KING GEORGE’S MEDICAL UNIVERSITY
K.G.M.U. COLLEGE OF NURSING
ASSESSMENT OF RESPIRATORY ASSESSMENT
SUBMITTED TO SUBMITTED BY
DR. RASHMI P. JOHN DIVYA PAL
PRINCIPAL M.SC. NURSING 1ST YEAR
K.G.M.U. ,COLLEGE OF NURSING K.G.M.U. COLLEGE OF NURSING
3/27/2023 1

OUTLINE
• Introduction
• Indications of assessment of respiratory system
• Purposes of assessment of respiratory system
• Parts of respiratory system and their function
• Preliminary measures
• Assessment of respiratory system
• Physical examination
• Diagnostic evaluation
3/27/2023 2

Introduction
• The Respiratory tract extends from the nose to the alveoli and includes not only
the air conducting passages also but the blood supply.
• The primary purpose of the respiratory system is gas exchange , which involves
the transfer of oxygen and carbon dioxide between the atmosphere and the blood.
• The respiratory system is divided into two parts:-
• The upper respiratory tract and the lower respiratory tract.
3/27/2023 3

Indications of assessment of respiratory system
Indications of respiratory system assessment:-
• Dyspnea
• Cough (wet or dry)
• Sore throat
• Running nose
• Sneezing
3/27/2023 4

Purposes
• To detect the abnormality of organs.
• To find out the abnormal sounds.
• Interpretations of vital signs.
• Inspection of patient’s breathing pattern.
• Skin colour and respiratory status.
• Auscultation of lung sounds, normal and abnormal.
3/27/2023 5

Upper respiratory tract
The upper respiratory tract includes-
• The nose
• Pharynx
• Adenoids
• Tonsils
• Epiglottis
• Larynx
• Trachea
3/27/2023 6

LOWER RESPIRATORY TRACT
• LUNGS
• THE BRONCHI
• BRONCHIOLES
• ALVEOLAR DUCTS
• ALVEOLI
3/27/2023 7

• The right lung is divided into three lobes-
• Upper
• Middle
• Lower
• The left lung into two lobes-
• Upper and lower
• The structures of the chest wall-ribs, pleura, muscles of respiration
3/27/2023 8

Nose
Also called external nares.
• Divided into two halves by the nasal septum.
• Contains the paranasal sinuses where air is warmed.
• Contains cilia which is responsible,
For filtering out foreign bodies.
3/27/2023 9

Internal nares - opening to exterior
• External nares - opening to pharynx
• Nasal conchae - folds in the mucous membrane that increase air turbulence and
ensures that most air contacts the mucous membranes.
3/27/2023 10

Functions
• Provides and airway for respiration.
• Moistens and warms entering air.
• Filters and cleans inspired air.
• Resonating chamber for speech.
• Detects odors in the air stream.
3/27/2023 11

Pharynx
• Common space used by both the respiratory and digestive systems.
• Commonly called the throat.
• Originates posterior to the nasal and oral cavities and extends inferiorly near the
level of the bifurcation of the larynx and esophagus.
• Common pathway for both air and food.
• Walls are lined by a mucosa and contain skeletal muscles that are primarily used for
swallowing.
• Flexible lateral walls are distensible in order to force swallowed food into the
esophagus.
3/27/2023 12

3/27/2023 13

Nasopharynx:-
• Contains the pharyngeal tonsils (adenoids) which aid in the body's immune
defense.
Oropharynx:-
• Back portion of the mouth that contains the palatine tonsils which aid in the
body's immune defense.
Laryngopharynx:-
• Bottom section of the pharynx where the respiratory tract divides into the
esophagus and the larynx. 3/27/2023 14

Larynx
Voice box is a short, somewhat cylindrical airway ends in the trachea, prevents
swallowed materials from entering the lower respiratory tract.
3/27/2023 15

