The Respiratory System (Intro)

8/19/2019 The Respiratory System (Intro)

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THE RESPIRATORYSYSTEM


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ESPIRATORY SYSTE


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ATOM

AND YSIOL

OGY


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UPPER RESPIRATORY

Nose

Paranasal Sinuses

Pharynx

Larynx

Trachea


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LOWER RESPIRATORY

LUNGS

PLEURA

MEDIASTINUM

LOES


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Thelungs


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A l v e o l i

A l v e o l a r D u c t s

B R O N C H I O L E S

T E R T I A R Y B R O N C H U S

S E C O N D A R Y B R O N C H U S

( i n L e ! t l u n g " # i n R I g h t l u n $ %

& R I ' A R Y B R O N C H I

T R A C H E A


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The Al#eoli o$ %he Lun&s


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S%ruc%ures o$ %heRes'ira%ory (one

ASE)CHANE


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!HEST

WALL


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The &leura


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)unc%ion o$

Res'ira%orySys%e*


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O)YEN TRANS&ORT


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*ENTILATI

ON


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'echanics o! Breathing*entilation is the +ove+ent o! air into an$ out o!

the lungs, Air +oves !ro+ an area o! higher-ressure to an area o! lo.er -ressure,

Ins'ira%ion occurs .hen the $ia-hrag+contracts an$ the e/ternal intercostal +uscles li!tthe ri0cage" thus increasing the volu+e o! thethoracic cavit1,

Ex'ira%ion occurs .hen the $ia-hrag+ rela/esan$ the internal intercostal +uscles $e-ress theri0cage" thus $ecreasing the volu+e o! thethoracic cavit1,


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'echanics o! Breathing


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'echanics o! BreathingLungs ten$ to colla-se 0ecause o! the

elas%ic recoil o! the connective tissue"

an$ sur!ace %ension o! the 2ui$ lining thealveoli,

The lungs nor+all1 $o not colla-se

0ecause sur$ac%an% re$uces the sur!acetension o! the 2ui$ lining the alveoli" an$the visceral -leura ten$s to a$here to the-arietal -leura,


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GA

SE+

!HAN

GE


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PULMONARY DI))USION


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ASSESSMENT

• HEALTH HISTORY

• &HYSICAL E)A'INATION

• LABORATORY3 DIANOSTIC TEST


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HEALTH HISTORY A, &resenting &ro0le+4 Su05ective Data

6, Nose3 nasal sinuses

, Throat#, Lungs

a, Cough

0, D1s-nea

c, 7hee8ing

$, Chest -ain


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, Li$es%yle - s*o.in&/ occu'a%ion/

!, Nu%ri%ion 0 1ie% -

D, Pas% *e1ical his%ory


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&HYSICAL E)A'INATION

A, Ins-ection !or con9guration o! the chest

B, Rate an$ -attern o! 0reathing

C, &al-ate s:in" su0cutaneous structures" ;+uscle !or te/ture" te+-erature" ; $egree o!$evelo-+ent,

D, &al-ate !or tracheal -osition" res-irator1

e/cursion an$ !re+itusE, &ercuss !or lung 9el$s


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S1+-to+s o! &ul+onar1 DiseaseD1s-nea

Sensation o! 0reathlessness that is e/cessive

!or an1 given level o! -h1sical activit1,&aro/1s+al nocturnal $1s-nea

Ina--ro-riate 0reathlessness at night,

Ortho-neaD1s-nea on recu+0enc1,

&lat1-neaD1s-nea on the u-right -osition relieve$ 01

recu+0enc1,


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S1+-to+s o! &ul+onar1 Disease&ersistent cough

Al.a1s a0nor+al

Chronic -ersistent cough +a1 0e cause$ 01cigarette s+o:ing" asth+a" 0ronchiectasis orCO&D,

'a1 also 0e cause$ 01 $rugs" car$iac$isease" occu-ational agents an$-s1chogenic !actors,

!o*'lica%ions inclu$e (6% .orsening o!0ronchos-as+" (% vo+iting" (#% ri0!ractures"

(=% urinar1 incontinence" an$ (>% s1nco-e,


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S1+-to+s o! &ul+onar1 DiseaseS%ri1or!ro2in& soun1 1urin&3rea%hin&,

Cause$ 01 tur0ulent air2o. through anarro2e1 u''er air2ay,

Ins'ira%ory s%ri1or i+-lies ex%ra%racheal#aria3le air.a1 o0struction,

Ex'ira%ory s%ri1or i+-lies in%ra%racheal#aria3le air.a1 o0struction,


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S1+-to+s o! &ul+onar1 DiseaseWhee4in&

Continuous musical or whistling noises

cause$ 01 tur0ulent air2o. through narro2e1in%ra%horacic air2ays,'ost" 0ut not all" are $ue to asth+a,

