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

2. Review of A&P

3. 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

4. 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

5. 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

6. Effects of Aging

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

8. 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

9. Inspection
Symmetry
Dyspnea
Use of Accessory Muscles
Color

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

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

12. 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

13. Auscultation Normal Breath Sounds Adventitious Sounds- abnormal sounds
Compare Bilaterally

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

15. Laboratory Tests
CBC
ABGs
D-Dimer
Cultures
SpO2

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

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

18. 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

19. 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

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

21. Oxygen Masks

22. 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

23. 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

24. Transtracheal Oxygen

25. NMT

26. MDI

27. Spacer

28. Incentive Spirometer

29. Chest Physiotherapy

30. Mucous Clearance Device

31. 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
Nursing Care

32. Chest Drainage System

33. Tracheostomy Definition Indications Nursing Care Suctioning Cleaning
Communication
Teaching

34. Passy-Muir Speaking Valve

35. Intubation

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

37. Noninvasive Positive Pressure Ventilation
Indications
Advantages
Nursing Care