Martha Bryant
STUDENT NAME _____________________________________
Respiratory Assessment
SKILL NAME ____________________________________________________________________________ REVIEW MODULE CHAPTER ___________
Description of Skill
Doing a respiratory assessment the nurse will observe respiratory rate and rhythm.
Indications CONSIDERATIONS
Checking oxygen saturations.
Nursing Interventions (pre, intra, post)
Inspecting skin color and nailbed for color
and clubbing Inspection : Inspect the chest for size, shape,
Inspect chest configuration and work of symmetry, movement, breast development.
breathing Palpation: Over the anterior and posterior
Ausculate lungs sounds chest to assess chest movement, respiratory
effort for any deformities or tenderness of
chest wall. Percussion assess the resonance
of the lungs and the density of underlying
organs. Auscualting is performed over all lung
Outcomes/Evaluation
Client Education
Newborn to 1yr: 30-35/ min
1-2 years: 25-30/ min Educate the client on the process.
2-6 years: 21-25/ min Have the patient take deep breaths in and
6-12 years: 19-21/ min out.
12yrs and older : 16-19/ min Encourage the family and the patient to ask
questions.
Potential Complications Nursing Interventions
Respiratory distress Ausculate lung sounds through each breath
Retractions cycle before moving to the next field.
Wheezes Observe the patients facial expressions to
Crackles see if there is any tenderness or difficulty.
Document findings.
ACTIVE LEARNING TEMPLATES