Respiratory Course Audit

n
The Respiratory
System
ANGEL LYNN R. SANTOS, MDRN
Organs of the Respiratory system
• Nose
• Pharynx
• Larynx
• Trachea
• Bronchi
• Lungs –
alveoli
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 13.1 Slide 13.1
Function of the Respiratory System
• Oversees gas exchanges between the

blood and external environment
• Exchange of gasses takes place within
the lungs in the alveoli
• Passageways to the lungs purify, warm,
and humidify the incoming air
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 13.2

The Nose
• The only externally visible part of the

respiratory system
• Air enters the nose through the external
nares (nostrils)
• The interior of the nose consists of a
nasal cavity divided by a nasal septum
Slide
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
13.3a
Upper Respiratory Tract
Figure 13.2
Slide
13.3b
Anatomy of the Nasal Cavity
• Olfactory receptors are located in the

mucosa on the superior surface
• The rest of the cavity is lined with
respiratory mucosa
• Moistens air
• Traps incoming foreign particles
Slide
13.4a
Anatomy of the Nasal Cavity
• Lateral walls have projections called
conchae
• Increases surface area
• Increases air turbulence within the nasal
cavity
• The nasal cavity is separated from the
oral cavity by the palate
• Anterior hard palate (bone)
• Posterior soft palate (muscle)
Slide
13.4b
Paranasal Sinuses
• Cavities within bones surrounding the

nasal cavity
• Frontal bone
• Sphenoid bone
• Ethmoid bone
• Maxillary bone
Slide
13.5a
Paranasal Sinuses
• Function of the sinuses

• Lighten the skull
• Act as resonance chambers for speech
• Produce mucus that drains into the nasal
cavity
Slide
13.5b
Pharynx (Throat)
• Muscular passage from nasal cavity to
larynx
• Three regions of the pharynx
• Nasopharynx – superior region behind
nasal cavity
• Oropharynx – middle region behind mouth
• Laryngopharynx – inferior region attached
to larynx
• The oropharynx and laryngopharynx are
common passageways for air and food
Structures of the Pharynx
• Auditory tubes enter the nasopharynx

• Tonsils of the pharynx
• Pharyngeal tonsil (adenoids) in the
nasopharynx
• Palatine tonsils in the oropharynx
• Lingual tonsils at the base of the tongue

Larynx (Voice Box)
• Routes air and food into proper

channels
• Plays a role in speech
• Made of eight rigid hyaline cartilages
and a spoon-shaped flap of elastic
cartilage (epiglottis)

Structures of the Larynx
• Thyroid cartilage
• Largest hyaline cartilage
• Protrudes anteriorly (Adam’s apple)
• Epiglottis
• Superior opening of the larynx
• Routes food to the larynx and air toward the
trachea
Slide
13.9a
Structures of the Larynx
• Vocal cords (vocal folds)

• Vibrate with expelled air to create sound
(speech)
• Glottis – opening between vocal cords
Slide
13.9b
Trachea (Windpipe)
• Connects larynx with bronchi
• Lined with ciliated mucosa
• Beat continuously in the opposite direction of
incoming air
• Expel mucus loaded with dust and other
debris away from lungs
• Walls are reinforced with C-shaped
hyaline cartilage
Slide
13.10
Primary Bronchi
• Formed by division of the trachea

• Enters the lung at the hilus
(medial depression)
• Right bronchus is wider, shorter,
and straighter than left
• Bronchi subdivide into smaller
and smaller branches
Slide
13.11
Lungs
• Occupy most of the thoracic cavity

• Apex is near the clavicle (superior portion)
• Base rests on the diaphragm (inferior
portion)
• Each lung is divided into lobes by fissures
• Left lung – two lobes
• Right lung – three lobes
Slide
13.12a
Lungs
Figure 13.4b
Slide
13.12b
Coverings of the Lungs
• Pulmonary (visceral) pleura covers the

lung surface
• Parietal pleura lines the walls of the
thoracic cavity
• Pleural fluid fills the area between layers
of pleura to allow gliding
Slide
13.13
Respiratory Tree Divisions
• Primary bronchi
• Secondary bronchi
• Tertiary bronchi
• Bronchioli
• Terminal bronchioli
Slide
13.14
Bronchioles
• Smallest
branches of
the bronchi
Figure 13.5a
Slide
13.15a
Bronchioles
• All but the smallest

