OXYGENATION Normal respiratory functioning depends on:  The ability of the airway system  A properly functioning alveolar system  A properly functioning cardio- vascular system  External respiration  Internal respiration

ANATOMY  LOBES/SEGMENTS  PLEURAE  UPPER RESPIRAATORY SYSTEM  FUNCTIONS:  LOWER RESPIRATORY SYSTEM  FUNCTIONS  DIFFERENCES IN PEDS  SURFACTANT  ALVEOLI  MUSCLES OF RESPIRATION

PHYSIOLOGY OF RESPIRATION CON’T CONTROL OF RESPIRATION:  VENTILATION  INHALATION  EXHALATION  DIFFUSION  TRANSPORTATION CELLULAR DIFFUSION

GENERAL PRINCIPLES OF OXYGENATION ALL LIVING CELLS REQUIRE OXYGEN, WHICH THE BODY CANNOT STORE AIR PASSAGES MUST REMAIN PATENT FOR RESPIRATION TO OCCUR MUSCLE MOVEMENTS PROVIDE THE PHYSICAL FORCE ESSENTIAL FOR RESPIRATION THE PRESSURE CHANGES RESULTING FROM EXPANSION AND CONTRACTION OF THE THORACIC CAVITY PRODUCE PULMONARY EXCHANGES

GENERAL PRINCIPLES CON’T ADEQUATE FLUID INTAKE IS ESSENTIAL TO RESPIRATORY FUNCTIONING VENTILATION DEPENDS ON THE EXTENT OF PERFUSION IN THE AREA OXHGEN & CARBON DIOXIDE MUST MOVE THROUGH THE ALVEOLI & BE CARRIED TO & FROM BODY CELLS BY THE BLOOD THERE MUST BE AN EXCHANGE OF 02 &C02 BETWEEN THE BLOOD AND BODY CELLS. CONDITIONS THAT AFFECT THE PASSAGE OF OXYGEN AND CARBON DIOXIDE THROUGH THE CELL WALL ADVERSELY AFFECT INTERNAL RESPIRATION

FACTORS INFLUENCING RESPIRATORY FUNCTIONING  Levels of health  Development/AGE  Opioids (narcotic analgesics)  Lifestyle  Environment  Psychological health

THE NURSE AS ROLE MODEL Will do the following:  Maintain adequate fluid intake and proper nutrition  Use deep-breathing exercises  Evaluate his or her own use of nicotine  Incorporate a plan to reduce smoking and then stop smoking on a specific target date  Reduce activity patterns i.e., (rest at home)  Create a pollution-reduced environment by avoiding use of strong perfumes, aftershaves, or other scents  Arrange to have a tuberculin test (ppd) done annually  Schedule three or four periods of exercise per week

ASSESSING RESPIRATORY FUNCTIONING NURSING HISTORY  Focused assessment guide (pg. 1229) PHYSICAL ASSESSMENT  Inspection  Palpation  Percussion  Auscultation

COMMON METHODS TO ASSESS RESPIRATORY FUNCTIONING Diagnostic procedures: Pulmonary Function studies (test) Spirometer Table 44-2 pg.131

NURSING DIAGNOSES Group Activity: Develop nursing diagnoses that correctly identify problems that may be treated by independent nursing interventions

PLANNING Expected Outcomes

IMPLEMENTING:  Establishing a trusting nurse-patient relationship  Promoting proper breathing  Promoting and controlling coughing  Promoting comfort  Using nebulizers  Providing supplemental oxygen  Using artificial airways  Assisting ventilation  Clearing an obstructed airway  Administering CPR  Hyperbaric oxygen therapy

EVALUATING

NURSING PROCESS IN CLINICAL PRACTICE  Impaired gas exchange  Ineffective breathing pattern  Ineffective airway clearance

PATIENT CARE STUDY

MEDICATIONS USED TO IMPROVE RESPIRATORY FUNCTIONING  TABLE 44-3 PG.1244

OXYGEN DELIVERY SYSTEMS TABLE 44-4 PG. 1248

USING ARTIFICIAL AIRWAYS OROPHARYNGEAL & NASOPHARYNGEAL AIRWAYS ENDOTRACHEAL TUBE TRACHEOSTOMY MECHANICAL VENTILATION CLEARING AN OBSTRUCTED AIRWAY ADMINISTERING CPR