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CHAPTER 26 Respiratory System

TABLE 26-7

COMMON ASSESSMENT ABNORMALITIES

Respiratory System
FINDING
Inspection

DESCRIPTION

POSSIBLE ETIOLOGY AND SIGNIFICANCE*

Pursed-lip breathing

Exhalation through mouth with lips pursed together to

slow exhalation

COPD, asthma; suggests breathlessness

Strategy taught to slow expiration, dyspnea

Tripod position; inability

to lie flat

Learning forward with arms and elbows supported on

overbed table

COPD, asthma in exacerbation, pulmonary edema

Indicates moderate to severe respiratory distress

Accessory muscle use;

intercostal retractions

Neck and shoulder muscles used to assist breathing;

muscles between ribs pull in during inspiration

COPD, asthma in exacerbation, secretion retention

Indicates severe respiratory distress, hypoxemia

Splinting

AP diameter

Voluntary in tidal volume to pain on chest expansion

Thoracic or abdominal incision; chest trauma, pleurisy

AP chest diameter equal to lateral; slope of ribs more

horizontal (90 degrees) to spine

COPD, asthma, cystic fibrosis; lung hyperinflation;

advanced age

Tachypnea

Rate >20 breaths/min; >25 breaths/min in elderly

Fever, anxiety, hypoxemia, restrictive lung disease

Magnitude of above normal rate reflects increased work
of breathing

Kussmaul respirations

Regular, rapid, and deep respirations

Metabolic acidosis; in rate aids body in CO2 excretion

Cyanosis

Bluish color of skin best seen in lips and on the palpebral

conjunctiva (inside the lower eyelid)

Finger clubbing

Depth, bulk, sponginess of distal portion of finger (see

Reflects 5-6 g of hemoglobin not bound with oxygen;

oxygen transfer in lungs, cardiac output; nonspecific,
unreliable indicator

eFig. 26-2 on the Evolve website for this chapter)

Abdominal paradox

Chronic hypoxemia; cystic fibrosis, lung cancer,

bronchiectasis

Inward (rather than normal outward) movement of

abdomen during inspiration

Inefficient and ineffective breathing pattern; nonspecific

indicator of severe respiratory distress

Tracheal deviation

Leftward or rightward movement of trachea from normal

midline position

Nonspecific indicator of change in position of mediastinal

structures; medical emergency if caused by tension
pneumothorax; trachea deviates to the side opposite the
collapsed lung

Altered tactile fremitus

Increase or decrease in vibrations

In pneumonia, pulmonary edema; in pleural effusion,

Altered chest movement

Unequal or equal but diminished movement of two sides

of chest with inspiration

Unequal movement caused by atelectasis, pneumothorax, pleural effusion, splinting; equal but diminished
movement caused by barrel chest, restrictive disease,
neuromuscular disease

Hyperresonance

Loud, lower-pitched sound over areas that normally

produce a resonant sound

Lung hyperinflation (COPD), lung collapse (pneumothorax),

air trapping (asthma)

Dullness

Medium-pitched sound over areas that normally produce a

resonant sound

Density (pneumonia, large atelectasis), fluid pleural

Fine crackles

Series of short-duration, discontinuous, high-pitched sounds

heard just before the end of inspiration; result of rapid
equalization of gas pressure when collapsed alveoli or
terminal bronchioles suddenly snap open; similar sound to
that made by rolling hair between fingers just behind ear

Idiopathic pulmonary fibrosis, interstitial edema (early

pulmonary edema), alveolar filling (pneumonia), loss of
lung volume (atelectasis), early phase of heart failure

Coarse crackles

Series of long-duration, discontinuous, low-pitched sounds

caused by air passing through airway intermittently
occluded by mucus, unstable bronchial wall, or fold of
mucosa; evident on inspiration and, at times, expiration;
similar sound to blowing through straw under water;
increase in bubbling quality with more fluid

Heart failure, pulmonary edema, pneumonia with severe

congestion, COPD

Rhonchi

Continuous rumbling, snoring, or rattling sounds from

obstruction of large airways with secretions; most
prominent on expiration; change often evident after
coughing or suctioning

COPD, cystic fibrosis, pneumonia, bronchiectasis

Wheezes

Continuous high-pitched squeaking or musical sound caused

by rapid vibration of bronchial walls; first evident on
expiration but possibly evident on inspiration as obstruction
of airway increases; possibly audible without stethoscope

Bronchospasm (caused by asthma), airway obstruction

(caused by foreign body, tumor), COPD

Stridor

Continuous musical or crowing sound of constant pitch;

result of partial obstruction of larynx or trachea

Croup, epiglottitis, vocal cord edema after extubation,

foreign body

Palpation

lung hyperinflation; absent in pneumothorax, atelectasis

Percussion

space (pleural effusion)

Auscultation

AP, Anterior-posterior; COPD, chronic obstructive pulmonary disease.

*Limited to common etiologic factors. (Further discussion of conditions listed may be found in Chapters 27 through 29.)

Continued