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MODULE 2 | CARE OF PATIENTS WITH PROBLEMS OF THE RESPIRATORY SYSTEM Components - Respiratory Tract Three Processes of Respiration VENTILATION →Movement of gases in and out of lungs (inhalation, exhalation) DIFFUSION →Exchange of gases from area of higher pressure to area of lower pressure
PERFUSION
→ Movement of blood for transport of gases, nutrients, and metabolic waste products. Functions UPPER PORTION OF RT → Act as the passage of air, it filters, moistens, and warms air during inspiration. LOWER PORTION OF RT → Enables the exchange of gases between blood and air to regulate the PO2, PCO2, and Ph. Gas Exchange (Blood & Alveoli) Nose →Nasal cavity →Nasal septum →Mucous membrane
- cilia
- olfactory receptors
MODULE 2 | CARE OF PATIENTS WITH PROBLEMS OF THE RESPIRATORY SYSTEM Pharynx Nasopharynx →Adenoids or pharyngeal tonsils oropharynx →Palatine tonsils laryngopharynx →Larynx Larynx →Voice box →Glottis (vocal apparatus)
- vocal bands or vocal cords Epiglottis ✓ Acts as a lid or flap that covers the larynx and trachea (airway), so food does not enter the lungs.
- GLOTTIS - opening between the vocal cords in the larynx. Trachea Windpipe or airway Mucous membrane lining with cilia Smooth muscle with c-shaped cartilage rings Divides into two branches: bronchi. No gaseous exchange Bronchi
- Bronchus , singular
- C-shaped cartilage rings with smooth muscle
- Each bronchus divides into bronchioles
- Terminate in air sacs called alveoli. Lungs RIGHT → 3 LOBES. LEFT → 2 LOBES. PLEURA ✓ Each lung is enclosed in pleura. ✓ Parietal pleura ( outer ) ✓ Visceral pleura ( inner )
MODULE 2 | CARE OF PATIENTS WITH PROBLEMS OF THE RESPIRATORY SYSTEM the peripheral receptors become primary stimuli.
Peripheral chemoreceptors
▪ Located in the carotid and aortic bodies. ▪ Sensitive to low arterial blood O2 level (PaO2 ≤ 60mm Hg) → ↑ respiratory rate
Neural receptors
▪ Stretch receptors are located within the alveoli. ▪ Inspiration is inhibited once the lung is inflated = Herring-Breuer reflex ▪ Prevents over inflation of the lungs.
Higher centers in the cortex
▪ exerts conscious control over respiration
- ability to modify breath. Measurement of Lung Function LUNG VOLUMES AND VITAL CAPACITY TIDAL VOLUME →Volume of air inhaled and exhaled in a single breath – 500 ml Dead space volume →The air that remains in the airways and does not participate in gas exchange Vital capacity →The maximal volume that can be exhaled after maximal inhalation – 4600 ml Inspiratory reserve volume →The amount of air that can be inhaled beyond the tidal volume Expiratory reserve volume →The amount of air that can be forcibly exhaled beyond the tidal volume Residual volume →The amount of air remaining in the lungs, even after a forceful maximal expiration
▪ Measurement: spirometer
▪ Directly related to pressure gradient between the atmosphere and the alveoli and inversely related to resistance that opposes airflow. Assessment of the RS A. CHIEF COMPLAINT
Most common symptoms
DYSPNEA
✓ Difficulty of breathing ✓ It is a subjective experience but is observed by another person. ✓ A distressful situation which may include chest tightness, suffocation, shortness of breath. A. ORTHOPNEA B. PAROXYSMAL NOCTURIAL DYSPNEA (PND) ✓ Sudden onset of DOB while sleeping in recumbent position.
