Lungs and Respiratory
System
Chapter 17
General Health History
• Present health status: chronic illness,
medications (what/when), allergies,
oxygen/inhaler, smoke(ed) (what/how long)?
• Past medical history: lung problems,
respiratory diseases or chest injury, surgery
and infections (what/describe)?
• Family history: any lung diseases
(who/what)?
Health History: General History
• Home environment: environmental conditions that
affect breathing (air pollution, allergens,
heating/AC, hobbies, secondhand smoke)?
• Occupational environment: where work, exposure
to irritants and toxins (wear protection, ventilation,
monitor, health exams)?
• Travel: traveled to countries or areas where
exposed to uncommon respiratory diseases?
Problem-Based History
• Cough
– First noticed, constant or intermittent, changed (worse),
describe (dry, productive, hacking, hoarse)?
– Productive: first noticed, changes, how often/much,
characteristics (color, consistency, odor), cause, other
symptoms, treated (effectiveness)?
• Shortness of breath
– Experience, how long, episodic (severity, frequency);
describe (inhale/exhale), interfere with activities, getting
better or worse?
– Triggers, other problems (what relieves)?
Problem-Based History
• Chest pain with breathing
– How long, when started, sudden or gradual,
where, radiate?
– Feel like, intensity, constant or intermittent,
associated with injury or infection, worse with
deep breaths, interfere with getting air?
– What makes worse, how treated
(effectiveness)?
Problem-Based History
• Hoarseness or voice change
– How long, constant or intermittent?
– Clear throat often, what makes worse,
associated with cold or sore throat?
– What makes better, how treated,
effectiveness?
Examination Overview
• General appearance
– Inspect: appearance, posture, breathing effort
• Chest wall configuration
– Inspect: shape and symmetry, muscle
development, diameter ratios, costal angle
• Oxygenation and respiratory effort
– Inspect: fingernails, skin, lips for color
– Observe respirations: rate,, pattern, expansion
Examination Techniques
• Anterior and posterior chest
– Palpate trachea: position
– Palpate chest and thoracic muscles:
tenderness, bulges, symmetry
Examination Techniques
• Anterior and posterior chest
– Auscultate thorax: breath sounds (bronchial,
vesicular, bronchovesicular)
• Location
• Characteristics
• Adventitious sounds: crackles, wheezes, rhonchi
• Stridor: harsh, high-pitched sound associated with
obstruction
Age-Related Variations:
Older Adults
• Health history
– Flu or pneumococcal shot?
– Fatigue and shortness of breath during daily
activities, harder to breathe, not as deep,
decreased energy and ability to complete
activities?
– Gained or lost weight (how much)?
Age-Related Variations:
Older Adult
• Examination: techniques and procedures
– Same as for younger adult
– Correlate findings with history
• Normal and abnormal findings
– Same as for adult
– Structural and functional differences
• Posterior thoracic stooping, bending, kyphosis:
adequate chest expansion difficult, causing decreased
tidal volume, contributing to shallow breathing
• Decreased lung expansion may be secondary to
sedentary lifestyle, disability, weakness
Common Problems and Conditions:
Infections/Inflammatory Conditions
• Acute bronchitis: inflammation of bronchial
tree (infection)
– Caused by viruses or bacteria
– Cough: common initial sign (initially
nonproductive, then productive after few days
– Substernal chest pain: aggravated by
coughing
– Also fever, malaise, tachypnea; rhonchi or
crackles; wheezing after coughing
Common Problems and Conditions:
Infections/Inflammatory Conditions
• Pneumonia: infection of terminal
bronchioles/alveoli
– Caused by bacteria, fungi, viruses, Viral
pneumonia, nonproductive cough; bacterial,
productive cough (white, yellow, green
sputum)
– Fever, tachypnea, dyspnea
Common Problems and Conditions:
Infections/Inflammatory Conditions
• Tuberculosis: bacterial infectious disease,
primary in lung; may include kidney, bone, lymph
node, meninges
– Screening: Mantoux’s test (PPD); diagnosis confirmed
by sputum culture (AFB)
• Asymptomatic is early stage; initially fatigue,
anorexia, weight loss, night sweats, fever
• Later, cough that increases in frequency with
sputum production
Common Problems and Conditions:
Infections/Inflammatory Conditions
• Pleural effusion: accumulation of
nonpurulent fluid in plural space secondary
to inflammation (pneumonia,TB, cancer,
injury
• Manifestations depend on fluid amount or
position of patient (accumulation in
dependent areas)
– If rapid/large amount, dyspnea, intercostal
bulging, decreased chest wall movement
Common Problems and Conditions:
Infections/Inflammatory Conditions
• Fever with increased respiratory rate
• Breath sounds distant to absent
• Dyspnea or tachypnea; purulent sputum
• Crackles, wheezing, rhonchi—may clear
after coughing
Common Problems and Conditions:
Chronic Obstructive Pulmonary
Disease
• Descriptive term for cluster of respiratory
diseases
– Increased resistance to airflow or obstruction
– Emphysema, asthma, chronic bronchitis
– Cystic fibrosis: obstruction but not classified
as COPD
• Jugular vein distention, weight gain,
peripheral edema, bounding pulse,
enlarged liver
Common Problems and Conditions:
Acute or Traumatic Conditions
• Pneumothorax: air entering plural space
– Closed: spontaneous, traumatic, iatrogenic
– Open: chest penetration (trauma/surgery)
– Tension: air leaks into pleura, can’t escape
• All cause respiratory distress, tension; life
threatening, emergency intervention
• Signs depend on amount of lung collapse
– Minor: slight SOB, anxious, chest pain
– Large amount : severe distress, dyspnea, tachypnea,
cyanosis
Common Problems and Conditions:
Acute or Traumatic Conditions
• Hemothorax: blood in plural space (blunt
or penetrating injury; thoracic surgery)
• Manifestations similar to pneumothorax
– Distant muffled breath sounds or dullness of
affected area
Common Problems and Conditions:
Other Pulmonary Conditions
• Atelectasis: collapsed alveoli from
accumulation of secretions in terminal
bronchiole or hypoventilation
– Decreased/absent breath sound
– Areas above affected area – increased
volume/clarity with egophony/whispered
pectoriloquy
– Oxygen saturation – decrease to < 90%
Common Problems and Conditions:
Other Pulmonary Conditions
• Lung cancer: uncontrolled growth of anaplastic
lung cells (tobacco smoke, asbestos, radiation,
noxious inhalants)
• Persistent cough
• May appear healthy or experience weight loss,
congestion, wheezing hemoptysis, labored
breathing, dyspnea
• Lungs sounds normal of diminished
• Partial obstruction wheezing