11972783 Respiratory System Review

8/8/2019 11972783 Respiratory System Review

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Respiratory System

STRUCTURALDIVISION

STRUCTURES OF THE UPPERAIRWAYS:

1. Nasal Cavity

II. Pharynx

III. Larynx

STRUCTURES OF THE LOWER

AIRWAYS:

1. Trachea

II. Bronchial Tree

III. Lungs

IV. Alveoli

FUNCTIONALDIVISION

STRUCTURES OF THE CONDUCTINGAIRWAYS:

1. Nasal Cavity

II. Pharynx

III. Larynx

IV. Tracheobronchial tree

STRUCTURES OF THE RESPIRATORY

TISSUES:

I. Lungs

II. Alveoli


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Conducting Airways

Divisions of the PHARYNX

NASOPHARYNXNASOPHARYNX

OROPHARYNXOROPHARYNX

LARYNGOPHARYNXLARYNGOPHARYNX


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Conducting Airways

LARYNX


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Conducting Airways

TRACHEA

supportedsupported byby HORSEHORSE--

SHOESHOE CC--SHAPEDSHAPED

CA

RTILAG

ESCA

RTILAG

ES (C(C--rings)rings)

protectionprotection::

MUCOCILIARYMUCOCILIARY BLANKETBLANKET

pointpoint of of bifurcationbifurcation::

CARINACARINA


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Respiratory Tissues

LUNGSFunctions of the

inactivates vasoactive substances

such as bradykinin

converts angiotensin I to angiotensin II

reservoir for blood storage

contains abundant heparin producing

cells located at the capillaries of the

lungs


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Parts of the Respiratory System:Parts of the Respiratory System:

LungsLungs soft, spongy, elasticsoft, spongy, elastic

structure, airtight chamber withstructure, airtight chamber with

distensible walls; functionaldistensible walls; functional

structure of the respiratorystructure of the respiratory

system; consists of an apex andsystem; consists of an apex and

a basea base

LobulesLobules functional units of thefunctional units of the

lungs; consist of respiratorylungs; consist of respiratory

bronchioles, alveoli andbronchioles, alveoli and

pulmonary capillaries.pulmonary capillaries.

Lung TissuesLung Tissues made up ofmade up of

elastinelastin and collagen fiber thatand collagen fiber that

encircle the airways and smallencircle the airways and small

blood vessels.blood vessels.


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PleuraPleura a thin, smooth, transparent, doublea thin, smooth, transparent, double--

layered serous membrane that lines the thoraciclayered serous membrane that lines the thoracic

cavity and encases the lungs; consists of acavity and encases the lungs; consists of a

visceral and parietal fluid layer.visceral and parietal fluid layer.

Pleural SpacePleural Space area of negative pressures toarea of negative pressures to

prevent lung from collapsing; contains pleuralprevent lung from collapsing; contains pleural

fluid which separates the pleural layers.fluid which separates the pleural layers.

AlveoliAlveoli grapelike cluster, around 300 to 400grapelike cluster, around 300 to 400

million in each lung where actual gas exchangemillion in each lung where actual gas exchange

occuroccur

Parts of the RespiratoryParts of the Respiratory

System:System:


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CIRCULATIONCIRCULATION

the lungs are provided with a dual bloodthe lungs are provided with a dual bloodsupply:supply:

a.a.Pulmonary CirculationPulmonary Circulation arises from thearises from the

pulmonary artery and provides for thepulmonary artery and provides for thegas exchange functions of the lungsgas exchange functions of the lungs

b.b.Bronchial CirculationBronchial Circulation distributes blooddistributes bloodto the conducting airways andto the conducting airways and

supporting structure of the lung.supporting structure of the lung.

HeparinHeparin--producing cellsproducing cells particularlyparticularlyabundant in the capillaries of the lungsabundant in the capillaries of the lungs

where small clots are trapped.where small clots are trapped.


