STRUCTURE AND FUNCTION OF THE RESPIRATORY SYSTEM.docx

**STRUCTURE AND FUNCTION OF** **THE RESPIRATORY SYSTEM** **PARTS OF UPPER RESPIRATORY TRACT :** **Nose:** **Air Intake**: The nose is the primary entry point for air. **Filtering:** The nasal hairs (vibrissae) trap large particles, such as dust and pollen, preventing them from entering the...

**STRUCTURE AND FUNCTION OF** **THE RESPIRATORY SYSTEM** **PARTS OF UPPER RESPIRATORY TRACT :** **Nose:** **Air Intake**: The nose is the primary entry point for air. **Filtering:** The nasal hairs (vibrissae) trap large particles, such as dust and pollen, preventing them from entering the respiratory system. **Humidification and Warming**: The nasal cavity has a rich blood supply and mucous membranes that warm and moisten the air, making it more suitable for the delicate tissues in the lower respiratory tract. **Smell:** The olfactory receptors in the upper part of the nasal cavity detect odors, contributing to the sense of smell. **Sinuses:** **Air Humidification and Warming:** Sinuses help humidify and warm theair as it passes through. **Lightening the Skull**: The sinuses are air-filled spaces that reduce the weight of the skull. **Resonance of Voice**: Sinuses contribute to the resonance and quality of the voice. **Pharynx:** **Passageway for Air and Food**: The pharynx serves as a shared pathway for air (to the lungs) and food (to the esophagus). **Protection**: The tonsils, located in the pharynx, contain lymphatic tissue that helps defend against inhaled or ingested pathogens. **Swallowing:** The pharynx plays a role in swallowing by guiding food from the mouth to the esophagus while ensuring that it does not enter the airway **Larynx:** **Voice Production:** The larynx contains the vocal cords, which vibrate to produce sound when air passes through them. **Airway Protection:** The larynx acts as a gatekeeper, preventing food and liquids from entering the trachea during swallowing. The epiglottis, a flap of tissue at the entrance of the larynx, closes over the trachea during swallowing to direct food and liquid into the esophagus. **Cough Reflex**: The larynx triggers the cough reflex when it detects irritants, helping to expel foreign particles from the airway. **PARTS OF THE LOWER RESPIRATORY TRACT** **Trachea (Windpipe):** ** Air Conduction:** The trachea serves as the primary airway, conducting air from the larynx to the bronchi. **Protection and Filtration**: The trachea is lined with *[\*pseudostratified ciliated columnar epithelium]* and mucus-producing cells that trap dust, pathogens, and other particles, moving them upwards towards the throat to be expelled or swallowed. *\* forms into stratified squamous epithelium to resist damage of smoking* **Support**: The trachea's C-shaped cartilage rings provide structural support, keeping the airway open while allowing flexibility during breathing. **Bronchi:** ** Air Conduction**: The bronchi continue the process of conducting air from the trachea to each lung. The primary bronchi branch into secondary (lobar) bronchi and then into tertiary (segmental) bronchi, each serving a specific lung area. ** Protection and Filtration**: Like the trachea, the bronchi are lined with ciliated cells and mucus to trap and remove foreign particles. **Air Distribution:** The branching structure of the bronchi helps distribute air evenly to all parts of the lungs. **Bronchioles:** ** Air Conduction:** The bronchioles are smaller airways that lead from the tertiary bronchi to the alveoli. They regulate airflow through smooth muscle constriction and dilation. **Gas Exchange Preparation:** The respiratory bronchioles are the smallest branches and are directly involved in gas exchange, as they lead to the alveoli. **Alveoli:** ** Gas Exchange:** The alveoli are tiny, balloon-like sacs at the end of the bronchioles where the actual exchange of oxygen and carbon dioxide occurs. The walls of the alveoli are extremely thin and surrounded by a network of capillaries, allowing oxygen to diffuse into the blood and carbon dioxide to be expelled. **Surfactant Production**: Alveolar