Chapter 13

Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.

Chapter 13

The Respiratory System


Theory Objectives

Recall the structure and function of the respiratory system.

Identify three causative factors related to disorders of the respiratory system.

Provide instructions to patients on measures to prevent long-term problems of the respiratory system.

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Theory Objectives (cont.)

Employ proper techniques for assessing the respiratory system.

List nursing responsibilities for patients undergoing diagnostic tests and procedures for disorders of the respiratory system.

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Clinical Practice Objectives

Verify that nursing diagnoses chosen for patients with problems of the respiratory system are appropriate.

Propose interventions for a patient who has a problem with oxygenation.

Teach a patient to cough effectively.

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Anatomy and Physiology of the Respiratory System

Upper respiratory system Structures Functions Airway protection Speech production

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Anatomy and Physiology of the Respiratory System (cont.)

Lower respiratory system Structures Functions Oxygen delivery and diffusion Lung protection Respiration control Exchange of oxygen and carbon dioxide

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Structures of the Upper Respiratory Tract

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Paranasal Sinuses

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Lower Respiratory Tract

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Terms Commonly Used in Respiratory Care

Diffusion Elastance Hypoxemia Hypoxia Lung compliance Perfusion

Pulmonary hygiene Resistance Respiratory failure Shunting Surfactant Ventilation

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What factors can affect the exchange of oxygen and carbon

dioxide?

Alveoli

Surfactant

Edema

Tumors

Oxygen, RBC’s

Carbon dioxide

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Respiratory Disorders

Trauma or disease Susceptible to harmful substances Restrictive diseases Obstructive pulmonary diseases

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Factors that Increase Risk for Respiratory Infection

Older than 65 years of age Cigarette smoking Residing in extended-care facilities Chronic respiratory disorders (includes asthma) Congenital or chronic cardiovascular disorders Chronic renal disease Diabetes mellitus or a chronic metabolic disorder Compromised immune response

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Preventing Respiratory Disorders

Practice hand hygiene frequently Stay out of crowds, especially during cold and

flu season Refrain from smoking Avoid known allergens as much as possible Maintain adequate nutrition and obtain

sufficient rest; helps keep the immune system healthy

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Elder Care Points

The elderly should not be exposed to children with colds and coughs

The elderly person who is mostly confined to the house or a long-term care facility and does not mingle with the public much does not have the immunity to common viruses and bacteria that younger, more socially active people do

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Pneumococcal Immunization for High-Risk Persons

The U.S. Public Health Service Advisory Committee on Immunization recommends immunization against pneumococcal infection for high-risk persons

Although there is some danger in taking the vaccine, the benefits far outweigh the risks

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Smoking and Tobacco Cessation

5 As Ask about tobacco use Advise about the health benefits of quitting Assess readiness to quit Assist in creating a cessation plan Arrange follow-up

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Assessment (Data Collection)

History-taking Physical assessment Diagnostic tests and procedures Diagnostic visual examination of the nose,

mouth, and throat

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Data Collection

Subjective What questions will you ask? Utilize listening skills

Objective What will you include in your physical

assessment?

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Clubbing of Fingers

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Characteristics of Sputum and Possible Causes

Thick, tenacious, and “ropey”; difficult to cough up Chronic bronchitis, emphysema

Scant, sticky, rust-colored Pneumococcal pneumonia

Frothy, pinkish, or blood-tinged Pulmonary edema

Yellow, yellow-green, or grayish-yellow, with foul odor or taste Pulmonary infection

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Characteristics of Sputum and Possible Causes (cont.)

Blood-tinged, bloody, or blood-streaked Tuberculosis, or ulcerated pulmonary vessel, or

bronchogenic carcinoma Large amounts

Pneumonia or bronchitis Scanty

Asthma Very thick and viscous

Inadequate hydration

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Sites for Auscultation of the Lungs

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Normal Lung Sounds

Vesicular breath sounds Low to medium pitch with a soft whooshing quality;

inspiration is two to three times the length of expiration

Bronchovesicular breath sounds Moderate to high pitch with a hollow, muffled quality;

equal time of inspiration and expiration Bronchial breath sounds

High pitch with a loud, harsh, tubular quality; inspiration half as long as expiration

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Adventitious Breath Sounds

Rales/crackles

Rhonchi

Wheezes

Pleuritic rubs

Stridor

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Barrel Chest Typical of COPD

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Diagnostic Tests and Procedures

Pulse oximetry

Arterial Blood Gases Ph PaO2 PaCO2 HCO3 Acidosis and alkalosis

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D-dimer

Sputum analysis

Capnography

Pulmonary Function Tests (PFT’s)

Chest x-ray

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Computed Tomography

Ventilation/Perfusion Scan (V-Q scan)

Pulmonary angiography

Bronchoscopy

Laryngoscopy

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Mediastinoscopy

Thoracentesis

Tuberculosis tests

Peak Flowmeter

Lung Biopsy

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Spirometry

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Nursing Diagnoses

Ineffective airway clearance

Ineffective breathing patterns

Risk for infection

Fatigue

Anxiety

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Nursing Goals

Promote oxygenation Prevent infection Prevent further lung damage Promote rehabilitation

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Evaluation

Improved breathing pattern, pulse oximeter readings, arterial blood gas values, and lung sounds

Decreases in coughing, sputum production, wheezing, and signs of infection

Lessened dyspnea and more energy and ability to perform more self-care

Reassessment is an ongoing nursing activity

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Patient Teaching: Deep Breathing

Clear the nasal passages Sit with feet about shoulder-width apart Lean forward with hands or elbows on the

knees and arms and hands completely relaxed Take a deep breath, allowing the diaphragm to

drop as you inhale; feel the abdomen expand Exhale slowly Continue to take several slow, deep breaths

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Patient Teaching: To Cough Effectively

Position tissues or a basin for expectoration While in a sitting position with the feet

supported, deep-breathe several times Bend head forward, slightly hunch shoulders

forward Take a deep breath and slowly exhale,

coughing three times in succession with exhalation

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Patient Teaching: To Cough Effectively (cont.)

The first cough mobilizes secretions and the next two bring secretions up to be expectorated

Repeat the process if secretions are still audible in the lungs

Rest in between attempts at coughing

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For the Patient Who Will Not Effectively Cough

After deep breathing, encourage the patient to take a deep breath through the nose and then forcibly exhale through the mouth

Repeat the process, producing “huffs” that move secretions upward until they can be expectorated

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Orthopneic Position

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Chapter 13