A focused assessment of the respiratory system includes a review for common or concerning symptoms including: Cough—productive/nonproductive, hoarse, or barking; Sputum characteristics—clear, purulent, bloody (hemoptysis), rust colored, or pink and frothy; Dyspnea (shortness of breath) with or without activity, wheezing, or stridor; Chest pain—on inspiration, expiration, or with coughing and location of pain. Ask about associated symptoms such as cold symptoms, fever, night sweats, and fatigue. For positive responses, ask when symptoms started (duration), location, severity, setting, time of day, alleviating factors (what helps), and aggravating factors (what makes it worse). In addition, ask about smoking history, environmental exposure, past medical and family history, and current medications (Bickley, 2012Mansen & Gabiola, 2015).

Because older adults are at increased risk for respiratory disease due to loss of elasticity and decreased ventilation of the lower lobes, specifically inquire about fatigue, weight change, dyspnea on exertion, flu and pneumonia vaccine status, and change in number of pillows used at night (Hogstel & Curry, 2005).