Respiratory System and Nursing Interventions

Respiratory System

• Ability to perform necessary nursing practices for the respiratory system is critical
• Applies nursing interventions for the diagnosis and treatment of the respiratory system
• Lungs occupy the thoracic cavity except for the mediastinum, which houses the heart, blood vessels, bronchi, esophagus and other organs

Pleura and Surfactant

• The surface of each lung is covered with visceral pleura
• The thoracic cavity walls are lined by parietal pleura
• Negative pressure exists between the two pleural layers
• Surfactant, a secretion that is secreted by epithelial cells covering the alveoli, prevents lung collapse

Respiratory Functions

• Ventilation involves air moving in and out of the lungs
• Diffusion constitutes the spontaneous movement of gases without energy, between alveoli and blood in capillaries
• Perfusion involves the cardiovascular system pumping blood throughout the lungs
• Regulation of respiration involves the respiratory center in the medulla oblongata and the pons
• Providing oxygen to tissues and removing carbon dioxide are basic functions

Pulse Oximetry

• Diffusion and perfusion are assessed by measuring the level of oxygen in the blood
• Hemoglobin combining with oxygen is expressed as saturation
• Saturation levels are generally between 95% and 100%

Respiratory Mechanisms

• Respiratory mechanisms begins with warming and moistening the air through the mouth or the nasal cavity
• Air passes through the pharynx, larynx, and trachea to the bronchi
• Air passes from the bronchi to the bronchioles in the lungs and reaches the alveoli
• Oxygen and carbon dioxide exchange happens in the alveoli
• Oxygen participates in the circulation, depending on hemoglobin in the erythrocyte, and is given to the cells as needed
• Carbon dioxide separates from erythrocytes and passes through capillary membrane pores to alveoli, while oxygen leaves the alveoli and enters the blood

Factors Affecting Oxygenation

• Factors affecting include health status, age, lifestyle, and environmental conditions

Examples of Health Status

• Blood diseases, such as anemia
• Problems with myocardial muscle contraction
• Increased metabolic rate from exercise, infection, fever, pregnancy, or wound healing
• Musculoskeletal disorders like costa fractures or kyphosis
• Carbon monoxide poisoning reduces oxygen transport capacity
• Chronic diseases

Age and Lifestyle factors

• Oxygen requirements increase in premature infants
• Oxygen requirements decrease in the elderly
• Lifestyle factors include inadequate nutrition, obesity, lack of exercise, drug use, and anxiety

Environmental Factors

• Environmental factors include polluted air
• High altitude places also affect because of low oxygen concentration

Examination of the Chest

• Inspection visually using eyes
• Palpation physically using hands
• Auscultation through the use of a stethoscope

Inspection Techniques

• Position, size, shape and symmetry of the chest all contribute to inspection quality
• Status of skin color, turgor, cutaneous lesions, muscular development, nutritional status, and vascular anomalies are also factors
• Includes assessing respiratory rate and rhythm, frequency, regularity, and duration of breathing naturally

Abnormalities of Respiratory Rate and Rhythm

• Eupnea constitutes normal breathing
• Bradypnea indicates an abnormal slowing of respiration potentially caused by central nervous system disorders or drugs
• Tachypnea consists of an abnormal increase of breathing frequency that presents when in severe pain, anxiety, or is cause by cardiac or pulmonary disease
• Apnea involves the temporary cessation of breathing
• Hyperpnea is the increased depth of breathing indicating metabolic acidosis
• Use of accessory muscles during respiration may be indicative of diseases with dyspnea

Thoracic Deformities

• Pectus excavatum, also called a funnel chest is thought to be caused by an abnormality of connective tissue and results in depression of the sternum
• Pectus carinatum, also called pigeon chest includes a raised sternum
• Barrel chest is not specifically a disease but may indicate underlying conditions