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Other Related Structures


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MECHANICS OFBREATHINGMECHANICS OFBREATHING1.1. VentilationVentilation movement of air betweenmovement of air betweenthe atmosphere and the respiratorythe atmosphere and the respiratory

portion of the lungs.portion of the lungs.

ResistanceResistance determined chiefly by thedetermined chiefly by the

radius of the airway through which theradius of the airway through which the

air is flowing.air is flowing.

Lung ComplianceLung Compliance refers to the easerefers to the ease

with which the lungs expands andwith which the lungs expands and

indicates the relationship between theindicates the relationship between the

volume and the pressure of the lungsvolume and the pressure of the lungs

a.a. Compliant LungCompliant Lung distends easily whendistends easily when

pressure is appliedpressure is applied

b.b. Noncompliant LungNoncompliant Lung requires greaterrequires greater

than normal pressure to distendthan normal pressure to distend it.it.

SURFACE TENSIONSURFACE TENSION result of air and liquidresult of air and liquid

interface, facilitated by type 2 cellsinterface, facilitated by type 2 cells Noncompliant LungNoncompliant Lung

Compliant LungCompliant Lung


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2.2. PerfusionPerfusion bloodblood flowflow throughthrough thethe lungslungs

VentilationVentilation PerfusionPerfusion RatioRatio (V/Q)(V/Q) necessarynecessary

toto meetmeet adequateadequate oxygenationoxygenation ofof thethe bloodblood..

3.3. DiffusionDiffusion processprocess byby whichwhich oxygenoxygen andand

carboncarbon dioxidedioxide areare exchangedexchanged atat thethe airair--bloodblood

interfaceinterface

MECHANICS OFBREATHINGMECHANICS OFBREATHING


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Intact and

patent airway

Normal Chest

Anatomy

Normal nerve stimuli for

Contraction and relaxation of

Respiratory muscles

Intact pleural

membrane

Adequate VentilationNormal

Contraction

Of RV

Normal

Pressure and

Resistance in

The PV

Intact

Pulmonaryvessels

Adequate

Perfusion

EFFECTIVEOXYGENATION

Adequate pumping

action of cardiac

muscles

Intact Blood

Vessels

Adequate Hgb

Adequate

Distribution of gases

Adequate

Diffusion

Adequate amt

Of O2 in the

air

Adequate amt

Of RBC to

Carry O2

Adequate bld

Flow to thelungs


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Respiratory Control

Cerebral Cortex


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NEUROLOGIC CONTROLNEUROLOGIC CONTROL MedullaMedulla OblongataOblongata

controlscontrols respirationrespiration andandexpirationexpiration

PonsPons controlscontrols raterate andanddepthdepth ofof ventilationventilation

1.1. ApneusticApneustic centercenter lowerlowerponspons;; stimulatesstimulates thetheinspiratoryinspiratory medullarymedullarycentercenter toto promotepromote deep,deep,prolongedprolonged inspirationinspiration

2.2. PneumotaxicPneumotaxic centercenter

controlscontrols patternpattern of ofrespirationrespiration

CortexCortex allowsallows voluntaryvoluntarycontrolcontrol ofof breathingbreathing


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Receptor Sites that Assists inReceptor Sites that Assists in

Breathing

Breathing

CentralCentral chemoreceptorschemoreceptors locatedlocated inin thethe

medullamedulla;; respondrespond toto anan increaseincrease oror

decreasedecrease inin thethe pHpH

PeripheralPeripheral chemoreceptorschemoreceptors locatedlocated inin

thethe aorticaortic archarch andand carotidcarotid arteriesarteries;;

respondrespond toto changeschanges inin PaCOPaCO22 andand pHpH..


