Vision: A PREMIER UNIVERSITY delivering

world-class education that promotes

Benguet State University “Excellent nursing education that
provides graduates with self-direction,
sustainable development amidst climate
change. COLLEGE OF NURSING competence and compassion.”

Mission: To provide quality education to La Trinidad, Benguet “The College of nursing is committed to
enhance food security, sustainable provide a strong academic and
communities, industry innovation, climate
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
resilience, gender equality, institutional of nursing.”
development and partnerships.

I. ASSESSING OXYGENATION

A. RESPIRATION

Throwback time! You’ve already learned about how to assess the respiration of your patient in your level
II competencies. If you can remember, we utilize the four techniques of assessment namely: Inspection, Palpation,
Percussion and Auscultation. For patients with oxygenation problems, we also utilize the pulse oximetry and ABG
results as part of evaluating the oxygenation status. The photo below shows you a picture of a patient in
respiratory distress. It’s time to jog your memory! Imagine yourself assessing this patient. Take a moment. What
do you inspect? What do you palpate? How do you percuss? How do you auscultate? Close your eyes and give
yourself some time to visualize the ward setting and imagine performing these assessments. Follow the checklist
provided below as you assess this patient.

Inspection
 Skin color
 Nail beds
 Capillary Refill Time
 Coughing
 Breathing pattern
 Chest rise and fall
 RR
 Use of accessory muscles
Palpation
 Tactile Fremitus
 Chest excursion
Percussion
 Resonant sounds
 Hyper-resonant sounds
 Dull sounds
 Tympanic sounds
Auscultation
 Breath Sounds
Other Assessments
 SpO2
 ABG
 X-Ray

Have you successfully evaluated for all the assessments in the checklist? If not, don’t worry. We can review
them in the context of a patient in distress. Refer to the table below:

INSPECTION ❖ Skin color Pallor/ Cyanotic? Pinkish?

❖ Nail beds Pale? Cyanotic? Clubbing present?
❖ Capillary Refill Time More than 2 seconds? This might
indicate respiratory or circulatory
problem.
❖ Coughing Productive or non-productive? Mucus
consistency, thickness and amounts?
❖ Breathing pattern Difficulty of breathing? Labored?
Shallow or deep breaths?
❖ Chest rise and fall Abdominal breathing? Complete rise and
fall?
Vision: A PREMIER UNIVERSITY delivering
world-class education that promotes
sustainable development amidst climate
change.
Mission: To provide quality education to
enhance food security, sustainable
communities, industry innovation, climate
resilience, gender equality, institutional
development and partnerships.
PALPATION
PERCUSSION
AUSCULTATION
OTHER ASSESSMENTS
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
COLLEGE OF NURSING competence and compassion.”
La Trinidad, Benguet “The College of nursing is committed to
provide a strong academic and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
❖ RR 1 breath = one inspiration and one
expiration; how many breaths per min?
Normal is 12- 20 breaths/min
❖ Use of accessory Use of substernal, intercostal muscles
muscles and sternocleidomastoid muscles?
Nasal/alar flaring?
❖ Tactile Fremitus Elicited by telling your patient to say
“99” or “33” while palpating the chest to
feel for vibration. This will test if air is
reaching all areas of the lungs.
❖ Chest excursion/ Elicited by palpating the chest and telling
expansion your patient to inhale and exhale. This
will test if both lungs are expanding well
and equally.
❖ Resonant sounds This is the normal percussion sounds to
be expected in the lungs.
❖ Hyper-resonant This may indicate an excessive residual
sounds air volume in the lungs upon exhalation
giving a louder sound when percussed.
Common in restrictive lung diseases such
as COPDs.
❖ Dull sounds This may indicate firm tissue. Common
in patients who developed fibrosis on
the lung tissue.
❖ Flat sounds This indicates presence of soft tissue.
❖ Tympanic sounds Not normally heard in chest percussion.
❖ Breath Sounds Normally clear. The presences of
rhonchi, crackles or rales indicate fluid in
the lungs and common during infection.
Stridor and wheezing are for upper
airway obstructions such as asthma.
❖ Bronchial sounds Heard over the anterior chest near the
second and third intercostal space.
Inspiration: Expiration ratio is 1:2
❖ Bronchovesicular Heard over the bronchial area and
posterior chest between the scapulae.
Inspiration: Expiration ratio is 1:1
❖ Vesicular Sounds Heard over most lung fields. Inspiration:
Expiration ratio is 2:1
❖ SpO2 Estimate of level of oxygen in the
periphery; Normally 95% to 100%.
Hypoxia might be determined if below
95% and consistent with other signs and
symptoms.
❖ Arterial Blood Gas We check the PaO2 or oxygen saturation
in the serum; normally 80 to 100 mmHg.
This is the most accurate measurement
of oxygen level.
❖ X-Ray This could be used to detect presence of
obstruction along the airway or the
presence of fluid, fibrosis and mass in
the lungs.
Vision: A PREMIER UNIVERSITY delivering
world-class education that promotes
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
sustainable development amidst climate
change. COLLEGE OF NURSING competence and compassion.”

Mission: To provide quality education to La Trinidad, Benguet “The College of nursing is committed to
enhance food security, sustainable provide a strong academic and
communities, industry innovation, climate
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
resilience, gender equality, institutional of nursing.”
development and partnerships.

OTHERS
1. Assignments
2. Advance reading
3. Asynchronous video for better explanation of the procedure and computation

REFERENCES
Bates' Visual Guide to Physical Examination. (n.d.). Examination of Thorax and Lungs [Video].
YouTube. https://www.youtube.com/watch?v=NCIf7WJDWd8

Berman, A. T., Snyder, S., & Frandsen, G. (2015). Kozier & Erb's fundamentals of nursing:
Concepts, process, and practice (10th) edition. MACMILLAN HEINEMANN

Perry, A. G., & Potter, P. A. (2017). Mosby's pocket guide to nursing skills and procedures - E-
book. Elsevier Health Sciences.

Pooler, C. (2009). Porth pathophysiology: Concepts of altered health states. Lippincott

Williams & Wilkins.

Prepared and submitted:

RLE CLINICAL FACILITATOR

Recommending approval:

JOCYLYN W. ANGELES, RN., MAN

Chairman, Dep’t of Clinical Instruction
Approved:
JUDE L. TAYABEN, PhDN
Dean
Vision: A PREMIER UNIVERSITY delivering
world-class education that promotes
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
sustainable development amidst climate
change. COLLEGE OF NURSING competence and compassion.”

Mission: To provide quality education to
enhance food security, sustainable
communities, industry innovation, climate
resilience, gender equality, institutional
development and partnerships.
La Trinidad, Benguet “The College of nursing is committed to
provide a strong academic and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”