Respiratory Assessment: You Must Know PIPPA

Respiratory AssessmentA respiratory assessment is an integral part of any head-to-toe physical exam.

It is also a valuable tool for identifying acute or chronic lung conditions.

A proper respiratory exam involves both skill and practice.

The following outlines the steps you should use in performing a respiratory assessment as well as how to identify potential problems.

What is a Respiratory Assessment?

A healthcare professional will perform a respiratory assessment as part of a complete physical exam or when a patient presents with the following:

Since some respiratory symptoms, such as chest pain, can mimic those associated with heart problems, the lung exam is often conducted along with a cardiac exam.

 

Steps for Performing a Respiratory Assessment:

The mnemonic “PIPPA” can help you remember the basic steps to any respiratory assessment.

PIPPA stands for the following:

1. Positioning the Patient and Adjusting the Environment:

To perform the exam, the patient should be sitting upright with their arms at their side.

The individual should be asked to expose their chest to make it easier to visualize their respiratory effort and listen to the anterior breath sounds.

Later in the exam, you will ask the patient to move their arms forward so that the scapulae will not interfere with you listening to the posterior breath sounds.

You should ensure that you perform the exam in a quiet, private area with plenty of lighting.

2. Inspection of the Patient:

You actually begin this step the minute you walk into the room with the patient.

As you watch the patient breathe, pay close attention to the following:

3. Palpation of the Posterior Chest Wall:

Palpation is a relatively small part of the respiratory assessment since the lungs are protected by the rib cage and not directly palpable.

However, you can use palpation to accentuate chest movement.

For example, you can place both hands on either side of the spine in the middle of the patient’s back.

Both hands should lift symmetrically each time the patient takes a breath.

In cases of severe lung disease or fluid or air surrounding the lung, the hand on the affected side will rise to a lesser degree.

Move your hands along the length of the spine as the patient repeats the word “ninety-nine.”

The vibrations should feel the same.

Areas of increased or decreased vibrations may indicate fluid in or around the lungs.

4. Percussion of the Chest Wall:

Respiratory ExamYou may have wondered why doctors and nurses tap your back during a respiratory exam.

This is a technique known as percussion and is used to identify potential areas of density in the lung fields.

To perform percussion, you should follow these steps:

Normal percussion will sound slightly resonant.

Fluid or bacteria infiltration will sound dull.

A tympanic or drum-like sound indicates air is trapped in or around the lungs, which is a sign of emphysema or a pneumothorax.

5. Auscultation of Lung Sounds:

Respiratory Assessment PIPPAThe final step of the respiratory exam is to auscultate, or listen, to lung sounds by positioning a stethoscope along the anterior and posterior lung fields.

The following are examples of abnormal sounds that you might hear:

Don’t worry if you find some of the above steps awkward or difficult at first.

Like any skill, it takes time and practice to perfect the technique and develop an eye and ear for what is normal and abnormal.

 

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