Which observation can be made in the pulmonary system without direct assessment?

In the pulmonary system, labored breathing is an observable external sign that can be assessed through visual observation and auditory cues without the need for direct diagnostic tools or assessments. Noticing labored breathing involves observing a patient’s effort to breathe, which may include signs such as an increased respiratory rate, use of accessory muscles for breathing, or audible wheezing and gasping. These indicators can give healthcare providers valuable information about the patient’s respiratory status based on what can be seen and heard.

In contrast, detecting chest sounds typically requires the use of a stethoscope to listen to the lungs directly, making that a more direct assessment method. A peak flow meter is a device used to measure the peak expiratory flow rate, which involves active participation by the patient and does not qualify as an observation. Performing a chest x-ray involves imaging technology that provides a detailed look at the lungs but is not an observation in the traditional sense and requires specific equipment and procedure. Thus, only noticing labored breathing fits the criterion of an observation that does not need direct assessment.