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StretchStretch ReceptorsReceptors locatedlocated inin thethe alveolialveoli

HeringHering--BreuerBreuer reflexreflex -- stimulatedstimulated whenwhen

thethe lungslungs areare distendeddistended andand inhibitsinhibits

respirationrespiration soso thatthat thethe lungslungs dodo notnotbecomebecome overover distendeddistended

ProprioceptorsProprioceptors locatedlocated inin thethe musclesmuscles andand

jointsjoints;; respondrespond toto bodybody movementsmovements

BaroreceptorsBaroreceptors locatedlocated inin thethe aorticaortic archarch andand

carotidcarotid bodiesbodies;; respondrespond toto anan increaseincrease oror

decreasedecrease inin arterialarterial bloodblood pressurepressure causingcausing aa

reflexreflex hypoventilationhypoventilation oror hyperventilationhyperventilation

Receptor Sites that Assists inReceptor Sites that Assists in

Breathing

Breathing


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NURSINGASSESSMENT

Nursing History: Risk factorAnalysis

Cancer:Cancer:

cigarette smokingcigarette smoking 3 or 43 or 4

clients who developclients who develop

laryngeal cancer havelaryngeal cancer have

smoked or currently smokesmoked or currently smoke

alcoholalcohol act synergisticallyact synergistically

with tobaccowith tobacco

occupational exposureoccupational exposure

asbestos, wood dust,asbestos, wood dust,mustard gas, petroleummustard gas, petroleum

products,otherproducts,other noxiousnoxious

fumesfumes

AgeAge

Genetic PredispositionGenetic Predisposition


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AsthmaAsthma

heredityheredity

environmental factorsenvironmental factors

excitatory states, exercise,excitatory states, exercise,changes in temperature,changes in temperature,strong odorsstrong odors

Chronic Obstructive PulmonaryChronic Obstructive PulmonaryDisease (COPD)Disease (COPD)

cigarette smokecigarette smoke-- leading riskleading riskfactorfactor

aging processaging process

hereditary and genetichereditary and geneticpredispositionpredisposition

PollenPollen

GrainsGrainsDustDust

MiteMite

House DustHouse Dust


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Pulmonary embolismPulmonary embolism

thrombithrombi most of whichmost of which

originated in the deeporiginated in the deepcalf, femoral,calf, femoral, poplitealpopliteal oror

lilac veinslilac veins

major operationsmajor operations tumors, air, fat, bonetumors, air, fat, bone

marrow, amniotic fluidmarrow, amniotic fluid



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PulmonaryPulmonaryTuberculosisTuberculosis repeated close contactrepeated close contact

with an infected personwith an infected person

low income population,low income population,

poor nutritionpoor nutrition residents of long term careresidents of long term care

facilities or institutionalfacilities or institutionalsettingssettings

homeless peoplehomeless people health care workershealth care workers

exposed to active TBexposed to active TB


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a. Biographical and Demographic Dataa. Biographical and Demographic Data

Name, sex, and living situationName, sex, and living situation

AgeAge lung cancer and chronic lunglung cancer and chronic lung

disorders make the client appeardisorders make the client appearolderolder

b. Current Health: Chief Complaintb. Current Health: Chief Complaint

DyspneaDyspnea difficult, uncomfortable ordifficult, uncomfortable orunpleasant breathing indicative ofunpleasant breathing indicative ofthe discrepancy between the needthe discrepancy between the needfor ventilation and the ability to meetfor ventilation and the ability to meet

the need; one of the most commonthe need; one of the most commonmanifestations of clients withmanifestations of clients withpulmonary and cardiac disorderspulmonary and cardiac disorders

Lung Cancer

Lung Cancer


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CoughCough a reflex that facilitates the removal of secretionsa reflex that facilitates the removal of secretionsand foreign materials from theand foreign materials from the tracheobronchialtracheobronchial tree andtree and

the lungsthe lungs-- Dry, hoarse, congested, barking, wheezing,Dry, hoarse, congested, barking, wheezing,

bubblingbubbling

-- weakness/paralysis of resp muscles, prolongrdweakness/paralysis of resp muscles, prolongrdinactivity, depression of medullary fxninactivity, depression of medullary fxn