He*o'%ysisE/-ectoration o! 0loo$,O!ten the 9rst in$ication o! serious

0roncho-ul+onar1 $isease,'assive he+o-t1sis4 coughing u- o! +ore %han

566 *l o$ 3loo1 in 78 hours,


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Signs o! &ul+onar1

DiseaseTachy'nea

Ra-i$" shallo. 0reathing,Ar0itraril1 $e9ne$ as a res-irator1 rate in

e/cess o! ?3+in,

ra1y'neaSlo. 0reathing,

Hy'er'neaRa-i$" $ee- 0reathing,Hy'er#en%ila%ion

Increase in the a+ount o! air entering thealveoli,


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Signs o! &ul+onar1

Disease9uss*aul res'ira%ion :air hun&er;

Dee'/ re&ular si&hin& res'ira%ion" .hetherthe rate 0e nor+al slo. or !ast,

Occurs in 1ia3e%ic .e%oaci1osis an1 ure*ia"as an e/aggerate$ !or+ o! 0ra$1-nea,

!heyne


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Signs o! &ul+onar1

Diseaseio% 3rea%hin&

Unco++on variant o! Che1ne@Sto:es res-iration,

&erio$s o! a-nea al%erna%e irre&ularly 2i%hseries o$ 3rea%hs o$ e=ual 1e'%h %ha%%er*ina%e a3ru'%ly,

'ost o!ten seen in *enin&i%is,

!yanosisBluish $iscoloration o! s.in or *ucous

*e*3ranes,&resents as either central or -eri-heral c1anosis


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Signs o! &ul+onar1

DiseasePercussion soun1s (resonance"

$ullness" h1-erresonance%

Auscul%a%ory soun1s (vesicular"0ronchial" 0ronchovesicular%

A1#en%i%ious soun1sA0nor+al soun$s on auscultation

'a1 0e classi9e$ as continuous (.hee8es"rhonchi% or $iscontinuous (crac:les"cre-itations%


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Signs o! &ul+onar1

DiseaseWhee4es

Hi&h


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Signs o! &ul+onar1

Disease!rac.les

enerate$ 01 the sna''in& o'en o$ s*allair2ays 1urin& ins'ira%ion,

Fine crackles are hear$ in interstitial$iseases" early pneumonia or pulmonaryedema, patchy atelectasis an$ in so+e-atients .ith asth+a or 0ronchitis,

!oarse crac.les are hear$ la%e in thecourse o! pulmonary edema or pneumonia.


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Signs o! &ul+onar1

Disease)re*i%us

Voice vibrations on the chest wall.

Locali8e$ re$uction in !re+itus occurs overareas o! air or >ui1 accu+ulation in the lungs,

Increase$ !re+itus suggests lung consoli$ation,

Broncho-hon1Increase1 in%ensi%y an1 clari%y o$ %hes'o.en 2or1 $uring auscultation,

Hear$ over areas o$ consoli1a%ion or lun&co*'ression,


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Signs o! &ul+onar1

Disease7his-ere$ -ectorilou1

Ex%re*e !or+ o! 0roncho-hon1 in .hichso$%ly s'o.en 2or1s are rea1ily hear101 auscultation,

Ego-hon1

Auscultation o! an ?a@ soun1 .hen the-atient s-ea:s an ?e@ soun1,


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La3ora%ory0Dia&nos%ic

Tes%s


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Arterial Bloo$ asesA +easure+ent o! oxy&en/ !O7/ an1 %he 'H o$%he 3loo1 %ha% 'ro#i1es a *eans o$assessin& %he a1e=uacy o$ #en%ila%ion

:Paco7;/ oxy&ena%ion :PaO7%,Allo.s assess+ent o! the aci1


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Inter-ret AB values 01 loo:ing at the !ollo.ing

(nor+al values are liste$%4• &aO-artial -ressure o! arterial o/1gen :6 %o

B66 ** H&;

• &aco-artial -ressure o! arterial car0on $io/i$e

:C %o 8 ** H&;• Saoarterial o/1gen saturation : F;

• -Hh1$rogen ion concentration" or $egree o!

aci$@0ase 0alance :,C %o ,8;

• 0icar0onate (HCO#@% ion -ri+aril1 a +eta0olic

0uFer77 %o 75 *E=0L,


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Routine Ra$iogra-h1Integral -art o! the $iagnostic

evaluation o! $iseases involving the

-ul+onar1 -arench1+a" the -leura" an$to a lesser e/tent" the air.a1s an$ the+e$iastinu+,

Usuall1 involves a 'os%ero


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Chest Ra$iogra-h1


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Ultrasonogra-h1Use$ to assess various 3o1y

s%ruc%ures,

Use$ in con5unction .ith other-ul+onar1 $iagnostic 'roce1ure suchas %horacen%esis an$ 0io-s1 to assess>ui1 or 3ro%ic a3nor*ali%ies,

