1. Stacie Pigues, MSN, RN NWCC NUR 1117 Foundations of Nursing
RESPIRATORY FUNCTION
Stacie Pigues, MSN, RN
NWCC NUR 1117
Foundations of Nursing

2. Structures of the Respiratory System

3. Structures of the Respiratory System
Upper Airway:
Mouth
Nose
Pharynx

4. Structures of the Respiratory System
Lower Airway:
Trachea
Bronchi
Bronchioles
Alveoli
Lungs

5. Normal Respiratory Function
Ventilation
Gas diffusion
Gas transport
Control of ventilation
Defenses of the respiratory system
Normal breathing pattern

6. Normal Respiratory Function
Ventilation, or breathing, is the process of moving air into and out of the lungs so that gas exchange can take place.
Gas Diffusion refers to the movement of oxygen between the alveoli and the blood.

7. Gas Diffusion
p. 736

8. Normal Respiratory Function
Gas Transport occurs when oxygen crosses the alveolar-capillary membrane into the blood where blood transports it to the tissues.
Control of Ventilation, this process is controlled through neural pathways.

9. Normal Respiratory Function
Normal Breathing Pattern depends on age, normal breathing is smooth, even, and regular.

10. Defenses of the Respiratory System
Upper Airway functions to:
Warm and humidify inspired air while maintaining the fluid character of the lower airway
Clean inspired air
Protect lower airway from infection and injury due to aspiration

11. Defenses of the Respiratory System
Lower Airway functions to:
Further clean inspired air
“Mucus Blanket” –protects
“Mucociliary Elevator”- helps remove bacteria

12. Protective Reflexes
Coughing
Sneezing

13. Factors that affect breathing
Age
Activity level
Life style

14. Normal Breathing Pattern
Normal Parameters of Respiratory Rates
effortless, smooth, even and regular
average adult moves ½ L of air per breath

15. Normal Breathing Pattern
Newborns and infants
Rapid breathers
Breathe times per minute
Surfactant replacement therapy

16. Normal Breathing Pattern
Toddler and Preschooler
Breathing even and smoother
By age three, breaths per min.
Risk for aspiration

17. Normal Breathing Pattern
Child and Adolescent
Breathing steadily slows
Breathe times per minute
Adolescence smoking and tobacco use

18. Normal Breathing Pattern
Adults
Breathe times per minute
Structural and functional changes:
Thoracic wall is more rigid
Lungs do not stretch as well
Gas exchange is affected
Protective functions are impaired
Cough is less effective

19. Normal Breathing Pattern
Older Adults (60 years and older)
Breathe times per minute
Factors that affect older adults respiratory
changes contribute to:
Activity intolerance
Increased

20. History Do you have a cough? Common causes: Histamines
Borderline heart failure
Nervous habit
“Common” cough-only concerned if it changes

21. history Are you coughing up sputum?
How much? Teaspoon, tablespoon or ½ cup
What is the color of the sputum? Clear, yellow, bloody (hemoptysis)
Consistency? Thick or thin

22. history Are you experiencing shortness of breath (dyspnea)?
Possible causes:
Lung disease
CHF
Anxiety

23. history Are you having any chest pain? Possible causes: Infection
Inflammation
Pneumonia
Bronchitis

24. history What is your normal breathing pattern?
When and how often do the breathing problems occur?
Identify any exposures putting the patient at risk.

25. Factors affecting respiratory function
Environment
Lifestyle and habits
Body position
Increased work of breathing

26. environment Weather Geographical location Air pollution
Pollens and allergens

27. Lifestyle and habits
Smoking: pack-years
Drugs and alcohol
Nutrition

28. Increased work of breathing
Restricted lung movement
Atelectasis
May be chronic or acute due to:
Smoke inhalation
Pulmonary fibrosis
Resp. distress syndrome
Pneumonia

29. Increased work of breathing
Restricted lung movement
Obesity
Chest or abdominal binders
Abdominal distension caused by gas/fluid
Meds/anesthesia
Rib injuries
Musculoskeletal chest deformities
Severe weakness
Neuromuscular disorders