-- may cause stress incontinencemay cause stress incontinence--SPUTUMSPUTUM

Characterististics:Characterististics:

Dry irritative coughDry irritative cough

Severe changing coughSevere changing cough

Cough at nightCough at night

Cough at AMCough at AM


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HemoptysisHemoptysis refers to the bloodrefers to the bloodexpectorated from the mouth in the form ofexpectorated from the mouth in the form of

gross blood, frankly bloody sputum, or bloodgross blood, frankly bloody sputum, or blood--

tinged sputumtinged sputum

Blood from noseBlood from nose due to sniffing/irritationdue to sniffing/irritation

Blood from lungsBlood from lungs bright red, frothy, saltybright red, frothy, salty

taste, alkalinic with tickling sensation ontaste, alkalinic with tickling sensation on

throat, burning/bubbling sensation onthroat, burning/bubbling sensation on

chestchest

Blood from stomachBlood from stomach dark in color, acidicdark in color, acidic


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Current Health: ChiefCurrent Health: Chief

ComplaintComplaintWheezingWheezing produced when air passesproduced when air passes

through partially obstructed orthrough partially obstructed or

narrowed airways on inspiration andnarrowed airways on inspiration and

expiration; may be audible or maybeexpiration; may be audible or maybeheard only with stethoscopeheard only with stethoscope

StridorStridor harsh, highharsh, high--pitched soundpitched soundproduced when air passes through aproduced when air passes through a

partially obstructed or narrowed upperpartially obstructed or narrowed upper

airway on inspiration; associated withairway on inspiration; associated with

respiratory distressrespiratory distress


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Chest PainChest Pain caused by coughing andcaused by coughing and pleuriticpleuriticinfectionsinfections

Onset, location and radiationOnset, location and radiation

Duration and character or qualityDuration and character or quality

FrequencyFrequency Factors that predispose or relieve theFactors that predispose or relieve the

painpain

RETROSTERNAL PAINRETROSTERNAL PAIN

PLEURITIC CHEST PAINPLEURITIC CHEST PAINCyanosisCyanosis bluish discoloration of the skin andbluish discoloration of the skin and

mucus membrane which occur when themucus membrane which occur when the

level of the hemoglobin present in the bloodlevel of the hemoglobin present in the blood

is reducedis reduced

Current Health: Chief ComplaintCurrent Health: Chief Complaint


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Symptoms Analysis SettingSetting time and place or particular situationtime and place or particular situation

physical setting and psychological environmentphysical setting and psychological environmentin which the client experiences the complaintin which the client experiences the complaint

TimingTiming onset and period during which theonset and period during which theproblem has occurred; specific time of dayproblem has occurred; specific time of day

Clients perceptionClients perception unique properties of theunique properties of the

complaintcomplaint Quantity and qualityQuantity and quality amount, size, number, andamount, size, number, and

extent of the chief complaintextent of the chief complaint

LocationLocation to determine whether the problem isto determine whether the problem iscardiac or respiratory in origincardiac or respiratory in origin

Aggravating and relieving factorsAggravating and relieving factors whatwhatprecipitates worsens or alleviates a symptom?precipitates worsens or alleviates a symptom?

Associated manifestationsAssociated manifestations chills, fever, nightchills, fever, nightsweats, anorexia, weight loss, excessive fatigue,sweats, anorexia, weight loss, excessive fatigue,

anxiety,anxiety, hoarsenesshoarseness


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Past Health History Childhood and Infectious DiseasesChildhood and Infectious Diseases occurrence ofoccurrence of

TB, bronchitis, influenza, asthma and pneumoniaTB, bronchitis, influenza, asthma and pneumonia;existence of congenital problems; premature birth;existence of congenital problems; premature birthhistory.history.

