Respiratory System Updated PDF

The S Respiratory System Respiratory System functions to supply oxygen for the metabolic needs of the cells and to remove one of the waste materials of cellular metabolism, the carbon dioxide Structural Anatomy of the Respiratory System Upper Respiratory Tract (Upper A...

The S Respiratory System Respiratory System functions to supply oxygen for the metabolic needs of the cells and to remove one of the waste materials of cellular metabolism, the carbon dioxide Structural Anatomy of the Respiratory System Upper Respiratory Tract (Upper Airway) primarily refers to the parts of the respiratory system lying outside of the thorax or above the sternal angle is the airway above the glottis or vocal cords Includes the Nose, Pharynx and Larynx Lower Respiratory Tract (Lower Airway) refers to the portions of the respiratory system from the trachea to the lungs  Functions of the Respiratory System Gas exchange or respiration The respiratory system allows oxygen from air to enter the blood and carbon dioxide to leave the blood and enter the air The cardiovascular system, on the other hand, transports oxygen from the lungs to the body cells and carbon dioxide from the body cells to the lungs. Respiration includes the following processes: Ventilation or breathing - the movement of air into and out of the lungs External respiration- exchange of oxygen and carbon dioxide between the air in the lungs (alveoli) and the blood Transport of respiratory gases- oxygen and carbon dioxide must be transported to and from the lungs and tissue cells of the body. This uses blood as the transporting fluid. Internal respiration- the exchange of oxygen and carbon dioxide between the blood and the cells. Functions of the Respiratory System Regulation of body pH Voice production Olfaction Innate immunity  Functional Anatomy of the Respiratory System Conducting Zones (Dead Space) These are the respiratory passages extending from the nose to the terminal bronchioles For passage or air Nose to terminal bronchioles Respiratory Zones Where absorption of oxygen and removal of carbon dioxide from the blood takes place Composed of the respiratory bronchioles, alveolar ducts and alveoli The respiratory zones begins as the terminal bronchioles feed into the respiratory bronchioles 1. The Nose  Divisions of the Pharynx Nasopharynx located posterior to the choanae and superior to the soft palate, an incomplete muscle and connective tissue partition separating the nasopharynx from the oropharynx. Uvula is the posterior extension of the soft palate where the auditory or eustachean tube opens pharyngeal tonsil or adenoid- upper end of the posterior wall of nasopharynx Function: serves only as passageway for air  Divisions of the Pharynx Oropharynx extends from the uvula to the epiglottis; located behind the oral cavity the oral cavity opens into the oropharynx both swallowed food and inhaled air pass through it Features of the oropharynx: Palatine and lingual tonsil Laryngopharynx passes posterior to the larynx and extends from the tip of the epiglottis to the esophagus common passageway for food and air 4. The Larynx (Voice box) located in the anterior throat (pharynx) and extends from the base of the tongue to the trachea Functions: passageway for air between the pharynx and the trachea specially modified for the production of voice also functions for sphincter for lower respiratory tract  Nine Cartilages of the Larynx Unpaired Thyroid cartilage Cricoid cartilage- the most inferior Epiglottis Paired Cuneiform cartilages Corniculate cartilages Arytenoid cartilages the most important among the three paired cartilages which anchor the vocal cords to the larynx 5. The Trachea (Windpipe) a membranous cylindrical tube attached to the larynx with 16-20 C –shaped pieces of hyaline cartilage extends from the level of the 6th cervical vertebra to the 5th thoracic vertebra Posterior wall has no cartilage and consists of a ligamentous membrane and smooth muscle Flattened posteriorly where it comes into contact with the esophagus The trachea projects through the mediastinum and divides into right and left main (primary) bronchi. Carina- the junction where the trachea and the two primary bronchi branch is reinforced by a cartilage plate Function: passage of air to reach