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Page 1: Respiratory System Review

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Page 2: Respiratory System Review
Page 3: Respiratory System Review

Respiratory SystemSTRUCTURAL DIVISION

STRUCTURES OF THE UPPER AIRWAYS:

1. Nasal CavityII. PharynxIII. Larynx

STRUCTURES OF THE LOWER AIRWAYS:

1. TracheaII. Bronchial TreeIII. LungsIV. Alveoli

FUNCTIONAL DIVISION

STRUCTURES OF THE CONDUCTING AIRWAYS:

1. Nasal CavityII. PharynxIII. LarynxIV. Tracheobronchial tree

STRUCTURES OF THE RESPIRATORY TISSUES:

I. LungsII. Alveoli

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Conducting AirwaysDivisions of the PHARYNX

NASOPHARYNXNASOPHARYNX

OROPHARYNXOROPHARYNX

LARYNGOPHARYNXLARYNGOPHARYNX

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Conducting AirwaysLARYNX

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Conducting AirwaysTRACHEA

supported by supported by HORSE-HORSE-SHOE C-SHAPED SHOE C-SHAPED CARTILAGES (C-rings)CARTILAGES (C-rings)

protection: protection: MUCOCILIARY BLANKETMUCOCILIARY BLANKET

point of bifurcation: point of bifurcation: CARINACARINA

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Respiratory TissuesLUNGSFunctions of the

inactivates vasoactive substances such as bradykinin

converts angiotensin I to angiotensin II

reservoir for blood storage

contains abundant heparin producing cells located at the capillaries of the lungs

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Parts of the Respiratory System:Parts of the Respiratory System:• Lungs – soft, spongy, elastic Lungs – soft, spongy, elastic

structure, airtight chamber with structure, airtight chamber with distensible walls; functional distensible walls; functional structure of the respiratory structure of the respiratory system; consists of an apex and a system; consists of an apex and a basebase

• Lobules – functional units of the Lobules – functional units of the lungs; consist of respiratory lungs; consist of respiratory bronchioles, alveoli and bronchioles, alveoli and pulmonary capillaries.pulmonary capillaries.

• Lung Tissues – made up of elastin Lung Tissues – made up of elastin and collagen fiber that encircle the and collagen fiber that encircle the airways and small blood vessels.airways and small blood vessels.

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• Pleura Pleura – a thin, smooth, transparent, double-– a thin, smooth, transparent, double-layered serous membrane that lines the thoracic layered serous membrane that lines the thoracic cavity and encases the lungs; consists of a cavity and encases the lungs; consists of a visceral and parietal fluid layer.visceral and parietal fluid layer.

• Pleural SpacePleural Space – area of negative pressures to – area of negative pressures to prevent lung from collapsing; contains pleural prevent lung from collapsing; contains pleural fluid which separates the pleural layers. fluid which separates the pleural layers.

• AlveoliAlveoli – grapelike cluster, around 300 to 400 – grapelike cluster, around 300 to 400 million in each lung where actual gas exchange million in each lung where actual gas exchange occuroccur

Parts of the Respiratory Parts of the Respiratory System:System:

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CIRCULATIONCIRCULATION• the lungs are provided with a dual blood supply:the lungs are provided with a dual blood supply:

a.a. Pulmonary CirculationPulmonary Circulation – arises from the – arises from the pulmonary artery and provides for the gas pulmonary artery and provides for the gas exchange functions of the lungsexchange functions of the lungs

b.b.Bronchial CirculationBronchial Circulation – distributes blood to the – distributes blood to the conducting airways and supporting structure of conducting airways and supporting structure of the lung.the lung.

• Heparin-producing cellsHeparin-producing cells – particularly abundant – particularly abundant in the capillaries of the lungs where small clots in the capillaries of the lungs where small clots are trapped.are trapped.

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Other Related Structures

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MECHANICS OF BREATHINGMECHANICS OF BREATHING1.1. VentilationVentilation – movement of air between – movement of air between

the atmosphere and the respiratory the atmosphere and the respiratory portion of the lungs.portion of the lungs.

