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Chapter 13. The Respiratory System. Theory Objectives. Recall the structure and function of the respiratory system. Identify three causative factors related to disorders of the respiratory system.

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Chapter 13

Chapter 13

The Respiratory System


Theory objectives
Theory Objectives

  • Recall the structure and function of the respiratory system.

  • Identify three causative factors related to disorders of the respiratory system.

  • Provide instructions to patients on measures to prevent long-term problems of the respiratory system.


Theory objectives cont
Theory Objectives (cont.)

  • Employ proper techniques for assessing the respiratory system.

  • List nursing responsibilities for patients undergoing diagnostic tests and procedures for disorders of the respiratory system.


Clinical practice objectives
Clinical Practice Objectives

  • Verify that nursing diagnoses chosen for patients with problems of the respiratory system are appropriate.

  • Propose interventions for a patient who has a problem with oxygenation.

  • Teach a patient to cough effectively.


Anatomy and physiology of the respiratory system
Anatomy and Physiology of the Respiratory System

  • Upper respiratory system

    • Structures

    • Functions

    • Airway protection

    • Speech production


Anatomy and physiology of the respiratory system cont
Anatomy and Physiology of the Respiratory System (cont.)

  • Lower respiratory system

    • Structures

    • Functions

    • Oxygen delivery and diffusion

    • Lung protection

    • Respiration control

    • Exchange of oxygen and carbon dioxide




Terms commonly used in respiratory care
Terms Commonly Used in Respiratory Care

  • Diffusion

  • Elastance

  • Hypoxemia

  • Hypoxia

  • Lung compliance

  • Perfusion

  • Pulmonary hygiene

  • Resistance

  • Respiratory failure

  • Shunting

  • Surfactant

  • Ventilation


What factors can affect the exchange of oxygen and carbon dioxide
What factors can affect the exchange of oxygen and carbon dioxide?

  • Alveoli

  • Surfactant

  • Edema

  • Tumors

  • Oxygen, RBC’s

  • Carbon dioxide


Respiratory disorders
Respiratory Disorders dioxide?

  • Trauma or disease

  • Susceptible to harmful substances

  • Restrictive diseases

  • Obstructive pulmonary diseases


Factors that increase risk for respiratory infection
Factors that Increase Risk for Respiratory Infection dioxide?

  • Older than 65 years of age

  • Cigarette smoking

  • Residing in extended-care facilities

  • Chronic respiratory disorders (includes asthma)

  • Congenital or chronic cardiovascular disorders

  • Chronic renal disease

  • Diabetes mellitus or a chronic metabolic disorder

  • Compromised immune response


Preventing respiratory disorders
Preventing Respiratory Disorders dioxide?

  • Practice hand hygiene frequently

  • Stay out of crowds, especially during cold and flu season

  • Refrain from smoking

  • Avoid known allergens as much as possible

  • Maintain adequate nutrition and obtain sufficient rest; helps keep the immune system healthy


Elder care points
Elder Care Points dioxide?

  • The elderly should not be exposed to children with colds and coughs

  • The elderly person who is mostly confined to the house or a long-term care facility and does not mingle with the public much does not have the immunity to common viruses and bacteria that younger, more socially active people do


Pneumococcal immunization for high risk persons
Pneumococcal Immunization for High-Risk Persons dioxide?

  • The U.S. Public Health Service Advisory Committee on Immunization recommends immunization against pneumococcal infection for high-risk persons

  • Although there is some danger in taking the vaccine, the benefits far outweigh the risks


Smoking and tobacco cessation
Smoking and Tobacco Cessation dioxide?

  • 5 As

    • Ask about tobacco use

    • Advise about the health benefits of quitting

    • Assess readiness to quit

    • Assist in creating a cessation plan

    • Arrange follow-up


Assessment data collection
Assessment (Data Collection) dioxide?

  • History-taking

  • Physical assessment

  • Diagnostic tests and procedures

  • Diagnostic visual examination of the nose, mouth, and throat


Data collection
Data Collection dioxide?

  • Subjective

    • What questions will you ask?

    • Utilize listening skills

  • Objective

    • What will you include in your physical assessment?



