Respiratory Anatomy and Physiology PDF

## Respiratory Anatomy and Physiology This video will discuss the care of a patient with a respiratory disorder with a focus on anatomy assessment and oxygen. ### Primary Function The primary function of the respiratory system is the exchange of gases. This exchange is broken down into two catego...

## Respiratory Anatomy and Physiology This video will discuss the care of a patient with a respiratory disorder with a focus on anatomy assessment and oxygen. ### Primary Function The primary function of the respiratory system is the exchange of gases. This exchange is broken down into two categories: - **External Respiration:** the exchange of oxygen and carbon dioxide between the lungs and the environment. - **Internal Respiration:** the exchange of oxygen and carbon dioxide at the cellular level. ### Respiratory System The respiratory system is responsible for the exchange of gases, and works in conjunction with the cardiovascular system, which transports the gases to the cells. ### Upper Respiratory Tract The upper respiratory tract includes the following components: - **Nose:** The nasal passageway is where air enters the respiratory system. This is where air is filtered, warmed, and moistened. This is also the location of the olfactory receptors, responsible for the sense of smell. - **Sinuses:** There are four main sinuses that empty into the nose (frontal, maxillary, ethmoid, and sphenoid). - **Pharynx:** The pharynx, or throat, is responsible for the passage of both air and food. It is divided into three components: - **Nasopharynx:** Located behind the nasal airway, should only transport air. - **Oropharynx:** Located behind the mouth, contains the tonsils. - **Laryngopharynx:** The lowest part of the pharynx, where the trachea and esophagus branch off. - **Larynx,** or **voice box:** This structure, made of cartilage, is responsible for voice production. It contains the epiglottis, which prevents aspiration during swallowing, and the glottis, the space between the vocal cords responsible for speech. ### Lower Respiratory Tract The lower respiratory tract is also lined with cilia and mucus and includes the following: - **Trachea:** The trachea descends from the larynx and branches into the left and right bronchi. - **Bronchi:** The right bronchus is larger and more vertical, increasing the risk of aspiration due to its accessibility. The left bronchus is smaller and more horizontal. - **Bronchioles:** The bronchioles branch off from the bronchi and resemble a grape-like structure. - **Alveoli:** Clusters of small air sacs at the ends of bronchioles, where the exchange of oxygen and carbon dioxide occurs. ### Mechanics of Breathing - **Visceral Pleura:** A lining that attaches to the lungs. - **Parietal Pleura:** A lining that adheres to the thoracic cavity. - **Pleural Fluid:** A lubricant secreted between the pleural layers to minimize any friction during movement. - **Negative Pressure System:** The pleural layers create a negative pressure that helps to maintain lung inflation and keeps atmospheric pressure inside the lungs. ### Normal Values - **Room Air:** 21% Oxygen - **Normal Adult Respiration Rate:** 12 to 20 breaths per minute - **Normal Blood pH:** 7.35 to 7.45 ### Regulation of Respiration - **Nervous Control:** The medulla oblongata, pons, and carotid sinus and aortic arch are responsible for regulating respiration. - **Chemoreceptors:** Sensitive to oxygen and CO2 levels, these receptors help to regulate pH levels in the blood. ### Assessment - **Subjective:** Information reported by the patient, such as shortness of breath or coughing. - **Objective:** Any observable or measurable data, such as respiratory rate, body position, and breath sounds. #### Breath Sounds - **Wheezes:** A whistling sound related to narrowing in the airways. - **Crackles:** A crunching sound due to air moving through fluid in the lungs. - **Friction Rubs:** A grating or creaking sound caused by inflammation of the pleura. - **Diminished Breath Sounds:** Reduced or difficult to hear breath sounds. - **Absent Breath Sounds:** A lack of breath sounds. ### Hypoxemia - Hypoxia is a deficiency in oxygen. ### Hypercapnia - Hypercapnia is an increased level of carbon dioxide (CO2) in the blood. This is usually due to a decreased respiratory rate or depth. ### Causes of Dyspnea - **Pulmonary:** Conditions like pneumonia, pulmonary embolism, and pneumothorax. - **Cardiac:** Heart failure can affect circulation of blood and affect oxygen levels. - **Neuromuscular:** Conditions that impact the muscles responsible for breathing, such as muscular dystrophy. - **Environmental:** Exposure to irritants or allergens can also cause dyspnea. ### Nursing Considerations - **Ineffective Airway Clearance:** Addressing any potential airway obstructions, such as mucus plugs, through techniques like suctioning. - **Ineffective Breathing Patterns:** Identifying and correcting any abnormal breathing patterns, such as rapid or shallow breathing. - **Impaired Gas Exchange:** Ensuring the patient receives adequate oxygenation. - **Anxiety:** Managing anxiety related to the patient's respiratory distress. - **Activity and Time:** Balancing the patient's need for physical activity and rest. - **Tolerance Altered Nutrition:** Ensuring the patient receives the correct nutrition based on their needs. ### Oxygen Therapy Oxygen therapy is used for patients with low oxygen levels or hypoxia. - **Causes of