• ResistanceResistance – determined chiefly by the – determined chiefly by the radius of the airway through which the radius of the airway through which the air is flowing. air is flowing. 

• Lung ComplianceLung Compliance – refers to the ease – refers to the ease with which the lungs expands and with which the lungs expands and indicates the relationship between the indicates the relationship between the volume and the pressure of the lungsvolume and the pressure of the lungs

a.a. Compliant LungCompliant Lung – distends easily when – distends easily when pressure is appliedpressure is applied

b.b. Noncompliant LungNoncompliant Lung – requires greater – requires greater than normal pressure to distend than normal pressure to distend it.it.

SURFACE TENSION SURFACE TENSION – result of air and liquid – result of air and liquid interface, facilitated by type 2 cellsinterface, facilitated by type 2 cells Noncompliant LungNoncompliant Lung

Compliant LungCompliant Lung

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2.2. PerfusionPerfusion – blood flow through the lungs– blood flow through the lungs

• Ventilation Perfusion Ratio (V/Q) – necessary Ventilation Perfusion Ratio (V/Q) – necessary to meet adequate oxygenation of the blood.to meet adequate oxygenation of the blood.

3.3. DiffusionDiffusion – process by which oxygen and – process by which oxygen and carbon dioxide are exchanged at the air-blood carbon dioxide are exchanged at the air-blood interfaceinterface

MECHANICS OF BREATHINGMECHANICS OF BREATHING

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Intact and patent airway

Normal Chest Anatomy

Normal nerve stimuli for Contraction and relaxation of

Respiratory muscles

Intact pleuralmembrane

Adequate VentilationNormal Contraction

Of RV

Normal Pressure and Resistance in

The PV

Intact Pulmonary

vessels

AdequatePerfusion

EFFECTIVEOXYGENATION

Adequate pumping action of cardiac

muscles

Intact Blood Vessels

Adequate Hgb

AdequateDistribution of gases

Adequate Diffusion

Adequate amtOf O2 in the

air

Adequate amt Of RBC to Carry O2

Adequate bld Flow to the

lungs

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Respiratory Control

Cerebral Cortex

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NEUROLOGIC CONTROLNEUROLOGIC CONTROL• Medulla OblongataMedulla Oblongata – –

controls respiration and controls respiration and expirationexpiration

• PonsPons – controls rate and – controls rate and depth of ventilationdepth of ventilation

1.1. Apneustic Apneustic center – lower center – lower pons; stimulates the pons; stimulates the inspiratory medullary inspiratory medullary center to promote deep, center to promote deep, prolonged inspirationprolonged inspiration

2.2. Pneumotaxic centerPneumotaxic center – – controls pattern of controls pattern of respirationrespiration

• CortexCortex – allows voluntary – allows voluntary control of breathingcontrol of breathing

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Receptor Sites that Assists in Receptor Sites that Assists in BreathingBreathing

• Central chemoreceptorsCentral chemoreceptors – located in the – located in the medulla; respond to an increase or medulla; respond to an increase or decrease in the pH decrease in the pH

• Peripheral chemoreceptorsPeripheral chemoreceptors – located in – located in the aortic arch and carotid arteries; the aortic arch and carotid arteries; respond to changes in PaCOrespond to changes in PaCO22 and pH. and pH.

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• Stretch ReceptorsStretch Receptors – located in the alveoli– located in the alveoli

• Hering-Breuer reflex Hering-Breuer reflex - stimulated when - stimulated when the lungs are distended and inhibits the lungs are distended and inhibits respiration so that the lungs do not respiration so that the lungs do not become over distendedbecome over distended

• ProprioceptorsProprioceptors – located in the muscles and – located in the muscles and joints; respond to body movementsjoints; respond to body movements

• Baroreceptors Baroreceptors – located in the aortic arch and – located in the aortic arch and carotid bodies; respond to an increase or carotid bodies; respond to an increase or decrease in arterial blood pressure causing a decrease in arterial blood pressure causing a reflex hypoventilation or hyperventilationreflex hypoventilation or hyperventilation

Receptor Sites that Assists in Receptor Sites that Assists in BreathingBreathing

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NURSING ASSESSMENT Nursing History: Risk factor Analysis

