THE RESPIRATORY SYSTEM &

OXYGENATIONLisa B. Flatt, RN, MSN, CHPN

Anatomy & Physiology

Nose Pharynx Larynx Tracheobronchial Tree Right & Left Bronchus Bronchioles Alveoli Lungs Cilia Diaphragm Pleural Cavity

Breathe Deeply……..

The pharynx is the passageway for _air_into the lungs and _food __into the __esophagus_.

The left lung has __2___lobes. The right lung has __3____lobes. The smallest structure in the lungs is the

_alveoli_ . The _alveoli__is the gas-exchange unit. What warms air _cilia____ and in conjunction

with mucus traps dust, allergens, particles…

The Alveoli

Are encased in parchment thin capillary filled sacks

O2 & CO2 are exchanged by diffusion (movement of particles from area of higher to lower concentration)

O2 combines with hemoglobin (goes to the tissue as oxyhemoglobin)

CO2 is exhaled after the venous system returns oxygen depleted blood to the lungs

What and how they do it….. Out into the body……

The Need to Breathe

The goal is to move air in and out of the lungs

You need physics and gas pressures and must equalize the pressure inside and out

Breathing is automatic Breathe in and diaphragm goes __down__

so the pressure inside your chest is __greater_than outside.

Need for oxygen & to get rid of excess CO2

What would cause an increased demand for oxygen?

Name some disease states __stress, anxiety__________ ___anemia, lung diseases_________

Name some illnesses ____infection, sepsis_________ ____fever_________

What about others? Pg. 57 ___activity__________ ___age related, shape you’re in!__________

Lung function, capacity and elasticity are measured by: Tidal volume-amt. you breath in and breath out Vital capacity-maximum amt. of air you breath out after the maximum

amt of air you breath in Total lung capacity-max amt of air in lungs after max inspiratory effort Residual volume-amt of air left in lungs after forced exhalation Expiratory reserve volume-amt of air forcefully exhaled after normal

TV exhalation Inspiratory reserve volume-amt of air forcefully inhaled after your

normal TV

Pulmonary Function Test (PFT) – measures all of above, tells us about overall lung function and if they are congruent with functioning

Disease States

Asthma Sudden Infant Death Syndrome Emphysema COPD Posture : kyphosis Cancer Bronchitis

Smoking……

What does it do to our bodies Cilia – decreased motility, get

stuck to the sides Mucus – gross colors, sticky and

thick, increased and cough it up Air exchange – poor, decreased,

deprives the body

Fun facts….

Narcotics effect on breathing___suppress, no effect/increase in O2 usage: Morphine, suppresses respiration, decreases the myocardial consumption of oxygen___

Lung cancer and predisposing occupations ___asbestosis, construction, radiation___________ ___farmers, agriculture, chemical exposure___________ ___coal mining, second hand smoke, smokers__________

Physical conditions that can affect oxygenation ___activity, breathing patterns___________ ___body habitus, stress, illness___________ ___age, pain, crying-depression/psychological

state___________

Respirations

Normal rate adults:_12-20bpm___infants:_30-60??___ Rapid rate is called_tachypnea___________

Reasons:__spesis, pain, fever, activity, metabolic acidosis_________________________

Decreased rate is called___bradypnea_______ Reasons:__medication, brain injury, psychological

state, metabolic states___ Excessive amount of air in lungs__hyperventilation___ Inadequate amount of air in lungs_hypoventilation___ Difficult or labored breathing__dyspnea________

Respirations cont’d

Labored or difficult breathing __dyspnea_______

Must sit upright to breath___orthopnea_____ Apnea is _not breathing____________________ Breathing pattern with periods of apnea

lasting __10-60 sec. is called___cheyne-stokes__

Gasping breathing associated with diabetes__kussmaul’s___

Thermoregulation – body maintaining a ‘normal’ temperature 98.6

Increased respiratory rate

Increased VS Vasodilation Diaphoretic seizures

Decreased respiratory rate

Shiver Pupillary changes Vasoconstriction Heart, vs

decrease

Hyperthermia Hypothermia

Contains and carrier iron

Low hgb treated with __iron____Side effects of Iron: constipation, dk stools, GI upset______

Hgb can be decreased from __CO poisoning, hemorrhage, GIB_____

Hemoglobin

How do the following affect breathing? Age – lung capacity decreases as you

age Sex – men have increased lungs/bigger

chests Cigar/cigarette smoking – decrease lung

compliance, damage structures Cultural/spiritual or religious background

– peace pipes, smoking, incense

More…… And More……….

Activity – good, increases lung capacity and compliance

Diet – healthy, iron Body weight - appropriate Height - OK Aerobic exercise – increase respiratory

rate, air exchange and burning calories Stress – (like aerobic exercise!), bad

stuff

….. And More……

Environmental Factors - toxins Altitudes- higher thinner air, less O2 Ventilation of space – air movement, clean Occupations – breathing in harmful

substances Air temperature and humidity – hot and

cold, painful, humid - stuffy Alternative and Holistic therapies –

hypnosis, etc…

3 Areas of Altered Respiratory Function Movement of air in or out of the lungs

(altered O2 intake and supply) Diffusion of O2 and CO2 (between alveoli

and pulmonary capillaries) Transport of O2 and CO2 (altered

cellular demand for O2)

Movement of air in or out of the lungs (altered O2 intake and supply)

Oxygen intake needs exceed what they can take in – blockage (nasal)

Tumor, food, mucus, anything….

Diffusion of O2 and CO2 (between alveoli and pulmonary capillaries)

Diffusion is movement of particles from an area of higher concentration to lower concentration

Anemia, BMT failures, lung diseases

Transport of O2 and CO2 (altered cellular demand for O2)

More hgb=greater O2 capacity Sepsis, fever, exercise

Oxygen Safety

No smoking No flames No fires Tripping over stuff, like tubing and

cannisters Humidifier with NS – keeps nasal mucosa

moist

Oxygen delivery methods

BVM – bag valve mask Ventilator – endotracheal tube Nasal cannula – 2-6 L Face Mask – varying amounts of oxygen Nonrebreather mask – 100% - 2/3 on inspiration –

completely collapses? = breath CO2 Face tent – rarely used Transtracheal oxygen – O2 via trach CPAP BiPAP

Oxygen

Oxygen saturation – amount/percent of O2 in RBC – used by pulse ox

FiO2 – fracional concentration of oxygen

Blood Products

Plasma – volume expander, clotting factors RBC – H/H and iron IVIG – intravenous immune globulins Platelets- clotting Cryoprecipitate – clotting factors / frozen

product from plasma Albumin – promotes intravascular fluid

absorption Prolastin – for alpha-one antitrypsin

disease (enzyme deficiency)

S/S Transfusion Reaction

Chills Fever Headache Backache Hematuria Clammy SOB

Others…

Circulatory overload – vein distention, cough, crackles, tachycardia, HTN – go slow, titrate up and check VS!

Nursing Promotions

Percussion Postural drainage Nasopharyngeal suctioning Incentive Spirometer Coughing and deep breathing Medications Pursed lip breathing – fish face Hydration Pulmonary toileting

Medications

Bronchodilators Expectorants Antitussives Some cardiac drugs can be used to

increase respiration and oxygens: NTG, calcium channel blockers, etc.. See page 71

Blood gases

See handout I gave you!

Care Plan