Respiratory Micrsosoft

8/14/2019 Respiratory Micrsosoft

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ANATOMY ANDANATOMY AND

PHYSIOLOGY OFPHYSIOLOGY OFRESPIRATORY SYSTEMRESPIRATORY SYSTEM


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Functions of the Respiratory System:Functions of the Respiratory System:

Ventilation (distribution of air)Ventilation (distribution of air)

Diffusion and Perfusion (movement ofDiffusion and Perfusion (movement of

oxygen and carbon dioxide across theoxygen and carbon dioxide across thealveolar-capillary membrane to the bloodalveolar-capillary membrane to the bloodin the pulmonary capillaries)in the pulmonary capillaries)

Blood flow( transportation of respiratoryBlood flow( transportation of respiratorygases)gases)

The Control of breathingThe Control of breathing


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Upper Respiratory TractUpper Respiratory Tract

1.1. NoseNose

a. passageway fora. passageway for

the incoming andthe incoming and

outgoing air, filtering,outgoing air, filtering,

warming, moistening.warming, moistening.

b. Organ of smellb. Organ of smell

c. Aids inc. Aids inphonationphonation


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2. Pharynx2. Pharynx

Serve asServe as

passageway andpassageway and

entrance to theentrance to therespiratory andrespiratory and

digestive tractsdigestive tracts

Aids in phonationAids in phonation


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LOWER RESPIRATORY TRACTLOWER RESPIRATORY TRACT

Trachea-Trachea-

furnishes anfurnishes an

openopen

passageway forpassageway forair going to andair going to and

from the lungsfrom the lungs


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Mechanism of ExpirationMechanism of Expiration

1.1. The respiratory muscles relaxThe respiratory muscles relax

2.2. The thorax decreases in sizeThe thorax decreases in size

3.3. The intrathoracic pressuresThe intrathoracic pressuresincreasesincreases

4.4. The lungs decrease in sizeThe lungs decrease in size

5.5. The intrapulmonic pressureThe intrapulmonic pressureincreasesincreases

6.6. Air is expelled from the lung,Air is expelled from the lung,which has a higher pressure towhich has a higher pressure tothe atmosphere, which has athe atmosphere, which has alower pressurelower pressure

7.7. The expiration is completedThe expiration is completed


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Chemical ControlChemical Control

1.1. Blood ph: a decrease in ph stimulates respiration throughBlood ph: a decrease in ph stimulates respiration throughthe direct stimulation of the neurons of the respiratorythe direct stimulation of the neurons of the respiratorycenter and indirectly, through the stimulation of thecenter and indirectly, through the stimulation of thecarotid and aortic chemoreceptorcarotid and aortic chemoreceptor

2.2.

Blood PCO2: an increase in the arterial results in aBlood PCO2: an increase in the arterial results in adecrease in pH and mimics the effects in no 1decrease in pH and mimics the effects in no 1

3.3. Blood PO2: a decrease in the arterial P02 producesBlood PO2: a decrease in the arterial P02 produceseffects similar to decreased blood ph.effects similar to decreased blood ph.

4.4. The stimulation of the respiratory center neurons orThe stimulation of the respiratory center neurons orchemoreceptors results in hyperventilation;chemoreceptors results in hyperventilation;hypoventilation occurs when the arterial ph rises or whenhypoventilation occurs when the arterial ph rises or whenthe arterial PC02 fallsthe arterial PC02 falls


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ASSESSMENTASSESSMENT

HEALTH HISTORYHEALTH HISTORY

A.A. Presenting problem:Presenting problem:

1. Nose/nasal sinuses: symptoms may1. Nose/nasal sinuses: symptoms may

include colds, discharge, epistaxis.include colds, discharge, epistaxis.

