RESPIRATORY

SYSTEM
The respiratory system is composed of the upper and 2. Paranasal Sinuses – includes four pair
lower respiratory tracts. Together, the two tracts are of bony cavities that are lined with nasal
responsible for ventilation (movement of air in and mucosa and ciliated epithelium.
3. Tubernate Bones (Conchae)
out of the airways). The upper tract, known as the upper
4. Pharynx – muscular passageway for
airway, warms and filters inspired air so that the lower both food and air
respiratory tract (the lungs) can accomplish • Nasopharynx
gas exchange. Gas exchange involves delivering oxygen • Oropharynx
to the tissues through the bloodstream and expelling • Laryngopharynx
waste gases, such as carbon dioxide, during expiration. 5. Tonsils and Adenoids
6. Larynx – voice production, coughing
reflex
Made up of framework of:
▪ Epiglottis – valve that covers
the opening to the larynx during
swallowing.
▪ Glottis – opening between the
vocal cords
▪ Hyoid bone – u shaped bone
in neck
▪ Cricoid cartilage
▪ Thyroid cartilage, forms the
Adam’s apple
▪ Arythenoid cartilage
▪ Speech production and
cough reflex
▪ Vocal cords
7. Trachea - consists of cartilaginous rings
- Passageway of air
- Site of tracheostomy (4th -6th
tracheal ring)

ANATOMY OF THE RESPIRATORY SYSTEM

Upper airway structures consist of the nose, sinuses and

nasal passages, pharynx, tonsils and adenoids, larynx,
and trachea.

OXYGENATON: the dynamic interaction of gases in the

body for the purpose of delivering adequate oxygen
essential for cellular survival

RESPIRATORY SYSTEM’S MAIN FUNCTION:

GAS EXCHANGE

Upper Respiratory Tract

A. Functions
1. Filtering
2. Warming and moistening
3. Humidification
B. Parts
1. Nose - made up of framework of
cartilages; divided into R and L by the
nasal septum.

JUAN LORENZO N. SORIANO | MS1 (LEC)

1

Lower respiratory tract PULMONARY CIRCULATION
A. Function:
facilitates gas exchange
B. Parts
1. Lungs, are paired elastic structure enclosed
in the thoracic cage, which is an airtight
chamber with distensible walls.
• Right – 3 lobes, 10 segments
• Left – 2 lobes, 8 segments
Client post pneumonectomy → affected side to
promote expansion
RESPIRATORY
SYSTEM
- Provides for reoxygenation of blood and release
of CO2
• PULMONARY ARTERIES, carry blood from
the heart to the lungs.
• PULMONARY VEINS, is a large blood vessel
of the circulatory system that carries blood
from the lungs to the left atrium of the
heart.

Post lobectomy →unaffected side to promote drainage

• Pleural cavity
o Parietal
o Visceral
o Pleural Fluid: prevents
pleural friction rub (as seen
in pneumonia and pleural
effusion)
2. Bronchi
• Lobar Bronchi: 3 R and 2 L
• Segmental Bronchi: 10 R and 8 L
• Subsegmental Bronchi
3. Bronchioles RESPIRATORY MUSCLES
- Terminal Bronchioles - PRIMARY: diaphragm and external intercostal
- Respiratory Bronchioles, muscles
considered to be the transitional - ACCESORY: sternocleidomastoid (elevated
passageways between the sternum), the scalene muscles (anterior, middle
conducting airways and the gas and posterior scalene) and the nasal alae
exchange
4. Alveoli
- functional cellular units or
gasexchange units of the lungs.
- O2 and CO2 exchange takes place
- Made up of about 300 million
TYPE 1 - provide structure to the alveoli
TYPE 2 - secrete SURFACTANT, reduces
surface tension; increases alveoli
stability & prevents their collapse
TYPE 3 – alveolar cell macrophages,
destroys foreign material, such as
bacteria
• Lecithin
• Sphingomyelin
o L/S ratio indicates lung
maturity
o 2:1 →normal
o 1:2 →immature lungs

JUAN LORENZO N. SORIANO | MS1 (LEC)

