UE 3 Flashcards
known as the upper airway, warms and filters inspired air so that the lower respiratory tract (the lungs) can accomplish gas exchange or diffusion.
Upper Respiratory Tract
Upper airway structures consist of
the nose; paranasal sinuses; pharynx, tonsils, and adenoids; larynx; and trachea.
performs this function by facilitating life-sustaining processes such as oxygen transport, respiration, ventilation, and gas exchange.
Respiratory system
➔ Oxygen is supplied to, and carbon dioxide is removed from, cells by way of the circulating blood through the thin walls of the capillaries.
➔ Oxygen diffuses from the capillary through the capillary wall to the interstitial fluid.
➔ it diffuses through the membrane of tissue cells, where it is used by mitochondria for cellular respiration.
➔ The movement of carbon dioxide occurs by diffusion in the opposite direction—from cell to blood
Oxygen Transport
The movement of air in and out of the airways continually
replenishes the oxygen and removes the carbon dioxide
from the airways and the lungs. This whole process of gas
exchange between the atmospheric air and the blood and
between the blood and cells of the body is called
Respiration
The goals of respiration are to
provide oxygen to the tissues and to remove carbon dioxide
Respiration is divided into:
● Pulmonary ventilation
● Diffusion
● Transport of oxygen
To achieve these goals of respiration, we should have:
● Efficient respiratory pump
● Efficient heart and circulatory system
● Efficient respiratory control
Mechanisms of Pulmonary Ventilation
Lungs can expand and contract in ways
Gas Transport
Oxygen Transport
Lungs can expand and contract in ways:
- Downward and upward movement of the diaphragm to
lengthen or shorten the chest cavity - Elevation and depression of the ribs to increase and
decrease the anteroposterior diameter of the chest cavity
● Inhaled: oxygen – contract of diaphragm → downward
● Exhaled: carbon dioxide – diaphragm relaxed
oxygen and carbon dioxide carried between the
lungs and body cells by the blood
These gasses can be:
1. Dissolve the blood plasma
2. Chemically combined with other atoms or molecules
present in the blood
Gas Transport
- Loosely binding to the iron present in the protein
hemoglobin in the red blood cells creatinine.
Oxygen transport
➔ requires movement of the walls of the thoracic
cage and of its floor, the diaphragm.
➔ When the chest wall and the diaphragm return to their
previous positions (expiration), the lungs recoil and force
the air out through the bronchi and the trachea.
➔ Inspiration occurs during the first third of the respiratory
cycle; expiration occurs during the latter two-thirds.
Ventilation
Inspiration occurs during
the first third of the respiratory cycle
expiration occurs during
the latter two-thirds.
this phase of respiration normally requires energy
Inspiratory phase
this phase is normally passive, requiring very little energy
Expiratory phase
Physical factors that govern airflow in and out of the lungs
are collectively referred to as
the mechanics of ventilation
Physical factors that govern airflow in and out of the lungs
are collectively referred to as the mechanics of ventilation
and include air pressure variances, resistance to airflow,
and lung compliance
★ During inspiration, diaphragm contract
★ Thoracic Rib cage increases
★ Thorax Pressure decreases
★ After inspiration, the diaphragm recoils
movements of the diaphragm and intercostal muscles enlarge the thoracic cavity and thereby lower the pressure inside the thorax to a level below that of atmospheric pressure. As a result, the air is drawn through the trachea and the bronchi into the alveoli.
Inspiration
the diaphragm relaxes and the lungs recoil, resulting in a decrease in the size of the thoracic cavity. The alveolar pressure then exceeds atmospheric pressure, and air flows from the lungs into the atmosphere.