the lungs 6. The Bronchi and Subdivisions: The Bronchial Tree The Respiratory Zones The respiratory zones begins as the terminal bronchioles feed into the respiratory bronchioles Alveolar ducts Alveolar sacs Alveoli The functional units of the lungs Gaseous exchange between blood and air occurs here where actual gas exchange happens  Summary of the Pathway of Air External nose→ Internal Nose (Nasal cavity) → Pharynx → Larynx → Trachea→ Right and left main (primary bronchi) → Lobar (secondary) bronchi → Segmental (tertiary) bronchi→ Bronchiole→ Terminal bronchiole→ Respiratory bronchioles→ Alveolar ducts→ Alveolar sacs→ Alveoli The branching of the primary bronchi occurs inside the LUNGS The Lungs the principal organs of respiration free at the pleural cavity, except for attachment to the heart and trachea at the hilum Characteristics of the lungs: soft, spongy, elastic organs, each weighing 0.5 kg (together weigh only 1 kg) cone-shaped, with its base resting on the diaphragm and its apex extending superiorly to a point about 1 in above the clavicle pinkish in infants, dark gray and patchily mottled in adults Inflated lungs float in water, fetal lung is solid and sink in water. Difference between Right and Left Lungs RIGHT LUNG LEFT LUNG Lobes Three (3) Two (2) Superior, Middle and Inferior Superior and Inferior Fissures 1 horizontal 1 oblique 1 oblique Diameter Wider Narrower Length Shorter Longer Weight Heavier Lighter Bronchi Eparterial and Hyparterial Hyparterial only Number of bronchopulmonary 10 8-10 segments Cardiac notch Absent Present (at the anterior border) Lingula Present (tongue-like portion of the Absent upper lobe between the cardiac notch and oblique fissure Others With deeper diaphragmatic surface due to presence of liver The Lungs Physiology of Respiration Functions of the Respiratory System Respiration includes the following processes: Ventilation or breathing - the movement of air into and out of the lungs External respiration- exchange of oxygen and carbon dioxide between the air in the lungs (alveoli) and the blood Transport of respiratory gases- oxygen and carbon dioxide must be transported to and from the lungs and tissue cells of the body. This uses blood as the transporting fluid. Internal respiration- the exchange of oxygen and carbon dioxide between the blood and the cells. Pulmonary Ventilation: Inspiration and Expiration Gas Exchange External respiration: Pulmonary gas exchange- exchange of oxygen and carbon dioxide between the air in the lungs (alveoli) and the blood TRANSPORT OF RESPIRATORY GASES IN THE BLOOD Internal Respiration: the exchange of oxygen and carbon dioxide between the blood and the tissues.  TRANSPORT OF RESPIRATORY GASES IN THE BLOOD Oxygen transport After oxygen diffuses through the respiratory membrane into the blood: 98.5%- combine reversibly with the iron-containing heme groups of hemoglobin (oxyhemoglobin) 1.5% - remains dissolved in the plasma Carbon dioxide transport CO2 diffuses from cells, where it is produced, into tissue capillaries. After carbon dioxide enters the blood, it is transported in 3 ways: 7%- dissolved in plasma 23%- transported in combination with haemoglobin (carbaminohemoglobin) 70%- transported in the form of bicarbonate ions CO2 + H2O H2CO2 H+ + HCO3 carbonic acid bicarbonate Control of Respiration MEDULLARY RESPIRATORY CENTERS Dorsal inspiratory group or inspiratory centers pace-setting nucleus which is responsible for the rhythm of breathing When the inspiratory neurons fire, nerve impulses travel along the phrenic and intercostal nerves to excite the diaphragm and external intercostals muscle respectively. When the inspiratory center becomes dormant, then expiration occurs passively, as the inspiratory muscles are allowed to relax and recoil. This cyclic on-off activity is repeated and produces a respiratory rate between 12 and 20 breaths per minute. Ventral respiratory group or expiratory center (VRG) Contains both inspiratory and expiratory neurons When forceful breathing becomes necessary, the expiratory center sends activating impulses to the muscles of expiration which cause vigorous depression of the rib cage and more strenuous expiratory movements Control of Respiration PONS RESPIRATORY CENTERS Pneumotaxic center This fine-tunes the breathing rhythm and prevents