cells produce surfactant, a substance that reduces surface tension, preventing the alveoli from collapsing and making breathing easier. **Lungs:** ** Gas Exchange Organs:** The lungs house the bronchi, bronchioles, and alveoli, and are the primary organs for gas exchange. **Oxygenation of Blood:** Oxygen is absorbed into the bloodstream in the alveoli, while carbon dioxide is removed from the blood to be exhaled. **Acid-Base Balance:** The lungs help maintain the body\'s pH balance by regulating the levels of carbon dioxide, a component of the acid-base system. The visceral pleura, parietal pleura, pleural fluid, and pleural space enable the lungs to move smoothly within the chest cavity during breathing. They help maintain the lungs\' position and ensure efficient respiration while protecting the lungs from friction and injury. The slight negative pressure in the pleural space is critical in keeping the lungs inflated, preventing lung collapse. **PHYSIOLOGY OF THE RESPIRATORY SYSTEM** ◉ **PULMONARY CIRCULATION** - provides for reoxygenation of blood and release of CO2 ◉ **Pulmonary Arteries** -- carry blood from the heart to the lungs. ◉ **Pulmonary Veins** -- is a large blood vessel of the circulatory system that carries blood from the lungs to the left atrium of the heart. **RESPIRATORY MUSCLES** **◉ PRIMARY:** diaphragm and external intercostal muscles ◉ **ACCESSORY:** sternocleidomastoid (elevated sternum), the scalene muscles (anterior, middle and posterior scalene) and the nasal alae. **Normal Respiration:** The diaphragm and external intercostals handle breathing with minimal involvement from accessory muscles. Accessory muscles become actively involved to assist in expanding the chest cavity and facilitating airflow, indicating that the body is struggling to meet its oxygen needs. The use of these muscles is a clear sign of increased respiratory effort and is often a key indicator of respiratory distress. **FUNCTION OF THE RESPIRATORY SYSTEM** Vital tissues, like the brain and the heart, cannot survive long without a continuous supply of oxygen. As a result of oxidation, carbon dioxide is produced and must be removed from the cells to prevent the buildup of acid waste products. The respiratory system performs this function by facilitating life-sustaining processes such as **[oxygen transport, respiration, ventilation, and gas exchange.]** **Ventilation** \- The movement of air in and out of the airways. ◉ The thoracic cavity is an airtight chamber, the floor of this chamber is the diaphragm. ◉ Inspiration: contraction of the diaphragm (movement of this chamber floor downward) and contraction of the external intercostal muscles increases the space in this chamber, [lowered intrathoracic pressure] causes air to enter through the airways and inflate the lungs. ◉ Expiration: with relaxation, the diaphragm moves up and intrathoracic pressure increases, this i[ncreased pressure pushes air] out of the lungs, expiration requires the elastic [recoil] of the lungs. Inspiration normally is 1/3 of the respiratory cycle and expiration is 2/3. Airflow variance ◉ Airflow is driven by the [pressure difference] between atmosphere (barometric pressure) and inside the lungs (intrapulmonary pressure). Flows from region of higher to lower pressure. Inspiration = enlarged thoracic cavity = lowers pressure inside thorax = air is drawn from atmosphere to lungs Expiration = decreases size of thoracic cavity =greater alveolar pressure = air flows from lungs into the atmosphere ◉Airway resistance refers to the resistance to airflow within the respiratory airways. It is a measure of [how much the airways oppose the flow of air] during inhalation and exhalation. Greatly affected by the [radius] of the airway. Any process that changes the bronchial diameter or width affects airway resistance and alters the rate of airflow for a given pressure gradient during respiration. Increased resistance = greater than normal respiratory effort +-----------------------------------------------------------------------+ | CAUSES OF INCREASED AIRWAY RESISTANCE | +-----------------------------------------------------------------------+ | **Contraction of bronchial smooth muscle**---as in asthma | | | | **Thickening of bronchial mucosa**---as in chronic bronchitis | | | | **Obstruction of the airway**---by mucus, a tumor, or a foreign body | | | | **Loss of lung elasticity**---as in emphysema, which is characterized | | by connective tissue encircling the airways, thereby keeping them | | open during both inspiration and expiration. | +-----------------------------------------------------------------------+ **Respiration** ◉ The process of gas exchange between atmosphere air and the blood at the alveoli, and between the blood cells and the cells of the body. ◉ Oxygen diffuses from the air into the blood at the alveoli to be transported to the cells of the body. ◉ Carbon dioxide diffuses from the blood into the air at the alveoli to be removed from the body. **NEUROCHEMICAL CONTROL** **MEDULLA OBLONGATA** -- respiratory center initiates each breath by sending messages to primary respiratory muscles over the phrenic nerve ( C3-c5). -has inspiration and expiration centers **PONS** -- has 2 respiration centers that work with the inspiration center [to produce normal rate of breathing] **PNEUMOTAXIC CENTER** -- affects the inspiratory effort by limiting the volume of air inspired **APNEUSTIC CENTER** -- prolongs inhalation NOTE: Chemoreceptors responds to changes in pH, increased PaCO2 = increase RR COMPLIANCE ◉ Compliance is the elasticity and expandability of the lungs and thoracic structures. Compliance allows the lung volume to increase when the difference in pressure between the atmosphere and the thoracic cavity (pressure gradient) causes air to flow in. Increased compliance - if lungs lost their elastic recoil and become overdistended (e.g. emphysema ) Decreased compliance - if lungs are "stiff" ( e.g conditions such as severe obesity, pneumothorax, hemothorax. Acute respiratory distress, pleural effusion, pulmonary edema , atelectasis, pulmonary fibrosis. **LUNG VOLUMES** +-----------------------+-----------------------+-----------------------+ | | definition | significance | +-----------------------+-----------------------+-----------------------+ | Tidal volume(TV/ VT ) | Volume of air inhaled | TV may not vary , | | 500ml or 5-10ml/kg | and exhaled with each | even with severe | | | breath | disease | +-----------------------+-----------------------+-----------------------+ | Inspiratory Reserve | The maximum volume of | \- | | Volume | air that can be | | | | inhaled after a | | | 3000 mL | normal inhalation | | +-----------------------+-----------------------+-----------------------+ | Expiratory Reserve | The maximum volume of | ERV is decreased with | | Volume | air that can be | restrictive | | | exhaled after a | conditions ( obesity, | | 1100 mL | normal exhalation | pregnancy and | | | | ascites. | +-----------------------+-----------------------+-----------------------+ | Residual Volume | The volume of air | RV may be increased | | | REMAINING in the | with obstructive | | 1200 mL | lungs after MAX | disease. | | | EXhalation | | +-----------------------+-----------------------+-----------------------+ **LUNG CAPACITIES** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Vital Capacity | Max volume of air | Decreased VC in | | | exhaled from the | neuromuscular | | 4600mL | point of maximum | disease, generalized | | | inhalation | fatigue, atelectasis, | | | | pulmonary edema, copd | | | TV + IRV + ERV | and obesity | +-----------------------+-----------------------+-----------------------+ | Inspiratory capacity | Max volume of air | Decreased IC may | | | inhaled after normal | indicate restrictive | | 3500mL | expiration | disease. , decreased | | | | in obesity | | | TV + IRV | | +-----------------------+-----------------------+-----------------------+ | Functional Residual | Volume in air after | FRC may be increased | | Capacity | normal expiration | with COPF and | | | | decreased in ARDS and | | 2300mL | ERV + RV | obesity | +-----------------------+-----------------------+-----------------------+ | Total