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Medical and Surgical Nursing ReviewThe Respiratory System Nurse Licensure Examination Review

Outline Of Review Concepts: Review

of the relevant respiratory anatomy Review of the relevant respiratory physiology The respiratory assessment Common laboratory examinations

Outline Of Review Concepts: Review

of the common respiratory problems and the nursing management Review of common respiratory diseases Upper

respiratory conditions Lower respiratory conditions

Respiratory Anatomy & Physiology The

respiratory system consists of two main parts - the upper and the lower tracts

Respiratory Anatomy & Physiology The

UPPER respiratory system consists

of: 1. nose 2. mouth 3. pharynx 4. larynx

Respiratory Anatomy & Physiology The

LOWER respiratory system consists of: 1. Trachea 2. Bronchus 3. Bronchioles 4. Respiratory unit

Upper Respiratory Tract

The Nose This

is the first part of the upper respiratory system that contains nasal bones and cartilages There are numerous hairs called vibrissae There are numerous superficial blood vessels in the nasal mucosa

The Nose The

functions of the nose are: 1. To filter the air 2. To humidify the air 3. To aid in phonation 4. Olfaction

The Pharynx The

pharynx is a musculo membranous tube that is composed of three parts 1. Nasopharynx 2. Oropharynx 3. Laryngopharynx

The Pharynx The

pharynx functions : 1. As passageway for both air and foods (in the oropharynx) 2. To protect the lower airway

The Larynx Also

called the voice box Made of cartilage and membranes and connects the pharynx to the trachea

The Larynx Functions

of the larynx: 1. Vocalization 2. Keeps the patency of the upper airway 3. Protects the lower airway

The Paranasal sinuses These

are four paired bony cavities that are lined with nasal mucosa and ciliated pseudostratified columnar epithelium Named after their location - frontal, ethmoidal, sphenoidal and maxillary

The Paranasal sinuses The

function of the sinuses: Resonating chambers in speech

The Lower Respiratory System The

lower respiratory system consists of 1. Trachea 2. Main bronchus 3. Bronchial tree 4. Lungs- 3R/ 2L The trachea to the terminal bronchioles is called the conducting airway The respiratory bronchioles to the alveoli is called the respiratory acinus

The TracheaA

cartilaginous tube measures 10-12 centimeters Composed of about 20 C-shaped cartilages, incomplete posteriorly

The Trachea The

function of the trachea is to conduct air towards the lungs The mucosa is lined up with mucus and cilia to trap particles and carry them towards the upper airway

The Bronchus The

right and left primary bronchi begin at the carina The function is for air passage

The Primary Bronchus



Wider Shorter More Vertical

Narrower Longer More horizontal

The Bronchioles The

primary bronchus further divides into secondary, then tertiary then into bronchioles The terminal bronchiole is the last part of the conducting airway

The Respiratory Acinus The

respiratory acinus is the chief respiratory unit It consists of 1. Respiratory bronchiole 2. Alveolar duct 3. alveolar sac

The Respiratory Acinus The

respiratory acinus is the chief respiratory unit The function of the respiratory acinus is gas exchange through the respiratory membrane

The Respiratory Acinus The

respiratory membrane is composed of two epithelial cells 1.The type 1 pneumocyte - most abundant, thin and flat. This is where gas exchange occurs 2. The type 2 pneumocyte - secretes the lung surfactant

The Respiratory AcinusA

type III pneomocyte is just the macrophage that ingests foreign material and acts as an important defense mechanism

Accessory StructuresThe PLEURA Epithelial serous membrane lining the lung parenchyma Composed of two parts- the visceral and parietal pleurae The space in between is the pleural space containing a minute amount of fluid for lubrication

Accessory StructuresThe Thoracic cavity The chest wall composed of the sternum and the rib cage The cavity is separated by the diaphragm, the most important respiratory muscle

Accessory StructuresThe Mediastinum The space between the lungs, which includes the heart and pericardium, the aorta and the vena cavae.


exchange through ventilation, external respiration and cellular respiration Oxygen and carbon dioxide transport

The AssessmentHISTORY Reason for seeking care Present illness Previous illness Family history Social history

The AssessmentPHYSICAL EXAMINATION Skin- cyanosis, pallor Nail clubbing Cough and sputum production Inspect - palpate - percuss - auscultate the thorax

The AssessmentLABORATORY EXAMINATION 1. ABG analysis 2. Sputum analysis 3. Direct visualization - bronchoscopy 4. Indirect visualization - CXR, CT and MRI 5. Pulmonary function test

