Oxygenation  Pharynx

Structure and Processes of the Respiratory  Shared pathway for air

System and food

 The function of the respiratory system is  Nasopharynx

gas exchange.  Oropharynx
 Oxygen is required for cell functioning.  Larynx
 Movement of oxygen and CO2 involves  Externally identified as
integration of several body systems. Adam's apple
 Oxygen from inspired air diffuses from  Epiglottis is inlet.
alveoli in lungs into blood in pulmonary
capillaries.
Structure of the Respiratory System
 Carbon dioxide produced during cell
metabolism builds up in tissues and
diffuses from blood into the alveoli to
be exhaled.

Structure of the Respiratory System

 Lower respiratory tract

 Trachea
 Bronchi
 Bronchioles
 Alveoli
 Upper respiratory tract  Respiratory membrane

 Mouth  Pulmonary capillary network

 Nose  Pleural membranes

 Air enters
 Warmed and filtered
 Pulmonary Ventilation
Inspiration (inhalation)
 Air flows into lungs.
Expiration (exhalation)
 Air flows out of lungs.
 Ventilation depends on:
 Clear airways (cilia)
 Intact CNS and respiratory center
 Ability of thorax to expand and contract
 Lung compliance and lung recoil
 Compliance
 Expansibility or stretchability of
lung tissue
 Recoil
 Continual tendency of lungs to
collapse away from the chest
wall
 Factors
o Intrapleural pressure
o Intrapulmonary pressure
o Tidal volume
o Atelectasis
o Surfactant
 Inspiration (inhalation)
o Diaphragm and intercostals
contract.
o Thoracic cavity size increases.
o Volume of lungs increases.
o Intrapulmonary pressure
decreases.
o Air rushes into lungs to equalize
pressure.
 Expiration (exhalation)
o Diaphragm and intercostals
relax.
o Volume of the lungs decreases.
o Intrapulmonary pressure rises.
o Air is expelled.
Alveolar Gas Exchange
 Occurs after alveoli are ventilated.
 Pressure differences on each side
of respiratory membranes affect
diffusion.
 Partial pressure
o Pressure exerted by each
individual gas in a mixture
according to its concentration
in the mixture
o Diffusion of oxygen from
alveoli into pulmonary blood
vessels on inspiration
o Diffusion of carbon dioxide
from pulmonary blood vessels
into alveoli for expiration
Transport of Oxygen and Carbon Dioxide Respiratory Regulation

 Oxygen  Includes both neural and chemical

o Transported from lungs to controls to maintain correct
tissues concentrations
o 97% of oxygen combines with  Nervous system adjusts rate to
hemoglobin in red blood cells maintain constant PO2(partial pressure
and is carried to tissues as of oxygen) and (partial pressure of
oxyhemoglobin. carbon dioxide) PCO2.
o Remaining oxygen is dissolved
 Respiratory center in medulla
and transported in plasma as
oblongata and pons of the brain
arterial oxygen pressure (PaO2).
o Chemosensitive receptors in
Rate of transport affected by: medulla oblongata respond to
changes in blood and hydrogen
o Cardiac output
o Number of erythrocytes (RBCs) ion concentration.
and blood hematocrit o Increased CO2 most strongly
o Normal hematocrit 40–54% in affects stimulation of
men, 37–50% in women respiration.
o Exercise o Neural receptors to O2 in
carotid bodies stimulate
 Carbon dioxide respiratory center.
o Must be transported from o In clients with emphysema, O2
tissues to lungs concentration affects
o Continually produced in respiration more strongly
process of cell metabolism (hypoxic drive) because of
o 65% is carried inside RBCs as constant buildup of CO2 in
bicarbonate. blood.
o 30% combines with
hemoglobin as Factors Affecting Respiratory Function
carbahemoglobin.
o 5% transported in solution in  Age
plasma and as carbonic acid.  Environment

Systemic Diffusion  Lifestyle

 Health status
 Diffusion down to capillary-tissue-cell
level is comparable to capillary-  Medications
alveolar level in the lungs.
 Stress
 Pressure gradients determine direction
of diffusion.
 Reduced blood flow (as in shock)
decreases capillary blood flow and
interferes with tissue oxygen delivery.

