Respiratory Assessment for Nurses (Inspection, Palpation

Respiratory

RespiratoryRNCanada exam scope

Pathophysiology

Clinical meaning

Respiratory Assessment for Nurses (Inspection, Palpation, Percussion, Auscultation) (Respiratory) links assessment, oxygen delivery, airway management, infection prevention, and critical care monitoring to nursing judgment: protect airway and breathing, titrate oxygen per orders and targets, recognize acute deterioration (silent chest, fatigue, rising CO₂, tension pneumothorax), support ventilation and chest drainage safely, and escalate when respiratory failure threatens perfusion or mentation. Canadian items may use metric units and provincial isolation wording; prioritization logic matches NCLEX-RN. Pathway context (RN, Canada). This lesson supports NCLEX-RN preparation with Canada-friendly practice framing (SI measures where shown, interprofessional norms). Continue with related lessons from the pathway lesson hub. Learning objectives - Integrate inspection, work of breathing, SpO₂, ABG when shown, breath sounds, ventilator/chest tube cues, and mentation to identify respiratory emergencies and complications. - Select nursing interventions and teaching aligned with orders, scope, RT and provider plans, and facility policy. - Communicate early when findings suggest complete obstruction, tension pneumothorax, massive hemothorax, ventilator failure, sudden desaturation with altered LOC, or rapid clinical decline.

Listen to real recordings of common breath sounds. Each sound includes timing, pitch characteristics, and clinical significance.

Vesicular breath sounds

Filter Normal

Normal peripheral lung sounds generated by airflow in smaller airways; inspiration is longer and louder than expiration.

Timing:

Inspiratory > expiratory (~3:1)

Pitch:

Soft, low-pitched, rustling

Best Auscultation

Most lung fields except central/tracheal areas

Clinical Significance:

Expected over healthy aerated lung; diminished/absent sounds are abnormal.

Common Causes:

— Normal aerated lung

Clinical Pearl Heading

Compare side-to-side: new focal loss raises pneumothorax, mucus plugging, or effusion until proven otherwise.

Recording

Bronchovesicular breath sounds

Filter Normal

Mixed central/peripheral quality heard near major bronchi — normally at selective anterior/posterior landmarks.

Timing:

Inspiratory ≈ expiratory

Pitch:

Medium pitch and intensity

Best Auscultation

1st–2nd intercostal spaces anteriorly; between scapulae posteriorly

Clinical Significance:

Normal near central bronchi; abnormal if heard diffusely in peripheral fields (think consolidation).

Common Causes:

— Normal over central airways
— Consolidation if peripheral

Recording

Bronchial (tubular) breath sounds

Filter Normal

Tubular sounds with a pause between phases — normal only over the trachea/main bronchi.

Timing:

Expiratory > inspiratory

Pitch:

Loud, high-pitched, hollow

Best Auscultation

Trachea and mainstem bronchi

Clinical Significance:

If peripheral, suggests consolidation/atelectasis with a patent airway conducting sound.

Common Causes:

— Normal over trachea
— Lobar pneumonia (if peripheral)
— Atelectasis with patent airway

Recording

Fine crackles (rales)

Filter Adventitious

Discrete “opening” sounds from small airways/alveoli snapping open; typically do not clear with coughing.

Canadian practice exams similarly pair crackles with volume overload and escalation of oxygen/notification.

Timing:

Late inspiratory

Pitch:

High-pitched, short, discontinuous pops

Best Auscultation

Often basilar; can be diffuse when interstitial fluid/fibrosis is widespread

Clinical Significance:

Fluid/fibrosis pattern: HF, ILD, interstitial processes; bilateral basilar crackles are classic for pulmonary edema.

Common Causes:

— Pulmonary edema (CHF)
— Pulmonary fibrosis
— ILD
— Early pneumonia

Recording

Coarse crackles (rales)

Filter Adventitious

Secretions or fluid in larger airways; may change or transiently clear with coughing.

Timing:

Inspiration and expiration

Pitch:

Low-pitched, louder “bubbling”

Best Auscultation

Variable — often central/large airway distribution

Clinical Significance:

Secretion burden vs alveolar fluid — clearing with cough leans toward larger-airway secretions.