• Conducts air into the lower respiratory tract.
• Produces sounds.
• Supported by a framework of nine pieces of cartilage (three individual pieces
and three cartilage pairs) that are held in place by ligaments and muscles.
3/27/2023 16

Bronchial tree
• A highly branched system of air-conducting passages that originate from the left and
right primary bronchi.
• Progressively branch into narrower tubes as they diverge throughout the lungs before
terminating in terminal bronchioles.
3/27/2023 17

• Incomplete rings of hyaline cartilage support the walls of the primary bronchi to
ensure that they remain open.
• Right primary bronchus is shorter, wider, and more vertically oriented than the
left primary bronchus.
• Foreign particles are more likely to lodge in the right primary bronchus.
3/27/2023 18

Lungs
• Each lung has a conical shape.
• Its wide, concave base rests upon the muscular diaphragm.
• Its superior region called the apex projects superiorly to a point that is slightly
superior and posterior to the clavicle.
• Both lungs are bordered by the thoracic wall anteriorly, laterally, and posteriorly,
and supported by the rib cage.
3/27/2023 19

• Toward the midline, the lungs are separated from each other by the mediastinum.
• The relatively broad, rounded surface in contact with the thoracic wall is called
the costal surface of the lung.
3/27/2023 20

Inhalation
Breathing in is called inhalation (inspiration) each inhalation, the air pressure
inside the lungs is equal to the air pressure of the atmosphere, which is about 760
mmhg.
• Air to flow into the lungs, the pressure inside the alveoli
• Must become lower than the atmospheric pressure.
• This condition is achieved by increasing the size of the lungs.
3/27/2023 21

Exhalation
• Breathing out or exhalation starts when the inspiratory muscles relax. As
• The diaphragm relaxes, its dome moves superiorly owing to its elasticity.
• As the external intercostals relax, the ribs are depressed.
• The pressure in the lungs is greater than the pressure of the atmosphere. Normal
exhalation during quiet breathing.
3/27/2023 22

It is a passive process because no muscular contractions are involved. Instead,
exhalation results from elastic recoil of the chest wall and
• Lungs, both of which have a natural tendency to spring back after they
have been stretched.
• Two inwardly directed forces contribute to elastic recoil:
• A. The recoil of elastic fibers that were stretched during inhalation b. The inward
pull of surface tension due to the film of alveolar fluid.
3/27/2023 23

Physiology of respiration
The process of gas exchange in the body, called respiration, it has three basic steps:
1. Pulmonary ventilation or breathing: -
• It is the inhalation (inflow) and exhalation (outflow) of air and involves the
exchange of air between the atmosphere and the alveoli of the lungs.
3/27/2023 24

External (pulmonary) respiration:-
• It is the exchange of gases between the alveoli of the lungs and the blood in
pulmonary capillaries across the respiratory membrane.
• In this process, pulmonary capillary blood gains o, and loses co₂
3/27/2023 25

3. Internal (tissue) respiration:-
• It is the exchange of gases between blood in systemic capillaries and tissue cells.
In this step the blood loses 0, and gains CO₂. Within cells, the metabolic
reactions that consume 0, and give off CO, during the production of ATP are
termed cellular respiration.
3/27/2023 26

Physical examination
Preparation:-
• Ask the person to sit upright and disrobe to the waist
• Provide warm room,a warm diaphragm endpiece perform inspection,palpation,
percussion and auscultation on the
• Posterior and lateral thorax
• Then repeat anterior chest
• Clean the stethoscope end piece with alcohol wipe
3/27/2023 27

Mouth and pharynx
• Inspects the interior of the mouth for color, lesions, masses, gum retraction,
bleeding, and poor dentation.
• Tongue is inspected for symmetry and presence of lesions inspect pharynx for
exudate, ulceration, swelling or postnasal.
• Drip tonsils are noted for colour, symmetry and any enlargement.
• Assess for gag reflex-indicates the cranial nerves IX and X are intact.
3/27/2023 28

