OXYGENATION (RESPIRATORY SYSTEM)

GAS EXCHANGE RESPIRATORY SYSTEM

The Lungs

PHYSIOLOGY OF THE RESPIRATORY SYSTEM

The function of respiratory system is gas exchange O2 from the inspired air diffuses from alveoli in the lungs into the blood in pulmonary capillaries CO2 produced during cell metabolism diffuses from the blood into the alveoli and is exhaled The organs of the respiratory system facilitate this gas exchange and protect the body from foreign matter such as particulates and pathogens

The Anatomy of the Respiratory System

Structure of the Respiratory System Two divisions of the respiratory system 1. Upper respiratory system - Mouth - Nose - Pharynx - Larynx 2. Lower respiratory system - Trachea - Bronchus - Bronchioles - Alveoli - Capillary network - Lungs

 Air enters the external nares of the nose to the nasal cavity to be: Warmed Humidified Filtered

 The pharynx A shared pathway for air and food 3 divisions: Nasopharynx - epipharynx - nasal cavity Oropharynx - mesopharynx - oral cavity Laryngopharynx - hypopharynx - larynx

 The larynx For voice production (voice box) Cartilaginous structure that can be identified externally as the Adams apple Maintains airway patency Protects the lower airway from swallowed food and fluids

 Parts of the larynx: 3 paired cartilage: Arytenoid Cuniculate Cuneiform 3 unpaired cartilage: Cricoid Thyroid Erytenoid

 Trachea
16-20 cartilages C shaped with deficient posterior portion Starts at the cricoid (C6) to upper border of T5 or lower border of T$ Divides at the level of the carina R bronchus more vertical and wider L bronchus more horizontal and narrower

 Lungs and pleura Parts of the pleura Parietal - lines the thorax and the diaphragm Visceral covers the external surface of the lungs Pleural fluid serous lubricating solution

 The Bronchial tree Primary bronchus Secondary bronchus Tertiary bronchus (bronchioles) Made up of smooth elastic muscles capable of bronchoconstriction and bronchodilatation Terminal bronchiole Respiratory bronchiole Start of respiratory zone Alveolar duct Alveolar vesicles Alveolar sac

 Volume Thoracic cavity Thoracic wall Alveoli

- 2.5 L -5L -1L

 Respiration Process of gaseous exchange between individual and the environment

A. Pulmonary ventilation Inflow and outflow of air between atmosphere and alveoli

 B. Diffusion of gases Airflow and outflow between alveoli and the pulmonary capillaries
C. Transport of O2 and CO2 Via blood to and from cells

 A. Pulmonary Ventilation
Act of breathing Inspiration inhalation upward movement of ribcage Expiration exhalation downward movement of ribcage

PHYSIOLOGY OF THE RESPIRATORY SYSTEM

Factors affecting adequate ventilation A. Clear airways Ciliary action Cough reflex Inflammation Edema Excess mucus production

 The cough reflex

Irritants nerve impulses medulla through the vagus nerve A large inspiration of about 2.5 L occurs

The epiglottis closes The glottis (vocal cords) close tightly to entrap air in the lungs Abdominal muscles contract forcefully pushing air to the diaphragm Simultaneously thoracic expiratory muscles contract forcefully

Intrapulmonary pressure increase to 100 mmHg Vocal cords and epiglottis open suddenly Pressure in the lungs explodes outward (75 100 mmHg)
Compression of the lungs collapses bronchi and trachea Mucus or foreign bodies are dislodged from the lower respiratory tract and are propelled up and out

 The sneeze reflex

Irritation of the nasal passages Impulses send to the medulla through the 5th CN Deep inspiration occurs Uvula is depressed Large volume of air passes through the nose and mouth Clearing the nasal passages

 B. An intact nervous system Respiratory centers: medulla and pons Effect of severe head injury and Drugs (opiates, barbiturates)

 C. An intact thoracic cavity capable of expanding and contracting

Intrapleural pressure:
pressure in the pleural cavity is slightly negative than the atmospheric pressure creates the suction that holds the visceral pleura and the parietal pleura as the chest cage expands and contracts the recoil tendency of the lungs is a major factor in creating the negative pressure

 Intrapleural fluid: causes the pleura to adhere together Intrapulmonary pressure the pressure within the lungs always equalizes with the atmospheric pressure

 During inspiration: Diaphragm and intercostal muscles contract Increasing the size of thoracic cavity The volume of lungs increases Decreasing the intrapulmonary pressure Air rushes into the lungs to equalize the pressure with the atmosphere

