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PhysiologicReview:
RespiratorySystemRachel Joy R. Rosale, RN, RM, MAN
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Anatomy & PhysiologyUpper RespiratoryTractNoseParanasal SinusesTurbinate Bones(Conchae)Pharynx, Tonsils andAdenoidsLarynxTrachea
Lower Respiratory
TractLungs
Pleura Mediastinum Lobes Bronchi and
Bronchioles
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Nose
Internal Hollow cavity separated
into R/L by the septum;
Lined with highlyvascular ciliated mucous
membranes, nasalmucosa
Each cavity is divided bythe projection of theturbinates
External Projects from the
face and issupported by thenasal bones andcartilage
Nares/nostrils
Serves as a passageway for air to pass to and
from the lungs;Filters impurities, humidifies and warms theair;Responsible for olfaction.
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Paranasal Sinuses
Include 4 pairs of bonycavities that are linedwith nasal mucosa andciliated epithelium.
Connected by series of
ducts that drain into thenasal cavity.
Serve as resonatingchamber in speech.
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Turbinate Bones
Conchae
Increase themucous
membranesurface of thenasal passages
Deflects air
entering thenostrils
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Pharynx, Tonsils,Adenoids Pharynx
Throat
Passageway forboth respiratory and
digestive tracts A tube-like structure
that connects thenasal and oralcavities to thelarynx
Divided into:nasopharynx,oropharynx, andlaryngopharynx
Tonsils
Adenoids Located in the roof
of the nasopharynx
Important in thechain of lymphnodes guarding thebody from invasionby organisms thru
the nose and mouth
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Trachea
Thyroid cartilage
Cricoid cartilage
Tracheal car tilage
Left upper lobeRight upper
lobe
Left bronchusRight
bronchus
Horizontal fissure
Right
middle
lobe
Oblique fissure
Oblique
fissureBronchioles
Left lower lobeRight lower
lobe
Windpipe
Composed of smooth musclewith C-shaped rings of cartilageat regular gaps
Serves as passageway betweenthe larynx and the bronchi
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Lungs
Lungs Paired elastic structures enclosed in the thoracic
cage
Pleura
Serous membrane that lines the lungs and wall ofthe thorax Visceral
Parietal
Mediastinum
Middle of the thorax, between the pleural sac thatencloses the lungs
Lobes Right Lung: 3 lobes
Left Lung: 2 lobes
Bronchi and Bronchioles
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Function of the
Respiratory System
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Function of the RespiratorySystem
Oxygen Transport
Respiration
CELLSO2 CO2
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Function of the RespiratorySystem
Ventilation
Inspiration normally is 1/3 of the respiratory cycle andexpiration is 2/3.
1.Air Pressure Variances - refers to changes in pressurebetween the atmospheric pressure and the thoraciccavity.
Airway Resistance determined by the radius or size ofthe airway; increased resistance = greater respiratoryeffort to achieve normal ventilation.
Compliance measure of the elasticity, expandabilityand distensibility of the lungs and the thoracic structure.
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Function of the RespiratorySystem
Lung Volumes and Capacities
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Function of the RespiratorySystem
Lung Volumes and Capacities
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Function of the RespiratorySystem Diffusion process by which O2 and CO2 are
exchanged at the air-blood interface.
Pulmonary Perfusion actual blood flow
through the pulmonary circulation.
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Ventilation-PerfusionRatios Ventilation (V) is the movement of air in and
out of the lungs
Perfusion (Q) is the filling of the pulmonary
capillaries with blood
Adequate gas exchange depends upon anadequate V/Q ratio, a match of ventilation and
perfusion
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Ventilation-PerfusionRatios
Air
Normal
Capillary flow
CO2 O2
alveolus
A
Air
Dead space
Blockage
alveolus
C
Shunt
Capillary Blood flow
Blockage of
alveolus
B
Silent
Blockage of
blood flow
Blockage of
alveolus
D
Normal Ratio (A) High Ventilation-Perfusion Ratio:
Dead Space (C)
Low Ventilation-Perfusion Ratio:Shunts (B)
Silent Unit (D)
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Gas Exchange
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Oxyhemoglobin DissociationCurve Shows the relationship between the partial
pressure of oxygen (PaO2) and the percentage ofsaturation of oxygen (SaO2) which can beaffected by: carbon dioxide, hydrogen ion
concentration, temperature and 2,3diphosphoglycerate.