Neck
Inspects for symmetry and presence of tender or swollen areas the lymph nodes are
palpated while the patient is sitting erect with the neck slightly flexed.
• Patient may have small, mobile, non-tender nodes (shotty nodes) which are not a
sign of a pathological condition.
• Tender, hard or fixed nodes indicates disease.
3/27/2023 29

Thorax and lungs-inspection
• Appearance-evidences of respiratory distress, tachypnea or use of accessory
muscles.
• Shape-elliptical shape with downward slopping ribs about 45 degrees relative to
the spine .
• Chest movements-equal, symmetry, ap diameter < transverse diameter by a ratio
1:2
3/27/2023 30

Palpation of the trachea
Palpate the trachea to assess for possible deviation. From in front of the patient
gently place the index and middle fingers on either side of the trachea in the
suprasternal notch.
• In a normal patient the trachea will be placed in the centre. If there is deviation
to one side there will be a bigger gap on one side compared to the other.
• Reduction in the normal three to four fingers' width from the suprasternal notch
to cricoid cartilage suggests over inflation of the chest.
3/27/2023 31

Palpation of the chest
• Palpate for any mass, tenderness, crepitus.
• Apex beat: the apex beat is often impalpable in a chest which is hyper-expanded
secondary to chronic airflow obstruction.
• Movement of the apex beat from one side to the other may be caused by several
conditions including pleural effusion, tension pneumothorax.
• Location of the apex beat.
3/27/2023 32

Chest expansion
By assessing chest expansion the examiner aims to assess-
• The range and symmetry of chest wall movements.
• Place your hands firmly on the chest wall, with your thumbs slightly lifted off
the chest so that they are free to move with respiration (placing your thumbs up
provides the examiner with a visible marker to assess the range and symmetry of
chest wall movements).
3/27/2023 33

• Ask the patient to take a deep breath in and observe the range and symmetry of
movement.
• Reduced expansion on one side indicates a lesion on that side. This should be
performed on the front and the back of the patient's chest.
3/27/2023 34

Palpation –anterior chest
• Palpate symmetric chest expansion.
• Place hand on the anterior lateral wall with thumbs along the costal margin and
pointing towards xiphoid process .
• Ask the person to take a deep breath.
• Watch the thumb move apart symmetrically
• Assess tactile fremitus .
• Palpate anterior chest wall for tenderness,lumps, masses.
• Grating sensation indicates pleural friction fremitus. 3/27/2023 35

• Abnormal costal wide angle occurs in emphysema.
• Lag in expansion occurs in atelectasis, pneumonia, postoperative guarding.
• Granting sensation indicates pleural friction fremitus.
3/27/2023 36

Palpation-posterior chest
• Confirm symmetry chest expansion by placing warmed hands sideways on the
posterolateral chest wall with thumbs pointing together at the level of T9 or T10
and pinch a fold of skin.
• Ask to inhale deeply thumbs should move apart symmetrically.
• Unequal expansion seen in atelectasis, lobar pneumonia, pleural effusion,
thoracic trauma, ribs, pacumothorax pain in deep breathing seen when the pleura
are inflamed.
3/27/2023 37

Percussion anterior wall
As needed, percuss the anterior and lateral chest, again comparing both sides.
• The heart normally produces an area of dullness to the left of the sternum from
the 3rd to the 5th interspaces.
• Dullness represents airway obstruction from inflammation or secretions.
3/27/2023 38

• Because pleural fluid usually sinks to the lowest part of the pleural space
(posteriorly in a supine patient), only a very large effusion can be detected
anteriorly.
• The hyperresonance of copd may obscure dullness over the heart.
• The dullness of right middle lobe pneumonia typically occurs behind the right
breast.
• Unless you displace the breast, you may miss the abnormal percussion note.
3/27/2023 39

Percussion-posterior chest
Sequence for percussion-
• Start at the apices and percuss the band of normally resonant tissue across the
tops of both shoulders.
• Percuss the interspaces, mark a side to side comparison all the way down the
lung region, Percuss at 5cm intervals.
• Avoid the damping effect of scapula and ribs.
3/27/2023 40

