Respiratory System Function, Assessment, and Therapeutic Measures Chapter 29 Respiratory System Function, Assessment, and Therapeutic Measures

Review of A&P

Acid-Base Balance Because of its role in the regulating the amount of carbon dioxide in body fluids the respiratory system is important in the acid – base balance, measured by blood PH Respiratory Acidosis- Any decrease in the rate or efficiency of respiration permits excess carbon dioxide to accumulate in the blood, The resulting accumulation of excess hydrogen ions lowers PH causing Hypoventilation Respiratory Alkalosis- Occurs when the rate of respiration increases, eliminating exhaled carbon dioxide very rapidly Less carbon dioxide in the blood means that fewer hydrogen ions are formed and the PH rises causing Hyperventilation

Mechanism of Breathing Inspiration: air entering the lungs Active contraction of the muscles and diaphragm and can be noted by an enlargement of the chest cavity Expiration: air leaving the lungs Muscles relax and the chest returns to normal size Normal breathing: 500 mL of air inhaled and exhaled Apnea: temporary interruption in the normal breathing pattern in which no air movement occurs Dyspnea: difficulty breathing, or shortness of breath Orthopnea: difficulty with breathing in a lying position

Physiology of the Respiratory System Respiratory center Located in medulla; controls breathing Stimulated by changing levels of carbon dioxide and oxygen in arterial blood Chemoreceptors in the aorta and carotid artery monitor the pH and amount of carbon dioxide and oxygen in the bloodstream Changes in the pH, increased levels of carbon dioxide, or decreased levels of oxygen cause signals to be sent to the phrenic nerves, which in turn send signals to the respiratory muscles to carry out the major work of breathing

Effects of Aging

History Upper Respiratory Symptoms Lower Respiratory Symptoms Exposures/Smoking Current Treatments Family History

WHAT’S UP? Where Is It?- Location How Does It Feel?-tight, gasping, painful Aggravating and Alleviating Factors Timing- when did you first experience, does it occur at certain times/year Severity- Scale of 0-10 Useful Other Data- any other symptoms Patient’s Perception- what do they think is causing the problem

Inspection Symmetry Dyspnea Use of Accessory Muscles Color

Inspection (cont’d) Respiratory Rate and Rhythm Chest Shape Page 598

Palpation Sinuses Respiratory Excursion Crepitus- rice Krispies due to pneumothorax or leaking chest tube

Percussion Done by the experienced nurse. Involves tapping on the anterior and posterior chest in each intercostal space, and comparing it from side to side. A normal chest sounds resonant and is the same on both the right and left sides except over the heart

Auscultation Normal Breath Sounds Adventitious Sounds- abnormal sounds Compare Bilaterally

Adventitious Breath Sounds Crackles—Coarse or Fine Wheezes Stridor Friction Rub Diminished Absent

Laboratory Tests CBC ABGs D-Dimer Cultures SpO2

Diagnostic Tests Chest X-Ray CT Scan VQ Scan PFTs Angiography Bronchoscopy

Therapeutic Measures Behavior Modification Counseling Setting Quit Date Nicotine Replacement Drug Therapy Hypnosis

Therapeutic Measures (cont’d) Deep Breathing and Coughing- Take 3 deep breaths hold the last one for a few seconds and cough forcefully- done every 1-2 hours Huff Coughing- Have patient exhale deeply to remove trapped air than take a deep breath and forcefully cough keeping the mouth open. Breathing Exercises- autogenic drainage used for patients with thick secretions (CF / COPD) pg 604

Therapeutic Measures (cont’d) Positioning Fowler’s Semi-Fowler’s Good Lung Down- Side lying position with the good lung in the dependent position, gravity causes greater blood flow thereby increasing oxygen saturation

Oxygen Therapy Nasal Cannula Need physicians order may deliver 1-6liters of oxygen. Patient must be able to breath through nose

Oxygen Masks

Oxygen Masks Used when a higher oxygen concentration is needed. Simple face mask- a rate of 5-10 L/M deliver oxygen concentration from 40-60% Partial rebreather mask- uses a reservoir to capture some exhaled gas for rebreathing vents on the side allow room air to mix with oxygen it can deliver oxygen concentration of 50% or greater

Oxygen Masks Nonrebreather Mask- Has one or both side vents closed to limit the mixing of the room air with the oxygen. The vents open to allow expiration but remain closed on inspiration. The reservoir bag has a valve to store oxygen fro inspiration but does not allow entry of exhaled air, it is used for deliver concentration of 70%-100% Venturi Mask (High – Flow devices) used for the patient who requires precise percentages of oxygen (COPD) Transtrachael catheter- a small tube that is surgically placed through the base of the neck directly into the trachea to deliver oxygen

Transtracheal Oxygen

NMT

MDI

Spacer

Incentive Spirometer

Chest Physiotherapy

Mucous Clearance Device

Chest Drainage Page 609 Indications- Drain fluid or air that has collected in the pleural space Chest Tube Insertion- Inserts through the chest wall into the pleural space Drainage System- Page 609-610 Nursing Care

Chest Drainage System

Tracheostomy Definition Indications Nursing Care Suctioning Cleaning Communication Teaching

Passy-Muir Speaking Valve

Intubation

Mechanical Ventilation Invasive Indications Nursing Care Trouble-Shooting Alarms Page 618

Noninvasive Positive Pressure Ventilation Indications Advantages Nursing Care