1. Respiratory Care Copyright © The McGraw-Hill Companies, Inc. Anatomy

2. Copyright © The McGraw-Hill Companies, Inc. 2 The Respiratory System The primary function is to provide oxygen and remove carbon dioxide. – accomplished with the help of the circulatory system.

3. Copyright © The McGraw-Hill Companies, Inc. Chapter 18 3 Other functions include: – nonspecific defenses against invading pathogens – sounds permitting speech, singing, and nonverbal communication – olfactory sensations to the CNS for sense of smell

4. Copyright © The McGraw-Hill Companies, Inc. Chapter 18 4 Anatomy of the Respiratory System The respiratory system consists of: – The lungs. – The respiratory tract.

5. Copyright © The McGraw-Hill Companies, Inc. 5 The Respiratory Tract - Nose Nares (Nostrils) Nasal cavities Each cavity is separated by the nasal septum. Cilia H airs in nose. Sinuses Warms and moistens air Turbinate (3) Slows air movement.

6. Copyright © The McGraw-Hill Companies, Inc. 6 The Throat (Pharynx) Passageway for both food and air. Divided into 3 sections: – Nasopharynx. – Oropharynx. – Laryngopharynx.

7. Copyright © The McGraw-Hill Companies, Inc. 7 The Larynx (Voice Box) Contains the vocal cords. Supported by various structures, including 2 disks. Joined at an angle to form the thyroid cartilage, or Adam’s apple.

8. Copyright © The McGraw-Hill Companies, Inc. 8 The Trachea (Windpipe) Tube that connects the larynx to the right and left bronchi. Contains hyaline cartridge keeping the tube open.

9. Copyright © The McGraw-Hill Companies, Inc. 9 Bronchi passageways through which air enters the lungs. 1. Trachea 2. Carina 3. Right main bronchus 4. Right superior lobe bronchus 5. Right middle lobe bronchus 6. Right lower lobe bronchus 7. Left main bronchus

10. Copyright © The McGraw-Hill Companies, Inc. 10 Alveolar Organization The adult lung contains 5,000,000 Alveoli Gas exchange takes place here. Covered in a fatty substance called surfactant.

11. Copyright © The McGraw-Hill Companies, Inc. 11 The Lung Exterior The right lung has three lobes and the left has two. The left lobe is smaller because of the hearts position. Surrounded by the pleura a thin membrane/sac.

12. Copyright © The McGraw-Hill Companies, Inc. 12 Muscles for Breathing The volume of the thoracic cavity is enlarged during inspiration and the volume decreases during expiration.

13. Respiratory Care Copyright © The McGraw-Hill Companies, Inc. Physiology

14. Copyright © The McGraw-Hill Companies, Inc. 14 Modes of Breathing Quiet Breathing – Inhalation requires muscles Contraction of diaphragm (75%), external intercostals (25%) – Exhalation passive Lungs recoil due to elasticity Forced Breathing – Inhalation Accessory muscles include sternocleidomastoid and scalenes (muscles of the neck) – Exhalation Internal intercostals, abdominal muscles

15. Copyright © The McGraw-Hill Companies, Inc. 15 Breathing Patterns Bradypnea – slow breathing. Tachypnea – fast breathing. Hypopnea – shallow breathing. Hyperpnea – abnormally deep breathing. Dyspnea – difficult breathing. Apnea – inability to breathe. Orthopnea – difficulty in breathing. Cheyne-Stokes respiration – irregular breathing pattern.

16. Copyright © The McGraw-Hill Companies, Inc. 16 Diseases and Disorders – Bronchitis. – Asthma. – Emphysema. – Chronic obstructive pulmonary disease (COPD). – Hemoptysis. – Lung cancer. – Upper respiratory infection (URI). – Epistaxis, or nosebleed. – Pneumonia. – Tuberculosis. – Anthracosis, or black lung. – Pleurisy. – Influenza.

17. Copyright © The McGraw-Hill Companies, Inc. 17 Respiratory Diagnostic Procedures Help assess the level of lung function. Determine whether specific types of illness or conditions are present.