branches have
reinforcing cartilage
Figure 13.5a
Slide
13.15b
Bronchioles
• Terminal
bronchioles end
in alveoli
Figure 13.5a
Slide
13.15c
Respiratory Zone
• Structures
• Respiratory bronchioli
• Alveolar duct
• Alveoli
• Site of gas exchange
Slide
13.16
Alveoli
• Structure of alveoli
• Alveolar duct
• Alveolar sac
• Alveolus
• Gas exchange takes place within the alveoli
in the respiratory membrane
Slide
13.17
Respiratory Membrane
(Air-Blood Barrier)
• Thin squamous epithelial layer lining

alveolar walls
• Pulmonary capillaries cover external
surfaces of alveoli
Slide
13.18a
Respiratory Membrane
(Air-Blood Barrier)
Figure 13.6
Slide
13.18b
Gas Exchange
• Gas crosses the respiratory membrane

by diffusion
• Oxygen enters the blood
• Carbon dioxide enters the alveoli
• Macrophages add protection
• Surfactant coats gas-exposed alveolar
surfaces
Slide
13.19
Events of Respiration
• Pulmonary ventilation – moving air in and

out of the lungs
• External respiration – gas exchange
between pulmonary blood and alveoli
Slide
13.20a
Events of Respiration
• Respiratory gas transport – transport of

oxygen and carbon dioxide via the
bloodstream
• Internal respiration – gas exchange
between blood and tissue cells in
systemic capillaries
Slide
13.20b
Mechanics of Breathing
(Pulmonary Ventilation)
• Completely mechanical process

• Depends on volume changes in the
thoracic cavity
• Volume changes lead to pressure
changes, which lead to the flow of
gases to equalize pressure
Slide
13.21a
Mechanics of Breathing
(Pulmonary Ventilation)
• Two phases
• Inspiration – flow of air into lung
• Expiration – air leaving lung
Slide
13.21b
Inspiration
• Diaphragm and intercostal muscles

contract
• The size of the thoracic cavity increases
• External air is pulled into the lungs due to
an increase in intrapulmonary volume
Slide
13.22a
Inspiration
Figure 13.7a
Slide
13.22b
Exhalation
• Largely a passive process which depends

on natural lung elasticity
• As muscles relax, air is pushed out of the
lungs
• Forced expiration can occur mostly by
contracting internal intercostal muscles to
depress the rib cage
Slide
13.23a
Exhalation
Figure 13.7b
Slide
13.23b
Accessory Muscles of
Respiration
Pressure Differences in the
Thoracic Cavity
• Normal pressure within the pleural

space is always negative (intrapleural
pressure)
• Differences in lung and pleural space
pressures keep lungs from collapsing
Slide
13.24
Nonrespiratory Air Movements
• Can be caused by reflexes or voluntary
actions
• Examples
• Cough and sneeze – clears lungs of debris
• Laughing
• Crying
• Yawn
• Hiccup
Slide
13.25
Respiratory Volumes and Capacities
• Normal breathing moves about 500 ml of air
with each breath (tidal volume [TV])
• Many factors that affect respiratory capacity
• A person’s size
• Sex
• Age
• Physical condition
• Residual volume of air – after exhalation,
about 1200 ml of air remains in the lungs
Slide
13.26
• Inspiratory reserve volume (IRV)

• Amount of air that can be taken in forcibly
over the tidal volume
• Usually between 2100 and 3200 ml
• Expiratory reserve volume (ERV)
• Amount of air that can be forcibly exhaled
• Approximately 1200 ml
Slide
13.27a
• Residual volume
• Air remaining in lung after expiration
• About 1200 ml
Slide
13.27b
• Vital capacity
• The total amount of exchangeable air
• Vital capacity = TV + IRV + ERV
• Dead space volume
• Air that remains in conducting zone and
never reaches alveoli
• About 150 ml
Slide
13.28
• Functional volume
• Air that actually reaches the respiratory
zone
• Usually about 350 ml
• Respiratory capacities are measured
with a spirometer
Slide
13.29
Respiratory Capacities
Figure 13.9
Slide
13.30
The Respiratory
System
DRA. JULIE C, YU-SANTOS

Respiratory Sounds
• Sounds are monitored with a

stethoscope
• Bronchial sounds – produced by air
rushing through trachea and bronchi
• Vesicular breathing sounds – soft
sounds of air filling alveoli
Slide
13.31
External Respiration
• Oxygen movement into the blood

• The alveoli always has more oxygen than
the blood
• Oxygen moves by diffusion towards the
area of lower concentration
• Pulmonary capillary blood gains oxygen
Slide
13.32a
External Respiration
• Carbon dioxide movement out of the

blood
• Blood returning from tissues has higher
concentrations of carbon dioxide than air in
the alveoli
• Pulmonary capillary blood gives up carbon
dioxide
• Blood leaving the lungs is oxygen-rich
and carbon dioxide-poor
Slide
13.32b
Gas Transport in the Blood
• Oxygen transport in the blood

