1. Respiratory #1

2. Anatomy of the Respiratory System

4. Nose External nose Nasal cavity The part that is seen on the face
Made of bones and cartilage covered with skin
Lining: thick mucous membranes and small hairs
Nasal cavity
Lies over the roof of the mouth
Lined with mucous membranes along with the cilia (small hairlike projections)

5. Pharynx*
A 5-inch tube extending from the back of the mouth to the esophagus
Nasopharynx lies behind the nose
Oropharynx lies behind the mouth
Laryngopharynx lies behind the larynx

6. Pharynx A passage for respiratory and the digestive systems
Functions in the formation of sounds, especially vowel sounds
Tonsils located in the pharynx; may interfere with breathing, particularly nasal breathing, if they become enlarged

7. Larynx The air passage between the pharynx and the trachea
Contains vocal cords and several types of cartilage, including the thyroid cartilage and the epiglottis
During swallowing the epiglottis acts like a lid to help prevent aspiration of food into the trachea
Vocal cords: folds of mucous membranes attached to cartilage; extend from the front to the back of the larynx
Sounds produced when air from the lungs causes a rapid, repeated opening and closing of the glottis
Sounds transformed into speech by lips, jaws, and tongue

8. Trachea
A 4- to 5-inch tube descending from the larynx into the bronchi
Made of cartilage, smooth muscle, and connective tissue lined by a layer of mucous membrane
A passageway for air to reach the lungs

9. Bronchi Passageway for air to and from the lungs
Two primary bronchi split to the right and left from the trachea
Right bronchus is shorter and wider and runs straighter up and down than the left bronchus

10. Bronchi
Larger bronchi divide into smaller, or secondary, bronchi; divide again into smaller tertiary bronchi
Tertiary bronchi divide into smaller bronchioles, which lead into tiny air sacs called alveoli in the lungs
Through the walls of the alveoli, exchange of oxygen and carbon dioxide takes place

11. Figure 30-2

12. Lungs
Located in right and left sides of the thoracic cavity within the chest wall
Thoracic cavity is separated from the abdominal cavity by the diaphragm, a large sheet of muscle
Three lobes on the right and two on the left
Each lung covered by membrane: the pleura
A sac containing a small amount of fluid that acts as a lubricant for the lungs when they expand and contract

13. CO2- The major regulator of respirations.*

14. Diagnostic Tests and Procedures
Radiologic studies
Chest radiography, fluoroscopy (a picture in motion), ventilation-perfusion scan
Imaging procedures*(Iodine)
Computed tomography, magnetic resonance imaging, positron emission tomography
Pulmonary function tests
Spirometry, arterial blood gas analysis
Pulse oximetry*
Sputum analysis
Culture and sensitivity
Fiberoptic bronchoscopy-
Look and sample
Post procedure…don’t what?

15. Assessing Lungs:

16. Sequence for percussion and auscultation of the lungs.16

17. Lung Sounds Websites Lung Sounds Part 1 Lung Sounds Part 2
QR CODE LUNG SOUNDS ASSESSMENT

18. Clubbing is a flattening of the angle between the nail and the skin
Clubbing is a flattening of the angle between the nail and the skin. A, Normal angle of 160 degrees. B, Early clubbing: the angle is flattened to 180 degrees. C, Advanced clubbing: the angle is greater than 180 degrees. D, The Schamroth technique: the patient puts the nails of the ring fingers of each hand together and holds the other fingers straight up. The examiner looks at the space between the touching nails. If there is no clubbing, the space is diamond shaped. 18

19. Common Therapeutic Measures
Thoracentesis—due to pleural effusion
Breathing exercises
Deep breathing and coughing exercises
Pursed-lip breathing
Sustained maximal inspiration
All to be taught preop
Chest physiotherapy*
Chest percussion and vibration
Postural drainage
Suctioning
Humidification and aerosol therapy

20. Figure 30-8

21. Figure 30-9

22. Figure 30-10A

23. Figure 30-10B

24. Common Therapeutic Measures
Oxygen therapy
Increase fluids if able*
Intermittent positive-pressure breathing treatments
Artificial airways
Oral airway
Nasal airway
Endotracheal tube
Tracheostomy
Mechanical ventilation
Chest tubes
Thoracic surgery

25. Figure 30-11

26. CHEST TUBES:
Used to drain air or fluid from the pleural spaces of the lungs. This permits re-expansion of a collapsed lung in a patient.
Chest fluid and air drain into the collection chamber of a drainage device.

27. If chest tube accidentally pulls out of chest, cover wound with sterile gauze and call MD STAT.
Air will cause the lung to collapse.

28. Chest tubes are connected to gentle suction to keep lung expanded and to draw out fluid.
Bubbling will occur in the suction chamber.
No continuous bubbling should be seen in water seal chamber - Air leak if this occurs.

29. If tubing disconnects from drainage system, double clamp close to insertion site (chest). Obtain help stat.
Monitor drainage every shift.

30. Monitor vital signs and breath sounds frequently.
Need MD order to change dressing. It is an airtight sterile dressing.

