objective 4: Respiratory alterations Flashcards
what is the primary purpose of the respiratory system?
gas exchange, transferring oxygen and carbon dioxide from the atmosphere to the blood
what are the 2 parts of the respiratory system?
the upper respiratory tract
the lower respiratory tract
what does the upper respiratory tract consist of?
nasal cavity, pharynx, and adnoids
what does the lower respiratory tract consist of?
bronchi, bronchioles, alveolar ducts and the alveoli
what are the structures of the chest wall?
ribs, pleura, muscles of respiration
exchange area for oxygen (energy supply), and
carbon dioxide (metabolic waste), regulating
acid/base balance
lungs
conduit for passage of oxygen and carbon
dioxide
bronchi
ribs (12), sternum, vertebrae provide support
and protection to the lungs and bronchi
thorax
what are the key processes of gas exchange?
ventilation
oxygenation
respiration
perfusion
decreased RR, sedation, neurological or muscular impairments, thorax shape alterations will affect ________
ventilation
decreased o2 concentration, blocked bronchi will affect _______
oxygenation
decreased surface area of the alveoli, fluid or pus filled, atelectase, lack of surfactant will affect _______
respiration
blockages or leaks in circulation, low RBC and Hgb will affect _______
perfusion
what are the essentials for respiratory function?
clear conduit
functioning lungs/brain
muscle stregnth
proper protection
nerve & vascular innervation
absence of obstruction
must be wide enough: narrows with inflammation, infection, and growths which increases resistance
clear conduit
Lung tissue and air sacs (alveoli) need to expand to allow air
in, and recoil with less compliance)
Surfactant in the alveoli ensure the air sacs open and close
without collapsing
Stiff lung tissue can impair the lung’s ability to expand
* Pulmonary function tests measure max volume of inspired and expired air,
normal breathing, and pressures
functioning lungs
Intercostal muscles, and those
connecting your diaphragm,
lose strength when clients are
not mobilizing or using assistive
breathing devices.
Client who have been on
ventilator need a lot of
retraining of their chest wall
and diaphragmatic muscles
(chest physio is important;
ensure the client completes the
required exercises.
muscle strength
Intact ribs and pleura (visceral and
parietal)
Trauma creates an interruption; lack of
negative pressure causes the lungs to
collapses. Therefore, the lungs are unable
to expand.
LPN: Not dislodging clients chest tube,
and monitoring the chambers attached to
them.
protection
- Transmission of appropriate signals is not
occurring or impaired (i.e., general
anesthesia) - LPN: Monitoring the patient’s level of
sedation and respiratory rate post surgery - Remember, alterations in respiratory
system results from interference with
ventilation (breathing), diffusion (crossing
over the alveoli), perfusion (getting it to
the organs)
nerve innervation
- Best to obtain first thing in the morning (secretions accumulate
at night) - Collect before antibiotics are initiated
- Ask the patient to clear their mouth from any secretions
- Instruct patient to deep breath in and out three times
- Have patient cough and expectorate sample into a sterile
specimen container - Do not contaminate with saliva
- Send to lab within two hours of collecting sample
- If unsuccessful with sample collection, increase oral fluids (if
permitted) and try again
sputum culture
A nasopharyngeal (NP), nose, and throat swab are
indicated to identify a specific microorganism(s)
that may be causing the respiratory alteration
Complete at least one hour before or after meals
(gagging, nausea, vomiting, or aspiration may
result)
Uncomfortable procedure where burning,
sneezing, and eye watering may result
Example: COVID-19 Test completed via NP Swab
nasopharyngeal swab
- Nasal- 2-2.5 cm insertion
- Rotate against nasal mucosa
- Avoid contamination when placing into transport
medium
nasal swab
- Use tongue depressor to visualize pharynx;
(anterior 1/3 tongue) - Rotate along reddened areas and tonsils
- Avoid contamination with saliva and when pacing
in transport medium
throat swab
- Most common diagnostic tool used to identify and
treat pulmonary alterations - Assesses progression of disease and response to
treatment - Most common views ordered is PA and Lateral
- When X-Rays pass through air, it is seen as black on
the image - Patent takes in a deep breath and holds their breath
until image is taken - LPNs can transport stable pt. to XRAY department
(Unstable or Telemetry = RN) - Change pt. into a gown, remove metal/jewelry from
neck to waist
chest X-ray
Usually collected by respiratory therapist
Measure’s acid-base balance (pH, CO2, O2, HCO3 levels)
Often used in managing care of patients with respiratory problems and when
adjusting O2 therapy
Aids in assessing the ability of lungs to provide adequate O2 remove CO2 and
the ability of kidneys to reabsorb or excrete HCO3- to maintain normal blood
pH
Obtained from a puncture at radial, brachial or femoral artery or with
indwelling arterial catheter
arterial blood gas
- Evaluates lung function
- It involves use of a spirometer to diagram air movement as patient
performs prescribed respiratory maneuvers. - Useful in monitoring disorder and it’s response to treatment (i.e., COPD,
Asthma) - Used in some patients prior to abdominal surgeries who are high risk (i.e.,
obese) - Completed on an outpatient basis
pulmonary function test
