Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 18

1. Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 18 NURSING CARE OF THE CLIENT: RESPIRATORY SYSTEM

2. Respiratory System • Its primary function is delivery of oxygen to the lungs and removal of carbon dioxide from the lungs.

3. Thoracic Cavity • The inside of the chest cage is called the thoracic cavity. • Contained within the thoracic cavity are the lungs, cone-shaped, porous organs encased in the pleura, a thin, transparent double-layered serous membrane lining the thoracic cavity.

4. The Physiology of the Lungs • The right lung is larger than the left and is divided into three sections or lobes: upper, middle, and lower. • The left lung is divided into two lobes: upper and lower. • The upper portion of the lungs is the apex; the lower portion is the base.

5. Conducting Airways • The conducting airways are tubelike structures that provide a passageway for air as it travels to the lungs. • The conducting airways include the nasal passages, mouth, pharynx, larynx, trachea, bronchi, and bronchioles.

6. Pharynx • The conducting airways that connect nasal passages and mouth to the lower parts of the respiratory tract.

7. Larynx • The passageway for air entering and leaving the trachea and containing the vocal cords.

8. Trachea • Commonly known as the windpipe, this tube is composed of connective tissue mucosa and smooth muscle supported by C-shaped rings of cartilage.

9. Bronchi • Two tubes, the right and left primary bronchi, that each pass into its respective lung.

10. Bronchioles • Within the lungs, the bronchi branch off into increasingly smaller diameter tubes until they become the terminal bronchioles.

11. Respiration • A process of gas exchange necessary to supply cells with oxygen for carrying on metabolism, and to remove carbon dioxide produced as a waste by-product. • Two types of respiration: external and internal.

12. External Respiration • The exchange of gases between the inhaled air and the blood in the pulmonary capillaries.

13. Internal Respiration • The exchange of gases at the cellular level between tissue cells and blood in systemic capillaries.

14. Assessment

15. Fine crackles (dry, high-pitched popping…COPD, CHF, pneumonia) Coarse crackles (moist, low-pitched gurgling…pneumonia, edema, bronchitis) Sonorous wheezes (low-pitched snoring…asthma, bronchitis, tumor) Sibilant wheezes (high-pitched, musical … asthma, bronchitis, emphysema, tumor) Pleural friction rub (creaking, grating… pleurisy, tuberculosis, abscess, pneumonia) Stridor (crowing…croup, foreign body obstruction, large airway tumor). Adventitious Breath Sounds Abnormal sounds and some conditions associated with them:

16. Common Diagnostic Tests for Respiratory Disorders • Laboratory Tests (Hemoglobin; Arterial blood gases; Pulmonary Function Tests; Sputum Analysis). • Radiologic Studies (Chest X-ray; Ventilation-perfusion scan; CAT scan; Pulmonary angiography). • Other (Pulse oximetry; Bronchoscopy; Thoracentesis; MRI).

17. Rhinitis (coryza, common cold) Allergic rhinitis Sinusitis Pharyngitis Tonsillitis Laryngitis Upper Respiratory Tract Infections/Inflammatory Disorders

18. Pneumonia • A lung infection wherein infectious secretions accumulate in the air passages and interfere with gas exchange. • Clients with chronic pulmonary disorders or problems of immobility are at increased risk of developing pneumonia.

19. Tuberculosis • Pulmonary TB is an infection of the lung tissue caused by the Mycobacterium tuberculosis. • Treatment of TB requires the long-term administration of pharmacological agents.

20. Pleurisy/Pleural Effusion • Pleurisy is a painful condition that arises from inflammation of the pleura, or sac that encases the lung. • Pleural effusion occurs when the inflamed pleura secretes increased amounts of pleural fluid into the pleural cavity.

21. Atelectasis • A common respiratory tract disorder associated with immobility and the administration of anesthetic agents. • Clients at risk are encouraged to cough and breathe deeply to aid in preventing atelectasis.

22. Pulmonary Embolism • Obstruction of a pulmonary artery by a bloodborne substance. • Deep vein thrombosis is a common cause of pulmonary embolism.

23. Pulmonary Edema • A life-threatening condition characterized by a rapid shift of fluid from plasma into the pulmonary interstitial tissue and the aveoli, resulting in markedly impaired gas exchange. • Can result from severe left ventrical failure, rapid administration of I.v. fluids, inhalation of noxious gases, or opiate or barbiturate overdose.

24. Adult Respiratory Distress Syndrome • A life-threatening condition characterized by severe dyspnea, hypoxemia, and diffuse pulmonary edema. • Usually follows major assault on multiple body systems or severe lung trauma.

25. Acute Respiratory Failure • Conditions wherein there is a failure of the respiratory system as a whole. • This condition occurs as a result of the client’s literally becoming too tired to continue the “work” of breathing.

26. Chronic Obstructive Pulmonary Disease • A collective term used to refer to chronic lung disorders wherein air flow into or out of the lungs is limited. • Disorders associated with COPD are asthma, chronic bronchitis, emphysema, and bronchiectasis.

27. Asthma • A condition characterized by intermittent airway obstruction in response to a variety of stimuli.

28. Bronchitis • An inflammation of the bronchial tree accompanied by hypersecretion of mucus.

29. Emphysema • A complex and destructive lung disease wherein air accumulates in the tissues of the lungs.

30. Bronchiectasis • A chronic dilation of the bronchi. • Main causes of this disorder are pulmonary TB infection, chronic upper respiratory tract infections, and complications of other respiratory disorders of childhood, particularly cystic fibrosis.

31. Pneumothorax/Hemothorax • Traumatic disorders of the respiratory tract wherein the underlying lung tissue is compressed and eventually collapses.

32. Neoplasms of the Respiratory Tract • Benign neoplasms. • Lung cancer. • Cancer of the larynx.

33. Epistaxis • A hemorrhage of the nares or nostrils. • May be unilateral (most common) or bilateral. • Blood loss can be minimal to severe.

34. Smoking • Cigarette smoking is indicated as a major causative factor in the development of respiratory disorders, such as lung cancer, cancer of the larynx, emphysema, and chronic bronchitis.