Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
System
Care of Clients with Respiratory Disorder
Respiration
Overview of Anatomy and Physiology of the Respiratory System
Respiration The process of gaseous exchange
between the individual and
The process of gaseous exchange between the individual and environment.
3 process of Respiration
environment.
1. Ventilation
• Inhalation
• Exhalation 3 process of Respiration
2. Diffusion/Gas exchange
3. Perfusion Ventilation

Structures in the Respiratory System Inhalation

1. The airways
1. Nasal Cavity or nares Exhalation
2. Pharynx
3. Larynx or Voice box Diffusion/Gas exchange
2. Lower Airways
Perfusion
1. Trachea
2. R and L mainstem bronchi
3. Segmental bronchi
4. Sub-segmental bronchi
5. Terminal bronchi

Function of Upper Airways

1. Transport gas to the lower airways
2. Protection of the lower airway from foreign matters
3. Warming, filtration and humidification of inspired air

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
Functions of the Lower Airways
System
1. Clearance mechanism
• Cough Respiration
• Mucociliary system
• Macrophages The process of gaseous exchange
• Lymphatics between the individual and
2. mmunologic Responses.
• Cell mediated immunity in the alveoli
environment.
3. Pulmonary protection in the injury
• Respiratory epithelium
• Mucociliary system 3 process of Respiration
The pleura Ventilation
• A serous membrane that encloses the lungs
• Directly covers the lungs-VP Inhalation
• Lines the cavity of hemi thorax-PP
Exhalation

Diffusion/Gas exchange

Perfusion

The Lungs

Right-3 Lobes/L-2 lobes

Separated by a space called?
Alveoli: Alveoli are tiny air sacs in your lungs that take up the oxygen you breathe in and keep your
body going. Although they’re microscopic, alveoli are the workhorses of your respiratory system.

Other Terms
Residual volume: RV: the amount of air that remains in the lungs after a forceful expiration: prevents lung collapse (1250ml)
KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
Tidal Volume: TV: amount of air that moves out in and out of the lungs with each normal breath(500ml)
System
Inspiratory reserve volume: IRV:the amount of extra air that can be inhaled beyond tidal volume. 2000ml
Expiratory reserve volume: ERV:the amount of extra air that can be exhaled after a normal breath 1250 ml
Respiration
Total lung capacity: TLC: total of all volume.RV+TV+IRV+ERV
Functional Residual Capacity: FRC: the amount of air that remains in the The
lungs after normal
process exhalation
of gaseous (2,500ml)
exchange
between the individual and
environment.

3 process of Respiration

Ventilation

Inhalation

Exhalation

Diffusion/Gas exchange

Perfusion

Thorax and Diaphragm

• Provides protection to the lungs, heart, great vessels.
• Thorax is made up of 12 pairs of ribs, bounded anteriorly by the sternum and posteriorly by the thoracic
vertebrae.
• The diaphragm is the main respiratory muscle for inspiration.it is supplied by the phrenic nerve.

Respiratory Centers
A. Medulla Oblongata: Primary Center
B. Pons contains the following:
• Pneumotach center: Rhythm and quality of breathing
• Apneustic center. Deep and prolonged inspiration.
C. Carotid and Aortic
• Peripheral Chemoreceptors
D. Muscle and Joints:
• Proprioceptors: Exercise

Physiologic Changes in the Respiratory System with Aging

• Reduce chest wall compliance that results from:

o Increase calcification of costal cartilage
o decrease strength of intercostal accessory muscle and diaphragm.
• Reduced breathing capacity
• Reduced Vital Capacity
• Increase Residual Volume
• Decrease Cough reflex
• Decrease ciliary activity

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
System
Assessment of Clients with Respiratory Disorder
A. History Respiration
o Biographic data
o Chief Complaint The process of gaseous exchange
▪ Dyspnea between the individual and
▪ Cough
▪ Sputum production
environment.
▪ Hemoptysis
▪ Wheezing
▪ Stridor 3 process of Respiration
▪ Chest Pain
B. Past Medical History Ventilation
o Childhood/infectious diseases
o Respiratory immunization Inhalation
o Major /Illnesses/Hospitalization
o Medications Exhalation
o Allergies
C. Family History Diffusion/Gas exchange
D. Psychosocial history and lifestyle
Perfusion
o Occupation or environmental exposure
E. Geographic location
F. Personal habits (years of smoking x 2packs/day=pack years