2

PHYSIOLOGY OF THE RESPIRATORY SYSTEM
VENTILATION
- The movement of air in and out of the airways.
- The thoracic cavity is an air tight chamber. the
floor of this chamber is the diaphragm.
- Inspiration: contraction of the diaphragm
(movement of this chamber floor downward)
and contraction of the external intercostal
muscles increases the space in this chamber.
lowered intrathoracic pressure causes air to
enter through the airways and inflate the lungs.
- Expiration: with relaxation, the diaphragm
moves up and intrathoracic pressure increases.
this increased pressure pushes air out of the
lungs. expiration requires the elastic recoil of the
lungs.
- Inspiration normally is 1/3 of the respiratory
cycle and expiration is 2/3.
DRIVING FORCE FOR AIR FLOW
- Airflow driven by the pressure difference
between atmosphere (barometric pressure) and
inside the lungs (intrapulmonary pressure).
RESPIRATORY
SYSTEM
- Oxygen diffuses from the air into the blood at
the alveoli to be transported to the cells of the
body.
- Carbon dioxide diffuses from the blood into the
air at the alveoli to be removed from the body.
NEUROCHEMICAL CONTROL
- MEDULLA OBLONGATA – respiratory center
initiates each breath by sending messages to
primary respiratory muscles over the phrenic
nerve
- has inspiration and expiration centers
PONS – has 2 respiration centers that work with
the inspiration center to produce normal rate of
breathing
1. PNEUMOTAXIC CENTER – affects
the inspiratory effort by limiting the
volume of air inspired
2. APNEUSTIC CENTER – prolongs
inhalation
NOTE: Chemoreceptors responds to changes in ph,
increased PaCO2 = increase RR

AIRWAY RESISTANCE
- Resistance is determined chiefly by the radius
size of the airway.
- Causes of Increased Airway Resistance
1. Contraction of bronchial mucosa
2. Thickening of bronchial mucosa
3. Obstruction of the airway
4. Loss of lung elasticity
RESPIRATION
- The process of gas exchange between
atmospheric air and the blood at the alveoli, and
between the blood cells and the cells of the
body.
- Exchange of gases occurs because of differences
in partial pressures.

JUAN LORENZO N. SORIANO | MS1 (LEC)

3

FUNCTIONS OF THE RESPIRATORY SYSTEM
• OXYGEN TRANSPORT. Oxygen is supplied to,
and carbon dioxide is removed from, cells by
way of the circulating blood
• Respiration. This whole process of gas
exchange between the atmospheric air and the
blood and between the blood and cells of the
body.
• Ventilation. During inspiration, air flows from
the environment into the trachea, bronchi,
bronchioles, and alveoli. During expiration,
alveolar gas travels the same route in reverse.
• Lung Volumes and Capacities. Lung volumes
are categorized as tidal volume, inspiratory
reserve volume, expiratory reserve volume, and
residual volume. Lung capacity is evaluated in
terms of vital capacity, inspiratory capacity,
functional residual capacity, and total lung
capacity.
• Diffusion and Perfusion. Diffusion is the
process by which oxygen and carbon dioxide are
exchanged at the air–blood interface. The
alveolar– capillary membrane is ideal for
diffusion because of its large surface area and
thin membrane. Pulmonary artery pressure,
gravity, and alveolar pressure determine the
patterns of perfusion. In lung disease these
factors vary, and the perfusion of the lung may
become very abnormal.
VENTILATION AND PERFUSION BALANCE AND
IMBALANCE
Ventilation is the flow of gas in and out of the lungs, and
perfusion is the filling of the pulmonary capillaries with
blood. A ventilation–perfusion V˙/Q˙ imbalance occurs
from inadequate ventilation, inadequate perfusion, or
both. Ventilation and perfusion imbalance cause
shunting of blood, resulting in hypoxia (low cellular
oxygen level).
RESPIRATORY
SYSTEM
ASSESSMENT OF CLIENTS WITH RESPIRATORY
DISORDERS
History Taking. The health history focuses on the
physical and functional problems of the patient and the
effect of these problems on his or her life
• Dyspnea (difficult or labored breathing,
shortness of breath) is a symptom common to
many pulmonary and cardiac disorders,
particularly when there is decreased lung
compliance or increased airway resistance.
a. Clinical significance. Orthopnea
(inability to breathe easily except in an
upright position) may be found in
patients with heart disease and
occasionally in patients with chronic
obstructive pulmonary disease (COPD).
Sudden dyspnea in a healthy person
may indicate pneumothorax (air in the
pleural cavity), acute respiratory
obstruction, or ARDS.
b. Relief Measures. The management of
dyspnea is aimed at identifying and
correcting its cause. It is achieved by
placing the patient at rest with the head
elevated (high Fowler’s position) and, in
severe cases, by administering oxygen.
• COUGH results from irritation of the mucous
membranes. The cough is the patient’s chief
protection against the accumulation of
secretions in the bronchi and bronchioles.
a. Clinical Significance: Cough may
indicate serious pulmonary disease. The
nurse needs to evaluate the character of
the cough.
• Sputum Production is the reaction of the
lungs to any constantly recurring irritant. It also
may be associated with a nasal discharge.
a. Clinical Significance: A profuse
amount of purulent sputum (thick and
yellow, green, or rust-colored) or a
change in color of the sputum probably
indicates a bacterial infection. Thin,
mucoid sputum frequently results from
viral bronchitis. A gradual increase of
sputum over time may indicate the
presence of chronic bronchitis or
bronchiectasis. Profuse, frothy, pink
material, often welling up into the
throat, may indicate pulmonary edema.
Foul smelling sputum and bad breath
point to the presence of a lung abscess,
bronchiectasis, or an infection.
JUAN LORENZO N. SORIANO | MS1 (LEC)
4

