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
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
- Examination of larynx, trachea, and bronchi
- Is an invasive procedure in which the bronchi are visualized through a fibre-optic tube
- May be used to obtain biopsy specimens, assess changes that have resulted from
treatment, remove mucous plugs or foreign bodies
bronchoscopy
Is the insertion of a needle through the chest
wall into the pleural space so specimens can
be obtained for diagnostic evaluation.
* Also used to remove pleural fluid, or to instill
medications into the pleural space.
Patient is positioned upright with elbows on
an overbed table and feet supported.
Skin is cleansed, local anaesthetic applied
(i.e., Xylocaine) is applied into the
subcutaneous space
thoracentesis
- Performed transbronchial (open lung procedure)
- Purpose is to obtain tissue, cells, or secretions for
evaluation - Forceps or a needle is passed through the
bronchoscope for specimen collection - Specimens can be cultured and/or examined for
malignant cells - Nursing care is the same as for fibre optic
bronchoscopy - A general anesthetic is given, and the chest is opened
via thoracotomy incision to obtain a biopsy
lung tissue biopsy
what are the resp alterations for upper?
*Infectious/ Inflammatory
* Rhinosinusitis
* Laryngitis
* Pharyngitis
* Influenza
* Structural
* Epistaxis
* Cancer
what are the respiratory alterations lower?
- Infectious/Inflammatory
- Pleural effusion, emphysema,
abscesses - Influenza, TB, pneumonia,
bronchitis, bronchiectasis - Obstructive
- Atelectasis
- COPD
- Asthma
Inflammation and irritation that occurs to the nasal mucosa
rhinitis
Caused by virus that invades
the upper respiratory tract (ex: common cold)
acute viral rhinitis
Reaction that occurs in the nasal
mucosa secondary to an allergen
allergic rhinitis
Develops when the exit from the sinuses is narrowed or blocked by
inflammation of the mucosa
* The secretions that accumulate behind the blockage is a rich medium for
bacteria overgrowth
* Acute(infection) or chronic (allergies) / Viral or bacterial
sinusitis
Surgical incision made into the
trachea to establish an airway.
An artificial airway is inserted
into the trachea during a ______
tracheostomy
Malignant tumor in and around voice box
laryngeal cancer
Combo for 2 month, followed by continued med for 4-7
months
active TB
6-9 months continuous (INH)
latent TB
- Older adults are a high-risk group with associated
mortality secondary to complications associated with
influenza (i.e., pneumonia) - Incubation period of 1-4 days; feel ill for 5-7 days
- Preventative Measure: vaccination
This Photo by Unknown Author is licensed under CC BY-ND
influenza
Inflammation of Bronchial mucous membranes
and their branches.
* Tracheobronchitis occurs if the
inflammation involves the trachea
acute brinchitis
Dilation of bronchial airways can occur
as a result of chronic bronchitis or other
respiratory disorders. This results in
localized or widespread scarring and
creates an ideal environment for
bacterial growth
bronchiectasis
- An acute inflammation of the lung
parenchyma by a microbial agent - High prevalence rate with significant
morbidity and mortality rates - Classified by causative organism and
treatment modality - Bacterial, viral, mycoplasma,
fungi, parasites, chemicals,
aspiration, etc
pneumonia
- Chronic inflammatory disorder of the
airways with varying degrees of
obstruction secondary to the degree of
inflammation - Airways are hyperresponsive
- Asthma occurs as the result of
environmental effects on the airways
which triggers the immune system - Triggers include allergens, respiratory
infections, nose/sinus problems,
emotional stress, exercise, GERD etc
asthma
- Preventable and progressive disease with
progressive airflow limitation - Etiology is chronic inflammatory response in
the airways that can be secondary to cigarette
smoking, noxious particles and gases, heredity,
and aging
COPD
is a form of COPD, which is a chronic
disabling disease,
* Characterized by abnormal alveoli distention; alveoli
walls and capillary beds show distinct destruction,
occurs over long period of time.
* The lungs are permanently damaged.
* It is the most common obstructive lung disorder
* Decreased surface area for gas exchange- more “dead
space”
* Chronic higher levels of PaCO2 with later progression
* Complications: Respiratory insufficiency and failure.
Right-sided heart lung failure
emphysema
Inherited, multisystem disorder marked
by altered function of the exocrine glands
involving primarily the lungs, pancreas
and sweat glands
Inherited from both parents
When 2 carriers give birth to a child, the
child has 25% chance of having CF
Most common fatal autosomal recessive
disease among Caucasians
cystic fibrosis
- An abnormal, life-threatening
accumulation of fluid within the alveoli
and interstitial spaces of the lungs - Often a complication of heart failure and
lung disease (usually left-sided heart
failure) - Interferes with gas exchange
- Review cardiovascular PPP on HF
pulmonary edema
- Thrombus, fat, or air embolism blocks the
pulmonary arteries, obstructing perfusing to the
alveoli. - Most arise from DVT’s of the legs
pulmonary embolism
sternal or rib fractures, flail chest, pulmonary contusion
blunt
stab or gunshot wounds, pneumothorax, subcutaneous emphysema
penetrating
can occur- 2 or more adjacent ribs
broken, and fragments are free floating
flail chest
Anything that pierces the parietal or visceral
lining of the lung will result in an increase in
pleural space
* This results in a change in the pressure in the
lung cavity.
* If not recognized and treated promptly, death
may occur because of its affects on ventilation,
oxygenation, respiration, and perfusion
penetrating chest trauma
- Sudden compression or positive pressure inflicted
to the chest wall; can result from severe coughing - Ribs 4 through 9 most fractured - the least
protected by chest muscles - Painful but not life threatening, unless has caused
other injuries; The sharp end of the broken bone
may tear the lung, pleura, or thoracic blood
vessels
blunt chest trauma
- Presence of air in the pleural space. A complete or partial collapse of
the lung results from this accumulation of air
pneumothorax
no associated external wound
closed
air enters through opening chest wall
open
rapid accummulation of air in pleural space, increasing intrapleural pressures, resulting in tension on heart and great vessels
tension
accumulation of blood in pleural spave
hemothorax
lymph fluid in the pleural space due to a leak in the thoracic duct
chylothorax
air passing through fluid
crackles
velcro like, CHF, PE
fine cracklesbu
bubbling, popping sounds, pneumonia
coarse crackles
air passing through inflammation
wheezes
obstruction of airway
stridor
visceral and parietal linings rubbing together during respiration
pleural friction rub
