1. Define important words in this chapter alveoli tiny, grape-like sacs in the lungs where the exchange of oxygen and carbon dioxide occurs. asthma a chronic and episodic inflammatory disease that makes it difficult to breathe and causes coughing and wheezing. bronchi branches of the passages of the respiratory system that lead from the trachea into the lungs. bronchiectasis a condition in which the bronchi become permanently dilated (widened) and damaged.

1. Define important words in this chapter bronchitis an irritation and inflammation of the lining of the bronchi. chest percussion clapping the chest to help lungs drain with the force of gravity. chronic obstructive pulmonary disease (COPD) a chronic, progressive, and incurable lung disease that causes difficulty breathing. emphysema a chronic, incurable lung disease in which the alveoli in lungs become filled with trapped air; usually results from smoking and chronic bronchitis.

1. Define important words in this chapter expiration the process of exhaling air out of the lungs. hemoptysis the coughing up of blood from the respiratory tract. inspiration the process of breathing air into the lungs. lungs main organs of respiration responsible for the exchange of oxygen and carbon dioxide.

1. Define important words in this chapter multidrug-resistant TB (MDR-TB) disease that occurs when the full course of medication is not taken for tuberculosis (TB). oxygen therapy the administration of oxygen to increase the supply of oxygen to the lungs. pneumonia acute inflammation in the lung tissue caused by a bacterial, viral, or fungal infection and/or chemical irritants. respiration the process of inhaling air into the lungs and exhaling air out of the lungs.

1. Define important words in this chapter sputum mucus coughed up from the lungs. trachea an air passage that goes from the throat (pharynx) to the bronchi; also called the windpipe. tuberculosis (TB) a contagious lung disease caused by a bacterium that is transmitted through the air; causes coughing, difficulty breathing, fever, and fatigue.

2. Explain the structure and function of the respiratory system Define the following terms: trachea an air passage that goes from the throat (pharynx) to the bronchi; also called the windpipe. bronchi branches of the passages of the respiratory system that lead from the trachea into the lungs. alveoli tiny, grape-like sacs in the lungs where the exchange of oxygen and carbon dioxide occurs. lungs main organs of respiration responsible for the exchange of oxygen and carbon dioxide.

2. Explain the structure and function of the respiratory system Define the following terms: inspiration the process of breathing air into the lungs. expiration the process of exhaling air out of the lungs. respiration the process of inhaling air into the lungs and exhaling air out of the lungs.

Transparency 20-1: The Respiratory System

2. Explain the structure and function of the respiratory system Remember these points about the respiratory system: The epiglottis shuts off the larynx during the swallowing process. The larynx enables humans to speak. Respiration, the body’s taking in of oxygen and removing of carbon dioxide, involves inspiration (breathing in) and expiration (breathing out).

2. Explain the structure and function of the respiratory system Functions of the respiratory system: Serves as an air filter, cleaning inhaled air Supplies oxygen to body cells Removes carbon dioxide from cells Produces the sounds associated with speech

2. Explain the structure and function of the respiratory system Normal changes of aging in the respiratory system: Lung strength decreases. Alveoli become less elastic and decrease in number. Airways become stiff and less elastic. Lung capacity decreases. Rib cage changes and chest muscles become weaker. Cough reflex becomes less effective and cough becomes weaker. Oxygen in the blood decreases. Decreased lung capacity causes voice to weaken.

4. Discuss common disorders of the respiratory system Define the following terms: chronic obstructive pulmonary disease (COPD) a chronic, progressive, and incurable lung disease that causes difficulty breathing. bronchitis an irritation and inflammation of the lining of the bronchi. sputum mucus coughed up from the lungs. emphysema a chronic, incurable lung disease in which the alveoli in lungs become filled with trapped air; usually results from smoking and chronic bronchitis.

4. Discuss common disorders of the respiratory system Think about these questions: How does it feel to take a deep breath and to be able to fill your lungs completely with oxygen? How would it feel to not be able to get enough air?