3/27/2023 41

Tactile fremitus
• Palpable vibrations transmitted through the broncho- pulmonary tree to the chest
wall when the patient.
• Ask the patient to repeat '99" or "1,1,1" while placing the ball of your hand or the
ulnar surface of your hand on symmetrical parts of the chest increased in
consolidation .
• Decreased in pneumothorax, pleural effusion, pleural thickening, emphysema
3/27/2023 42

• Variation in percussion note "Resonant"
• When percussing a normal chest the noise generated should be resonant "Dull"
• When percussing over a solid structure (such as the liver or a consolidated lung)
produces a dull note, "Stony dull”.
3/27/2023 43

• Percussion over a fluid filled area such as a pleural effusion produces a Stony
dull note.
• "Hyper-resonant" -percussion over hollow structures (e.G. Pneumothorax) may
produce a hyper-resonant note- such as a pneumothorax ‘Tympanatic’.
• High pitched sound while percussing gastric air bubble.
3/27/2023 44

Diaphragmatic excursion
Reason for assessing diaphragmatic excursion-to determine the movement of
diaphragm that occurs during inspiration. Possible reasons for decreased descent
include: atelectasis of lower lobes, emphysema, pleural effusion, pain, abdominal
changes such as tumors and extreme ascites.
• Normal range of diaphragm movement: 3-5cm but may be up to 7-8cm in well
conditioned people.
3/27/2023 45

Procedure
1. First, ask the person to take "exhale and hold it" while you percuss down the left
scapular line until the sound changes from resonant to dull. Mark the area. This
estimates the level of the diaphragm separating the lungs from the abdominal
viscera.
3/27/2023 46

2. Allow the patient to take a few normal breaths. Then, ask the person to "take a
deep breath and hold it." Continue percussing down from the first mark to the level
where the sound changes to dull. Mark the area.
3. Measure the two marks. Repeat the same procedure on the right side. It should
be equal bilaterally and measure about 3-5 cm. In adults. It may be up to 7-8 cm. In
well-conditioned people.
4. Level of the diaphragm may be higher on the right side because of the liver.
3/27/2023 47

Auscultation
• When listening to the patients chest the diaphragm component of the stethoscope
is usually used to instruct the patient to breath in and out with an open mouth
every time you move the stethoscope.
• Listen both to the supraclavicular areas, anterior, axillary and posterior aspects of
the chest.
3/27/2023 48

• Remember to compare left with right at each level.
• Auscultation of the lungs allows an appreciation of the intensity and quality of
breath sounds and the presence of additional sounds best described as crackles,
wheezes, and rubs.
3/27/2023 49

Ascultation-anterior chest
Listen to the chest anteriorly and laterally as the patient breathes with mouth open,
and somewhat more deeply than normal.
• Compare symmetric areas of the lungs, using the pattern suggested for
percussion and extending it to adjacent areas, if indicated.
3/27/2023 50

• Listen to the breath sounds, noting their intensity and identifying any variations
from normal vesicular breathing.
• Breath sounds are usually louder in the upper anterior lung fields.
Bronchovesicular breath sounds may be heard over the large airways, especially
on the right.
3/27/2023 51

Breath sounds
Breath sounds are produced by vibrations due to turbulent airflow through out the
airways. These sounds are transmitted through the smaller airways and lungs to the
chest wall.
1. Vesicular breath sounds:
• The intensity of the sounds increase during inspiration and then fade away during
the first third of expiration.
• Low pitched.
3/27/2023 52

2. Bronchial breath sounds:-
• Expiration is longer than inspiration. They result from enhanced transmission of
higher frequency sounds through solid lung tissue as in consolidation, pulmonary
edema.
3. Bronchovesicular sound:-
• Inspiration and expiration are equal. Typically heard in the 1’’ and the
2’’interspaces and between the scapulae.
3/27/2023 53

