FAITH Prayer

We praise and thank you dear God for the blessings You have
showered upon us. Empower us that we may have the intelligence to
be competent and perform in the best way we can; the will for total
commitment to truth, justice, freedom, peace and unity among people
and the environment; and the heart to be compassionate and sensitive
to the needs of others, especially the poor.
This we ask in the name of Mary, our Mother And Jesus our Lord, Amen.
Mater Fidelium, Mater Fidelis, Ora Pro Nobis!
 NCM1128
Care of Clients with Problems in Oxygenation, Fluid and
Electrolytes, Infectious, inflammatory and Immunologic
Response, Cellular Aberrations, Acute and Chronic
ASSESSMENT OF THE
RESPIRATORY
FUNCTION
 Nose/Nasal Cavity
Mouth/Oral Cavity
Pharynx

Larynx

Trachea
Lung

Left Bronchus
Right Bronchus

Bronchioles

Diaphragm Alveoli
Learning Objectives:
1. Describe the structures and functions of the upper and lower
respiratory tracts.
2. Differentiate ventilation, diffusion, perfusion, and ventilation–
perfusion imbalances.
3. Explain proper techniques utilized to perform a comprehensive
respiratory assessment.
4. Discriminate between normal and abnormal assessment
findings identified by inspection, palpation, percussion, and
auscultation of the respiratory system.
5. Recognize and evaluate the major symptoms of respiratory
dysfunction by applying concepts from the patient’s health
history and physical assessment findings.
6. Identify the diagnostic tests used to evaluate respiratory
function and related nursing implications.
 ◦ Deliver oxygen to and expel
carbon dioxide from the
body, works in conjunction
Purpose of the with the circulatory system
Respiratory ◦ Upper respiratory system
System warms and filters air
◦ Lower respiratory system
accomplishes gas exchange
 UPPER
RESPIRATORY
SYSTEM
 Sinuses and
Nose nasal
passages
Structures of
Pharynx
Tonsils and the Upper
adenoids Respiratory
Tract
Larynx: epiglottis,
glottis, vocal cords, Trachea
and cartilages
Question #1
Is the following statement true
or false?
The purpose of the cilia is to
move the mucus back to the
larynx
Answer to Question #1

True
The purpose of the
cilia is to move the
mucus back to the
larynx
PARANASAL
SINUSES
 Two lungs: five lobes
• Left: upper and lower
• Right: upper, middle, and lower

Pleura
Lower Respiratory
System Structures Mediastinum

Bronchi and bronchioles

Alveoli
 THE LOBES
OF THE
LUNGS AND
BRONCHIOLE
TREE
 Oxygen is supplied to, and carbon
dioxide is removed from, cells
by way of the circulating blood.

Oxygen diffuses from the capillary

Oxygen Transport through the capillary wall to the
interstitial fluid

Oxygen is transported to the cells of

the body by combining with
hemoglobin (plasma protein in
RBC, Hgb), this combining is called
oxyhemoglobin, HgbO2
Diffuse from tissue cells to
blood and is transported to the
lungs for excretion.

Carbon dioxide crosses the alveolar–

capillary membrane into venous
blood by diffusion, perfusion carries
Carbon Dioxide
deoxygenated blood back to the Transport
lungs

Carbon dioxide diffuses more

easily than oxygen across the
alveolar–capillary membrane
 Process of gas exchange
between the atmospheric Oxygen concentration in
air and the blood and capillaries of the lungs is
between the blood and lower than in the alveoli
cells of the body

Respiration
Movement of air in and out
Due to this concentration of the airways continually
gradient: oxygen diffuses replenishes the oxygen and
from the alveoli to the removes the carbon
blood dioxide from the airways
and lungs
 The in and out of air
into the lungs.
Ventilation:
Breathing
(Air Exchange) During inspiration, air flows from the
environment into the trachea,
bronchi, bronchioles, and alveoli.
During expiration, alveolar
gas travels the same route in reverse.
 Inspiration: contraction of the diaphragm
(movement of chamber floor downward) and
contraction of external intercostal muscles
increases space in thoracic chamber, lowering
intrathoracic pressure (negative pressure); air
enters the airways and inflates the lungs

Ventilation: Expiration: relaxation of the diaphragm

(movement of chamber floor upward) relaxation
of external intercostal muscles, increasing
Breathing intrathoracic pressure (positive pressure), air
exits the airways, deflation and elastic recoil of

(Air Exchange) the lungs

◦ 1 respiration = inspiration, 1/3 of the

respiratory cycle; and expiration, 2/3 of the
respiratory cycle
 Process by which oxygen and carbon
dioxide are exchanged at the air–blood
interface

Diffusion
The alveolar–capillary membrane is
ideal for diffusion because of its
large surface area
and thin membrane.
 The actual blood flow through the
pulmonary circulation and
influence by the alveolar
pressure.