30. Increased work of breathing
Airway Obstruction
Any process that reduces the diameter of the airways causing increased airway resistance which requires more effort to breath because air is moving through a narrower passage

31. Increased work of breathing
Airway Obstruction
Possible causes of airway obstruction are:
Foreign bodies aspiration
Excessive mucus
Chronic bronchitis
Cystic Fibrosis
Asthma
Croup
Epiglottis
Abnormal growths in the airway

32. Assessment - Inspection
Body position
Assess how your patient is sitting or lying
Upright posture (high Fowler’s) allows for better lung expansion
Reposition patient

33. Assessment - Inspection
What is the rate?
How hard are they working to breathe?
Describe breathing pattern.
Hypoxemia-low oxygen levels in the blood
Hypercapnia-abnormally high carbon dioxide in the blood
Hyperventilation- excessive elimination of carbon dioxide causing dizziness and resp. alkalosis

34. Assessment - Inspection
Assessing color:
Cyanosis- bluish skin discoloration caused by a desaturation of oxygen on the hemoglobin
Central cyanosis-mucus membranes blue around mouth and eyes - indicates SEVERE oxygenation problems

35. Assessment - Inspection
Clubbing- round and enlarged fingers and
toes
Chest deformities- barrel chest
Wounds
Masses

36. Assessment - Inspection
Other signs of respiratory distress:
Gasping
Panting
Wheezing
Nasal flaring
Retractions

37. Assessment - Pulse Oximetry

38. Assessment - Pulse Oximetry
Pulse Oximetry - O2 Saturation
Any changes in a patient’s level of consciousness, dizziness, restlessness, agitation, etc.—check pulse oximeter-may be due to hypoxia! If oxygen level normal—check glucose level.
Normal Oxygen sat % with O2 intervention generally required if < 93%
Patients with sleep apnea may need to bring their machines to the hospital. These patients are at high risk for hypoxia and respiratory arrest especially post-op.
Higher altitudes= less oxygen available for gas diffusion = SOB & activity intolerance (p. 738)

39. Assessment- Auscultation
Anterior Posterior

40. Auscultation-Crackles

41. Auscultation-wheezes

42. Diagnostic tests and procedures
Sputum culture- Culture & Sensitivity
Thick and sticky
Yellow or green
Putrid or musty odor
Blood streaked
Frankly red, bloody (hemoptysis)

43. Diagnostic tests and procedures
Arterial blood gas (ABG) monitoring
Arterial blood levels of oxygen, carbon dioxide and PH are the best indicator of gas exchange.
Hyperventilation
Hypoventilation

44. Diagnostic tests and procedures
Chest x-ray
Pulmonary function tests (PFT)
Bronchoscopy
Lung scan/CT/MRI

45. Diagnostic tests and procedures
Throat culture
Sputum specimens
Cytology
Thoracentesis
Skin tests
PPD given to test TB exposure
Allergy tests identify airway hypersensitivity in asthmatics

46. Nursing diagnoses
Ineffective Breathing Pattern-monitor the patient and encourage slow, deep breathing, turning and coughing
Ineffective Airway Clearance-ensure adequate hydration, instruct on how to cough effectively
Impaired Gas Exchange- monitor cognitive changes, ABG, O2 Saturation, S & S of respiratory failure.

47. Outcomes identification and planning
Knowledge regarding prevention of respiratory dysfunction
Adequate oxygenation
Mobilize pulmonary secretions
Cope with changes in self-concept and lifestyle

48. implementation Health promotion Preventing respiratory infections
Encouraging smoking cessation
Reducing allergens
Monitoring peak flow

49. implementation Providing adequate hydration Positioning and ambulation
Health promotion
Providing adequate hydration
Positioning and ambulation
Deep breathing and coughing
Assisting with incentive spirometry