4. Discuss common disorders of the respiratory system Know these points about chronic obstructive pulmonary disease (COPD): Cause: obstruction of airways Includes chronic bronchitis and emphysema Chronic bronchitis occurs when lining of the bronchial tubes becomes inflamed, causing scarring. Symptoms of chronic bronchitis: excessive mucus production, long-lasting cough

4. Discuss common disorders of the respiratory system Points about COPD (cont’d.): Treatment of chronic bronchitis: reducing triggers, quitting smoking, medications Symptoms of emphysema: shortness of breath, coughing, difficulty breathing Treatment for emphysema: providing comfort, relieving symptoms, quitting smoking, oxygen, medication, respiratory therapy

4. Discuss common disorders of the respiratory system Know the general symptoms of COPD: Coughing or wheezing Dyspnea Shortness of breath Cyanosis Chest pain or tightness Confusion Weakness Weight loss or loss of appetite Fear and anxiety

4. Discuss common disorders of the respiratory system Remember these care guidelines for COPD: Be supportive, calm, and empathetic. Use pillows to help residents sit up or lean forward. Be supportive of residents who are quitting smoking. Encourage healthy diet. Offer fluids. Encourage rest.

4. Discuss common disorders of the respiratory system Care guidelines for COPD (cont’d.): Use proper infection prevention practices. Report signs of colds or flu immediately. Residents must take medication as ordered. Follow safety guidelines for oxygen therapy. Report fever, confusion or changes in mental state, refusal of medications, change in breathing patterns, change in color or consistency of mucus or sputum, chest pain, inability to sleep, anxiety or fear.

4. Discuss common disorders of the respiratory system Define the following term: asthma a chronic and episodic inflammatory disease that makes it difficult to breathe and causes coughing and wheezing.

4. Discuss common disorders of the respiratory system Know these points about asthma: Chronic, episodic disorder in which irritants, allergens, infections and cold air cause inflammation and swelling in the air passages in the lungs Can be worsened by exercise or stress Symptoms: heavy wheezing, coughing, tight feeling in chest Treatment: medication, avoidance of triggers, reducing stress levels Report: changes in vital signs, especially respiratory rate; wheezing, shortness of breath or dyspnea; cyanosis; chest pain or tightness; refusal to use inhaler

4. Discuss common disorders of the respiratory system Define the following terms: bronchiectasis a condition in which the bronchi become permanently dilated (widened) and damaged. chest percussion clapping the chest to help lungs drain with the force of gravity.

4. Discuss common disorders of the respiratory system Remember these points about bronchiectasis: Condition in which the bronchi become permanently dilated Causes: infection of the airways, cystic fibrosis, presence of tumors, inhaling foreign material Symptoms: chronic coughing, shortness of breath, wheezing, weight loss, cyanosis, coughing up blood, respiratory infections, halitosis Treatment: postural drainage, chest percussion Report: fever, chest pain, change in mucus or phlegm production

4. Discuss common disorders of the respiratory system Define the following term: pneumonia acute inflammation in the lung tissue caused by a bacterial, viral, or fungal infection and/or chemical irritants.

4. Discuss common disorders of the respiratory system Know these points about pneumonia: Inflammation of the lungs Causes: viral, bacterial, or fungal infection; chemical irritants Symptoms: high fever, chest pain, coughing, difficulty breathing, shortness of breath, chills, rapid pulse, thick secretions coughed up from the lungs Treatment: antibiotics and other medication, inhaler, special diet, increased fluid intake Report if resident is not taking medication.

4. Discuss common disorders of the respiratory system Define the following terms: tuberculosis (TB) a contagious lung disease caused by a bacterium that is transmitted through the air; causes coughing, difficulty breathing, fever, and fatigue. hemoptysis the coughing up of blood from the respiratory tract. multidrug-resistant TB (MDR-TB) disease that occurs when the full course of medication is not taken for tuberculosis (TB).

4. Discuss common disorders of the respiratory system Remember these points about tuberculosis: Highly contagious lung disease Cause: bacterium that is carried on mucous droplets suspended in the air Can be spread by infected person coughing, breathing, singing, sneezing, or laughing Symptoms: fatigue, loss of appetite, weight loss, slight fever and chills, night sweats, prolonged coughing, hemoptysis, chest pain, shortness of breath, dyspnea Multidrug-resistant tuberculosis (MDR –TB) can develop when person with TB does not take all of his prescribed medication.

4. Discuss common disorders of the respiratory system Remember these care guidelines for tuberculosis: Follow Standard Precautions and Airborne Precautions. Wear PPE. Be careful when handling sputum. Resident must take all of the medication prescribed.

5. Describe oxygen delivery Define the following term: oxygen therapy the administration of oxygen to increase the supply of oxygen to the lungs.

5. Describe oxygen delivery There are different methods of oxygen delivery: Piped into room through wall outlet at facility Compressed oxygen in cylinders Liquid oxygen in special reservoirs Oxygen concentrators

5. Describe oxygen delivery The doctor determines which oxygen delivery device is the best for a resident who needs additional oxygen.

