Nurs 421 exam 2/respiratory system assessment and diognostic
guide 2022
• Oxygenation & Tissue Perfusion:
o Delivery of oxygen to the cells and tissues requires the pumping mechanism of the
heart and oxygen-carrying mechanism of the hemoglobin in red blood cells
o When oxygen needs increase, oxygen intake through the respiratory system
increases to compensate (or adapt by increasing rate and depth of respiration, along
with increased heart rate and blood pressure) and to keep oxygen delivery to the tissues
in balance with their oxygen need.
o Some health problems reduce the body’s ability to compensate when oxygen need
is greater than basic (basal) levels. (i.e. Asthma: they may be able to take in enough
oxygen to meet basic oxygen needs but cannot adjust or compensate when a greater
oxygen intake is needed- exercise. The heart will compensate MORE to increase
delivery of the set amount of oxygen taken in by the lungs.)
• Structure and Function:
o Upper Respiratory Tract: nares, naso/oro/laryngopharynx, hard/soft palate,
trachea, epiglottis deliver/filter air to LRT
o Lower Respiratory Tract
▪ Bronchioles:
• L: lower and less accessible b/c of location of heart
• R: higher and more accessible than left; helps w/ intubation
▪ Gas exchange happens in alveoli (air sacs) [exchange O2 and CO2]
• If disrupted or filled with fluid, gas exchange can’t occur
• Population Considerations:
o Gerontological (Older Pop.)
▪ Structural Changes Intercostal muscles not as strong (slumped position
constantly)
▪ Defense Mechanism Changes
▪ Respiratory Control
o Cultural/Gender
▪ Dark skin decreased SaO2 read(does not reflect true O2 status)
• Want pink mucous membranes, can they carry on conversation?
▪ Female
• Increased bronchial hyperactivity
o Asthma, juvenile, exercise induced
• Decreased lung mass
o Pregnancy, etc.
▪ Compensatory mechanisms
• Respiratory Assessment Questions: Need to know hx of current illness; then ask about other
resp questions
o Childhood illnesses (asthma, cystic fibrosis, etc.)
o Adult illnesses (COPD, pneumonia, TB, etc.)
o Vaccinations (Flu and Pneumonia)
o Smoking History
o Nutritional Status
,Nurs 421 exam 2/respiratory system assessment and diognostic
guide 2022
• Respiratory Assessment Techniques:
o Inspection: WOB (work of breathing), Retractions, labored/unlabored
o Palpation: Symmetry (expansion in both, vibrations)
o Percussion: Try to get b/t ribs (normal: resonant [sound bounces through air])
o Auscultation: Listen through all lung fields
▪ Need at least 4-5 fields (posterior best)
• Anatomical Dead Space: Place where air flows but the structures are too thick for gas exchange.
o Approximately 30% of Tidal Volume
▪ Tidal volume: amount of air exchange with each breath
o Stale alveolar air at end of expiration
o First air to enter alveoli during inspiration
• Surfactant: Lipoprotein (fatty, slippery)
o Decreases surface tension in alveoli
o Decreases amount of pressure needed to inflate alveoli
o Prevents collapse of alveoli
o If not enough, won’t open alveoli
o Body knows more needed: cough forces air in stress of being pressed open tells it
needs to make more surfactant
• Atelectasis (collapsed lung): Area of collapsed alveoli
o Not the same as pneumonia (infection w/fluid)
o Causes: surgery, increased chest pressure, blocked airway, lung conditions (lung
cancer, pneumonia, pleural effusion, RDS, etc.)