4. Bronchial (tracheal) sounds:-
• High pitched loud .
• Hearded over trachea and larynx.
3/27/2023 54

Adventitious sounds
Crackles (rales):-
• Non continuous explosive popping sounds heared more often on inspiration can
also present on expiration it may be fine and coarse.
• Coarse crackles are associated with larger airways and fine crackles are
associated with smaller branches.
• Seen in asthma, copd, bronchiectasis, pulmonary edema, pneumonia, lung
cancer, pulmonary fibrosis.
3/27/2023 55

• Wheezes
• Continual, high pitched musical sounds heard at the end of inspiration or at the
start of expiration.
• Seen in asthma, copd, respiratory tract infection airway narrowing allows airflow
induced oscillation of airway walls producing acoustic waves.
• Monophonic wheeze- single notes.
• Polyphonic wheeze-different tones.
3/27/2023 56

Pleural rub
A pleural rub is a discontinuous, low-frequency, grating sound that arises from
inflammation and roughening of the visceral pleura as it slides against the parietal
pleura. This nonmusical sound is biphasic, heard during inspiration and expiration,
and often best heard in the axilla and base of the lungs.
3/27/2023 57

Mediastinal crunch
• A mediastinal crunch is a series of precordial crackles synchronous with the
heartbeat, not with respiration.
• Best heard in the left lateral position, it arises from air entry into the mediastinum
causing mediastinal emphysema (pneumomediastinum).
• It usually produces severe central chest pain and may be spontaneous.
• It has been reported in cases of tracheobronchial injury, blunt trauma,
• Pulmonary disease, use of recreational drugs, childbirth, and rapid ascent from
scuba diving.
3/27/2023 58

Bronchophony
• Ask the patient to say "ninety-nine."
• Normally the sounds transmitted through the chest wall are muffled and
indistinct.
• Louder voice sounds are called bronchophony localized bronchophony and
egophony are seen in lobar consolidation from pneumonia.
• In patients with fever and cough, the presence of bronchial breath sounds and
egophony more than triples the likelihood of pneumonia.
3/27/2023 59

3/27/2023 60

Egophony
You will normally hear a muffled long ee sound.
• If "ee" sounds like "A" and has a nasal bleating quality, an e-to-a Change, or
egophony, is present.
• Seen in over consolidation or compression.
3/27/2023 61

Whispered pectoriloquy
• Ask the patient to whisper "ninety-nine" or "one-two-three."
• The whispered voice is normally heard faintly and indistinctly, if at all.
• Louder, clearer whispered sounds are called whispered pectoriloquy seen in mild
consolidation.
3/27/2023 62

Pursed lip breathing
A breathing practice often taught which includes a long slow expiration against
pursed lips.
• Seen in COPD
• Inflammation of the airways leads to destruction of lung parenchyma results in
reduction in elastic recoil fibrosis, and muscle hypertrophy causes increased
airways resistance and premature airway closing on expiration or expiratory
airflow limitation this results in air trapping at end expiration and with time
hyperinflation.
3/27/2023 63

Tracheal tug
Downward displacement of thyroid cartilage during inspiration most common-
respiratory distress/COPD campbell's sign.
• Less common-arch of aorta aneurysm (oliver’s sign).
3/27/2023 64

Barrel chest
• Anterioposterior diameter tranverse diameter with ratio of 1:1
• Ribs are horizontal indicated normal.
• Downward slope soon in normal aging and hyperinflated lungs such as COPD.
• Due to overactivity of scalene and sternocleidomastoid muscle which lifts the
upper ribs and sternum and this overase causes remodelling of the chest.
3/27/2023 65

3/27/2023 66

Pectus excavatum-funnel breast
A markedly sunken or concave appearance of sternum and adjacent cartilages
depression begins with 2nd intercoastal becoming depressed most at junction of
xyphoid process congenital disorder.
3/27/2023 67

