Prepared by: Prof. T.R.Rodriguez Jr.

RN, MAN
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RESPIRATORY SYSTEM

CARDIOVASCULAR SYSTEM

Exchange of gases
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Transport of gases
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The Respiratory System

of the

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of the

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Respiratory Tract
1. 2. 3. 4. 5. Nose and Nasal Cavity Paranasal Sinuses Pharynx Tonsils & Adenoids Larynx

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Respiratory Tract

1. Trachea 2. Bronchi and the Bronchial Tree 3. Lungs and Alveoli

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Nose & Nasal Cavity

Passageway of air into & out of the lungs

Filters, humidifies &

warms inspired air

Sense of smell

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Paranasal Sinuses

1. Lightens the weight of the skull 2. 2/9/2013 Resonance chambers for speech

Pharynx
Common passageway for food and air
NASOPHARYNX OROPHARYNX

LARYNGOPHARYNX

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Tonsils & Adenoids

Trap and remove any bacteria and other pathogens from the throat.

ADENOIDS

TONSILS

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Larynx
For sound production Passageway of air Protects the lungs from foreign bodies

Thyroid cartilage

Epiglottis

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Trachea
Consists of smooth muscles and C-shaped rings of hyaline cartilage

Passageway of air

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Bronchi & the Bronchial Tree

R L
Primary Bronchus

Secondary/Lobar Bronchus Tertiary/Segmental Bronchus Subsegmental bronchus Bronchioles

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Lungs

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Alveoli

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Respiratory Zones

Alveoli

Respiratory Bronchioles

Alveolar duct

Alveolar sacs
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Structure of an Alveolus

Respiratory Membrane

Type I (Squamous) Alveolar Cell

SURFACTANT
Type III (Macrophage) Alveolar Cell

Type II (Great) Alveolar Cell

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Physiology of Respiration
(4) Processes Involved in Respiration

Pulmonary Ventilation External Respiration Transport of Gases Internal Respiration

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1. Pulmonary Ventilation
(2) Phases of Breathing

1. Inhalation
Active phase

2. Exhalation
Passive phase

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Pleural Cavity

1. Parietal Pleura 2. Visceral Pleura

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Respiratory Pressures

1. Intraalveolar/ Intrapulmonary 2. Intrapleural 3. Transpulmonary

Atmospheric Pressure N 760 mmHg

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Air is not made up of a single gas, but a mixture of gases as follows:

Gas N2 O2 CO2 H2O
Atmospheric Air Humidified Air % mmHg % mmHg 78.6 597.0 74.0 563.4 20.8 159.0 19.0 149.3 0.04 0.3 0.04 0.3 0.50 3.7 6.2 47.0 Alveolar Air % mmHg 74.9 569.0 13.6 104.0 5.3 40.0 6.2 47.0

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Respiratory Volumes & Capacities

Volumes 1. TV 2. IRV 3. RV 4. ERV

Capacities 1. IC - TI 2. FRC - RE 3. VC - TIE 4. TLC - TIRE

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The maximum airair inhaledinhaled lungs TheThe volumevolume ofofthat that can exhaled maximum volume air exhaled after TheThe volumevolumeremainingafter lungs after a Themaximumofairofremainingair&can a from the maximum of in theofairair the be be the MAXIMUM Thevolume of volumeof lungsin inexhaled a volume air The inhaledaafter each breath ( 500 ml)(1100ml) forciblynormal expiration (3500(1200 ml) point ofwith inspirationinhalation(4600 ml) after NORMAL expiration (2300 ml) ml) after a normal exhalation(3000 MAXIMUM exhalation ml) MAXIMUM inspiration a normal (5800 ml)

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Exchange of gases between the systemic CAPILLARIES and the tissue CELLS 2/9/2013

Actual exchange of gases 2. External Respiration between the ALVEOLI in the lungs and the BLOOD in the capillaries. (pulmonary gas exchange) Oxygen 1. As oxyhemoglobin 2. Dissolved in plasma Carbon Dioxide 3. Transport of Gases 1. Dissolved in plasma as bicarbonate ion 2. As carbaminoglobin
4. Internal Respiration
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Regulation of Respiration
1. Neural Regulation a. Respiratory Centers Medulla Oblongata Pons of the brainstem b. Stretch Receptors and Hering-Breuer Reflex

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2. Chemical Regulation

a. Changes in the pH, PCO2 and PO2 b. Chemoreceptors Central (medulla) Peripheral (carotid & aortic bodies)

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3. Others

a. Changes in blood pressure & body temperature b. Drugs

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Good assessment skills play a vital role in providing nursing care for patients with oxygenation problems.

