Respiratory System: Functions and Nursing Practices

Respiratory System and Applications

• Nursing practices pertaining to the respiratory system involves applying appropriate interventions for diagnosis and treatment.
• The lungs are located in the thoracic cavity, excluding the mediastinum, which houses the heart, major blood vessels, bronchi, esophagus and other organs.
• The lung surface is covered by visceral pleura, while the thoracic cavity walls are lined by parietal pleura.
• There is negative pressure between both pleurae.
• Surfactant, secreted by epithelial cells in the alveoli, prevents lung collapse.
• Respiration is regulated by the respiratory center in the medulla oblongata and pons.

Respiratory System Functions

• The basic respiratory function is to provide oxygen to the tissues and remove carbon dioxide.
• Ventilation is the process of air moving in and out of the lungs.
• Inspiration occurs when the diaphragm and intercostal muscles contract, increasing thoracic cavity size and pulling external air into the lungs.
• Expiration is a passive process dependent on natural lung elasticity where muscles relax and air is pushed out.
• Forced expiration occurs mostly by contracting internal intercostal muscles to depress the rib cage.
• Diffusion is the spontaneous movement of gases between alveoli and blood in the capillaries, without energy use.
• Perfusion involves the cardiovascular system pumping blood throughout the lungs.
• Diffusion and perfusion are assessed by measuring blood oxygen levels, expressed as % saturation; the general range is between 95% and 100%.
• O2 participates in the circulation with hemoglobin in the erythrocyte and is released to the cells.
• CO2 separates from erythrocytes, passes through capillary membrane pores to alveoli so the O2 molecule leaves the alveoli and enters the blood.

Factors Affecting Oxygenation

• Factors affecting oxygenation include health status, age, lifestyle, and environmental factors.

Health Status

• Health conditions impacting oxygenation include blood diseases like anemia, myocardial muscle contraction problems, increased metabolic rate due to exercise, infection, fever, pregnancy or wound healing.
• Musculoskeletal disorders like costa fractures and kyphosis, CO poisoning reducing O2 transport capacity and chronic diseases also affect oxygenation.

Age

• Oxygen requirements increase in premature infants with advancing age.
• Oxygen need decreases when aging.

Lifestyle

• Lifestyle factors impacting the respiratory system encompass inadequate nutrition, obesity, lack of exercise, drug use of narcotics, and anxiety.
• Overuse of narcotics suppresses the respiratory center, decreasing respiratory depth, rate, and consequently, O2 intake.

Environmental Factors

• The respiratory system is susceptible to environmental factors including polluted air and high altitude, where O2 concentration is low.

Chest Examinations

• Chest exams involve inspection with eyes, palpation with hands, and auscultation with a stethoscope. Inspection includes assessing patient position, chest size, shape, and symmetry, thoracic deformities, skin condition, muscular development, nutritional status and vascular anomalies.
• Regularity refers to the rhythm of breathing.
• Rate refers to the frequency of breaths observed.
• Duration refers to how long a breach lasts.
• Eupnea refers to natural breathing.
• Abnormal respiratory patterns include bradypnea, an abnormal slowing of respiration from central nervous system diseases or drugs.
• Tachypnea, an abnormal increase in breathing frequency from severe pain, chronic pulmonary or cardiac diseases, and anxiety.
• Hyperpnea, an increased depth of breathing from metabolic acidosis, use of accessory muscles during respiration in diseases with dyspnea.
• Apnea is the temporary cessation of breathing.

Thoracic Deformities

• Pectus excavatum (funnel chest): An abnormality of connective tissue resulting in a depressed sternum.
• Pectus carinatum (pigeon chest): A raised sternum.
• Barrel chest isn't a disease, but it may indicate an underlying condition.

Auscultation Sounds

• Tracheal: Harsh sounds over the trachea, like air through a pipe.
• Bronchial: Present over large airways in the anterior chest near the 2nd and 3rd intercostal spaces.
• Bronchovesicular: Heard in posterior chest between scapulae and in the center part of the anterior chest.
• Vesicular: Soft, blowing, or rustling sounds throughout most lung fields.
• Rales: The abnormal breath sound of small clicking, bubbling or rattling heard when a person breaths in.
• Rhonchi: The abnormal breath sound that resemble snoring.
• Stridor: The abnormal breath sound similar to wheezing when a person breathes.
• Wheezing: The abnormal breath sound of high pithed sounds.
• Pleural friction: Sound of leaves rubbing due to decrease or loss of pleural fluid as a result of inflammation of pleura. This can e heard in Pneumonia.

