Lecture Notes: Inspection in Respiratory Assessment

Importance of Position and Behavior

• Observing the client's position is critical.
• Relaxed Breathing:
  • Looks relaxed, upright.
  • Relaxed facial expressions.
• Difficulty Breathing:
  • Anxious, panicked expressions.
  • Frequent position changes (e.g., hands on hips or head).
  • Display a tripod position (leaning over with hands or elbows on knees).

Level of Consciousness (LOC)

• Alertness: Key indicator of oxygenation.
  • Good oxygenation: Alert and oriented (AO) times three or four.
  • Poor oxygenation: Confusion, altered LOC, possibly unconscious.

Skin Color as an Indicator

• Good Oxygenation: Pink undertones regardless of pigmentation.
• Early Deoxygenation: Pallor (pale skin).
• Late Deoxygenation: Cyanosis (blue skin tones).

Nail Condition

• Profile Sign: Normal is 160 degrees.
  • Clubbing (180 degrees or more) indicates poor oxygenation or chronic hypoxia.

Respiratory Rate and Rhythm

• Normal Breathing: Regular rate and rhythm, inhalation and exhalation.
• Tachypnea: Fast breathing, early response to difficulty.
• Bradypnea: Slow breathing, occurs when labored breathing can't be maintained.

Work of Breathing (WOB)

• Unlabored Breathing: No accessory muscle use, no nostril flaring.
• Increased Work: Tripod position, pursed-lip breathing.

Accessory Muscle Use

• Involves intercostal muscles and muscles between the ribs.
• Increased use indicates difficulty in breathing.

Chest Wall Observation

• Anterior to Posterior Diameter: Normal is 1:2 ratio (front to side).
• Barrel Chest: Indicates COPD or emphysema, with an increased front to back diameter, resulting in air trapping.

Costal Angle

• Normal Angle: About 90 degrees.
• Increased Angle: Seen in emphysema or pregnancy, more than 90 degrees indicating alterations in the chest wall.

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Practice Question

• Increased Costal Angle: Associated with emphysema and pregnancy due to air trapping or increased abdominal size.