Cancer:Cancer:

♥ ♥ cigarette smoking cigarette smoking – 3 or 4 – 3 or 4 clients who develop clients who develop laryngeal cancer have laryngeal cancer have smoked or currently smokesmoked or currently smoke

♥ ♥ alcohol alcohol – act synergistically – act synergistically with tobaccowith tobacco

♥ ♥ occupational exposure occupational exposure – – asbestos, wood dust, asbestos, wood dust, mustard gas, petroleum mustard gas, petroleum products,other noxious products,other noxious fumesfumes

♥ ♥ AgeAge

♥ ♥ Genetic PredispositionGenetic Predisposition

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Nursing History: Risk factor Analysis

AsthmaAsthma♥ ♥ heredityheredity♥ ♥ environmental factorsenvironmental factors♥ ♥ excitatory states, exercise, excitatory states, exercise,

changes in temperature, changes in temperature, strong odorsstrong odors

Chronic Obstructive Pulmonary Chronic Obstructive Pulmonary Disease (COPD)Disease (COPD)

♥ ♥ cigarette smoke- leading risk cigarette smoke- leading risk factorfactor

♥ ♥ aging processaging process♥ ♥ hereditary and genetic hereditary and genetic

predispositionpredisposition

Pollen Pollen GrainsGrainsDust Dust

MiteMite

House DustHouse Dust

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Pulmonary embolismPulmonary embolism♥ ♥ thrombi thrombi – most of which – most of which

originated in the deep originated in the deep calf, femoral, popliteal or calf, femoral, popliteal or lilac veins lilac veins

♥ ♥ major operationsmajor operations

♥ ♥ tumors, air, fat, bone tumors, air, fat, bone marrow, amniotic fluidmarrow, amniotic fluid

Nursing History: Risk factor Analysis

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Pulmonary Pulmonary TuberculosisTuberculosis

♥ ♥ repeated close contact repeated close contact with an infected personwith an infected person

♥ ♥ low income population, low income population, poor nutritionpoor nutrition

♥ ♥ residents of long term care residents of long term care facilities or institutional facilities or institutional settingssettings

♥ ♥ homeless peoplehomeless people♥ ♥ health care workers health care workers

exposed to active TBexposed to active TB

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a. Biographical and Demographic Dataa. Biographical and Demographic Data• Name, sex, and living situationName, sex, and living situation• Age – lung cancer and chronic lung Age – lung cancer and chronic lung

disorders make the client appear disorders make the client appear olderolder

  b. Current Health: Chief Complaintb. Current Health: Chief Complaint  DyspneaDyspnea – difficult, uncomfortable or – difficult, uncomfortable or

unpleasant breathing indicative of unpleasant breathing indicative of the discrepancy between the need the discrepancy between the need for ventilation and the ability to meet for ventilation and the ability to meet the need; one of the most common the need; one of the most common manifestations of clients with manifestations of clients with pulmonary and cardiac disorderspulmonary and cardiac disorders

  

Lung CancerLung Cancer

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CoughCough – a reflex that facilitates the removal of secretions and foreign – a reflex that facilitates the removal of secretions and foreign materials from the tracheobronchial tree and the lungsmaterials from the tracheobronchial tree and the lungs

- Dry, hoarse, congested, barking, wheezing, bubbling- Dry, hoarse, congested, barking, wheezing, bubbling- weakness/paralysis of resp muscles, prolongrd inactivity, - weakness/paralysis of resp muscles, prolongrd inactivity,

depression of medullary fxndepression of medullary fxn- may cause stress incontinence- may cause stress incontinence-SPUTUM -SPUTUM

Characterististics:Characterististics:• Dry irritative coughDry irritative cough• Severe changing cough Severe changing cough • Cough at night Cough at night • Cough at AMCough at AM

  

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• HemoptysisHemoptysis – refers to the blood – refers to the blood expectorated from the mouth in the form of expectorated from the mouth in the form of gross blood, frankly bloody sputum, or blood-gross blood, frankly bloody sputum, or blood-tinged sputumtinged sputum