An increase results to a shift to the right = more O2
A decrease results to a curve to the right = less O2
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Assessment of
PulmonaryFunction
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Assessment
Signs and symptoms
Dyspnea
Cough
Sputum Production
Chest Pain Wheezing
Clubbing of Fingers
Hemoptysis
Cyanosis
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Key Assessments
Breathing Pattern and RespiratoryRates
Eupnea
Bradypnea vs Tachypnea Hyperpnea
Hyperventilation vd Hypoventilation
Kussmauls respiration
Apnea Cheyne-Stokes respiration
Biots Respiration
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Key Assessments
Breath Sounds
Normal Breath Sounds Vesicular
Bronchovesicular
Bronchial
Abnormal (Adventitious) Breath Sounds Crackles
Wheezes
Friction Rubs
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Key Assessments
Chest Configurations
Normal
Barrel Chest
Funnel Chest (Pectus Excavatum) Pigeon Chest (Pectus Carinatum)
Kyphoscoliosis
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Diagnostic Evaluation
Pulmonary Function Tests
Measurements oflung volumes, ventilation,mechanics of breathing, diffusion and gasexchange.
Incentive spirometer
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Diagnostic Evaluation
Arterial Blood Gas Studies
Purpose is to assess ventilation and acid-basebalance
10 mL blood is drawn from the radial artery
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Diagnostic Evaluation
Pulse Oximetry
Determines O2 saturations in the blood
Allens test is performed prior to drawing of blood
Placed in the index finger, middle finger or ear lobe
Cover the sensor with and opaque material
NORMAL: 95 100%
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Diagnostic Evaluation
Cultures
Swab the nose and throat using a sterile cotton swab
Place in a sterile culture tube
Sputum Studies Early morning specimen
Rinse mouth with plain water
Approximately 15 mL is required
Use sterile container
Important: Specimen for C&S is
collected prior the 1st dose of antibiotic.
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Diagnostic Evaluation
Imaging Studies
Chest X-ray
Radiographic visualization of the chest
Instruct the client to hold his breath and remove metals
from the chest Upon inhalation, the diaphragm is at its lowest level
Computed Tomography
An imaging method in which the lungs are scanned in
successive layers by a narrow beam x-ray Provides cross-sectional view of the chest
Shows images not visible in x-ray
Used with contrast agent
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Diagnostic Evaluation
Imaging Studies
Magnetic Resonance Imaging
A test that uses a magnetic field and pulses of radio wave energy tomake pictures of organs and structures that are inside the body
Yields a much more detailed diagnostic image than CT Scan
Fluoroscopic Studies
Pulmonary Angiography
A procedure that uses a radiopaque dye and x-rays to see howblood flows through the lungs
Used to investigate thromboembolic diseases of the lungs
Radioisotope Diagnostic Procedures (Lung Scans)
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Diagnostic Evaluation
Endoscopic Procedures Bronchoscopy Direct inspection and examination of
the larynx, trachea and bronchi througha flexible or rigid fluoroscope.
Dx Uses: to collect secretion, todetermine location of pathologicprocess and collect specimen
Therapeutic Uses: remove foreignobject and excise lesion
Nursing Interventions Obtain a signed consent
NPO 6-8 hours before the procedure
Explain the procedure
Administer atropine SO4 and a sedativeor opioid, as ordered
Remove dentures and oral prostheses
Post bronchoscopy NPO until gag or cough reflex returns
Offer ice chips then fluids
Assess LOC then the ABCs of life
Side-lying position
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Diagnostic Evaluation
Endoscopic Procedures
Thoracoscopy
Examination of the pleural cavitywith an endoscope
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Diagnostic Evaluation
Thoracentesis
Aspiration of pleural fluid for diagnostic ortherapeutic purposes.
Performed between the ribs, in the space around the
lung, not INTO the lung.
Purposes:
Removal of fluid and air from the pleural cavity
Aspiration of fluid for analysis
Pleural biopsy Instillation of meds
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Diagnostic Evaluation
Thoracentesis
Aspiration of fluid or air from the pleural cavity
Nursing Interventions
Obtain signed consent
Administer pre-op meds as prescribed Position: UPRIGHT or ORTHOPNEIC or LYING ON
UNAFFECTED SIDEwith HOB elevated at 30-45 deg;Straddling
Instruct to remain still; encourage to refrain from
coughing
Apply pressure over the puncture site with a small steriledressing
Bed rest
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Diagnostic Evaluation
Biopsy
Pleural Biopsy
Needle biopsy of the pleura or pleuroscopy
When there is a need to culture or stain the tissue toidentify tuberculosis or fungi
Lung Biopsy Procedures
When chest x-ray findings are inconclusive or showspulmonary density
Transcatheter bronchial brushing
Transbronchial lung biopsy
Percutaneous needle biopsy
Lymph Node Biopsy