Expiration
● MEDULLA OBLONGATA and PONS
● CCR- CO2 and hydrogen level s
● PCR- Ph and level of O2 and CO
Brain
● DETERMINES THE CO2
● (INCREASED CO2, DECREASED PH)
● (DECREASED CO2- INCREASED PH)
Lungs
BOTH MAINTAIN THE RATIO OF CARBONIC ACID
Brain and Lungs
- LUNGS ELIMINATE CARBONIC ACID “BLOWING CO2, CONSERVE CO2 BY SLOWING VOLUME & REABSORB HCO3)
- KIDNEYS EXCRETE MORE BICARBONATE
Compensatory Mechanism
● 98% oxygen transport
○ Oxygen bound w/ hemoglobin
● If hemoglobin is saturated → deoxygenated blood
● ↑ acidity, temperature, partial pressure of carbon
dioxide
○ Oxygen is an area for respiration
Hemoglobin
● Plasma is 7%
● Hemoglobin is 15%-25%
● Bicarbonate Ion is 70%
● Transport via plasma
Carbon dioxide
● Muscle cramps, palpitation, confusion, loss of
consciousness
● High carbon dioxide in the body
● Transport via bicarbonate ions
○ CO2 diffuse in alveoli, ↓ partial pressure of
CO2 in plasma
Ammonia
ABG
➢ Respiratory Acidosis - kidney retain more HCO3, ↑ pH
➢ Respiratory alkalosis – kidney excrete more HCO3, ↓ pH
➢ Metabolic Acidosis – lugs blow off CO2, ↑pH
➢ Metabolic Alkalosis – lungs retain CO2, ↓ pH
The process in which blood is forced to flow through a
network of microscopic vessels within biologic tissue,
allowing the exchange of oxygen and other molecules
across semipermeable microvascular walls.
Pulmonary Circulation
blood is forced to flow to exchange oxygen across the
semipermeable microvascular wall
Perfusion
● conducting airways
● the systemic vascular supply to the lung and supplies
blood to conducting airways down to the level of the
terminal bronchioles as well as nerves, lymph nodes,
visceral pleura, and the walls of large pulmonary
vessels.
Bronchial Circulation
● system supply to the lungs
● ↓ pressure system
● ↑ alveolar pressure “narrow”
● ↓ alveolar pressure “decreases” converting energy
● Process of gravity
Pulmonary Circulation
● Release energy and convert energy and stored ATP
molecules
Cellular Respiration
3 Stages of Cellular Respiration
- Glycolysis
- Kreb’s Cycle
- Electron Transport Chain
● The liver converts fat to sugar
● Does not require oxygen (anaerobic)
● The cytosol of cytoplasm converts glucose
Glycolysis
● 2nd stage, artic acid cycle
Kreb’s Cycle
● Last stage of respiratory pathology
● Produce ATP molecules
Electron transport chain
Common symptoms
- Dyspnea
- Cough
- Sputum production
- Chest Pain
- Wheezing
- Hemoptysis
○ The subjective feeling of difficult or labored
breathing, breathlessness, shortness of breath
○ It is especially important to assess the patient’s
rating of the intensity or distress of
breathlessness, what breathing feels like, and its
impact on the patient’s general health, function,
and quality of life.
Dyspnea
is a reflex that protects the lungs from the
accumulation of secretions or the inhalation of
foreign bodies.
○ results from irritation or inflammation of the
mucous membranes anywhere in the respiratory
tract
○ A dry, irritative cough is characteristic of an upper
respiratory tract infection
Cough
A nurse interviewing a patient who says he has a dry,
irritating cough that is not “bringing anything up” should ask whether he is taking
ACE inhibitors
is the reaction of the lungs to any
constantly recurring irritant and often results from persistent
coughing.
● A profuse amount of purulent sputum (thick and yellow,
green, or rust-colored) or a change in color of the sputum is a common sign of a bacterial infection
Sputum Production
associated with pulmonary conditions may be
sharp, stabbing, and intermittent, or it may be dull, aching,
and persistent.
● Pleuritic pain from irritation of the parietal pleura is sharp and seems to “catch” on inspiration; patients often describe it as being “like the stabbing of a knife.”
● Patients are more comfortable when they lay on the
affected side because this position splints the chest wall,
limits expansion and contraction of the lung, and reduces
the friction between the injured or diseased pleurae on that side.
● The nurse assesses the quality, intensity, and radiation of pain and identifies and explores precipitating factors and their relationship to the patient’s position.
Chest Pain
is a high-pitched, musical sound heard on either
expiration (asthma) or inspiration (bronchitis).
Wheezing
is the expectoration of blood from the respiratory tract.