– Blood from nose – due to sniffing/irritationBlood from nose – due to sniffing/irritation– Blood from lungs – bright red, frothy, salty Blood from lungs – bright red, frothy, salty

taste, alkalinic with tickling sensation on taste, alkalinic with tickling sensation on throat, burning/bubbling sensation on throat, burning/bubbling sensation on chestchest

– Blood from stomach – dark in color, acidicBlood from stomach – dark in color, acidic

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Current Health: Chief Current Health: Chief ComplaintComplaint

WheezingWheezing – produced when air passes – produced when air passes through partially obstructed or through partially obstructed or narrowed airways on inspiration and narrowed airways on inspiration and expiration; may be audible or maybe expiration; may be audible or maybe heard only with stethoscope heard only with stethoscope

StridorStridor – harsh, high-pitched sound – harsh, high-pitched sound produced when air passes through a produced when air passes through a partially obstructed or narrowed upper partially obstructed or narrowed upper airway on inspiration; associated with airway on inspiration; associated with respiratory distressrespiratory distress

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Chest Pain Chest Pain – caused by coughing and pleuritic – caused by coughing and pleuritic infectionsinfections

– Onset, location and radiationOnset, location and radiation– Duration and character or qualityDuration and character or quality– FrequencyFrequency– Factors that predispose or relieve the Factors that predispose or relieve the

painpain– RETROSTERNAL PAIN RETROSTERNAL PAIN – PLEURITIC CHEST PAINPLEURITIC CHEST PAIN

CyanosisCyanosis – bluish discoloration of the skin and – bluish discoloration of the skin and mucus membrane which occur when the mucus membrane which occur when the level of the hemoglobin present in the blood level of the hemoglobin present in the blood is reducedis reduced

Current Health: Chief ComplaintCurrent Health: Chief Complaint

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Symptoms Analysis• SettingSetting – time and place or particular situation – – time and place or particular situation –

physical setting and psychological environment physical setting and psychological environment in which the client experiences the complaintin which the client experiences the complaint

• TimingTiming – onset and period during which the – onset and period during which the problem has occurred; specific time of dayproblem has occurred; specific time of day

• Client’s perception Client’s perception – unique properties of the – unique properties of the complaintcomplaint

• Quantity and quality Quantity and quality – amount, size, number, and – amount, size, number, and extent of the chief complaintextent of the chief complaint

• LocationLocation – to determine whether the problem is – to determine whether the problem is cardiac or respiratory in origincardiac or respiratory in origin

• Aggravating and relieving factors Aggravating and relieving factors – what – what precipitates worsens or alleviates a symptom?precipitates worsens or alleviates a symptom?

• Associated manifestations Associated manifestations – chills, fever, night – chills, fever, night sweats, anorexia, weight loss, excessive fatigue, sweats, anorexia, weight loss, excessive fatigue, anxiety, anxiety, hoarsenesshoarseness

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Past Health History • Childhood and Infectious Diseases Childhood and Infectious Diseases – occurrence of – occurrence of

TB, bronchitis, influenza, asthma and TB, bronchitis, influenza, asthma and pneumonia ;existence of congenital problems; pneumonia ;existence of congenital problems; premature birth history.premature birth history.

• ImmunizationImmunization – vaccination against pneumonia and – vaccination against pneumonia and influenza; date of vaccinationinfluenza; date of vaccination

• Major Illnesses and Hospitalization Major Illnesses and Hospitalization – previous – previous hospitalization for respiratory problems; medical hospitalization for respiratory problems; medical treatment; and the present status of the problemtreatment; and the present status of the problem

• MedicationsMedications – prescribed and OTC medications; – prescribed and OTC medications; herbal remedies many products affect the respiratory herbal remedies many products affect the respiratory systemsystem

• AllergiesAllergies – foods, medications, pollens, smoke, – foods, medications, pollens, smoke, fumes, dust and animal dander, molds allergic fumes, dust and animal dander, molds allergic manifestations (chest tightness, wheezing, cough, manifestations (chest tightness, wheezing, cough, rhinitis, watery eyes, scratchy throat)rhinitis, watery eyes, scratchy throat)

