Respiratory Assessment

Jan Bazner-Chandler
CPNP, CNS, MSN, RN

Respiratory

Bifurcation of trachea

Change in chest wall shape

Upper Airway Characteristics

Narrow tracheo-bronchial lumen until age 5

Tonsils, adenoids, epiglottis proportionately
larger in children
Tracheo-bronchial cartilaginous rings collapse
easily
Infants up to 4-6 weeks are obligate nose
breathers
Tongue is large in proportion to the mouth

Lower Airway Characteristics

Lack of firm bony structure to ribs/chest make

child more prone to retractions when in
respiratory distress
Fewer alveoli in the neonate
Poor quality of alveoli until age 8
Lack of surfactant that lines the alveoli in the
premature infant

Inhibits alveolar collapse at end of expiration

Focused Health History

Reason for the visit

Include questions about the environment

What makes condition worse triggers

Allergies

Past medical history: birth history, previous

health problems, childhood illness,
immunizations
Family medial history: respiratory illness
genetic link

Focused Physical Assessment

Types of breathing:

Less than 7 years abdominal breathing

Greater than 7 years abdominal breathing can

indicate problems

Respiratory Rate

Inspiratory phase slightly longer or equal to

expiratory phase

Prolonged expiratory phase = asthma

Prolonged inspiratory phase = upper airway
obstruction

Croup
Foreign body

Color

Observe color of face, trunk, and nail beds

Cyanosis = inadequate oxygenation

Clubbing of nails = chronic hypoxemia

Respiratory Distress

Grunting = impending respiratory failure

Severe retractions
Diminished or absent breath sounds
Apnea or gasping respirations
Poor systemic perfusion / mottling
Tachycardia to bradycardia
Decrease oxygen saturations

Chest Muscle Retraction

Chest Retractions

Retractions suggest an obstruction to

inspiration at any point in the respiratory
tract.
As intrapleural pressure becomes increasingly
negative, the musculature pulls back in an
effort to overcome the blockage.
The degree and level of retraction depend on
the extent and level of the obstruction.

Diagnostic Tests

Detects abnormalities of chest or lungs

Chest x-ray
Sweat chloride Test
MRI
Laryngoscope / bronchoscopy
CT Scan

White Patchy Infiltrates

X-ray Hyperinflation of Lung

Vh.org

Pleural Effusion

Pleural Effusion X-Ray

vh.org

Foreign Body Aspiration

A foreign body in one

or the other of the bronch
causes unilateral
retractions.
*usually the right due to
broader bore and more
vertical placement.

Sweat Test for Cystic Fibrosis

Gold Standard test

for Cystic Fibrosis

Oxygen Therapy: Nursing

Interventions

Proper concentration

Adequate humidity: make sure there is fluid in the bottle

Make sure prongs are in nose and that the nares are
patent suction out nares to increase oxygen flow

Monitor oxygen SATS: if alarm keeps on going off but the

infant / child looks good, check the device

Monitor activity level or infant / child

Aerosol Therapy

Respiratory Therapist will do the treatment

Communicate with therapist eliminated
needless paging for treatments
Treatment should be done before the infant
eats
When you make your morning rounds assess if
there is any infant / child that needs an
immediate treatment

Home Teaching Inhaled Medications

Correct dosage
Prescribed time
Proper use of inhaler
No OTC drugs
Encourage fluids
When to call physician

Aerosol Therapy

Medication
administered
by oxygen or
compressed
air.

Outpatient Aerosol Treatment

Postural Drainage and Percussion

In the small child you can position on
your lap
Do first thing in the AM
Do before meals or one hour after
Do after the aerosol treatment since the
treatment will help open the airways and
loosen the mucous
Suction the infant after treatment teach
parents to do bulb suction

Percussion
and
postural
drainage

Mechanical Ventilation

Alterations in Respiratory Function

Severe Respiratory Distress

Nasal flaring and grunting
Severe retractions
Diminished breath sounds
Hypotonia
Decreased oxygen saturations

What to do if infant / child in

respiratory distress!

Stimulate the infant / child - remember crying

or activity will help mobilize secretions and
expand lungs
Have the older child sit up take deep breaths
and cough
Chest percussion to loosen secretions
Give oxygen
Assess if interventions work
Call for help if you need it pull the
emergency cord yell for help