Auscultation and Breath Sounds

• Turbulence in the large airways creating vibrations transmits through the chest wall
• Never acceptable to listen though clothing and the stethoscope must be in contact with skin
• Tracheal sounds are heard over the trachea, described as harsh and sounding as if air is being blown through a pipe.
• Bronchial sounds are heard over the large airways in the anterior chest near the second and third intercostal spaces
• Bronchovesicular sounds are heard in the posterior chest between the scapulae and in the center anterior chest.
• Vesicular, which are soft, blowing, or rustling sounds are normally heard throughout most of the lung fields

Abnormal Breath Sounds

• Rales are clicking, bubbling, or rattling sounds while inhaling
• Rhonchi resembles snoring sounds
• Stridor sounds like wheezing when breathing
• Wheezing constitutes narrow airways producing high-pitched sounds

Pleural Friction

• It is produced by the sound of the leaves rubbing against each other
• Occurs as a result of decreased pleural fluid due to inflammation of the pleura and it’s losses
• Pleural Friction can be heard in cases of pneumonia

Changes in Respiratory Function

• Tachypnea is a rate greater than 24/min
• Bradypnea is a rate less than 10/min
• Hyperventilation is an increased rate and depth of breathing
• Hypoventilation is a decreased rate and depth of breathing that is irregular

Key Respiratory Terms

• Anoxia constitutes absence of oxygen
• Hypoxia is the lack of oxygen for cells and tissues
• Dyspnea is difficult breathing
• Cyanosis occurs when skin and mucous membrane tissues close to the skin have low oxygen saturation

Diagnostic Procedures

• Tests measuring oxygenation and ventilation adequacy can be performed
• Tests for evaluating the structure of the respiratory system can be performed
• Tests for determining respiratory tract infection and abnormal cells can be performed, with throat culture is a key part

Tests for Oxygen and Ventilation

• Respiratory Function Tests, or spirometry test to exchange O2 and CO2
• Measuring arterial blood gasses determines the adequacy of tissue oxygenation by checking the PH, PO2, PCO2 values
• Blood analysis determines erythrocyte, hemoglobin and hematocrit levels

Reasons for Respiratory System Applications

• To use the lungs with maximum capacity
• Throwing pulmonary secretions
• Provide airway opening
• Provide tissue oxygenation
• Improve cardio-pulmonary function

Improve Lung Capacity

• Use positioning
• Breathing exercises
• Use of assisted breathing devices
• Mechanical ventilators
• Use a chest tube

Positioning

• In immobile patients, secretion accumulates in the lungs and airways
• Chest wall can not expand sufficiently
• Rotation every two hours are critical

Techniques for Breathing Excercises

• Deep breathing
• Coughing
• Extending expiration

Deep Breathing Techniques

• Bend knees slightly on the bed
• Utilize hands on the patient under the costas to feel the diaphragm
• Breath deep from the nose
• Hold for up to 5 breaths
• Leave mouth open and breath slow, like whistling
• Repeat process 5 - 10 times

Coughing Exercises

• Complete three deep breathing exercises
• After the third breath, take a deep breath
• Cough strong and intermittently with intermittent until breather out
• Repeat process three to five times

Purposes of Pursed-lip Breathing

• Sit with proper fowler positioning
• Breath deeply
• Purse lips while breathing
• Leave air slowly while counting up to four every time

Assisted Breathing Devices

• Assists with the need for inspiration, especially post-operations
• Provides notification of visual and breath movements
• As each breath moves, the balls should move up

Mechanical Ventilation

• Mechanical ventilation occurs by breathing artificially with a mechanical ventilation

Purposes of Chest Tubes

• System of one-way discharge of fluid and air to help with a system of closed drainage

Respiratory Secretion Removal

• Hydration through sufficient fluid levels by providing 1500 - 2000cc fluid per day to soften secretions in the lungs
• Moistening through humidification of airways, which aids in removing secretions
• Nebulization facilitates the removal of secretions through bronchodilators and mucolytic drugs
• Postural Drainage can be completed by changing positions and moving mucus along

