Adult Health Exam (Respiratory)
Role of the respiratory system
Oxygenation and tissue perfusion
Patient history relating to the respiratory system
- family and personal data
- smoking and pack years
- drug use
- allergies
- travel
- nutritional status
- cough, sputum production, chest pain, dyspnea, orthopnea
Indicators of respiratory adequacy
- clubbing
- weight loss
- unevenly developed muscles
- skin and mucous membrane changes
- general appearance
- endurance
Psychosocial assessment
- stress may worsen some respiratory problems
- chronic respiratory disease may cause changes in family roles, social isolation, financial problems due
to unemployment or disability
- discuss coping mechanisms, offer access to support systems
Testing for respiratory
- laboratory
- function
- non-invasive
- invasive
Lab Tests
- blood (ABGs)
- sputum
- pertussis
- viral
Pulmonary function testing
,- noninvasive
- spirometry (incentive spirometer)
- evaluate lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance,
distribution of ventilation
Capnometry and Capnography
- noninvasive
- measure amount of carbon dioxide present in exhaled air
- normal pressure between 20 and 40
Non-invasive testing
- standard chest x-rays and CT
- ventilation and perfusion scan
- pulse oximetry
Invasive diagnostic testing
- endoscopy
- bronchoscopy
- laryngoscopy
- mediastinoscopy
Thoracentesis
- invasive diagnostic test
- aspiration of pleural fluid or air from the pleural space
- stinging sensation and feeling pressure
- correct position (sitting down, bending forward, arms on table)
- motionless patient
- follow-up assessment for complications
Lung biopsy
- invasive diagnostic test
- obtain tissue for histologic analysis, culture, cytologic examination
- may be performed in patient's room
Follow up care for invasive testing
- assess vital signs
- breath sounds at least every 4 hours for 24 hours
- assess for respiratory distress
- report reduced/absent breath sounds immediately
- monitor for hemoptysis
Why do we need oxygen?
- essential for life and function of cells/tissues
- respiratory, cardiovascular, hematologic systems work together, providing sufficient tissue perfusion to
, the body
- oxygen therapy improves oxygenation and tissue perfusion
Clinical manifestations of respiratory distress
- dyspnea
- nasal flaring
- use of accessory muscles to breathe
- pursed-lip or diaphragmatic breathing
- decreased endurance
- skin, mucous membrane changes (pallor, cyanosis)
- chest pain
Respiratory assessment
- nose and sinus
- pharynx, trachea, larynx
- lungs and thorax (movement, symmetry, fremitus, resonance, breath sounds)
- general appearance (muscle development)
- skin and mucous membranes
What is the best way to determine need for oxygen therapy?
ABG analysis
Purpose of oxygen therapy
Relieves hypoxemia (low levels of oxygen in blood)
Hypoxia
Decreased tissue oxygenation
Goal of oxygen therapy
Use lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side
effects
Type of oxygen used depends on:
- oxygen concentration required/achieved
- importance of accuracy and control of oxygen concentration
- patient comfort
- importance of humidity
- patient mobility
What is the basic level of O2 given?
2L nasal cannula
What happens when they need more oxygen than 2L?
Role of the respiratory system
Oxygenation and tissue perfusion
Patient history relating to the respiratory system
- family and personal data
- smoking and pack years
- drug use
- allergies
- travel
- nutritional status
- cough, sputum production, chest pain, dyspnea, orthopnea
Indicators of respiratory adequacy
- clubbing
- weight loss
- unevenly developed muscles
- skin and mucous membrane changes
- general appearance
- endurance
Psychosocial assessment
- stress may worsen some respiratory problems
- chronic respiratory disease may cause changes in family roles, social isolation, financial problems due
to unemployment or disability
- discuss coping mechanisms, offer access to support systems
Testing for respiratory
- laboratory
- function
- non-invasive
- invasive
Lab Tests
- blood (ABGs)
- sputum
- pertussis
- viral
Pulmonary function testing
,- noninvasive
- spirometry (incentive spirometer)
- evaluate lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance,
distribution of ventilation
Capnometry and Capnography
- noninvasive
- measure amount of carbon dioxide present in exhaled air
- normal pressure between 20 and 40
Non-invasive testing
- standard chest x-rays and CT
- ventilation and perfusion scan
- pulse oximetry
Invasive diagnostic testing
- endoscopy
- bronchoscopy
- laryngoscopy
- mediastinoscopy
Thoracentesis
- invasive diagnostic test
- aspiration of pleural fluid or air from the pleural space
- stinging sensation and feeling pressure
- correct position (sitting down, bending forward, arms on table)
- motionless patient
- follow-up assessment for complications
Lung biopsy
- invasive diagnostic test
- obtain tissue for histologic analysis, culture, cytologic examination
- may be performed in patient's room
Follow up care for invasive testing
- assess vital signs
- breath sounds at least every 4 hours for 24 hours
- assess for respiratory distress
- report reduced/absent breath sounds immediately
- monitor for hemoptysis
Why do we need oxygen?
- essential for life and function of cells/tissues
- respiratory, cardiovascular, hematologic systems work together, providing sufficient tissue perfusion to
, the body
- oxygen therapy improves oxygenation and tissue perfusion
Clinical manifestations of respiratory distress
- dyspnea
- nasal flaring
- use of accessory muscles to breathe
- pursed-lip or diaphragmatic breathing
- decreased endurance
- skin, mucous membrane changes (pallor, cyanosis)
- chest pain
Respiratory assessment
- nose and sinus
- pharynx, trachea, larynx
- lungs and thorax (movement, symmetry, fremitus, resonance, breath sounds)
- general appearance (muscle development)
- skin and mucous membranes
What is the best way to determine need for oxygen therapy?
ABG analysis
Purpose of oxygen therapy
Relieves hypoxemia (low levels of oxygen in blood)
Hypoxia
Decreased tissue oxygenation
Goal of oxygen therapy
Use lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side
effects
Type of oxygen used depends on:
- oxygen concentration required/achieved
- importance of accuracy and control of oxygen concentration
- patient comfort
- importance of humidity
- patient mobility
What is the basic level of O2 given?
2L nasal cannula
What happens when they need more oxygen than 2L?