 During expiration: Diaphragm and intercostal muscles relax The volume of the lungs decreases Increasing the intrapulmonary pressure Air is expelled

 D. Adequate pulmonary compliance and recoil 1. Lung compliance 2. Lung recoil

 1. Lung compliance
The expansibility or stretchability of lung tissue Plays an important role in the ease of ventilation Necessary for normal inspiration At birth, the lungs are filled with fluid, stiff and resistant to expansion

 With each subsequent breath, the alveoli become more compliant and easier to inflate Compliance tends to decrease with aging and making it more difficult to expand the alveoli and increasing risk of atelectasis, or collapse of a portion of the lung

 2. Lung recoil

The tendency of the lungs to collapse away from the chest wall Necessary for normal expiration Elastic fibers in the lung tissue contribute to lung recoil

 Surface tension of the fluid lining the alveoli has the greatest effect on recoil Surfactant, a lipoprotein produced by specialized alveolar cells, reduce the surface tension of the alveolar fluid Without surfactant, lung expansion is exceedingly difficult and the lungs collapse

 Pulmonary Volumes Tidal Volumes (TV): normal volume of air inspired and expired with each breath (at rest) 5 10 ml / kg BW Males: 500 ml Females: 400 ml Residual Volume (RV): the amount of air remaining in lungs after forced exhalation 1,200 ml

 Inspiratory Reserve Volume (IRV): amount of air that can be forcefully inhaled after normal tidal volume inhalation 3,100 ml Expiratory Reserve Volume (ERV): the amount of air that can be forcefully exhaled after normal tidal volume exhalation 1,200 ml

 Pulmonary Capacities
Combination of pulmonary volumes Total Lung Capacity (TLC) Maximum amount of air contained in lungs after maximal inspiratory effort TLC = TV + IRV + ERV + RV 6,000 ml

 Vital Capacity (VC) Maximum amount of air that can be expired after a maximal inspiratory effort VC = TV + IRV + ERV 4,800 ML Should be 80% of the TLC

 Inspiratory Capacity (IC) Maximal amount of air IC = TV + IRV 3,600 ml Functional Residual Capacity (FRC) Volume of air remaining in the lungs after a normal tidal volume expiration FRC = ERV + RV 2,400 ml

 B. ALVEOLAR GAS EXCHANGE BY DIFFUSION Diffusion The movement of gases from an area of greater pressure or concentration to an area of lower pressure or concentration

 Partial pressure of O2 in the alveoli: 100 mm Hg Partial pressure of O2 in the venous blood: (PO2) 60 mm Hg The pressure exerted by each individual gas in a mixture according to each concentration in the mixture The pressure is greater in the alveoli than in the venous blood, thus O2 diffuses into the blood Rapid equalization of the arterial O2 pressure occurs once O2 is in the alveoli

 Partial pressure of CO2 in the venous blood: 45 mm Hg Partial pressure of CO2 in the alveoli: 40 mm Hg CO2 diffuses from the blood into the alveoli and eliminated through expiration

 C. TRANSPORT OF OXYGEN AND CARBON DIOXIDE Oxygen transport: O2 (97%) is transported from the lungs to the tissues by combining loosely with the hemoglobin in the RBC called Oxyhemoglobin The remaining O2 is dissolved and transported in the fluid of the plasma and cells

 O2 and hemoglobin combination Hgb can combine with 4 O2 molecules 100 % saturated = 1 Hgb with 4 O2 75% saturated = 1 Hgb with 3 O2 50% saturated = 1 Hgb with 2 O2

 Factors affecting the rate of O2 transport from the lungs to the tissues: 1. Cardiac output: 5 L/min Any pathologic condition CO - O2 delivered to the tissues e.g. damage to the heart muscles, blood loss, pooling of blood in the peripheral vessels The heart compensates for inadequate output by HR Severe damage or blood loss may not be able to compensate and restore the adequate blood flow and O2 in the tissues

 2. Number of erythrocytes and blood hematocrit Men: 5 million / cu ml of blood Women: 4.5 million / cu ml of blood It is the percentage of RBC in the blood Men: 40 54% Female: 37 48% Excessive hematocrit - blood viscosity, CO, O2 transport Excessive hematocrit, like in anemia - O2 transport