Perfusion
The filling of the pulmonary
capillaries with blood
 Adequate gas exchange
depends upon balanced V/Q
Ventilation– ratio
Perfusion Imbalanced V/Q ratio causes
(V/Q Ratio) shunting of blood and results in
hypoxia
Supplemental oxygen may
eliminate hypoxia
 What is gas exchange
between the lungs and
blood and between the
blood and tissues?
Question #2
• Diffusion
• Perfusion
• Respiration
• Ventilation
Answer to
Answer to Question #2
Question #2
C. Respiration
C. Respiration
Respiration
Respiration isexchange
is gas gas exchange
between between
the the lungs and
lungs and blood and blood and tissues
blood and blood and tissues

Diffusion is exchange of oxygen and

carbon dioxideisatexchange
Diffusion the alveolar–capillary
of oxygen
and carbon
membrane
dioxide at the alveolar–capillary membrane
Perfusion is arterial/venous circulation
filling pulmonary
Perfusion capillaries with blood
is arterial/venous circulation filling
pulmonary
Ventilation capillaries
is flow with
of air in and out blood
of the
lungs
Ventilation is flow of air in and out of the lungs
 Normal breath sounds:

• Vesicular
• Bronchovesicular
• Bronchial
Assessment
Abnormal (adventitious)
breath sounds
:
• Crackles
• Wheezes
• Friction rub
 Is the following statement
true or false?
Question #3
Wheezes are considered an
adventitious breath sound
Answer to
QuestionQuestion
#2 #3
C. Respiration
True
Respiration is gas exchange between the
lungs and blood and blood and tissues

Diffusion is exchange of oxygen and

carbon dioxide at the alveolar–capillary
membrane
Wheezes are considered
Perfusion is arterial/venous circulation

an adventitious breath
filling pulmonary capillaries with blood
Ventilation is flow of air in and out of the
lungs
sound
 Tidal volume Inspiratory
(TV) reserve(IRV)

Vital capacity
Expiratory
Lung Capacity reserve(ERV)
(VC) VC = TV
+ IRV + ERV

Forced
expiratory
volume
(FEV)
 Evaluates the inspiratory effort in one
breath

Monometer: device to measure inspiratory

effort can be attached to a mask or endotracheal
tube
Inspiratory Force
Normal inspiratory pressure is approximately
100 cm H2O

Force of less than 25 cm usually requires

mechanical ventilation
 Measurement of arterial
oxygenation and carbon
dioxide levels
Used to assess the
adequacy of alveolar
Arterial Blood ventilation and the ability of
Gases the lungs to provide oxygen
and remove carbon dioxide
Also assesses acid–base
balance
 A noninvasive method to monitor
the oxygen saturation of the blood

Pulse Oximetry
Does not replace ABGs

Normal level is 95% to 100%

May be unreliable
 Health History

Patient’s presenting problem and associated

Focus on
symptoms
Patient’s health, medical conditions, injuries,
Explore hospitalizations, surgeries, allergies, and
current medications
Risk factors and genetic factors that may
Assess
contribute to the patient’s lung condition
 ◦ General appearance may
give clues to respiratory
status
◦ Clubbing of the fingers
Physical ◦ Skin color
Assessment ◦ Routine examination of the
upper airway
◦ Assessment of the lower
respiratory structures
 Pulmonary function tests

Arterial blood gases

Sputum tests
Diagnostic Tests
Chest x-ray

Computed tomography (CT)

Magnetic resonance imaging
(MRI)
Fluoroscopic studies and angiography

Radioisotope procedures—lung scans

Endoscopic bronchoscopy
Diagnostic
Endoscopic thoracoscopy Tests
Thoracentesis

Biopsies
Nursing Interventions
 Before the Procedure
1.Informed Consent
2.NPO 6 hours before the procedure
3.Remove dentures and jewelries, no make up and nail polish

 After Procedure
1.NPO until gag or cough reflex returns
2.May have liquids first until fully awake.
3.Watch out for fever, DOB, shortness of breath and bleeding
on the site.