b. Relief Measures. If the sputum is too
thick for the patient to expectorate, it
is necessary to decrease its viscosity
by increasing its water content through
adequate hydration (drinking water) and
inhalation of aerosolized solutions. The
nurse encourages adequate oral hygiene
and wise selection of food, measures
that will stimulate appetite.
• Chest pain associated with pulmonary
conditions may be sharp, stabbing, and
intermittent, or it may be dull, aching, and
persistent
a. Clinical Significance. Chest pain may
occur with pneumonia, pulmonary
embolism with lung infarction, and
pleurisy. Pleuritic pain from irritation of
the parietal pleura is sharp and seems
to “catch” on inspiration; patients often
describe it as “like the stabbing of a
knife”. The nurse assesses the quality,
intensity, and radiation of pain and
identifies and explores precipitating
factors, along with their relationship to
the patient’s position.
b. Relief Measures: Analgesic
medications may be effective in relieving
chest pain, but care must be taken not
to depress the respiratory center or a
productive cough, if present.
• WHEEZING is often the major finding in a
patient with bronchoconstriction or airway
narrow.
a. Relief Measures. Oral or inhalant
bronchodilator medications reverse
wheezing in most instances.
• Clubbing of the fingers is a sign of lung
disease found in patients with chronic hypoxic
conditions, chronic lung infections, and
malignancies of the lung.
RESPIRATORY
SYSTEM
• Hemoptysis (expectoration of blood from the
respiratory tract) is a symptom of both
pulmonary and cardiac disorders. The onset of
hemoptysis is usually sudden, and it may be
intermittent or continuous.
• Cyanosis a bluish coloring of the skin, is a very
late indicator of hypoxia. The presence or
absence of cyanosis is determined by the
amount of unoxygenated hemoglobin in the
blood. In the presence of a pulmonary condition,
central cyanosis is assessed by observing the
color of the tongue and lips. This indicates a
decrease in oxygen tension in the blood.
Peripheral cyanosis results from decreased blood
flow to a certain area of the body.
PHYSICAL ASSESSMENT of the LUNGS and
THORAX
INSPECTION. Inspection of the thorax provides
information about the musculoskeletal structure, the
patient’s nutritional status, and the respiratory system.
The nurse observes the skin over the thorax for color
and turgor and for evidence of loss of subcutaneous
tissue. It is important to note asymmetry, if present.
CHEST CONFIGURATION Normally, the ratio of the
anteroposterior diameter to the lateral diameter is 1:2
➢ Barrel chest
o anteroposterior (AP) diameter is
increased compared with lateral
diameter
o causes: hyperinflation due to asthma,
emphysema
➢ Funnel chest (pectus excavatum)
o developmental defect involving a
localized depression of lower end of
sternum in severe cases, lung capacity
may be restricted
➢ Pigeon chest chest (pectus carinatum)
o localised prominence (outward bowing