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General Nursing Assessment

1. 2. 3. Health History Physical Assessment Laboratory/Diagnostic Examinations Medications

4.

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Health History
Reasons for seeking health care
1. Dyspnea
2. Cough
3. Sputum Production

4. Chest Pain
5. Wheezing 6. Hemoptysis 7. Cyanosis 8. Clubbing of fingers
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Risk Factors
Smoking
Personal / Family History Occupational exposure Allergens & environmental pollutants Activities Age-related changes

Health History

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Dyspnea

Decreased lung compliance

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Increased airway resistance

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Types of Dyspnea

1. Exertional Dyspnea Exertional Dyspnea 1. Sudden dyspnea Exertional Dyspnea 2. Sudden Dyspnea Most common Orthopnea PND when physical obstruction, ARF, Pneumothorax, airway 2. Sudden dyspnea exertion & relieved ARDS, Occurs with in reclining/ lying position SOB with with wheezes orDyspnea embolism SOB 3. Orthopnea sudden onset pulmonary by restAsthma sitting up Relieved during sleep 3. Orthopnea by or COPD or at night Occurs Occurs disease or COPD with the body uses 4.4. Dyspnea when bronchoconstriction oxygen Heart associated more suffocation Awakens patient with feeling Due to Dyspnea associateddioxide -of and makes more carbon with during Relieved by sitting up wheezes or physical activity wheezes failure exercise Heart 5.5. Paroxysmal Nocturnal Dyspnea Paroxysmal Nocturnal Dyspnea
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Visible sternocleidomastoid contractions Hyperexpansion of the chest (Increased AP diameter) Anxious appearance Circumoral cyanosis Suprasternal retractions Intercostal retractions Substernal retractions

DYSPNEA

Difficult or labored breathing Shortness of breath (SOB)

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Sitting posture with body slightly bent forward

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What to assess.
Acute or chronic Progressive, recurrent or paroxysmal Associated with cough, fever, chills or night sweats

Sudden or gradual Relieved by any interventions Worse when upset

Any changes in body weight

At rest or with exertion

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Related to activities

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Cough
Cough of worsens recent Cough thatnight onset Cough at cough Dry,acute infection irritative when inor changing cough supine Severe or Asthma sputum LSHF cough with Morning VIRAL respiratory tract position - Sinusitis Bronchogenic carcinoma production - Bronchitis infection

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Cough
Productive? color, consistency, odor & amount Dry, hacking or wheezy

Particular time/event

Recent or gradual Smoking history/ past medical illness

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Strong or weak

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Sputum Production
Increased production - profuse or small in amount
Purulent, rusty, bloody, frothy or mucoid Thick (tenacious) or thin Offensive odor/ foul-smelling
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Sputum Production
Profuse Purulent Thick (yellowish, greenish or rusty-colored) Bacterial infection Foul- smelling lung abscess or Profuse, frothy, pink pulmonary bronchiectasis edema Thin, mucoid Viral bronchitis Pink-tinged mucoid Lung tumor

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Chest Pain
Intermittent or persistent

Localized or radiating intensity

Sharp, dull, stabbing or aching

Relieved by any interventions

Smoking history & environmental exposure

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Effects on respiration

Past medical history 42

Wheezing

High-pitched, musical sound heard mainly on expiration Common in patient with bronchoconstriction or airway narrowing

Loud or soft Expiratory or inspiratory

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Clubbing of the Fingers

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Hemoptysis
Bright red or frothy

URT, GIT or LRT

amount

Associated with certain circumstances or activities

History of chest trauma

Sudden, intermittent or continuous
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Salty taste, burning or bubbling sensation before bleeding