Age:
o Changes especially important if system
compromised by infection, physical or
emotional stress, surgery, anesthesia,
or other procedures.
o Chest wall, airways more rigid and less
elastic
o Drier mucous membranes
o Increased risk of aspiration from GERD
(Gastroesophageal reflux disease)
Environment:
o Altitude
o Transport of oxygen and carbon
dioxide via blood to and from tissue
cells
Partially obstructed airway indicated by
low-pitched snoring during inhalation
 Upper airway
-Gurgly or bubbly sound passing
obstruction.
 Lower airway harder to observe
- Stridor
- Harsh, high-pitched sound in
inspiration
- Adventitious (abnormal) breath sounds

o Pollution Completely obstructed airway

Lifestyle:  Extreme inspiratory effort with no chest
movement
o Physical activity
o Occupation

Health Status: Conditions Affecting Movement of

o Diseases of the respiratory system
Air
Breathing patterns
Medications:
 Eupnea (normal)
o Benzodiazepine sedative-hypnotics  Tachypnea (rapid)
o Antianxiety drugs  Bradypnea (slow)
 Apnea (absent)
Stress:  Hypoventilation
o Hyperventilation o Hypercarbia, hypercapnia
o Epinephrine o Increased levels of carbon
dioxide
 Hypoxemia
 Kussmaul breathing
Alterations in Respiratory Function  Cheyne-Stokes respirations
Conditions affect: o Rhythmic waxing, waning
of respirations from very
o Patency
deep to very shallow
o Movement of air into, out of lungs
 Biot (cluster) respirations
o Diffusion of oxygen and carbon dioxide
 Orthopnea
between alveoli, pulmonary capillaries
 o Difficulty breathing while
lying down
Dyspnea
 Difficulty breathing
o Shortness of breath (SOB)
o Nostril flaring
o Increased heart rate
 Stems from cardiac or respiratory
problem
Conditions Affecting Movement of
Air
Conditions Affecting Diffusion
 Hypoxemia
o Reduced oxygen level in blood
o May be caused conditions that
impair alveolar-capillary
diffusion (e.g., pulmonary
edema)
 Compensation by increased heart rate
and cardiac output
Hypoxia
 Condition of insufficient oxygen in
body tissue
o Results from unresolved
hypoxemia
o Signs and symptoms
 Rapid pulse
 Rapid, shallow
respirations and
dyspnea
 Increased restlessness
or lightheadedness
o Signs and symptoms
 Flaring of nares
 Substernal or
intercostal retractions
 Cyanosis
o Bluish discoloration of skin,
nail beds, mucous membranes
due to reduced hemoglobin-
oxygen saturation
o Anemia or epinephrine
diminish signs.
 Conditions Affecting Transport
Conditions Affecting Diffusion

Assessing
 Nursing history
 Current and past respiratory
problems
 Lifestyle, risk factors for
impaired oxygen status
 Presence of cough and
sputum or pain
 Medications for breathing
 Physical examination
 Nurse observes rate, depth,
rhythm, and quality of
respirations
 Conditions that decrease cardiac output  Inspects variations of shape
o Hypovolemia of thorax
 Diagnostic studies
 Sputum specimens
 Throat cultures
 Visualization procedures
 Venous and arterial blood
specimens
  Pulmonary function tests
 Require active client
participation
Diagnosing
 Difficulty maintaining a clear airway
(Ineffective Airway Clearance)
 Altered breathing pattern
(Ineffective Breathing Pattern)
 Altered gas exchange
(Impaired Gas Exchange)
 Inadequate physical energy for
activities
 Prevent risks associated with
oxygenation problems such as skin
and tissue breakdown, syncope,
acid–base balances, and feelings of
hopelessness and social isolation.
Planning for home care
 Client
o Self-care abilities
o Exercise/activity pattern
o Assistive devices required
o Environmental risk factors
o Home and community

(Activity Intolerance) o Current level of knowledge of client

condition and community resources
 Etiology of other nursing diagnoses
 Fatigue related to altered
breathing pattern
 Insomnia related to
orthopnea and required
oxygen therapy
 Social seclusion related to
inadequate physical energy
for activities and inability to
travel to usual social
activities
Planning
 Maintain a patent airway
 Improve comfort and ease of
breathing
 Maintain or improve pulmonary
ventilation and oxygenation
 Improve ability to participate in
physical activities