of sternum and costal cartilages)
o causes:
▪ manifestation of chronic
childhood illness (due to
repeated strong contractions of
diaphragm while thorax is still
pliable)
▪ rickets
JUAN LORENZO N. SORIANO | MS1 (LEC)
5
 RESPIRATORY
SYSTEM
➢ Kyphoscoliosis PALPITATION. The nurse palpates the thorax for
o causes: tenderness, masses, lesions, respiratory excursion, and
▪ idiopathic (80%) vocal fremitus.
▪ secondary to poliomyelitis ➢ RESPIRATORY EXCURSION- an estimation of
(inflammation involving grey thoracic expansion and may disclose significant
matter of cord) information about thoracic movement during
▪ (note: severe thoracic breathing.
kyphoscoliosis may reduce lung ➢ TACTILE FREMITUS- Sound generated by the
capacity and increase work of larynx travels distally along the bronchial tree to
breathing) set the chest wall in resonant motion.
➢ PERCUSSION sets the chest wall and
➢ Harrison's sulcus underlying structures in motion, producing
o inner depression of lower ribs just above audible and tactile vibrations
costal margins at site of attachment of ➢ DIAPHRAGMATIC EXCURSION. Decreased
diaphragm diaphragmatic excursion may occur with pleural
o causes: effusion.
▪ severe asthma in childhood ➢ with left hand on chest wall and fingers slightly
▪ rickets separatedand aligned with ribs, the middle
finger is pressed firmly against the chest; pad of
➢ Kyphosis, exaggerated forward curvature of right middle finger is used to strike firmly the
spine middle phalanx of middle finger of left hand
➢ percussion of symmetrical areas of:
➢ Scoliosis, lateral bowing ✓ anterior (chest)
✓ posterior (back) (ask patient to move
BREATHING PATTERNS AND RESPIRATORY elbows forward across the front of chest
RATES. The normal adult who is resting comfortably - this rotates the scapulae anteriorly, i.e.
takes 12 to 18 breaths per minute. Eupnea moves it out of the way)
➢ Bradypnea ✓ axillary region (side)
➢ Tachypnea ✓ supraclavicular fossa
➢ Hypoventilation ➢ percussion over a solid structure (e.g. liver,
➢ Hyperventilation consolidated lung) produces a dull note
➢ Hyperpnea ➢ percussion over a fluid filled area (e.g. pleural
➢ Kussmaul’s respiration effusion) produces an extremely dull (stony dull)
➢ Apnea. note
➢ Cheyne-Stokes respiration ➢ percussion over the normal lung produces a
➢ Biot’s respirations resonant note
➢ Asymmetric bulging of the intercostal spaces, on ➢ percussion over a hollow structure (e.g. bowel,
one side or the other-created by an increase in pneumothorax) produces a hyperresonant note
pressure within the hemithorax. ➢ liver dullness:
✓ upper level of liver dullness is
determined by percussing down the
anterior chest in mid-clavicular line
✓ normally, upper level of liver dullness is
6th rib in right mid-clavicular line
✓ if chest is resonant below this level, it is
a sign of hyperinflation usually due to
emphysema, asthma
➢ cardiac dullness:
✓ area of cardiac dullness is usually
present on left side of chest
✓ this may decrease in emphysema or
asthma