31. Figure 30-12

32. Figure 30-13

33. VOCAB:

34. Respiratory Terms Apnea Dyspnea Orthopnea Bradypnea Tachypnea
Hemothorax
Pneumothorax
Crackles – coarse & fine
Rhonchi
Wheezes
Biot’s Resp
Cheyne Stokes Resp
Kussmaul’s Resp
Clubbing (and it is not a night out)
What is normal respiratory rate?
Consider dividing up this word list among students and have them do the work
Refer to Types of Breathing Patterns Table 30-1 page 543
Links to breath sounds on next slide

35. Respiratory Terms Atelectasis Empyema Hypercapnia Hypoxemia Hypoxia
Arterial Blood Gases
Bronchoscopy
Thoracentesis
Thoracotomy
Pulse Oximetry
Decongestants
Antitussives
Antihistamines
Expectorants
Bronchodilators
Atelectasis
Empyema
Hypercapnia
Hypoxemia
Hypoxia
Pleural Effusion
Ventilation
Tissue Perfusion
Atelectasis
Empyema
Hypercapnia
Hypoxemia
Hypoxia
Pleural Effusion
Ventilation
Tissue Perfusion
Arterial Blood Gases
Bronchoscopy
Thoracentesis
Thoracotomy
Pulse Oximetry
Decongestants
Antitussives
Antihistamines
Expectorants
Bronchodilators

36. Cyanosis: blueness or duskiness of the skin caused by a deficiency of O2 in the blood.

37. Crackles*: non-musical, coarse respiratory sound (like Velcro being pulled apart). Also called rales. May indicate congestion and is most often due to fluid/pus in the lung.

38. Dyspnea. : difficulty breathing; aware of the need to breathe
Dyspnea*: difficulty breathing; aware of the need to breathe. Raise HOB.
Empyema: accumulation of pus in a body cavity, often the pleural cavity.

39. Emphysema: inflammation or swelling of tissues due to the presence of air. COPD is usually a severe lung disorder.
Eupnea: normal respirations. Rate: breaths/minute.

40. Hypercapnia: excess CO2 in the blood.
Hyperpnea: abnormally increased rate and depth of respirations.
Hypocapnia: low CO2 in the blood.

41. Hypoxia. : decrease of O2 in the tissues, also called hypoxemia
Hypoxia*: decrease of O2 in the tissues, also called hypoxemia. Early signs of hypoxia include restlessness, anxiety and increased respirations.

42. Tachypnea: respirations of 20 or more per minute.
Wedge Resection: surgical removal of a wedge-shaped piece of tissue

43. Wheezes: a whistling respiratory sound (typical w/asthma) produced by the obstruction or constriction of the bronchi.

44. Vital Capacity: sum of inspiratory & expiratory reserve volume; deepest inhalation followed by most forceful exhalation. Average = 4,000 – 5,000 ml.

45. Tidal Volume: amount of air inspired or expired during normal inspiration or expiration. Average = 500ml.
Inspiratory Reserve Volume: amount taken in w/the deepest possible inhalation. Average = 2,500 – 4,300 ml.

46. Expiratory Reserve Volume: amount of air that can be expelled w/most forceful exhalation. Average = 1,200 – 1,500 ml.
Residual Volume

47. Acid Base Balance
pH Level: hydrogen Ion concentration or the body’s acid/base balance.
ABG’s tell you if the regulatory mechanisms of the body (kidney & lungs)* are successfully maintaining the proper pH.

48. PAO2: partial pressure of oxygen in the arterial blood
PAO2: partial pressure of oxygen in the arterial blood. Less than 80mmHg = hypoxia

49. PaCO2: respiration’s effect on pH is indicated by the partial pressure of carbon dioxide or PaCO2.
Normal PaCO2: mmHg.

50. CO2 reacts w/ H2O to become acidic
CO2 reacts w/ H2O to become acidic. If CO2 accumulates such as when respiration is impaired, CO2 levels increase (Asthma, Bronchitis, Emphysema, CHF).*
Increased levels of CO2 denote respiratory acidosis.

51. If CO2 levels drop, the pt. is in respiratory alkalosis (hyperventilation, pain).

52. Less (lower) HCO3= metabolic acidosis
HCO3: Metabolic influences on pH= amount of Bicarbonate
Normal HCO3: 22 to 26 meq/L
Less (lower) HCO3= metabolic acidosis
More (higher) HCO3= metabolic alkalosis

53. Meta How to assess ABG’s:
Always start with the pH to determine whether the pt. is acidotic or alkalotic. Then move on to PaCO2 & HCO3, which will reveal whether the imbalance, if any, is respiratory or metabolic in origin.
Meta

54. ROME Respiratory Opposite Metabolic Equal
i always use the rome mnemonic: respiratory opposite (ph and co2 go opposite directions in resp disorders) metabolic equal (ph and hco3 go same direction in metabolic disorders)

55. Normal Ranges: pH
Below = acidosis
Above = alkalosis

56. PaCO mmHg.
Increase = respiratory acidosis
Decrease = respiratory alkalosis

57. HCO meq/L
Decrease = metabolic acidosis
Increase = metabolic alkalosis

58. O2 SAT %
Below 95, decreases O2 capacity of Hgb.
Need to draw ABG’s on patient for further assessment.

59. Examples:
pH 7.3-acidotic
PaCO2 35-normal
HCO3 20-low, Acidotic
Metabolic Acidosis
(diabetic ketoacidosis)

60. pH 7.48-alkalotic
PaCO2 38-normal
HCO3 30-high, alkalotic
Answer: Metabolic alkalosis (vomiting).

61. pH 7.3-low, acidic
PaCO2 50-high, acidic
HCO3 24-normal
Answer: Respiratory acidosis (COPD, pneumonia).

62. pH 7.49-high, alkalotic
PaCO2 30-low, alkalotic
HCO3 24-normal
Answer: Respiratory alkalosis (hyperventilation, acute asthma).*

63. Drug Therapy Decongestants Corticosteroids Antitussives Antihistamine
Antihistamines
Expectorants
Antimicrobials
Bronchodilators
Corticosteroids
Antihistamine

64. The End