1 Respi Nsg- Ana & Physio, Dx Test

8/6/2019 1 Respi Nsg- Ana & Physio, Dx Test

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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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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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Lung Volumes and Capacities


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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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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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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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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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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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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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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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Endoscopic Procedures

Thoracoscopy

Examination of the pleural cavitywith an endoscope


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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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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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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

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1 Respi Nsg- Ana & Physio, Dx Test