Physical Examination

Inspection:
S and Sx of respiratory distress
I:E ;ratio 1:2
Speech pattern
Chest wall configuration
Chest movement
Fingers and toes
Palpation
Trachea
Chest wall
Thoracic excursion
Tactile fremetous
Percussion
Resonnance
Hyperresonance
Dullness

Auscultation: Sounds
Adventitious sounds
Normal Breath Sounds Crackles
• Bronchial (Tracheal) Crackles
• Bronchovesicular Pleural friction rub
• Vesicular Wheeze

Voice Sounds
A. Egophony:
A. Say prolonged ‘e”
B. If “a”? Consilidation
B. Whispered Pectoriloquy
A. Whisper 1,2,3
B. Auscultated as muffled 1,2,3
C. Bonchophony
C. Bronchophony
A. Say 99
B. Increase resonance and word are head clearly
KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
Altered Breathing Pattern
System
• Cheyne Stokes breathing
o marked rhythmic waxing and waning respiration from very deep or very shallow breathing and
Respiration
temporary apnea.
• Kausmulls breathing The process of gaseous exchange
o Hyperventilation increase rate and depth between the individual and
• Hypoventilation
o Slow and shallow respiration
environment.
• Biot’s
o Shallow breaths interrupted by apnea”irregular irregularity
• Apneustic breathing 3 process of Respiration
o Prolonged,gasping inspiration followed by a short inefficient expiration
Ventilation
Normal Findings
1. General appearance: Inhalation
2. Breathing Pattern
3. Respiratory rate Exhalation
4. Skin
5. Nails Diffusion/Gas exchange
6. Chest wall configuration
Perfusion
7. Tracheal position
8. Vocal/Tactile fremitus
9. Abnormal Responses
10. Increase fremitus
11. Decrease fremitus
12. Percussion tones
1. Resonant: Normal
2. Flat-Hear over airless tissue
3. Dull: occur over dense lung tissue such as tumor or consolidation
4. Tympanic :pneumothorax
5. Hyperresonant
1. Air tapping
Diagnostic Studies and Therapies
• Skin test: Mantoux Test
o Route: ID
o Read 48 to 72 hours after administration
o (+) if more than 10 mm
o HIV px: 5mm is considered positive
o (+)Mantoux Test (exposure to MTB)
o (+) in clients who received BCG
• X-ray
o Chest x Ray:
o Hold breath and to do deep breathing
o No metals from the chest
▪ interfere with the images
• Fluoroscopy

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
• Bronchogram
System
o Radiopaque medium is instilled directly into the trachea and bronchi and the entire bronchial
tree or selected areas may be visualized through X-ray Respiration
Before:
▪ consent The process of gaseous exchange
▪ allergies between the individual and
▪ NPO 6t0 8 hours
environment.
▪ Pre op meds: Atropine SO4;Topical anesthesia;then LA
▪ O2 ready and anti spasmodic drugs
After
▪ side lying: Aspiration 3 process of Respiration
▪ NPO until gag reflex and cough
▪ low grade fever is common Ventilation

Inhalation

Exhalation

Diffusion/Gas exchange

Perfusion

• Bronchoscopy
o detect the cause of breathing difficulties and lung problems, such as tumors, infection, and
bleeding.

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
• Lung Scan
System
o Injection of radio isotope
o Scans are taken with scintillation camera Respiration
o Measures the blood perfusion through the lungs.Confirms Pulmonary-embolism or other blood
flow abnormalities The process of gaseous exchange
o Instruct client to remain still during the procedure between the individual and
environment.

3 process of Respiration

Ventilation

Inhalation

Exhalation

Diffusion/Gas exchange

Perfusion

• Sputum Examination:
o A sputum culture requires minimal effort on your part. You simply need to provide the sample
for the lab to test. You'll be asked to cough deeply to bring up the sputum from your lungs.
Saliva that can come up when someone is asked to cough is typically from the mouth and upper
airways and isn't useful for this test.

• Lung Biopsy

• Transbroncoschopic Biopsy: During bronchoscopy

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
• Percutaneous Needle Biopsy: Aspiration
System

Respiration

The process of gaseous exchange

between the individual and
environment.