2 Throat: symptoms may include sore2 Throat: symptoms may include sore

throat, hoarseness, difficultythroat, hoarseness, difficultyswallowing, strep throatswallowing, strep throat


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3. Lung symptoms may3. Lung symptoms may

include:include:a.a. Cough: note of duration; frequency,Cough: note of duration; frequency,

type (dry, hacking, bubbly, barky,type (dry, hacking, bubbly, barky,

hoarse, congested); sputum (productivehoarse, congested); sputum (productivevs nonproductive) circumstancesvs nonproductive) circumstances

related to cough (time of the day,related to cough (time of the day,

positions, talking, anxiety); Treatmentpositions, talking, anxiety); Treatment


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b.b. Dyspnea: note onset, severity, duration, efforts to treat,Dyspnea: note onset, severity, duration, efforts to treat,

whether associated with radiation, if accompanied by coughwhether associated with radiation, if accompanied by cough

or diaphoresis, time of the day when; whether precipitatedor diaphoresis, time of the day when; whether precipitatedby and specific activities , whether accompanied byby and specific activities , whether accompanied by

cyanosis.cyanosis.

Examples:Examples:

1.) Paroxysmal nocturnal dyspnea is1.) Paroxysmal nocturnal dyspnea is

shortness of breath that awakens theshortness of breath that awakens the

individual in the middle of the night.individual in the middle of the night.

2.) Asthma attacks are triggered by specific2.) Asthma attacks are triggered by specific

allergen.allergen.

3.) Orthopnea is difficulty of breathing when3.) Orthopnea is difficulty of breathing when

the individual is lying down.the individual is lying down.


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3. Chest pain with breathing3. Chest pain with breathing

Take note of the duration, location, andTake note of the duration, location, and

nature pain, time started and was itnature pain, time started and was itassociated with injury or respiratoryassociated with injury or respiratory

infection.infection.

Treatment and medication.Treatment and medication.


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4.4. WheezingWheezing

5.5. HemoptysisHemoptysis


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Nursing health history should also focus on riskNursing health history should also focus on risk

factor for respiratory dysfunction, including:factor for respiratory dysfunction, including:a. Personal or family history of lung diseasea. Personal or family history of lung disease

b. Smoking (note type of tobacco, duration,b. Smoking (note type of tobacco, duration,

number per/day, number of years of smoking,number per/day, number of years of smoking,

inhalation, related cough, desire to quit.inhalation, related cough, desire to quit.c. Occupational or avocational exposure toc. Occupational or avocational exposure to

allergens or environmental pollutantsallergens or environmental pollutants

d. Age-related changes in lung capacity andd. Age-related changes in lung capacity and

respiratory functionrespiratory function


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e.e. History of upper respiratory infectionHistory of upper respiratory infection

f.f. Postoperative changes resulting inPostoperative changes resulting in

diminished respiratory excursiondiminished respiratory excursiong.g. Nutrition/diet: fluid intake per 24 hoursNutrition/diet: fluid intake per 24 hours

period;period;

intake of vitamins and minerals.intake of vitamins and minerals.


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Past medical historyast medical history Take note of immunizations (yearlyTake note of immunizations (yearly

immunizations for colds/flu; frequencyimmunizations for colds/flu; frequency

and results of tuberculin skin testing);and results of tuberculin skin testing);allergies (foods, drugs, contact orallergies (foods, drugs, contact or

inhallant allergens, precipitating factors,inhallant allergens, precipitating factors,

specific treatment, desensitization)specific treatment, desensitization)


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PhysicalhysicalexaminationxaminationA.A. InspectionInspection

B.B. PalpationPalpation

C.C. PercussionPercussion

D.D. AuscultationAuscultation


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a.. General appearance,nera appearance,Posturing, Breathingosturing, BreathingEffort and tracheaffort and tracheapositionositionThe clients generalThe clients generalappearance and posturingappearance and posturingshould be relaxed. Theshould be relaxed. Theposturing should beposturing should beupright. Breathing shouldupright. Breathing shouldoccur with no effort and aoccur with no effort and arate that is appropriate forrate that is appropriate forthe clients age. Inspectthe clients age. Inspectthe trachea for position. Itthe trachea for position. It

should be midline in theshould be midline in theneck.neck.


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Abnormal findingsbnormal findings Tracheal deviation to one side or other mayTracheal deviation to one side or other may

indicate atelectasis, partial or completeindicate atelectasis, partial or complete

pneumothorax or pulmonary fibrosispneumothorax or pulmonary fibrosis

An appearance of apprehension withAn appearance of apprehension with

restlessness, forward leaning posture, possiblerestlessness, forward leaning posture, possible

nasal flaring, supraclavicular or intercostalnasal flaring, supraclavicular or intercostal

retractions or bulging with expiration, or use ofretractions or bulging with expiration, or use ofaccessory muscles during breathing are allaccessory muscles during breathing are all

signs of respiratory compromise and distress.signs of respiratory compromise and distress.