 3. Exercise Well trained athletes, O2 transport 20 times the normal rate, CO and use of O2 in the cell

 Carbon dioxide transport CO2 is continually produced in the processes of cell metabolism Three ways of CO2 transport: 1) As a bicarbonate (HCO3), (65%) inside the RBC A component of the bicarbonate buffer system 2) As a carbhemoglobin or carbaminohemoglobin (30%) 3) As carbonic acid (CO2 + H2O) dissolved in the plasma (5%)

 RESPIRATORY REGULATION Two regulatory mechanisms: 1) Neural control Respiratory center: medulla oblongata and pons 2) Chemical control Blood CO2 concentration and the H ion concentration

 The respiratory center: Groups of neurons located in the medulla oblongata and pons of the brain
Highly responsive to the increase in blood CO2 or H+ ions concentrations Increasing the activity or respiratory center Respiratory rate Depth of respiration

 Chemoreceptors: Special receptors sensitive to the decrease in O2 concentration Carotid bodies: just above the bifurcation of the common carotid arteries Aortic bodies: at the aorta Ventilation

 Three blood gases that can trigger chemoreceptors: 1) Hydrogen 2) Oxygen 3) Carbon dioxide: normally stimulate respiration most strongly

Hypoxic drive Found in chronic lung ailments such as emphysema O2 concentration, and not CO2 , play a major role in regulating respiration Decrease O2 concentrations are the main stimuli for respiration Increasing the concentration of O2 depresses the respiratory rate Thus, low concentrations of supplemental O2 are given

 FACTORS AFFECTING RESPIRATORY FUNCTIONS Age At birth, fluid filled lungs drain, the PCO2 rises and the neonate takes a first breath Gradual lung expansion occur with each breath Full lung inflation by 2 weeks of age Changes of aging Chest wall and airways rigid, elastic Amount of exchanged air Cough reflex and ciliary action Mucus membrane drier , fragile

 Muscle strength and endurance Lung expansion compromised if osteoporosis is present Immune system efficiency Risk of aspiration , GERD
RR Infants: 40 80 / min Children: 25 / min adolescence to adult: 12 18 / min

 Environment Altitude PaO2 RR, depth respiration, HR Temperature: dilatation of peripheral blood vessels Blood flow to the skin Heat loss HR, O2 consumption, RR, depth of respiration

 Lifestyle Physical activity: RR, depth of respiration, O2 supply in the body Occupational diseases: silicosis, asbestosis, anthracosis (coal miners), organic dust disease (farmers)

 Health status Respiratory system can provide sufficient O2 to meet the body needs in healthy persons Medications Narcotics: Demerol , morphine Stress Hyperventilation in response to stress

 ALTERATIONS IN RESPIRATORY FUNCTION

The movement of air into or out of the lungs Diffusion of O2 and CO2 between alveoli and pulmonary capillaries Transport of O2 and CO2 via blood to and from the tissue cells

 Three major alterations in respiration: Hypoxia Altered breathing patterns Obstructed airway
A. Hypoxia Condition of insufficient O2 anywhere in the body Alterations in: Ventilation Diffusion of gases Transport of gases by the blood

 Hypoxia: Hypoventilation Diseases of the respiratory muscles, drugs, anesthesia Inadequate alveolar ventilation Accumulation of CO2 in the blood: hypercarbia or hypercapnia

 Diffusion of O2 from alveoli to arterial blood Pulmonary edema Problems in the delivery of O2 into the tissues Anemia Heart failure Embolism

 Hypoxemia O2 in the blood Partial pressure of O2 in arterial blood Hemoglobin saturation Signs of hypoxia PR shallow respiration and dyspnea restlessness or lightheadedness Flaring of the nares Substernal or intercostal retractions Cyanosis

 B. Altered breathing patterns Breathing patterns: rate, volume, rhythm, relative ease or effort of respiration Eupnea: Normal respiration: quiet, rhythmic, effortless Tachypnea RR: in fever, metabolic acidosis, pain

 Bradypnea Abnormally slow respiratory rate Morphine, metabolic alkalosis, ICP Apnea Cessation of breathing Hyperventilation Alveolar hyperventilation Movement of air into and out of the lungs Rate and depth of respiration CO2 eliminated than produced

 Hyperventilation Kussmauls breathing Type of hyperventilation that accompanies metabolic acidosis or in stress The body tries to compensate to drive off excess CO2 through deep and rapid breathing

 Altered respiratory rhythms create irregular breathing patterns Cheyne-Stokes respiration Marked rhythmic waxing and waning of respirations from very deep to very shallow breathing and temporary apnea waning Causes: CHF, ICP, drug overdose

