Objectives Identify and define the parts and functions of the
upper and lower respiratory system Define common terminology
associated with respiratory anatomy, physiology and assessment
Identify components of a complete respiratory assessment
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Terminology Airway Obstruction Something blocks the airway
Prevents air from entering or leaving lungs Anoxia Absence of
oxygen Apnea Absence of spontaneous respiration SAS (sleep apnea)
Asphyxia Impairment of ventilation and exchange of oxygen and
carbon dioxide
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Terminology Bradypnea Abnormally slow rate of respiration
Terminology Kussmaul Respirations Deep and labored breathing
Respiratory Failure Dangerously low level of oxygen (O2) in the
blood OR Dangerously high level of carbon dioxide (CO2) in the
blood Tachypnea Abnormally rapid rate of respiration > 20
respirations per minute
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The Respiratory System We cannot live without air. Millions of
cells in our bodies need a continuous supply of oxygen.
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Respiratory System Anatomy and Physiology
http://www.youtube.com/watch?v=DCVIEMNPe1E Respiratory Anatomy
Video
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Structures of the Respiratory System Upper Respiratory Tract
Nose Pharynx Mouth Larynx Trachea Lower Respiratory Tract Bronchial
tree Lungs: alveolar ducts and alveoli
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The Pleurae Multilayered membranes that are serous and moist
Surround and protect each lung Parietal Pleura: outer layer of the
pleura Lines the thoracic cavity and forms the sac containing each
lung. Visceral Pleura: inner layer of pleura Closely surrounds the
lung tissue.
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The Pleural Space The space between the folds of the pleural
membranes Contains lubricating fluid Prevents friction during
respiration. Airtight vacuum Contains negative pressure Keeps the
lungs inflated.
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The Diaphragm Muscle that separates the thoracic cavity from
the abdomen Contracts and Relaxes Phrenic nerve Stimulates
diaphragm to contract during respiration.
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BREATHING exchange of oxygen and carbon dioxide between the
environment and the lungs (ventilation) and Between the alveolus
and the alveolar capillaries (which are IN the lungs) External
Respiration
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Exchange of oxygen and carbon dioxide cellular level AKA
internal respiration Internal Respiration
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CELLULAR RESPIRATION CELLULAR RESPIRATION Exchange of gases
within the cells of body organs and tissues. Exchange of gases
within the cells of body organs and tissues. Oxygen passes from the
bloodstream into the tissue cells as carbon dioxide passes from the
tissue cells back into the blood stream. Oxygen passes from the
bloodstream into the tissue cells as carbon dioxide passes from the
tissue cells back into the blood stream.
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Pulmonary Circulation Superior Vena Cava Inferior Vena Cava
Right LungLeft Lung Pulmonary Arteries Pulmonary Veins Aorta
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Respiratory System Function To exchange carbon dioxide (CO2)
and oxygen (O2) To make oxygen (O2) available to the blood stream
So that it can be picked up and used by the cells of organs and
tissues in the body To remove carbon dioxide (CO2) waste from the
blood stream
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Respiratory Assessment The respiratory assessment is always
included in a patients physical exam. Individuals require more
extensive data- gathering - chronic lung conditions - allergic
reactions - trauma - recent surgery, etc.
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Lung Assessment
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SUBJECTIVE What the patient tells you OBJECTIVE What you see
and hear
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Subjective Assessment Ask the patient to describe any symptoms
he/she is experiencing - shortness of breath - difficulty breathing
- cough - orthopnea - pain with inspiration - wheezing, etc.
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Subjective Assessment Data must include details such as - onset
- duration - precipitating factors - measures that relieve the
symptoms - these may be medications, positioning, oxygen,
alternative measures, etc.
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Subjective Assessment Cough If present, ask for details
Productive/Non-productive Frequency/sound If productive, ask for
Color Amount Tenacity Use quotes from the patient whenever
possible! Use quotes from the patient whenever possible!
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Productive and Non-Productive Cough
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Objective Assessment Observe the patient - Facial expressions
when breathing - Chest movement - Quality of respirations - rate,
rhythm, depth Normal Range = 12-20 breaths per minute
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Objective Assessment Observe for Observe for - flaring nostrils
- color of lips and nailbeds - anxiety on the patients face - skin
color and turgor - equality of breathing on both lungs -
retractions - Dyspnea - Orthopnea
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Dyspnea and Orthopnea Dyspnea = Difficulty Breathing
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Flaring Nostrils
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Lip Cyanosis
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Cyanosis of the Nail Beds
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Lung Auscultation
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Auscultation Listening for sounds ALL Auscultate ALL lung
fields Both anteriorly and posteriorly Be sure to warm your
stethoscope!!
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Anterior and Posterior Lung Auscultation
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B = Bronchial BV = Bronchial Vesicular V = Vesicular
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Lung Auscultation adventitious The nurse notes the presence of
any adventitious sounds (abnormal breath sounds) - wheezes -
crackles - pleural friction rub - absence of breath sounds
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Normal Breath Sounds Listen:
http://www.youtube.com/watch?v=-S8T2JhMrYM
Adventitious Breath Sounds Crackles: Crackles: - common on
inspiration - interrupted crackling/bubbling sounds - brief, not
continuous - can be fine, medium or coarse
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Adventitious Breath Sounds Crackles - Occurs when air is forced
through respiratory passages narrowed by fluid, mucous, etc. -
Inflammation or infection of the small bronchi, bronchioles, and
alveoli - To simulate the sound of Crackles Take a few strands of
hair between your fingers Hold it up to your ear Rub back and
forth
Slide 42
Adventitious Breath Sounds Wheezes: Sibilant: - Musical,
high-pitched, whistling sounds. - Caused by rapid movement of air
through narrowed bronchioles. - May occur during inspiration or
expiration - The sound may consist of one or several notes
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Adventitious Breath Sounds Wheezes Sonorous: - Low-pitched,
loud, snoring sounds. - Can be heard at any point of inspiration or
expiration. - May be continuous
Adventitious Breath Sounds Pleural Friction Rub Low-pitched
grating or creaking sounds Heard during both inspiration and
expiration Sound does not originate in the lungs outside the lung
fields I nflamed pleural surfaces rubbing together during
respiration Usually indicates Pleurisy
Slide 46
Adventitious Breath Sounds Pleural Friction Rub This sound
occurs when inflamed pleural surfaces rub together during
respiration.
http://www.youtube.com/watch?v=t2QE0O_exAQListen..
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Summary Defined common terminology associated with respiratory
assessment and diagnostic testing Identified components of a
complete respiratory assessment Identified methods for common
respiratory diagnostic testing