1. THE RESPIRATORY SYSTEM & OXYGENATION Lisa B. Flatt, RN, MSN, CHPN

2. Anatomy & Physiology  Nose  Pharynx  Larynx  Tracheobronchial Tree  Right & Left Bronchus  Bronchioles  Alveoli  Lungs  Cilia  Diaphragm  Pleural Cavity

3. 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…

4. 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……

5. 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

6. 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!__________

7. 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

8. Disease States  Asthma  Sudden Infant Death Syndrome  Emphysema  COPD  Posture : kyphosis  Cancer  Bronchitis

9. 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

10. 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___________

11. 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________

12. 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___

13. 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 HyperthermiaHypothermia

14. 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

15. 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

16. 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

17. ….. 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…

18. 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)

19. 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….

20. 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

21. Transport of O2 and CO2 (altered cellular demand for O2)  More hgb=greater O2 capacity  Sepsis, fever, exercise

22. Oxygen Safety  No smoking  No flames  No fires  Tripping over stuff, like tubing and cannisters  Humidifier with NS – keeps nasal mucosa moist

23. 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

24. Oxygen  Oxygen saturation – amount/percent of O2 in RBC – used by pulse ox  FiO2 – fracional concentration of oxygen

25. 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)

26. S/S Transfusion Reaction  Chills  Fever  Headache  Backache  Hematuria  Clammy  SOB

27. Others…  Circulatory overload – vein distention, cough, crackles, tachycardia, HTN – go slow, titrate up and check VS!

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

29. Medications  Bronchodilators  Expectorants  Antitussives  Some cardiac drugs can be used to increase respiration and oxygens: NTG, calcium channel blockers, etc.. See page 71

30. Blood gases  See handout I gave you!

31. Care Plan