1. Chapter 12 The Respiratory System Medical-Surgical Nursing: Concepts & Practice 3 rd edition Copyright © 2017, Elsevier Inc. All rights reserved.

2.  Describe the structure and function of the respiratory system.  Analyze three causative factors related to disorders of the respiratory system.  Summarize nursing responsibilities for patients undergoing diagnostic tests and procedures for disorders of the respiratory system.  Provide instructions to patients on measures to prevent long-term problems of the respiratory system. 2 Theory Objectives

3. Copyright © 2017, Elsevier Inc. All rights reserved.  Employ proper techniques for assessing the respiratory system.  Verify that nursing diagnoses chosen for patients with problems of the respiratory system are appropriate.  Propose interventions for a patient who has a problem with oxygenation.  Teach a patient about smoking cessation. 3 Clinical Practice Objectives

4. Copyright © 2017, Elsevier Inc. All rights reserved.  Upper respiratory system  Structures  Functions  Airway protection  Speech production 4 Anatomy and Physiology of the Respiratory System

5. 5

6. Copyright © 2017, Elsevier Inc. All rights reserved. 6 Structures of the Upper Respiratory Tract

7. Copyright © 2017, Elsevier Inc. All rights reserved. 7 Paranasal Sinuses

8. Copyright © 2017, Elsevier Inc. All rights reserved.  Lower respiratory system  Structures  Functions  Oxygen delivery and diffusion  Lung protection  Respiration control  Exchange of oxygen and carbon dioxide 8 Anatomy and Physiology of the Respiratory System (Cont.)

9. 9

10. Copyright © 2017, Elsevier Inc. All rights reserved.  Diffusion  Elastance  Hypoxemia  Hypoxia  Lung compliance  Perfusion  Pulmonary hygiene  Resistance  Respiratory failure  Shunting  Surfactant  Ventilation 10 Terms Commonly Used in Respiratory Care

11. Copyright © 2017, Elsevier Inc. All rights reserved.  Trauma or disease  Susceptible to harmful substances  Restrictive diseases  Obstructive pulmonary diseases 11 Respiratory Disorders

12. Copyright © 2017, Elsevier Inc. All rights reserved.  Older than 65 years of age  Cigarette smoking  Residing in extended-care facilities  Chronic respiratory disorders (includes asthma)  Congenital or chronic cardiovascular disorders  Chronic renal disease  Diabetes mellitus or a chronic metabolic disorder  Compromised immune response 12 Factors that Increase Risk for Respiratory Infection

13. Copyright © 2017, Elsevier Inc. All rights reserved.  Practice hand hygiene frequently.  Stay out of crowds, especially during cold and flu season.  Refrain from smoking.  Avoid known allergens as much as possible.  Maintain adequate nutrition and obtain sufficient rest; helps keep the immune system healthy. 13 Preventing Respiratory Disorders

14. Copyright © 2017, Elsevier Inc. All rights reserved.  Teach people to seek medical assessment when hoarseness or a sore throat lasts longer than 2 weeks because this will assist in the early detection of throat malignancy. 14 Sore Throat

15. Copyright © 2017, Elsevier Inc. All rights reserved.  Older adults should not be exposed to children with colds and coughs.  An older adult who is mostly confined to the house or a long-term care facility and does not mingle with the public much does not have the immunity to common viruses and bacteria that younger, more socially active people do. 15 Older Adult Care Points

16. Copyright © 2017, Elsevier Inc. All rights reserved.  The U.S. Public Health Service Advisory Committee on Immunization recommends immunization against pneumococcal infection for high-risk persons.  Although there is some danger in taking the vaccine, the benefits far outweigh the risks. 16 Pneumococcal Immunization for High-Risk Persons

17. Copyright © 2017, Elsevier Inc. All rights reserved. 17 Smoking and Tobacco Cessation  5 As  Ask about tobacco use.  Advise about the health benefits of quitting.  Assess readiness to quit.  Assist in creating a cessation plan.  Arrange follow-up.

