Respiratory System 3.

Relieves anxiety
4. Eliminate ineffective uncoordinated patterns of
I. Review of Anatomy and Physiology respiration and slow down respiratory rate
 Nose – filters impurities, humidifies and warms the 5. Decrease work of breathing
air
 Nasal cavity – passageway of air Instructions:
1. Breathe slowly and rhythmically, and empty lungs
 Paranasal sinuses – lightens the weight of the completely
skull; resonating chambers of speech 2. Inhale through the nose and exhale through the
 Turbinates (Conchae) – warms and humidifies air; mouth
contains nerves that detect odors and initiates 3. Keep air moist with humidifier
sneezing reflex (CN1)
 Pharynx – serves as passageway of food, water, Techniques:
air 1. Diaphragmatic Breathing
 Epiglottis – flap-like cover during the swallowing to  strengthens diaphragm during breathing
avoid foreign objects from getting into the lungs  indicated to client with pulmonary disease,
 Larynx – voice box; initiates the cough reflex COPD, postoperative, pain control
 Trachea – has cricoids process; encloses thyroid 2. Pursed-lip Breathing
and parathyroid gland  same with diaphragmatic breathing
 Lungs – inspiration and respiration site  prolonged exhalation time
 Mediastinum – allow full expansion of the lungs  increase airway pressure during expiration thus
 Bronchia reducing amount of trap air in the lungs
 Mainstream bronchi
IV. Coughing Exercise
 Lobar bronchi Purposes:
 Segmental bronchi 1. Remove secretions in the lungs
 Subsegmental bronchi – keep moisture in lungs and 2. Active contraction of expiratory muscles
prevents excessive liquid accumulation 3. Opens glottis to provide momentum on
 Bronchioles expectoration
 Terminal bronchioles
 Respiratory bronchioles – serves as transitional Techniques:
1. Cascade
passageway to the alveoli
 to clear large amount of sputum
 Alveoli – site of gas exchange
2. Huff
o Type 1 – made-up of epithelial cells that
 to stimulate natural cough reflex
provide structure
o Type 2 – metabolically active cells that  effective in clearing central airways
3. Quad
produce surfactant
o Type 3 – macrophages that engulfs  most brutal
foreign bodies  contraindicated to those with involuntary control

