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RESPIRATORY SYSTEM CARDIOVASCULAR SYSTEM

Exchange of gases Transport of gases

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 Regulation of Respiration

1. Neural Regulation

a. Respiratory Centers
• Medulla Oblongata
• Pons of the brainstem

b. Stretch Receptors and

Hering-Breuer Reflex

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 2. Chemical Regulation

a. Changes in the pH, PCO2 and PO2

b. Chemoreceptors
• Central (medulla)
• Peripheral (carotid & aortic bodies)

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 3. Others

a. Changes in blood pressure

& body temperature
b. Drugs

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 “Good assessment skills play a vital role in
providing nursing care for patients with
oxygenation problems.”

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 General Nursing
Assessment

1. Health History
2. Physical Assessment
3. Laboratory/Diagnostic
Examinations
4. Medications

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 Health History
Reasons for seeking health care
1. Dyspnea
2. Cough
3. Sputum Production
4. Chest Pain
5. Wheezing
6. Hemoptysis
7. Cyanosis
8. Clubbing of fingers
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 Health History
Risk Factors
• Smoking
• Personal / Family History
• Occupational exposure
• Allergens &
environmental pollutants
• Activities
• Age-related changes

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 Dyspnea

Decreased lung Increased airway

compliance resistance

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 Types of Dyspnea

1. Exertional Dyspnea
2. Sudden dyspnea
3. Orthopnea
4. Dyspnea associated with
wheezes
5. Paroxysmal Nocturnal Dyspnea

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 Types of Dyspnea

Exertional Dyspnea
• Most common
• Occurs with physical exertion & relieved by rest
• Occurs when the body uses more oxygen and
makes more carbon dioxide - during exercise or
physical activity

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 Types of Dyspnea

Sudden Dyspnea
• Pneumothorax, airway obstruction,
ARF, ARDS, or pulmonary
embolism

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 Types of Dyspnea

Orthopnea
• SOB when in reclining/ lying
position
• Relieved by sitting up
• Heart disease or COPD

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 Types of Dyspnea

Dyspnea with
wheezes
• Asthma or COPD
• Due to bronchoconstriction

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 Types of Dyspnea

Dyspnea with
wheezes
• Asthma or COPD
• Due to bronchoconstriction

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 Visible
sternocleidomastoid
contractions
Anxious
Hyperexpansion appearance
of the chest
(Increased AP Circumoral
DYSPNEA diameter) cyanosis

Suprasternal
• Difficult or labored retractions
breathing
Intercostal
• Shortness of retractions
breath (SOB)
Substernal
retractions

Sitting posture with body

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slightly bent forward
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What to assess….
Sudden or gradual
Acute or chronic
Progressive, recurrent Relieved by any
or paroxysmal interventions

Associated with Worse when upset

cough, fever,
chills or night sweats Any changes in
body weight

At rest or with exertion

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 Cough Dry, irritative cough –
VIRAL respiratory tract
infection
Morning cough with sputum
production - Bronchitis

Severe or changing cough –

Bronchogenic carcinoma Cough that worsens
when in supine position -
Cough at night – Sinusitis
LSHF or Asthma
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 Cough
Productive? – color, consistency,
odor & amount

Dry, hacking
or wheezy
Particular time/event

Recent or gradual

Smoking history/
past medical illness
Strong or weak
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 Sputum Production
Increased production
- profuse or small in amount

Purulent, rusty, bloody, frothy or mucoid

Thick (tenacious) or thin

Offensive odor/
foul-smelling
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 Sputum Production
Profuse Purulent Thick (yellowish,
greenish or rusty-colored) –
Bacterial infection
Pink-tinged mucoid – Lung tumor
Thin, mucoid – Viral bronchitis
Profuse, frothy, pink – pulmonary
edema
Foul- smelling – lung abscess or
bronchiectasis
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 Chest Pain
Intermittent or persistent

Localized or radiating Sharp, dull,

stabbing or aching
intensity
Relieved by any interventions

Smoking history &

environmental
exposure

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Effects on respiration Past medical history
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 • High-pitched, musical sound

Wheezing •
heard mainly on expiration
Common in patient with
bronchoconstriction or airway
narrowing

Loud or soft

Expiratory or
inspiratory

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 Clubbing of the Fingers

Clubbing develops in five steps:

-Fluctuation and softening of the nail bed (increased
ballotability)
-Loss of the normal <165° angle (Lovibond angle) between the
nailbed and the fold (cuticula)
-Increased convexity of the nail fold
-Thickening of the whole distal (end part of the) finger
(resembling a drumstick)
-Shiny aspect and striation of the nail and skin
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Hemoptysis
Bright red or frothy

