09/12/2023

LEARNING
NCM 112 OUTCOMES
MIDTERMS
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Compare and contrast the
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Use the nursing process as a
upper respiratory tract framework for care of the
infections according to cause, patient with upper airway
incidence, clinical infection and the patient
manifestations, management, undergoing laryngectomy.
and the significance of
preventive health care.

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TERMINOLOGIES
TOPIC • Apnea - temporary cessation of breathing
• Bronchophony - abnormal increase in clarity of
RESPONSES TO transmitted voice sounds heard when
ALTERATIONS/PROBLEMS AND IT’S auscultating the lungs
• Bronchoscopy - direct examination of the larynx,
PATHOPHYSIOLOGIC BASIS IN trachea, and bronchi using an endoscope
OXYGENATION, FLUID & ELECTROLYTES • Cilia - short, fine hairs that provide a constant
whipping motion that serves to propel mucus
and ACID-BASE BALANCE, INFECTIOUS, and foreign substances away from the lung
INFLAMMATORY & IMMUNOLOGIC toward the larynx
• Compliance - measure of the force required to
RESPONSE, CELLULAR ABERRATIONS, expand or inflate the lungs
ACUTE & CHRONIC • Crackles - nonmusical, discontinuous popping
sounds during inspiration caused by delayed
reopening of the airways heard on chest
auscultation

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LEARNING TERMINOLOGIES
OUTCOMES • Dyspnea - subjective experience that describes
an uncomfortable or painful breathing sensation
when either at rest or while walking or climbing
stairs; also commonly referred to as shortness of

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breath
• Egophony - abnormal change in tone of voice
that is heard when auscultating the lungs
• Fremitus - vibrations of speech felt as tremors of
the chest wall during palpation
Describe the structures Explain and demonstrate Recognize and evaluate the • Hemoptysis - expectoration of blood from the
and functions of the upper proper techniques major symptoms of respiratory respiratory tract
dysfunction by applying • Hypoxemia - decrease in arterial oxygen tension
and lower respiratory utilized to perform a
concepts from the patient’s in the blood
tracts and concepts of comprehensive
health history and physical • Hypoxia - decrease in oxygen supply to the
ventilation, diffusion, respiratory assessment.
assessment findings. tissues and cells
perfusion, and ventilation–
perfusion imbalances.

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TERMINOLOGIES
• Obstructive sleep apnea - temporary absence of
breathing during sleep secondary to transient
REVIEW OF
upper airway obstruction
• Orthopnea - shortness of breath when lying flat;
relieved by sitting or standing
THE
• Oxygen Saturation - percentage of hemoglobin
that is bound to oxygen
• Physiologic dead space - portion of the
RESPIRATORY
tracheobronchial tree that does not participate in
gas exchange
• Pulmonary diffusion - exchange of gas
SYSTEM
molecules (oxygen and carbon dioxide) from
areas of high concentration to areas of low
concentration
• Pulmonary perfusion - blood flow through the
pulmonary vasculature

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TERMINOLOGIES • The respiratory system is made of organs involved in

DIVISIONS OF
the exchange of oxygen and carbon dioxide.
• The system is divided into 2 parts: the upper
• Respiration - gas exchange between
respiratory tract and the lower respiratory tract.

THE
atmospheric air and the blood and between the
• Upper Respiratory Tract - nose, nasal cavity, sinuses
blood and cells of the body
and larynx
• Rhonchi - deep, low-pitched snoring sound • Lower Respiratory Tract - trachea, lungs, bronchi and
associated with partial airway obstruction, heard

RESPIRATORY
bronchioles, alveoli or air sacs
on chest auscultation • The right lung has 3 sections or lobes. The left lung
• Stridor - continuous, high-pitched, musical
has 2 lobes.
sound heard on inspiration, best heard over the

SYSTEM
• Respiration - act of breathing
neck; may be heard without use of a stethoscope,
• Inhalation/Inspiration - act of breathing in oxygen
secondary to upper airway obstruction
• Exhalation/Expiration - act of breathing out carbon
• Tachypnea - abnormally rapid respirations
dioxide
• Tidal volume - volume of air inspired and expired
with each breath during normal breathing
• Ventilation - movement of air in and out of the
airways

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ANATOMY OF THE UPPER

TERMINOLOGIES RESPIRATORY TRACT
• Wheezes - continuous musical sounds
associated with airway narrowing or partial

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obstruction NOSE
• Whispered pectoriloquy - whispered sounds serves as a passageway for air to pass to and
heard loudly and clearly upon thoracic from the lungs. It filters impurities and
auscultation humidifies and warms the air as it is inhaled
• Resistance - determined by the radius or size of
the airway through which the air is flowing
• Pressure Variances - airflow from a region of
PARANASAL SINUSES

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higher pressure to a region of lower pressure

include four pairs of bony cavities that are lined with

nasal mucosa and ciliated pseudostratified columnar
epithelium. A prominent function of the sinuses is to
serve as a resonating chamber in speech. The sinuses
are a common site of infection.

