Anatomy of respiratory system

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Function of respiratory system

Oxygen transport: exchange of O2 &CO2 “diffusion” , increase O2 sat

Ventilation: flow of air in &out of the lung, clear CO2, RR,TV

Mechanism of spontaneous breathing : diaphragm movement& atmospheric pressureInhalation (-ve pressure), exhalation (+ve pressure)

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Airway resistance : any change on the airway diameter which effects airway flow to/ out the lung.

Compliance :elasticity, expandability of the lung. Effected by age, disease, surfectant, lung tissue (collagen, elastin)

Positioning &lung perfusion :

Upper right position : lower part perfused more due to low PAP

Lateral position: one side perfused more than other

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Inhaled air consists of Nitrogen 78%Oxygen 21%CO2 .04%Vapor water .05%HeliumArgon Oxygen carried in form of:

Dissolved in the Plasma (PaO2) 70-80 mmhg

With hemoglobin in RBC (O2 sat) 90%

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Control of ventilationCentralChemoreceptors in Medulla & Pons which are sensivitive

to PH, CO2, O2 controls rate &depth of ventilation through phrenic nerve.

Pripheral : in Aortic Arch, carotid arteries.

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Assessment of respiratory systemDyspnea Difficult breathing, shortness of breathDue to decreased lung compliance, high

airway pressureEffect RV due to high resistanceSudden dyspea in a healthy person may

indicate pneumothorax, ARDS, respiratory obstruction

In immobilized person may indicate Pulmonary emboli

Orthopnea indicates heart disease.Rx: treat causes, O2 administer

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Cough :Irritation of mucus membrane in respiratory tractFrom infection, airborne irritants (smoke, dust)Serve as natural protection Night cough due to Lt side heart failure, bronchial asthmaMorning cough due to brochitisSupine cough due to sunusitis

Sputums production: Thick, (yellow, green) indicates bacterial infectionThin indicates viral infectionPink indicates lung tumour Fouel smelling indicates lung abscessRx: if pt able to expactorate, hydation, inhalation of

aerosolized solutions (spray to humidify air)

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Wheezing RT bronchoconstriction, narrowing airwaysRx: bronchodilators

Clubbing fingersRT hypoxia

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ASTHMA WHEEZE.wav

Hemoptysis : blood in sputums, p.emboli, PA/PV diseases, heart disease

Cynosis: indicate hypoxia, can be central or peripheral

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Physical assessment of respiratoryNose/ SinusesInspect nose for color, bleeding,

dischargesPalpate sinuses for tender

Phrynx/ Mouth:

Inspect mouth for color, symmetry, exudates, ulcerationUse tongue depression to inspect pharynx

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Trachea Palpate and inspect for symetery or deviation (tension

pneumotharx)

Breathing patterns& respiratory ratesEupnea : normal breathing rate 12-18 bpmBradypnea: slow breathing, less than 12bpmTachypnea: fast breathing, more than 18bpmHypoventilation: shallow breathingHyperventilation: deep breathing, to correct acidosis,

athelets Apnea: cessation of breathing

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Thoracic palpataionPalpate for tenderness

Respiratory excursionTo determine symmetryOf expirartion

Pulse oximeter To determine O2 sat

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Thoracic auscultation

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Adventitious Breath Sounds

Fine crackles (dry, high-pitched popping…COPD, CHF, pneumonia)

Coarse crackles (moist, low-pitched gurgling…pneumonia, edema, bronchitis)

Sonorous wheezes (low-pitched snoring…asthma, bronchitis, tumor)

Sibilant wheezes (high-pitched, musical … asthma, bronchitis, emphysema, tumor)

Pleural friction rub (creaking, grating… pleurisy, tuberculosis, abscess, pneumonia)

Stridor (crowing…croup, foreign body obstruction, large airway tumor).

Abnormal sounds and some conditions associatedwith them:

Fric_rub.wav

STDR MUTH.wav

FINE RALES.wav

MEDIUM RALES.wav

ASTHMA WHEEZE.wav

Upper respiratory tract RhinitisInflammation of nose by viral , obstructive ,allergic

reaction.Clinical manifestations1.Rhinorrhea “ excessive nasal drainage”2.Nasal congestion, Itching ,& sneezing3.Headache may occur

Medical Management1.Treatment of cause “antibiotics”2.Decongestant agents3.Antihistamine 4.In severe cases corticosteroids

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common coldOften is used when referring to a symptoms of an

upper respiratory tract infection ch.ch.by nasal congestion ,sore throat , & cough

Cold referred to a febrile, infectious, acute inflammation,of the mucus membranes of the nasal cavity

Clinical manifestations1.Nasal congestion2.Scratchy or sore throat3.Sneezing & cough4.Headache & muscle ache5.Herpes simplex sore (cold sore )

common cold Medical Management (symptomatic

management)

Fluid intake ,rest ,prevention of chills. Aqueous decongestant,anti histamin, Vit. C. Expectorant as needed Analgesic for aches ,pain , & fever. Antimicrobial to reduce incidence of

complications

Nursing Management Patient teaching of self care & prevention

of infection & break chain of infection

Acute Sinusitis It is inflammation of sinuses , it is resolved

promptly if their opening into nasal cavity .