• Inside red blood cells attached to
hemoglobin (oxyhemoglobin [HbO2])
• A small amount is carried dissolved in the
plasma
Slide
13.33a
Gas Transport in the Blood
• Carbon dioxide transport in the blood

• Most is transported in the plasma as
bicarbonate ion (HCO3–)
• A small amount is carried inside red blood
cells on hemoglobin, but at different binding
sites than those of oxygen
Slide
13.33b
Internal Respiration
• Exchange of gases between blood and

body cells
• An opposite reaction to what occurs in
the lungs
• Carbon dioxide diffuses out of tissue to
blood
• Oxygen diffuses from blood into tissue
Slide
13.34a
Figure 13.11
Slide
13.34b
External Respiration,
Gas Transport, and
Summary
Figure 13.10
Slide
13.35
Neural Regulation of Respiration
• Activity of respiratory muscles is transmitted
to the brain by the phrenic and intercostal
nerves
• Neural centers that control rate and depth are
located in the medulla
• The pons appears to smooth out respiratory
rate
• Normal respiratory rate (eupnea) is 12–15
respirations per minute
• Hypernia is increased respiratory rate often
due to extra oxygen needs
Slide
13.36
Neural Regulation of Respiration
Figure 13.12
Slide
13.37
Factors Influencing Respiratory
Rate and Depth
• Physical factors
• Increased body temperature
• Exercise
• Talking
• Coughing
• Volition (conscious control)
• Emotional factors
Slide
13.38
Rate and Depth
• Chemical factors
• Carbon dioxide levels
• Level of carbon dioxide in the blood is the
main regulatory chemical for respiration
• Increased carbon dioxide increases
respiration
• Changes in carbon dioxide act directly on
the medulla oblongata
Slide
13.39a
Rate and Depth
• Chemical factors (continued)

• Oxygen levels
• Changes in oxygen concentration in the
blood are detected by chemoreceptors in
the aorta and carotid artery
• Information is sent to the medulla oblongata
Slide
13.39b
Respiratory Disorders: Chronic
Obstructive Pulmonary Disease
(COPD)
• Exemplified by chronic bronchitis and

emphysema
• Major causes of death and disability in
the United States
Slide
13.40a
(COPD)
• Features of these diseases
• Patients almost always have a history of
smoking
• Labored breathing (dyspnea) becomes
progressively more severe
• Coughing and frequent pulmonary
infections are common
Slide
13.40b
(COPD)
• Features of these diseases (continued)

• Most victimes retain carbon dioxide, are
hypoxic and have respiratory acidosis
• Those infected will ultimately develop
respiratory failure
Slide
13.40c
Emphysema
• Alveoli enlarge as adjacent chambers break
through
• Chronic inflammation promotes lung fibrosis
• Airways collapse during expiration
• Patients use a large amount of energy to
exhale
• Overinflation of the lungs leads to a
permanently expanded barrel chest
• Cyanosis appears late in the disease
Slide
13.41
Chronic Bronchitis
• Mucosa of the lower respiratory
passages becomes severely inflamed
• Mucus production increases
• Pooled mucus impairs ventilation and
gas exchange
• Risk of lung infection increases
• Pneumonia is common
• Hypoxia and cyanosis occur early
Slide
13.42
Chronic Obstructive Pulmonary Disease
(COPD)
Figure 13.13
Slide
13.43
Lung Cancer
• Accounts for 1/3 of all cancer deaths in
the United States
• Increased incidence associated with
smoking
• Three common types
• Squamous cell carcinoma
• Adenocarcinoma
• Small cell carcinoma
Slide
13.44
Sudden Infant Death syndrome
(SIDS)
• Apparently healthy infant stops
breathing and dies during sleep
• Some cases are thought to be a
problem of the neural respiratory control
center
• One third of cases appear to be due to
heart rhythm abnormalities
Slide
13.45
Asthma
• Chronic inflamed hypersensitive

bronchiole passages
• Response to irritants with dyspnea,
coughing, and wheezing
Slide
13.46
BRONCHIAL TUBE
Developmental Aspects of the
Respiratory System
• Lungs are filled with fluid in the fetus

• Lungs are not fully inflated with air until
two weeks after birth
• Surfactant that lowers alveolar surface
tension is not present until late in fetal
development and may not be present in
premature babies
Slide
13.47a
Developmental Aspects of the
Respiratory System
• Important birth defects

• Cystic fibrosis – oversecretion of thick
mucus clogs the respiratory system
• Cleft palate
Slide
13.47b
Aging Effects
• Elasticity of lungs decreases

