PULMONARY SYSTEM

1. Making breathing easier 2. Preventing transmission of infection (airborne, droplet)

O2 is delivered throughout the body by means of blood. Every cell in the body produces CO2 as it is the waste product. It is transported in veins and it is exhaled into the atmosphere when it reaches the lungs. When the body does not eliminate CO2 (whether d/t disease, distress, etc.), it creates chemical reactions causing an acid buildup in the blood. Death results if levels of acid and CO2 are too high.

 Less muscular strength making it more difficult to recover from effects of immobility  Less lung capacity, making it more difficult to recover from effects of anesthesia and surgery  Weaker coughs so more susceptible to pneumonia  Lungs lose their elasticity so there is less lung capacity

S&S OF RESPIRATORY PROBLEMS ( EARLY) S&S OF RESPIRATORY DISTRESS (LATE)  Increased RR  SOB  Anxiety/ Restlessness  Color changes  Skin changes  Respiratory arrest!!

INSUFFICIENT OXYGEN IN BLOODSTREAM Patients who are immobile, elderly, obese, post-op or have cardiac disease are high risk for hypoxemia Many risk for hypoxemia are on REGULAR medical/surgical floors in the hospital

 Pulse oximeter (pg. 622)- measures saturation of level of pt.’s hemoglobin with O2. Hemoglobin is the part of the blood that carries O2 to the cells  Capillary refill (pg. 622)- indicator of person’s peripheral circulation and how well tissues are being nourished with oxygen.

Indicator of person’s PERIPHERAL circulation and how well tissues are being nourished with O2

S&S OF DECREASED OXYGENATION S&S OF INADEQUATE BREATHING  RR below 12 or above 20  Cyanosis  Cool, clammy skin  SOB  Noisy breathing  Changes in mental status  Wheezing  Movement in chest is absent/minimal  Abdominal breathing  RR is too slow/rapid  Respirations appear labored  Pt. unable to speak d/t SOB  Nasal flaring

Infants and children do NOT have energy reserve so they become ill (respiratory distress) very quickly!!!

 Assess for S&S of respiratory distress (???)  High fowler’s position  Rest between ADL activities  Note VS, especially RR  After surgery: Breathe deeply Splint abd. Help pt. cough and deep breathe to expectorate sputum Incentive spirometer

Chronic Obstructive Pulmonary Disease (COPD) Group of conditions that result in CHRONIC blockage or obstruction of the respiratory system. Not reversible; (99% caused by smoking) EMPHYSEMA, CHRONIC BRONCHITIS

1. Emphysema - air sacs become distended, lose their elasticity so patients are unable to exchange O2 and CO2. Patients can inhale easily, but difficulty exhaling. Develops after chronic obstruction of air flow to alveoli. Caused by: smoking, exposure to chemicals Increase risk of developing pneumonia Causes strain on heart

Symptoms Headache- most common d/t increased CO2 levels Fatigue SOB Chronic low oxygen levels Loss of appetite Weight loss

Prolonged inflammation in bronchi S&S Persistant “wet cough” Sputum production (phlegm from lungs) SOB w/ exertion

Constriction of muscles of BRONCHIOLES w/ swelling of respiratory membranes, production of large amounts of mucous that fill the narrowed airways. S&S Labored breathing Tightness in chest Wheezing Frequent coughing

URI – Upper respiratory infection Pneumonia – Inflammation/infection in lungs. Most pneumonia is treatable with antibiotics

Respiratory Positions : --High Fowler’s --Orthopneic- makes thorax larger on inspirations, allowing pt. to inhale more air

Respiratory Treatments : 1. Oxygen Therapy- Mask, nasal cannula. Need doctor’s order, know the O2 flow rate, check for proper positioning of oxygen and may need cannula while eating if mask. Monitor O2 throughout shift.

2. Incentive Spirometer- Apparatus to encourage better ventilation and prevent atalectasis (collapse of alveoli) and pneumonia.

3. Nebulizer - delivers moisture and medications into lungs

General 1. Assist with breathing techniques (purse-lip) 2. Good nutrition 3. Pace ADL activities 4. Encourage fluid intake 5. Encourage deep breathing and coughing (relationship between pneumonia/coughing)

 Breathe deeply  Splint abd.  Help pt. cough and deep breathe to EXPECTORATE  Purse- lip breathing

1. Tracheostomy (pg. 671)- external opening on skin surface (STOMA) that provides airway for people requiring a ventilator or respirator or need suctioning. RN responsibility 2. Chest tube (pg. 673)- Sterile plastic tubes that are inserted through skin or chest, between ribs and into spaces between plueral membrane. Used after surgery to drain bloody fluid drainage from chest. RN responsibility CNA —Nothing should pull on tube, drainage system remains upright, below level of heart at ALL times, never twist or kink tubing