ImmunizationImmunization vaccination against pneumonia andvaccination against pneumonia andinfluenza; date of vaccinationinfluenza; date of vaccination

MajorIllnesses and HospitalizationMajorIllnesses and Hospitalization previousprevioushospitalization for respiratory problems; medicalhospitalization for respiratory problems; medicaltreatment; and the present status of the problemtreatment; and the present status of the problem

MedicationsMedications prescribed and OTC medications;prescribed and OTC medications;herbal remedies many products affect the respiratoryherbal remedies many products affect the respiratory

systemsystem AllergiesAllergies foods, medications, pollens, smoke,foods, medications, pollens, smoke,

fumes, dust and animal dander, molds allergicfumes, dust and animal dander, molds allergicmanifestations (chest tightness, wheezing, cough,manifestations (chest tightness, wheezing, cough,rhinitis, watery eyes, scratchy throat)rhinitis, watery eyes, scratchy throat)


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Family Health History

Identify bloodIdentify bloodrelatives and familyrelatives and family

members who havemembers who havehad respiratoryhad respiratorydisorders, age anddisorders, age andcause of death ofcause of death of

deceased familydeceased familymember; householdmember; householdmembers whomembers whosmokesmoke


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Psychosocial HistoryPsychosocial History

OccupationOccupation -- work environment andwork environment andhobbies; exposure to dust, asbestos,hobbies; exposure to dust, asbestos,beryllium, silica and other toxins orberyllium, silica and other toxins orpollutantspollutants

Geographical LocationGeographical Location recent travel torecent travel to

areas where respiratory disorders areareas where respiratory disorders areprevalentprevalent

EnvironmentEnvironment living conditions; how manyliving conditions; how manyare in the householdare in the household

HabitsHabits history of smoking; use ofhistory of smoking; use ofsmokeless tobacco; alcohol use; use ofsmokeless tobacco; alcohol use; use ofrecreational drugsrecreational drugs

ExerciseExercise typical activitiestypical activities

NutritionNutrition amount of caloric intakeamount of caloric intake


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Concept ofOxygenation

ASSESSMENT


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Physical AssessmentPhysical Assessment

establish the baselineestablish the baseline

information and provideinformation and provideframework for the detection offramework for the detection of

any changes that might occur inany changes that might occur in

a clients conditiona clients condition


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HeadHead andand NeckNeck inspect for grossinspect for gross

abnormalities that would interfere withabnormalities that would interfere with

respiration; odor of breathrespiration; odor of breath

Note nasal flaring, breathing with pursedNote nasal flaring, breathing with pursedlips, or cyanosislips, or cyanosis

InspectionInspection


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ChestChest observe chest wall configuration;observe chest wall configuration;

size, contour, andsize, contour, and anteroposterioranteroposterior diameterdiameter


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CHEST WALLDEFORMITIES

TYPE OFDEFORMITY DESCRIPTION ETIOLOGYBARREL CHEST APD = TD Chronic Airflow Disorder

FUNNEL CHEST

(Pectus excavatum)

Sternum is

DEPRESSED, narrowing

of the APD

Congenital in nature

PIG

EON

CHEST(Pectus carinatum) Sternum projectsforward,

increased APD, wider TD

Congenital in nature

Thoracic Kyphoscoliosis Appearance: hunch-

over, hunch back

Congenital in nature,

spinal TB, osteoporosis,

RA, poor posture

INSPECTION HEAD and NECK

CHEST Chest Wall Configuration

* SHAPE OF THE CHEST: elliptical


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Chest movementChest movement

A.A. RetractionsRetractions most prominent in themost prominent in the

lateral chest; indicative of laboredlateral chest; indicative of laboredbreathingbreathing

B.B. RespirationsRespirations

BiotsBiots RespirationRespiration irregular periods ofirregular periods ofapnea that are followed by severalapnea that are followed by several

breaths that are even in rate and depthbreaths that are even in rate and depth CheyneCheyne Stokes respirationStokes respiration

characterized by periods ofcharacterized by periods ofhyperventilation alternating withhyperventilation alternating withperiods of apneaperiods of apnea

Kussmauls

Kussmauls respirationrespiration increasedincreaseddepth in breathingdepth in breathing

C. PatternC. Pattern

RateRate

VolumeVolume


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IRREGULAR BREATHING PATTERNS

TYPES OFIRRGULAR BREATHING

PA

TTERN

DESCRITPTION

KUSSMAULS RESPIRATION Blows more carbon dioxide through

DEEP and RAPIDBREATHING.

