NCM 118 Respiratory System: Preliminary Topics PDF

NCM 118 ------- ### THE 3 PROCESS OF RESPIRATION: 1. Pulmonary Ventilation / Breathing: The movement as inflow and outflow of the air between the atmosphere and the alveoli of the lungs (300 -- 500 cc of air tidal volume ) 2. Gas Diffusion: Takes along the alveoli capillary membrane to...

NCM 118 ------- ### THE 3 PROCESS OF RESPIRATION: 1. Pulmonary Ventilation / Breathing: The movement as inflow and outflow of the air between the atmosphere and the alveoli of the lungs (300 -- 500 cc of air tidal volume ) 2. Gas Diffusion: Takes along the alveoli capillary membrane to the pulmonary capillaries. - Diffusion process is the exchange of gases or movement of gases from the area of higher 3. Gas Perfusion: The availability & movement of the blood for transport of gases, nutrients, and metabolic waste products. - The process of gas transport is the function of the cardiovascular system -- the heart pumps oxygen rich blood via the blood vessels as the transportation network. As (arteries, arterioles, veins, capillaries to the tissues.) ### NURSING ASSESSMENT - Present Health History -- aside from biographic data of the client. It also includes or focuses on the physical & functional problem, the effect of this problem to the patient, including the ability to carry out ADL. - Chief Complaints / Reason in seeking healthcare -- the nurse also determine when the health problem or symptoms started & how long it lasted In seeking health care. Information about precipitating factors, duration, severity, & - Past Health History -- previous diseases acquired by the patient prior to seeking consultation, includes childhood illness, immunization, hospitalization and medication maintenance. - Family History of Illness - parents, grandparents, current health or cause of death, nearest kin. It also reveals for certain diseases as DM, HPN, OBESITY, CA,OBESITY and respiratory impairment (asthma, lung ca., history of cystic fibrosis & COPD). - Social History -- psychosocial factors include anxiety, role changes, family relationship, financial problems, employment status. ### PHYSICAL ASSESSMENT - Respiratory System General Appearance -- the nurse inspects for clubbing of fingers and skin color as cyanosis as signed of tissue hypoxia. Lungs & Thorax (IPPA) - Inspection: Look for this characteristics in - Observe use of accessory muscles to assist in breathing not usually used, instead diaphragm is the major muscle at work. - Inspect for client positioning -- client should be sitting up & relaxed. Not in tripod position commonly seen in COPD. - The nurse also observes the: rate, depth (volume of breathing). ### THE RHYTHM & QUALITY OF BREATHING - Breathing patterns includes rate, (nv: 12 -- 20 in adult) \[EUPNEA\] - TACHYPNEA -- rapid marked by quick, shallow breaths - BRADYPNEA -- abnormally slow breathing ; seen in patient with brain injury like CVA / STROKE. - APNEA -- cessation of breathing. - *Ex. obstructive sleep apnea as temporarily only related to transient upper airway obstruction.* ### VOLUME OF BREATHING/DEPTHNESS - Hyperventilation -- an increase in the amount of air in the lungs characterized by prolong & deep breaths associated with anxiety, stress. - Hypoventilation -- reduction in the amount of air in the lungs, characterized by shallow respiration. Ex -- COPD. ### RHYTHM - Cheyne -- Stokes Breathing -- respiration is from very deep to very shallow breathing and temporary apnea, often associated with cardiac failure, ICP/ brain damage. (Ex; COPD). - Biots Respiration -- refers to sequences of uniformly deep gaps, followed by "apnea". ### CHEST MOVEMENTS - Intercostal Retraction -- indrawing between the ribs. - Substernal Retraction -- in drawing beneath the breastbone. - Suprasternal Retraction -- in drawing above the clavicles. - Tracheal Tug -- in drawing & downward full of the trachea during inspiration. - Flail Chest -- the ballooning out of the chest walls. Through injured rib spaces resulting to *paradoxical breathing*. ### ABNORMAL BREATH SOUNDS / ADVENTITIOUS SOUNDS (AUSCULTATION) - Crackles / Rales -- intermittent, non musical loud low pitched, gurgling sounds heard during early inspiration & possible during expiration. Simulated by rolling a lock of hair near the ear. - Wheezing / Wheezes -- continuous sounds musical, high pitched, whistling sounds predominantly heard during expiration but also occur during inspiration. Associated with airway narrowing or partial obstruction. - Stridor -- loud, high pitched crowing sound can be heard on inspiration / usually no need of stethoscope, caused by upper airway obstruction. - Stertorous Breaths -- snoring or sonorous respiration, usually