Nursing 2220The Respiratory System

Nursing Assessment (Auscultation)

By Ginger VanDenBerg

Respiratory & AuscultationCourse Objectives

Discuss upper and lower respiratory anatomy

Discuss ventilation versus oxygenation Identify nursing auscultation assessment of

the respiratory system Define assessment of normal versus

abnormal respiratory sounds

Respiratory AnatomyOverview

Upper Respiratory System

-Nasal Cavity

-Oral Cavity

-Pharnyx

Respiratory AnatomyOverview

Lower Respiratory System

-Larnyx (Opening of the trachea)

-Trachea (Windpipe)

-Lungs (right/left)

-Bronchus (divides into right/left)

Upper & Lower Respiratory anatomy is consider to be the CONDUCTING portion No Gas Exchange Occurs

Respiratory Anatomy Overview

Terminal Bronchioles (<1mm diameter

Alveolar Ducts

Alveolar Sacs -Actual units of gaseous exchange in lungs

Respiratory bronchioles to alveoli is consider to be the Respiratory Portion Gas Exchange does occur

POP QuizStructures of the upper airway

include all of the following except?a. Nasal Cavityb. Oral Cavity

c. Pharnyxd. Larnyx

Nursing Auscultation Assessment

Place the diaphragm of your stethoscope over the posterior chest between the ribs

Ask patient to take slow – deep breaths

Listen to an entire inspiration & expiration cycle at each position

Compare the sounds in one region to sounds in the same region on the opposite side

Anterior follows same pattern as posterior, with attention to the lower lobes for increased secretions

Normal Breath SoundsPosterior Thorax

Posterior Thorax Sounds

Bronchovesicular – medium pitched blowing sounds, between the scapulae. Equal inspiratory & expiratory phases

Vesicular- heard over the lung periphery, smaller airways, soft & low pitched. Inspiratory phase is about 3x longer than expiratory phase

Normal Breath SoundsAnterior Thorax

Anterior Thorax Sounds Bronchovesicular &

vesicular sounds-are heard above & below the clavicles and along the lung periphery

Bronchial-loud, high pitched, hollow sound, heard over the trachea, expiration last longer than inspiration

POP Quiz During auscultation the nurse compares lung sounds on one side of the body to lung sounds in the same field on the opposite of the body?

a. Trueb. False

Abnormal Breath Sounds

(Adventitious) Crackles-heard in dependent lobes,

lung bases, sudden reinflation of alveoli. Bowl of rice krispies

Ronchi-heard over trachea & bronchi, caused by muscular spasm, fluid or mucus in larger airways, turbulent sound

Wheezes-heard over all lung fields, high-velocity airflow through narrow bronchus

Pleural friction rub-heard over anterior lung surface, parietal pleura rubbing against visceral pleura

Final POP Quiz The following lungs sounds are considered to

be advantitious except?a. Cracklesb. Ronchi

c. Vesculard. Wheezes

The End

Questions and AnswersPlease referred to the our assigned discussion

board for questions and answers

References Nursing Assessing Lung Sounds (n.d.). Retrieved from

http://www.barcharts.com/Inventory/Navision/97815722276133.

Potter, P. A., Perry, A. G., Stocker, P. A. & Hall, A. (2010). Basic Nursing (7th ed.), St. Louis, MO: Elsevier Health Science.

Respiratory System (n.d.). Retrieved from http://www.medical/exam-essentials.com/respiratory-system-diagram.html.