o Manifestations: lowered O2 sats, lowered PaO2 in blood, SOB, increased HR,
coughing, angina, skin and lips turning blue
o Assessment:
▪ Hear bronchial sounds rather than vesical
▪ Diminished/absent breath sounds
o Diagnosis: x-ray, CT; severe cases can see w/ bronchoscopy to visualize blockage
• Chest Wall:
o Thoracic Cage (ribs and sternum)
o Pleura: fluid in between spaces to keep them unstuck from each other and
moving properly
▪ Parietal pleura: On the outside
▪ Visceral pleura: On the inside
o Respiratory Muscles
• Elastic Recoil & Compliance:
o Elastic Recoil: Ability to recoil after being stretched or expanded
▪ Decreased elasticity fibrotic lungs
o Compliance: A measure of the elasticity of lungs and thorax
▪ Inflatability of the lungs
▪ Decreased compliance hard to inflate
▪ Increased compliance like a Walmart sack; didn’t get any good gas exchange
• How body knows where to drop off O2
o Oxygen tension: tissue tells how much O2 needs to be dropped of when flowing through
(ex: wound, broken bone, etc)
,Nurs 421 exam 2/respiratory system assessment and diognostic
guide 2022
• Therapeutic Modalities:
o Oxygen Therapy
▪ Requires an order Oxygen is considered a medication
▪ Oxygen-induced hypoventilation Our need for O2 is driven by hypoxia
• We all have certain level of hypoxia don’t have to turn blue to be
hypoxic
▪ Oxygen toxicity Lung damage may occur when an oxygen level greater than
50% is given continuously for more than 24-48 hours
• Always give O2 at lowest effective dose can OD someone on O2
▪ Indicated for pts with hypoxemia as indicated by ABGs
• PAO2 < 60mm Hg
• SAO2 < 90%
▪ Categories:
• Low flow
• Reservoir
• High flow
▪ Delivery Systems:
• Low flow system:
o Nasal Cannula
o Simple Facemask
o Partial Rebreather
o Non-Rebreather
• High flow system: provide all the gas pt needs; doesn’t have to be
only O2
o Venturi mask
o Face Tent
o Aerosol mask
o Tracheostomy Collar
o T-piece
• Trach Tube: Inserted directly into trachea via an incision in the neck
o Bypasses the pharynx, epiglottis, & larynx preventing damage to these structures
o May be single or double lumen
o Try to keep on vent for 2 wks before moving to trach b/c of ulceration damage to
mucous membranes
o Tracheostomy tube may or may not have a cuff
• CPAP: Continuous Positive Airway Pressure
o Delivers set positive airway pressure throughout each cycle of inhalation and exhalation
o Pushes air into pts lungs Opens collapsed alveoli
o Used for atelectasis after surgery or cardiac-induced pulmonary edema, sleep apnea
o Ventilation mechanical process; exchanging gases; opening/closing alveoli and moving
gases to then help in oxygenation process
o NEEDS GOOD SEAL
o BiPAP Can be used to stall a vent
• Diagnostic & Laboratory Tests:
o Radiography: x-ray
, Nurs 421 exam 2/respiratory system assessment and diognostic
guide 2022
▪ CXR: Used for screening, diagnosis, and evaluation of change in
respiratory disorders
• Patient Prep: explain procedure, remove all metal objects between
neck and chest
• Posteroanterior (PA) and Left Lateral views are most common…
taken on full inspiration
▪ CT Scan: Differentiates calcified lesions from tumors, detects small nodules
and effusions
• Patient Prep:
o NPO 4hrs prior to test if contrast used
▪ Contrast makes you feel like you pee yourself (hot
and tingly)
▪ Need functioning large bore IV
o Allergies to iodine/contrast/shellfish
▪ Give Benadryl drip/premedicate
o Remove all metal
o Must lie still during test
▪ Give sedative
▪ Pulmonary Angiography: Visualizes pulmonary vasculature, helps detect
obstructions of pulmonary vessels
• ***Provides a definitive diagnosis for Pulmonary Embolism***
• Patient prep:
o NPO except sips H2O 4-6hrs prior
o Allergies to iodine/contrast
o Monitor VS, BP 4-6 hrs, monitor dressing for bleeding
and urinary output
▪ MRI: Produces images of soft tissue detail that can differentiate between
tumors, cysts, and abscesses
• Patient prep:
o Remove all metal objects
o May cause claustrophobia
o Patient should void prior to test
▪ Ventilation-Perfusion Scan (V/Q): Used to screen and detect
thromboembolic diseases and obstructive lung diseases
• Patient prep: try not to use on pregnant
o Perfusion: IV for pts being injected with macro aggregated
albumin tagged with a radioisotope
o Ventilation: Pts receive an isotope via inhalation
o Pulse Oximetry
o Pulmonary function test: measuring tidal volume and how much air exhaled in
first second (forced exhaled volume 1)
▪ Pt with chronic lung breath on tube in pressurized room to measure room
difference and how much they put out
▪ Most accurate with use of spirometry
• Forced vital capacity (FVC): Volume of exhaled air from
full inhalation to full exhalation
guide 2022
• Oxygenation & Tissue Perfusion:
o Delivery of oxygen to the cells and tissues requires the pumping mechanism of the
heart and oxygen-carrying mechanism of the hemoglobin in red blood cells
o When oxygen needs increase, oxygen intake through the respiratory system
increases to compensate (or adapt by increasing rate and depth of respiration, along
with increased heart rate and blood pressure) and to keep oxygen delivery to the tissues
in balance with their oxygen need.
