Oxygenation

mseuf- cnahsFunction of the Respiratory System The function of the respiratory system is gas exchangeOxygen from inspired air diffuses from alveoli in the lung into the blood in the pulmonary capillariesCarbon dioxide produced during cell metabolism diffuses from the blood into the alveoli and is exhaled.

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Essential to Normal Functioning of the Respiratory SystemIntegrity of the airway system to transport air to and from lungsProperly functioning alveolar system in lungsOxygenate venous bloodRemove carbon dioxide from bloodProperly functioning cardiovascular and hematological systemCarry nutrients and wastes to and from body cell

Upper AirwayFunction warm, filter, humidify inspired airComponentsNosePharynxLarynxEpiglottis

Lower AirwayFunctions conduction of air, mucociliary clearance, production of pulmonary surfactantComponentsTracheaRight and left mainstem bronchiSegmental bronchiTerminal bronchioles

mseuf- cnahsThe Respiratory System A

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Anatomy of the LungsMain organs of respirationExtend from the base of diaphragm to the apex above first ribThe right lung has three lobes; left lung has twoThe lungs are composed of elastic tissue (alveoli, surfactant, pleura)

Pulmonary VentilationInspiration the active phase of ventilationInvolves movement of muscles and thorax to bring air into lungsExpiration the passive phase of ventilationMovement of air out of the lungs

Process of VentilationThe diaphragm contracts and descends, lengthening the thoracic cavity.The external intercoastal muscles contract, lifting the ribs upward and outward.The sternum is pushed forward, enlarging the chest from front to back.Increased lung volume and decreased intrapulmonic pressure allows air to move from an area of greater pressure (outside lungs ) to lesser pressure (inside lungs).The relaxation of these structures results in expiration.

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Gas ExchangeRefers to the intake of oxygen and release of carbon dioxideMade possible by respiration and perfusionOccurs via diffusion (movement of oxygen and carbon dioxide between the air and blood)

mseuf- cnahsGas ExchangeOccurs after the alveoli are ventilatedPressure differences on each side of the respiratory membranes affect diffusionDiffusion of oxygen from the alveoli into the pulmonary blood vesselsDiffusion of carbon dioxide from pulmonary blood vessels into alveoli

mseuf- cnahsGas Exchange AnimationClick here to view an animation on gas exchange.Back to Directory

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Four Factors Influencing Diffusion of Gases in the LungsChange in surface area availableThickening of alveolar-capillary membranePartial pressureSolubility and molecular weight of the gas

Transport of Respiratory GasesOxygen is carried in the body via plasma and red blood cells.Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin.Hemoglobin also carries carbon dioxide in form of carboxyhemoglobin.Internal respiration between the circulating blood and tissue cells must occur.

mseuf- cnahsOxygen Transport AnimationClick here to view an animation on oxygen transport.Back to Directory

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Respiratory Activity in the InfantLungs are transformed from fluid-filled structures to air-filled organs.The infants chest is small, airways are short, and aspiration is a potential problem.Respiratory rate is rapid and respiratory activity is primarily abdominal.Synthetic surfactant can be given to the infant to reopen alveoli.Crackles heard at the end of deep respiration are normal.

Respiratory Activity in the ChildSome subcutaneous fat is deposited on the chest wall making landmarks less prominent.Eustachian tubes, bronchi, and bronchioles are elongated and less angular.The average number of routine colds and infections decreases until children enter day care or school.Good hand hygiene and tissue etiquette are encouraged.By end of late childhood, immune system protects from most infections.

Respiratory Functioning in the Older AdultBony landmarks are more prominent due to loss of subcutaneous fat.Kyphosis contributes to appearance of leaning forward.Barrel chest deformity may result in increased anteroposterior diameter.Tissues and airways become more rigid; diaphragm moves less efficiently.Older adults have an increased risk for disease, especially pneumonia.

Factors Affecting Respiratory FunctioningLevels of healthDevelopmental considerationsMedicationsLifestyleEnvironment Psychological health

Guidelines for Obtaining a Nursing HistoryDetermine why the patient needs nursing care. Determine what kind of care is needed to maintain a sufficient intake of air.Identify current or potential health deviations.Identify actions performed by the patient for meeting respiratory needs. Make use of aids to improve intake of air and effects on patients lifestyle and relationship with others.

