuration in which one
chest wall moves inwards during inspiration(multiple
rib fractures)
Kyphoscoliosis results in abnormal anterio-
posterior and lateral curvature of the spine.
Palpation
Temperature
Place the dorsal aspect of your hand onto the patient’s to
assess temperature
Heart rate
Palpation of the chest (Palpate the apex beat, Assess chest
expansion.
The degree of symmetry of chest can be determined
Palpation of areas of tenderness
A complaint of chest pain may associated with
musculoskeletal disease and not diseases of the chest or
heart.
Palpation
Evaluate tactile fremitus
When palpates the chest wall while an individual is
speaking, these vibration can be felt and are termed
tactile fermitus
Tactile fermitus
increased decreased

pneumonia Pleural effusion

Bronchial obstruction
Atelectasis (incomplete expansion of the
lung tissue)
Chronic obstructive lung disease
Chest wall thickening(muscle, fat)
percussion
This refers to tapping on a surface to determine the
underlying structure.
Percussion over a structure containing air within a
tissue, such the lung, produce a resonant .
Auscultation
There are four types of normal breath sounds.
 Breath sounds are heard over most of the lungs fields
expiratory phase.
Tracheal 
Bronchial
Vesicular
Bronchovesicular
tracheal
Tracheal sounds are harsh, loud, high pitched sounds.
The inspiratory and expiratory are approximately
equal in length.
They are always heard over the trachea.
They do not represent any clinical lung problems
bronchial
Bronchial breath sounds are loud and high pitched.

The expiratory is louder and longer than the

inspiratory component.

One listens over the manubrium

A definate pause is head between the two phases.
vesicular
These are the soft, low bitched sounds herd over most
of the lung fields.
The inspiratory phase is much longer than the
expiratory phase which much softer and frequently un
audible
Bronchovesicular 
Bronchovesicular sounds are heard in the posterior
chest between the scapulae and in the center part of
the anterior chest.
 Bronchovesicular sounds are about equal during
inspiration and expiration.
 Pathological sounds
1. Crackles
These are short discontinuous, non musical sounds
heard mostly during inspiration.
Crackles are like the sound made by rubbing hair next to
the ear.
The common causes of crackles include:
Congestive heart failure, pulmonary edema, pulmonary
fibrosis, pneumonia.
Cont…
2. wheeze
These are continuous , musical, high pitched sounds
heard mostly during expiration
They are produced by airflow through narrowed
bronchi.
These narrowing may be due to swelling, secretions,
spasm, tumor, or foreign body.
Wheeze is commonly associated with broncho-spasm of
asthma
Cont…
3. Pleural rub
Pleural rub is an abnormal lung sound which is caused
by inflammation of the pleural layer of the lungs
rubbing together.
 this is low-pitch harsh/grating noises.
It is heard at the end of inspiration and at the
beginning of expiration.