Transcript Learning Outcomes

The Respiratory System and
Assessment
Learning Outcomes
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Describe the structure and functions of the respiratory tract.
Explain the mechanics of respiration.
Conduct and appropriately document a focused assessment of the
upper and lower respiratory systems, demonstrating sensitivity and
respect for individual concerns, values, and preferences.
Learning Outcomes
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5.
Provide appropriate nursing care and teaching for patients
undergoing diagnostic tests and procedures related to the
respiratory system.
Monitor diagnostic test results, recognizing and communicating
abnormal or unexpected findings within the interprofessional team.
Structure and Function of the Upper
Respiratory Tract
 Air moves into lungs.
 Carbon dioxide moves out of body through upper respiratory tract.
 Upper airway
 Cleans, humidifies, warms air
 Needs to be open for effective breathing
Figure 21-1. (A) Structures of the upper
respiratory system. (B) The sinuses.
Noses and Sinuses
 Nose
 Begin respiratory system
 Filter and warm air
 Nares separated by septum
 Sinuses
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Openings in facial bones
Lighten skull
Assist in speech
Produce mucus
Pharynx
 Nasopharynx
 Oropharynx
 Laryngopharynx
Larynx
 Connects laryngopharynx to trachea
 Routes air and food to proper passageway
Structure and Function of the Lower
Respiratory System
 Lungs and bronchi
 Respiration
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Ventilation
External respiration
Gas transport
Internal respiration
Figure 21-2. The lower respiratory system,
showing the lungs, the mediastinum, and layers of
the visceral and parietal pleura.
(Source: Patrick Watson, Pearson Education.)
Lungs
 Separated by mediastinum
 Composed of elastic connective tissue
 Divided into lobes which are further divided into segments
Bronchi and Alveoli
 Trachea divides into right and left mainstem bronchi.
 Bronchi continue to branch and get smaller (bronchioles) and end as
alveoli.
 Air moves through passageways to alveoli where gas exchange
occurs.
Figure 21-3. The functional tissue of the lungs,
including the respiratory bronchioles and alveoli.
(Source: Pearson Education.)
Pulmonary Circulation
 Pulmonary arteries
 Blood from body tissues, via right heart, to lungs
 Pulmonary veins
 Oxygenated blood to left heart
 Pulmonary capillary network
Pleura
 Double-layered membrane that covers lungs
 Parietal
 Visceral
 Hold lungs out to chest wall
Rib Cage and Intercostal Muscles
 Protect lungs
 12 pairs ribs
 Intercostal muscles are between ribs
 Assist with process of breathing
Mechanics of Respiration
 Ventilation
 Divided into inspiration and expiration
 Normal is 12–20 breaths per minute
 Inspiration
 Lasts 1–1.5 seconds
 Diaphragm contracts and flattens
 Intercostal muscles contract
 Increases size of chest cavity
Mechanics of Respiration
 Inspiration
 Lungs stretch and volume increases
 Pressure in lungs slightly less than atmospheric
 Causes air to rush in
 Expiration
 Lasts 2 to 3 seconds
 Passive
 Muscles relax
Mechanics of Respiration
 Expiration
 Diaphragm rises
 Ribs descend
 Lungs recoil
 Pressure in chest cavity increases, compressing alveoli.
 Pressure in lungs higher than atmospheric causes gases to flow out of
the lungs.
Factors Affecting Respiration
 Respiratory center of the brain
 Chemoreceptors in the brain, aortic arch, and carotid arteries
 Other factors
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Airway resistance
Compliance
Elasticity
Surface tension of alveoli
Respiratory Changes Associated with Aging
 Cartilage that connects ribs to sternum and spinal cord calcifies
 Anterior-posterior diameter of chest increases
 Respiratory muscles weaker
 Cough and laryngeal reflexes less effective
Respiratory Changes Associated with Aging
 Size of lungs decreases
 Alveoli less elastic
 Older patient at greater risk for developing respiratory infections
Assessment
 Subjective data
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Current complaint or existing condition
Onset or duration of symptoms
Ability to maintain ADL
Nasal congestion, nosebleeds
Sore throat, difficulty swallowing
Changes in voice quality
Difficulty breathing, orthopnea
Pain on breathing
Assessment
 Subjective data
 Presence of cough frequency, duration, productive or unproductive
 Sputum amount, color, and consistency
 Exposure to infections
 Colds or influenza
 History of chronic lung conditions
 Occupational exposure to chemicals, smoke, asbestos
Assessment
 Subjective data
 History of previous respiratory problems
 Allergies to medication or environmental allergens
 Use of tobacco, chewing tobacco, marijuana, cocaine, injected drugs, or
alcohol
Assessment
 Physical examination
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Assess state of health
Color
Ease of breathing
Note respiratory rate and pattern
Observe nasal flaring
Use of accessory muscles for breathing
Listen for hoarseness in patient's speech
Assessment
 Physical examination
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Inspect mucosa of nose, mouth, and oropharynx
Inspect neck, position of trachea
Inspect anterior/posterior diameter of chest
Palpate lips for nodules, chest for tenderness or swelling
Assessment
 Physical examination
 Auscultate breath sounds, note absence or presence and quality
 Note adventitious breath sounds
 Wheezing or crackles
Diagnostic Tests
 Sputum and tissue specimens
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Throat or nose swab
Sputum specimen
Culture and sensitivity
Gram stain
Acid-fast stain
Cytology
TABLE 21-1 Common Laboratory Tests and Studies
continued on next slide
TABLE 21-1 (continued) Common Laboratory Tests and Studies
Diagnostic Tests
 Imaging techniques
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X-rays
CT scans
Ventilation–perfusion scans
Nursing care and patient teaching
 If contrast used remember to ask about allergies, especially iodine and seafood.
TABLE 21-2 Imaging Studies
continued on next slide
TABLE 21-2 (continued) Imaging Studies
Diagnostic Tests
 Pulmonary function tests
 Measure lung volume and capacity
 Smoking, caffeine, and bronchodilators interfere with results
 Nursing care and patient teaching
 Instruct patient to stop bronchodilators 4–6 hours prior to test
 Instruct patient not to smoke or drink caffeinated drinks prior to test
Figure 21-9. The relationship of lung volumes
and capacities. Volumes shown are for an average
adult male.
Diagnostic Tests
 Direct visualization
 Direct or indirect laryngoscopy
 Used to identify and evaluate laryngeal tumors
 Nursing care and patient teaching
 Make sure consent form has been signed.
 Remove dentures, partial plates, bridges prior to procedure.
 NPO before procedure
Diagnostic Tests
 Direct visualization
 Nursing care and patient teaching
 NPO after procedure until gag reflex returns
 Fiberoptic bronchoscopy
 Visualize trachea, bronchi and bronchioles
 Tumors and structural disorders
Diagnostic Tests
 Direct visualization
 Fiberoptic bronchoscopy
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Obtain tissue biopsy
Obtain sputum specimen
Removal of foreign body
Nursing care and teaching