18. Copyright © The McGraw-Hill Companies, Inc. 18 Pulmonary Function Test - Spirometer Measures of air flow and volume to assess lung health or progression of disease process Measured by FEV1 (Forced Expiratory Volume in One Second) Noninvasive, painless Should have first test at 25yo. Smokers, chemical exposures, and those with lung disease every 3 – 5 years (NHLBI) With COPD – FEV1 less than 70% considered mild and less than 35% severe.

19. Copyright © The McGraw-Hill Companies, Inc. 19 Other Pulmonary Function Test Lung Volume – measures the amount of air in the lungs without forcibly blowing out – Used with lung diseases such as emphysema, chronic bronchitis (cause lungs to contain too much air), fibrosis of the lungs and asbestosis (make the lungs scarred and smaller so that they contain too little air. – Normal values are based upon your age, height, ethnicity, and sex Diffusion capacity (also called the DLCO) – allows the doctor to estimate how well the lungs move oxygen from the air into the bloodstream. – Normal value ranges may vary slightly among different laboratories

20. Copyright © The McGraw-Hill Companies, Inc. Chapter 18 20 Arterial blood gas determination Arterial blood gas tests measure the levels of oxygen and carbon dioxide in the arterial blood and determine the acidity (pH) of the blood. Blood is taken from an artery (Invasive) Normal Arterial Blood Gas Values – pH 7.35-7.45 – PaCO2 35-45 mmHg Pa (peripheral arterial) – PaO2 80-95 mmHg – HCO3 22-26 mEq/LO2 HCO3 – Bicarbonate – Saturation 95-99% – BE +/- 1 BE – Base Excess

21. Copyright © The McGraw-Hill Companies, Inc. 21 Arterial blood gas (cont.) Acidosis Poisons – wood alcohol (methanol) – Antifreeze – large doses of aspirin Kidney Disease Decreased respirations – Lung disease – Muscle impairment – Nerve impairment – Medication Sedation Alkalosis Medications – Corticoidsteriods – Diuretics Vomiting Diarrhea Cushing Syndrome Hyperventilation

22. Copyright © The McGraw-Hill Companies, Inc. 22 Oximeters Oxygenation of the blood can be monitored using a sensor placed on a finger or an earlobe Noninvasive

23. Copyright © The McGraw-Hill Companies, Inc. Chapter 18 23 Exercise tolerance evaluates the ability of the heart and lungs to provide oxygen and remove carbon dioxide from the bloodstream before, during, and after exercise. typically a workout on a stationary bicycle or a treadmill A pulse oximeter is placed on the earlobe or fingertip to monitor blood oxygen levels. If arterial blood gas samples are to be taken during the exercise, a catheter will be placed in an artery in your arm.

24. Copyright © The McGraw-Hill Companies, Inc. 24 Radiography Used to diagnosis cancerous masses or infiltrates. Includes: x-ray MRI CT PET Scan Ultrasound

25. Copyright © The McGraw-Hill Companies, Inc. 25 Bronchoscopy direct visual examination of the voice box (larynx) and airways through a flexible viewing tube (a bronchoscope). bronchoscope has a light at the end Uses: – investigate the source of bleeding in the lungs – specimens can be taken from any areas that look cancerous (biopsy) – Assessment of burns and smoke injury – place drugs in specific areas of the lung – as a guide over which a tube can be inserted to assist breathing

26. Copyright © The McGraw-Hill Companies, Inc. 26 Lab Test - Culture, sensitivity Culture – is when the organism causing an infection is identified by the lab, for identification purposes. Sensitivity – List what medications will kill the organism.

27. Respiratory Care Copyright © The McGraw-Hill Companies, Inc. Therapy

28. Copyright © The McGraw-Hill Companies, Inc. 28 Respiratory Care Procedures Used for the care or prevention of disease process

29. Copyright © The McGraw-Hill Companies, Inc. 29 Oxygen Therapy Used to increase O2 levels of patients. Reasons for Oxygen Therapy – Low levels of oxygen in the blood (hypoxemia). – Work demands of breathing. – Work of the heart. Oxygen is considered a drug and must be ordered by a physician.