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Family Health History• Identify blood relatives Identify blood relatives

and family members and family members who have had who have had respiratory disorders, respiratory disorders, age and cause of death age and cause of death of deceased family of deceased family member; household member; household members who smokemembers who smoke

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Psychosocial History Psychosocial History • OccupationOccupation - work environment and - work environment and

hobbies; exposure to dust, asbestos, hobbies; exposure to dust, asbestos, beryllium, silica and other toxins or beryllium, silica and other toxins or pollutantspollutants

• Geographical Location Geographical Location – recent travel to – recent travel to areas where respiratory disorders are areas where respiratory disorders are prevalentprevalent

• Environment Environment – living conditions; how many – living conditions; how many are in the householdare in the household

• HabitsHabits – history of smoking; use of – history of smoking; use of smokeless tobacco; alcohol use; use of smokeless tobacco; alcohol use; use of recreational drugsrecreational drugs

• Exercise Exercise – typical activities– typical activities• NutritionNutrition – amount of caloric intake – amount of caloric intake

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Concept of Oxygenation

•ASSESSMENT

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Physical Assessment Physical Assessment

• establish the baseline establish the baseline information and provide information and provide framework for the detection of framework for the detection of any changes that might occur in any changes that might occur in a client’s conditiona client’s condition

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• HeadHead andand NeckNeck – inspect for gross – inspect for gross abnormalities that would interfere with abnormalities that would interfere with respiration; odor of breath respiration; odor of breath

● ● Note nasal flaring, breathing with pursed Note nasal flaring, breathing with pursed lips, or cyanosislips, or cyanosis

Inspection Inspection

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• ChestChest – observe chest wall configuration; – observe chest wall configuration; size, contour, and anteroposterior size, contour, and anteroposterior diameterdiameter

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CHEST WALL DEFORMITIES

TYPE OF DEFORMITY DESCRIPTION ETIOLOGY

BARREL CHEST APD = TD Chronic Airflow Disorder

FUNNEL CHEST (Pectus excavatum)

Sternum is DEPRESSED, narrowing

of the APD

Congenital in nature

PIGEON CHEST (Pectus carinatum)

Sternum projects forward,

increased APD, wider TD

Congenital in nature

Thoracic Kyphoscoliosis Appearance: hunch-over, hunch back

Congenital in nature, spinal TB, osteoporosis,

RA, poor posture

• INSPECTION HEAD and NECK CHEST Chest Wall

Configuration* SHAPE OF THE CHEST: elliptical

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Chest movementChest movementA.A. RetractionsRetractions – – most prominent in the most prominent in the

lateral chest; indicative of labored lateral chest; indicative of labored breathing breathing

B.B. RespirationsRespirations Biot’s RespirationBiot’s Respiration – irregular periods of – irregular periods of

apnea that are followed by several apnea that are followed by several breaths that are even in rate and depthbreaths that are even in rate and depth

Cheyne – Stokes respirationCheyne – Stokes respiration – – characterized by periods of characterized by periods of hyperventilation alternating with hyperventilation alternating with periods of apneaperiods of apnea

Kussmauls respirationKussmauls respiration – increased – increased depth in breathingdepth in breathing

C. Pattern C. Pattern RateRate VolumeVolume

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IRREGULAR BREATHING PATTERNS

TYPES OF IRRGULAR BREATHING PATTERN

DESCRITPTION

KUSSMAUL’S RESPIRATION Blows more carbon dioxide through DEEP and RAPID BREATHING.

CHEYNE-STOKES RESPIRATION(also classified under APNEIC

BREATHING PATTERNS)

Marked rhythmic, WAXING and WANING, from, VERY DEEP and VERY SHALLOW breathing and

TEMPORARY APNEA.Common with CHF, ICP and drug

overdose.

BIOT’S (Cluster) RESPIRATION(also classified under APNEIC

BREATHING PATTERNS)

SHALLOW BREATHS interrupted by APNEA.

Common with CNS disorders.