Due to inadequate amount of oxygen in the blood Appears when Hgb level = 5 g/dl

Central or Peripheral

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Physical Assessment

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Nose & Sinuses

Inspect
1. For lesions, asymmetry or inflammation 2. Nasal mucosa for color, swelling, exudates or bleeding 3. Septum for deviation, perforation or bleeding 4. Turbinates for color and presence of polyps

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Nose & Sinuses

Palpate
1. Sinuses for tenderness

TRANSILLUMINATION

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Mouth & Pharynx

Inspect
1. For color, symmetry, exudates, ulceration, enlargement

Trachea
Palpate
1. Position & mobility

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Inspection

General Appearance: body size, age, skin quality & color, posture Movement of thorax Characteristics of respiration Symmetry/ Deviation Discoloration Lesions, polyps & mass Exudates & other discharges

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Inspection

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Normal ratio of AP :: Transverse diameter = 1:2 AbN: Barrel, Funnel, Pigeon, kyphoscoliosis RR = 16- 20 cpm Regular in depth & rhythm AbN: bradypnea, tachypnea, hyperpnea, Kussmaul breathing, Cheyne-Stokes breathing (-) retractions/ bulging
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Chest Landmarks

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Palpation

Painful areas or masses Chest & Diaphragmatic Excursion Tactile fremitus

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Palpation

Symmetrical chest excursion AbN: decreased in chronic fibrotic disease; asymmetrical in pleurisy, chest trauma, bronchial obstruction Fremitus: normally louder near the large bronchi AbN: absent (emphysema); increased (pneumonia)

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Percussion

Percussion Sounds/Notes 1. Resonance 2. Dullness 3. Flatness 4. Hyperresonance

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Percussion

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Resonance in normal lungs & simple chronic bronchitis Flatness: Pleural effusion Dullness: Lobar pneumonia Tympany: Pneumothorax Hyperresonance: Emphysema Diaphragmatic Excursion: 3-4 inches or 2-2.75 inches Higher in the right AbN: Decreased in pleural effusion and emphysema
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Auscultation
Breath Sounds Vocal Fremitus

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Auscultation
Normal Breath Sounds: 1. Vesicular ( entire lung field) low pitched 2. Bronchial (over the trachea ) high pitched 3. Bronchovesicular ( over the main bronchus) medium pitched AbN: diminished or absent in atelectasis, & pleural effusion
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Auscultation

Adventitious Breath Sounds Crackles (Rales) Inflammation or Congestion as in Pneumonia, Bronchitis, CHF, Bronchiectasis & Pulmonary Fibrosis Wheezes bronchoconstriction due to increased secretions or edema as in Asthma, CB, Bronchiectasis Friction Rubs pleurisy or pleuritis
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Auscultation

Vocal Fremitus 1. Bronchophony clear and more intense 2. Egophony distorted; E to A 3. Whisphered Pectoriloquy lung consolidation

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Laboratory & Diagnostic Studies

1. Radiographic & Scanning Studies CXR CT scan Lung Scan PET Fluoroscopy Barium Swallow
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Laboratory & Diagnostic Studies

2. Endoscopic Studies Bronchoscopy Esophagoscopy Mediastinoscopy Thoracoscopy 3. Thoracentesis 4. Needle Biopsy
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Laboratory & Diagnostic Studies

5. Pulmonary Function Tests Spirometry Peak Flow 6. ABG Analysis 7. Pulse Oximetry 8. Sputum Examination & Culture

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Chest X-ray/ CT Scan

Done to visualize the structures of the respiratory system

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Chest X-ray

Practice the client on how to hold his breath and to do deep breathing
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Lung Scan
To assess ventilation & perfusion in the lungs. To detect pulmonary embolism. To assess the function of the lungs in anticipation of lung surgery.
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Remain still during the procedure

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Bronchography
A radiopaque medium is instilled directly into the trachea and bronchi then visualized through x-ray
Check for allergies to sea foods or iodine Have O2 and antispasmodic agents ready during procedure.
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Side-lying; NPO after the procedure 69

Bronchoscopy
A procedure that involves placement of a viewing instrument into the trachea and bronchi to diagnose or treat lung and airway problems.