● Blood sa pag ubo
Hemoptysis
Health Assessment
● General History
○ Clubbing of the fingers
○ Cyanosis- bluish coloring of the skin
● Health history
○ onset, location, duration, character, aggravating
and alleviating factors, radiation (if relevant), and
timing of the presenting problem and associated
signs and symptoms.
● Lifestyle
● Diagnostic exam & procedures
● Occupation
● Diuretics
Inspect
● Respiration status
● Signs of injury
● Laryngoscope
● The contour of the chest wall
Percussion
● Flat- solid areas
● Dull
○ Dullness over the lung occurs when air-filled lung
tissue is replaced by fluid or solid tissue
● Hyper resonant- free air exist
● Tympanic- normal sounds of a stomach
● Resonant- Healthy lung tissue
Adventitious sounds:
● Crackles
● Wheezes
● Sonorous wheezes
● Friction rub
delayed opening of the deflated airway
Crackles
Narrowed air passage
Wheezes
Low pitch (adventitious sounds)
Sonorous wheezes
Grunting an inspiration
Friction rub
The sound heard through the stethoscope as the patient
speaks is known as
Vocal resonance
Stethoscope:
Low pitch
use the bell
Stethoscope:
High pitch
use the diaphragm
Palpate
● Nodules, Masses, Lesions, Respiratory excursion.
Vocal fremitus
● Tenderness (pain upon palpation)
○ Thick, muscles, lung disease
● Vibration (thin PT is highly palpable)
○ Position hands sa likod and instruct to PT to
say “blue moon/99”
helps the nurse assess the flow of air through
the bronchial tree and evaluate the presence of fluid or
solid obstruction in the lung. The nurse auscultates for
normal breath sounds, adventitious sounds, and voice
sounds.
● Vesicular (bronchioles and alveoli)
● Bronchial (trachea)
● Bronchovesicular
Auscultation
studies aid in assessing the ability
of the lungs to provide adequate oxygen and remove
carbon dioxide, which reflects ventilation, and the ability of
the kidneys to reabsorb or excrete bicarbonate ions to
maintain normal body pH, which reflects metabolic states.
➔ ABG levels are obtained through an arterial puncture at the
radial, brachial, or femoral artery or through an indwelling
arterial catheter.
● Condition affects ABG
● Hyperventilation- ↑ PaO2
● Hypoventilation- ↓ PaO2
● Chronic obstructive pulmonary disease (COPD)- ↑
PaCO2
● Anxiety- ↓ PaCO2
Arterial blood gas (ABG)
➔ is a noninvasive method of continuously monitoring the
oxygen saturation of hemoglobin (SaO2)
➔ it is an effective tool to monitor for subtle or sudden
changes in SaO2
➔ Normal SpO2 values are more than 95%
➔ Values less than 90% indicate that the tissues are not
receiving enough oxygen
Steps:
● 0.1 PPD in a tuberculin
● Prepare the site
● Inject the PPD to form a wheel
● Record site (date and time)
● 48-72 hours after
Pulse Oximetry
➔ Mycobacterium tuberculosis
● 0.1 PPD in a tuberculin
Steps:
● 1. 0.1 PPD in a tuberculin
● Prepare the site
● Inject the PPD to form a wheel
● Record site (date and time)
● 48-72 hours after
● 0-4mm negative reaction
● 5-9 mm questionable reaction
● 10mm positive reaction
Tuberculin Test
➔ They are performed to assess respiratory function and to
determine the extent of dysfunction, response to therapy,
and as screening tests in potentially hazardous industries,
such as coal mining and those that involve exposure to
asbestos and other noxious irritants.
➔ Such tests include measurements of lung volumes,
ventilatory function, and the mechanics of breathing,
diffusion, and gas exchange
-generally are performed by a technician using a
spirometer that has a volume-collecting device attached to
a recorder that demonstrates volume and time
simultaneously
Pulmonary Function Test (PFT)
➔ Sputum is obtained for analysis to identify pathogenic
organisms and to determine whether malignant cells
are present.
➔ Sputum samples ideally are obtained early in the
morning before the patient has had anything to eat or
drink.
➔ the patient coughs deeply and expectorates sputum
from the lungs into a sterile container.