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b. Chest wall. Chest wallconfigurationonfiguration Inspect chest wall for Form ofInspect chest wall for Form of

Symmetry MuscleSymmetry MuscleDevelopment, Anterior:Development, Anterior:Posterior (AP) Diameter, andPosterior (AP) Diameter, andCostal Angle. The thoraxCostal Angle. The thorax

should be symmetric in anshould be symmetric in anelliptical form, with ribselliptical form, with ribssloping down at about 45sloping down at about 45degrees relative to spine.degrees relative to spine.Muscle development shouldMuscle development shouldbe equal. The spinousbe equal. The spinous

processes should appear inprocesses should appear instraight line. The scapulaestraight line. The scapulaeshould be symmetric in eachshould be symmetric in eachhemothorax.hemothorax.


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Abnormal findings:bnormal findings: Asymmetry or unequal muscleAsymmetry or unequal muscle

development is abnormal. Skeletaldevelopment is abnormal. Skeletal

deformities such as scoliosis or kyphosisdeformities such as scoliosis or kyphosismay limit the expansion of the chest.may limit the expansion of the chest.

In chronic lung hyperinflation conditionsIn chronic lung hyperinflation conditions

such as chronic emphysema, the chestsuch as chronic emphysema, the chestwall may have a barrel chestwall may have a barrel chest

appearanceappearance


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In this situation, theIn this situation, the

ribs are moreribs are more

horizontal and thehorizontal and the

chest looks like it ischest looks like it is

held in constantheld in constant

inspiration. Theinspiration. The

costal angle iscostal angle isgreater than 90greater than 90

degrees.degrees.


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Other chest wall deformities includether chest wall deformities includepectus carinatum and pectusectus carinatum and pectusexcavatumxcavatum


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C. Observe and evaluate. Observe and evaluaterespirations for rate and quality,espirations for rate and quality,Breathing Pattern and Chestreathing Pattern and Chestexpansionsxpansions Note the respiratory rate. In men this isNote the respiratory rate. In men this is

generally more diaphragmatic or abdominal,generally more diaphragmatic or abdominal,and in women more thoracic. Breathing shouldand in women more thoracic. Breathing should

be smooth and even. In the adult, passivebe smooth and even. In the adult, passivebreathing should occur at a rate of 12-20breathing should occur at a rate of 12-20breaths per minute. The ratio of respirations tobreaths per minute. The ratio of respirations topulse rate should be 1:4pulse rate should be 1:4

Evaluate the rhythm or pattern of breathing.Evaluate the rhythm or pattern of breathing.The chest wall should be symmetrically riseThe chest wall should be symmetrically riseand expand and then relax. It should appearand expand and then relax. It should appeareasy and without effort. There should be noeasy and without effort. There should be no

bulging or retractions observed.bulging or retractions observed.


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Abnormal breathingbnormal breathingpatterns include:atterns include: Hyperventilation: Breathing is rapid andHyperventilation: Breathing is rapid and

shallow. This may occur secondary to anxietyshallow. This may occur secondary to anxiety

or exercise or a metabolic disease.or exercise or a metabolic disease.

Kussmaul Breathing: Breathing appears veryKussmaul Breathing: Breathing appears very

deep, rapid and laborious. This type ofdeep, rapid and laborious. This type of

breathing may be associated with metabolicbreathing may be associated with metabolic

acidosis.acidosis.


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Hypoventilation: Breathing is veryHypoventilation: Breathing is very

shallow. This may be seen in clients withshallow. This may be seen in clients with

broken ribs or pleuritic pain wherebroken ribs or pleuritic pain whereinspiration is painful.inspiration is painful.


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Patterns of respirationatterns of respiration


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B. Palpation. Palpation Palpate the trachea forPalpate the trachea for

position. It should beposition. It should be

palpable just below thepalpable just below the

thyroid. The tracheathyroid. The tracheashould be midline andshould be midline and

slightly moveable. If theslightly moveable. If the

trachea is not midline, Ittrachea is not midline, It

may be indication ofmay be indication ofsome degree of lungsome degree of lung

collapsecollapse


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Palpate chest wall for Symmetry. With the palmarPalpate chest wall for Symmetry. With the palmarsurface of your fingers, use both handssurface of your fingers, use both handssimultaneously to compare the two sides of thesimultaneously to compare the two sides of the

posterior chest wall.posterior chest wall. The skin should be smooth and warm and the spineThe skin should be smooth and warm and the spine

should be straight and nontender from C7 throughshould be straight and nontender from C7 throughT12.T12.

