Respiratory System. The ABCs of Respiratory and Cardiovascular Assessment. Throughout your nursing career thus far, you have undoubtedly heard a lot about the ABCs: airway, breathing, and circulation. As you are aware, this is how we prioritize many nursing interventions, regardless of the specifics of a given scenario.
The initial assessment of the client is accomplished through observation. Look at the client’s appearance. Visualize the ABCs as the sides of a triangle that work together to give you an initial impression of the client’s overall well-being.
When assessing the client’s appearance, first look at the overall body position and how the client holds him or herself. Ask yourself, what is the client’s mental status? Does the client look comfortable?
Next, assess the client’s breathing. Is the client working hard to breathe? Is the client using accessory muscles to move air in or out?
Finally, assess the client’s circulation. What is the overall skin and nail color? Is it normal for the client’s age and race?
Assessing a client through the lens of the ABCs gives you a good idea of whether you need to drill down into the client’s respiratory and cardiovascular systems during the head-to-toe assessment.
The general survey is the beginning of the investigation, but to obtain more information, the right questions still need to be asked. Common complaints related to the respiratory system include shortness of breath, coughing, wheezing, and chest pain. Complete this activity to help hone your interviewing skills.
Asking the Right Questions: Respiratory System
- The client comes in complaining of shortness of breath.
- The client comes in complaining of a cough that has persisted “for forever.”
- Some questions that you could ask right now include the following.
- Is the cough productive?
- If it is productive, how much sputum does it produce? What does the sputum look like?
- How long have you had the cough? Has it changed recently?
- What makes the cough better?
- What makes it worse?
- Do you take any medications for your cough? If so, what and how often?
- What time of day do you cough most often?
- Are you coughing up blood?
Landmarks are places on the external body that help you locate internal structures. Landmarks help you find lung fields so you can listen and compare them to each other. Consistent use of the same landmarks during assessment and documentation helps to accurately communicate findings among members of the healthcare team.
In addition to physical landmarks, there are sound landmarks where, if you listen with a stethoscope, you can expect to hear certain breath sounds. There are four types of normal breath sounds that are described in your reading assignment. It is important to know how to identify normal sounds and where you would expect to hear them. If you hear a different kind of normal breath sound over an area where you would not expect to hear it, this could be a sign of a serious problem that needs to be investigated further.
Interactive- Breath Sounds
Special Considerations For Older Adults and Children
In older adults, the chest wall becomes stiffer and harder to move. Lungs lose some of their elasticity, and respiratory muscles weaken. Usually the capacity for exercise decreases. Skeletal changes occur that accentuate the curve of the thoracic spine, which produces kyphosis and increases the AP diameter of the chest. This does not usually affect function.
In children, the exam is usually unchanged from that of an adult, with emphasis on distraction, so you may get the children to take a deep breath to auscultate their lungs.
Despite major state, federal, and international initiatives, tobacco use remains the single most preventable cause of death and disability in the world today. Smoking has been linked to lung diseases including COPD, emphysema, and chronic bronchitis, most forms of lung cancer as well as various other types of cancer including bladder, colon, and kidney among others (CDC, 2010; HHS, 2014). In addition, smoking has been found to increase the risk for developing cataracts, type II diabetes, and Rheumatoid arthritis.
Each year in the United States, smoking-related diseases claim the lives of 480,000 with an additional 50,000 deaths occurring as the result of exposure to secondhand smoke (CDC, 2010; CDC, 2014; HHS, 2014). Smoking causes diminished overall health, including self-reported poor health, days of work lost, and greater healthcare costs (HHS, 2014).
Nurses and other healthcare professionals play a crucial role in directly helping tobacco users quit, but they need to collaborate with tobacco-control advocates in their communities to develop a comprehensive tobacco control program as these programs promote quitting smoking and help smokers stay nonsmokers. It takes community collaboration to decrease the death, disease, and suffering caused by tobacco use. A community needs a collective will to implement the best practices for community intervention (Fildes & Blacher, 2015, p.332).
Best Practices in Community Interventions
- Raise prices (taxes)
- Clean indoor air
- Create counter marketing
- Provide cessation aids: counseling and pharmacotherapy, alone or in combination
- Directly by clinician in individual or group sessions (in-patient or out-patient settings)
- Toll-free telephone quit line
The Best Practices in Community Interventions highlight the role of smoking cessation, counseling, and pharmacotherapy in helping smokers quit. The Public Health Service Guideline Treating Tobacco Use and Dependence.
An excellent resource filled with approaches on how to help your patients to quit smoking may be found at the CDC (2015) at http://www.cdc.gov/tobacco/campaign/tips/partners/health/hcp/ (Links to an external site.).
Nurses, physicians, health educators, and other trained medical and health professionals are positioned to deliver brief interventions during primary care visits or other similar office visits and by doing so capitalize on teachable moments.
Visit http://www.surgeongeneral.gov/library/reports/50-years-of-progress (Links to an external site.) and read the Surgeon General’s report to learn more about the devastating effects of tobacco use and the resources available to assist your patients with smoking cessation. How could you apply what you have learned to convey a teachable moment?
Smoking and second-hand smoke place individuals at increased risk for developing diseases of the respiratory system. Nurses must have a strong understanding of the normal assessment findings associated with the respiratory system in order to be able to quickly recognize changes and signs of deterioration.
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