3 process of Respiration

Ventilation

Inhalation

Exhalation

• Open biopsy: surgery Diffusion/Gas exchange

Perfusion

• Lymph node biopsy

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
• Pulmonary Function Studies
System
o Vital Capacity
o Tidal Volume Respiration
o Inspiratory reserve volume
o Functional Residual Capacity The process of gaseous exchange
o Residual volume between the individual and
• Pulse oximetry
environment.

3 process of Respiration

Ventilation

Inhalation

Exhalation

Diffusion/Gas exchange

Perfusion

Thoracentesis
➢ Aspiration of fluid or air from the pleural space:
Before
• Secure written consent. (invasive)
• Take VS (Hypovolemia)
• Position: upright leaning over bed table.
• Remain still; avoid coughing during needle insertion. (trauma to lungs)
• Pressure sensation is felt on insertion of needle.
• Topical anesthetic is used at the site of insertion
After:
• Turn the client on the unaffected side to prevent leakage of fluid in the thoracic capacity.
• Bed rest (prevent postural hypotension)
• Check the expectoration of blood (trauma) notify the physician
• Monitor VS to Assess for signs and symptoms of internal hemorrhage.

Arterial Blood Gas

Step 1: Remember!!!!!

Normal Values:
blood pH 7.35-7.45
paCO2 35- 45 mm/Hg
HCO3 22-26 mEq/L
pO2 80-100
Step 2:look at the pH. Does it indicate precence of acedemia,or alkalemia or normal
pH low below 7.35 ACIDOSIS
pH high above 7.45 ALKALOSIS
middle range is 40
Step 3: Look for paCO2
• paCO2 is the respiratory indicator
• CO2 acts as an acid. When CO2 combines with plasma, Carbonic acid is formed
• (CO2+H2O=H2CO3)

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
Step 4: Look at the HCO3 (Bicarbonate)
System
• HCO3 higher than 26 METABOLIC ALKALOSIS
• HCO3 lower than 22 METABOLIC ACIDOSIS Respiration
Step 5: Determine the ACID-Base Disturbance: The process of gaseous exchange
1. pH and PaCO2: between the individual and
pH decreases Acidosis
PaCO2 increases Acidosis
environment.
pH increases Alkalosis
paCO2 decreases Alkalosis
2. pH and HCO3 3 process of Respiration
pH increases Alkalosis
HCO3 increases Alkalosis Ventilation
- pH decreases Acidosis
HCO3 decreases Acidosis Inhalation

Step 6: Look at the degree of compensation: Exhalation

Check relationship between PaCO2 and HCO3
• Remember: the lungs and kidneys normally attempt to help eachDiffusion/Gas exchange
other to maintain acid-base balance.
• If the lungs are unable to maintain acid-base balance, the kidneys will attempt to adjust levels of HCO3.
Perfusion
• If the kidneys are unable to maintain acid-base balance, the lungs will attempt to adjust levels of CO2.
• If CO2 AND HCO3 levels move towards the same direction, i.e. both are high or both are low, then the
acid-base imbalance is compensated.

Nursing Diagnosis
Altered respiratory function related to chronic lung disease requiring tracheostomy and ventilator support.
Risk for ineffective respiratory function and impaired gas exchange related to: chronic lung disease; and
tracheostomy (altered secretions - plugging, ineffective airway clearance)
Risk of impaired spontaneous ventilation and hypoxemia related to respiratory insufficiency
Risk of dysfunctional ventilatory weaning response related to: fatigue; ineffective airway clearance; other
physical/ emotional factor(s)
Risk for equipment malfunction
Alteration in oral motor function related to medical condition and lack of use.
Alteration in mobility related to disuse of legs (long hospitalizations, medical condition)
Alteration in nutrition related to medical condition with delayed oral-motor development, feeding via
gastrostomy tube, decreased oral stimulation, and oral aversion.
Alteration in elimination
Fatigue related to medical condition and related compromised endurance.

