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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

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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.

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

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

  • 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

  • Upper respiratory system

    • Structures

    • Functions

    • Airway protection

    • Speech production

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

Structures of the Upper Respiratory Tract

Paranasal Sinuses

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?

  • Alveoli

  • Surfactant

  • Edema

  • Tumors

  • Oxygen, RBC’s

  • Carbon dioxide

Respiratory Disorders

  • Trauma or disease

  • Susceptible to harmful substances

  • Restrictive diseases

  • Obstructive pulmonary diseases

Factors that Increase Risk for Respiratory Infection

  • 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

  • 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

  • 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

  • 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

  • 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)

  • History-taking

  • Physical assessment

  • Diagnostic tests and procedures

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

Data Collection

  • Subjective

    • What questions will you ask?

    • Utilize listening skills

  • Objective

    • What will you include in your physical assessment?

Clubbing of Fingers

Characteristics of Sputum and 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.)

  • 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

Sites for Auscultation of the Lungs

Normal Lung Sounds

  • 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

  • Rales/crackles

  • Rhonchi

  • Wheezes

  • Pleuritic rubs

  • Stridor

Barrel Chest Typical of COPD

Diagnostic Tests and Procedures

  • Pulse oximetry

  • Arterial Blood Gases

    • Ph

    • PaO2

    • PaCO2

    • HCO3

    • Acidosis and alkalosis

Diagnostic Tests and Procedures

  • D-dimer

  • Sputum analysis

  • Capnography

  • Pulmonary Function Tests (PFT’s)

  • Chest x-ray

Diagnostic Tests and Procedures

  • Computed Tomography

  • Ventilation/Perfusion Scan (V-Q scan)

  • Pulmonary angiography

  • Bronchoscopy

  • Laryngoscopy

Diagnostic Tests and Procedures

  • Mediastinoscopy

  • Thoracentesis

  • Tuberculosis tests

  • Peak Flowmeter

  • Lung Biopsy


Nursing Diagnoses

  • Ineffective airway clearance

  • Ineffective breathing patterns

  • Risk for infection

  • Fatigue

  • Anxiety

Nursing Goals

  • Promote oxygenation

  • Prevent infection

  • Prevent further lung damage

  • Promote rehabilitation


  • 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

  • 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

  • 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.)

  • 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

  • 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

Orthopneic Position

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