JUAN LORENZO N. SORIANO | MS1 (LEC)

6

AUSCULTATION is useful in assessing the flow of air
through the bronchial tree and in evaluating thepresence
of fluid or solid obstruction in the lung structures.
➢ BREATH SOUNDS. Normal breath sounds are
distinguished by their location over a specific
area of the lung and are identified as vesicular,
bronchovesicular, and bronchial (tubular) breath
sounds.
❖ ADVENTITIOUS SOUNDS- abnormal
condition that affects the bronchial tree
and alveoli.
There are two categories:
1. CRACKLES- discrete, noncontinuous
sounds
2. WHEEZES- continuous musical sounds
❖ VOICE SOUNDS- The sound heard
through the stethoscope as the patient
speaks is known as vocal resonance.
Voice sounds are usually assessed by
having the patient repeat “ninety-nine”
or “eee” while the nurse listens with the
stethoscope in corresponding areas of
the chest from the apices to the bases.
Bronchophony describes vocal resonance that is more
intense and clearer than normal.
Egophony describes voice sounds that are distorted.
Whispered pectoriloquy is a very subtle finding,
heard only in the presence of rather dense consolidation
of the lungs.
DIAGNOSTIC/ LABORATORY FINDINGS
NON-INVASIVE
➢ Pulmonary function tests (PFTs)- performed
to assess respiratory function and to determine
the extent of dysfunction.
➢ Pulse oximetry - a noninvasive method of
continuously monitoring the oxygen saturation
of hemoglobin (SpO2 or SaO2). Normal SpO2
values are 95% to 100%.
➢ Ventilation-Perfusion lung scan is first
performed by injecting a radioactive agent into
a peripheral vein and then obtaining a scan of
the chest to detect radiation.
➢ Chest x-ray may reveal an extensive pathologic
process in the lungs in the absence of
symptoms.
➢ Computed Tomography. CT is an imaging
method in which the lungs are scanned in
successive layers by a narrow-beam x-ray. The
images produced provide a cross-sectional view
of the chest.
RESPIRATORY
SYSTEM
➢ Magnetic Resonance Imaging. MRIs are
similar to CT scans except that magnetic fields
and radiofrequency signals are used instead of
a narrow-beam x-ray.
➢ Fluoroscopic Studies. Fluoroscopy is used to
assist with invasive procedures, such as a chest
needle biopsy or transbronchial biopsy,
performed to identify lesion.
➢ Pulmonary angiography is most commonly
used to investigate thromboembolic disease of
the lungs, such as pulmonary emboli and
congenital abnormalities of the pulmonary
vascular tree.
➢ Positron emission tomography (PET) is a
radioisotope study with advanced diagnostic
capabilities. It is used to evaluate lung nodules
for malignancy.
➢ Sputum is obtained for analysis to identify
pathogenic organisms and to determine
whether malignant cells are present.
COMMON RESPIRATORY INTERVENTIONS
OXYGEN THERAPY
✓ Assess signs and symptoms of hypoxemia.
✓ Check doctor’s order.
✓ Position patient preferably Semi- Fowler’s
✓ Open source of oxygen before insertion of
oxygen device.
✓ Regulate oxygen flow accurately.
✓ Avoid use of oil, grease, alcohol, and ether near
the client.
✓ Place a “No Smoking” sign at the bedside.
✓ Check electrical appliances before use.
✓ Avoid materials that generate static electricity.
✓ Humidify the oxygen.
✓ Provide good oronasal hygiene.
✓ Lubricate nares with water-soluble lubricant
✓ Assess effectiveness of oxygen therapy.
✓ Documentation.
JUAN LORENZO N. SORIANO | MS1 (LEC)
7