5. Describe oxygen delivery Common types of oxygen delivery devices include the following: Nasal cannula This device has a set of two prongs which are placed into the nostrils, and a plastic tube that fits behind the ears. Simple face mask This plastic device is shaped to fit over the nose and mouth. It is held in place with an elastic band that slides over the head and above the ears. Oxygen concentrator An oxygen concentrator filters oxygen from normal room air. It delivers low-flow oxygen. It is generally used in conjunction with a nasal cannula.

5. Describe oxygen delivery Think about this question: How would it feel to need oxygen delivered through a face mask or nasal cannula?

5. Describe oxygen delivery REMEMBER: Oxygen is considered a drug and cannot be applied or adjusted by nursing assistants.

5. Describe oxygen delivery Think about this question: Why is oxygen considered a drug?

5. Describe oxygen delivery Remember these care guidelines for residents using oxygen: Perform frequent skin care. Observe for redness, sores, bruising, or discomfort in ear, nose, mouth or chin area. Lubricate sensitive areas. Take vital signs as ordered. Check device for fit and comfort. Notify nurse if equipment does not seem to be working.

5. Describe oxygen delivery Care guidelines for residents using oxygen (cont’d.): Post “No Smoking” and “Oxygen in Use” signs. Know location of fire alarms and extinguishers. Add pillows, as needed, to improve breathing. Encourage activity. Provide emotional support. Report sores or crusts on nasal area, dry or reddened areas on the skin, discomfort or pain, shortness of breath, changes in vital signs, cyanosis, and chest pain or tightness.

5. Describe oxygen delivery REMEMBER: When oxygen has been ordered for a resident, be alert to fire hazards, such as smoking materials, flammable liquids, and open flames, which can spark and cause fire. Remove any fire hazards.

Handout 20-1: Oxygen Therapy Using a Humidification Device Oxygen administration can dry out the mucous membranes of the nose and mouth. Because of this, humidifying devices are often added to oxygen therapy devices. The humidifying container is filled with sterile or distilled water. The oxygen moves through the water and collects moisture before it is transferred to the resident. Humidification devices are commonly pre-filled devices; nurses or respiratory therapists will replace the humidification device when its water level is low with a new, pre-filled container. Some facilities may use humidification devices that have to be refilled by the nurse or the respiratory therapist when the water level becomes low. The nursing assistant’s responsibility is to observe the humidification device and report promptly when the water level becomes low. In addition, if the device is not bubbling, or the bubbling decreases, report this promptly to the nurse. Guidelines for Oxygen Therapy using a Humidifying Device • Check the humidification device often to make sure it is bubbling. Carefully observe the water level in the humidification device. Notify the nurse if the following occurs: • Water in the humidification device stops bubbling • Decrease in bubbling • Water level in the humidification device becomes low

6. Describe how to collect a sputum specimen Know these points about collecting a sputum specimen: Sputum is mucus that comes from inside the respiratory system. Sputum may show evidence of cancer or bacteria. Some facilities do not allow nursing assistants to collect sputum specimens; always follow facility policy. Early morning is the best time to collect sputum. Resident should rinse mouth with water but not with mouthwash before specimen collection.

Collecting a sputum specimen Equipment: specimen container and lid, completed label (labeled with resident’s name, room number, date, and time), tissues, plastic bag, gloves, mask, emesis basin Identify yourself by name. Identify the resident. Greet the resident by name. Wash your hands. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with a curtain, screen, or door.

Collecting a sputum specimen Put on mask and gloves. If the resident has known or suspected TB or another infectious disease, wear the proper mask when collecting a sputum specimen. Ask the resident to rinse her mouth with water. Assist as necessary. Have her spit rinse water in the emesis basin, if she does not use the sink.

Collecting a sputum specimen Ask the resident to cough deeply, so that sputum comes up from the lungs. To prevent the spread of infectious material, give the resident tissues to cover his or her mouth. Ask the resident to spit the sputum into the container. When you have obtained a good sample (about two tablespoons of sputum), cover the container tightly. Wipe any sputum off the outside of the container with tissues. Discard the tissues. Apply the label and put the container in the plastic bag and seal the bag.

Collecting a sputum specimen Remove and discard gloves and mask. Wash your hands. Leave call light within resident’s reach. Wash your hands. Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure using facility guidelines. Take specimen container and lab slip to the designated place promptly.

7. Describe the benefits of deep breathing exercises Residents who have had surgery, such as hip replacement or abdominal surgery, are instructed to do deep breathing exercises to regularly expand the lungs.