The scapulae should be symmetric and theThe scapulae should be symmetric and thesurrounding musculature well developed. Thesurrounding musculature well developed. Theposterior ribs should be stable and nontender.posterior ribs should be stable and nontender.


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Note any curvature of the spine,Note any curvature of the spine,

scoliosis or kyphosisscoliosis or kyphosis

Muscular development that isMuscular development that isasymmetric or an unstable chest wallasymmetric or an unstable chest wall

may indicate a thoracic disorder. Notemay indicate a thoracic disorder. Note

areas that are tender, where there areareas that are tender, where there aremasses, or where you note crepitusmasses, or where you note crepitus


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Abnormal findings:bnormal findings: Asymmetry of expansion is abnormal.Asymmetry of expansion is abnormal.

Note if there is any lag between theNote if there is any lag between the

movement of your thumbs. Unequalmovement of your thumbs. Unequalchest expansion can accompanychest expansion can accompany

atelectasis, pneumonia, traumatic injuryatelectasis, pneumonia, traumatic injury

such as fractured ribs or pneumothorax.such as fractured ribs or pneumothorax.

Pain is noted when there is inflammationPain is noted when there is inflammation

of the pleuraeof the pleurae


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Pleural friction fremitus or palpablePleural friction fremitus or palpablefriction rub occurs when there isfriction rub occurs when there isinflammation of either the parietal orinflammation of either the parietal orvisceral pleurae, causing a decrease invisceral pleurae, causing a decrease innormal lubrication. Thus a grating feelingnormal lubrication. Thus a grating feelingmay be palpated. (Although pleuralmay be palpated. (Although pleural

friction rub is most easily identified byfriction rub is most easily identified byauscultation if it is severe enough, it mayauscultation if it is severe enough, it maybe identified through palpation.be identified through palpation.


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C. Percussion. Percussion1.1. Percuss the thorax for tonePercuss the thorax for tone

and Respiratory Excursionand Respiratory Excursion

PercussionPercussion is the tapping ofis the tapping ofan object to set the underlyingan object to set the underlyingstructures in motion and thusstructures in motion and thus

produce sound. If performedproduce sound. If performedcorrectly, it will penetrate to acorrectly, it will penetrate to adepth of 5 to 7 cm into thedepth of 5 to 7 cm into thechest. Systematically percusschest. Systematically percussfirst the posterior and then thefirst the posterior and then theanterior chest wall. Startanterior chest wall. Startposteriorly above the scapulaposteriorly above the scapulaand end at the bottom of theand end at the bottom of therib area. Percuss down therib area. Percuss down theposterior chest from side toposterior chest from side toside, comparing two sides. Doside, comparing two sides. Donot percuss over bone surfacenot percuss over bone surface


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The sound should beThe sound should be

resonance which is loudresonance which is loud

in intensity, low in pitch,in intensity, low in pitch,

long in duration andlong in duration andhollow in quality. Move tohollow in quality. Move to

the anterior chest,the anterior chest,

instruct the client to pullinstruct the client to pull

the shoulders and repeatthe shoulders and repeat

the percussionthe percussion

techniquestechniques


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Abnormal findingsbnormal findings Hyperesonance is heard when there isHyperesonance is heard when there is

overinflation of the lungs. It has a veryoverinflation of the lungs. It has a very

loud resonance of low pitch that lastsloud resonance of low pitch that lastslonger than normal and seems boominglonger than normal and seems booming

This may be found in individuals withThis may be found in individuals with

emphysema. Dull tones may be heard inemphysema. Dull tones may be heard inclients with pneumonia, pleural effusion,clients with pneumonia, pleural effusion,

or atelectasis.or atelectasis.