• Vital capacity decreases
• Blood oxygen levels decrease
• Stimulating effects of carbon dioxide
decreases
• More risks of respiratory tract infection
Slide
13.48
Respiratory Rate Changes
Throughout Life
• Newborns – 40 to 80 respirations per
minute
• Infants – 30 respirations per minute
• Age 5 – 25 respirations per minute
• Adults – 12 to 18 respirations per
minute
• Rate often increases somewhat with old
age
Slide
13.49
RESPIRATORY
DISORDERS
DRA. JULIE C. YU-SANTOS
OBSTRUCTIVE DISORDERS
1. MECHANICAL 3. INFECTIONS
OBSTRUCTION (LRTI)
a. Foreign Bodies a. Laryngitis
b. Tracheitis
b. Tongue Falling
c. Bronchitis
d. Bronchiolitis
2. ALLERGIES e. Pneumonitis
a. Hay Fever 4. TUMORS
(Allergic Rhinitis)
a. BenignTumors
b. Bronchial Asthma b. Lung Cancer
DIFFUSIVE DISORDERS
A. Loss of Aerating Surface
B.  Pulmonary Perfusion
ALVEOLAR INFEC.
OVERSTRETCHING
 Pneumonia
 ( Compliance,  Recoil)
 PTB
 Pulmonary
 Histoplasmosis
Emphysema
FLUIDS IN ALVEOLI  Bronchiectasis
 Pulmonary Edema
 COMPLIANCE
 A.R.D.S.  PTB Fibrosis
ATELECTASIS  Consolidations
 IRDS (Pneumonia, Tumors)
 Pneumothorax  Pneumothorax
I.RESTRICTION or
PARALYSIS OF RESP.
RESTRICTIVE
M: DISORDERS
 Poliomyelitis
 Myasthenia Gravis
II.LOSS OF NORMAL
 Guillain-Barre’ Synd
NEGATIVE
 Multiple Sclerosis PRESSURE:
 Amyotropic Lateral
Sclerosis (ALS)  Pneumothorax
 Scleroderma  Hemothorax
 Pleural Effusion
 Kyphoscoliosis
 Empyema Thoracis
 Obesity
 Multiple Rib
 Brain/SC Injury
Fracture (Flail
 Gen. Anes./ Narcotic O. Chest)
DIFFUSIVE DISORDERS
= Disorders affecting Alveolar Diffusion
 LOSS OF AERATING  PULMONARY

SURFACE PERFUSION
LOSS OF AERATING
SURFACE
 ALVEOLAR INFEC.  OVERSTRETCHING
*Pneumonia ( Compliance, Recoil)
*PTB *Pul. Emphysema
*Histoplasmosis *Bronchiectasis
FLUIDS IN ALVEOLI  COMPLIANCE
*Pulmonary Edema
*PTB Fibrosis
*A.R.D.S.
*Consolidations:
ATELECTASIS (Tumors, Pneumonias)
*IRDS *Pneumothorax
*Pneumothorax
Loss of alveolar tissues
Pulmonary Resectional Surgeries
 Lobectomies--removal of lobe/s but not the
entire lung
 Pneumonectomy—removal of a lung
 Segmental Resection—removal of
segments but not entire lobe
 Wedge Resection—removal of wedges but
not entire segment; commonly done for open
lung biopsy
Nursing Diagnosis: Gas Exchange, Impaired

BRONCHIAL
ASTHMA
BRONCHIAL Asthma
 Inappropriate response of the immune
system to allergens or foreign proteins
 Allergy involving the lower respiratory tract
 Non-infectious
 Inflammatory
Predisposing Etiology:
@ Heredity
Precipitating Etiology:
@Extrinsic allergens
@Intrinsic allergens
Types of Asthma
A. Extrinsic or Atopic Asthma: r/t
external allergens such as:
 -contactants: dust, chemicals, soaps,
perfumes, lotions, make-up
 -inhalants: dust, hay, scents, smoke,
sprays
 -ingestants: food, milk, chicken, beef,
pork, eggs, etc.
 -Sudden changes in temperature
Types of Asthma
B. Intrinsic or Non-Atopic
Asthma= not r/t external allergens
Stress
Fatigue
Lack of Sleep
Anxiety
C. MIXED type of Asthma= both
types present
Bronchial Asthma:
 Heredity + Allergens
 Release of IgE from B lymphocytes
 IgE
+ Mast cells of respiratory tract =
damage to mast cells
 Release
of: Histamine, Bradykinin,
Serotonin, Leukotriennes,
Prostaglandins, ECF-A, SRS-A from
damaged mast cells to respiratory
membranes
Bronchial Asthma: Pathophysiology
 Inflammatory reaction @ linings of
the airway
 S-welling
 H-eat
 A-airway obstruction
 R-edness
 P-ain (Back pains)
Bronchial Asthma
 =S-ecretions: copious, viscous,
sticky, stringy, whitish
 =S-pasms: laryngo-tracheo-
bronchial spasm
 =S-welling: edema of the airway
 Airway Obstruction
 Dyspnea
Signs and Symptoms: Asthma
 Successive episodes of coughing:
dry, hacking, non-productive cough
 Increased respiratory secretions:
whitish, stringy
 Wheezing on expiration
 Prolonged expiration
 Dry lips and mucous membranes

