NUR 350 - Health Assessment Exam Study Guide-2025
Update.
Upper Airway - > Mouth and oropharynx, nose and nasopharynx, pharynx, larynx
Conducts air to lower airway; protects lower airways; warms, filters and humidifies air
Lower Airway - > Trachea, carina, bronchi, terminal bronchioles, and alveoli
Structures pull in air from upper respiratory system, absorb oxygen, and release carbon
dioxide in exchange
Acinus - > Functional respiratory unit that consists of the respiratory bronchioles, alveolar
ducts, alveolar sacs, and the alveoli
Alveoli - > Primary gas exchange units on surface of lungs; 2 types of cells: type I alveolar
cells and type II alveolar cells
Type I Alveolar Cells - > Provide structure to alveoli
Type II Alveolar Cells - > Secrete surfactant, which lowers surface tension during
aspiration so that alveoli does not collapse
Alveolar Macrophages - > Ingest particles in the respiratory tract and remove them
through the lymphatic system
Pleura - > Double-layered membrane surrounding each lung; made up of visceral pleura
(inner layer) and parietal pleura (outer layer); fluid-filled parietal space in b/w both layers
to allow for movement
4 Major Functions of the Respiratory System - > 1. Supply oxygen to the body
2. Remove carbon dioxide
3. Maintain homeostasis (hypoventilation increases CO2 in blood; hyperventilation
decreases CO2 in blood)
4. Maintain heat exchange
,Control of Respirations - > Breathing patterns change involuntarily/without
awareness in response to varying levels of O2 and CO2 in the blood; mediated by
respiratory centre in brainstem
Hypercapnia - > Increase of CO2 in the blood; increases respirations (stimulus to breathe
in healthy people)
Hypoxemia - > Decreased O2 in the blood; increases respirations, but less effectively than
hypercapnia
Thoracic Cage - > Protects lungs; made up of sternum, 12 pairs of ribs (first 7 attached to
sternum), 12 thoracic vertebrae, diaphragm (muscle that splits thoracic and abdominal
cavities)
Mediastinum - > Area between the lungs; contains: heart, esophagus and trachea
Right Pleural Cavity - > Contains right lung (shorter lung because of liver; 3 lobes)
Left Pleural Cavity - > Contains left lung (narrower because heart pushes into it; 2 lobes)
Respiratory Considerations: Infants and Children - > - surfactant not present in adequate
amounts until 32 wks gestation (babies born before could have resp. illnesses)
- smaller size of resp. system (narrower diameter; easily blocked by items)
- immune system not fully mature until 5/6 yo
Respiratory Considerations: Pregnant People - > - decreased space for lung expansion
(diaphragm elevates 4cm)
- increased circumference of thoracic cage (due to increased estrogen which relaxes
ligaments in rib cage)
- increased demand for O2
Respiratory Considerations: Aging Adult - > - costal cartilage calcification (more rigid)
- decreased resp. muscle strength (less easily inflated/deflated)
- decreased elasticity w/i lungs
,- increase in small airway closures or collapsed alveoli (shortness of breath)
Subjective Assessment of the Respiratory System - > - cough: frequent, severe, hacking,
dry, wet, productive, hemoptysis (blood in sputum - frank, streak, pink)
- dyspnea/shortness of breath
- chest pain
- hist of resp. infections
- hist of smoking
- environmental exposure
- self-care behaviours (ex. flu shot)
Respiratory Assessment: Inspection - > - skin colour/cond.
- nail beds (cap. refill/clubbing)
- thoracic cage (shape/config)
- resp. rate, rhythm, depth, pattern
- work of breathing (WOB); facial expression, straining
- LOC
- sputum (amount, viscosity, colour, blood)
Thoracic Cage: Unexpected Configurations - > - barrel chest: bigger chest cavity (chronic
emphysema)
- scoliosis
- kyphosis (curvature in thoracic spine)
- pectus excavatum (depression in sternum; congenital)
- pectus carinatum (end of sternum protrudes; congenital)
Respiratory Assessment: Signs of Distress (Inspection) - > - increased WOB, gasping
- colour changes around lips/nails
- increased RR
- decreased O2
, - changes in LOC
- *tracheal tugging (skin sucks in around trachea with each breath)
- *retractions/indrawing (skin retracts in b/w ribs)
- *nasal flaring w each breath
*changes you would see in children
Respiratory Assessment: Palpation - > - lumps, tenderness, bruising, temp
- symmetrical chest expansion
- tactile fremitus
- pleural effusion
- pneumothorax
- crepitus
Tactile Fremitus - > Vibration you can feel when client repeats word
Pleural Effusion - > Excess fluid in pleural space
Pneumothorax - > Collapsed lung; air in the pleural cavity caused by a puncture of the
lung or chest wall
Crepitus - > Crackling/grating feeling under the skin
Respiratory Assessment: Percussion - > Method of tapping on surface (not bone) to
determine underlying structure; begin at apices and move downwards; listen for
resonance, hyperresonance, dullness, tympany
Resonance - > Hollow, air-filled sound
Hyperresonance - > Very air-filled sound; lower-pitched; when too much air is present
(emphysema or pneumothorax)
Dullness - > Thud like sound produced by dense tissue such as the liver, spleen, heart or
bone
Update.