o Some health problems reduce the body’s ability to compensate when oxygen need
is greater than basic (basal) levels. (i.e. Asthma: they may be able to take in enough
oxygen to meet basic oxygen needs but cannot adjust or compensate when a greater
oxygen intake is needed- exercise. The heart will compensate MORE to increase
delivery of the set amount of oxygen taken in by the lungs.)
• Structure and Function:
o Upper Respiratory Tract: nares, naso/oro/laryngopharynx, hard/soft palate,
trachea, epiglottis deliver/filter air to LRT
o Lower Respiratory Tract
▪ Bronchioles:
• L: lower and less accessible b/c of location of heart
• R: higher and more accessible than left; helps w/ intubation
▪ Gas exchange happens in alveoli (air sacs) [exchange O2 and CO2]
• If disrupted or filled with fluid, gas exchange can’t occur
• Population Considerations:
o Gerontological (Older Pop.)
▪ Structural Changes Intercostal muscles not as strong (slumped position
constantly)
▪ Defense Mechanism Changes
▪ Respiratory Control
o Cultural/Gender
▪ Dark skin decreased SaO2 read(does not reflect true O2 status)
• Want pink mucous membranes, can they carry on conversation?
▪ Female
• Increased bronchial hyperactivity
o Asthma, juvenile, exercise induced
• Decreased lung mass
o Pregnancy, etc.
▪ Compensatory mechanisms
• Respiratory Assessment Questions: Need to know hx of current illness; then ask about other
resp questions
o Childhood illnesses (asthma, cystic fibrosis, etc.)
o Adult illnesses (COPD, pneumonia, TB, etc.)
o Vaccinations (Flu and Pneumonia)
o Smoking History
o Nutritional Status
,Nurs 421 exam 2/respiratory system assessment and diognostic
guide 2022
• Respiratory Assessment Techniques:
o Inspection: WOB (work of breathing), Retractions, labored/unlabored
o Palpation: Symmetry (expansion in both, vibrations)
o Percussion: Try to get b/t ribs (normal: resonant [sound bounces through air])
o Auscultation: Listen through all lung fields
▪ Need at least 4-5 fields (posterior best)
• Anatomical Dead Space: Place where air flows but the structures are too thick for gas exchange.
o Approximately 30% of Tidal Volume
▪ Tidal volume: amount of air exchange with each breath
o Stale alveolar air at end of expiration
o First air to enter alveoli during inspiration
• Surfactant: Lipoprotein (fatty, slippery)
o Decreases surface tension in alveoli
o Decreases amount of pressure needed to inflate alveoli
o Prevents collapse of alveoli
o If not enough, won’t open alveoli
o Body knows more needed: cough forces air in stress of being pressed open tells it
needs to make more surfactant
• Atelectasis (collapsed lung): Area of collapsed alveoli
o Not the same as pneumonia (infection w/fluid)
o Causes: surgery, increased chest pressure, blocked airway, lung conditions (lung
cancer, pneumonia, pleural effusion, RDS, etc.)