Respiratory Function Changes

• The respiratory rate of Tachypnea is greater than 24/min, with rate is more than 24/min.
• In bradypnea, respiratory rate is less than 10/min.
• Hyperventilation is increased rate and depth of breathing.
• Hypoventilation is decreased rate and depth of breathing, with irregularities.

Definitions

• Anoxia: Absence of oxygen
• Hypoxia: Cells and tissues cannot get enough oxygen.
• Dyspnea: Difficult breathing.
• Cyanosis: Bluish discoloration of skin or mucous membranes due to low oxygen saturation. It's observed in lips, ear lobes, nails & oral mucosa.

Diagnostic Procedures and Nurising Activities

• Measures of oxygenation and ventilation adequacy.
• Respiratory Function test (solunum fonksiyon test-SFT).
• Arterial Blood Gas Measurement and Blood Analysis.
• Tests evaluating the structure of the respiratory system include X-rays, bronchoscopy and lung scans.

Tests for Respiratory Tract Infection

• Tests that determine respiratory tract infection or the presence of abnormal cells include throat cultures, sputum cultures and thoracentesis.
• Sputum cultures are generally give on an empty stomach in the mornings.

Respiratory Function Tests

• Respiratory Function Tests aim to determine the lungs' ability to exchange O2 and CO2. SPIROMETRY involves measuring lung volumes.

Measurement of Arterial Blood Gasses

• Measurement of Arterial Blood Gases aims to determine the adequacy of tissue oxygenation, checking pH, PO2, and PCO2 values in the arterial blood.
• Normal arterial blood gas values: pH 7.35-7.45, PO2 80-100 mm Hg, PaCO2 35-45 mm Hg.

Blood Analysis

• Blood analysis in the vein blood evaluates erythrocyte, hemoglobin, and hematocrit levels.

Purposes

• For respiratory system applications, includes aiming to allow maximum function of lungs, clearing pulmonary secretions, opening the airway, ensuring adequate tissue oxygenation and improving cardiopulmonary function.

How to Maximize Lung Function

• Positioning
• Breathing Exercises
• Assisted Breathing Devices
• Mechanical Ventilator
• Chest Tube

Positioning

• Positioning involves changing posture regularly and is especially important for immobile patients, secretions may accumulate and the chest will be unable to expand sufficiently
• Positions can be changed every 2 hours to maximize capacity and to prevent pressure ulcer.
• Position can often be right lateral, semi fowler, left lateral, and supine.

Breathing Exercises

• Deep breathing exercises, coughing exercises, and extension of expiration are helpful for breathing.

Deep Breathing Exercises

• Deep breathing exercises involve lying on bed, knees slightly bent, placing hands under the costas, feeling the diaphragm, taking a deep nose breath and hold up to 5 breaths, leaving the mouth open and repeating the process 5-10 times.

Cough Exercises

• Cough exercises include performing 3 deep breathing exercise with a breath and coughing strongly until you breathe out. Repeat the process 3-5 times

Breathing Pursed Lip Extensions

• Breathe deeply while purse your lips and breathing. Leave air slowly while counting up to 4.

Use of Assisted Breathing

• Triflow devices increase inspiration, especially in the post-op period by providing visual notification while the each balls move up

Mechanical Ventilation

• Mechanical ventilation artificially provides respiratory function.

Chest Tubes

• Allows one-way discharge of fluid or air in the pleural cavity with a closed drainage system.

Removing Pulmonary Secretions

• Hydration, nebulization, moistening/humidification, and postural drainage are all interventions to aid in removal of pulmonary secretions.
• Hydration involves sufficient fluid delivery with 1500-2000 cc fluid per day, softening lung secretions making it more clear.

Moistening and Humidification

• By moisturizing the airways, heat and humidity are provided in the mucous membranes, facilitating removal of secretions, distilled water and steam can be used.

Nebulization

• Nebulization facilitates secretion removal with bronchodilator and mucolytic drugs.

Postural Drainage

• Postural and gravity is used to drain congestion.

Interventions Before Postural Drainage

• Before postural drainage it often includes having bronchodilator, steam, and/or Oxygen.
• Hands should be cupped when performing chest percussions.

Situations were Postural Drainage should be avoided.

• Hemorrhage disorders.
• Osteoporosis.
• Rib Fractures

Airway opening

• Cough exercises and aspiration is done.

Coughing

• Secrets are removed by coughing with deep breathing exercise on a regular basis. If there is too much septum and it is often done every 2-3 hours at night.

Aspiration Techniques

• Orafarengeal and nasopharyngeal is is performed by a surgical tube that is inserted in the central area but only as far as the brain. Is the secretion isn't removed with cough then aspiration can been done one or several times.