50. Nursing interventions
Coughing
Deep cough
Stacked cough
Low-flow (huff) cough
Quad cough

51. Nursing interventions
Pursed-lip breathing
Chest physiotherapy
Percussion
Vibration
Postural drainage

52. Nursing interventions
Aerosol Therapy
Aerosol medications-a suspension of liquid droplets in air or oxygen.
Aerosols can be uses for several reasons:
Adds moisture to oxygen
Hydrates mucus to prevent mucus plugs
Used to administer drugs, such as:
Bronchodilator
Corticosteroids
Antibiotics

53. Metered-dose inhalers (MDI’s)

54. Handheld nebulizers

55. Oxygen therapy administration
Oxygen therapy can be used to accomplish three fundamental goals in patient care:
Improves tissue oxygenation allowing for better healing to occur- when in the healing process, the body’s metabolic demand for oxygen is increased.
Helps decrease work of breathing in patients with shortness of breath or dyspnea
Decreases the work of the heart in patients with cardiac diseases

56. Oxygen therapy administration
Oxygen flow is ordered in liters per minute. General rule in the use of O2 therapy is to use the lowest amount possible to achieve an acceptable blood oxygen level.
You will find that most patients’ will have an order for Oxygen if the SaO2 is below 93%. Oxygen is used to help stabilize the patient and then they will be slowly weaned off O2 therapy. You will monitor for color, alertness, heart rate, O2 Sat, and breathing effort.
*ENSURE THAT THE APPROPRIATE AMOUNT OF OXYGEN PRESCRIBED IS BEING DELIVERED!

57. Selection of oxygen systems
Various devices are available for providing oxygen at different flow rates and concentrations
Device used depends on patients oxygenation status
Best oxygen device is provided with consideration of comfort for the patient

58. Oxygen Therapy Nasal Cannula By Nasal Cannula(BNC)
Flow Rate- 1L to 6L per minute
Oxygen concentration range 22%-44%
Oxygen concentration varies with breathing patterns

59. Oxygen Therapy Venturi mask Flow rate- 3L to 8L per minute
Oxygen concentration range- 24% to 50%

60. Oxygen Therapy Simple mask Flow rate- 6 to 10L per minute
Oxygen conc. range 40%-60%
Oxygen conc. varies with breathing patterns

61. Oxygen Therapy Reservoir (Non-rebreather) mask
Flow rate- 10 to 15L per minute
Oxygen concentration range 90%+
Used for critically ill patients

62. Oxygen safety Oxygen is a drug; an order is required
Monitor flow rate to ensure accurate amount is being administered
Normal range for oxygen saturation is %; O2 for <93%
Teach the importance of wearing oxygen device
Smoking is prohibited

63. Oxygen safety
Review the Safety Alerts in Craven regarding COPD & oxygen
The normal drive to breath is high carbon dioxide level (hypercapnia); however, the patient with COPD has become accustomed to this, therefore their drive to breath is hypoxemia (low oxygen level).
Patients with COPD must be maintained with low concentrations of oxygen.
Oxygen therapy requires physician order-may see oxygen initiated, changed and discontinued without a written order on the chart if respiratory therapy utilizes oxygen protocol. This protocol has medical staff approval.

64. Nursing interventions
Dyspnea management
Hyperventilation management
Assisted ventilation
BiPAP (Bilevel positive airway pressure)
CPAP (Continuous positive airway pressure)

65. Nursing interventions
Artificial Airways
Oral or Nasal Pharyngeal Airways
Endotracheal Tubes
Tracheostomy

66. Pharyngeal Airways
Oral Airways Nasal Trumpets

67. Endotracheal tube

68. Tracheostomy
Uncuffed
Cuffed

69. Suctioning
Suction catheter kit Yankauer

70. Chest tubes Pneumothorax- air in the pleural space
Hemothorax-blood in the pleural space

71. ventilators

72. Discharge needs Infection control Medications Home oxygen systems
Energy conservation
Fostering self-esteem

73. references
Craven, R, Hirnle, C. & Jensen, S.(2013). Fundamentals of Nursing (7th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Chapter 25.