COUGHING TECHNIQUES
CONTROLLED COUGHING
✓ Sit on a chair with both feet on the floor.
✓ Take a slow, deep breath through your nose.
Hold for 2 counts.
✓ Lean forward slightly.
✓ Cough twice—2 short coughs.
✓ Relax for a few seconds
HUFF TECHNIQUE
✓ Sit on a chair with both feet on the floor.
✓ Take a slow, deep breath through your nose.
Hold for 2 counts.
✓ To breathe out, open your mouth and make a
“huff” sound in your throat. (The same way you
might breathe to clean a pair of eyeglasses.)
✓ Huff 2 to 3 times as you breathe out.
✓ Relax for a few seconds.
SUCTIONING
✓ Client should be in semi-fowler’ s or high
fowler’s
✓ Practice sterile technique.
✓ Hyperventilate client with 100% oxygen before
and after suctioning.
✓ Insert catheter with gloved hand at around 3-5
inches length of catheter insertion.
✓ Apply suction during withdrawal of catheter.
✓ When withdrawing catheter, rotate the catheter
while applying intermittent suction.
✓ Suctioning should take only 5-10 seconds.
✓ Evaluate after for clear breath sounds.
INCENTIVE SPROMETRY
Done to enhance deep inhalation As the patient inhales
with the spirometer. The balls in the spirometer goes up
which signifies good lung expansion
AEROSOL THERAPHY
a technique of administering medication directly into the
airway and lungs. An aerosol is a suspension of liquid
and/or solid particles, usually administered by a medical
device like an inhaler.
POSTURAL DRAINAGE
the positioning of a patient with an involved lung
segment such that gravity has a maximal effect of
facilitating the drainage of broncho-pulmonary
secretions from the tracheobronchial tree.It is based on
the concept of gravity-assisted mobilization of secretions
and transport it for removal.
✓ Verify doctor’s order.
✓ Assess areas of accumulation of mucus
secretions
✓ Position to allow expectoration of mucus
secretions by gravity.
RESPIRATORY
SYSTEM
✓ Breathing treatment should be done before CPT.
place patient in sitting upright position before
Trendelenburg position.
✓ Do it with the upper lobes before lower lobes.
✓ Place the client in each position for 10-15
minutes.
✓ Percussion and vibration are done to loosen
mucus secretions
✓ Change position gradually to prevent postural
hypotension.
✓ Procedure is best done 60-90 minutes before
meals to prevent vomiting or in the morning
upon awakening and at bedtime.
✓ Provide good oral care after the procedure.
VENTILATION THERAPY
Mechanical ventilation, assisted ventilation or
intermittent mandatory ventilation (IMV), is the medical
term for artificial ventilation where mechanical means
are used to assist or replace spontaneous breathing.
The main benefits of mechanical ventilation are
the following:
✓ The patient does not have to work as hard to
breathe – their respiratory muscles rest.
✓ The patient's as allowed time to recover in
hopes that breathing becomes normal again.
✓ Helps the patient get adequate oxygen and
clears carbon dioxide.
✓ Preserves a stable airway and preventing injury
from aspiration.
This risk of infection increases the longer mechanical
ventilation is needed and is highest around two weeks.
Another risk is lung damage caused by either over
inflation or repetitive opening and collapsing of the
small air sacs (alveoli) of the lungs.
ARTIFICIAL AIRWAYS
A tube or tube-like device that is inserted through the
nose, mouth, or into the trachea to provide an opening
for ventilation
INDICATIONS:
✓ Relief of airway obstruction -guarantees the
patency of upper airway regardless of soft
tissue obstruction.
✓ Protecting or maintaining an airway
✓ Facilitation of tracheobronchial clearance -
mobilization of secretions from the trachea
requires either an adequate cough or direct
suctioning of the trachea
✓ Facilitation of artificial ventilation - ventilation
with a mask
TYPES:
✓ OROPHARYNGEAL AIRWAY- An airway
adjunct used to maintain or open the airway by
stopping the tongue from covering the epiglottis
JUAN LORENZO N. SORIANO | MS1 (LEC)
8

