Oxygen, 1.

Rib muscles = the muscles between the ribs in

A clear, odorless gas that constitutes
approximately 21% of the air we breathe, is
necessary for proper functioning of all the living
cells.
Respiration
Is the process of gas exchange between the
individual and environment.
three components of respiration
1.Pulmonary ventilation or breathing; the
movement of air between the atmosphere and
the alveoli of the lungs as we inhale and exhale.
2. Gas exchange, which involves diffusion of
oxygen and carbon dioxide between the alveoli and
pulmonary capillaries.
3. Transport of oxygen from the lungs to the
tissues, and carbon dioxide from the tissues to
the lungs.
UPPER RESPIRATORY SYSTEM
the chest.
2. Diaphragm muscle
Muscle movement – the diaphragm and rib
muscles are constantly contracting and relaxing
(approximately 16 times per minute), thus causing
the chest cavity to increase and decrease.
During inhalation – the muscles contract:
Contraction of the diaphragm muscle – causes
the diaphragm to flatten, thus enlarging the chest
cavity.
Contraction of the rib muscles – causes the
ribs to rise, thus increasing the chest volume.
The chest cavity expands, thus reducing air
pressure and causing air to be passively drawn into
the lungs. Air passes from the high pressure
outside the lungs to the low pressure inside the
lungs.
During exhalation – the muscles relax:

These sequential steps during inspiration:

Nose or mouth > pharynx > larynx > trachea >
the right or left bronchi of the lung >
bronchioles of the lungs > alveoli of the lungs.
Inhalation – the intake of air into the lungs through
expansion of chest volume.
Exhalation – the expulsion of air from the lungs
through contraction of chest volume.
Inhalation and exhalation involves muscles: Factors Affecting the Respiratory System
H-ealth status=diseases in the respiratory system
can affect respiratory function
M-edications=anti-anxiety drugs and sedative-
hypnotics can decrease the rate and depth of
respirations. (ex. Diazepam (Valium),
Flurazepam (Dalmane), Barbiturates
(Phenobarbital)
E- nvironment=altitude, heat, cold and air pollution
affect oxygenation
A-ge= increase in newborn, slows until adulthood
and decreases for elderly
L-ifestyle= increase due to physical exercise/
activity; occupations can predispose individual to
lung diseases. Silicosis (sandstone blasters and
potters),asbestosis (asbestos workers),
anthracosis(coal miners), organic dust disease(
farmers/ agricultural workers)
S-tress= some hyperventilate when stressed,
when stress continues this increase the risk of
cardiovascular disease.
Assessing the Respiratory System
• Complaints of shortness of breath (dyspnea)
• Bluish or cyanotic appearance of the nail
beds, lips, mucous membranes and skin
• Restlessness, irritability, confusion, decreased
level of consciousness
• Pain during inspiration and expiration
• Labored or difficult breathing
• Orthopnea
• Use of accessory muscles
• Abnormal breath sounds such as wheezes,
rhonchi or rales
• Inability to breathe spontaneously
• Thick, frothy, blood-tinged or copious sputum
production
• Paradoxical chest wall movement
Nasal prongs/cannula.
• Comfortable and simple, and allows client to move
about in bed.
• Delivers 25% to 40% oxygen at flow rates of 4 to
6 L/min.
• Difficult to keep in position unless client is alert
and cooperative.
Venturi mask.
Lubricate
o Naso- water soluble lubricant
o Oro- sterile water or NSS
Non-rebreather reservoir mask.
• Reservoir bag has one-way valve preventing
the client from exhaling back into the bag.
• Oxygen flow rate prevents collapse of bag during
inhalation.
• Delivers 90% to 95% oxygen at flow rates of 10 to
12 L/min.
• Ideal for severe hypoxia, but client may complain
of feelings of suffocation.
T-tube.
• Provides humidification and enriched oxygen
mixtures to tracheostomy or endotracheal tube.
• Delivers up to 100% oxygen at flow rates at
least twice the minute ventilation.
V. Intubation and Mechanical Ventilation:
A. Indications:
• Apnea.
• Inadequate upper airway or inability to clear
secretions.
• Worsening respiratory acidosis (PaCO2 greater
than 50 mm Hg) and
hypoventilation.
• PaO2 less than 55 mm Hg.
• Absent gag reflex.
• Heavy sedation or paralysis.
• Imminent respiratory failure (respiratory rate less
than 8 to 10
breaths/min or greater than 30 to 40 breaths/min).
• Chest wall trauma.
• Profound shock.
• Controlled hyperventilation (e.g., increased ICP).
B. Types of positive-pressure ventilators:
• Pressure cycled—gas flows into the client until
a predetermined airway pressure is reached. Tidal
volume is not constant.
• Time cycled—gas flows for a certain percentage
of time during ventilatory cycle.
• Volume cycled—most common ventilators used;
tidal volume is determined, and a fixed volume is
delivered with each breath.
C. Ventilator modes:
• Controlled—machine delivers a breath at a
fixed rate regardless of client’s effort or demands.
• Assist-controlled—machine senses a client’s
efforts to breathe and delivers a fixed tidal volume
with each effort.
• Intermittent mandatory ventilation (IMV)—
breaths are delivered by the machine, but the
client may also breathe spontaneously without
machine assistance.
• Pressure support—client breathes spontaneously
and determines ventilator rate. Tidal volume
determined by inflation pressure and client’s lung-
thorax compliance.
D. Minute ventilation—determined by the
respiratory rate and the tidal volume. A
respiratory rate of 10 to 15 breaths/min is
considered appropriate. Close monitoring is
required to achieve desired (not necessarily
normal) PaCO2.
E. Positive end-expiratory pressure (PEEP)—
maintenance of positive airway pressure at the
end of expiration. Applied in the form of
continuous positive airway pressure (CPAP) for
the client breathing spontaneously or continuous
positive-pressure ventilation (CPPV) for the client
receiving mechanical breaths. Applied in 3- to 5-cm
H2O
increments. Levels greater than 10 to 15 cm
H2O are associated with cardiovascular
dysfunction and hemodynamic compromise.
Suctioning
Oropharyngeal and Nasopharyngeal suctioning
o Assess indications for suctioning:
▪ audible secretions during respiration
▪ adventitious breath sounds
o Position
▪ Conscious: Semi- fowler’s
▪ Unconscious: Lateral
o Pressure of suction equipment to prevent trauma
to mucous membrane of airways.
o Appropriate size of sterile suction catheter
• High flow: High flow systems are specific
devices that deliver the patient's entire
ventilatory
demand, meeting, or exceeding the patients
Peak Inspiratory Flow Rate (PIFR), thereby
providing an accurate FiO2. Where the total flow
delivered to the patient meets or exceeds their
Peak Inspiratory Flow Rate the FiO2 delivered
to the patient will be accurate. High flow in
approved areas only. Consult your NUM if unsure.
• Humidification is the addition of heat and moisture
to a gas. The amount of water vapour that a
gas can carry increases with temperature.
• Hypercapnea: Increased amounts of carbon
dioxide in the blood.
• Hypoxaemia: Low arterial oxygen tension (in the
blood.)
• Hypoxia: Low oxygen level at the tissues.
• Low flow: Low flow systems are specific
devices that do not provide the patient's entire
ventilatory requirements, room air is entrained with
the oxygen, diluting the FiO2.
• Minute ventilation: The total amount of gas
moving into and out of the lungs per minute. The
minute ventilation (volume) is calculated by
multiplying the tidal volume by the respiration rate,
measured in litres per minute.
• Peak Inspiratory Flow Rate (PIFR): The fastest
flow rate of air during inspiration, measured in
liters per second.
• Tidal Volume: The amount of gas that moves
in, and out, of the lungs with each breath,
measured in millilitres (6-10 ml/kg).
• Ventilation - Perfusion (VQ) mismatch: An
imbalance between alveolar ventilation and
pulmonary capillary blood flow
.