Assessment of Respiratory System

■ Inspect: Respirations for rate, depth, effort, pattern, and presence of cough (productive or nonproductive); note signs of distress such as nasal flaring or sternal retractions. Inspect size and shape of chest, symmetry of chest wall movement, and use of accessory muscles. Inspect extremities for cyanosis and fingers for clubbing indicating chronic hypoxia. Inspect trachea for scars, stomas, or deviation from midline.

■ Palpate: Anterior and posterior thorax for subcutaneous emphysema, crepitus, and tenderness. Assess tactile fremitus by palpating the chest as the Pt says “99.”

■ Percuss: Anterior and posterior thorax for tympany (hollow organs), resonance (air-filled organs), dullness (solid organs), or flatness (muscle or bone).

■ Auscultate: Using stethoscope, auscultate all anterior and posterior lung fields, noting normal, abnormal, or absence of lung sounds.

Respiratory Patterns
Normal (eupnea)	Regular and comfortable at 12–20 breaths/minute.
Tachypnea	>20 breaths/minute.
Bradypnea	<12 breaths/minute.
Hyperventilation	Rapid, deep respiration >20 breaths/minute.
Apneustic	Neurologic: sustained inspiratory effort.
Cheyne-Stokes	Neurologic: alternating patterns of depth separated by brief periods of apnea.
Kussmaul	Rapid, deep, and labored: common in DKA.
Air trapping	Difficulty during expiration: emphysema.