RESPIRATORY SYSTEM ANATOMY & PHYSIOLOGY  FUNCTIONS: y Provides oxygen for tissue metabolism y Removes carbon dioxide &

waste product metabolism  UPPER RESPIRATORY TRACT 1. Nose humidifies, warms, filters inspired air 2. Sinuses air-filled cavities; provide resonance during speech 3. Pharynx located behind the oral and nasal cavities; passageway for the respiratory and digestive tract 4. Larynx located above the trachea; called the voice box; contains the glottis which plays an important role in coughing (fundamental defense mechanism of the lungs) 5. Epiglottis leaf-shaped structure on top of the larynx; closes over the glottis during swallowing  LOWER RESPIRATORY TRACT 1. Trachea located in front of the esophagus; branches into right & left bronchi 2. Mainstem bronchi y Right bronchus slightly wider, shorter & more vertical than the left bronchi y Lined with cilia 3. Bronchioles no cartilage & depends on the elastic recoil of the lung; terminal bronchioles has no cilia; do not participate in gas exchange 4. Alveolar ducts & alveoli all structures distal to the terminal bronchiole; cells in the walls of the alveoli secrete surfactant that reduces the surface tension in the alveoli 5. Lungs y Extend just above the clavicles to the diaphragm y Right lung larger than the left lung; divided into 3 lobes y Left lung is narrower divided into 2 lobes

Innervated by the phrenic nerve, vagus nerve & thoracic nerves y Has the parietal and visceral pleura; lining the pleural is a thin fluid layer 6. Accessory muscles of respiration include the scalene, sternocleidomastoid, trapezius & pectoralis muscles y  THE RESPIRATORY PROCESS 1. At rest y Inspiratory muscles relax y Atmospheric pressure is maintained in the tracheobronchial tree y No air movement occurs 2. Inhalation y Inspiratory muscles contract y Diaphragm descends y Negative alveolar pressure is maintained y Air moves into the lungs 3. Exhalation y Inspiratory muscles relax, causing the lungs to recoil to their resting size and position y The diaphragm ascends y Positive alveolar pressure is maintained y Air moves out of the lungs COMMON DIAGNOSTIC EXAMS  CHEST XRAY y Shows anatomical location & appearance of the lungs  Pre: y Remove all jewelry & other metal objects y For female clients, assess for pregnancy or the possibility of pregnancy  SPUTUM SPECIMEN y Assist in identification of organisms or abnormal cells  Pre: y Instruct to rinse mouth with water before collection y Instruct to take several deep breaths & then cough deeply

y y y

Always collect specimen before antibiotic therapy begins obtain an early morning sterile specimen from suctioning or expectoration obtain 15 ml of sputum

y y y

Avoid taking BP for 24 hrs on the affected extremity Monitor circulatory and neurovascular status of affected extremity Assess for bleeding on insertion site & delayed reaction to the dye

 BRONCHOSCOPY y Direct visualization of the larynx, trachea, & bronchi  Pre: y Obtain informed consent y NPO status from midnight before the test y Obtain baseline VS y Prepare suction equipment  Post: y Monitor VS, monitor respiratory status y Place client in semi-fowler position y Maintain on NPO until gag reflex returns y Monitor for complications: (Bronchospasm, perforation, fever, bacteremia, hemorrhage, hypoxemia & pneumothorax) notify physician immediately  PULMONARY ANGIOGRAPHY y Invasive procedure y Catheter is inserted through the antecubital or femoral vein into the pulmonary artery or one of its branches y Involves injection of iodine or radiopaque or contrast media  Pre: y Obtain informed consent y Assess allergies to iodine, seafood or other radiopaque dyes y Maintain NPO status 8 hrs before procedure y Assess results of coagulation workups y Monitor VS y Instruct to lie still; administer sedatives if prescribed y Inform client that he may feel an urge to cough, flushing, nausea or salty taste ff injection of the dye y Have emergency resuscitation equipment ready  Post: y Monitor VS

 THORACENTESIS y Removal of fluid or air from the pleural space  Pre: y Obtain informed consent y Obtain VS y Prepare client for UTZ or CXR if prescribed y Assess coagulation studies y Position client sitting upright with the arms and head supported by a table at the bedside during the procedure or placed lying in bed on the unaffected side with head of the bed elevated 45 degrees y Instruct not to cough, breathe deeply or move during the procedure  Post: y Monitor VS, respiratory status y Apply pressure dressing and assess for bleeding and crepitus at the puncture site y Monitor for pneumothorax, air embolism & pulmonary edema