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Bronchoscopy

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THORACENTESIS
To remove fluid or air from the chest. To determine why an abnormal amount of fluid has collected To help relieve the symptoms of shortness of breath when the fluid is causing compression of the normal lung.
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Thoracentesis

Site of insertion: 2nd or 3rd ICS air 8th to 9th ICS - fluid

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 Take initial VS before the procedure

Position: Upright leaning on overbed table Instruct to remain still and avoid coughing during insertion of needle After the procedure: Turn on the unaffected side
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Check for expectoration of blood

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Lung biopsy
Performed to obtain a small piece of lung tissue for examination under a microscope. Biopsy examinations are usually performed by pathologists

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Pulmonary Function Test (PFT)

A series of tests that measure lung function. Provide information about the amount of air a person's lungs can hold, and how effectively the lungs work.
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Med graphics Profiler Machine

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Spirometry

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Peak Flow Meter

A portable, hand held device used to evaluate the changes in the severity of your asthma and your response to medication. It simply involves taking a deep breath and blowing into the device as quickly and forcefully as possible.
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ABG Analysis

Measures the amount of oxygen and carbon dioxide in the blood, as well as its acidity.

Use heparinized syringe

Radial artery common site
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Pulse Oximetry
A simple non-invasive method of monitoring the percentage of hemoglobin (Hgb) which is saturated with oxygen.
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Sputum Examination
1. 2. Gross Examination Microscopic examination

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Mouth should be free of foreign objects Early morning specimen is BEST Induce sputum if necessary Cough into sterile specimen cup

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Common Respiratory Tract Agents

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Common Pulmonary

1. Bronchodilators Sympathomimetics

Xanthine derivatives
2. Corticosteroids

3. Mucolytics, Expectorant & Antitussive

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 Open narrowed airways or dilate the bronchus either by their betaadrenergic activity or by directly relaxing the smooth muscle of the bronchus
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 Sympathomimetics 1. Albuterol (Ventolin) 2. Terbutaline (Bricanyl) Xanthine-Derivative 1. Aminophylline 2. Epinephrine 3. Theophylline

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Sympathomimetics
1. Beta-adrenergic agonist Relax smooth muscles of all airways Best administered as INHALANTS

Either MDI or mist

S/E: tremor, tachycardia, palpitations

Albuterol (Ventolin)
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2. Anti-cholinergic
Bind to acetylcholine receptors and result in bronchodilation (of mostly larger airways) Reduces sputum production
Inhaled route is preferred S/E: palpitations Atrovent (Ipratropium Bromide)
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Methylxanthines or Xanthine- Derivative

Weak bronchodilator Delays respiratory muscle fatigue Reduces trapped lung gas Improves respiratory muscle mechanics

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Theophylline
Relax and open airways Improve the diaphragm's ability to contract. Increase the clearance of mucus

S/E: nervousness, tremors, or nausea

Check the blood level from time to time to ensure that you are getting the correct dose. Signs of toxicity: vomiting, agitation, apical pulse of 200 bpm
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Aminophylline (Theophylline )
BEST taken in AM on an empty stomach, because it can causes INSOMNIA Check HR can cause tachycardia Maintain adequate urine output Avoid caffeine containing foods Stop smoking!
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Reduce airway inflammation

Efficacy and role in stable COPD uncertain

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Anti-Inflammatory Drugs (Steroids)

(Prednisone, Methylprednisolone) Can be given in several forms.

1. Inhaled form
2. Pill form 3. Intravenous form

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Prednisone
BEST given after meals S/E: weight gain and increased appetite Check serum K level can cause hyperkalemia

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 Loosen secretions in respiratory tract by altering the viscosity of sputum Example: Mucomyst (Acetylcysteine)

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Drugs that block or suppress the cough reflex

Used for respiratory disorders nonproductive, irritating cough Examples: Codeine, dextromethorphan, Benzonatate
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 Drugs that liquefy secretions or decrease viscosity of secretions Often in combination with antihistamines and decongestants Example: Guaifenesin
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 Relieve allergy symptoms H1 blockers = block histamine Example: Diphenhydramine HCl

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