ABG Analysis This

test helps to evaluate gas exchange in the lungs by measuring the gas pressures and pH of an arterial sample

ABG Analysis Pre-test:

choose site carefully, perform the Allens test, secure equipmentssyringe, needle, container with ice Intra-test: Obtain a 5 mL specimen from the artery (brachial, femoral and radial) Post-test: Apply firm pressure for 5 minutes, label specimen correctly, place in the container with ice

ABG AnalysisABG normal values PaO2 80-100 mmHg PaCO2 35-45 mmHg pH 7.35- 7.45 HCO3 22- 26 mEq/L O2 Sat 95-99%

Sputum Analysis This

test analyzes the sample of sputum to diagnose respiratory diseases, identify organism, and identify abnormal cells

Sputum AnalysisPre-test: Encourage to increase fluid intake Intra-test: rinse mouth with WATER only, instruct the patient to take 3 deep breaths and force a deep cough, steam nebulization, collect early morning sputum Post-test: provide oral hygiene, label specimen correctly

Pulse Oximetry Non-invasive

method of continuously monitoring the oxygen saturation of hemoglobin A sensor or probe is attached to the earlobe, forehead, fingertip or the bridge of the nose


direct inspection of the trachea and bronchi through a flexible fiber-optic or a rigid bronchoscope Done to determine location of pathologic lesions, to remove foreign objects, to collect tissue specimen and remove secretions/aspirated materials

BronchoscopyPre-test: Consent, NPO x 6h, teaching Intra-test: position supine or sitting upright in a chair, administer sedative, gag reflex will be abolished, remove dentures Post-test: NPO until gag reflex returns, position SEMI-fowlers with head turned to sides, hoarseness is temporary, CXR after the procedure, keep tracheostomy set and suction x 24 hours

Thoracentesis Pleural

fluid aspiration for obtaining a specimen of pleural fluid for analysis, relief of lung compression and biopsy specimen collection

ThoracentesisPre-test: Consent Intra-test: position the patient sitting with arms on a table or side-lying fowlers, instruct not to cough, breathe deeply or move Post-test: position unaffected side to allow lung expansion of the affected side, CXR obtained, maintain pressure dressing and monitor respiratory status

Pulmonary Function Tests Volume

and capacity tests aid diagnosis in patient with suspected pulmonary dysfunction Evaluates ventilatory function Determines whether obstructive or restrictive disease Can be utilized as screening test

Pulmonary Function TestLung Volumes Tidal volume Inspiratory reserve volume Expiratory reeve volume Residual volume

Pulmonary Function TestLung capacities Inspiratory capacity Vital capacity Functional residual capacity Total lung capacity

Pulmonary Function TestPre-test: Teaching, no smoking for 3 days, only light meal 4 hours before the test Intra-test: position sitting, bronchodilator, nose-clip and mouthpiece, fatigue and dyspnea during the test Post-test: adequate rest periods, loosen tight clothing

Common Respiratory Problemsand the common interventions


difficulty Associated with many conditions- CHF, MG, GBS, Muscular dystrophy, obstruction, etc

DyspneaGeneral nursing interventions: 1. Fowlers position to promote maximum lung expansion and promote comfort. An alternative position is the ORTHOPNEIC position 2. O2 usually via nasal cannula 3. Provide comfort and distractions

Cough and sputum productionCough is a protective reflex Sputum production has many stimuli Thick, yellow, green or rust-colored bacterial pneumonia Profuse, Pink, frothy pulmonary edema Scant, pink-tinged, mucoid Lung tumor

Cough and sputum productionGeneral nursing Intervention 1. Provide adequate hydration 2. Administer aerosolized solutions 3. advise smoking cessation 4. oral hygiene

Cyanosis Bluish

discoloration of the skin A LATE indicator of hypoxia Appears when the unoxygenated hemoglobin is more than 5 grams/dL Central cyanosis observe color on the undersurface of tongue and lips Peripheral cyanosis observe the nail beds, earlobes

Cyanosis Interventions: Check

for airway patency Oxygen therapy Positioning Suctioning Chest physiotherapy Check for gas poisoning Measures to increased hemoglobin

Hemoptysis Expectoration

of blood from the respiratory tract Common causes: Pulmo infection, Lung CA, Bronchiectasis, Pulmo emboli Bleeding from stomach acidic