Clinical Manifestations Pressure , pain over the sinus area Tenderness Purulent nasal secretions

Medical Management Antimicrobial agent “Amoxicillin” Oral & Topical Decongestant Heated mist or Saline irrigation

Nursing management Teaching pt. to promote drainage “inhaling

steam, more intake, applying local heat” Teaching pt. about rebound effect of nasal

decongestant. Complications Meningitis &osteomylitis Brain abscess Ischemic infarction

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Acute Pharyngitis It is a febrile inflammation of throat ,caused by virus about

70% , uncomplicated viral infection usually subsided promptly within 3-10 days

Clinical Manifestations Fiery red pharyngeal membrane& tonsils Lymphoid follicles that are swollen Enlarge tender cervical lymph node Fever & malaise Sore throat , hoarseness,& cough

Medical Management Supportive measures for viral infection Pharmacologic therapy antibiotics for 10

days “cephalosporin”analgesic for severe sore anti tussive medications

Nutritional therapy liquid or soft diet “If liquid can’t tolerated IV fluid administered “

Nursing Management (bed rest ,skin assessment, mouth care &normal saline gargle & self care teaching

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Chronic Pharyngitis Common in adults who work or live in dusty

surrounding ,use the voice too excess , suffer from chronic cough , & habitually use alcohol & tobacco

Types of pharyngitis1. Hypertrophic :ch.ch.by general thickening&

congestion of pharyngeal mucus membrane2. Atrophic : probably late stage of first type 3. Chronic Granular : ch.ch.by numerous swollen

lymph follicles on the pharyngeal wall

Clinical Manifestations

Constant sense of irritation or fullness in throat

Mucus expelled by coughing Difficulty in swallowing

Medical Management Relieving symptoms Avoiding exposure to irritant Correct respiratory & cardiac conditions

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Antihistamine drugs Decongestant Controlling malaise

Nursing Management Patient teaching of self care Avoid alcohol , tobacco , exposure to

cold Face mask to avoid pollutant Warm fluids,&warm saline gargle

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TonsillitisThe tonsils are composed of lymphatic tissue & situated on

each side of the oropharynx ,they frequently are the site of acute infection (tonsillitis)

Clinical ManifestationsTonsils : sore throat, fever , snoring & difficulty of

swallowing Adenoids : ear ache , mouth breathing , drainage ear ,frequent

cold , bronchitis, noisy respiration, foul smelling breath &voice impairment

Medical Management For recurrent tonsillitis “tonsillectomy” Conservative or symptomatic therapy Antimicrobial therapy “penicillin” for 7 days

Nursing Management Provide post op. care :V/S ,hemorrhage , position head

turned to side,water or ice chips Teaching patient :S&S of hemorrhage Avoid too much talking or coughing Liquid or semi liquid diet for several days Alkaline mouth washing with warm saline

Laryngitis It is an inflammation of larynx ,often occur as a result

of voice abuse or exposure to dust , chemicals , smoke , & other pollutants

Common in winter & easily transmitted The cause of infection is almost virus

Clinical Manifestations Hoarseness or aphonia Severe cough

Medical Management

Resting voice & avoid smoking Inhale cool steam or an aerosol Conservative treatment Antibiotics for bacterial organisms

Nursing Management Rest voice Maintain a well humidified environment Daily fluid intake

Sleep apneaCan be obstructive, central, or mixed

Manifestations :Excessive daytime sleepiness, morning headache,

personality change, mentality changes, loud snoring, restless sleep

Need sleep test “cardiopulmonary status monitored during sleeping”

Cause hypoxia, hypoventilation, MI, HTN, dysrythmias

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Medical treatment:+ve airway pressure with O2 nasal canulaOR to correct obstructionTracheostomy to be open during sleepTriptil at bed time to increase airway

diameter

Epistaxis Bleeding from the noseDue to rupture of tiny vesselsCaused by trauma, infections, some

medicationsTreatment: nasal packing, suctioning

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Nursing process: pt with upper respiratory tract

Assessment

Diagnosis

Planning & goals Interventions

Evaluation

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Conclusion

Any question

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