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D. Auscultation. Auscultation1.1. Auscultate breath soundsAuscultate breath sounds

for location. Evaluate thefor location. Evaluate theclients breath soundsclients breath soundsover the posterior,over the posterior,

anterior, and lateralanterior, and lateralchest walls. Instruct thechest walls. Instruct theclient to sit upright andclient to sit upright andbreath deeply and slowlybreath deeply and slowlythrough the mouth.through the mouth.Using diaphragm of theUsing diaphragm of thestethoscope , startstethoscope , startposteriorly and moreposteriorly and morelaterally to auscultate thelaterally to auscultate thechest from apex to base.chest from apex to base.


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Auscultation involves listening to air movement in lungs toAuscultation involves listening to air movement in lungs todetect normal or adventitious breath sounds,detect normal or adventitious breath sounds,

including:including:

a. Vesicular sounds: low-pitched rustling sounda. Vesicular sounds: low-pitched rustling sound

heard over most of lung field, most prominentlyheard over most of lung field, most prominently

on inspiration; indicative of normal, clear lungson inspiration; indicative of normal, clear lungsb. Bronchial sounds: high-pitched tubular soundb. Bronchial sounds: high-pitched tubular sound

with slight pause between inspiration andwith slight pause between inspiration and

expiration; normal over large airwaysexpiration; normal over large airways

c. Brochovesicular sound: combination of vesicular andc. Brochovesicular sound: combination of vesicular and

bronchial sound, normally heard anteriorly to the rightbronchial sound, normally heard anteriorly to the right

or left of the sternum and posteriorly between theor left of the sternum and posteriorly between thescapulae; inspiration and expiration equalscapulae; inspiration and expiration equal

d. Adventitious breath sounds: crackles (fine to coarse),d. Adventitious breath sounds: crackles (fine to coarse),

wheezes (sibilant, sonorous), pleural friction rubwheezes (sibilant, sonorous), pleural friction rub


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6.6. During assessment, the nurse should be alert forDuring assessment, the nurse should be alert forcardinal signs and symptoms of respiratory dysfunction,cardinal signs and symptoms of respiratory dysfunction,including:including:

a. Dyspneaa. Dyspnea

b. Orthopneab. Orthopneac. Cough; may be hacking, brassy, wheezing,c. Cough; may be hacking, brassy, wheezing,

productive or nonproductiveproductive or nonproductive

d. Increased sputum production; purulent (yellowd. Increased sputum production; purulent (yellow

or green), rusty, bloody or mucoid sputumor green), rusty, bloody or mucoid sputum


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e.e. Chest painChest pain

f.f. WheezingWheezing

g.g. Clubbing of fingersClubbing of fingers

h.h. HemoptysisHemoptysis

i.i. cyanosiscyanosis


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B. Laboratory studies andB. Laboratory studies and

diagnostic testsdiagnostic tests

1.1. Radiographic and scanning studies, done toRadiographic and scanning studies, done tovisualize respiratory system structures,visualize respiratory system structures,include:include:

a. Chest radiographa. Chest radiographb. Chest tomographyb. Chest tomography

c. Lung Scanc. Lung Scan

d. Computed tomography (CT) scand. Computed tomography (CT) scan

e. Positron-emission tomography scane. Positron-emission tomography scanf . Fluoroscopyf . Fluoroscopy

g. Barium swallowg. Barium swallow


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2.2. Endoscopy studies, invasive techniqueEndoscopy studies, invasive techniqueperformed to visualize pulmonary structuresperformed to visualize pulmonary structuresand obtain tissue specimens, include:and obtain tissue specimens, include:

a. Bronchoscopya. Bronchoscopy

b. Esophogoscopyb. Esophogoscopy

c. Mediastinoscopyc. Mediastinoscopy

3.3. Thoracentesis involves needle aspiration ofThoracentesis involves needle aspiration ofpleural fluid for diagnostic and therapeuticpleural fluid for diagnostic and therapeuticpurposespurposes

4.4. Needle biopsy is an invasive techniqueNeedle biopsy is an invasive techniqueinvolving entering the lung or pleura to obtaininvolving entering the lung or pleura to obtaintissue for analysistissue for analysis

5.5. Spirometry (pulmonary function test) is aSpirometry (pulmonary function test) is anoninvasive technique used to determine lungnoninvasive technique used to determine lungvolumes, ventilatory function, airwayvolumes, ventilatory function, airway

resistance, and distribution of gases.resistance, and distribution of gases.6.6. Sputum culture determines the presence ofSputum culture determines the presence of

pathogenic organisms.pathogenic organisms.

