1. Respiratory Teresa V. Hurley, MSN, RN

2. Anatomy of the Lungs Main organs of respiration Main organs of respiration Extend from the base of diaphragm to the apex above first rib Extend from the base of diaphragm to the apex above first rib The right lung has three lobes; left lung has two The right lung has three lobes; left lung has two The lungs are composed of elastic tissue (alveoli, surfactant, pleura) The lungs are composed of elastic tissue (alveoli, surfactant, pleura)

3. Transport of Respiratory Gases Oxygen is carried in the body via plasma and red blood cells. Oxygen is carried in the body via plasma and red blood cells. Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin. Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin. Internal respiration between the circulating blood and tissue cells must occur. Internal respiration between the circulating blood and tissue cells must occur.

4. Respiratory Functioning in the Older Adult Bony landmarks are more prominent due to loss of subcutaneous fat. Bony landmarks are more prominent due to loss of subcutaneous fat. Kyphosis contributes to appearance of leaning forward. Kyphosis contributes to appearance of leaning forward. Barrel chest deformity may result in increased anteroposterior diameter. Barrel chest deformity may result in increased anteroposterior diameter. Tissues and airways become more rigid; diaphragm moves less efficiently. Tissues and airways become more rigid; diaphragm moves less efficiently. Older adults have an increased risk for disease, especially pneumonia. Older adults have an increased risk for disease, especially pneumonia.

5. Guidelines for Obtaining a Nursing History Determine why the client needs nursing care. Determine why the client needs nursing care. Determine what kind of care is needed to maintain a sufficient intake of air. Determine what kind of care is needed to maintain a sufficient intake of air. Identify current or potential health deviations. Identify current or potential health deviations. Identify actions performed by the client for meeting respiratory needs. Identify actions performed by the client for meeting respiratory needs. Make use of aids to improve intake of air and effects on client’s lifestyle and relationship with others. Make use of aids to improve intake of air and effects on client’s lifestyle and relationship with others.

6. Breath Sounds Vesicular — low pitched soft sound during expiration heard over most of lungs Vesicular — low pitched soft sound during expiration heard over most of lungs Bronchial — high pitch and longer, heard primarily over trachea Bronchial — high pitch and longer, heard primarily over trachea Bronchovesicular — medium pitch and sound during expiration, heard over upper anterior chest and intercostal area Bronchovesicular — medium pitch and sound during expiration, heard over upper anterior chest and intercostal area

7. Abnormal (Adventitious) Lung Sounds Crackles — intermittent sounds occurring when air move through airways that contain fluid Crackles — intermittent sounds occurring when air move through airways that contain fluid Classified as fine, medium, or coarse Classified as fine, medium, or coarse Wheezes — continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors Wheezes — continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors Classified as sibilant or sonorous Classified as sibilant or sonorous

8. Planning: Expected Outcomes Demonstrate improved gas exchange in lungs by absence of cyanosis or chest pain and a pulse oximetry reading >95% Demonstrate improved gas exchange in lungs by absence of cyanosis or chest pain and a pulse oximetry reading >95% Relate the causative factors and demonstrate adaptive method of coping Relate the causative factors and demonstrate adaptive method of coping

9. Planning: Expected Outcomes Preserve pulmonary function by maintaining an optimal level of activity Preserve pulmonary function by maintaining an optimal level of activity Demonstrate self-care behaviors that provide relief from symptoms and prevent further problems Demonstrate self-care behaviors that provide relief from symptoms and prevent further problems

10. Nursing Interventions Promoting Adequate Respiratory Functioning Teaching about a pollution-free environment Teaching about a pollution-free environment Promoting optimal function Promoting optimal function Promoting proper breathing Promoting proper breathing Promoting and controlling coughing Promoting and controlling coughing Promoting comfort Promoting comfort Meeting respiratory needs with medications Meeting respiratory needs with medications

11. Promoting Proper Breathing Deep breathing Deep breathing Using incentive spirometry Using incentive spirometry Pursed-lip breathing Pursed-lip breathing Abdominal or diaphragmatic breathing Abdominal or diaphragmatic breathing

12. Types of Cough Medications Cough suppressants Cough suppressants Expectorants Expectorants Lozenges Lozenges

13. Promoting comfort Positioning Positioning Maintaining adequate fluid intake Maintaining adequate fluid intake Providing humidified air Providing humidified air Performing chest physiotherapy Performing chest physiotherapy Maintaining good nutrition Maintaining good nutrition

14. Administering Inhaled Medications Bronchodilators — open narrowed airways Bronchodilators — open narrowed airways Mucolytic agents — liquefy or loosen thick secretions Mucolytic agents — liquefy or loosen thick secretions Corticosteroids — reduce inflammation in airways Corticosteroids — reduce inflammation in airways

15. Oxygen Delivery Systems Nasal cannula Nasal cannula Nasal catheter Nasal catheter Transtracheal catheter Transtracheal catheter Simple mask Simple mask

16. Oxygen Delivery Systems Partial rebreather mask Partial rebreather mask Nonrebreather mask Nonrebreather mask Venturi mask Venturi mask Tent Tent

17. Precautions for Oxygen Administration Avoid open flames in client’s room Avoid open flames in client’s room Place no smoking signs in conspicuous places Place no smoking signs in conspicuous places Check to see that electrical equipment in room is in working order Check to see that electrical equipment in room is in working order Avoid wearing and using synthetic fabrics (builds up static electricity) Avoid wearing and using synthetic fabrics (builds up static electricity) Avoid using oils in the area (ignite spontaneously in oxygen) Avoid using oils in the area (ignite spontaneously in oxygen)

18. Types of Inhalers Nebulizers — disperse fine particles of medication into deeper passages of respiratory tract where absorption occurs Nebulizers — disperse fine particles of medication into deeper passages of respiratory tract where absorption occurs Metered dose inhalers — delivers controlled dose of medication with each compression of the canister Metered dose inhalers — delivers controlled dose of medication with each compression of the canister