Respiratory System

• Assessment & Disorders

• Dr. Mohamed Idriss

26/10/2009 1
Upper Respiratory System
 Noses and Sinuses

• Nose
• Begin respiratory system
• Filter and warm air
• Sinuses
• Openings in facial bones
• Lighten skull
• Assist in speech
• Produce mucus
 Pharynx and Larynx
• Pharynx
• Nasopharynx
• Oropharynx
• Laryngopharynx
• Larynx
• Connects laryngopharynx to trachea
• Routes air and food to proper passageway
Pharynx and Larynx

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Lower Respiratory system
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 Lungs

• Separated by mediastinum
• Composed of elastic connective tissue
• Divided into lobes which are further divided into segments
 Bronchi and Alveoli

• Trachea divides into right and left mainstem

bronchi
• Bronchi continue to branch and get smaller
(bronchioles) and end as alveoli
• Air moves through passageways to alveoli where
gas exchange occurs
Bronchioles and Alveoli
 Pulmonary Circulation

• Pulmonary arteries
• Pulmonary veins
• Pulmonary capillary network
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 Pleura

• Double-layered membrane that covers lungs

• Parietal
• Visceral
• Hold lungs out to chest wall
 Rib Cage and Intercostal
Muscles
• Protect lungs
• 12 pairs ribs
• Intercostal muscles are between ribs
• Assist with process of breathing
 Ventilation

• Divided into inspiration and expiration

• Normal is 12–20 breaths per minute
 Factors Affecting Respiration

• Respiratory center of the brain

• Chemoreceptors in the brain, aortic arch, and
carotid arteries
• Airway resistance
• Compliance
• Elasticity
• Surface tension of alveoli
 Respiratory Changes Associated
with Aging
• Cartilage that connects ribs to sternum and spinal
cord calcifies
• Anterior-posterior diameter of chest increases
• Respiratory muscles weaker
• Cough and laryngeal reflexes less effective
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 Respiratory Changes Associated
with Aging
• Size of lungs decreases
• Alveoli less elastic
• Older client at greater risk for developing
respiratory infections
 Assessment
• Subjective
• Current complaint or existing condition
• Onset or duration of symptoms
• Ability to maintain ADL
• Nasal congestion, nosebleeds
• Sore throat, difficulty swallowing
• Changes in voice quality
• Difficulty breathing, orthopnea
• Pain on breathing
 Assessment (continued)

• Subjective
• Presence of cough frequency, duration, productive or
unproductive
• Sputum amount, color, and consistency
• Exposure to infections (colds or influenza)
• History of chronic lung conditions
• Occupational exposure to chemicals, smoke, asbestos
 Assessment (continued)

• Subjective
• History of previous respiratory problems
• Allergies to medication or environmental allergens
• Use of tobacco, chewing tobacco, marijuana, cocaine, injected drugs,
and alcohol
 Assessment (continued)

• Objective
• Assess state of health
• Color
• Ease of breathing
• Note respiratory rate and pattern
• Observe nasal flaring
• Use of accessory muscles for breathing
• Listen for hoarseness in client’s speech
 Assessment (continued)

• Objective
• Inspect mucosa of nose, mouth, and oropharynx
• Inspect neck, position of trachea
• Inspect anterior/posterior diameter of chest
• Palpate lips for nodules, chest for tenderness or swelling
 Assessment (continued)

• Objective
• Auscultate breath sounds, note absence or presence and
quality
• Note adventitious breath sounds (wheezing or crackles)
 Pulse Oximetry

• Monitors oxygen saturation (SpO2)

• Amount of arterial hemoglobin that is combined with oxygen
• Nursing Care
• Apply to fingertip, forehead, earlobe, or nose
• Remove nail polish when using fingertip
 Arterial Blood Gases

• Nursing care
• Apply pressure to site 2–5 minutes following arterial
puncture
 Arterial blood gases
measurement(ABGs)
To assess baseline oxygenation and gas exchange. In advanced cases there is
evidenced of hypoxemia and hypercapnea
 Sputum and Tissue

• Throat or nose swab

• Sputum specimen
• Culture and sensitivity
• Gram’s stain
• Acid-fast stain
• Cytology
 Imaging Techniques

• X-rays
• CT scans
• Ventilation perfusion scans
• Nursing care and client teaching
• If contrast used remember to ask about allergies, especially
iodine and seafood
 computed tomography (CT)

• May help in the differential diagnosis.

Echocardiography To assess pulmonary artery pressure
 Spirometry
is used to evaluate airflow obstruction which is determined by the ratio of FEV to
FVC.
• Volume Measuring Spirometer • Flow Measuring Spirometer
CON…INVEST
❖ X-ray chest to exclude alternative diagnoses.
❖show signs of hyperinflation.
❖Bullae may be present.
 Pulmonary Function Tests

• Measure lung volume and capacity

• Smoking, caffeine, and bronchodilators interfere
with results
• Nursing care and client teaching
• Instruct client to stop bronchodilators 4–6 hours prior to
test
• Instruct client not to smoke or drink caffeinated drinks
prior to test
Pulmonary Function Tests

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Lung Volumes and Capacities
 Direct Visualization

• Direct or indirect laryngoscopy

• Used to identify and evaluate laryngeal tumors
• Nursing care and client teaching
• Make sure consent form has been signed
• Remove dentures, partial plates, bridges prior to procedure
• NPO before procedure
• NPO after procedure until gag reflex returns
 Bronchoscopy

• Visualize trachea, bronchi and bronchioles

• Tumors and structural disorders
• Obtain tissue biopsy
• Obtain sputum specimen
• Removal of foreign body
• Nursing care and teaching