30. Copyright © The McGraw-Hill Companies, Inc. 30 Oxygen Delivery Devices Nasal Cannula Simple Mask NRB Non-rebreather Mask

31. Copyright © The McGraw-Hill Companies, Inc. 31 Mechanical Ventilation Reasons to use: – To keep moving enough oxygen into the bloodstream and removing enough carbon dioxide from the lungs when other respiratory procedures fail. – When the client has gone into respiratory arrest (stopped breathing).

32. Copyright © The McGraw-Hill Companies, Inc. 32 Monitoring Oxygen Therapy Improvements expected with oxygen therapy: Client’s thinking ability should improve. Shortness of breath (SOB) should decrease. Vital signs should become closer to normal. PaO 2 should rise to an acceptable level. Pulse oximetry values should improve.

33. Copyright © The McGraw-Hill Companies, Inc. 33 Hazards of Oxygen Therapy Oxygen toxicity – too much oxygen for too long a time. Retinopathy of prematurity (ROP) – high oxygen levels in infants. Atelectasis – lung collapse.

34. Copyright © The McGraw-Hill Companies, Inc. 34 Oxygen Safety Flammable! O2 is extremely flammable. – Signs must be posted where canisters are kept. – Floor staff must be aware of cut off valve. – Must educate patients about smoking.

35. Copyright © The McGraw-Hill Companies, Inc. 35 Medicated Aerosol Therapy Causes airways to open up, or bronchodilate. Has minimal side effects, since the medication travels directly into the lungs.

36. Copyright © The McGraw-Hill Companies, Inc. Chapter 18 36 Types of Drugs Given by Aerosol Nasal decongestants – Contain vasoconstrictors, drugs that decrease the blood flow to nose vessels causing nasal passages to open. Bronchodilators – Drugs that increase the diameter of lung airways. Antiasthmatics – Used to prevent or decrease the number of asthma attacks. Corticosteroids – Drugs that may be inhaled and are used for anti-inflammatory maintenance. Mucolytics – Drugs used to break down secretions within the lungs. Antimicrobials – Used to treat a number of bacterial and fungal pulmonary infections.

37. Copyright © The McGraw-Hill Companies, Inc. 37 Aerosol Drug Delivery System The Metered Dose Inhaler (MDI) – The most commonly used aerosol drug delivery system. – A small portable pressurized device that delivers medication to the lungs. Add-on devices include: spacer, holding chamber, and extension device.

38. Copyright © The McGraw-Hill Companies, Inc. 38 Hyperinflation Therapy Also known as lung expansion therapy. Partial or full lung collapse is known as atelectasis. Used when the client is unable to take an occasional deep breath. Incentive Spirometer Most Common

39. Copyright © The McGraw-Hill Companies, Inc. Chapter 18 39 STOP

40. Respiratory Care Copyright © The McGraw-Hill Companies, Inc. Careers

41. Copyright © The McGraw-Hill Companies, Inc. 41 The Certified Respiratory Therapist and the Registered Respiratory Therapist Both require a 2- or 4-year educational program approved by the Committee on Accreditation for Respiratory Care (CoARC). Both must pass board examinations given by the National Board for Respiratory Care (NBRC). Both work to help clients breathe more easily.

42. Copyright © The McGraw-Hill Companies, Inc. 42 The Pulmonary Function Technologist Respiratory therapists often qualify for positions as pulmonary function technologists. They assess the need for therapeutic respiratory procedures. To monitor the outcome of the therapy to determine whether the treatment objectives were met.

43. Copyright © The McGraw-Hill Companies, Inc. 43 Pulmonologist Education in Internal Medicine Graduation from an approved medical school Completion of an ACGME (American Council for Graduate Medical Education) accredited internal medicine residency program, which takes a minimum of 3 years A minimum of 2 years of meaningful patient contact and responsibility Of the 2 years, 20 months must be spent in in-patient services, ambulatory settings, and in the services of dermatology or neurology 4 months may be taken outside the above areas, subject to program director approval The level of responsibility for patients must increase with each year of training Education in Pulmonary Medicine A minimum of 2 years of full-time graduate training in pulmonary disease, including instruction in the basic sciences with emphasis on molecular biology, pulmonary physiology, and pulmonary immunology 12 months of the 2 years must be spent in clinical training in diagnosis and management