18. Copyright © 2017, Elsevier Inc. All rights reserved. 18 Assessment (Data Collection)  History taking  Physical assessment  Diagnostic tests and procedures  Diagnostic visual examination of the nose, mouth, and throat

19. Copyright © 2017, Elsevier Inc. All rights reserved. 19 Clubbing of Fingers

20. Copyright © 2017, Elsevier Inc. All rights reserved.  Thick, tenacious, and “ropey”; difficult to cough up  Chronic bronchitis, emphysema  Scant, sticky, rust colored  Pneumococcal pneumonia  Frothy, pinkish, or blood-tinged  Pulmonary edema  Yellow, yellow-green, or grayish-yellow, with foul odor or taste  Pulmonary infection 20 Characteristics of Sputum and Possible Causes

21. Copyright © 2017, Elsevier Inc. All rights reserved.  Blood tinged, bloody, or blood streaked  Tuberculosis, ulcerated pulmonary vessel, or bronchogenic carcinoma  Large amounts  Pneumonia or bronchitis  Scanty  Asthma  Very thick and viscous  Inadequate hydration 21 Characteristics of Sputum and Possible Causes (Cont.)

22. Copyright © 2017, Elsevier Inc. All rights reserved. 22 Sites for Auscultation of the Lungs

23. 23

24. Copyright © 2017, Elsevier Inc. All rights reserved.  Vesicular breath sounds  Low to medium pitch with a soft whooshing quality; inspiration is two to three times the length of expiration  Bronchovesicular breath sounds  Moderate to high pitch with a hollow, muffled quality; equal time of inspiration and expiration  Bronchial breath sounds  High pitch with a loud, harsh, tubular quality; inspiration half as long as expiration 24 Normal Lung Sounds

25. 25

26. Copyright © 2017, Elsevier Inc. All rights reserved. 26 Barrel Chest Typical of Chronic Obstructive Pulmonary Disease

27. Copyright © 2017, Elsevier Inc. All rights reserved.  Throat culture  Lung function tests  Peak flowmeter  Lung biopsy 27 Diagnostic Tests and Procedures

28. Copyright © 2017, Elsevier Inc. All rights reserved. 28 Spirometry

29. Copyright © 2017, Elsevier Inc. All rights reserved.  Promote oxygenation.  Prevent infection.  Prevent further lung damage.  Promote rehabilitation. 29 Nursing Goals

30. Copyright © 2017, Elsevier Inc. All rights reserved.  Improved breathing pattern, pulse oximeter readings, arterial blood gas values, and lung sounds  Decreases in coughing, sputum production, wheezing, and signs of infection  Lessened dyspnea and more energy and ability to perform more self-care  Reassessment is an ongoing nursing activity. 30 Evaluation

31. Copyright © 2017, Elsevier Inc. All rights reserved.  Clear the nasal passages.  Sit with feet about shoulder width apart.  Lean forward with the hands or elbows on the knees and arms and hands completely relaxed.  Take a deep breath, allowing the diaphragm to drop as you inhale; feel your abdomen expand.  Exhale slowly.  Continue to take several slow, deep breaths. 31 Patient Teaching: Deep Breathing

32. Copyright © 2017, Elsevier Inc. All rights reserved.  Position tissues or a basin for expectoration.  While in a sitting position with the feet supported, deep breathe several times.  Bend your head forward, slightly hunch shoulders forward.  Take a deep breath and slowly exhale, coughing three times in succession with exhalation. 32 Patient Teaching: To Cough Effectively

33. Copyright © 2017, Elsevier Inc. All rights reserved. 33 Patient Teaching: To Cough Effectively (Cont.)  The first cough mobilizes secretions, and the next two bring secretions up to be expectorated.  Repeat the process if secretions are still audible in the lungs.  Rest in between attempts at coughing.

34. Copyright © 2017, Elsevier Inc. All rights reserved.  After deep breathing, encourage the patient to take a deep breath through the nose and then forcibly exhale through the mouth.  Repeat the process, producing “huffs” that move secretions upward until they can be expectorated. 34 For the Patient Who Will Not Effectively Cough

35. Copyright © 2017, Elsevier Inc. All rights reserved. 35 Orthopneic Position