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• INSPECTION HEAD and NECK

CHEST Chest Wall

Configuration Chest Movement * normal respiratory rate (accdg. to KOZIER) = 12 – 22 cpm.* men: abdominal breathers* women: thoracic breathers

FINGERS and TOES observe for clubbing perform the Schamroth’s Test perform the Blanch Test

SKIN

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PalpationPalpation

• TracheaTrachea – palpate for – palpate for masses, crepitus (air masses, crepitus (air in the subcutaneous in the subcutaneous tissues), or deviation tissues), or deviation from the midlinefrom the midline

• TacrileTacrile Fremitus/VocalFremitus/Vocal FremitusFremitus

• Thoracic excursionThoracic excursion

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• PALPATION TRACHEA

> Place the thumb of the palpating hand on one side of the trachea and the remaining of the fingers on the other side.> Move the trachea gently from side-to-side along its length while palpating for masses, crepitus or deviations from the midline.

NORMAL FINDINGS: trachea is movable and

quickly returns to midline after displacement.

CHEST WALL

> Holding the HEEL or ULNAR ASPECT OF THE HAND against the client’s chest.> Palpate for the ribs and intercostal spaces.> Locate the angle of Louis (manubriosternal junction) by first palpating the clavicle and following its course of attachment at the manubrium.

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• PALPATIONCHEST WALL: POSTERIOR THORACIC

EXCURSION> Place the palms of both hands over the lower thorax with the thumbs adjacent to the spine and fingers stretched laterally.> Ask the client to take a deep breath while observing the movement of the hands an any lag in movement.NORMAL FINDINGS: full and symmetric chest expansion (thumbs should move apart with an equal distance at the same time. Approximately 3 to 5 cm (1.5 to 2 in).CHEST WALL: ANTERIOR THORACIC EXCURSION> Place the palms of both hands on the lower thorax with fingers laterally along the lower rib cage and thumbs along the costal margin.

> Ask the client to take a deep breath while observing the movement of the hands and any lag in movement.

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PercussionPercussion SoundsSounds• Resonant sounds Resonant sounds – low pitch hollow sounds heard – low pitch hollow sounds heard

over normal tissueover normal tissue• Hyperresonant sounds Hyperresonant sounds – louder and lower pitch – louder and lower pitch

than resonant which indicate increases amount of than resonant which indicate increases amount of air in the lungs or pleural space (EMPHYSEMA, air in the lungs or pleural space (EMPHYSEMA, PNEUMOTHORAX)PNEUMOTHORAX)

• Dull sounds Dull sounds – thudlike and medium pitch and – thudlike and medium pitch and normally heard over the liver and heart, occur over normally heard over the liver and heart, occur over dense lung tissue such as tumor or consolidationdense lung tissue such as tumor or consolidation

• Flat notes Flat notes – soft high pitch heard during percussion – soft high pitch heard during percussion of airless tissue (bony structure)of airless tissue (bony structure)

• Tympanic notes Tympanic notes – high, drumlike sounds heard with – high, drumlike sounds heard with percussion over the stomach, a large tension on percussion over the stomach, a large tension on pneumothorax or a large air-filled chamberpneumothorax or a large air-filled chamber

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• AUSCULTATIO

NNORMAL BREATH SOUNDS UPON AUSCULTATION

BREATH SOUNDS DESCRIPTION LOCATION CHARACTERISTIC

VESICULAR Soft-intensity, low-pitched, “gentle-sighing” sounds created by air

moving through smaller airways (bronchioles &

alveoli).

Peripheral lungs,

bases of the lungs

INSPIRATION.

About 2.5 times longer than the

expiratory phase (2:1).

BRONCHOVESICULAR Moderate intensity and moderate

pitched blowing sounds created by air moving through

larger airways (bronchi).

Between the scapulae and lateral to the sternum at

the 1st and 2nd ICS.

Equal inspiratory and expiratory phases

(1:1).

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NORMAL BREATH SOUNDS UPON AUSCULTATION

BREATH SOUNDS DESCRIPTION LOCATION CHARACTERISTIC

BRONCHIAL High-pitched, loud, “harsh-sounds”.

Trachea. Louder than vesicular sounds.

Have short inspiratory and long expiratoryphases

(1:2).

