Respiratory Assessment (IPPA)

Age Infant Newborns 2 months to 1 year old 1 year old to 5 years old Adult Range 30 60 bpm >50 indicates fast breathing 40 59 bpm 30 49 bpm 20 39 bpm 12 20 bpm 16 20 bpm (main average) 18 main RR)

Check Tactile Fremitus 1. Patients arm across his chest 2. Nurse should open palms lightly place with fingers not touching the skin. 3. Ask patient to repeat 99 ( loud enough to produce palpable vibrations) Interpretations: (+) Intense Consolidation of the Lungs a. Less intense vibration emphysema b. No vibration bronchial obstruction Auscultation of Breath Sounds 1. Instruct patient to breathe thru his mouth (nose breathing alters the pitch of breath sounds) 2. Diaphragm should be against the skin. (effective for high frequency sounds bronchial sounds) 3. If patient is hairy, use a damp wash cloth. (for good sound transmission) Placement of Stethoscope for Common Breath Sounds (Normal Lung) 1. Tracheal Location: Above Supraclavicular Notch Quality of Sound: harsh, high pitch usually appreciated; I = E 2. Bronchial Location: above clavicles on each side of sternum, between scapula over manibrium Quality of Sound: loud high pitch; E > I 3. Bronchovesicular Location: Next to sternum, between scapula Quality of Sound: medium in loudness; pitch similar to tracheal; I = E 4. Vesicular Location: Remainder of lungs Quality of Sound: soft, low pitch

B. Vocal Fremitus Chest vibration that occurs as the patient speaks. Normal: Sound is not distinguishable Abnormal: Sound is loud & clear; abnormal transmission of sound indicates consolidated lung 1. Bronchophony Let patient speak 99 or blue moon (unusually loud sound indicates consolidated lung) 2. Egophony Let patient speak letter E (If A is heard instead of E indicates consolidated lung) 3. Whispered Pectoriloquy Let patient whisper 1, 2, 3 (If numbers are loud and clear indicates consolidated lung)

Normal Breath Sound: Silent or Quiet Abnormal Breath Sounds 1. Crackles non musical crackling sound heard during inspiration (inhalation). Fine Crackles Occurs when the patient stops inhaling (alveoli gas exchange stops; surfactant ) Best heard at the base of the lungs Sound: piece of hair being rubbed together; Velcro Occurs on the ff diseases: CHF Atelectasis (partial or total lung collapse) Asbestosis Pulmonary Fibrosis Silicosis 2. 3. 4. 5. Course Crackles Occurs when the patient starts to inhale Maybe heard thru lungs and mouth Sound: Harsh, louder, & low heard primarily in trachea and bronchi Occurs on the ff diseases: COPD Pulmonary Edema Severely Ill patients who cant cough (Rattle Death or Death Rattle)

Wheezing high pitch sound heard first during exhalation. Rhonchi Senorous low pitch, snoring sound heard during expiration. Stridor noisy breathing, loud high pitch, heard even w/o stethoscope Pleural Friction Rub low pitch rubbing, grating sound (sound of Velcro); Inspiration and Exhalation

ACUTE RESPIRATORY INFECTIONS (ARI) Diseases infecting the respiratory system, which trachea, bronchi, and lungs. Includes such illnesses a. Cough b. Colds c. Otitis Media d. Tonsillitis includes the nose, throat, ears, nostrils, e. f. g. h. Laryngitis Bronchiolitis Pneumonia Broncho Pneumonia

Classification of Severity of ARI Classification Mild Moderately Severe Severe Severe Complicated Symptoms Cough w/o fast breathing Cough and fast breathing Cough and chest in drawing Cough and cyanosis Inability to feed and drink

Cough Usually the first symptom of ARI which manifest a productive or non productive cough a. Productive Cough expectorations of sputum / phlegm b. Non Productive Cough harsh, dry, and no secretions When the body clears and removes bronchial debris from the lungs. Fast Breathing Sign of Moderately Severe ARI in a child with cough Child has a fast breathing if he breathes more >50 bpm. Chest In-drawing A child has chest in-drawing if the skin between his ribs goes in during inhalation. a. Intercostal Retractions indarwings between ribs b. Suprasternal Retractions indrawings above clavicles c. Substernal Retractions indrawings between breastbone

Cyanosis Indication of Severe Complicated ARI Bluish discoloration of lips and nail beds due to inadequate oxygenation of blood or secondary to hypoxia (decreases oxygen in cells; possible lung and heart disease) Grading Dyspnea Ask patient to grade shortness of breath from 0 (no difficulty) 10 (worst)

Grading Dyspnea in Hospital 0 = Not troubled with breathlessness except strenuous exercise 1= Troubled by shortness of breath when hurrying on a level path or walking up in a slight hill. 2 = Walks more slowly on a level path because of breathlessness 3 = Patient stops to breathe after walking of at least 100 yards or 91.5 meters on a level path. 4 = Too breathless to leave the house or during dressing or undressing 5 up = Difficulty of Breathing

Consider Cough Ask patient if its a productive or non productive cough. Ask the ff: a. Color b. Amount (1 tsp = 4 to 5 ml; 1 tbsp = 15 ml; 1 oz = 30 ml) c. Frequency d. How often

Characteristics of Sputum associated with Diseases 1. Asthma whitish, frothy (mabula) 2. Pneumonia a. If bacterial rusty (copperlike) b. If viral watery or rusty 3. Bronchitis gelatinous 4. Tuberculosis with blood streaks Hemoptysis Expectoration of sputum with blood tinge (blood + sputum) Color: frothy bright red or pink sputum (-) Litmus Paper Test (remains blue) Hematemesis Vomiting of blood (Blood + Food Particles) Usually mixed with food particles Color: Dark red usually COFFEE BROWN (+) Litmus Paper Test (turns into pink color)

UPPER RESPIRATORY TRACT BLEEDING 1. Oral Sores Blood mixed with saliva (blood + saliva) Indicates mouth and tongue laceration or gum bleeding (gingivitis) (-) Litmus Paper Test

2. Nasal Sinuses Tickling sensations (obstructed by blood clot) (-) Litmus Paper Test

Position of Patient with DOB 1. Tripod Sitting Position 2. Orthopneic Position Costochondral; Costochondritis chest pain due to inflammation and tenderness costochondral joints.