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Chapter 10 Respiratory Function and Therapy

Chapter 10 Respiratory Function and Therapy

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RESPIRATORY FUNCTION
RESPIRATORY FUNCTION

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Authors/Editors: Nettina, Sandra M.; Mills, Elizabeth JacquelineTitle: Lippincott Manual of Nursing Practice, 8th EditionCopyright ©2006 Lippincott Williams & Wilkins> Table of Contents > Part Two - Medical-Surgical Nursing > Unit II - Respiratory Health >Chapter 10 - Respiratory Function and TherapyChapter 10Respiratory Function and TherapyP.201GENERAL OVERVIEWRESPIRATORY FUNCTIONThe major function of the pulmonary system (lungs and pulmonary circulation) is to deliver oxygen to cells and remove carbon dioxide (CO
2
) from the cells (gas exchange). The adequacyof oxygenation and ventilation is measured by partial pressure of arterial oxygen (PaO
2
) and partial pressure of arterial carbon dioxide (Paco
2
). The pulmonary system also functions as a blood reservoir for the left ventricle when it is needed to boost cardiac output; as a protector for the systemic circulation by filtering debris/particles; as a fluid regulator so water can be keptaway from alveoli; and as a provider of metabolic functions such as surfactant production andendocrine functions.Terminology
y
 
Alveolusâ¼´air sac where gas exchange takes place
y
 
Apexâ¼´top portion of the upper lobes of lungs
y
 
B
aseâ¼´bottom portion of lower lobes, located just above the diaphragm
y
 
B
ronchoconstrictionâ¼´constriction of smooth muscle surrounding bronchioles
y
 
B
ronchusâ¼´large airways; lung divides into right and left bronchi
y
 
Carinaâ¼´location of division of the right and left main stem bronchi
y
 
Ciliaâ¼´hairlike projections on the tracheobronchial surface lining, which aid in themovement of secretions and debris
y
 
Complianceâ¼´ability of the lungs to distend (eg, emphysemaâ¼´lungs very compliant;fibrosisâ¼´lungs noncompliant or stiff)
y
 
D
ead spaceâ¼´ventilation that does not participate in gas exchange; also known as wastedventilation when there is adequate ventilation but no perfusion, as in pulmonary embolusor pulmonary vascular bed occlusion. Normal dead space is 150 ml.
y
 
D
iaphragmâ¼´dome-shaped muscle; the primary muscle used for respiration (located just below the lung bases)
y
 
D
iffusion (of gas)â¼´movement of gases from a higher to lower concentration
y
 
D
yspneaâ¼´subjective sensation associated with unpleasant, uncomfortable respiratorysensations, often caused by a dissociation between motor command and mechanicalresponse of the respiratory system such as:
o
 
Respiratory muscle abnormalities (hyperinflation and airflow limitation fromchronic obstructive pulmonary disease [COP
D]
).
o
 
Abnormal ventilatory impedance (narrowing airways and respiratory impedancefrom COP
D
or asthma).
 
o
 
Abnormal breathing patterns (severe exercise, pulmonary congestion or edema,recurrent pulmonary emboli).
o
 
Arterial blood gas (A
B
G) abnormalities (hypoxemia, hypercarbia).
y
 
Hemoptysisâ¼´bleeding from the lung; main symptom is coughing up blood
y
 
Hypoxemiaâ¼´PaO
2
less than normal, which may or may not cause symptoms (NormalPaO
2
is 80 to 100 mm Hg on room air.)
y
 
Hypoxiaâ¼´insufficient oxygenation at the cellular level due to an imbalance in oxygendelivery and oxygen consumption (Usually causes symptoms reflecting decreased oxygenreaching the brain and heart.)
y
 
Mediastinumâ¼´compartment between lungs containing lymph and vascular tissue thatseparates left from right lung
y
 
Orthopneaâ¼´shortness of breath when in reclining position
y
 
Paroxysmal nocturnal dyspnea (PN
D
)â¼´shortness of breath with sudden onset; occursafter going to sleep in recumbent position
y
 
Perfusionâ¼´blood flow, carrying oxygen and CO
2
that passes by alveoli
y
 
Pleuraâ¼´membrane that covers the outside of the lung (visceral pleura) and lines thethorax (parietal pleura) that creates a potential space
y
 