Lung Capacity | Volume of air in | TLC may be decreased | | | lungs after a maximum | with restrictive | | 5800mL | inspiration | disease such as | | | | atelectasis and | | | TV + IRV + ERV + RV | pneumonia and | | | | increased in COPD. | +-----------------------+-----------------------+-----------------------+  **Diffusion and Perfusion** ◉ **Diffusion** is the process by which [oxygen and carbon dioxide are exchanged at the air--blood interface.] The alveolar--capillary membrane is ideal for diffusion because of its large surface area and thin membrane. ◉ **Pulmonary perfusion** is the [actual blood flow through the pulmonary circulation.] The blood is pumped into the lungs by the right ventricle through the pulmonary artery. The pulmonary artery divides into the right and left branches to supply both lungs. These two branches divide further to supply all parts of each lung. **Ventilation and Perfusion Balance and Imbalance** ◉ Ventilation: the flow of gas in and out of the lungs ◉ Perfusion: the filling of the pulmonary capillaries with blood. ◉ Adequate gas exchange [depends on an adequate ventilation--perfusion ratio]. In different areas of the lung, the ratio varies. Alterations in perfusion may occur with a [change in the pulmonary artery pressure, alveolar pressure, and gravity. Airway blockages, local changes in compliance, and gravity] may alter ventilation. V./Q. imbalance occurs as a result of inadequate ventilation, inadequate perfusion, or both. (A)Normal Ratio \(B) Low Ventilation- Perfusion Rate : Shunt \- seen in pneumonia, atelectasis, tumor or mucus plug. ( C ) High Ventilation- Perfusion Rate : Dead Space -pulmonary emboli, pulmonary infarction and cardiogenic shock D. Silent Unit - absence of both ventilation and perfusion \- seen in pneumothorax and sever ARDS.  **ASSESSMENT OF THE RESPIRATORY SYSTEM** Health History : OLDCARTS ◉ Onset ◉ Location ◉ Duration ◉ Character ◉ Aggravating and Alleviating factors ◉ Radiation and Timing of the presenting problem ◉ Severity ◉ how these factors impact the patient's activities of daily living, usual work and family activities, and quality of life. ◉ patient's health, personal, and social history, and the family health history Common Symptoms ◉ Dyspnea ◉ Cough ◉ sputum production ◉ chest pain ◉ Wheezing ◉ Hemoptysis ◉ During the health history, the nurse should also consider nonpulmonary diseases when evaluating symptoms, as these symptoms may occur with a variety of other illnesses. **Physical Assessment:** **Inspection** **Palpation** **Percussion** **Auscultation** General Appearance **CLUBBING OF THE FINGERS** ◉ a change in the normal nail bed. It appears as sponginess of the nail bed and loss of the nail bed angle. ◉It a sign of lung disease that is found in patients with chronic hypoxic conditions, chronic lung infections, or malignancies of the lung.  **CYANOSIS** ◉ a bluish coloring of the skin is a very late indicator of hypoxia. The presence or absence of cyanosis is determined by the amount of unoxygenated hemoglobin in the blood. Upper Respiratory Structures **◉ Nose and Sinuses** \- inspect the external nose for lesions, asymmetry, or inflammation \- ask the patient to tilt the head backward \- Gently pushing the tip of the nose upward, the nurse examines the internal structures of the nose, inspecting the mucosa for color, swelling, exudate, or bleeding. Next, inspect the srptum for deviation, perforation or bleeding. ◉ **Mouth and Pharynx** After the nasal, inspection, the nurse assesses the mouth and the pharynx, instructing the patient to open the mouth wide and take a deep breath. Usually, this flattens the posterior pillars, tonsils, uvula, and posterior pharynx. ◉ **Trachea** \- the position and mobility of the trachea are noted by direct palpation. This is performed by placing the thumb and the index finger of one hand on either side of the trachea just above the sternal notch. \- highly sensitive, and palpating too firmly may trigger a coughing or gagging response Lower Respiratory Structures and Breathing ◉ **Positioning** To assess the posterior thorax and the lungs, the