Respiratory assessment

Positioning

• Observe the patient’s most comfortable position
• Only reposition if there is altered consciousness, or reduced ability for the patient to reposition themselves.

Look

• Look at the chest and abdomen, maintaining normothermia and privacy.
• Look at the overall appearance of the patient, including their level of activity, ability to speak in sentences and shortness of breath.
• Assess for injury, deformity, wounds or swelling.
• Look for signs of upper airway obstruction, including drooling and stridor.
• Look at the colour, peripherally and centrally.
• Count the respiratory rate and assess the pattern of respirations as:
• regular
• irregular
• shallow
• tachypnoeic
• bradypnoeic.
• Assess the patient's respiratory effort.
• Look for use of accessory muscles.
• Assess chest expansion for symmetry. Consider flail chest or pneumothorax in asymmetrical movements.
• Check if the trachea is midline.
• Listen for a productive or dry cough or sputum.
• Measure the oxygen saturation.
• Look for finger clubbing.

Listen

• Auscultate the lung fields with a stethoscope, listening for:
• quality of breath sounds
• adventitious breath sounds, e.g. wheeze, crackles, crepes or stridor
• location of sounds.
• Listen for audible sounds, e.g. stridor, hoarse voice, wheeze, grunting or cough.

Feel

• Feel for even chest expansion. Consider flail chest or pneumothorax in asymmetrical chest movements.
• Feel for skin temperature, turgor and moisture.
• Measure the capillary return, centrally and peripherally.
• Feel for fremitus. Increased fremitus may indicate inflammation or dense lung tissue.
• Feel for subcutaneous emphysema.

Other

• Check if the patient has had any pain, pressure or tightness in their chest or radiation of pain to the jaw, shoulder or arm. Consider chest pain protocol.