due to partial obstruction of upper airway. Seen in unconscious patients. - Pleural Friction Rub -- low pitched grating sound produced by the rubbing together of inflamed pleura. ### ASSESSMENT ACCORDING TO SECRETIONS / COUGHING - Hemoptysis -- presence of blood in the sputum. - Productive cough & Non -- productive cough ### CHEST PAIN / DISCOMFORT - May be due to pulmonary or cardiac diseases. - Utilized the mnemonic point of assessment as; ### "COLDSPA". - Chest pain may occur with pneumonia, pulmonary embolism, with lung infarction, bronchogenic ca. ### NON-INVASIVE DIAGNOSTIC ASSESSMENT - Radiographic or chest x-ray - Direct visualization - PFT's - Broncho Spirometry - Ventilation Therapy - Sputum analysis or microscopy - Pulse oximeter - Smoke analyzer - Fagerstrom Test ### INVASIVE PROCEDURES - Pulmonary Bronchoscopy - ABG (Arterial Blood Gases) - Thoracentesis - Pulmonary Angiography - Biopsy - Laboratory Studies ACUTE RESPIRATORY SYSTEM FAILURE ================================ ### RESPIRATORY SYSTEM - The respiratory system is the set of organs and tissues that help you breathe and exchange the gases of life -- oxygen and carbon dioxide. - The respiratory system consists of your airways, your lungs , certain blood vessels that contribute to the functioning of your lungs and muscles that support your airways and lungs. - 2 separate process of respiration: 1. External respiration -- gas exchange between oxygen and carbon dioxide within the lung (O2 diffuses into the blood stream from the lung, is delivered to the tissues and CO2 is removed. 2. Internal respiration -- the internal utilization of oxygen in the phosphorylation process. Both ATP which are high-energy phosphate bonds and CO2 are by-products of this intracellular metabolism.  ### NORMAL GAS EXCHANGE - In the lungs, there are two types of respiratory units: *alveoli* and *capillaries*. - The *alveoli* are small air sacs where oxygen and carbon dioxide are exchanged between the air and the blood. - The capillaries are tiny blood vessels that surround the alveoli. - Gas exchange occurs through diffusion. Oxygen moves from the alveoli to the blood, and carbon dioxide moves from the blood to the alveoli. The amount of gas that diffuses depends on the concentration gradient between the alveoli and the blood. - The normal alveolar-arterial oxygen difference (A-aDO2) is less than 15 mmHg. This means that the oxygen level in the alveoli is about 15 mmHg higher than the oxygen level in the blood. ### ACUTE RESPIRATORY FAILURE - Acute respiratory failure is a pathological condition arising from numerous causes which results in impairment of gas exchange related to abnormalities either within ventilation, diffusion or gas transport. Each of these may react singularly or in combination to induce ARD. - Patients presenting in ARF represent a critical care emergency and may be one of the most prevalent problems facing the critical care nurse. - ARF patients are unable to maintain an adequate gas exchange ; thereby presenting with severe hypoxemia (PaO2 \ - Alveolar hypoventilation: This is when the lungs do not get enough ventilation. This can happen due to factors such as central nervous system depression, neuromuscular weakness, and chest wall deformities. - Ventilation/perfusion (V/Q) mismatch: There is an imbalance between the amount of ventilation (airflow) and perfusion (blood flow) to the alveoli. This can happen in - Shunt: This is when blood bypasses the alveoli and does not get oxygenated. This can happen in diseases such as congenital heart defects and pulmonary embolism. - Diffusion impairment: This is when the oxygen molecules have difficulty diffusing across the alveolar-capillary membrane. This can happen in diseases such as interstitial lung disease and pulmonary fibrosis. ### ASSESSMENT - ARF represents a medical emergency which may limit an in depth -- assessment of the patient. - In this instance the assessment is directed towards the patient's chief complaints, precipitating factors, symptomatology. A. The clinical manifestations associated with ARF maybe differential on the basis of a low PaO2 and high PaCO2 in ARF (Type II). ### TREATMENT OF RESPIRATORY FAILURE - Oxygen therapy: This may be given by nasal cannula, face mask, or mechanical ventilation. - Medications: These may be used to treat the underlying cause of respiratory failure, such as bronchodilators for asthma or antibiotics for pneumonia. - Mechanical ventilation: This may be necessary in severe cases of respiratory failure. - *Note: Respiratory failure is a serious condition that can be life-threatening. Early diagnosis and treatment are important to improve the chances of survival.*