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
Common Respiratory Interventions
System
Oxygen Therapy Respiration
ꙋ Assess signs and symptoms of hypoxia
ꙋ Check doctors order. The process of gaseous exchange
ꙋ Position: semi fowlers between the individual and
ꙋ Open source of oxygen before insertion of O2 device.to check for malfunctioning device.
environment.
ꙋ Regulate oxygen flow accurately. Excessive administration of oxygen can cause oxygen narcosis
(respiratory alkalosis).
ꙋ Place a “No Smoking” sign at the bedside.
ꙋ Avoid use of oil, greases, alcohol and ether near the client receiving oxygen.ofThese
3 process may further support
Respiration
combustion.
ꙋ Check electrical appliances before use. Small spark may cause aVentilation
fire if there is leakage of oxygen.
ꙋ Avoid materials that generate static electricity, such as woolen blankets and synthetic fabrics. Use
cotton blankets. Inhalation
ꙋ Humidify oxygen. Place sterile water into the oxygen humidifier. To prevent dryness and irritation of
mucus membrane in the airways. Exhalation
ꙋ Provide good oronasal hygiene. To prevent dryness and irritation of mucus membrane .
ꙋ Lubricate nares with water-soluble lubricant to sooth the mucousDiffusion/Gas
membrane. Doexchangenot use oil. Oil ignites
when exposed to compressed oxygen.
Perfusion
ꙋ Assess effectiveness of oxygen therapy. Make relevant documentation

Tracheobronchial Suctioning: TO REMOVE RESPIRATORY SECCRETIONS

Client should be in semi- or high-Fowler’s position.
Practice sterile technique. Use sterile gloves, sterile suction catheter. To prevent infection.
Hyperventilate client with 100% oxygen before and after suctioning. To prevent hypoxia.
Insert catheter with gloved hand (3-5 inches length of catheter insertion). The trachea is 4-5 inches in length.
ꙋ Apply suction during withdrawal of the catheter. To prevent trauma to the mucous membrane of
airways. Applying suction during insertion of the catheter causes trauma and bleeding.
ꙋ When withdrawing the catheter, rotate the catheter while applying intermittent suction. To ensure
adequate removal of mucous secretions.
ꙋ Suctioning should only take 5 to 10 seconds (maximum of 15 seconds). To prevent hypoxia, vagal
stimulation and bleeding. Vagal stimulation causes hypotension and bradycardia.
ꙋ Evaluate: clear breath sounds on auscultation of the chest.

Bronchial Hygiene Measures

• Therapy (BHT) is a broad term used to describe various airway clearance techniques: chest
physiotherapy (which consists of postural drainage, percussion, vibration, coughing, and suctioning),
breathing exercises (such as huffing and diaphragmatic breathing used in spontaneously breathing
patients),

Suctioning: oropharyngeal; nasopharyngeal

Steam inhalation
Aerosol inhalation
Medimist inhalation

Chest Physiotherapy
• Postural drainage
• Percussion
• Vibration
Nursing Interventions in CPT
ꙋ Do CPT with upper lobes before lower lobes of the lungs.
ꙋ Place client in each position for 10 to 15 minutes; a total of 30 minutes for each treatment
ꙋ Percussion and vibration are done to loosen mucus secretions
ꙋ Change position gradually to prevent postural hypotension
ꙋ Procedure is best done 60 to 90 minutes before meals to prevent vomiting, or in the morning upon
awakening (mucus secretions tend to accumulate during the night) and at bedtime.
ꙋ Provide good oral care after the procedure. To remove the unpalatable taste of sputum from the
mouth.

KENPOGI
 Hand Out 3

Overview in the Care of Clients

with Respiratory Disorder

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,Overview of Anatomy
Infectious Inflammation and
and Immunity
Response, Cellular Aberration NCM 112 Theory
Physiology of the Respiratory
System
Incentive Spirometry Respiration
Incentive Spirometry
ꙋ This is done to enhance deep inhalation The process of gaseous exchange
ꙋ As the patient inhales, the balls in the spirometer goes up. This signifies
betweengoodthe
lung expansion.
individual and
Closed Chest Drainage (Thoracostomy Tube)
ꙋ Purposes:
environment.
- To remove air and/or fluids from the pleural space.
- To reestablish negative pressure and re expand the lungs
3 process of Respiration
Thank You Very Much for Reading Ventilation
If you have questions feel free to comment in out chat box in the discussion area Thank You Very Much God
Inhalation
Bless and Stay safe everyone.
Exhalation

Diffusion/Gas exchange

Perfusion

KENPOGI