CHEYNE-STOKES RESPIRATION

(also classified under APNEICBREATHING PATTERNS)

Marked rhythmic, WAXING and

WANING, from, VERYDEEP andVERY SHALLOW breathing and

TEMPORARYAPNEA.

Common with CHF, ICP and drug

overdose.

BIOTS (Cluster) RESPIRATION

(also classified under APNEIC

BREATHING PATTERNS)

SHALLOW BREATHS interrupted by

APNEA.

Common with CNS disorders.


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INSPECTION

HEAD and NECK

CHEST Chest Wall Configuration Chest Movement

* normal respiratory rate (accdg. to

KOZIER) = 12 22 cpm.* men: abdominal breathers

* women: thoracic breathers

FINGERS and TOES

observe for clubbing

perform the Schamroths Test perform the Blanch Test

SKIN


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PalpationPalpation TracheaTrachea palpate forpalpate for

masses,masses, crepituscrepitus (air(air

in the subcutaneousin the subcutaneoustissues), or deviationtissues), or deviationfrom the midlinefrom the midline

TacrileTacrile

FremitusFremitus/Vocal/VocalFremitusFremitus

Thoracic excursionThoracic excursion


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PALPATIONTRACHEA

> Place the thumb of the palpating hand on one side of the

trachea and the remaining of the fingers on the other side.

> Move the trachea gently from side-to-side along its length

while palpating for masses, crepitus or deviations from the

midline.

NORMALFINDINGS: trachea is movable and

quickly returns to midline after displacement.

CHEST WALL

>Holding the HEE

Lor U

LNAR

ASPECT

OFTHE H

ANDagainst the clients chest.

> Palpate for the ribs and intercostal spaces.

>Locate the angle ofLouis (manubriosternal junction) by

first palpating the clavicle and following its course of

attachment at the manubrium.


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PALPATIONCHEST WALL: POSTERIOR THORACIC EXCURSION

> Place the palms of both hands over the lower thorax

with the thumbs adjacent to the spine and fingersstretched laterally.

>Ask the client to take a deep breath while observing the

movement of the hands an any lag in movement.

NORMALFINDINGS: full and symmetric chest expansion(thumbs should move apart with an equal distance at the

same time. Approximately 3 to 5 cm (1.5 to 2 in).

CHEST WALL: ANTERIOR THORACIC EXCURSION

> Place the palms of both hands on the lower thorax withfingers laterally along the lower rib cage and thumbs

along the costal margin.

>Ask the client to take a deep breath while observing the

movement of the hands and any lag in movement.


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PercussionPercussionSoundsSounds

Resonant soundsResonant sounds low pitch hollow sounds heardlow pitch hollow sounds heardover normal tissueover normal tissue

HyperresonantHyperresonant soundssounds louder and lower pitchlouder and lower pitch

than resonant which indicate increases amount ofthan resonant which indicate increases amount ofair in the lungs or pleural space (EMPHYSEMA,air in the lungs or pleural space (EMPHYSEMA,PNEUMOTHORAX)PNEUMOTHORAX)

Dull soundsDull sounds thudlikethudlike and medium pitch andand medium pitch andnormally heard over the liver and heart, occur overnormally heard over the liver and heart, occur overdense lung tissue such as tumor or consolidationdense lung tissue such as tumor or consolidation

Flat notesFlat notes soft high pitch heard during percussionsoft high pitch heard during percussionof airless tissue (bony structure)of airless tissue (bony structure)

Tympanic notesTympanic notes high,high, drumlikedrumlike sounds heard withsounds heard withpercussion over the stomach, a large tension onpercussion over the stomach, a large tension onpneumothoraxpneumothorax or a large airor a large air--filled chamberfilled chamber


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NORMALBREATH SOUNDS UPONAUSCULTATION

BREATH SOUNDS DESCRIPTION LOCATION CHARACTERISTIC

BRONCHIAL High-pitched, loud,

harsh-sounds.