Pectus carinatum -pigeon chest
A forward protrusion of the sternum with ribs sloping back at either side and
vertical depression along costochondral junctions congenital disorder.
3/27/2023 68

Scoliosis
A lateral s-shaped curvature of the thoracic and lumbar spine with involved
vertebrae rotation.
3/27/2023 69

Kyphosis-dowager's hump
Exaggerated posterior curvature of the thoracic spine (humpback).
3/27/2023 70

Harrison's sulcus (harrison's groove)
Visible depression of the lower ribs above the costal margin, at the area of
attachment of the diaphragm.
• Seen in rickets, severe asthma in childhood, cystic fibrosis, pulmonary fibrosis.
• Before the bone mineralize and harden the downward tension from the
diaphragm and other accessory muscles used during increased respiratory effort
can bend the ribs inwards over time.
3/27/2023 71

3/27/2023 72

Hoover's sign
• Paradoxical inward movement of the lower costal margins on inspiration .
• Seen in emphysema, chest hyperinflation- C.O.P.D.
• When the chest becomes hyperinflated, the diaphragm often becomes stretched,
which causes contraction of diaphragm at inspiration results in an inward
movement, bringing the costal margins with it, as opposed to normal downward
movement.
3/27/2023 73

3/27/2023 74

Diagnostic evaluation
Oximetry:- Arterial 02 saturation can be monitored noninvasively and continuously
using a pulse oximetry probe on the finger, toe, ear, forehead, or bridge of the nose.
• The abbreviation spo2is used to indicate the o2 saturation of hemoglobin as measured
by pulse oximetry. Spo2 and heart rate are displayed on the monitor as digital
readings.
• Normal spo2 values are 94% to 99%
3/27/2023 75

BLOOD STUDIES
Hemoglobin:-
• Test reflects the amount of hemoglobin available for combination with oxygen.
• Normal-13.5 to18mg/dl (men) , 12 to 16 mg/dl (women)
Hematocrit:-
• Test reflects ratio of red cells to plasma.
• Increased hematocrit found in hypoxemia.
• Normal-40 to 54% (men) ,38 to 47 (women)
3/27/2023 76

Arterial blood gases
ABGs are obtained to determine oxygenation status and acid-base balance.
• ABG analysis includes measurement of the pao2, paco2 (the partial pressure of CO2 in
arterial blood), acidity (ph), bicarbonate (HCO3 ), and sa02.
• Blood for ABG analysis can be obtained by arterial puncture or from an arterial catheter,
which is usually inserted into the radial or femoral artery.
• Both techniques allow only intermittent analysis, but an arterial catheter permits abg
sampling without repeated arterial punctures.
• The normal pao2 decreases with advancing age.
3/27/2023 77

SPUTUM STUDIES
Culture and sensitivity:-
• Single sputum specimen is collected in a sterile container.
• Purpose is to diagnose bacterial infection, select antibiotics and evaluate
treatment.
• Takes 48-72 hours for results.
3/27/2023 78

Gram stain:-
• Staining of sputum permits classification of bacteria into gram negative positive
types.
• Results guides therapy until culture and sensitivity results are obtained.
Acid fast smear and culture:-
• Test is to performed to collect sputum for acid fast bacilli.
• A series of three early morning specimen is used .
3/27/2023 79

Cytology
Single sputum specimen is collected in special container with fixative solution.
• Purpose is to determine presence of abnormal cells that may indicate
Malignant condition.
3/27/2023 80

Chest x-ray
It is most commonly used test for assessment that exposes a patients respiratory
system used to assess progressive of disease and response to treatment.
• The most common views used are the posterior-anterior view and lateral.
3/27/2023 81

Computed tomography
A computed tomography, which exposes a patients to radiation may be used to
examine cross section of the entire body.
• Used to evaluates areas that are difficulty to assess by conventional x rays.
• Common types of CT scan are helical or spiral CT in which contrast dye is
usually used in high resolution CT contrast dye is not used.
• Spiral CT is most common non invasive imaging procedure used to diagnose
pulmonary embolism.
3/27/2023 82