➔ 1-3 ml sputum
➔ Pathologic microorganisms
➔ Culture and sensitivity
Steps:
● Explain the procedure
● Collect early in the morning
● Instruct to several deep breaths, cough forcefully and
expectorate
Sputum Test
is used to investigate
congenital abnormalities of the pulmonary vascular
tree
➔ To visualize the pulmonary vessels, a radiopaque
agent is injected through a catheter, which has been
initially inserted into a vein
➔ Dye
➔ Assess arterial circulation
Steps:
● Explain the procedure and determine the level of
anxiety
● Assess allergy for contrast dye (e.g., iodine and
shellfish)
● The nurse should instruct patients that they may
experience a warm flushing sensation or chest pain
during the injection of the dye.
● Assess distal circulation and sensation
● Notify for diminished distal pulse
● Bed rest for 2-6 hours
● NPO 6-8 hours
Pulmonary Angiography
is the direct inspection and examination
of the larynx, trachea, and bronchi through either a
flexible fiberoptic or rigid bronchoscope
Bronchoscopy
is a thin, flexible bronchoscope that can be directed into the segmental bronchi.
■ Because of its small size, its flexibility, and its excellent optical system, it allows increased 1432 visualization of the peripheral airways
fiberoptic bronchoscope
is a hollow metal tube with
a light at its end.
■ It is used mainly for removing foreign
substances, investigating the source of
massive hemoptysis, or performing
endobronchial surgical procedures.
● Insertion of the tube (sa baba)
● Visualization of the larynx, trachea and bronchi
● NPO for 6 hours
● Local anesthesia is given
● Atropine sulfate (dili mag laway)
● Remove dentures
● Lidocaine (Xylocaine)- to suppress the cough reflex
and minimize discomfort
Rigid bronchoscope
is a hollow metal tube with a light at its end. It is used mainly for removing foreign substances, investigating the source of massive hemoptysis, or performing endobronchial surgical procedures.
Rigid bronchoscope
● Visualization of the larynx using laryngoscope
● Sa ilong isulod
● NPO for 6 hours
● Local anesthesia is given
● Atropine sulfate (dili mag laway)
● Thoracentesis- remove fluid/air from the lungs. Needle
in chest wall in the pleural space
○ Thin gap between pleura and inner chest wall
then proceed with CTT
Laryngoscopy
● A procedure to remove fluid or air from around the
lungs. A needle is put through the chest wall into the
pleural space. The pleural space is the thin gap
between the pleura of the lung and of the inner chest
wall
Thoracentesis
is a group of disorders characterized by
inflammation and irritation of the mucous membranes
of the nose.
● Cause of Rhinovirus
Rhinitis
Causes of Rhinitis
● Inhalation droplets & direct contact
● Allergic rhinitis (hypersensitivity reaction)
● Pneumonia
Manifestion of Rhinitis
● Sneezing, nasal congestion, RHINORRHEA, SORE
THROAT, WATERY EYES, LOW-GRADE FEVER
HEADACHE, ACHING MUSCLES, MALAISE
Rhinitis Nursing Management
● Rest
● Increased fluid intake
● Blowing nose with mouth open
● Wash hands often
● OTC medications
● Vaporizer
● The nurse instructs the patient with allergic rhinitis to
avoid or reduce exposure to allergens and irritants,
such as dusts, molds, animals, fumes, odors, powders,
sprays, and tobacco smoke.
It releases water vapors into the atmosphere which in turn
moisturizes the nasal tissues so Room’s recommended humidity level is between 30 to 50 percent A hygrometer can help to estimate the humidity.
Rhinitis Pharmacological Management
● Antihistamines
○ remain the most common treatment and are given
for sneezing, pruritus, and rhinorrhea.