✓ NASOPHARYNGEAL AIRWAY- is a soft
rubber or plastic tube inserted into the nostril
and advanced along the floor of the nose
✓ TRACHEOSTOMY - is a medical procedure —
either temporary or permanent — that involves
creating an opening in the neck in order to
place a tube into a person’s windpipe. The tube
is inserted through a cut in the neck below the
vocal cords. This allows air to enter the lungs.
Breathing is then done through the tube,
bypassing the mouth, nose, and throat.
CHEST SURGERIES
➢ LOBECTOMY- is a surgical procedure where an
entire lobe of your lung is removed for a variety
of reasons that may include a lung cancer
diagnosis, infection, COPD or benign tumors.
➢ PNEUMONECTOMY- is a type of surgery to
remove one of your lungs because of cancer,
trauma, or some other condition. You have two
lungs: a right lung and a left lung.
➢ SEGMENTAL RESECTION- refers to removing
a section of a lobe of the lung.
➢ WEDGE RESECTION- Surgery to remove a
triangle-shaped slice of tissue. It may be used
to remove a tumor and a small amount of
normal tissue around it.
➢ DECORTICATION- a type of surgical
procedure performed to remove a fibrous tissue
that has abnormally formed on the surface of
the lung, chest wall or diaphragm.
➢ EXPLORATORY THORACOTOMY- Exploratory
surgical procedure in which the chest is opened
to inspect the heart, lungs, and mediastinal
contents.
➢ VIDEO ASSISTED THORACIC SURGERY- a
procedure in which a small tube called a
thoracoscope is inserted through a small incision
between the ribs. At the end of the tube is a
small camera. This lets the surgeon see the
entire chest cavity without having to open up
the chest or spread the ribs.
➢ LUNG VOLUME REDUCTION SURGERY
(LVRS) - a surgical procedure to remove
diseased, emphysematous lung tissue. This
procedure reduces the size of an over-inflated
lung and allows the expansion (growth) of the
remaining, often more functional lung.
➢ CHEST DRAINAGE- Chest drainage is a
procedure to drain fluid from the pleural space
between the lung and chest wall. Inflammation,
infection and traumatic injury, among other
things, can cause fluid to build up in the cavity.
PURPOSE:
1. To remove air and/or fluids from the
pleural space.
RESPIRATORY
SYSTEM
2. To reestablish negative pressure and re-
expand the
3. lungs
TYPES:
1. One-bottle system- the bottle serves
as a drainage and water seal bottle.
2. Two- bottle system- it is either
connected to suction machine or not;
one bottle serves as a drainage and one
is a water sealed bottle.
3. Three bottle – system- the first bottle
serves as a drainage; the second bottle
is the water sealed and the third is
suction- control bottle.
Nursing Care of Client with Upper Airway
Disorders
SLEEP APNEA SYNDROME
defined as cessation of breathing (apnea) - CLINICAL
MANIFESTATION:
✓ five apneic episodes per hour to several hundred
per night.
✓ excessive daytime sleepiness
✓ morning headache
✓ sore throat
✓ intellectual deterioration
✓ personality changes
✓ behavioral disorders
✓ enuresis
✓ impotence
✓ obesity
Medical Management:
a. Continuous positive airway pressure or bilevel
positive airway pressure therapy with
supplemental oxygen via nasal cannula.
b. performed to bypass the obstruction if the
potential for respiratory failure or life-
threatening dysrhythmias exists
c. Pharmacological Therapy: Protriptyline (Triptil)
Medroxyprogesterone acetate (Provera) and
acetazolamide (Diamox)
Nursing Management:
1. explains the disorder in language that is
understandable to the patient and relates
symptoms (daytime sleepiness) to the
underlying disorder.
2. instructs the patient and family about
treatments,
3. including the correct and safe use of oxygen, if
prescribed.
JUAN LORENZO N. SORIANO | MS1 (LEC)
9
 RESPIRATORY
SYSTEM
EPISTAXIS 4. Provide emotional support.
- bleeding coming from the nose.
- caused by trauma, infection, inhalation of illicit LARYNGEAL TRAUMA and OBSTRUCTION
drugs, cardiovascular diseases, blood - Swelling of the laryngeal mucous membranes
dyscrasias, nasal tumors, low humidity, a - Edema of glottis
foreign body in the nose, and a deviated nasal - Aspiration of foreign bodies
septum Medical Management:
a. Administration of subcutaneous epinephrine or
Medical management: b. corticosteroid
a. Application of direct pressure-initial step c. Application of ice pack
b. Pharmacological treatment: silver nitrate
applicator and Gelfoam, or by electrocauter: NURSING CARE OF CLIENTS WITH VENTILATION
topical vasoconstrictor such as adrenaline DISORDERS
(11,000), cocaine (0.5%), and phenylephrine
may be prescribed. PLEURITIS
- inflammation of the pleura and the inner chest
Nursing management wall.
1. Monitors the vital signs, assists in the control of - Causes:
bleeding,  infections,
2. Provides tissues and an emesis basin to allow  tuberculosis (TB),
the Patient to expectorate any excess blood.  congestive heart failure,
3. Assuring the patient in a calm, efficient manner  cancer,
that bleeding can be controlled can help reduce  pulmonary embolism, and
anxiety. TEACHING PATIENTS SELF-CARE  collagen vascular diseases.

NASAL OBSTRUCTION Symptoms: Chest pain, Shortness of breath, and local

- may lead to a condition of chronic infection of tenderness.
the nose and result in frequent episodes of Diagnostics: Chest X-ray, ultrasound, and CT scan
nasopharyngitis.

Medical Management
a. Requires the removal of the obstruction,
followed by measures to overcome whatever
chronic infection exists.