Common Causes:

— Bronchiectasis
— Productive pneumonia
— COPD with mucus
— Severe pulmonary edema

Recording

Inspiratory crackles (mixed pattern)

Filter Adventitious

Crackles during inhalation from airway/alveolar opening — fine vs coarse depends on location and cause.

Timing:

Primarily inspiratory

Pitch:

Variable, discontinuous

Best Auscultation

Depends on etiology (bases vs diffuse)

Clinical Significance:

Persistent after repositioning leans toward fibrosis/HF; clearing may suggest atelectasis.

Common Causes:

— Atelectasis
— Pulmonary fibrosis
— Heart failure
— Pneumonia
— ILD

Recording

Wheezes

Filter Adventitious

Airflow through narrowed airways; polyphonic suggests diffuse narrowing, monophonic suggests focal obstruction.

Timing:

Often expiratory; can be biphasic

Pitch:

Musical, continuous, high-pitched

Best Auscultation

Diffuse or focal over involved lobes

Clinical Significance:

Bronchospasm/narrowing; silent chest in distress is an emergency (minimal air movement).

Common Causes:

— Asthma
— COPD
— Anaphylaxis
— Foreign body (monophonic)

Recording

Expiratory wheeze

Filter Adventitious

Classic pattern in asthma/COPD exacerbations from dynamic intrathoracic airway narrowing.

Timing:

Expiratory phase

Pitch:

High-pitched, continuous

Best Auscultation

Diffuse over lung fields

Clinical Significance:

Expiratory-only wheeze can still indicate significant obstruction — trend work of breathing and SpO₂.

Common Causes:

— Asthma
— COPD
— Bronchospasm

Recording

Rhonchi

Filter Adventitious

Air moving through secretions in larger airways; may improve after cough.

Timing:

Inspiratory and expiratory

Pitch:

Low-pitched, snoring/rattling

Best Auscultation

Central/large airways

Clinical Significance:

Helps differentiate secretion-related sounds from fixed wheeze in some vignettes.

Common Causes:

— COPD with mucus
— Chronic bronchitis
— Pneumonia
— Cystic fibrosis

Recording

Stridor

Filter Adventitious

Upper-airway obstruction pattern; may be audible without a stethoscope when severe.

Timing:

Primarily inspiratory

Pitch:

High-pitched, harsh/crowing

Best Auscultation

Over neck/larynx/trachea (listen at mouth/nose too in severe cases)

Clinical Significance:

Escalate acutely — airway compromise until proven otherwise.

Common Causes:

— Croup
— Epiglottitis
— Foreign body
— Anaphylaxis
— Post-extubation edema

Recording

Pleural friction rub

Filter Adventitious

Inflamed pleural surfaces rubbing — classically worsens with continued inspiration/expiration.

Timing:

Biphasic (inspiration and expiration)

Pitch:

Low-pitched, grating, superficial

Best Auscultation

Localized pleural area (varies with effusion/pneumonia/PE context)

Clinical Significance:

Pleural inflammation; distinguish from pericardial rub by persistence/change with breath hold maneuvers per exam teaching.

Common Causes:

— Pleurisy
— Pneumonia with pleural involvement
— PE
— Pleural malignancy

Recording

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Clinical meaning

Respiratory Assessment for Nurses (Inspection, Palpation

Clinical meaning

Respiratory Sounds Library

Vesicular breath sounds

Bronchovesicular breath sounds

Bronchial (tubular) breath sounds

Fine crackles (rales)

Coarse crackles (rales)

Inspiratory crackles (mixed pattern)

Wheezes

Expiratory wheeze

Rhonchi

Stridor

Pleural friction rub

Exam relevance

Core concept

Clinical scenario

Takeaways

Respiratory Assessment for Nurses (Inspection, Palpation

Clinical meaning

Respiratory Sounds Library

Vesicular breath sounds

Bronchovesicular breath sounds

Bronchial (tubular) breath sounds

Fine crackles (rales)

Coarse crackles (rales)

Inspiratory crackles (mixed pattern)

Wheezes

Expiratory wheeze

Rhonchi

Stridor

Pleural friction rub

Exam relevance

Core concept

Clinical scenario

Takeaways

Check your understanding

Check your understanding

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