(mouth)
 Dyspnea, Tachypnea, Tachycardia
 Apprehension and restlessness

NCP: Bronchial Asthma
 Nsg. Dx.#1: Ineffective Airway
Clearance r/t Secretions, Spasms and
Swelling of airway ass’d w/ allergy of the
LRT
 Goals:
Long-term Goal: Patient will achieve an open

airway and adequate ventilation as
manifested by normal VS and relief of
symptoms
Short-term Objectives:
e. Liquify secretions
f. Easily expectorate and drain secretions
g. Relieve spasms
 Nursing Actions:
 1. Liquify secretions.
= Increase fluid intake @ 2-3 l/day

= Nebulization
= Steam inhalation
= Avoid creams, milk
= Humidify room
= Mucolytics as ordered
Bromhexine HCl… (Bisolvon)
Ambroxol…(Solmux Broncho; Broncho fluid)
Guiafenesin…(Robitussin)
Carboxycisteine… (Loviscol)
Ammonium Citrate… (Citrex)
 2. Drain and easily expectorate
secretions
= Deep breathing
= Coughing
= Vibration
= Percussion
= Postural Drainage
 3. Relieve bronchospasm and
swelling of airways
= Administer Bronchodilators
= Administer anti-histaminics
 BRONCHODILATORS:
A. Direct bronchodilators
= Xanthine bronchodilators (Theophyllines:
Aminophyllines, Nuelin, Marax, Brolexin, Asma-
Solon, etc.)
= Sympathomimetic bronchodilators
(Adrenaline, Ephedrine SO4, Neosynephrine,
Phenylephrine HCl, Bronkosol, Isoproterenol)
= New generation bronchodilators
(Salbutamol-Ventolin; Terbutaline-Bricanyl; )
B. Indirect bronchodilators
= antibiotics
= steroids
 ANTI-HISTAMINICS.
 Diphenhydramine HCl-(Benadryl),
 Chlorpheniramine Maleate-(Chlortrimeton),
 Brompheniramine Maleate-(Dimetapp),
 Terfenadine HCl-(Teldane),
 Loratadine HCl-(Claritin)
 Nsg. Dx. #2: Impaired Breathing
Pattern r/t airway obstruction
 Goal:
= Improve ventilation
= Relieve signs of dyspnea
 Actions:
 Administer O2 @ 2-3 l/min via