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ANATOMY OF THE UPPER ANATOMY OF THE LOWER

RESPIRATORY TRACT RESPIRATORY TRACT

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PHARYNX MEDIASTINUM
functions as a passageway for the respiratory a space in the chest that holds the heart and all
and digestive tracts the thoracic tissue outside the lungs

LARYNX BRONCHI & BRONCHIOLES

04 the major function is vocalization, it also protects the

lower airway from foreign substances and facilitates
coughing; it is, therefore, sometimes referred to as the
04 deliver air to the exchange surfaces of the lungs

“watchdog of the lungs”

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ANATOMY OF THE UPPER ANATOMY OF THE LOWER

RESPIRATORY TRACT RESPIRATORY TRACT

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TRACHEA ALVEOLI
serves as the passage between the larynx and is the center of the respiratory system’s gas
the right and left main stem bronchi, which exchange. The alveoli pick up the incoming
enter the lungs through an opening called the energy (oxygen) you breathe in and release the
hilus. outgoing waste product (carbon dioxide) you
exhale.

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ANATOMY OF THE LOWER

RESPIRATORY TRACT LUNGS

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LUNGS • A pair of cone shaped organs made of spongy
are paired elastic structures enclosed in the
pinkish gray tissue, taking most of the space in the
thoracic cage, which is an airtight chamber with
thorax or chest
distensible walls
• Lungs take in oxygen which the body cells need in
*right lung has upper, middle, and lower lobes
*left lung consists of upper and lower lobes order to carry out their normal functions.
• Lungs get rid of carbon dioxide, a waste product of
PLEURA

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the cells.
serve to lubricate the thorax and the lungs and permit • Lungs is surrounded by the pleural membrane.
smooth motion of the lungs within the thoracic cavity
during inspiration and expiration

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LUNGS
• It is separated by the mediastinum, containing the
heart and its vessels, trachea, esophagus, thymus
gland and lymph nodes.
• Air enters the body through the nose or mouth,
travels down the throat through the larynx and
OXYGEN
TRANSPORT
Oxygen is supplied to, and carbon dioxide is
removed from, cells by way of the circulating blood
through the thin walls of the capillaries. Oxygen
diffuses from the capillary through the capillary
wall to the interstitial fluid. At this point, it diffuses
through the membrane of tissue cells, where it is
used by mitochondria for cellular respiration. The
movement of carbon dioxide occurs by diffusion in
the opposite direction—from cell to blood.

trachea.
• Air goes into the lungs through the tubes called
mainstem bronchi RESPIRATION
is the whole process of gas exchange between the
atmospheric air and the blood and between the
blood and cells of the body

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MAINSTEM
BRONCHI VENTILATION

during inspiration, air flows from the environment

• One mainstem bronchus leads to the right lung
and the other to the left lung
• In the lungs, the mainstem bronchi divide into
smaller bronchi
• Smaller Bronchi divide into even small tubes
(bronchioles)
• Bronchioles end in tiny air sacs or alveoli where the
exchange of oxygen and carbon dioxide occurs.
into the trachea, bronchi, bronchioles & alveoli.
During expiration, alveolar gas travels the same
route in reverse. Physical factors that govern
airflow in and out of the lungs are collectively
referred to as the mechanics of ventilation &
include air pressure variances, resistance to airflow
and lung compliance

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PULMONARY
GAS DIFFUSION
EXCHANGE is the process by which oxygen and carbon dioxide
are exchanged from areas of high concentration to
areas of low concentration at the air–blood
interface.

• Ventilation: Movement of gases in and out of the

alveoli PULMONARY
• Diffusion at Pulmonary Capillaries : Diffusion of
Oxygen and Carbon Dioxide at the Pulmonary PERFUSION
Capillary Level
• Perfusion ( Transportation): Oxygenated blood is is the actual blood flow through the pulmonary
vasculature. The blood is pumped into the lungs
perfused or transported to the tissues
by the right ventricle through the pulmonary
• Diffusion of Cells
artery.