Associated with certain

URT, GIT or LRT
circumstances or activities

amount History of chest trauma

Salty taste, burning or Sudden, intermittent

bubbling sensation or continuous
before bleeding
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 • Due to inadequate amount of
oxygen in the blood
• Appears when Hgb level = 5 g/dl

Central or
Peripheral

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 Palpation

• Painful areas or masses

• Chest & Diaphragmatic
Excursion
• Tactile fremitus

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 Palpation

• Symmetrical chest excursion

• AbN: decreased in chronic
fibrotic disease; asymmetrical in
pleurisy, chest trauma, bronchial
obstruction
• Fremitus: normally louder near
the large bronchi
• AbN: absent (emphysema);
increased (pneumonia)

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 Percussion

• Percussion Sounds/Notes
1. Resonance
2. Dullness
3. Flatness
4. Hyperresonance

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 Percussion

• Resonance in normal lungs &

simple chronic bronchitis
• Flatness: Pleural effusion
• Dullness: Lobar pneumonia
• Tympany: Pneumothorax
• Hyperresonance: Emphysema

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 Auscultation

• Normal Breath Sounds:

1. Vesicular ( entire lung field) –
low pitched
2. Bronchial (over the trachea ) –
high pitched
3. Bronchovesicular ( over the
main bronchus) – medium
pitched
• AbN: diminished or absent in
atelectasis, & pleural effusion
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 Auscultation

• Adventitious Breath Sounds

• Crackles (Rales) – Inflammation or
Congestion as in Pneumonia, Bronchitis,
CHF, Bronchiectasis & Pulmonary Fibrosis
• Wheezes – bronchoconstriction due to
increased secretions or edema as in
Asthma, CB, Bronchiectasis
• Friction Rubs –pleurisy or pleuritis adventitious

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Nursing Diagnoses

Ineffective airway clearance r/t

• bronchoconstriction
• increased mucus production
• ineffective cough
• Possible bronchopulmonary
infection
Ineffective breathing pattern r/t
• SOB
• mucus production,
• bronchoconstriction
• airway irritants
• chronic airflow limitation
Impaired gas
exchange r/t
• chronic pulmonary
obstruction
• ventilation-perfusion
inequality due to
destruction of alveolar
capillary membrane
Activity Intolerance r/t
compromised pulmonary
function, resulting in SOB
& fatigue
Nursing Interventions
Promoting smoking
cessation
1. Explain the risk of smoking
2. Provide a strong warning and establish a
definite “quit date”
3. Refer to smoking cessation program
4. Continue reinforcement and analyze
relapses.

“EMPHASIZE SUCCESSES rather than

failures!”
 Improving airway clearance

1. Eliminate or minimize exposure to all

pulmonary irritants
2. Increase fluid intake within cardiac
reserve
3. Diaphragmatic breathing & coughing
techniques
4. Perform CPT: postural drainage, chest
clapping/percussion or vibration & suctioning
as indicated
5. Assist in administering nebulizer and
bronchodilators
 Improving breathing pattern

1. Diaphragmatic breathing &

Pursed-lip breathing exercises
2. Encourage alternating activity
with rest periods
3. Assume position of comfort
4. Relaxation techniques
 Improving gas exchange

1. Diaphragmatic breathing & coughing

techniques
2. Administer bronchodilators as
prescribed
3. Administer low –flow oxygen ( 1-2 lpm
or based on ABG results)
 Increasing Activity Tolerance

1. Graded physical exercises:

walking, stationary bicycling,
swimming
2. Regular exercise program
3. Energy conservation techniques
Energy-Conservation Techniques

1. Control Your Breathing

2. Eliminate Unnecessary Activities
3. Get Assistance
4. Organize Your Time
5. Organize Your Methods
6. Organize Your Space
7. Pace Yourself
8. Maintain a Good Posture
9. Avoid lifting
10. Choose a work height
11. Relax
12. Use Proper Equipment
 Reference

 Berman, A. & Snyder, S. (2016).Kozier and Erb’s
Fundamentals of Nursing Concepts, Process and Practice
(10th ed.). New Jersey. Pearson Education, Inc.
 Hinkle, J. , et al (2018), Brunner and Suddarth’s ,
Textbook of Medical – Surgical Nursing (1 4th
Edition ), Wolters Kluwer
 Weber, J. & Kelly, J. (2018). Health Assessment in
Nursing (6th ed.). Wolters Kluwer