7.7. Arterial blood gas (ABG) studies determine O2Arterial blood gas (ABG) studies determine O2and C02 content and evaluate the bodys acid-and C02 content and evaluate the bodys acid-base balancebase balance


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Respiratory Diseasesespiratory Diseases Chronic Bronchitis is an inflammation ofChronic Bronchitis is an inflammation of

bronchi caused by irritantants (cigarettebronchi caused by irritantants (cigarette

smoke, air polutants) It can be acute orsmoke, air polutants) It can be acute orchronic and is characterized bychronic and is characterized by

obstruction of airflow.obstruction of airflow.

Chronic bronchitis is defined as theChronic bronchitis is defined as thepresence of productive cough that last 3presence of productive cough that last 3

months a year for 2 consecutive years.months a year for 2 consecutive years.


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Clinical Manifestationlinical Manifestation Chronic, productive coughChronic, productive cough

DyspneaDyspnea

Body weaknessBody weakness


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Diagnostic testiagnostic test Chest x-ray may show hyperinflation andChest x-ray may show hyperinflation and

increased bronchovascular markingsincreased bronchovascular markings

Pulmonary function demonstratePulmonary function demonstrateincreased residual volume, decreasedincreased residual volume, decreased

vital capacity and forced expiratory flow,vital capacity and forced expiratory flow,

and normal static compliance andand normal static compliance anddiffusing capacity.diffusing capacity.


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Nursing Careursing CarePlanlan


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Nursing Diagnosis andursing Diagnosis andPlan of carelan of care1.Ineffective airway clearance related to1.Ineffective airway clearance related to

increased tracheobronchial secretions asincreased tracheobronchial secretions as

manifested by : productive cough,manifested by : productive cough,purulent sputum and dyspnea.purulent sputum and dyspnea.

Plan: The Client will be able toPlan: The Client will be able to

expectorate phlegm effectively. Theexpectorate phlegm effectively. Thebreath sounds clear and respirationsbreath sounds clear and respirations

noiseless.noiseless.


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Evaluationvaluation The client was able to expectorateThe client was able to expectorate

moderate amount of sputum.moderate amount of sputum.

Respiratory rate of 22 fRespiratory rate of 22 f


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2. Emphysema. Emphysema Is an abnormal permanent enlargementIs an abnormal permanent enlargement

of gas exhange airway. Accompanied byof gas exhange airway. Accompanied by

destruction of alveolar wall. Obstructiondestruction of alveolar wall. Obstructionresults from changes in the lung tissue,results from changes in the lung tissue,

rather than mucus production andrather than mucus production and

inflammation as in chronic bronchitis.inflammation as in chronic bronchitis.

The major mechanism of airflowThe major mechanism of airflow

limitation is loss of elastic recoil.limitation is loss of elastic recoil.


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Clinical Manifestationlinical Manifestation DyspneaDyspnea

WheezesWheezes

TachypneaTachypnea AnorexiaAnorexia

Weight lossWeight loss


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Nursing Care Planursing Care Plan1.1. Impaired gas exchange related toImpaired gas exchange related to

destruction of alveoli as manifested by:destruction of alveoli as manifested by:

dyspnea, presence of wheezes on rightdyspnea, presence of wheezes on rightlung field.lung field.

Plan of Care:Plan of Care:

The clients respiratory rate, color andThe clients respiratory rate, color andABGs value will be within normal limits.ABGs value will be within normal limits.


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Nursing Interventionursing Intervention Administer oxygen at least 1-2 liter perAdminister oxygen at least 1-2 liter per

minute as ordered by physician.minute as ordered by physician.

Encourage deep breathing exercise.Encourage deep breathing exercise. Maintain restful environment.Maintain restful environment.

Elevate the clients head of the bed 30 toElevate the clients head of the bed 30 to

45 degrees and encourage the client to45 degrees and encourage the client tochange positions frequently.change positions frequently.


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EvaluationvaluationRespiratory rate is 22 breaths per minute,Respiratory rate is 22 breaths per minute,

ABGs results are normal.ABGs results are normal.


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Thank youhank you


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Respiratory Micrsosoft