Nebulization Techniques

• To assist with the removal of oxygen
• Semi-Fowler positions can be applied during use
• Process takes roughly 10-15 minutes on average
• After, the mouth is to be rinsed out with water to limit throat infection

Postural Drainage

• Patient positioning of the individual to effectively move the mucus by steam
• Can also oxygenate through steam
• Is achieved by cupping the hands and performing chest percussions

Contraindications for Chest Percussion

• Hemorrhage Disorder
• Osteoporosis
• If the individual presents a current rib fracture

Purposes of Airway Openings

• Cough exercise to maintain openness, also aids with aspiration, and can be supported by applying medical grade applications
• If sputum comes too much complete this exercise for 2-3 hours at night

Aspiration

• If secretions are preventing from removing you can administer to the individual and airway

Airway Technique for Aspiration:

• 1. Orafarengeal and nasopharyngeal
• 2. Orotrakeal
• 3. Nasotrakeal
• 4. Endotractheal
• A sterile airway with one hand should be used

Oropharyngeal/ Nasopharyngeal Aspiration

• Occurs by entering the upper respiratory tract, ending in the pharynx
• Releases the secretions through coughing

Orotracheal / Nasotracheal Aspiration

• Provides entry for airways that go through the trachea and through the mouth
• Typically completed on individuals whom exhibit pulmonary sections, to assist in clearing

Orofarengeal / Nasopharyngeal Aspiration

• Uses a cather that extends to the pharynx, which causes issues

Symptoms that Require Aspiration

• The primary expression of the patient
• Wheezing issues
• Presence of Cough and Secretion

Aspiration Rules

• Aspiration Cather is used for a single purpose, it does not have a dual function
• Follows aseptic protocols to maintain order
• Typically will complete with short breaks after 20-30 seconds

Rules for Aspirated Aspiration

• If the individual needs more work provide appropriate positioning
• All efforts related to using a cather should be done during inspiration
• Pay attention to the patient, and review before working in a new environment

Oropharyngeal

• Can be used in the mouth to administer help

Oral - Nose Aspiration

• When patients have issues around the mouth and nose

Orotracheal / Nasotracheal Technique

• Provides airway assistance, or 100% oxygen at two intervals to help patient through

Suction Settings

• Adults:100-120 MG // Probe ranges from 12-14
• In Children suction works from 50-100 MG // Probe ranges between 8-10
• In newborn probe: 40-60 with a smaller size, around probe size 6

Equipment Needs fo Airway

• Oxygen Source
• Ambu Airbag
• Airway tools
• Sterile Air and Gloves

Nose for Cather

• Catheters need to extend long and far so be flexible with your movement
• Should try and provide this through nose than the mouth

Oxygen Tools for Help

• For oxygen, the patient typically needs to take nasal breaths during the process
• Be flexible, but provide tools to the areas

Mechanical Airway Tools

• Aids all the tools with maintaining patients well being and to improve workflow

Indications and Care

• All indications and care need to be provided and be clean for maximum function

Tracheostomy

• Should be followed after aspiration to clear infection for optimal outcome

General Precautions

• When doing suction it is important to make sure everything is done aseptically, for all types of cather
• The patient requires a safe and stable flow to function as the heart needs to function at a good rate
• The cather needs to move and follow protocol when breathing

Respiratory Cather

• Catheters need to be handled in accordance, with specific focus on non sterile left hands
• The airway needs to be monitored and have 100% flow for safe protocol
• It is critical and essential that during the implementation of the suction cather it is ready for use

Airway Types

• Oral is a key component for airway systems
• It is an adjunct to maintain and open a stable patients airway
• Aides in preventing the tongue from clotting and preventing individuals from airway support

Purpose of Tracheostomy Tubes

• To create an open airway
• To deliver safe and effective oxygen to the lungs
• It is critical to understand if the oxygen is stable and to clean infection spots to clean before implementing oxygen