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Rachel S. Natividad, RN, MSN, NP N212 Medical Surgical Nursing 1. The Respiratory System. Structure and Function. Gas exchange. Changes associated to Aging. ↓ recoil and compliance  AP diameter ↓ functional alveoli ↓ in Pa02 Respiratory defense mechanisms less effective

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Rachel s natividad rn msn np n212 medical surgical nursing 1

Rachel S. Natividad, RN, MSN, NPN212 Medical Surgical Nursing 1

The Respiratory System

Changes associated to aging
Changes associated to Aging

  • ↓ recoil and compliance

  •  AP diameter

  • ↓ functional alveoli

  • ↓ in Pa02

  • Respiratory defense mechanisms less effective

  • Altered respiratory controls

    • More gradual response to changes in O2 and Co2 levels in blood


Pulse Oximetry

Chest X-Ray

Computed Tomography (CT scan)



Pulmonary Function Tests

Sputum Specimen and Cultures


Diagnostics pulse oximetry
Diagnostics: Pulse Oximetry

  • Measures arterial oxygen saturation

  • Pulse oximetry probe on forehead, ears, nose, finger, toes,

  • False readings

  • Intermittent or continuous monitoring

  • Ideal values: 95-100%

  • When to Notify MD

    • < 91%

    • 86% (Medical Emergency)

Diagnostics chest x ray

Screen, diagnose, evaluate treatment

Instructions: No metals/jewelry

Diagnostics: Chest X-Ray

Diagnostics chest x ray cont
Diagnostics: Chest X-Ray Cont.



Posterior Anterior View

Left Lateral View

Diagnostics sputum specimen
Diagnostics: Sputum Specimen

  • To diagnose; evaluate treatment

  • Specimen: ID organisms or abnormal cells

    • Culture & Sensitivity (C&S)

    • Cytology

    • Gram stains

      • (e.g. Acid Fast Bacilli)

Diagnostics computed tomography ct scan
Diagnostics: Computed Tomography: CT Scan

  • Images in cross-section view

  • Uses contrast agents

  • Instructions:

Right upper Lobe

Diagnostics bronchoscopy

Diagnose problems and assess changes in bronchi/bronchioles

Performed to remove foreign body, secretions, or to obtain specimens of tissue or mucus for further study

Diagnostics: Bronchoscopy

Procedure Care/Instructions:

  • NPO 6 -8 hrs prior

  • Sedation during procedure

    Post Procedure:

  • HOB elevated

  • Observe for hemorrhage

  • NPO until gag reflex returns

Diagnostics pulmonary function test pfts
Diagnostics: Pulmonary Function Test (PFTs)

  • Evaluate lung function

  • Observe for increased dyspnea or bronchospasm

  • Instructions:

  • No bronchodilators 6 hours prior

Diagnostics thoracentesis

Specimen from pleural fluid

Treat pleural effusion

Assess for complications

Post-Procedure care:

CXR after procedure

Diagnostics: Thoracentesis

  • Positions

    • Sitting on side of bed over bedside table chest

    • elevated

    • Lying on affected side

    • Straddling a chair

Assessment cues to respiratory problems




Assessment: Cues to Respiratory Problems

Pneumonia case study
Pneumonia: Case Study


Pneumonia etiology
Pneumonia: Etiology

  • Cause

    • bacteria (75%)

    • viruses

    • fungi

    • Mycoplasma

    • Parasites

    • chemicals

Pneumonia classifications
Pneumonia: Classifications

  • Community-acquired pneumonia (CAP)

    • Onset in community or during 1st 2 days of hospitalization (Strep. pneumoniae most common)

  • Hospital-acquired Pneumonia(HAP/nosocomial)

    • Occurring 48 hrs or longer after hospitalization

  • Aspiration pneumonia

  • Pneumonia caused by opportunistic organisms

    • Pneumocystis Carinii

Pneumonia risk factors


Older adult

Chronic/coexisting condition

Recent history or exposure to viral or influenza infections

History of tobacco or alcohol use


Older adult

Chronic lung disease



ET, Trach, NG / GT


Mechanical ventilation

Pneumonia: Risk Factors

Pneumonia clinical manifestations
Pneumonia: Clinical Manifestations

  • Fevers, chills, anorexia

  • Pleuritic chest pain

  • SOB

  • Crackles/wheezes

  • Cough, sputum production

  • Tachypnea

Pneumonia clinical manifestations cont
Pneumonia: Clinical Manifestations-Cont.

Mycoplasma (Atypical)

  • feeling tired or weak, headaches, sore throat, or diarrhea.

  • Eventually, most develop a dry cough.  They can, also, develop fever, chills, earaches, chest pain

  • “walking pneumonia”

Pneumonia diagnosis
Pneumonia: Diagnosis

  • Diagnosis →

    • Physical exam → crackles, rhonchi/wheezes

    • CXR →area of increased density

      (infiltrates/ consolidation)

    • Sputum specimen –

      • Gram stain

LUL Infiltrates

Pneumonia interventions tx
Pneumonia :Interventions/Tx

  • Treatment

    • Antibiotics → choose based on age, suspected cause & immune status

    • Supportive care → IV fluids, supplemental oxygen therapy, respiratory monitoring, cough enhancement

  • *may take 6-8 weeks for CXR to normalize

Nursing diagnoses
Nursing Diagnoses…

  • Impaired gas exchange R/T Pneumonia

  • Pain R/T infection in lung Pneumonia

Pneumonia complications


Pleural effusion



Pneumonia: Complications



Pleural Effusion