Sounds Heard Upon Percussion of Chest WallResonance loud, hollow low-pitched sound, heard over normal lungsHyperresonance loud, low booming sound heard over emphysematous lungsFlat sound detected over bone or heavy muscleDull sound with medium pitch and intensity heard over the liverTympany high-pitched, loud, drum-like sound produced over the stomach

Breath SoundsVesicular low pitched soft sound during expiration heard over most of lungsBronchial high pitch and longer, heard primarily over tracheaBronchovesicular medium pitch and sound during expiration, heard over upper anterior chest and intercostal area

Abnormal (Adventitious) Lung SoundsCrackles intermittent sounds occurring when air move through airways that contain fluidClassified as fine, medium, or coarseWheezes continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumorsClassified as sibilant or sonorous

Common Diagnostic MethodsPulmonary function studiesPeak expiratory flow ratePulse oximetryThoracentesis

Lung Volumes Tidal volume (TV) amount of air inspired and expired in normal respiration (normal = 500mL)Inspiratory reserve volume (IRV) amount of air inspired beyond tidal volume (normal = 3100mL)Expiratory reserve volume (ERV) amount of air that can be exhaled beyond tidal volume (normal = 1200mL)Residual volume (RV) amount of air remaining in lungs after a maximal expiration (normal = 1200mL)

Lung CapacitiesVital capacity (VC) amount of air that can be exhaled after a maximal inhalation (normal = 4800mL)Inspiratory capacity (IC) largest amount of air that can be inhaled after normal quiet exhalation (normal = 3600mL)Functional residual volume (FRV) equal to the expiratory reserve volume plus the residual volume (normal = 2400mL)Total lung capacity (TLC) the sum of the TV, IRV, ERV, and RV (normal = 6000mL)

mseuf- cnahsFactors that Influence Respiratory FunctionAgeEnvironmentLifestyleHealth statusMedicationsStress

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mseuf- cnahsCommon Manifestations of Impaired Respiratory FunctionHypoxiaAltered breathing patternsObstructed or partially obstructed airway

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mseuf- cnahsHypoxiaCondition of insufficient oxygen anywhere in the bodyRapid pulseRapid, shallow respirations and dyspneaIncreased restlessness or lightheadednessFlaring of naresSubsternal or intercostal retractionsCyanosis

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mseuf- cnahsAltered Breathing PatternsTachypnea (rapid rate)Bradypnea (abnormally slow rate)Apnea (cessation of breathing)Kussmauls breathingCheyne-Stokes respirationsBiots respirations

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mseuf- cnahsAlterations in Ease of BreathingOrthopneaDyspnea

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mseuf- cnahsObstructed or PartiallyObstructed AirwayPartial indicated by low-pitched snoring during inhalationComplete indicated by extreme inspiratory effort with no chest movement

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mseuf- cnahsDesired OutcomesMaintain a patent airwayImprove comfort and ease of breathingMaintain or improve pulmonary ventilation and oxygenationImprove ability to participate in physical activitiesPrevent risks associated with oxygenation problems

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Planning: Expected OutcomesDemonstrate improved gas exchange in lungs by absence of cyanosis or chest pain and a pulse oximetry reading >95%Relate the causative factors and demonstrate adaptive method of copingPreserve pulmonary function by maintaining an optimal level of activityDemonstrate self-care behaviors that provide relief from symptoms and prevent further problems

Nursing Interventions Promoting Adequate Respiratory FunctioningTeaching about a pollution-free environmentPromoting optimal functionPromoting proper breathingManaging chest tubesPromoting and controlling coughingPromoting comfortMeeting respiratory needs with medications

mseuf- cnahsNursing Measures to Promote Respiratory FunctionEnsure a patent airwayPositioningEncouraging deep breathing, coughingEnsuring adequate hydration

mseuf- cnahsTherapeutic Measures to Promote Respiratory FunctionMedicationsIncentive spirometryChest PTPostural drainage Oxygen therapyArtificial airwaysAirway suctioningChest tubes

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Types of Cough MedicationsCough suppressantsExpectorantsLozenges

Administering Inhaled MedicationsBronchodilators open narrowed airwaysMucolytic agents liquefy or loosen thick secretionsCorticosteroids reduce inflammation in airways

Types of InhalersNebulizers disperse fine particles of medication into deeper passages of respiratory tract where absorption occursMetered dose inhalers delivers controlled dose of medication with each compression of the canisterDry powder inhaler activated by the patients inspiration

mseuf- cnahsIncentive SpirometryAB

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mseuf- cnahsChest PT

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mseuf- cnahsOxygen Therapy

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mseuf- cnahsOxygen TherapySimple face maskPartial rebreathermaskNasal cannula

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mseuf- cnahsOxygen Therapy

Nonrebreather maskVenturi mask

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Precautions for Oxygen AdministrationAvoid open flames in patients roomPlace no smoking signs in conspicuous placesCheck to see electrical equipment in room is in good working orderAvoid wearing and using synthetic fabrics (builds up static electricity)Avoid using oils in the area (ignite spontaneously in oxygen)

mseuf- cnahsHumidifier VideoClick here to view a video on humidifiers.Back to Directory