 Biots respiration Shallow breaths interrupted by apnea In nervous system disorders Orthopnea Inability to breath except in an upright or standing position

 Dyspnea Difficult or uncomfortable breathing In cardiac and respiratory disorders Shortness of breath or a feeling of being unable to get enough air

 C. Obstructed airway Partial or complete obstruction anywhere along the upper or lower respiratory passageway Upper airway obstruction: nose, pharynx or larynx Caused by foreign body like food When the tongue falls back into the oropharynx in unconscious patient

 Secretions collect in the passageway Partial upper airway obstruction: low pitched snoring sound during inhalation Complete upper airway obstruction: extreme inspiratory effort that produces no chest movement

 Lower airway obstruction Bronchi or lungs Not as easy to observe Stridor: harsh, high pitch sound maybe heard during inspiration Alteration of blood gas levels Restlessness, dyspnea, abnormal breath sounds (adventitious sounds) Nursing responsibility: maintaining an open airway

 NURSING MANAGEMENT ASSESSMENT Nursing history Comprehensive history relevant to oxygenation status Current and past respiratory problems Lifestyle Presence of cough Medications for breathing

 Physical examination Inspection: Nose: (-) flaring, (-) discharge, nares patent, mucosa pink and moist, septum at midline without masses or perforation Thorax: even color of skin, even contour, respiration quiet, unlabored, of even depth, without retractions (rate, rhythm, and quality of respirations)

 Palpation: Trachea at midline and mobile Chest wall symmetrical, smooth without lumps, masses, tenderness, and crepitus, symmetrical excursion, tactile fremitus present Tactile fremitus: - the intense vibration felt on the thorax on palpation while the patient says 99

 Percussion: Resonant lung fields Auscultation Vesicular sound: - throughout lung fields - low pitched, swishing sound, best heard during inspiration

 Bronchovesicular: over the area of tracheal bifurcation, both anterior and posteriorly - tubular, breezy sounding quality during inspiration and expiration

 Bronchial sound: - over the trachea anteriorly - heard over the manubrium, best heard during expiration which loud, high pitch and a hollow or harsh quality

 Diagnostic examination Sputum examination For culture and sensitivity Cytology AFB Gram staining Blood : for CBC and ABG

 ABG pH = 7.35 7.45 PaCO2 = 35 45 mm Hg HCO3 = 22 26 mEq / L PaO2 = 80 100 mEq / L O2 saturation = 95 98% Throat culture

 Pulse oximeter Non-invasive device that measures arterial blood saturation Attached to the finger, toe, nose, earlobe, forehead Can detect hypoxia before signs and symptoms

 Process of spectrophotometry: measures the amount of light absorbed - Oxygenated blood absorbs more infrared light - Deoxygenated blood absorbs more red light Normal: 95 100% Below 70% : life threatening

 Pulmonary function test Measures lung volume and capacity Bronchoscopy Laryngoscopy Thoracentesis Chest x-ray

 Visualization procedures Lung scan - records on photographic plate - emission of radioactive waves from substance injected IV as it circulates throughout the lungs - check the integrity of blood flow: perfusion - check ventilatory abnormality: ventilation

 NURSING DIAGNOSIS Ineffective Airway Clearance Inability to clear the respiratory tract to maintain a clear airway Related to: Tracheobronchial infection and obstruction Excessive thick tracheobronchial secretions Decreased energy, fatigue, trauma, and pain

 Ineffective Breathing Pattern Inspiration and or expiration that does not provide adequate ventilation Related to Anxiety, neuromuscular musculoskeletal impairment Decreased energy

 Activity Intolerance Insufficient physiological or psychological energy to endure or to complete required or desired daily activities Related to Altered O2 supply Altered pulmonary blood flow Altered O2 carrying capacity Changes in alveolar capillary membrane Ventilation perfusion imbalance

 PLANNING Overall goals for a client with oxygenation problems Maintain a patent airway Improve comfort and ease of breathing Maintain and improve pulmonary ventilation and oxygenation Improve ability to participate in physical activity

 IMPLEMENTATION
To facilitate pulmonary ventilation Ensure patent airway Positioning Deep breathing and coughing exercises Adequate hydration Suctioning

 Lung inflation techniques Analgesic prior to deep breathing Postural drainage, percussion and vibration To facilitate diffusion Deep breathing and coughing Suitable activity