nasal cannula
 Fowler’s or orthopneic position
 Nsg. Dx. #3: Gas Exchange,
impaired r/t increased physiologic
shunting defect.
 Goal: Improve gas exchange as
shown by normal ABGs
 Actions:
 Monitor ABG findings
 Intubate as needed
 Connect to artificial ventilator
 Continue with bronchodilators and
steroids
 IVF to kvo.
LUNG
CANCER
Lung Cancer: Definition
malignant growth in airways ,
alveolar tissues or interstitial
spaces in the lungs
Atypical cells growing in a very
fast pace resulting to
tumors
Lung Cancer: Incidence
Incidence As to
 In Adults: Leading Types:
Cause of Death in
U.S. in both men and  Adenocarcinoma
women
 Highest in age 60 …………....35-40%
and up  Epidermoid/Squam
 Seldom seen in age ous cell...………30-
group below 40 35%
 Approx. 180,000  Oat cell……20-25%
Americans will  Large cell…15-20%
Classification: LUNG CANCER
 According to
Origin
 According to
Location:
1. Primary Tumor-
I. Centrally-located
primary lesion
Tumors
originated from
Bronchogenic lungs
Carcinoma
2. Secondary or
II. Peripherally Metastatic
located Tumors Tumor- original
Lung tumor from
Carcinoma other parts of
Classification: Histology
1. ADENOCARCINOMA=
 not associated with any known cause
 Incidence equal among smokers and non-smokers
 Increasing incidence among women
 Peripherally-located : broncho-alveolar area
 Incidence: 2003 Statistics……………………..35-40%
2. EPIDERMOID CARCINOMA
 Squamous Cell Type
 Entirely associated with heavy smoking
 History: > 1p/y
 Highest incidence among Males > 40
 Most common cause of death among males in US today
 Centrally located in large bronchi
 Incidence: 2003 Statistics……………………..30-35%
Classification: Histology
3. OAT-CELL Ca
 Fusiform, polygonal
 Oat-like, small cells
 4. LARGE-CELL Ca
 Highly metastatic
 Large cells
 Peripherally-located  Slow-growing
 Usually not operable  Prognosis: Good
at time of diagnosis
 Poor Prognosis
 Incidence: 2003
Statistics……20-25%
METASTASES: LUNG CA
 Lymph nodes
 Bones
 Brain
 Contralateral Lung
 Adrenals
 Kidneys
 Liver
 Peritoneal organs
Diagnostic Exams: Lung Ca
 Chest X-ray
 Tomography
Signs and Symptoms: Lung Ca
5. CHEST PAINS/Tightness=
1. COUGH spread to regional lymph nodes
 Persistent for 2-3 weeks 6. Dysphagia= spread to
 Changing quality esophagus, trachea
 From hacking and non- 7. Head & neck edema=spread
productive to thick and to esophagus and lymphatic
purulent sputum structures
2. HEMOPTYSIS- esp in am 8. Dyspnea
3. UNILATERAL WHEEZE on 9. Anorexia, Weight loss,
expiration (partial
obstruction) Anemia,
4. CHX IN VOICE QUALITY 10. Infections=Fever, chills
= from hoarseness to Recurring
11. Dx:
aphonia (laryngeal n. Pneumonia
compression)
PULMONARY
EMPHYSEMA
Pulmonary Emphysema
 Terminal stage : C.A.L. (Chronic Airway
Limitation)
 Old Name: COPD
 Chief characteristics:
– Chronic airway obstruction

– Poor entry of O2
– Poor removal of CO2
– Air trapping
– Overstretching of alveolar walls
– Inc Compliance, Dec Recoil
– Formation of emphysematous blebs or
bullae
Etiology:Pulmonary
Emphysema
Predisposing Factors:
 A=uto-Immunity
 H=eredity = lack or absence of alpha-1 & 2
anti-trypsin
 A=ging
Precipitating Factors:
 S=moking
 P=ollution
 A=llergies
 I=nfections
Pathophysiology: Pul. Emphysema
 Chronic airway obstruction
 O2 intake CO2 removal
 Hypoxemia Air trapping
 Hypercapnea
Overdilation
 Hypoxia Resp. Acidosis Blebs

CHEST XRAY
 Provides information regarding the
anatomic location and appearance
of the lungs
 PREPROCEDURE
 1.Remove all jewelry and other
metal objects from the chest area
 2.Assess the client’s ability to
inhale and hold breath
 Question females regarding
pregnancy or the possibility of
pregnancy
POSTPROCEDURE
 Assist the client to dress