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mseuf- cnahsIncentive Spirometry VideoClick here to view a video on incentive spirometry.Back to Directory

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mseuf- cnahsNasal Cannula Video

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mseuf- cnahsNonrebreather Mask Video

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mseuf- cnahsArtificial AirwaysOropharyngeal AirwayNasopharyngeal Airway

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Type of Artificial AirwaysOropharangeal and nasopharyngeal airwayEndotracheal tubeTracheostomy tube

mseuf- cnahsArtificial Airways

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mseuf- cnahsTracheostomy Tube

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Managing Chest TubesAssist with insertion and removal of chest tubeMonitor the patients respiratory status and vital signsCheck the dressingMaintain the patency and integrity of the drainage system

mseuf- cnahsChest Drainage System

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mseuf- cnahsHeimlich Chest Drainage Valve

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mseuf- cnahsPneumostat

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Administering Cardiopulmonary Resuscitation (ABCs)Airway: tip the head and check for breathingBreathing: if victim is not breathing spontaneously, give two breaths lasting 1.5 to 2 secondsCirculation: check the pulse, if victim has no pulse, initiate chest compressions

***Figure 50-1 A, Organs of the respiratory tract. B, Respiratory bronchioles, alveolar ducts, and alveoli.*Figure 50-2 Gas exchange occurs between the air on the alveolar side and the blood on the capillary side.**Figure 1-2 Harriet Tubman (18201913) was known as The Moses of Her People for her work with the Underground Railroad. During the Civil War (18611865), she nursed the sick and suffering of her own race. (CORBIS Images)Figure 1-3 Sojourner Truth (17971883), abolitionist, Underground Railroad agent, preacher, and womens rights advocate, was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedmens Relief Association after the war. (Randall Studio (1805-1875) Sojourner Truth (c. 1797-18--), abolitionist. Copyright 1870. Photograph, Albumen Silver Print. Copyright National Portrait Gallery, Smithsonian Institution/Art Resources, NY.)Figure 1-4 Dorothea Dix (18021887) was the Unions Superintendent of Female Nurses during the Civil War. (CORBIS Images)Figure 1-9 Considered the founder of modern nursing, Florence Nightingale (18201910) was influential in developing nursing education, practice, and administration. Her publication, Notes on Nursing: What It Is, and What It Is Not, first published in England in 1859 and in the United States in 1860, was intended for all women. (Bettman/CORBIS).Figure 1-10 Clara Barton (18121912) organized the American Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882.*Figure 1-2 Harriet Tubman (18201913) was known as The Moses of Her People for her work with the Underground Railroad. During the Civil War (18611865), she nursed the sick and suffering of her own race. (CORBIS Images)Figure 1-3 Sojourner Truth (17971883), abolitionist, Underground Railroad agent, preacher, and womens rights advocate, was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedmens Relief Association after the war. (Randall Studio (1805-1875) Sojourner Truth (c. 1797-18--), abolitionist. Copyright 1870. Photograph, Albumen Silver Print. Copyright National Portrait Gallery, Smithsonian Institution/Art Resources, NY.)Figure 1-4 Dorothea Dix (18021887) was the Unions Superintendent of Female Nurses during the Civil War. (CORBIS Images)Figure 1-9 Considered the founder of modern nursing, Florence Nightingale (18201910) was influential in developing nursing education, practice, and administration. Her publication, Notes on Nursing: What It Is, and What It Is Not, first published in England in 1859 and in the United States in 1860, was intended for all women. (Bettman/CORBIS).Figure 1-10 Clara Barton (18121912) organized the American Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882.********Figure 50-4 A client using the overbed table to assist with breathing.

**Figure 50-5 A, Flow-oriented SMI; B, volume-oriented SMI.*Figure 50-6 Percussing the upper posterior chest.Figure 50-7 Vibrating the upper posterior chest.*Figure 50-9 Insert flow meter into the wall unit.Figure 50-8 An oxygen humidifier attached to a wall outlet oxygen flow meter.Figure 50-10 This flow meter is set to deliver 2 L/minute.