Trachea. Louder than

vesicular sounds.

Have short

inspiratory and longexpiratoryphases

(1:2).

AUSCULTATION


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ABNORMALBREATH SOUNDS UPONAUSCULTATION

BREATH

SOUNDS

DESCRIPTION COURSE LOCATION

CRACKLES/

RALES

High-pitched.

Fine, short, interrupted

crackling sounds.

Sounds like rubbing

locks of hair between

thumbs and fingers

Heard during

INSPIRATIONand do

not clear with cough

Air passing through fluid

or mucus in any air

passage.

CONDITION:

Pulmonary Edema,fibrosis, pneumonia

Bases of the

lower lung

lobes.

GURGLES/

RONCHI

Continuous, low-

pitched, coarse,gurgling, harsh, louder

sounds, with moaning

and snoring quality.

EXPIRATION(can be

heard on both)

Air passing through

narrowed air passagesas a result of secretions,

swelling and tumors.

CONDITION:

PNEUMONIA,

BRONCHITIS,

BRONCHIECTASIS

Most lung

areas but arelouder on the

trachea and

bronchi.

AUSCULTATION


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ABNORMALBREATH SOUNDS UPONAUSCULTATION

BREATH

SOUNDS

DESCRIPTION COURSE LOCATION

FRICTION

RUB

Superficial grating or

creaking sound .

2 pcs of leather rubbing

together

INSPIRATIONand

EXPIRATION

Rubbing together

of inflamed pleural

surfaces.

CONDITION:

Pleurisy,

Pneumonia, Pleural

infarct

Heard most often in

areas of greater

thoracic expansion

(lower anterior and

lateral chest).

WHEEZE Continuous, high-

pitched, squeaky,

musical sounds.

EXPIRATION.

Air passing through

constricted

bronchus as aresult of secretions,

swelling or tumors.

CONDITION:

Asthma

On all lung fields.

AUSCULTATION


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INSPECTIONOFANOBSTRUCTEDAIRWAY

UPONINSPECTION INTERPRETATION

Low-pitched snoring sound during

inhalation, labored breathing

Partial obstruction of the upper

airway

Absence of sounds and rise andfall, accompanied (at times seen

with deep retractions)

Complete/total airway obstruction

Stridor (a harsh high-pitched soundheard during inspiration)

Lower airway obstruction

Other adventitious breath sounds


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DIAGNOSTIC

PROCEDURES


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PULMONARYFUNCTION

TESTSNursing Responsibilities:

Determine whether an analgesic that may

depress the respiratory function is being

administered.

Advise the client not to SMOKE OR EAT

A HEAVY MEAL = 4 to 6 hrs before the

test.

Withhold BRONCHODILATORmedications for 6 hrs before the test.

> Provide information about

respiratory function by measuringlung volume, lung mehanics and

diffusion capabilities of the lungs


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PULMONARYFUNCTION TESTS

Instruct the client to void before the

procedure and wear loose clothing.

Remove dentures.

The client is asked to breathe through the

mouth only. A nose clip is used to prevent

air from escaping. The client is asked to

perform different breathing maneuverswhile measurements are obtained


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PULSE OXIMETRY

Pulse oximeter measures thepercentage of Hemoglobin saturated

with OXYGEN.

Pulse oximeter passes a beam oflight through the tissue and the

sensor measures the AMOUNT oflight absorbed by O2- saturatedHgB.