Hypoxia:** Low hemoglobin, decreased diffusion of oxygen across the alveoli, impaired analation, and poor tissue profusion. - **Ordering Oxygen Therapy:** Always requires a physician’s order, specifying delivery method and volume. ### Safety Precautions - **Combustibility:** Explain to patients using oxygen at home the importance of refraining from smoking. ### Oxygen Flow Rates - **Room Air:** 21% oxygen. - **One liter:** 24% oxygen. - **Two liters:** 28% oxygen. - **Three liters:** 32% oxygen. - **Four liters:** 36% oxygen. - **Five liters:** 40% oxygen. - **Six liters:** 44% oxygen. - **Seven liters:** 48% oxygen. - **Eight liters:** 52% oxygen. - **Nine liters:** 56% oxygen. - **Ten liters:** 60% oxygen. ### Oxygen Administration - **Airflow Monitoring:** Ensure the oxygen delivery device is functioning correctly. ### Oxygen Masks - **Simple Face Mask:** Used for mouth breathers, can be problematic for patients with claustrophobia. - **Nasal Cannula:** Used for meals, provides precise oxygen concentrations. - **Venturi Mask:** Provides specific oxygen concentrations. - **Partial Rebreather Mask:** Allows for some CO2 reabsorption or retention. - **Non-Rebreather Mask:** Prevents CO2 from mixing with oxygen and does not collapse. ### Nursing Interventions Monitor the following every 2 hours: - **O2 levels:** Monitor oxygen saturation. - **Liters delivered:** Ensure the appropriate volume of oxygen is being delivered. - **Flow rate:** Check the oxygen’s flow rate to ensure it is correct. - **Humidification:** Monitor the humidity level. ### Oxygen Therapy Goal - **Chronic Conditions:** To maintain the patient’s baseline oxygen levels. - **Acute Conditions:** To achieve an oxygen saturation of 92% or higher. ### Types of Breathing - **Kussmaul Breathing:** Rapid, deep breathing seen in Diabetic Ketoacidosis (DKA). - **Cheyne-Stokes:** A cycle of progressively rapid breathing followed by a period of apnea. - **Tachypnea:** Respiratory rate greater than 20 breaths per minute. - **Bradypnea:** Respiratory rate less than 12 breaths per minute. ### Medications - **Bronchodilators:** Medications that open the airways, used for conditions like emphysema and asthma. - **Beta Agonists:** Medications that relax the airway muscles. - **Anticholinergics:** Medication that affect the muscles around the bronchi, used for COPD. - **Theophylline:** A bronchodilator that can cause side effects like nausea, vomiting, and tachycardia. - **Corticosteroids:** Reduce inflammation in the airways, administered orally or through inhalation. - **Decongestants:** Narrow blood vessels and decrease swelling in the nasal passages. - **Antihistamines:** Block histamine, reduce inflammation, and relieve itching. - **Antitussives:** Suppress the cough center, used to treat coughs. - **Mucolytics:** Break down mucus to make it easier to expel. ### Laboratory Diagnostics - **Pulse Oximetry:** Non-invasive method to monitor oxygen saturation. - **Sputum Samples:** Analyze for the presence of abnormal cells or specific bacteria, like Mycobacterium tuberculosis. - **Throat Cultures:** Identify any type of infection in the throat. - **Arterial Blood Gases (ABGs):** Measure blood pH, oxygen (O2), and carbon dioxide (CO2) levels. - **Chest X-Rays:** Identify potential lung abnormalities, such as pneumonia. - **Pulmonary Function Tests:** Evaluate lung capacity. - **CT Scan:** Provide detailed images of the lungs. ### Procedures - **Mediastinoscopy :** Procedure where a scope is inserted through an incision above the sternum to visualize the mediastinum (space between the lungs). - **Laryngoscopy:** A scope is used to examine the larynx and vocal cords. - **Bronchoscopy:** A scope is inserted into the bronchi to examine the airways. - **Thoracentesis:** Procedure where fluid is removed from the pleural space, typically using a needle. - **Tuberculin Skin Test (TST):** Used to identify exposure to the tuberculosis bacillus. - **Tracheostomy:** A surgical opening made in the trachea to create a new airway. ### Ventilator Care - **Communication:** Establish a communication system with the patient. - **Ventilator Settings:** Verify ventilator settings are appropriate for the patient. - **Monitor Vital Signs:** Regularly monitor vital signs, including oxygen saturation, blood pressure, and heart rate, to ensure the ventilator is providing adequate support. - **Prevent Ventilator-Associated Pneumonia:** Implement measures to reduce the risk of infection. ### Ventilator Weaning - **Weaning Protocol:** Gradually reduce ventilator support to prepare the patient to breathe on their own. - **Respiratory Muscle Strength:** Assess the patient's ability to breathe independently. ### Alarms - **High-Pressure Alarms:** Can be caused by a kink in the tubing, mucus plug, or patient biting on the tube. - **Low-Pressure Alarms:** Caused by a disconnection in the tubing or leak in the system. - **Accidental Extubation:** The endotracheal tube is pulled out of the trachea. ### Always Remember - **Never adjust the ventilator settings without a physician’s order.** - **Never completely remove the tracheostomy collar while on the ventilator.** - **Always notify another healthcare professional if you silence an alarm.** **Note:** This summary is based on the information provided in the document, but it is important to understand that this is not a replacement for professional medical advice. It is always best to consult a qualified healthcare professional for any health concerns.