Pulmonary circulation (bronchial circulation)â¼´circulatory system that suppliesoxygenated blood to the respiratory system
y
 
Respirationâ¼´gas exchange from air to blood and blood to body cells
y
 
Shuntâ¼´adequate perfusion without ventilation, with deoxygenated blood conducted intothe systemic circulation, as in pulmonary edema, atelectasis, pneumonia, COP
D
 
y
 
Surfactantâ¼´substance released by cells within the lung; maintains surface tension andkeeps alveoli open allowing for better gas exchange
y
 
Ventilationâ¼´movement of air (gases) in and out of the lungs
y
 
Ventilation-perfusion ([V with dot above
]
/[Q with dot above
]
) imbalance or mismatchâ¼´imbalance of ventilation and perfusion; a cause for hypoxemia. [V with dotabove
]
/[Q with dot above
]
mismatch can be due to:
o
 
B
lood perfusing an area of the lung where ventilation is reduced or absent.
o
 
Ventilation of parts of lung that are not perfused.ASSESSMENTSU
B
JECTIVE
D
ATAExplore the patient's symptoms through characterization and history taking to help anticipateneeds and plan care.
D
yspnea
y
 
Characteristicsâ¼´Is the dyspnea acute or chronic? Has it come about suddenly or gradually? Is more than one pillow required to sleep? Is the dyspnea progressive,recurrent, or paroxysmal? Walking how far leads to shortness of breath? How does itcompare to the patient's baseline level of dyspnea?P.202
 
 Ask patient to rate dyspnea on a scale of 1 to 10 scale with 1 being no dyspnea and 10 being the worst imaginable. What relieves and what aggravates the dyspnea?
y
 
Associated factorsâ¼´Is there a cough associated with the dyspnea and is it productive?What activities precipitate the shortness of breath?
D
oes it seem to be worse when upset?Is it influenced by the time of day, seasons and/or certain environments?
D
oes it occur atrest or with exertion? Any fever, chills, night sweats? Any change in body weight?
y
 
Historyâ¼´Is there a patient history or family history of chronic lung disease, cardiac or neuromuscular disease? What is the smoking history?
y
 
Significanceâ¼´Sudden dyspnea could indicate pulmonary embolus, pneumothorax,myocardial infarction, acute ventricular failure, or acute respiratory failure. In a postsurgical or postpartum patient, dyspnea may indicate pulmonary embolus or edema.Orthopnea can be indicative of heart disease or COP
D
. If dyspnea is associated with awheeze, consider asthma, COP
D
, or heart failure.Chest Pain
y
 
Characteristicsâ¼´Is the pain sharp, dull, stabbing, or aching? Is it intermittent or  persistent? Is the pain localized or does it radiate? If it radiates, where? How intense isthe pain? Are there factors that alleviate or aggravate the pain, such as position or activity?
y
 
Associated factorsâ¼´What effect do inspiration and expiration have on the pain? Whatother symptoms accompany the chest pain? Is there diaphoresis, shortness of breath,nausea?
y
 
Historyâ¼´Is there a smoking history or environmental exposure? Has the pain ever beenexperienced before? What was the cause? Is there a preexisting pulmonary or cardiacdiagnosis?
y
 
Significanceâ¼´Chest pain related to pulmonary causes is usually felt on the side where pathology arises, but it can be referred.
D
ull persistent pain may indicate carcinoma of the lung, whereas sharp stabbing pain usually arises from the pleura.Cough
y
 
Characteristicsâ¼´Is the cough dry, hacking, wheezy, or more like clearing the throat? Isit strong or weak? How frequent is it? Is it worse at night or at any time of day? Is itaggravated by food intake or exertion; is it alleviated by any medication? How long has it been going on?
y
 
Associated factorsâ¼´Is the cough productive? If so, what is the consistency, amount,color, and odor of the sputum? How does sputum compare to the patient's baseline? Is itassociated with shortness of breath or pain?
y
 
Historyâ¼´Has there been any environmental or occupational exposure to dust, fumes, or gases that could lead to cough? Is there a smoking history? Is the smoking current or in past? Are there past pulmonary diagnoses, asthma, rhinitis, allergy or exposure toallergens such as pollen, house dust mites, animal dander, mold, cockroach waste,irritants (smoke, odors, perfumes, cleaning products, exhaust, pollution, cold air)?
D
oes

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