patient should be in a sitting position with arms crossed in front of the chest and hands placed on the opposite shoulders. \- to assess aterior thorax and lungs, pt should be supine / sitting. if unable to sit, supine and roll from side to side to complete posterior examination. ◉ **Thoracic Inspection** Inspection of the thorax provides information about the respiratory system, the musculoskeletal structure and the patient's nutritional status. The nurse observes the skin over the thorax for color and turgor and for evidence of loss of subcutaneous tissue. **Chest Configuration** Normally, the ratio of the anteroposterior diameter to the lateral diameter is 1:2. However, there are four main deformities of the chest associated with respiratory disease that alter this relationship: A. **Barrel Chest** \- occurs as a result of overinflation of the lungs, which increases the anteroposterior diameter of the thorax. It occurs with aging an is a hallmark sign of emphysema and COPD. B. **Funnel Chest ( Pectus Excavatum )** \- Funnel Chest occurs when there is a depression in the lower portion of the sternum. Funnel chest may occur with rickets or \*Marfan syndrome. \* *is a genetic disorder that changes the proteins that help make healthy connective tissue. This leads to problems with the development of connective tissue, which supports the bones, muscles, organs, and tissues in your body.* C. **Pigeon Chest (Pectus Carinatum)** \- A pigeon chest occurs as a result of the anterior displacement of the sternum, which also increases the anteroposterior diameter. D. **Kyphoscoliosis** \- characterized by elevation of the scapula and a corresponding S-shaped spine. Breathing Patterns and Respiratory Rate Normal RR: 12-20bpm Eupnea : normal pattern associated with breathing Apnea : temporary pauses of breathing **Thoracic Palpation** \- nurse palpates the thorax for [tenderness, masses,] [lesions, respiratory excursion, and vocal fremitus.] \- If the patient has reported an area of pain or if lesions are apparent, the nurse performs direct palpation with the fingertips (for skin lesions and subcutaneous masses) or with the ball of the hand (for deeper masses or generalized flank or rib discomfort). **Respiratory Excursion** Respiratory excursion is an [estimation of thoracic expansion a]nd may disclose significant information about thoracic movement during breathing.  Posteriorly, at level of T9 or T10. pinch a small amount of skin between your thumbs, Observe for symmetry as pt exhales fully following a deep inspiration. ◉ Tactile Fremitus \- vibrations of the chest wall that result from speech detected on palpation. \- Normally, sounds generated by the larynx travel distally along the bronchial tree to set the chest wall in resonant motion. This is most pronounced with consonant sounds. *\*bony areas are not assessed.* ◉ Thoracic Percussion Percussion produces audible and tactile vibration and allows the nurse to determine whether underlying tissues are filled with air, fluid, or solid material. Healthy lung tissue i[s resonant.] **◉ Diaphragmatic Excursion** The normal resonance of the lung stops at the diaphragm. The position of the diaphragm is different during inspiration and expiration.  ◉ **Thoracic Auscultation** Assessment concludes with auscultation of the anterior, posterior, and lateral thorax. Auscultation helps the nurse [assess the flow of air through the bronchial tree and evaluate the presence of fluid or solid obstruction in the lung. ] *\*ladder pattern : to differentiate left and right sounds.* ◉ Breath Sounds Normal breath sounds are distinguished by their location over a specific area of the lung and are identified as vesicular, bronchovesicular, and bronchial (tubular) breath sounds.  ◉ Adventitious Sounds An abnormal condition that affects the bronchial tree and alveoli may produce adventitious (additional) sounds Some adventitious sounds are divided into two categories: [discrete, discontinuous sounds (crackles)] and [continuous musical sounds (wheezes)] +-----------------+-----------------+-----------------+-----------------+ | CRACKLES | description | | | | | | | | | \- | | | | | discontinuous | | | | | popping sound | | | | +-----------------+-----------------+-----------------+-----------------+ | Crackles in | soft, | During | | | general | high-pitched | inpiration/ | | | | | expiration | | | | | | | | | | May or may not | | | | | be cleared by | | | | | coughing | | +-----------------+-----------------+-----------------+-----------------+ | Coarse crackles | Harsh, moist | Early | Large bronchi | | | sound | inspiration | | +-----------------+-----------------+-----------------+-----------------+ | Fine crackles | Like hair | Late | alveoli | | | rubbing | inspiration | | | | together | | | +-----------------+-----------------+-----------------+-----------------+ +-----------------+-----------------+-----------------+-----------------+ | WHEEZES | | | | +-----------------+-----------------+-----------------+-----------------+ | Wheezes in | | Expiration, may | | | general | | be heard on | | | | | inspiration | | | | | depending on | | | | | the cause | | +-----------------+-----------------+-----------------+-----------------+ | Sonorous | Deep, | During | Narrowed | | wheezes ( | low-pitched | expiration | tracheobronchia | | Rhonchi ) | rumbing soundss | | l | | | | | passage | +-----------------+-----------------+-----------------+-----------------+ | Sibilant | Continuous, | During | Narrowed or | | wheezes | musical, high | inspiration and | partially | | | pitched, | expiration | obstructed | | | whistle like | | airways | | | sounds | \- may clear | | | | | with coughing | | +-----------------+-----------------+-----------------+-----------------+ +-----------------+-----------------+-----------------+-----------------+ | Pleural | Harsh, | During | | | friction rub | crackling | inspiration | | | | sound, like two | alone or both | | | | pieces of | in and | | | | leather being | expiration | | | | rubbed together | | | | | | \- may subside | | | | | when pt holds | | | | | breath | | | | | | | | | | \- heard over | | | | | the lower | | | | | lateral | | | | | anterior | | | | | surface of | | | | | thorax | | +-----------------+-----------------+-----------------+-----------------+ Breathing Patterns and Respiratory Rates **◉ Voice Sounds** The sound heard through the stethoscope as the patient speaks is known as vocal resonance. The nurse should assess voice sounds when abnormal breath sounds are auscultated. The vibrations produced in the larynx are transmitted to the chest wall as they pass through the bronchi and alveolar tissue. ◉ Bronchophony describes vocal resonance that is more intense and clearer than normal. ◉ Egophony describes voice sounds that are distorted. It is best appreciated by having the patient repeat the letter E. The distortion produced by consolidation transforms the sound into a clearly heard A rather than E. ◉ Whispered pectoriloquy describes the ability to clearly and distinctly hear whispered sounds that should not normally be heard. **DIAGNOSTIC EVALUATION** 1. **SKIN TEST: MANTOUX TEST OR TUBERCULIN TEST** ◉ This is used to determine if a person has been infected or has been exposed to TB bacillus ◉ This utilizes the PPD (Purified Protein Derivatives) and is injected intradermally usually in the inner aspect of the lower forearm about 4 inches below the elbow ◉ The test is read [48 to 72 hours] after injection ◉ (+) Mantoux test is induration of 10 mm or more ◉ Induration of 5 mm for immunocompromised hosts (HIV positive patient) is considered positive ◉ Signifies exposure to M. tubercule bacilli. 2. **PULSE OXIMETER** ◉ Non-invasive method of continuously monitoring the oxygen saturation of hemoglobin ◉ A probe or sensor is attached to the fingertip , forehead, earlobe or bridge of the nose ◉ Sensor detects changes in O2 sat levels by monitoring light signals generated by the oximeter and reflected by the blood pulsing through the tissue at the probe. ◉ Normal SpO2 = 95%-100% ◉ \ 8. **LUNG SCAN** Nursing interventions BEFORE the procedure: ◉ Allay the patient's anxiety ◉ Instruct the patient to remain still during the procedure Nursing interventions AFTER the procedure: ◉ Check the catheter insertion site for bleeding ◉ Assess for allergies to injected radioisotopes ◉ Increase fluid intake, unless contraindicated. 