o Manifestations: lowered O2 sats, lowered PaO2 in blood, SOB, increased HR,
coughing, angina, skin and lips turning blue
o Assessment:
▪ Hear bronchial sounds rather than vesical
▪ Diminished/absent breath sounds
o Diagnosis: x-ray, CT; severe cases can see w/ bronchoscopy to visualize blockage
• Chest Wall:
o Thoracic Cage (ribs and sternum)
o Pleura: fluid in between spaces to keep them unstuck from each other and
moving properly
▪ Parietal pleura: On the outside
▪ Visceral pleura: On the inside
o Respiratory Muscles
• Elastic Recoil & Compliance:
o Elastic Recoil: Ability to recoil after being stretched or expanded
▪ Decreased elasticity fibrotic lungs
o Compliance: A measure of the elasticity of lungs and thorax
▪ Inflatability of the lungs
▪ Decreased compliance hard to inflate
▪ Increased compliance like a Walmart sack; didn’t get any good gas exchange
• How body knows where to drop off O2
o Oxygen tension: tissue tells how much O2 needs to be dropped of when flowing through
(ex: wound, broken bone, etc)
,Nurs 421 exam 2/respiratory system assessment and diognostic
guide 2022
• Therapeutic Modalities:
o Oxygen Therapy
▪ Requires an order Oxygen is considered a medication
▪ Oxygen-induced hypoventilation Our need for O2 is driven by hypoxia
• We all have certain level of hypoxia don’t have to turn blue to be
hypoxic
▪ Oxygen toxicity Lung damage may occur when an oxygen level greater than
50% is given continuously for more than 24-48 hours
• Always give O2 at lowest effective dose can OD someone on O2
▪ Indicated for pts with hypoxemia as indicated by ABGs
• PAO2 < 60mm Hg
• SAO2 < 90%
▪ Categories:
• Low flow
• Reservoir
• High flow
▪ Delivery Systems:
• Low flow system:
o Nasal Cannula
o Simple Facemask
o Partial Rebreather
o Non-Rebreather
• High flow system: provide all the gas pt needs; doesn’t have to be
only O2
o Venturi mask
o Face Tent
o Aerosol mask
o Tracheostomy Collar
o T-piece
• Trach Tube: Inserted directly into trachea via an incision in the neck
o Bypasses the pharynx, epiglottis, & larynx preventing damage to these structures
o May be single or double lumen
o Try to keep on vent for 2 wks before moving to trach b/c of ulceration damage to
mucous membranes
o Tracheostomy tube may or may not have a cuff
• CPAP: Continuous Positive Airway Pressure
o Delivers set positive airway pressure throughout each cycle of inhalation and exhalation
o Pushes air into pts lungs Opens collapsed alveoli
o Used for atelectasis after surgery or cardiac-induced pulmonary edema, sleep apnea
o Ventilation mechanical process; exchanging gases; opening/closing alveoli and moving
gases to then help in oxygenation process
o NEEDS GOOD SEAL
o BiPAP Can be used to stall a vent
• Diagnostic & Laboratory Tests:
o Radiography: x-ray
, Nurs 421 exam 2/respiratory system assessment and diognostic
guide 2022
▪ CXR: Used for screening, diagnosis, and evaluation of change in
respiratory disorders
• Patient Prep: explain procedure, remove all metal objects between
neck and chest
• Posteroanterior (PA) and Left Lateral views are most common…
taken on full inspiration
▪ CT Scan: Differentiates calcified lesions from tumors, detects small nodules
and effusions
• Patient Prep:
o NPO 4hrs prior to test if contrast used
▪ Contrast makes you feel like you pee yourself (hot
and tingly)
▪ Need functioning large bore IV
o Allergies to iodine/contrast/shellfish
▪ Give Benadryl drip/premedicate
o Remove all metal
o Must lie still during test
▪ Give sedative
▪ Pulmonary Angiography: Visualizes pulmonary vasculature, helps detect
obstructions of pulmonary vessels
• ***Provides a definitive diagnosis for Pulmonary Embolism***
• Patient prep:
o NPO except sips H2O 4-6hrs prior
o Allergies to iodine/contrast
o Monitor VS, BP 4-6 hrs, monitor dressing for bleeding
and urinary output
▪ MRI: Produces images of soft tissue detail that can differentiate between
tumors, cysts, and abscesses
• Patient prep:
o Remove all metal objects
o May cause claustrophobia
o Patient should void prior to test
▪ Ventilation-Perfusion Scan (V/Q): Used to screen and detect
thromboembolic diseases and obstructive lung diseases
• Patient prep: try not to use on pregnant
o Perfusion: IV for pts being injected with macro aggregated
albumin tagged with a radioisotope
o Ventilation: Pts receive an isotope via inhalation
o Pulse Oximetry
o Pulmonary function test: measuring tidal volume and how much air exhaled in
first second (forced exhaled volume 1)
▪ Pt with chronic lung breath on tube in pressurized room to measure room
difference and how much they put out
▪ Most accurate with use of spirometry
• Forced vital capacity (FVC): Volume of exhaled air from
full inhalation to full exhalation