Symptoms associated with dyspnea
1 Use Of Accessory Muscles 2 Dilated Nostrils/Flaring 3 Cyanosis
MODULE 2 | CARE OF PATIENTS WITH PROBLEMS OF THE RESPIRATORY SYSTEM COUGH ✓ Described as acute, chronic, paroxysmal, productive, non-productive, or dry, barking, hoarse, hacking. ✓ Onset (gradual or sudden) ✓ Duration and frequency, pattern (occasional, on arising, with activity) ✓ Severity, effect on ADLS. ✓ Aggravating factors (hot, cold, exercises) ✓ Associated symptoms (chest tightness, fever) ✓ Cough lasting longer than 2 - 3 weeks indicates serious respiratory problem and should be evaluated. Sputum production ✓ described in terms of its color, consistency, and amount: Clear non-infectious Yellow staphylococcal Green pseudomonas Rusty pneumococcal Pink tinged mucoid lung tumor Profuse, Frothy, Pink pulmonary edema
- MUCOID OR MUCOPURULENT - viral bronchitis
- FOUL SMELLING SPUTUM AND BAD BREATH - lung abscess
- Note for the AMOUNT ❖ Most accurately assessed by seeing it rather than accepting patient’s description Hemoptysis ✓ Coughing out blood or blood-tinged sputum ✓ Usually frothy with air bubbles, alkaline in pH (7), bright red ✓ Must be distinguished from hematemesis. ✓ Must be quantified. Wheezing ✓ High pitched musical sound mainly heard on expiration caused by bronchoconstriction of the airway. ✓ Exposure to irritants, stress, or anxiety. Chest pain ✓ Must be differentiated from cardiac origin. ✓ Pulmonary origin: pain can originate from the chest wall, pleura, or lung parenchyma. ✓ Sharp, stabbing, intermittent, dull, aching & persistent. Clubbing of the Fingers ✓ Sign of lung disease in pt with chronic hypoxic conditions Cyanosis ✓ Bluish discoloration of the skin ✓ Last indicator of hypoxia
MODULE 2 | CARE OF PATIENTS WITH PROBLEMS OF THE RESPIRATORY SYSTEM
THORACIC CONFIGURATION
NORMAL RATIO - 1:
Barrel chest AP diameter increased Kyphoscoliosis Pectus carinatum Pigeon Chest Pectus excavatum Funnel Chest
PALPATION
TACTILE FREMITUS
✓ The vibration of the chest wall produced by vocalization.
- The nurse places palms of the hands against the patient’s chest and ask the patient to repeat a phrase “ninety-nine.”
- All areas of the chest must be palpated and compare vibrations.
- Most intense in areas close to the major bronchi.
- Increase, decrease, or absence of fremitus should be noted.
- Increased when the lung is filled with fluid.
- Decreased in hyperinflated lungs. NOTE: Absent in pneumothorax.
PERCUSSION
✓ Elicit sound to evaluate underlying tissues. RESONANT indicates air-filled lung DULL / FLAT suggests presence of firm mass; no air entry ✓ The patient is in a semi sitting or supine position. ✓ Percuss downward interspace by interspace.
BREATH SOUNDS
Normal breath sounds
▪ Moderately pitched, breezy.
Adventitious sounds
1. FINE CRACKLES
▪ Result of sudden opening of small airways and alveoli that contain fluid. ▪ Short high-pitched bubbling sounds (rubbing few strands of hair behind the ear
- COARSE CRACKLES ▪ Rush of air passing through airway intermittently occluded by mucus. ▪ Short low-pitched bubbling sounds ▪ Most common on inspiration ▪ Associated with pneumonia, pulmonary edema. ▪ Similar sound to blowing straw under water. 3. WHEEZES ▪ result of air passing through narrowed small airways ▪ High-pitched and musical and rumbling ▪ Most common on expiration ▪ Associated with asthma and conditions that involve obstruction of airway by mucus, foreign body, or tumor
MODULE 2 | CARE OF PATIENTS WITH PROBLEMS OF THE RESPIRATORY SYSTEM
4. PLEURAL FRICTION RUB ▪ Result of roughened pleural surfaces rubbing across each other ▪ Sounds are cracking, grating. ▪ Most common during the height of inspiration ▪ Associated with conditions causing inflammation of the pleura. 5. RHONCHI ▪ Continuous rumbling, snoring, or rattling sounds from obstruction of large airways with secretions ▪ Most prominent on expiration ▪ There is evident change after coughing or suctioning. 6. STRIDOR ▪ Continuous musical sound of constant pitch ▪ Result of partial obstruction of larynx or trachea Laboratory Studies & Diagnostics
COMPLETE BLOOD COUNT
Hgb F 12 – 16 g/dl M 14 – 18 g/dl Hct F 38 – 47% M 40 – 54%
ARTERIAL BLOOD GAS (ABG)
✓ Provides information about oxygenation, ventilation, and the presence of acid- base disorder. pH 7.35 – 7. PaO2 100 mm Hg SaO2 (percentage of O2 bound to Hb)
PaCO2 35 – 45 mmHg HCO3 22 – 26 mEq/L ✓ A PREHEPARINIZED SYRINGE is used to obtain a blood sample by direct puncture of RADIAL ARTERY
Oximetry
▪ noninvasive monitoring of oxygen saturation ▪ A probe is applied to finger, earlobe.
SPUTUM STUDIES
- Culture and sensitivity
- Gram’s stain
- Acid-fast smear
RADIOLOGY
PULMONARY ANGIOGRAM
→ Injection of dye into the pulmonary artery
ENDOSCOPIC EXAMINATIONS
OTHERS
- Thoracentesis
- Pulmonary function test