II. Functions of Respiratory System V. Chest Physiotherapy

1. Oxygen transport  Group of therapies used in combination to mobilize
2. Respiration pulmonary secretions
3. Ventilation  Includes postural drainage, chest vibration, and
4. Perfusion chest percussion
5. Diffusion  Generally indicated to client who can produce
6. Gas exchange productive cough (30mL)
7. Acid-base balance  Contraindications:
o patients with trauma in chests
III. Breathing Exercises
Purposes: o conditions or diseases related to childhood
1. Promote maximal alveolar inflation o those with spinal injury
2. Promote muscle relaxation
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 o those who are mentally challenged  Assessment Parameters:
 Nursing Considerations: o signs and symptoms of restlessness
o assess vital signs o gurgling sounds during respiration
o know medications used by the patient o adventitious breath sounds upon
o client’s tolerance to position auscultation
o assess energy level of patient o change in skin color
o change in respiratory rate and pattern
VI. Incentive Spirometry (Sustained Maximal o change in pulse rate and rhythm
Inspiration)  Principles:
 method of encouraging voluntary deep breathing by o Maintain sterile technique
providing visual feedback on client about their o Dominant hand is always sterile; other
inspiratory volume hand is clean
 prevent and treat atelectasis o Entire suctioning procedure should only
 promote maximal lung inflation last less than 2 minutes
o Suctioning attempt should only last 10-15
VII. Oxygen Therapy seconds
 Administration of oxygen greater than what is found o Hyperoxygenate patient before and after
in the environment each suctioning attempt
 Indications: o Insert catheter during inhalation
o Change in client’s respiratory rate and o Suction patient intermittently
pattern o Allow 30 seconds interval in between
o Hypoxemia
suctioning attempt
o Hypoxia
 Complications: Portable Unit Wall Suction Outlet
o Oxygen toxicity which cause suppression Adult 10-15 mmHg 100-120 mmHg
of ventilation Childre 5-10 mmHg 95-110 mmHg
o Potential source of infection n
o Supports combustions Infant 2-5 mmHg 50-95 mmHg
o Use separate suction catheter for each
 Nursing Consideration:
airway to be suctioned
o No smoking sign
o Do not apply suction upon insertion of
o Orient visitors/relatives about precaution
catheter
o Assess all electrical equipments  Equipments:
o Locate all close fire extinguishers o Suction catheter
o Orient client and relatives about fire  Adults: French 12-18
procedure and evacuation area  Children: French 8-10
o Use cotton instead of synthetic fiber for  Infants: French 5-8
linens and clothing o Suction machine
o Do not use alcohol in cleaning the
oxygen tank
o Soil is the most effective fire extinguisher
VIII. Suctioning
 aspiration of secretions through a catheter
connected to a suctioning machine or wall suction o Ovum forceps
outlet o NSS solution/sterile water
 Purposes: o Towel
o to remove secretions o 2 sterile basin
o facilitate ventilation o 2 sterile gloves
o obtain secretions for diagnostic procedures o Stethoscope
o to prevent infection o Penlight
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  Procedure: o If pilot balloon is inflated
1. Verify doctor’s order  Principles:
a. Size of catheter o Maintain sterile technique
b. Type of solution o Pilot balloon should be inflated
c. Airway to be suctioned
d. Pressure to be used  Equipments:
2. Go to patient’s room o NSS solution
3. Establish rapport o Hydrogen peroxide
4. Assess need for suctioning o Towel
5. Assess patency of nares o 2 4”x4” gauze
6. Wash hands o Sterile gloves
7. Prepare equipments o Temporary canula
8. Provide comfort, privacy, and safety to client
9. Position client o Trachesotomy brush
Conscious: sitting, semi/high fowler’s o 2 medicine glass
Unconscious: side lying o 2 basin
10. Put towel o Tracheostomy tie (should not be elastic)
11. Open sterile equipments and attach to where o Cotton applicators
closest to the client
 Procedure
12. Indicate date and time opened
13. Open sterile basin 1. Verify doctor’s order
14. Put NSS solution/sterile water 18 inches above a. Solution to be used
basin 2. Establish rapport
15. Test suction machine 3. Assess respiratory rate and pattern
16. Don gloving 4. Prepare equipments
17. Hyperoxygenate client 5. Provide comfort, privacy, and safety
18. Ask client to inhale deeply then insert catheter 6. Position client
19. Suction Conscious: semi/high fowler’s
20. Reassess client Unconscious: side lying
a. Secretions on mouth or nose? 7. Put towel
b. How do you feel right now? 8. Open all sterile packaging
21. After care 9. Make 50% H2O2 solution on first 2 containers
22. Hand wash 10. Don gloving
23. Documentation 11. Get canula on dominant hand
a. Untoward reaction of client during the 12. Remove inner canula
procedure 13. Put temporary canula immediately
b. Characteristic of secretion 14. Put inner cannula to the solution, brush it, and
c. Duration of suctioning discard the brush
15. Use cotton applicator to clean inner surface
IX. Tracheostomy Care 16. Discard the cotton applicator
17. Drop the canula on the other container for rinsing
 care given to patient with tracheostomy tube and tap
 Purposes: 18. Place canula to one gauze and air dry
o Maintain airway patency 19. Remove the soiled gauze on the trachesotomy site
o Maintain cleanliness and prevent infection 20. Dip cotton applicator on medicine glass with the
o To clean stoma and promote healing solution
o To provide comfort 21. Clean the tracheostomy and stoma using the rays
of the sun technique
 Assessment Parameters: 22. Rinse the tracheostomy and stoma
o Respiration status 23. Put the tie; let the patient put his 2 fingers on
o Characteristic and amount of secretions neck
o Presence of drainage
 Palpate nape of client
 Look at tracheostomy site
o Appearance of stoma
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