REMINDERS:

SensorNOT placed distally in BP cuffs,

pressure dressings etc. Sensor should NOT be taped into the

finger.

No dark nail polish. Normal O2 Sat. 90-100%


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ARTERIALBLOODGAS

ANALYS

ISUse of ARTERIAL BLOOD to measure:

PaO2, PaCo2, pHNurses Responsibilities:

Educate the client regarding the need forthe test.

Explain to the client the need to hold

still. Perform the Allens Test.

Keep the client calm.

5 10 mL of arterial blood is drawn.


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Arterial Blood Gas Analysis

A needle connected to a heparinizedsyringe is utilized.

Most common site for blood withdrawal

is the RADIAL ARTERY. Apply continuous pressure to the site for

5 minutes and 10 minutes for femoralsites

. Place specimen on a container with ice &

transport immediately to the lab.

ARTERIALBLOODGAS

ANALYS

IS


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ABGINTERPRETATION

Oxygenation Status

O2 Therapy

Acid Base Interpretation pH: 7.35 7.45

PaCO2: 35- 45 mmHg

HC

O3: 22- 26mEq

/L

Presence of and degree of compensation


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CHEST X RAY

Visualization of lungs, heart andsurrounding structures.

Routine screening procedure

Suspicion of pulmonary disease

Monitor status of respiratory disorders

Evaluate extent of traumatic chestinjury

Provide radiographic information for

management of a respiratory problem.


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CT SCAN

Cross sectional view of anatomic structures.

MRI SCAN Use ofmagnetic field to provide a more

detailed imagery than a CT scan.

May permit visualization of structures as

they function.


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LARYNGOSCOPY

Permits visualization of the larynx

INDIRECT

Use of a mirror to visualize nasopharynx

for drainage, bleeding and ulceration.

DIRECT

Use of an endoscope to visualize themovement and characteristic of the

vocal chords.


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ALVEOLAR LAVAGE

Sterile saline injected to wet the

tissue, then aspirated to examine

atypical cells.


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PULMONARYANGIOGRAPHY

Assessment of pulmonary vascular

structures through an injection of a

contrast medium through an indwellingcatheter.

NURSING RESPONSIBILITIES:

Obtain informed consentAssess of allergies to iodine, seafood

& other rediopaque dyes

NPO for 8 hrs before the test

-Administer sedation as prescribed

- Avoid taking BP for 24 hrs in the involved

extremity

-Monitor peripheral neurovascular status of

extremities


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THORACENTESIS

NURSING RESPONSIBILITIES:Pre-procedure:

Obtain informed consent

Ask pt. to sit upright while leaning on the traytable.

Instruct the client to hold still.

Post-procedure:

- Position pt. on the UNAFFECTED SIDE.- Apply pressure dressing & assess puncture

site for bleeding & crepitus

- Monitor for signs of pneumothorax, air

embolism & pulmonary edema.


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SPUTUM COLLECTION

Acid fast bacillus staining/ sputum culture

Direct method:

Obtain early morning specimen (15 ml)

Instruct client to rinse mouth with water

Deep breathing

Cough out sputum in container

Indirect method:

Sterile suction catheter with an attached sputumtrap or transtracheal aspiration.

Gastric lavage

Note color, consistency, odor and amount


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LUNGBIOPSY

Open Lung Biopsy

Aspiration Biopsy

After identification of the lesion viaCXR and fluoroscopy, a needle will

be inserted through the chest wall

into the lung tissue and the lesion.

Definitive diagnosis of malignant

neoplasms and granulomas

CX: hemoptysis, pneumothorax,

hemothorax


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SKIN TEST/MANTOUX TEST

PPD (Purified Protein Derivative)

Intradermal

Read within 48-72 hrs after injection

(+) = induration of10 mm or more

HIV (+) clients = 5 mm induration is (+)

(+) result = exposure to Mycobacteriumtubercle bacilli

11972783 Respiratory System Review

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