● Antipyretic
● Decongestants- loratadine pseudoephedrine
(Claritin-D, Alavert allergy and sinus)
● Antitussive- dextromethorphan
● Saline for sore throat
● (Astelin, astepro) or Olopatadine hydrochloride
(patanase)
● Desensitize for allergy
● Prednisolone (asthma)/corticosteroids (inflammatory)
● Inflammation of sinus (4 kabuok sinus naa sa tao)
● Spread of infection: droplet
● Nasal passages: sinuses
● Blockage
● Trapped secretions (infected)
● Edema of membranes
Sinusitis
Sinusitis Manifestion
● Headache
● Fever
● Pain
● Nasal congestion
● Pain and pressure
● Malaise
Sinusitis Management
● Saline irrigation
● Antibiotics
● Vasoconstrictions
● Endoscopic sinus surgery
● caldwell luc procedure
● sphenoethmoidectomy (high level of analgesic)
● Opioids
● Morphine
Sinusitis Nursing Management
● Mouthwash
● Humidification
● Nasal packing and dressing under nares
● Oral hygiene, ice chips, small sip of fluids
● Instruct not to perform blowing of nose, lift heavy
things
○ Avoid valsalva maneuver (mo utong)
Sinusitis Post OP complications
● Hemorrhage, optic nerve, temperature, pain, impaired
drainages, PRN analgesic
● Acute pharyngitis is a sudden painful inflammation of
the pharynx
● Responsible viruses include the adenovirus, influenza
virus, Epstein–Barr virus, and herpes simplex virus.
● Incubation period 2-4 days
● Pharyngitis—inflammation without exudate.
● Sore throat
● Severe “dysphagia”
○ difficulties in swallowing
Pharyngitis
Pharyngitis Manifestations
● Fever (higher than 38.3°C [101°F])
● chills, headache, and malaise
● While exudate patch, swollen glands
● fiery-red pharyngeal membrane and tonsils, lymphoid
follicles that are swollen and flecked with white-purple
exudate, enlarged and tender cervical lymph nodes,
and no cough.
Pharyngitis Management
● penicillin
● C/S
● Strep A optical immunomicroscopic
● Rapid antigen detection test
● Culture and sensitivity test
● Antibiotics x 7-14 days
● liquid or soft diet is provided
● warm saline gargles or throat irrigations are used
● not sharing eating utensils
● replace their toothbrush with a new one
● Tonsils and adenoids
● The tonsils are composed of lymphatic tissue and are
situated on each side of the oropharynx.
● The adenoids or pharyngeal tonsils consist of
lymphatic tissue near the center of the posterior wall of
the nasopharynx.
○ Acute tonsillitis can be confused with pharyngitis.
○ Infection of the adenoids frequently accompanies
acute tonsillitis.
● The most common viral pathogen is Epstein–Barr
virus, although cytomegalovirus may also cause
tonsillitis and adenoiditis.
● Enlarged & partially obstructed airway passage
Tonsilitis and Adenoiditis
Tonsilitis and Adenoiditis Manifestations
● Sore throat, fever, malaise, nasal obstruction, pain
upon swallowing, noisy breathing, snoring, nasal voice
Tonsilitis and Adenoiditis Management
● Antibiotics
○ oral penicillin or cephalosporin (e.g., cefdinir
[Omnicef] or moxifloxacin).
● Analgesic, saline gargle
● Tonsillectomy- Tonsillectomy is indicated if the patient
has had repeated episodes of tonsillitis despite
antibiotic therapy
● Adenoidectomy
● RECURRENT
Tonsilitis and Adenoiditis Assesments
● Enlarged reddened tonsils
● White patches
● Culture & Sensitivity- determine the presence of
bacterial infection.
Tonsilitis and Adenoiditis Post operation
● Report signs of bleeding
○ Postoperative bleeding may be seen as bright red
blood if the patient expectorates it before
swallowing it
○ If the patient swallows the blood, it becomes
brown because of the action of the acidic gastric
juice
○ If the patient vomits large amounts of dark blood
or bright-red blood at frequent intervals, or if the
pulse rate and temperature rise and the patient is
restless, the nurse notifies the surgeon
immediately
● Warm saline gargle, liquid, and soft diet avoid irritating
foods
● WOF aspiration, pain, tissue integrity
Tonsilitis and Adenoiditis Nursing management
● The most comfortable position is prone,with the patient’s
head turned to the side to allow drainage from the mouth
and pharynx
● Ice collar to the neck, and a basin and tissues are provided
for the expectoration of blood and mucus
● The patient is instructed to refrain from too much talking
and coughing