Aspiration

• Aspiration is the technique where secretions are extracted where people don't cough effectively

Techniques

• Oropharyngeal / nasopharyngeal aspiration (performed by entering upper respiratory tract in patients who can't release secretion despite effective coughing).
• Orotracheal / nasotracheal aspiration (entering bronchus and trachea through mouth and nose for patients who can't cough effectively or don't have artificial airway).
• Endotracheal aspiration (entering bronchus and trachea through endotracheal tube or tracheostomy cannula).

Indications for requiring Aspiration

• A need for aspiration is often marked by the patients expression or symptoms of wheezing, coughing, presence of secretin, tachypnea, hyperventilation, cyanosis, Tachycardia, rhythm problems, high or low blood pressure, sweating, and unrest.
• Aspiration catheter is for single use only and should be done with aseptic technique.
• The act should not last longer than 15 secs with 20-30 second space between each application for a total of 3 applications.
• Family can be used to aid the concious patient to move lateral in an unconscious patient.
• During aspiration, the patient's heart rate, rhythm, respiration and skin color must be observed ad secretions have to be cleared.

Key Rules for Aspiration

• Too much pressure on aspirator may cause a negative pressure causing pneumothorax.
• Adult suction must be in the range of 100-120mmHg and probe of 12-14. Children suction must be a probe of 8-10 and 50-100 mmHg. A newborns suction must be a probe of 6 and 40-60 mmHg.

The right tools

• You need an Aspirator, Aspirator probe, Sterile gloves, Ambu, Oxygen source, Airway, and Sterile water for successful aspiration.

Guiding Points for Nasopharyngeal Aspiration

• The mouth must be opened slowly in order to allow mucus to be discharged. In the case where the is a blockage, then insert the to the nose.

Orotracheal Aspiration

• It is important to always prefer having air flow through the nose than the mouth. The catheter often needs to be extended right up to the trachea and must be handled with sterile hands.

  -Hands are washed according to infection protocols -Patients placed in in a fowler position with their head in slight extension. -If it is too difficult, than the patient can be given 100 percent Oxygen in 2 mins.

Key Guiding Points for this technique

-With the non-sterile left hand, the aspiration tip is often folded at the bottom with downward. However, as the catheter is progressing, the coughing is stimulated (as cough is related cough reflux is related to not being advanced due to section -The tip is removed and then it rotated and aspirated slowly

-The catheter must be completely withdrawn and the process must then be terminated on regular intervals for a max 3 times as part of that treatment. -The progress must not be longer than 15 secs with 3 applications max -The nose must be preferred to the mouth by applying gel.

For proper care, remember that

• It is critical to note to follow to not insert due catheter while the suction is active. Also, in order for maximum effectiveness, must it should not exceed those measurements.

An Airway involves:

• Oral
• Endotracheal
• Nasotracheal
• Tracheostomy tube

Using an Oral Airway:

• The purpose is to maintain or open a patient's airway in sudden sudden respiratory failure. This is done to to prevent the tongue from prevent covering the epiglottis, preventing which would breath.
• If a patient has a retching reflex, it may lead to further like threatening complications.
• It is important to perform the act correctly while carefully monitoring the patient.

-One must provide information for a patient is unconscious because is also used to remove any left of out section. -Place into a supination position and put head to an extended position while inserting the slope in mouth and along forehead. -As you get closer the pharynx side, rotate inside then keep an eye one respiration

Main Goal

• Endotracheal.
• Nasotracheal
• Tracheal.

Tracheostomy

• Tracheostomy is done to create as surgical operation that builds and airway in the central part -A tube is implemented inside allowing further air the central parts.

Important points:

• To bypass the upper airway from any blockages, while cleaning and removing any leftover. In order to ensure that the airway has oxygen and has access it. Patients a often given an anti infection.

Provide and maintaining Oxygenation

• The purpose for Oxygenation includes the ability to both remove or prevent hypoxia by creating masks that administer oxygen safely.

-Oxygen is to be given often times at 1-6 it per min, with a need to always keep the skin checked for irritation. -Oxygen given 3-7 IT per set point in order that patients gain full coverage. -Its important to ensure that all devices one used are not heaters and can safely used. It would also be pertinent to mention to stay a safe distance and ensure nothing could result in injury

There are cases where you should stay away and take proper course of action in order to prevent complications, which may arise. Complications with high level treatments Oxygen levels can lead to -Slow oxygen, high blood pressure with high carbon oxide, and in a loss of conscious. One may also see lung collapse as a result to the high levels, or a risk of permanent vision and eye damage, The first thing you should do in case of a medical event in that order is consult the higher officials and order any needs or requirements you may seek.