• AUSCULTATIO

N

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ABNORMAL BREATH SOUNDS UPON AUSCULTATION

BREATH SOUNDS

DESCRIPTION COURSE LOCATION

CRACKLES/RALES

High-pitched.Fine, short, interrupted

crackling sounds.Sounds like rubbing

locks of hair between thumbs and fingers

Heard during INSPIRATION and do not clear with cough

Air passing through fluid or mucus in any air

passage.

CONDITION:Pulmonary Edema, fibrosis, pneumonia

Bases of the lower lung

lobes.

GURGLES/RONCHI

Continuous, low-pitched, coarse,

gurgling, harsh, louder sounds, with moaning and snoring quality.

EXPIRATION (can be heard on both)

Air passing through narrowed air passages

as a result of secretions, swelling and tumors.

CONDITION: PNEUMONIA, BRONCHITIS,

BRONCHIECTASIS

Most lung areas but are louder on the trachea and

bronchi.

• AUSCULTATIO

N

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ABNORMAL BREATH SOUNDS UPON AUSCULTATION

BREATH SOUNDS

DESCRIPTION COURSE LOCATION

FRICTION RUB

Superficial grating or creaking sound .

“2 pcs of leather rubbing together”

INSPIRATION and EXPIRATION

Rubbing together of inflamed pleural

surfaces.

CONDITION: Pleurisy,

Pneumonia, Pleural infarct

Heard most often in areas of greater

thoracic expansion (lower anterior and

lateral chest).

WHEEZE Continuous, high-pitched, squeaky, musical sounds.

EXPIRATION.

Air passing through constricted

bronchus as a result of secretions, swelling or tumors.

CONDITION: Asthma

On all lung fields.

• AUSCULTATIO

N

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INSPECTION OF AN OBSTRUCTED AIRWAY

UPON INSPECTION INTERPRETATION

Low-pitched snoring sound during inhalation, labored breathing

Partial obstruction of the upper airway

Absence of sounds and rise and fall, accompanied (at times seen

with deep retractions)

Complete/total airway obstruction

Stridor (a harsh high-pitched sound heard during inspiration)

Lower airway obstruction

Other adventitious breath sounds

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DIAGNOSTIC PROCEDURES

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PULMONARY FUNCTION TESTS• Nursing Responsibilities:

– Determine whether an analgesic that may depress the respiratory function is being administered.

– Advise the client not to SMOKE OR EAT A HEAVY MEAL = 4 to 6 hrs before the test.

– Withhold BRONCHODILATOR medications for 6 hrs before the test.

> Provide information about respiratory function by measuring lung volume, lung mehanics and diffusion capabilities of the lungs

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PULMONARY FUNCTION TESTS

– Instruct the client to void before the procedure and wear loose clothing.

– Remove dentures. – The client is asked to breathe through

the mouth only. A nose clip is used to prevent air from escaping. The client is asked to perform different breathing maneuvers while measurements are obtained

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PULSE OXIMETRY

• Pulse oximeter measures the percentage of Hemoglobin saturated with OXYGEN.

• Pulse oximeter passes a beam of light through the tissue and the sensor measures the AMOUNT of light absorbed by O2- saturated HgB.

• REMINDERS: – Sensor NOT placed distally in BP

cuffs, pressure dressings etc.– Sensor should NOT be taped into the

finger.– No dark nail polish. – Normal O2 Sat. 90-100%

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ARTERIAL BLOOD GAS ANALYSIS

• Use of ARTERIAL BLOOD to measure: – PaO2, PaCo2, pH

• Nurse’s Responsibilities: – Educate the client regarding the

need for the test. – Explain to the client the need to

hold still. – Perform the Allen’s Test.– Keep the client calm. – 5 – 10 mL of arterial blood is

drawn.

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Arterial Blood Gas Analysis

• A needle connected to a heparinized syringe is utilized.

• Most common site for blood withdrawal is the RADIAL ARTERY.

• Apply continuous pressure to the site for 5 minutes and 10 minutes for femoral sites.

• Place specimen on a container with ice & transport immediately to the lab.