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ASSESSMENT OF PATIENTS
SEEKING CARE WITH RESPIRATORY
GAS DISORDERS
EXCHANGE
Hea l th Hi s tory
occurs in the lungs between alveolar air & the
blood of the pulmonary capillaries. For effective
gas exchange to occur, alveoli must be ventilated
and perfused. • Identify chief reason for seeking care
• Determine onset and duration of problems,
• Ventilation refers to the flow of air into and out medications and treatment
of the alveoli. • Collects precipitating factors, severity, associated
• Perfusion refers to the flow of blood to alveolar
signs and symptoms
capillaries
• Assess risk and genetic factors that contribute to the
condition
• Assess impact of signs and symptoms on patient’s
ability to perform activities of daily living

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ASSESSMENT OF PATIENTS
SEEKING CARE WITH RESPIRATORY
CARBON DIOXIDE DISORDERS
TRANSPORT
S i g n s an d S ymp toms
At the same time that oxygen diffuses from the
blood into the tissues, carbon dioxide diffuses from
tissue cells to blood and is transported to the lungs • Dyspnea
for excretion. The amount of carbon dioxide in
• Cough
transit is one of the major determinants of the
• Sputum Production
acid–base balance of the body
• Chest Pain
• Wheezing
• Clubbing Fingers
• Hemoptysis
• Cyanosis

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PHYSICAL ASSESSMENT OF
NEUROLOGIC CONTROL
UPPER STRUCTURES OF THE
OF VENTILATION
RESPIRATORY SYSTEM
Resting respiration is the result of cyclic excitation
NOSE AND SINUSES
of the respiratory muscles by the phrenic nerve.
• Inspect external nose for lesions, symmetry or inflammation
The rhythm of breathing is controlled by
respiratory centers in the brain. The inspiratory and • Examine internal structure for swelling, color, odor exudates or
expiratory centers in the medulla oblongata and bleeding
pons control the rate and depth of ventilation to • Inspect for septum deviation, perforation or bleeding
meet the body’s metabolic demands. • Palpate frontal and maxillary sinuses for tenderness
PHARYNX AND MOUTH
The apneustic center in the lower pons stimulates • Instruct patient to open mouth and take deep breath
the inspiratory medullary center to promote deep,
• Inspect structures for color, symmetry and evidence of exudates,
prolonged inspirations. The pneumotaxic center in
ulceration or enlargement
the upper pons is thought to control the pattern of
respirations. TRACHEA
• Place thumb and index finger of one hand on either side of the
trachea above sternal notch

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DIAGNOSTIC TESTS PERFORMING INCENTIVE

PULMONARY FUNCTION TEST
SPIROMETRY
• Assess respiratory function and dysfunction using a INCENTIVE SPIROMETER
• Records lung volume, ventilatory function, breathing mechanics and gas The inspired air helps inflate the lungs. The ball or weight in the
spirometer rises in response to the intensity of the intake of air. The
exchange
higher the ball rises, the deeper the breath.

ARTERIAL BLOOD GAS

• Arterial puncture at the radial, brachial or femoral artery

• Measures Arterial Oxygen Saturation ( PaO2 ) degree of blood oxygenation and
Arterial CO2 Pressure (Pa CO2) indicates alveolar ventilation
• Measures the body’s ability to maintain normal ph

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DIAGNOSTIC TESTS PERFORMING INCENTIVE

PULSE OXIMETRY SPIROMETRY
CHEST XRAY The nurse instructs the patient to:
COMPUTED TOMOGRAPHY (CT SCAN ) 1. Assume a semi-Fowler position or an upright position before
initiating therapy.
• Imaging method for lung scan to distinguish fine tissue density 2. Use diaphragmatic breathing.
• Define pulmonary nodules and small tumors adjacent to pleural surfaces not 3. Place the mouthpiece of the spirometer firmly in the mouth,
visible to routine xray breathe air in (inspire) slowly through the mouth, and hold the
breath at the end of inspiration for about 3 seconds to maintain the
MAGNETIC RESONANCE IMAGING ball/indicator between the lines. Exhale slowly through the
• More detailed diagnostic image than CT Scan mouthpiece.
4. Cough during and after each session. Splint the incision when
FLOUROSCOPIC STUDIES coughing postoperatively.
5. Perform the procedure approximately 10 times in succession,
• Used to assist in invasive procedures ( chest needle biopsy or transbronchial biopsy )
repeating the 10 breaths with the spirometer each hour during
waking hours.

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INCENTIVE
SPIROMETER
• Incentive spirometry is a method of deep
breathing that provides visual feedback to
encourage the patient to inhale slowly and
deeply to maximize lung inflation and
prevent or reduce atelectasis.

• Incentive spirometer is a medical device

that helps remove the mucus and other
fluids from your lungs as you recover from
a procedure.

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