Upper Airway - > Mouth and oropharynx, nose and nasopharynx, pharynx, larynx
Conducts air to lower airway; protects lower airways; warms, filters and humidifies air
Lower Airway - > Trachea, carina, bronchi, terminal bronchioles, and alveoli
Structures pull in air from upper respiratory system, absorb oxygen, and release carbon
dioxide in exchange
Acinus - > Functional respiratory unit that consists of the respiratory bronchioles, alveolar
ducts, alveolar sacs, and the alveoli
Alveoli - > Primary gas exchange units on surface of lungs; 2 types of cells: type I alveolar
cells and type II alveolar cells
Type I Alveolar Cells - > Provide structure to alveoli
Type II Alveolar Cells - > Secrete surfactant, which lowers surface tension during
aspiration so that alveoli does not collapse
Alveolar Macrophages - > Ingest particles in the respiratory tract and remove them
through the lymphatic system
Pleura - > Double-layered membrane surrounding each lung; made up of visceral pleura
(inner layer) and parietal pleura (outer layer); fluid-filled parietal space in b/w both layers
to allow for movement
4 Major Functions of the Respiratory System - > 1. Supply oxygen to the body
2. Remove carbon dioxide
3. Maintain homeostasis (hypoventilation increases CO2 in blood; hyperventilation
decreases CO2 in blood)
4. Maintain heat exchange
,Control of Respirations - > Breathing patterns change involuntarily/without
awareness in response to varying levels of O2 and CO2 in the blood; mediated by
respiratory centre in brainstem
Hypercapnia - > Increase of CO2 in the blood; increases respirations (stimulus to breathe
in healthy people)
Hypoxemia - > Decreased O2 in the blood; increases respirations, but less effectively than
hypercapnia
Thoracic Cage - > Protects lungs; made up of sternum, 12 pairs of ribs (first 7 attached to
sternum), 12 thoracic vertebrae, diaphragm (muscle that splits thoracic and abdominal
cavities)
Mediastinum - > Area between the lungs; contains: heart, esophagus and trachea
Right Pleural Cavity - > Contains right lung (shorter lung because of liver; 3 lobes)
Left Pleural Cavity - > Contains left lung (narrower because heart pushes into it; 2 lobes)
Respiratory Considerations: Infants and Children - > - surfactant not present in adequate
amounts until 32 wks gestation (babies born before could have resp. illnesses)
- smaller size of resp. system (narrower diameter; easily blocked by items)
- immune system not fully mature until 5/6 yo
Respiratory Considerations: Pregnant People - > - decreased space for lung expansion
(diaphragm elevates 4cm)
- increased circumference of thoracic cage (due to increased estrogen which relaxes
ligaments in rib cage)
- increased demand for O2
Respiratory Considerations: Aging Adult - > - costal cartilage calcification (more rigid)
- decreased resp. muscle strength (less easily inflated/deflated)
- decreased elasticity w/i lungs
,- increase in small airway closures or collapsed alveoli (shortness of breath)
Subjective Assessment of the Respiratory System - > - cough: frequent, severe, hacking,
dry, wet, productive, hemoptysis (blood in sputum - frank, streak, pink)
- dyspnea/shortness of breath
- chest pain
- hist of resp. infections
- hist of smoking
- environmental exposure
- self-care behaviours (ex. flu shot)
Respiratory Assessment: Inspection - > - skin colour/cond.
- nail beds (cap. refill/clubbing)
- thoracic cage (shape/config)
- resp. rate, rhythm, depth, pattern
- work of breathing (WOB); facial expression, straining
- LOC
- sputum (amount, viscosity, colour, blood)
Thoracic Cage: Unexpected Configurations - > - barrel chest: bigger chest cavity (chronic
emphysema)
- scoliosis
- kyphosis (curvature in thoracic spine)
- pectus excavatum (depression in sternum; congenital)
- pectus carinatum (end of sternum protrudes; congenital)
Respiratory Assessment: Signs of Distress (Inspection) - > - increased WOB, gasping
- colour changes around lips/nails
- increased RR
- decreased O2
, - changes in LOC
- *tracheal tugging (skin sucks in around trachea with each breath)
- *retractions/indrawing (skin retracts in b/w ribs)
- *nasal flaring w each breath
*changes you would see in children
Respiratory Assessment: Palpation - > - lumps, tenderness, bruising, temp
- symmetrical chest expansion
- tactile fremitus
- pleural effusion
- pneumothorax
- crepitus
Tactile Fremitus - > Vibration you can feel when client repeats word
Pleural Effusion - > Excess fluid in pleural space
Pneumothorax - > Collapsed lung; air in the pleural cavity caused by a puncture of the
lung or chest wall
Crepitus - > Crackling/grating feeling under the skin
Respiratory Assessment: Percussion - > Method of tapping on surface (not bone) to
determine underlying structure; begin at apices and move downwards; listen for
resonance, hyperresonance, dullness, tympany
Resonance - > Hollow, air-filled sound
Hyperresonance - > Very air-filled sound; lower-pitched; when too much air is present
(emphysema or pneumothorax)
Dullness - > Thud like sound produced by dense tissue such as the liver, spleen, heart or
bone