ARTERIAL BLOOD GAS ANALYSIS

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ABG INTERPRETATION • Oxygenation Status

– O2 Therapy

• Acid – Base Interpretation – pH: 7.35 – 7.45– PaCO2: 35- 45 mmHg– HCO3: 22- 26mEq/L

• Presence of and degree of compensation

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CHEST X – RAY • Visualization of lungs, heart and

surrounding structures.

– Routine screening procedure– Suspicion of pulmonary disease– Monitor status of respiratory disorders– Evaluate extent of traumatic chest

injury– Provide radiographic information for

management of a respiratory problem.

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CT SCAN • Cross – sectional view of anatomic

structures.

MRI SCAN

• Use of magnetic field to provide a more detailed imagery than a CT scan.

• May permit visualization of structures as they function.

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ULTRASONOGRAPHY • Helpful and accurate in detecting

the amount and location of 50mL or less of pleural fluid.

• Permits visualization for obtaining an adequate amount of pleural fluid for laboratory analysis without unnecessary puncturing and probing.

• 15 – 30 minutes in duration.

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BRONCHOSCOPY

• Diagnostic/ Therapeutic • Permits visualization of the bronchial

tree via a lighted bronchoscope

• Pre - procedure – Explain. Obtain informed consent. The test

lasts 30 – 45 minutes in duration. – NPO 6 hours prior to the test.– Client must remove dentures, contact lenses

and other prosthesis. – IV sedatives are administered to suppress

cough and anxiety. – Topical anesthetic will be applied at the back

of the mouth to decrease the gag reflex. – Patient is positioned supine with head

hyperextended. – Inform the client that it is normal for the

client to feel sore in the throat and difficulty in swallowing.

•Post - procedure– Monitor patient’s vital signs.– Take note of the patient’s

respiratory status.– Observe expectorated secretions. – NPO until reflex returns.– Feeding begins with ice chips.– Monitor lung sounds.

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LARYNGOSCOPY •Permits visualization of the larynx

– INDIRECT •Use of a mirror to visualize nasopharynx for drainage, bleeding and ulceration.

–DIRECT •Use of an endoscope to visualize the movement and characteristic of the vocal chords.

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ALVEOLAR LAVAGE

•Sterile saline injected to wet the tissue, then aspirated to examine atypical cells.

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PULMONARY ANGIOGRAPHY

• Assessment of pulmonary vascular structures through an injection of a contrast medium through an indwelling catheter.

• NURSING RESPONSIBILITIES:– Obtain informed consent– Assess of allergies to iodine, seafood & other rediopaque dyes– NPO for 8 hrs before the test

-Administer sedation as prescribed

- Avoid taking BP for 24 hrs in the involved extremity

-Monitor peripheral neurovascular status of extremities

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THORACENTESIS• NURSING RESPONSIBILITIES:

Pre-procedure:– Obtain informed consent– Ask pt. to sit upright while leaning on the tray

table.– Instruct the client to hold still.Post-procedure:- Position pt. on the UNAFFECTED SIDE.- Apply pressure dressing & assess puncture site

for bleeding & crepitus- Monitor for signs of pneumothorax, air

embolism & pulmonary edema.

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SPUTUM COLLECTION

• Acid – fast bacillus staining/ sputum culture

• Direct method: – Obtain early morning specimen (15 ml) – Instruct client to rinse mouth with

water– Deep breathing – Cough out sputum in container

– Indirect method: •Sterile suction catheter with an

attached sputum trap or transtracheal aspiration.

• Gastric lavage

Note color, consistency, odor and amount

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NOSE AND THROAT

CULTURE • Swab nose and

throat with the use of sterile cotton swab.

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LUNG BIOPSY • Open Lung Biopsy • Aspiration Biopsy

– After identification of the lesion via CXR and fluoroscopy, a needle will be inserted through the chest wall into the lung tissue and the lesion.

– Definitive diagnosis of malignant neoplasms and granulomas

– CX: hemoptysis, pneumothorax, hemothorax

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SKIN TEST/MANTOUX TEST

• PPD (Purified Protein Derivative)• Intradermal• Read within 48-72 hrs after injection• (+) = induration of 10 mm or more• HIV (+) clients = 5 mm induration is

(+)• (+) result = exposure to

Mycobacterium tubercle bacilli