Overview
This lecture reviews the inspection process for respiratory assessment, highlighting key visual clues, normal and abnormal findings, and their clinical significance.
Patient Position and Appearance
- Patients with easy breathing appear relaxed, upright, and have calm facial expressions.
- Trouble breathing can cause anxiety, panic, and changes in position (hands on hips/head, tripod position).
- The tripod position (leaning over, hands/elbows on knees) helps expand the lungs.
Level of Consciousness (LOC)
- Assess if the patient is alert and oriented (AOx3 or AOx4) as oxygen is crucial for brain function.
- Early deoxygenation leads to confusion or altered LOC, progressing to unconsciousness.
Skin Color and Nails
- Well-oxygenated patients have pink undertones regardless of skin pigmentation.
- Early hypoxia causes pallor; late hypoxia results in cyanosis (blue skin).
- Clubbing (nail angle ≥180°) indicates chronic hypoxia.
Respiratory Rate, Rhythm, and Work of Breathing
- Normal respiratory rate is 12–20 breaths/min, with regular rhythm and unlabored breathing.
- Tachypnea (fast breathing) occurs early in distress; bradypnea (slow breathing) occurs later.
- Increased work of breathing is seen as accessory muscle use, nostril flaring, and excessive effort.
Accessory Muscle Use
- Accessory muscles (including intercostals) assist with difficult breathing and are visibly active during increased work.
- Shoulder movement and visible retraction between ribs indicate respiratory distress.
Chest Wall and Shape
- Normal chest ratio: transverse (side-to-side) is twice the anterior-posterior (front-to-back) (2:1 ratio).
- Barrel chest (increased AP diameter) is seen in COPD/emphysema due to air trapping.
- A normal costal angle is ~90°; it increases (>90°) in barrel chest, emphysema, and pregnancy.
Key Terms & Definitions
- Tripod Position — Leaning forward, hands/elbows on knees to aid breathing.
- AOx3/AOx4 — Alert and oriented to person, place, time (and situation).
- Clubbing — Nail profile angle ≥180°, indicating chronic low oxygen.
- Tachypnea — Abnormally rapid breathing.
- Bradypnea — Abnormally slow breathing.
- Work of Breathing (WOB) — Observable effort needed to breathe.
- Pursed-lip Breathing — Breathing technique that helps keep airways open.
- Accessory Muscles — Extra muscles aiding breathing during distress.
- Barrel Chest — Increased anterior-posterior diameter, common in COPD.
- Costal Angle — The angle at the front of the ribs; normal ≈ 90°.
Action Items / Next Steps
- Practice identifying inspection findings in clinical scenarios.
- Review respiratory assessment techniques and normal vs. abnormal findings.