7. Describe the benefits of deep breathing exercises Understand these points about deep breathing exercises: Help expand the lungs, clear them of mucus, and prevent infections The care plan may include using an incentive spirometer. Usually a goal volume is set and attempted for a minimum of three seconds. Do not assist with these exercises if you have not been trained to do so.

7. Describe the benefits of deep breathing exercises Points about deep breathing exercises (cont’d.): Do not share incentive spirometers between residents. Make sure you and the resident wash hands prior to using the spirometer. Don gloves before assisting with this procedure. Encourage, but do not force, the resident to use the incentive spirometer.

Assisting with deep breathing and coughing exercises Equipment: gloves, pillow, tissues, emesis basin Identify yourself by name. Identify the resident. Greet the resident by name. Wash your hands. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with a curtain, screen, or door. Put on gloves.

Assisting with deep breathing and coughing exercises Position resident in the Fowler’s position with a pillow over the abdomen, if needed. You may also be instructed to position the resident in a dangling position. Ask her to wrap her arms around the pillow and hold the pillow tightly against her abdomen. Tell the resident to take a deep breath and hold the breath for a few seconds. Ask the resident to exhale for as long as possible through lips that are pursed.

Assisting with deep breathing and coughing exercises Tell the resident to then repeat the deep breathing exercise a few more times. Ideally, the deep breathing exercise should be repeated five times in a row. Make sure the tissues are nearby. Ask the resident to hold the pillow tightly, breathe in once deeply, and then cough as forcefully as possible. Collect any secretions with the tissues and dispose of tissues temporarily in the emesis basin. Repeat the sequence above the designated number of times or the number of times the resident is able to perform the exercises.

Assisting with deep breathing and coughing exercises Dispose of tissues in nearest no-touch receptacle. Clean and store emesis basin. Remove and discard gloves. Wash your hands. Make resident comfortable. Remove privacy measures. Leave call light within resident’s reach. Wash your hands.

Assisting with deep breathing and coughing exercises Be courteous and respectful at all times. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Exam Multiple Choice. Choose the correct answer. 1. The _______ acts like a lid to shut off the larynx during the swallowing process. (A) Trachea (B) Epiglottis (C) Bronchi (D) Alveoli 2. What is the function of the larynx? (A) Enables speech (B) Blocks food from entering the trachea (C) Allows for passage of air and food (D) Transfers air to the lungs

Exam (cont’d.) 3. The process of breathing in and out is called: (A) Inspiration (B) Respiration (C) Expiration (D) Expansion 4. Which of the following is a function of the respiratory system? (A) Regulates body temperature (B) Pumps blood throughout the body (C) Supplies oxygen to body cells (D) Gives the body shape and structure

Exam (cont’d.) 5. Normal age-related changes for the respiratory system include: (A) Lung strength decreases (B) Airways become more elastic (C) Cough becomes stronger Oxygen in the blood increases 6. Residents with COPD have trouble with: (A) Breathing (B) Urination (C) Losing weight (D) Vision

Exam (cont’d.) 7. How should a resident with COPD be positioned? (A) Flat on his back (B) Sitting upright (C) Lying on his stomach (D) Lying on his side 8. What should a resident who has asthma avoid? (A) Inhalers (B) Talking (C) Fluids (D) Strong smells

Exam (cont’d.) 9. A person with ______ TB does not show symptoms and cannot infect others; a person with ______ TB shows symptoms of the disease and can spread it to others. (A) Latent, active (B) Active, latent (C) MDR-TB, active Latent, MDR-TB 10. Why is it important for a resident with TB to take all of the prescribed medication? (A) The medication is very expensive. (B) The healthcare facility loses Medicare funding if all of the medication is not taken. (C) Failure to finish the medication makes the person more likely to spread the disease to others. (D) Failure to take all of the medication prescribed can weaken the person’s musculoskeletal system.

Exam (cont’d.) 11. Which of the following guidelines is true of working around oxygen equipment? (A) Nursing assistants should not allow open flames around oxygen. (B) Nursing assistants should adjust oxygen levels when they are too high or too low. (C) Nursing assistants should replace oxygen tubing if it becomes clogged. (D) Nursing assistants should prescribe a new oxygen delivery device if the current one is causing skin problems. 12. The best time to collect a sputum specimen is: (A) Early in the morning (B) After the resident has eaten a meal (C) Right before bedtime (D) Right before lunch

Exam (cont’d.) 13. What is a possible benefit of using an incentive spirometer? (A) Increasing heart strength (B) Strengthening back muscles (C) Opening nasal passages (D) Helping clear the lungs