3/27/2023 83

Magnetic resonance imaging
In a strong magnetic field the alignment of spinning nuclei can be changed with a
super imposed radio frequency and the rate at which they return to alignment with
the field can be measured the patient is not exposed to radiation.
3/27/2023 84

Ventilation-perfusion scan
A ventilation perfusion scan is used primarily to check the presence of pulmonary
Embolism, but it cannot determine with 100% certainty of the presence of PE.
• An iv isotope is given and the pulmonary vasculature is outlined and photographed the
patient inhales a radioactive gas (xenon, krypton) which outlines the alveoli and
another photograph is taken.
3/27/2023 85

Pulmonary angiography
Pulmonary angiography is the most specific examination used to confirm the
diagnosis of pulmonary edema.
• A series of x-ray is taken after radio opaque dye is injected into the pulmonary
artery. This test also detect congenital and acquired lesions of the pulmonary
vessels.
3/27/2023 86

Positron emission tomography
Positron emission tomography scans the use of radio nuclides with short half lives
used to distinguish benign and malignant solitary pulmonary nodules, because
malignant lung cells have an increased uptake of glucose.
3/27/2023 87

Bronchoscopy
Bronchoscopy is a procedure in which the bronchi are visualised through a
fiberoptic tube.
• Used to obtain biopsy specimen and assess changes resulting from treatment
small amount (30ml) of sterile saline may be injected through the scope and
withdrawn and examined for cells ,a technique termed as bronchoalveolar lavage
used to diagnose pneumonia, mucus plug, foreign bodies.
3/27/2023 88

3/27/2023 89

Mediastinoscopy
A scopy is inserted through a small incision in the supra sternal notch and
advanced through mediastinum to inspect and biopsy lymph nodes.
• The test is used to diagnose carcinoma, non-hodgkins lymphoma, granulomatous
infections, and sarcoidosis.
3/27/2023 90

Lung biopsy
Lung biopsy may be done -
1. Transbronchially
2. Percutaneously or via transthoracic needle aspiration
3. Video assisted thoracic surgery
4. As an open lung biopsy
Purpose is to obtain tissue cells or secretion for evaluation.
3/27/2023 91

Thoracentesis
It is the insertion of a large bore needle through the chest wall into pleural space to
obtain specimen for diagnosis, evaluation, remove pleural fluids, or instil
medications into the pleural space.
• The patient is positioned upright with elbows in an overbed table and feet
supported.
• The skin is cleansed and a local anesthetic is instilled subcutaneously.
• A test tube may be inserted to permit further drainage of fluids
3/27/2023 92

3/27/2023 93

Pulmonary function test
• Pulmonary function test measures lung volumes and airflow the results of PFT
are used to diagnose pulmonary disease, monitor disease progression evaluate
disability and evaluate response to bronchodilators airflow is measured by a
spirometer and administered by trained personal.
• The patients inserts a mouth piece, takes as deep breath as possible and exhales
as hard fast and long as possible.
3/27/2023 94

3/27/2023 95

Spirometry
• Spirometry may be ordered before and after the administration of bronchodilator
to determine the degree of response.
• Home spirometry may be used to monitor lung function in person with asthma or
cystic fibriods.
3/27/2023 96

Exercise testing
Exercise testing is used to diagnose in determining exercise capacity and for
disability evaluation A complete exercise test involves walking on a threadmill
while expired.
• Oxygen and carbon dioxide, respiratory rate, heart rate, and heart rhythm are
monitored a modified test (desaturation test) may be used to monitor spo2.
3/27/2023 97

3/27/2023 98

Skin test
Skin test may be performed to test for allergic reactions or exposure to tuberculosis bacilli or
fungai.
• It involves the intradermal injection of an antigen.
• A positive result on a TB skin test indicate the TB
is currently active.
• A negative results indicates patients has exposed to TB.
3/27/2023 99

3/27/2023 100