 Promoting abdominal breathing and coughing Assume a comfortable semi-sitting position in bed or in a chair, or lying in bed with one pillow Flex the knees to relax the muscles of the abdomen Place one or both hands on your abdomen, just below the ribs Breath in deeply through the nose, keeping the mouth close

 Concentrate on feeling your abdomen rise as far as possible Purse the lips as if about to whistle Breath out slowly through the pursed lips while counting to seven Concentrate on feeling the abdomen fall or sink Done 5 10 min 4x daily with gradual increase in duration and frequency

 Adequate hydration Normally, respiratory secretions are thin and easily moved by the ciliary action Fluid intake should be increased as the client can tolerate Humidifiers prevent drying of mucus membranes by providing water vapors to inspired air Nebulizers are used to deliver humidity and medications, and with O2 delivery to provide moistened air to the lungs

 Medications Bronchodilators Xanthines, salbutamol Anti-inflammatory Glucocorticoids Expectorants Guaifenesin Cough suppressants Codeine

 Incentive spirometry or Sustained Maximal Inspiration device (SMIs) Improve pulmonary ventilation Counteract the effect of anesthesia or hypoventilation Loosen respiratory secretions Facilitate respiratory gaseous exchange Expand collapse alveoli

 Incentive spirometry Upright sitting position Hold the spirometer in upright position Exhale normally Seal the lips tightly around the mouthpiece Take in a slow deep breath to raise the balls Hold the breath for 2 sec initially, increasing to 6 sec , to keep the balls elevated if possible

 Remove the mouthpiece and exhale normally Cough after the incentive effort Relax and take a several normal breaths before using the spirometer again Repeat the procedure several times and then 4-5 x hourly

 Percussion, Vibration and Postural Drainage (PVD) A dependent nursing intervention Percussion Clapping (chest clapping) Forceful striking of the skin with cupped hands Mechanical dislodgement of the tenacious secretions from the bronchial walls

 Chest Percussion Cover the area with towel to reduce discomfort Ask the client to breath slowly and deeply Alternately flex and extend the wrist rapidly to slap the chest Percuss each affected lung segment for 1-2 min

 Vibration Series of vigorous quivering produced by hands that are placed flat against the clients chest wall Used after percussion to increase turbulence of the exhaled air, loosening the thick secretions Done alternately with percussion

 Place hands , palms down, on the chest area to be drained One hand placed over the other, with fingers together and extended, or maybe placed side by side Ask the client to inhale deeply and exhale slowly through the nose or pursed lips

 During the exhalation, tense all the hands and arm muscles Vibrate the hand (mostly the heel), moving them downward, and stop when client starts to inhale Vibrate during 5 exhalations over one affected lungs After each vibration, encourage to cough and expectorate secretions

 Postural Drainage Drainage by gravity of secretions from various lung segments Bronchodilators are given prior to procedure Sequence of PVD Positioning Percussion Vibration Removal of secretions by coughing and suction

 Each position is assumed for 10-15 min Auscultate lungs after the procedure Oxygen therapy An emergency measure that can be initiated by the nurse To prevent hypoxia in clients with Difficulty ventilating their lungs Impaired gas exchange Heart failure

 Specifications of O2 therapy Concentration: most important factor Method of delivery Liter flow per minute

 O2 by itself will not burn or explode, but will facilitate combustion The greater the concentration of O2, the more rapidly the fire starts and burn O2 is colorless, odorless and, tasteless, thus people are unaware of its presence O2 from the cylinders is dry, thus humidifiers (20-40% humidity) are used to avoid dryness of the respiratory mucous membrane

 Safety precautions No smoking or smoke only in the designated areas away from the client Place cautionary sign No smoking O2 in use on the clients door, at the foot of the bed, and on the O2 tank Instruct client and visitors the hazards of smoking with O2 in use

 Make sure electric devices are in good working conditions so that short circuit sparks are avoided Avoid materials that can generate static electricity like wool and synthetic fibers. Use cotton fabrics, instead

 Avoid the use of volatile flammable materials near clients receiving O2 therapy Ground electric monitoring equipment, suction machine, and portable diagnostic machines Make known the location of fire extinguishers and make sure are trained of its use

 Oxygen Delivery Systems Depends on the clients O2 needs, comfort, developmental considerations The amount of O2 delivered depends on the flow rate

 Nasal Cannula: Most common and inexpensive device Does not interfere with eating and talking Easy to apply Fraction of Inspired O2 (FiO2): 24 45% at 2-6.1 L/min Above 6L : clients swallow the air and the FiO2 will not increase