SPUTUM SPECIMEN
A specimen obtained by expectoration or tracheal
suctioning to assist in the identification of
organisms or abnormal cells
 1. PREPROCEDURE
 A. Determine specific purpose of
collection and check with institutional
policy for appropriate collection of
specimen
 B. Obtain an early morning sterile
specimen from suctioning or
expectoration after a respiratory
treatment, if a treatment is prescribed
 C. Obtain 15 ml of sputum
 D. Instruct the client to rinse the mouth
with water prior to collection
 E. Instruct the client to take several deep
breaths and then cough deeply to obtain
 POSTPROCEDURE
 A. If a culture of sputum is
prescribe, transport specimen to
laboratory immediately
 B. Assist the client with mouth
care
BRONCHOSCOPY
 1. Direct visual examination of the larynx, trachea,
and bronchi with a fiberoptic bronchoscope
 PREPROCEDURE
 A. Obtain informed consent
 B. NPO from midnight prior to the procedure
 C. Obtain vital signs
 D. Assess the results of coagulation studies
 E. Remove dentures or eyeglasses
 F. Prepare suction equipment
 G. Administer medication for sedation as prescribed
 H. Have emergency resuscitation equipment readily
available
POSTPROCEDURE
 A. Monitor vitals signs
 B. Maintain semi-fowler’s position
 C. Assess for the return of gag reflex
 D. Maintain NPO status until gag reflex returns
 E. Have an emesis basin readily available for
client to expectorate sputum
 F. Monitor for bloody sputum
 G. Monitor respiratory status, particularly if
sedation was administered
 H. Monitor for complications, such as
bronchospasm , bronchial perforation
indicated by facial or neck crepitus,
dysrhythmias, fever, bacteremia, hemorrhage,
hypoxemia, and pneumothorax
 I. Notify the physician if fever, difficulty of
PULMONARY ANGIOGRAPHY
 1. An invasive fluoroscopic procedure in which
a catheter is inserted through the antecubital
or femoral vein into the pulmonary artery or
one of its branches
 2. Involves an injection of iodine or
radiopaque or contrast material
 PREPROCEDURE
 B. Assess for allergies to odine, seafood, or
other radioopaque dyes
 C. Maintain NPO status for 8 hours prior to the
procedure
 D. Monitor vital signs
 E. Assess results of coagulation studies
 F. Establish an IV access
 PREPROCEDURE (CONT.)
 H. Instruct the client that he or she
must lie still during the procedure
 I. Instuct the client that she or he may
feel an urge to cough, flushing, nausea,
or a salty taste following injection of the
dye
 J. Have emergency resuscitation
equipment available
 POSTPROCEDURE
 A. Monitor vital signs
 B. Avoid taking blood pressures for 24
hours in the extremity used for the
injection
 C. Monitor peripheral neurovascular
status
THORACENTESIS
 Removal of fluid or air from the pleural space
via a transthoracic aspiration
 PREPROCEDURE
 A. Obtain consent
 B. Obtain vital signs
 C. Prepare the client for ultrasound or chest
radiograph, if prescribed, prior to procedure
 D. Assess results of coagulation studies
 E. Note that the client is positioned sitting
upright, with the arms and head supported
by a table at the bedside during the
procedure
 F. If the client cannot sit up, the client is
placed lying in bed on the unaffected side
with the head of the bed elevated 45 degrees
 G. Instruct the client not to cough, breath
 POSTPROCEDURE
 B. Monitor respiratory status
 C. Apply a pressure dressing, and
assess the puncture site for
bleeding and crepitus
 D. Monitor for signs of
pneumothorax, air embolism, and
pulmonary edema
PULMONARY FUNCTION TEST
- Include a number of different tests used to evaluate
lung mechanics, gas exchange, and acid base
disturbance through spirometric measurements, lung
volumes, and arterial blood gases
PREPROCEDURE
C. Determine if an analgesic that may depress the
respiratory function is being administered
D. Consult with the physician regarding holding
bronchodilators prior to testing
E. Instruct the client to void prior to procedure
and to wear loose clothing
F. Remove denture
G. Instruct the client to refrain from smoking or
eating a heavy meal for 4 to 6 hours prior to
the test
POSTPROCEDURE
LUNG BIOPSY
 1. A percutaneous lung biopsy is
performed to obtain tissue for analysis
by culture or cytologic examination
 2. A needle biopsy is done to identify
pulmonary lesions, changes in lung
tissue, and the cause of pleural effusion
 PREPROCEDURE
 B. Maintain NPO status prior to the procedure
 C. Inform the client that a local anesthetic
will be used but that a sensation of pressure
during needle insertion and aspiration may
be felt
 POSTPROCEDURE
 B. Apply a dressing to the biopsy site
and monitor for drainage or bleeding
 C. Monitor for signs of respiratory
distress, and notify the physician if they
occur
 D. Monitor for signs of pneumothorax
and air emboli, and notify the physician
if they occur
 E. Prepare the client for chest x-ray film
if prescribed
VENTILATION PERFUSION LUNG
SCAN
 1. In the perfusion scan, blood flow to the lungs
is evaluated
 2. The ventilation scan determines the patency
of the pulmonary airways and detects
abnormalities in ventilation
 3. A radionuclide may be injected for the
procedure
 PREPROCEDURE
 B. Assess for allergy to dye, iodine, or seafood
 C. Remove jewelry around the chest area
 D. Review breathing methods that may be
required during testing
 POSTPROCEDURE
 A. Monitor client for reaction to the
radionulide
 B. For 24 hours following the procedure,
rubber gloves worn when urine is being
discarded should be washed with soap
and water before removing; then the
hands should be washed after the
gloves are removed
 C. Instruct client to wash hands
carefully with soap and water for 24
hours following the procedure
SKIN TESTS
 An intradermal injection used to assist in
diagnosing various infectious diseases
 PREPROCEDURE
 Determine hypersensitivity or previous
reactions to skin tests
 PROCEDURE
 A. Use a test site that is free of excessive
body hair , dermatitis, and blemishes
 B. Apply at the upper one third of inner
surface of left arm
 C. Circle and mark the injection test site
 D. Document the date, time, and test site
 POSTPROCEDURE
 A. Advise the client not to scratch the
test site, to prevent infection and
abscess formation
 B. Instruct the client to avoid washing
the test site
 C. Interpret the reaction of the injection
site 24 to 72 hours after administration
of the test antigen
 D. Assess the test site for the amount of
induration (hard swelling) in millimeters
and the presense of erythema and
vesiculation (small blister like
elevations)
ARTERIAL BLOOD GASSES
 Measure the dissolved oxygen and
carbon dioxide in the arterial blood and
reveal the acid-base state and how the
oxygen is being carried to the body
 NORMAL ABG VALUES
 Ph: 7.35 to 7.45
 Pco2: 35 to 45 mm Hg
 HCO3: 22 to 27 mEq/L
 Po2: 80 to 100 mm Hg
 O2 saturation: 96% to 100%
 Oxyhemoglobin dissociation curve: no
shift
 PREPROCEDURE
 A. Perform Allen’s test prior to drawing
radial artery specimens
 B. Have the client rest for 30 minutes
prior to specimen collection
 C. Avoid suctioning prior to drawing
ABGs
 D. Do not turn off oxygen unless the
ABGs are ordered to be drawn at room
air
 POSTPROCEDURE
 A. Place the specimen on ice
 B. Note the client’s temperature on