Nursing Management
1. Elevates the head of the bed to
2. promote drainage and to help alleviate
discomfort from edema.; Frequent oral hygiene. PLEURAL EFFUSION
- accumulation of fluids in the pleural space.
NASAL TRAUMA AND SURGERIES
NASAL FRACTURE TYPES:
- usual result of direct assault. a. Hemothorax- blood in the pleural space
- Clinical Manifestation: BLEEDING, b. Pyothorax/empyema- Pus in the pleural
SWELLING and DEFORMITY space
- Assessment & diagnostics: INSPECTION, c. Hydrothorax- water in the pleural space
PALPATATION and X-ray d. Chylothorax- lymphatic fluid in the pleural
space due to a leak in the thoracic duct
Medical Management:
a. control bleeding; Closed and/ or Open
Reduction; Rhinoplasty

Nursing Management Goals:

1. Maintain patent airway.
2. Reduce edema
3. Prevent complications

JUAN LORENZO N. SORIANO | MS1 (LEC)

10

PNEUMOTHORAX
- accumulation of air in the pleural space.
Types:
• CLOSED PNEUMOTHORAX- it has no
associated external wound.
o Causes:
▪ Injury to the lungs from
mechanical ventilation.
▪ Injury to the lungs from
▪ subclavian catheter insertion
▪ Perforation of the esophagus
▪ Injury to the lungs from broken
ribs
▪ Ruptured blebs and bullae in a
patient with COPD
• OPEN PNEUMOTHORAX- occurs when air
enters the pleural space through an opening in
the chest wall.
• TENSION PNEUMOTHORAX- a pneumothorax
with rapid accumulation of air in the pleural
space causing severely high intrapleural
pressures with resultant tension on the heart
and great vessels
TRAUMA OF THE CHEST
- Injuries to the chest are often life-threatening.
The initial assessment of thoracic injuries
includes assessment of the patient for airway
obstruction, tension pneumothorax, open
pneumothorax, massive hemothorax, flail chest,
and cardiac tamponade. Secondary assessment
would include simple pneumothorax,
hemothorax, pulmonary contusion, traumatic
aortic rupture, tracheobronchial disruption,
esophageal perforation, traumatic diaphragmatic
injury, and penetrating wounds to the
mediastinum.
Medical management:
1. An airway is immediately established with
oxygen support and, in some cases, intubation
and ventilatory support.
2. Re-establishing fluid volume and negative
intrapleural pressure and draining intrapleural
fluid and blood are essential.
RESPIRATORY
SYSTEM
FRACTURES
- Sternal fractures - most common in motor
vehicle crashes with a direct blow to the
sternum via the steering wheel and are most
common in women, patients over age 50, and
those using shoulder restraint.
- Rib Fractures- are benign and are treated
conservatively.
Clinical manifestations:
a. Sternal fractures- chest pain, overlying
tenderness, ecchymosis, crepitus, swelling, and
the potential of a chest wall deformity.
b. Rib fractures- severe pain, point tenderness,
and muscle spasm over the area of the fracture,
which is aggravated by coughing, deep
breathing, and movement.
Medical management:
1. Sternal fractures- directed toward controlling
pain, Avoiding excessive activity, and treating
any associated Injuries.
2. Rib fractures- control pain and to detect and
treat the Injury. Sedation is used to relieve pain
and to allow deep Breathing and coughing.
FLAIL CHEST
- Occurs when three or more adjacent ribs
(multiple contiguous ribs) are fractured at two
or more sites, resulting in free-floating rib
segments.
Medical management:
1. providing ventilatory support, clearing
secretions from the lungs, and controlling pain.
The specific management depends on the
degree of respiratory dysfunction.
PULMONARY CONTUSION
- damage to the lung tissues resulting in
hemorrhage and localized edema.
- an abnormal accumulation of fluid in the
interstitial and intra-alveolar spaces.
Clinical manifestations: tachypnea, tachycardia,
pleuritic chest pain, hypoxemia, and blood-tinged
secretions to more severe tachypnea, tachycardia,
crackles, frank bleeding, severe hypoxemia, and
respiratory acidosis.
Assessment: Chest X-ray
Medical management:
1. Treatment priorities include maintaining the
airway, providing adequate oxygenation, and
controlling pain.
JUAN LORENZO N. SORIANO | MS1 (LEC)
11