 Face mask Covers the mouth and the nose Exhalation ports on the sides of the mask allow exhaled CO2 to escape Simple face mask - 40-60% at 5-8 L/min

 Partial rebreather mask - 60-90% at 6-10 L/min - O2 reservoir bag is attached to allow to rebreath the air and the O2 Non rebreather mask - 95-100% at 10-15 L/min: the highestO2 concentration O2 reservoir bag is attached with a one way valve, preventing room air and exhaled air to enter the bag. Only the O2 is inhaled

 Venturi mask - delivers a precise concentration of O2, from 24-40% 50% at 4-10 L/ min Face tent Used when face mask is not tolerated by client

 Transtracheal O2 delivery Plastic cannula surgically inserted to the trachea to deliver O2 directly to the lungs Requires only low flow of O2, 0.52 L/min

 Artificial Airways Airways are inserted to maintain a patent air passage for clients whose airway has become or may become obstructed Four common types: Oropharyngeal Nasopharyngeal Endotracheal Tracheostomy

 Oropharyngeal and nasopharyngeal Used to keep the upper air passages open when they become obstructed by secretions or the tongue Easy to insert and have low risk for complications Airways should be well lubricated with water soluble gel prior to insertion

 Oropharyngeal airways Stimulate the gag reflex and are only used for clients with altered level of consciousness, e.g. under general anesthesia, head injury Procedure: Position: supine or semi-fowlers Put on a clean gloves Hold the lubricated airway by the outer flange, with the distal end pointing upward

 Open the mouth and insert the airway along the top of the tongue When the distal end of the airway reaches the soft palate at the back of the tongue, rotate the airway 180 downward and slip it past the uvula into the oral pharynx

 May turn the client to the side lying position to drain the secretions May suction the secretions as indicated May remove the airway once the client starts to gag or cough Mouth care every 2-4 hours, with suction available at bedside all the time

 Nasopharyngeal airways Tolerated better by alert clients Inserted in the nares terminating at the oropharynx Provide frequent oral and nasal care Reposition the airway alternately every 8 h to prevent necrosis of the mucosa

 Endotracheal tubes Used for clients under general anesthetics or during emergency situation requiring mechanical ventilation Inserted with the guide of the laryngoscope The tube terminates just above the bifurcation of the trachea to the bronchi

 The tube has air-filled cuff to prevent leakage of air The client will be unable to talk because the tube pass through the glottis and epiglottis Tracheostomy Clients who need long term airway support Done with surgical incision of the trachea below the larynx

 Suctioning Done when client has difficulty handling their secretions or in the presence of an airway Sterile technique is recommended to avoid introduction of pathogens into the airway, even though the upper airway is not sterile

 Suction pressure: Wall unit: adult 100 120 mm Hg child 95 110 mm Hg infants 50 95 mm Hg
Portable unit: adult 10 - 15 mm Hg child 5 - 10 mm Hg infants 2 5mm Hg

 Suctioning Apply suction only during withdrawal of the catheter for 510 sec Allow 20-30 seconds intervals between each suction Limit suctioning to 5 min in total

 Complications of suctioning: Hypoxia Trauma to the airway Nosocomial infection Cardiac dysrhythmia

 Techniques to minimize complications Hyperinflation - giving the clients breaths that are 1-1.5 x the tidal volume set on the ventilator - 3-4 breaths are delivered before and after each pass of the suction catheter

 Hyperoxygenation: done with manual resuscitation bag or through the ventilator and is performed by increasing the oxygen flow (usually 100%) before suctioning and between suction attempts

 Chest Tubes and Drainage System

Chest Tubes and Drainage System When the thin, double layer pleural membrane is disrupted by lung disease, trauma or surgery, the negative pressure is lost The lungs will collapse because its no longer drawn outward as the diaphragm and intercostal muscles contract during inhalation

 Pneumothorax Collection of air in the pleural space Chest tubes are inserted upper anterior thorax Hemothorax Collection of blood or fluid in the pleural space Chest tubes are inserted at the lower lateral chest wall Chest tubes are inserted into the pleural cavity to restore the negative pressure and drain collected fluid or blood

 Both cause pressure on the lungs and interfere with lung expansion Chest tubes are attached to a water sealed drainage system should be kept below the level of the clients chest to prevent blood or fluid from being drawn back to the chest cavity A must at bedside: rubber-tipped forceps