1. RESPIRATORY SYSTEM AND DISORDERS S. Buckley RN, MSN Copyright 2008

2. Respiratory System Purpose Anatomical Structures Potential Causes of Aspiration Surfactant: Decreases tendency of the Alveoli to collapse. Blood Supply: Pulmonary and Bronchial

3. CHEST Chest Cavity: Lined with a membrane called Parietal Pleura. Lungs: Lined with a membrane called the Visceral Pleura. Intra-pleural Space Fluid Empyema

4. PROCESS OF RESPIRATION Diaphragm: Major muscle of respiration Inspiration: Diaphragm contracts, Thoracic Cavity increases, Intra-thoracic pressure decreases and air enters. Expiration: Is passive Elastic Recoil Compliance

5. RESPIRATORY DEFENSE MECHANISMS Filtration of Air Mucociliary Clearance System: Mucus Blanket protects against bacteria and viruses. Cilia: Beat rhythmically and move mucus towards mouth. Cough Reflex Alveolar Macrophages: Ingest foreign debris.

6. LUNGS: STRUCTURAL EFFECTS OF AGING Decrease In Elastic Recoil Decrease In Chest Wall Compliance A-P Diameter Increases Decrease In Number Of Functional Alveoli Respiratory Defense Mechanisms Are Less Effective Less Forceful Cough Less Functional Cilia

7. DIAGNOSTIC STUDIES Chest X-Ray Ct Scan MRI Ventilation-Perfusion Scan: Used for Pulmonary Emboli. Bronchoscopy: Uses a Fiberoptic Tube to visualize, biopsy, remove cells, assess.

8. Thoracentesis: Insertion of a needle through the chest wall into the pleural space for biopsy and evaluation and treatment. Pulmonary Function Tests: Measure lung volumes and airflow and diagnose pulmonary disease.

9. ACUTE BRONCHITIS Acute Bronchitis: Inflammation of the lower respiratory tract usually due to infection. Occurs: In those with COPD or follows upper respiratory infection. Can be an acute bacterial infection or viral. Symptoms: Persistent Cough, Sputum clear or purulent, Fever, Headache, ^Pulse, ^Respiratory Rate, and Malaise.

10. ATELECTASIS Atelectasis: Collapse of lung tissue at any structural level. Caused by interference with lung expansion. Common Post-Op Detected by X-Ray

11. CLINICAL MANIFESTATIONS Dyspnea Tachypnea Tachycardia Cyanosis Decreased Breath Sounds Crackles Fever

12. PREVENTION IS KEY Frequent Position Changes Early Ambulation Deep Breathing Effective Coughing Incentive Spirometry Oxygen Postural Drainage Suctioning

13. SIGNS AND SYMPTOMS OF INADEQUATE OXYGENATION Respiratory TachypneaEarly Dyspnea on ExertionEarly Dyspnea at RestLate Use of Accessory MusclesLate Retraction of ICS on inspirationLate Breathless When SpeakingLate

14. Cardiovascular TachycardiaEarly Mild HypertensionEarly Arrhythmias (PVC’s)Early/Late HypotensionLate CyanosisLate Cool, Clammy SkinLate

15. Central Nervous System Unexplained ApprehensionEarly Unexplained RestlessnessEarly Unexplained IrritabilityEarly Unexplained Confusion/LethargyEarly/lat CombativenessLate ComaLate

16. Other DiaphoresisEarly or Late Decreased Urinary OutputEarly or Late Unexplained FatigueEarly or Late

17. PNEUMONIA Pneumonia: Inflammatory process in lung parenchyma, usually associated with a marked increase in interstitial and alveolar fluid. Causes: Virulence or quantity of infectious agents.

18. METHOD OF INFECTION Aspiration Inhalation Hematogenous

19. CLASSIFYING PNEUMONIA Community Acquired Pneumonia Organisms Hospital Acquired Pneumonia Organisms

20. PNEUMONIA CLINICAL MANIFESTATIONS Fever and Tachycardia Chills and Sweats Pleuritic Chest Pain Cough and Sputum and Sore Throat Dyspnea Headache Fatigue and Weakness Nausea and Vomiting

21. CHEST AUSCULTATION Bronchial Breath Sounds Crackling Tactile Fremitus Diagnosis: Sputum Culture, Serologic Testing, Skin Tests, Blood and Urine Cultures, ABG’s, Vital Signs, O2 Sats, Chest X-Ray.

22. COMPLICATIONS OF PNEUMONIA Pleurisy Pleural Effusion Atelectasis Consolidation Lung Abscess Empyema Pericarditis Arthritis Meningitis Endocarditis

23. TREATMENT Oxygen Antibiotics Fluids Rest Antipyretics Analgesics

24. PREVENTION Good Health Habits Protect Airway of those with altered consciousness. Oral Care Dysphagia Precautions Avoid over medicating Strict Medical Asepsis Vaccines

25. REMEMBER HHead of Bed 30 Degrees MMobility OOral Care: Brush To Clean 2 Times Daily Swab In Between