Lecture 1: Care of Clients with Problems in Oxygenation PDF

LECTURE 1: CARE OF CLIENTS WITH PROLEM IN OXYGENATION 1st SEMESTER AY 2024-2025 – BSN 3101 SOURCE: PPT TRANSCRIBER: Tetel Marasigan TOPIC OUTLINE Bronchial...

LECTURE 1: CARE OF CLIENTS WITH PROLEM IN OXYGENATION 1st SEMESTER AY 2024-2025 – BSN 3101 SOURCE: PPT TRANSCRIBER: Tetel Marasigan TOPIC OUTLINE Bronchial Tubes – connected to 1 Respiratory System trachea Lungs – remove oxygen from Respiratory System Anatomy and Physiology 2 the air and pass to the blood. Review Oxygen is also delivered to the 3 Parts of Respiratory System bloodstream 4 Assessment of Respiratory System Diaphragm – helps airs into MUSCLES 5 Breathing Patterns and out of the lungs 6 Normal and Abnormal Breath/Lung Sounds Ribs – protecting lungs and BONES heart 7 Breath Sounds 8 Altered Breathing Pattern 9 Respiratory Patterns PARTS OF RESPIRATORY SYSTEM Other components that work with the lungs and blood vessels include: RESPIRATORY SYSTEM tiny air sac, gas exchange and The respiratory system is the network of organs ALVEOLI CO2 take place and tissues that help you breathe. It includes your airways, lungs and blood vessels. branch that connects trachea FUNCTIONS OF RESPIRATORY SYSTEM BRONCHIOLES and alveoli Airways, lungs and blood vessels located inside the alveoli, blood Warms air to match your body temperature and CAPILLIARIES vessel in the walls of alveoli moisturizes it to the humidity level your body needs. move oxygen and removes CO2. Sinus – responsible for warming the air that enters section of the lungs the body. LUNG LOBES 5 lobes (RIGHT – 3, LEFT – 2) Gas exchange – ALVEOLI, which is commonly Thin sacs that protects the lungs damage if a person is diagnosed with COPD. and separate lung from the chest Delivers oxygen to the cells in your body wall Removes waste gases, including carbon dioxide, Hemothorax – blood in the from the body when you exhale. pleural space Protects your airways from harmful substance and PLEURA Pneumothorax – air in the pleural irritants - Cilliants space Vocal cords – allows to talk and produces sound Epyema – pus in the pleural space RESPIRATORY SYSTEM ANATOMY AND Toracocentesis – process of PHYSIOLOGY REVIEW draining pleural flui Filter dust and other irritants CILIA Tiny hair Flaps in the entrance of trachea when we swallow foods EPIGLOTTIS Dysphagia – difficulty of swallowing LARYNX Allow to talk and make sound (VOICE BOX) ASSESSMENT OF RESPIRATORY SYSTEM SUBJECTIVE DATA A focused assessment of the respiratory system includes a review for common or concerning symptoms including Identify whether productive or non-productive cough Productive Cough – with COUGH phlegm (may putok) Non-Productive – dry cough Hoarse Barking PARTS OF THE RESPIRATORY SYSTEM Identify the color: Mouth and nose – openings for o Normal – clear air going to the lungs o Purulent – yellowish Sinuses – humidify and warms o Rust colored air SPUTUM o Greenish – viral infection AIRWAYS Pharynx (throat) – tubes that o Pink colored (pink fruity deliver air to the trachea sputum) - hemothorax (windpipe) o Hemoptysis – blood in Trachea – connecting pharynx sputum and bronchial tubes DYSPNEA Difficulty of breathing  Shortness of breath There is pain during inhalation or expiration To assess: o Where is the pain CHEST PAIN o Quality of pain – PQRST o COLDSPA o Pain scale TACHYPNEA Rapid breathing ASK ABOUT If there is onset symptoms aside ASSOCIATED from respiratory part SYMPTOMS Past medical history Medication HISTORY Environmental surroundings Nature of job BRADYPNEA Slow breathing OBJECTIVE DATA Visual inspection begins with observation of facial expression, skin color, moisture, and temperature. a) Skin should be warm and dry, and skin color should be uniform and consistent with ethnicity. APNEA b) Facial expression should be Absent of breathing INSPECTION relaxed, without signs of distress or apprehension. c) Observe nail beds, lips, mouth, ears, and conjunctiva for oxygen saturation. d) Observe the neck for contraction HYPERPNEA of the sternomastoid muscles Deep breathing Using the palmar surface of the fingers, palpate the anterior and posterior chest. PALPATION Vocal fremitus is a vibration felt on the posterior chest using the HYPOPNEA ulnar side of the hand. Shallow breathing Percussion is helpful to determine the density of the underlying lung tissue and PERCUSSION identify the position of the diaphragm during inspiration and expiration. CHEYNE STOKES BREATHING