Hel-!ul in the $etection an$ locali8ationo! 'leural >ui1,


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Co+-ute$ To+ogra-h1OFers several a$vantages over

conventional ra$iogra-hs,

Use o! cross


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Co+-ute$ To+ogra-h1


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'agnetic Resonance

I+aging


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&ul+onar1


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&ul+onar1


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&ul+onar1


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Biologic S-eci+en

CollectionS'u%u* collec%ion

S-ontaneous e/-ectoration or s-utu+in$uction

Percu%aneous nee1le as'ira%ionUsuall1 carrie$ out un$er !T or ul%rasoun1

gui$ance,&otential ris:s inclu$e in%ra'ul*onary

3lee1in& an$ creation o! a 'neu*o%horax,


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Biologic S-eci+en

CollectionThoracen%esis

Insertion o! nee$les through the ches% 2allinto the -leural s-ace to o0tain a s-eci+en!or $iagnostic evaluation" re+oval o! -leural2ui$s" or to ins%ill *e1ica%ion in%o %he'leural s'ace,


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Biologic S-eci+en

Collectionronchosco'y

&rovi$es !or $irect visuali8ation o! the%racheo3ronchial %ree,

Rigid bronchoscopy is -er!or+e$ in ano-erating roo+ on a -atient un$er generalanesthesia,

Flexible bronchoscopy +a1 0e $oneun$er local anesthesia 3 se$ation,

Diagnostic uses inclu$e histologici$enti9cation or neo'las*s an$i$enti9cation o! sources o! he+o-t1sis,

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Biologic S-eci+en

Collectionronchosco'y

Thera-eutic in$ications are retrieval o!!oreign 3o1ies an1 con%rol o$ 3lee1in&,

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Biologic S-eci+en

Collection"i1eo


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ANALYSISNursing Diagnoses

a, I+-aire$ gas E/change

0, IneFective 0reathing &atternc, I+-aire$ *er0al Co++unication

$, I+-aire$ Air.a1 Clearance

e, Activit1 Intolerance

!, An/iet1g, I+-aire$ Nutrition4 Less than 0o$1reuire+ents

H, Ris: !or in!ection

&LANNIN ;


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&LANNIN ;

I'&LE'ENTATIONA$euate *entilation .ill 0e +aintaine$'aintain o! -atent air.a1

EFective 0reathing -atterns .ill 0e+aintaine$

Client .ill co++unicate in an eFective+anner

Client .ill $e+onstrate increase$ tolerance!or activit1

An/iet1 .ill 0e re$uce$

A$euate nutritional status .ill 0e +aintaine$

Clients re+ains !ree !ro+ in!ections


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INTER"ENTIONS• Chest Drainage S1ste+s

• Chest &h1siothera-1

• O/1gen Thera-1

• Tracheo0ronchial Suctioning

• &ostural Drainage


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!hes%

Physio%hera'y


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!hes% 'hysio%hera'y is the

ter+ !or a grou- o! treat+ents$esigne$ to i+-roveres-irator1 eGcienc1" -ro+ote

e/-ansion o! the lungs"strengthen res-irator1 +uscles"an$ eli+inate secretions !ro+

the res-irator1 s1ste+,


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•

Pos%ural 1raina&e Uses $orce o$ &ra#i%y to assist in

eFectivel1 $raining secretions !ro+the lungs an$ into the central air.a1

.here the1 can either 3e cou&he1u' or suc%ione1 ou%,

@ &atient is -lace$ in a hea1 or ches%

1o2n 'osi%ion an$ is :e-t in this-osition !or u- to B *inu%es,


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• Percussion

Consists o! rh1th+icall1 stri:ing

the chest .all .ith cu--e$ han$s,

Also calle$ cu''in&/ cla''in&/

or %a'o%e*en%,

To 0rea: u- thic: secretions in

the lungs,

&er!or+e$ on each lung seg+ent!or one to t.o +inutes at a ti+e,


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• "i3ra%ion

- To hel- 0rea: u- lung secretions

- Coul$ either 0e +echanical or +anual

- &er!or+e$ as the -atient 0reathes $ee-l1

- 'anual 4 -erson -er!or+ing the vi0ration-laces his or her han$s against the -atientschest an$ creates vi0rations 01 uic:l1

contracting an$ rela/ing ar+ an$ shoul$er+uscles .hile the -atient e/hales

- Re-eate$ several ti+es each $a1 !or a0out9ve e/halations


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• Turnin&

-

&er+its lung e/-ansion- Hea$ o! the 0e$ can 0e elevate$ to

-ro+ote $rainage

- Criticall1 ill -atients an$ those

$e-en$ent on +echanical res-iration

are turne$ once ever1 one %o %2ohours aroun$ the cloc:,


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• !ou&hin&

-

Hel-s 0rea: u- secretions in thelungs

-&atients sit u-right an$ inhale

$ee-l1 through the nose

- E/hale in short -uFs or coughs

-

Re-eate$ several ti+es a $a1


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• Dee' rea%hin&

- Hel-s e/-an$ the lungs an$

!orces 0etter $istri0ution o! the

air into all sections o! the lung- Done several ti+es each $a1

!or short -erio$s


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•&t, Co+!ort•Non@restrictive clothing•

Avoi$ eating 0e!ore•'e$icate !or -ain•S-lint incisions

Nursing 'anage+ent


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•Avoi$ eating•Co+!ort•Avoi$ restrictive clothing•'e$icate•S-lint !or co+!ort•STO& c3o -ain

Nursing 'anage+ent4

&ERCUSSION an$ *IBRATION

The Respiratory System (Intro)

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