Characteristics of sputum and possible causes
Characteristics of Sputum and dioxide?Possible Causes

  • Thick, tenacious, and “ropey”; difficult to cough up

    • Chronic bronchitis, emphysema

  • Scant, sticky, rust-colored

    • Pneumococcal pneumonia

  • Frothy, pinkish, or blood-tinged

    • Pulmonary edema

  • Yellow, yellow-green, or grayish-yellow, with foul odor or taste

    • Pulmonary infection


Characteristics of sputum and possible causes cont
Characteristics of Sputum and dioxide?Possible Causes (cont.)

  • Blood-tinged, bloody, or blood-streaked

    • Tuberculosis, or ulcerated pulmonary vessel, or bronchogenic carcinoma

  • Large amounts

    • Pneumonia or bronchitis

  • Scanty

    • Asthma

  • Very thick and viscous

    • Inadequate hydration



Normal lung sounds
Normal Lung Sounds dioxide?

  • Vesicular breath sounds

    • Low to medium pitch with a soft whooshing quality; inspiration is two to three times the length of expiration

  • Bronchovesicular breath sounds

    • Moderate to high pitch with a hollow, muffled quality; equal time of inspiration and expiration

  • Bronchial breath sounds

    • High pitch with a loud, harsh, tubular quality; inspiration half as long as expiration


Adventitious breath sounds
Adventitious Breath Sounds dioxide?

  • Rales/crackles

  • Rhonchi

  • Wheezes

  • Pleuritic rubs

  • Stridor



Diagnostic tests and procedures
Diagnostic Tests and Procedures dioxide?

  • Pulse oximetry

  • Arterial Blood Gases

    • Ph

    • PaO2

    • PaCO2

    • HCO3

    • Acidosis and alkalosis


Diagnostic tests and procedures1
Diagnostic Tests and Procedures dioxide?

  • D-dimer

  • Sputum analysis

  • Capnography

  • Pulmonary Function Tests (PFT’s)

  • Chest x-ray


Diagnostic tests and procedures2
Diagnostic Tests and Procedures dioxide?

  • Computed Tomography

  • Ventilation/Perfusion Scan (V-Q scan)

  • Pulmonary angiography

  • Bronchoscopy

  • Laryngoscopy


Diagnostic tests and procedures3
Diagnostic Tests and Procedures dioxide?

  • Mediastinoscopy

  • Thoracentesis

  • Tuberculosis tests

  • Peak Flowmeter

  • Lung Biopsy


Spirometry
Spirometry dioxide?


Nursing diagnoses
Nursing Diagnoses dioxide?

  • Ineffective airway clearance

  • Ineffective breathing patterns

  • Risk for infection

  • Fatigue

  • Anxiety


Nursing goals
Nursing Goals dioxide?

  • Promote oxygenation

  • Prevent infection

  • Prevent further lung damage

  • Promote rehabilitation


Evaluation
Evaluation dioxide?

  • Improved breathing pattern, pulse oximeter readings, arterial blood gas values, and lung sounds

  • Decreases in coughing, sputum production, wheezing, and signs of infection

  • Lessened dyspnea and more energy and ability to perform more self-care

  • Reassessment is an ongoing nursing activity


Patient teaching deep breathing
Patient Teaching: dioxide?Deep Breathing

  • Clear the nasal passages

  • Sit with feet about shoulder-width apart

  • Lean forward with hands or elbows on the knees and arms and hands completely relaxed

  • Take a deep breath, allowing the diaphragm to drop as you inhale; feel the abdomen expand

  • Exhale slowly

  • Continue to take several slow, deep breaths


Patient teaching to cough effectively
Patient Teaching: dioxide?To Cough Effectively

  • Position tissues or a basin for expectoration

  • While in a sitting position with the feet supported, deep-breathe several times

  • Bend head forward, slightly hunch shoulders forward

  • Take a deep breath and slowly exhale, coughing three times in succession with exhalation


Patient teaching to cough effectively cont
Patient Teaching: dioxide?To Cough Effectively (cont.)

  • The first cough mobilizes secretions and the next two bring secretions up to be expectorated

  • Repeat the process if secretions are still audible in the lungs

  • Rest in between attempts at coughing


For the patient who will not effectively cough
For the Patient Who Will Not Effectively Cough dioxide?

  • After deep breathing, encourage the patient to take a deep breath through the nose and then forcibly exhale through the mouth

  • Repeat the process, producing “huffs” that move secretions upward until they can be expectorated



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