Visual Inspection – Respiratory Assessment (Nursing)

00:00 Now, we're ready to start the respiratory assessment.

00:03 You understand the pieces of your stethoscope and how they work.

00:06 Now, let's talk about how a nurse uses those tools in assessment.

00:10 First, visual inspection. Look at your patient, notice how they're breathing and the rate in respirations.

00:18 Auscultation is when you're gonnna listen to the patient.

00:22 So, you're gonna use that stethoscope listening to the front and to the back for their breath sounds.

00:28 Now, we stress that because I want you to understand as a nurse how important it is that you not just do a quick on the front and, then, move on.

00:37 You really need to listen to the patient's lung sounds. This is a key part of every assessment.

00:44 Sometimes you'll see people take shortcuts but I hope you don't practice in that manner because just for an example, one reason listening in the back or posterior is so important is that crackles are a lung sounds that you can learn to auscultate.

00:59 They're also an indication of fluid volume overload.

01:02 The very first place it will develop is in the back and in the bases.

01:08 If you never do what it takes to position your patient so you can listen to their lung sounds in the back, you might miss a very important clue that this patient's gonna get into lots of severe trouble.

01:20 It's coming. You've got the signal.

01:23 But if you don't take the time to do a thorough lung sound assessment, you'll miss it and your patient will suffer. So, let's talk about visual inspection.

01:32 When you first walk in, you're gonna introduce yourself and while you're talking with a patient, just observe how they're breathing. So, don't let them know that's what you're doing.

01:41 Make eye contact. Don't just look at their chest because that would be weird.

01:45 Just come in, introduce yourself, "Good morning, Mrs. Taylor, my name is Rhonda and I'm gonna be your nurse." I'm making eye contact with her but I'm also using my peripheral vision to watch how she's breathing.

01:57 So, I'm gonna observe the respiratory rate, how fast she's breathing, the rhythm, and the effort.

02:03 It should be fairly consistent, right? The rhythm should have a consistent rate and it shouldn't look like they're working too hard if they're having normal respirations and the rate is gonna be within the normal range.

02:16 So, are these breaths normal in rate, and depth, and pattern? Do they seem to be working really hard to try to breathe? Does the chest rise and fall symmetrically? And that's really important. If it had some type of damage or injury, you may see things that are asymmetrical. If that's a new development, that's a reason to contact the healthcare provider. Now, look at do they inhale longer than they exhale? Remember, respiratory rate, you're gonna count the number of times their chest rises and falls, 15 seconds, and multiply by four. Because we always record respiratory rate per minute.

02:56 So, you don't have to count for a full 60 seconds.

02:59 Just count for 15 seconds then, multiply that number by four to get their rate over 60 seconds.

03:06 I wanna go back to that last point. What did you think about do they inhale longer than they exhale? Well, the length of those phases can tell us a lot about their lung function.

03:17 Patients with COPD tend to have extended periods of exhale when they're having respiratory problems.

03:25 So, If you know your patient has COPD, watch the length of those phases and see if you can see if they might be starting to have to work harder because of their lung disease.

03:36 Now, we talk about respiratory pattern there's normal.

03:38 It's regular, comfortable, 12 to 20 breaths a minute.

03:42 Now, if that rate's over 20, that's considered tachypnea.

03:46 Now, there might be some argument whether is it more than 20, is it more than 22, is it more than 24? But if somebody's breathing more than 20 breaths a minute, you wanna pay attention to see how far over that mark it is.

04:01 Bradypnea would just be less than 12 breaths a minute.

04:04 Now, this is a recognized universal standard.

04:07 They're breathing 12 or less than a minute and they're not some rock star athlete, you wanna make sure if they're symptomatic with that or what else is going on with him.

04:17 It's pretty unusual for someone to breathe that slowly.

04:20 If they've had opioids, I'm going to be really concerned.

04:24 Now, hyperventilation, have rapid, deep, short respirations, greater than 20 a minute where you can tell they are breathing what seems to be an abnormally fast rate. You wanna look at the cause.

04:35 Is it panic attack? Is it anxiety? Is it pain? What's the cause of this rate? Now, Cheyne-Stokes, that's a really kind of weird one to experience.

04:46 It's a neurological problem and they're gonna have alternating patterns of depth.

04:50 They can have periods of apnea that can be up to 30 seconds and the rest will be really fast.

04:55 So, you'll see nothing, and then they'll breathe really fast, and it's a bizarre form of a respiratory pattern.

05:03 So, Cheyne-Stokes respirations, once you observe them, you will never forget them.

05:09 Kussmaul's, now that's a rapid, deep, and labored breathing.

05:16 Now, if they haven't just stopped running or overexerting themselves, we see this in DKA.

05:21 It's common in DKA because that's Diabetic Ketoacidosis. Patients in a form of metabolic acidosis.

05:30 So, in order to compensate, that's why the body is breathing rapid, deep, and labored.

05:35 It's trying to blow off that CO2 to bring that pH back within normal limits.

05:40 Now, lastly, I wanna talk about air trapping.

05:44 Remember, we just talked about COPD-ers and it's particular with emphysema, they have this air trapping. So, that's why they usually naturally will pick up the strategy of exhaling longer like twice as long as they inhale, trying to catch their breath is what they may tell you.

06:02 But what they're doing is taking longer to exhale because that air gets trapped in their lungs.

06:12 They've had damage to the walls of their alveoli in their lungs and, so, air gets trapped in there.

06:17 By extending or making the time they take to exhale longer, they're trying to get rid of that air that's trapped in there.