9. **SPUTUM EXAMINATION** ◉ Laboratory test ◉ Indicated for microscopic examination of the sputum: Gross appearance, sputum C&S, AFB staining, and for Cytologic examination/Papanicolaou examination. Nursing interventions: ◉ Early morning sputum specimen is to be collected (suctioning or expectoration) ◉ Rinse mouth with plain water ◉ Use sterile container ◉ Sputum specimen for C&S is collected before the first dose of anti-microbial therapy. ◉ For AFB staining, collect sputum specimen for three consecutive mornings. 10. **BIOPSY OF THE LUNGS** ◉ Percutaneous removal of a smallamount of lung tissue ◉ For histologic evaluation ◉ Transbronchoscopic biopsy -- done during bronchoscopy ◉ Percutaneous needle biopsy ◉ Open lung biopsy Nursing interventions BEFORE the procedure: ◉ Withhold food and fluids ◉ Place obtained written informed consent in the patient's chart Nursing interventions AFTER the procedure: ◉ observe the patient for signs of Pneumothorax and air embolism ◉ check the patient for hemoptysis and hemorrhage ◉ monitor and record vital signs ◉ check the insertion site for bleeding ◉ monitor for signs of respiratory distress 11. **LYMPH NODE BIOPSY** ◉ scalene or cervicomediastinal ◉ to assess metastasis of lung cancer 12. **PULMONARY FUNCTION TEST/ STUDIES** ◉ Pulmonary function tests (PFTs) are routinely used in patients with chronic respiratory disorders to aid diagnosis. ◉ They are performed to assess respiratory function and to determine the extent of dysfunction, response to therapy, and as screening tests in potentially hazardous industries. ◉ PFTs generally are performed by a technician using a spirometer that has a volume-collecting device attached to a recorder that demonstrates volume and time simultaneously. \- non-invasive test \- measurement of lung volume, ventilation and, diffusing capacity Nursing interventions: document bronchodilators or narcotics used before testing allay the patient's anxiety during the testing 13. ARTERIAL BLOOD GASES (ABGs) ◉ Laboratory test ◉ Indicate respiratory functions ◉ Assess the degree to which the lungs are able to provide adequate oxygen and remove CO2. ◉ Assess the degree to which the kidneys are able to reabsorb or excrete bicarbonate ◉ Assessment of arterial blood for tissue oxygenation, ventilation, and acid-base status ◉ Arterial puncture is performed on areas where good pulses are palpable (radial, brachial or femoral). Radial artery is the most common site for withdrawal of blood Specimen Nursing interventions: ◉ - utilize a 10-ml pre-heparinized syringe to prevent clotting of specimen ◉ - soak specimen in a container with ice to prevent hemolysis ◉ - if ABG monitoring will be done, do \* Allen's test to assess for adequacy of collateral circulation of the hand (the ulnar arteries) \* 14. **PULMONARY ANGIOGRAPHY** ◉ This procedure takes x-ray pictures of the pulmonary blood vessels (those in the lungs) ◉ Because arteries and veins are not normally seen in an x-ray, a contrast material is injected into one or more arteries or veins so that they can be seen. 15. **THORACENTESIS** ◉ Procedure using needle aspiration of intrapleural fluid or air under local anesthesia ◉ Specimen examination or removal of pleural fluid Nursing intervention **DURING** the procedure: ◉ Reassess the patient ◉ Place the patient in the proper position: ◉ Upright or sitting on the edge of the bed ◉ Lying partially on the side, partially on the back Nursing interventions **AFTER** Thoracentesis \- Assess the patient's respiratory status \- Monitor vital signs frequently \- Position the patient on the [affected side], as ordered, for at least 1hour to seal the puncture site \- turn on the unaffected side to prevent leakage of fluid in the thoracic cavity \- check the puncture site for fluid leakage \- auscultate lungs to assess for pneumothorax \- monitor oxygen saturation (SaO2 ) levels \- bed rest \- Check for expectoration of blood.