RESPIRATORY DISORDERS  CHRONIC OBSTRUCTIVE PULMONARY DISEASE y Group of diseases that includes: 1. Emphysema 2. Chronic Bronchitis 3. Bronchiectasis 4. Asthma y Characterized by progressive airflow limitations into & out of the lungs, elevated airway resistance, irreversible lung distention and ABG imbalance y Leads to pulmonary insufficiency, pulmonary hypertension and cor pulmonale y Causes: smoking, recurrent or chronic respiratory tract infection, allergies, familial alpha1-antitrypsin deficiency

1. EMPHYSEMA y Abnormal, irreversible enlargement of air spaces distal to terminal bronchioles due to: destruction of alveolar walls, resulting to decreased elastic recoil of the lungs  PATHOPHYSIOLOGY: y Recurrent inflammation associated with release of proteolytic enzymes from cells leading to bronchiolar and alveolar wall damage and ultimately destruction y Decreased surface area for gas exchange due to alveolar wall destruction y Decreased elastic recoil and airway collapse  ASSESSMENT: y Barrel chest y Use of accessory muscles for breathing y Dyspnea, tachypnea, orthopnea y Prolonged expiratory period with grunting y Pursed-lip breathing  INTERVENTIONS: y Administer low concentration of oxygen (1-2L/min) as prescribed y Advise purse-lip breathing y Position in high fowlers position to aid in breathing 2. CHRONIC BRONCHITIS (BLUE BLOATER) y Excessive mucus production with productive cough for at least 3 months per year for 2 successive years y Related to smoking; exacerbated by respiratory infection  PATHOPHYSIOLOGY: y Hypertrophy and hyperplasia of bronchial mucus glands, increased goblet cells, damaged cilia, chronic leukocytic & lymphocytic infiltration of bronchial walls  ASSESSMENT: y Increased sputum production; copious sputum (gray, white, yellow)

y y

Worsening dyspnea, tachypnea Wheezes, rhonchi

 INTERVENTIONS: y increase humidity y provide postural drainage before meals y teach the patient about breathing techniques like: blowing bubbles, blowing a trumpet, blowing a feather in the air y administer bronchodilators to relieve bronchospasm and antibiotics for infection y oxygen for hypoxemia 3. BRONCHIECTASIS y Irreversible condition marked by chronic abnormal dilation of bronchi & destruction of bronchial walls y Results from repeated damage of bronchial walls & abnormal mucociliary clearance that causes breakdown of supportive tissue adjacent to the airways  ASSESSMENT: y Chronic cough y Copious, foul-smelling, mucopurulent secretions y Crackles, occasional wheezes y Dyspnea y Recurrent fever, chills & other signs of infection 4. ASTHMA y Increased bronchial reactivity to various stimuli which produces episodic bronchospasm & airway obstruction in conjunction with airway inflammation y Caused by: allergy, release of mast cell vasoactive & bronchospastic mediators in response to allergic reaction y Triggered by 3 Es (exercise especially in cold weather, environmental factors like dust, pollen; emotional factors)  ASSESSMENT: y Intermittent attacks of dyspnea & wheezing y Productive cough y Dyspnea, orthopnea

 INTERVENTIONS: y Instruct the patient to avoid the 3 Es y Advise to sit upright and lean forward on during asthmatic attacks y Encourage to do purse lip breathing y Adequate fluid intake & chest physiotherapy to mobilize secretions y Administer bronchodilators, steroids & mucolytics as prescribed y Oxygen for hypoxemia  PULMONARY EMBOLISM y Occurs when a thrombus that forms in a deep vein detaches and travels to the right side of the heart & then lodges in a branch of the pulmonary artery y Risk factors: DVT, prolonged immobilization, surgery, obesity, pregnancy, CHF, advanced age, or history of thromboembolism  PATHOPHYSIOLOGY: y Thrombus loosen or fragmentize, now an embolus floats to the right side of the heart & enters the lung through the pulmonary artery leading to obstruction resulting to alveoli collapse & atelectasis  ASSESSMENT: y Dyspnea, shallow respirations y Blood-tinged sputum y Angina or pleuritic chest pain y Cough y Tachycardia, hypotension y Low grade fever  INTERVENTIONS: y Administer oxygen as prescribed y Position client in high fowlers position y Maintain bed rest & active & passive range of motion exercises y Monitor pulse oximetry y Monitor protrombin time and partial thromboplastin time y Prepare client for Embolectomy, vein ligation or insertion of an umbrella filter, as prescribed y Administer medications as prescribed:

1. Anticoagulation therapy IV with heparin sodium bolus ff by continuous infusion 2. Warfarin (Coumadin) orally when heparin infusion is discontinued