laboratory form
 C. Note the oxygen and type of
ventilation that the client is receiving on
the laboratory form
 D. Apply pressure to the puncture site
for 5 to 10 minutes and longer if the
client is on anticoagulant therapy or has
a bleeding disorder
 E. Transport the specimen to the
PULSE OXIMETRY
 1. A non invasive test the registers the
oxygen saturation of the client’s hemoglobin
 2. This arterial oxygen saturation (SaO2) is
recorded as a percentage
 3. The normal value is 95% to 100%
 4. After a hypoxic client uses up the readily
available oxygen (measured as the arterial
oxygen pressure, PaO2, on arterial blood
gas testing) the reserve oxygen, that
oxygen attached to the hemoglobin (SaO2),
is drawn on to provide oxygen to the tissues
 5. A pulse oximeter reading can alert the
nurse to hypoxemia before clinical signs
occur
 PROCEDURE
 A. A sensor is placed on the client’s
finger, toe, nose, earlobe, or forehead
to measure oxygen saturation, which is
then displayed on a monitor
 B. Maintain the transducer at heart level
 C. Do not select an extremity with an
impediment to blood flow
 D. Results lower than 91% necessitate
immediate treatment
 E. If the SaO2 is below 85%, the body’s
tissues have a difficult time becoming
oxygenated; an SaO2 of less than 70%
is life threatening

Respiratory Course Audit

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Respiratory Course Audit

Uploaded by

Copyright:

Available Formats

n

• Oversees gas exchanges between the

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 13.2

• The only externally visible part of the

• Olfactory receptors are located in the

• Cavities within bones surrounding the

• Function of the sinuses

• Auditory tubes enter the nasopharynx

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 13.7

• Routes air and food into proper

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 13.8

• Vocal cords (vocal folds)

• Formed by division of the trachea

• Occupy most of the thoracic cavity

• Pulmonary (visceral) pleura covers the

• All but the smallest

• Thin squamous epithelial layer lining

• Gas crosses the respiratory membrane

• Pulmonary ventilation – moving air in and

• Respiratory gas transport – transport of

• Completely mechanical process

• Diaphragm and intercostal muscles

• Largely a passive process which depends

• Normal pressure within the pleural

• Inspiratory reserve volume (IRV)

DRA. JULIE C, YU-SANTOS

• Sounds are monitored with a

• Oxygen movement into the blood

• Carbon dioxide movement out of the

• Oxygen transport in the blood

• Carbon dioxide transport in the blood

• Exchange of gases between blood and

• Chemical factors (continued)

• Exemplified by chronic bronchitis and

• Features of these diseases (continued)

• Chronic inflamed hypersensitive

• Lungs are filled with fluid in the fetus

• Important birth defects

• Elasticity of lungs decreases

 LOSS OF AERATING  PULMONARY

Nursing Diagnosis: Gas Exchange, Impaired

 Release of IgE from B lymphocytes

 Dry lips and mucous membranes

 Apprehension and restlessness

Long-term Goal: Patient will achieve an open

= Increase fluid intake @ 2-3 l/day

 Administer O2 @ 2-3 l/min via

– Chronic airway obstruction

 O2 intake CO2 removal

 Hypoxemia Air trapping

 Hypoxia Resp. Acidosis Blebs

 Assist the client to dress

 B. Note the client’s temperature on

You might also like