Ask the patient to breathe slowly Gradual change between Hypopnea and and deeply through their open Hyperpnea, followed by Apnea mouth. Using the diaphragm of your AUSCULTATION stethoscope, listen in the ladder pattern posterior and anterior, noting the breath sounds. Listen in each area for at least BIOT’S BREATHING one full breath. Periods of Hyperpnea followed by Apnea BREATHING RATES AND PATTERN KUSSMAUL’S BREATHING Combination of tachypnea and hyperpnea EUPNEA Normal breathing NOTE: Listen to the normal and abnormal breath sounds NORMAL AND ABNORMAL BREATH/LUNG SOUNDS NORMAL VESICULAR BREATH SOUNDS  Normal sound on most of the lungs 3. Late Inspiratory – in pulmonary fibrosis, Soft Pulmonary fibrosis, COPD, Resolving Low pitch Pneuominia, Lung abscess, TB lung Inspiration longer than Expiration cavities No gap between both phrases 4. Biphasic in bronchiectasis Crackles will be either Fine or Coarse quality 1. Fine – crepitations heard in broncholitis, Pulmunary oedema, Pulmonary fibrosis 2. Coarse – crepitations in COPD, Resolving Pneumonia, Lung abscess, TB lung cavities or Bronchiectasis PLEURAL FRICTION RUB Pleural rub is most commonly caused by an inflammation of either the visceral and/or parietal pleura Low pitched, grating sound similar to the sound of ABNORMAL walking on snow BRONCHIAL BREATH SOUNDS Caused in consolidation, pulmonary infarction, Abnormal in majority of lung that is far from main uremia etc. airways Heard during Inspiration when visceral and parietal Loud and tubular quality pleura slides over each other. High pitched To differentiate between the rub if it is being caused Inspiratory and expiratory phase by the pleural lining or the pericardium, you must Definite gap between both phases perform a brief inspiratory hold maneuver, if the Heard in: rub continues during the maneuver it is most likely a o Consolidation pericardial rub. o Lobar collapse with patent bronchus o Lung cavity If associated with consolidation, you may be able BREATH SOUNDS to elicit following maneuvers: Caused by the small airways o Increased tactile fremitus reopening as the chest walls o Bronchophony expands, forcing air through o Aegophony i.e., BEE heard as BAY CRACKLES passages narrowed by fluid, o Whispering oectoriloquy mucous, or pus, and is heard most frequently in the bases due to hypoventilation. Coarse rattling respiratory sounds somehow like snoring, RHONCHI usually caused by secretions in bronchial pathways Continuous, coarse whistling sound and suggests narrow WHEEZE WHEEZE airways (bronchospasm); and Continuous and musical quality common in asthma, COPD, Expiratory usually and bronchitis Indicates narrowing of airways either due to Medical emergency and is bronchospasm or secretion in small airways loud, rough, continuous, and Low pitch and High pitch STRIDOR high pitched due to upper High pitch polyphonic or monophonic airway obstruction, heard HIGH PITCH (SIBILANT) – wheeze are the usual loudest over the trachea whistling quality wheeze heard due to smaller airway Squeaking or grating sound of narrowing in bronchospasm (like in asthma) the pleural linings rubbing PLEURAL LOW PITCH (SONOROUS) – wheeze also called together and can be described FRICTION RUB as the sound made by treading rhonchi heard when smaller airways narrow due to secretions (e.g., in Chronic bronchitis) on fresh snow High pitch wheeze - is usually Polyphonic due to variable degree of bronchospasm like in asthma and ALTERED BREATHING PATTERNS is more common form we hear in daily practice Progressively deeper and Monophonic - wheeze is heard is there is CHEYNE-STOKES sometimes faster obstructing pathology in a localized area. BREATHING Near death breathing CRACLES/ CREPITATIONS pattern Interrupted and non-musical quality Deep labored breathing Inspiratory usually Indication of severe Peripheral airway collapse on expiration due either KUSSMAUL’S metabolic acidosis either to interstitial fibrosis or secretions/fluid BREATHING kidney failure nor DKA During inspiration, rapid air entry abruptly opens Fruity acetone breath these collapsed smaller airways and alveoli Respiratory depression producing crackling noise There is inadequate Can be: HYPOVENTILATION ventilation 1. Early Inspiratory – in small airway disease Cannot perform needed like broncholitis respiratory gas exchange 2. Mid Inspiratory – in pulmonary edema  BIOT’S Irregular breathing BREATHING APNEUSTIC Deeper gasping inspiration BREATHING RESPIRATORY PATTERNS