*Figure 50-11 A nasal cannulaFigure 50-12 A simple face mask.Figure 50-13 A partial rebreather mask.Figure 50-13 A partial rebreather mask.*Figure 50-14 A nonrebreather mask.Figure 50-15 A Venturi mask.*Figure 1-2 Harriet Tubman (18201913) was known as The Moses of Her People for her work with the Underground Railroad. During the Civil War (18611865), she nursed the sick and suffering of her own race. (CORBIS Images)Figure 1-3 Sojourner Truth (17971883), abolitionist, Underground Railroad agent, preacher, and womens rights advocate, was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedmens Relief Association after the war. (Randall Studio (1805-1875) Sojourner Truth (c. 1797-18--), abolitionist. Copyright 1870. Photograph, Albumen Silver Print. Copyright National Portrait Gallery, Smithsonian Institution/Art Resources, NY.)Figure 1-4 Dorothea Dix (18021887) was the Unions Superintendent of Female Nurses during the Civil War. (CORBIS Images)Figure 1-9 Considered the founder of modern nursing, Florence Nightingale (18201910) was influential in developing nursing education, practice, and administration. Her publication, Notes on Nursing: What It Is, and What It Is Not, first published in England in 1859 and in the United States in 1860, was intended for all women. (Bettman/CORBIS).Figure 1-10 Clara Barton (18121912) organized the American Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882.*Figure 1-2 Harriet Tubman (18201913) was known as The Moses of Her People for her work with the Underground Railroad. During the Civil War (18611865), she nursed the sick and suffering of her own race. (CORBIS Images)Figure 1-3 Sojourner Truth (17971883), abolitionist, Underground Railroad agent, preacher, and womens rights advocate, was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedmens Relief Association after the war. (Randall Studio (1805-1875) Sojourner Truth (c. 1797-18--), abolitionist. Copyright 1870. Photograph, Albumen Silver Print. Copyright National Portrait Gallery, Smithsonian Institution/Art Resources, NY.)Figure 1-4 Dorothea Dix (18021887) was the Unions Superintendent of Female Nurses during the Civil War. (CORBIS Images)Figure 1-9 Considered the founder of modern nursing, Florence Nightingale (18201910) was influential in developing nursing education, practice, and administration. Her publication, Notes on Nursing: What It Is, and What It Is Not, first published in England in 1859 and in the United States in 1860, was intended for all women. (Bettman/CORBIS).Figure 1-10 Clara Barton (18121912) organized the American Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882.*Figure 1-2 Harriet Tubman (18201913) was known as The Moses of Her People for her work with the Underground Railroad. During the Civil War (18611865), she nursed the sick and suffering of her own race. (CORBIS Images)Figure 1-3 Sojourner Truth (17971883), abolitionist, Underground Railroad agent, preacher, and womens rights advocate, was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedmens Relief Association after the war. (Randall Studio (1805-1875) Sojourner Truth (c. 1797-18--), abolitionist. Copyright 1870. Photograph, Albumen Silver Print. Copyright National Portrait Gallery, Smithsonian Institution/Art Resources, NY.)Figure 1-4 Dorothea Dix (18021887) was the Unions Superintendent of Female Nurses during the Civil War. (CORBIS Images)Figure 1-9 Considered the founder of modern nursing, Florence Nightingale (18201910) was influential in developing nursing education, practice, and administration. Her publication, Notes on Nursing: What It Is, and What It Is Not, first published in England in 1859 and in the United States in 1860, was intended for all women. (Bettman/CORBIS).Figure 1-10 Clara Barton (18121912) organized the American Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882.*Figure 1-2 Harriet Tubman (18201913) was known as The Moses of Her People for her work with the Underground Railroad. During the Civil War (18611865), she nursed the sick and suffering of her own race. (CORBIS Images)Figure 1-3 Sojourner Truth (17971883), abolitionist, Underground Railroad agent, preacher, and womens rights advocate, was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedmens Relief Association after the war. (Randall Studio (1805-1875) Sojourner Truth (c. 1797-18--), abolitionist. Copyright 1870. Photograph, Albumen Silver Print. Copyright National Portrait Gallery, Smithsonian Institution/Art Resources, NY.)Figure 1-4 Dorothea Dix (18021887) was the Unions Superintendent of Female Nurses during the Civil War. (CORBIS Images)Figure 1-9 Considered the founder of modern nursing, Florence Nightingale (18201910) was influential in developing nursing education, practice, and administration. Her publication, Notes on Nursing: What It Is, and What It Is Not, first published in England in 1859 and in the United States in 1860, was intended for all women. (Bettman/CORBIS).Figure 1-10 Clara Barton (18121912) organized the American Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882.**Figure 50-22 An endotracheal tube (ET).*Figure 50-25 A tracheostomy tube with a low-pressure cuff.Figure 50-27 A tracheostomy mist collar.Figure 50-26 A tracheostomy tube with a foam cuff.*Figure 50-32 A disposable chest drainage system. (From Genzyme Biosurgery, Cardiothoracic Division, Fall River, MA).*Figure 50-33 Heimlich chest drain valve.*Figure 50-34 The Pneumostat is an example of a device often used for clients with a pneumothorax. It uses a one-way valve and has a small collection chamber. (Atrium Medical Corporation).