over inflation of the lungs Continuously sends inhibitory impulses to the inspiratory center of the medulla, and when signals are particularly strong, the duration of inspiration is shortened. Apneustic center Provides inspiratory drive by continuously stimulating the medullary inspiratory center Its effect is to prolong inspiration with very short expiration to cause breath holding in the inspiratory phase, called apneusis. HERING-BREUER REFLEX This supports the rhythmic respiratory movements by limiting the extent of inspiration When the lung is filled with air, the stretch receptors in the visceral pleura and conducting passages are stimulated, and transmit inhibitory signals to the medullary inspiratory center and allow expiration to occur. As the lungs recoil, the stretch receptors become quiet, and inspiration is initiated once again Chemical Control of Respiration Carbon dioxide levels in the blood are the major driving force for regulating breathing. A greater than normal amount of CO2 in the blood is called hypercapnia and less than normal CO2 in the blood is called hypocapnia. Oxygen is not normally as important as carbon dioxide in regulating breathing because hemoglobin is very effective at picking up oxygen in the lungs. As long as carbon dioxide levels are normal, blood oxygen levels are usually normal as well. Changes in blood carbon dioxide levels are not directly detected, however. Instead, changes in blood pH are monitored. This can occur because changes in CO2 cause changes in pH. Sensors responding to changing levels of CO2, O2, and H+ ions in the arterial blood are called chemoreceptors. Chemical Control of Respiration Central chemoreceptors located bilaterally in the medulla These are sensitive to small changes in blood CO2 and pH As the blood carbon dioxide levels increase, the blood pH decreases (becomes more acidic). Conversely, as blood carbon dioxide levels decrease, the blood pH increases (becomes more basic) Can detect a decrease in blood pH, typically caused by an increase in blood CO2 (hypercapnia) → the respiratory center increases breathing and therefore CO2 is removed from the blood. As the blood CO2 levels decrease, blood pH increases; homeostasis is maintained. Can also detect an increase in blood pH, typically caused by a decrease in carbon dioxide (hypocapnia) → respiratory center decreases breathing and therefore less CO2 is removed from the blood. Because CO2 is continually produced, CO2 levels now increase, causing pH to decrease; thus homeostasis is again maintained. Chemical Control of Respiration Peripheral chemoreceptors These are found within the vessels of the neck (the carotid bodies and aortic bodies) Sensitive to arterial oxygen levels Between the two, the carotid bodies are the main oxygen sensors When blood oxygen declines to a low level, a condition called hypoxia results. The chemoreceptors of the carotid bodies and aortic bodies are strongly stimulated. They send action potentials to the respiratory center and produce an increase in rate and depth of breathing. The increased breathing increases diffusion from the alveoli in the blood, resulting in more oxygen in the blood.  OXYGEN TRANSPORT MECHANISM The oxygen transport mechanism in the human body is a complex physiological process that ensures the delivery of oxygen from the lungs to tissues and the removal of carbon dioxide from tissues to the lungs. This process is vital for cellular metabolism and involves several key components: ventilation-perfusion (V/Q) matching, the oxyhemoglobin dissociation curve, oxygen partial pressure, and clinical assessment and diagnostics.  VENTILATION-PERFUSION (V/Q) MATCHING Ventilation-perfusion (V/Q) matching is the relationship between the amount of air reaching the alveoli (ventilation) and the amount of blood flow reaching the alveoli (perfusion). For optimal gas exchange, these two processes must be closely matched. The normal V/Q ratio is approximately 0.8, indicating that perfusion is slightly greater than ventilation.  IMBALANCE VENTILATION-PERFUSION (V/Q) RATIO High V/Q Ratio: Occurs when ventilation exceeds perfusion, leading to wasted ventilation. Conditions such as pulmonary embolism, where blood flow is obstructed, can cause a high V/Q ratio. IMBALANCE VENTILATION-PERFUSION (V/Q) RATIO Low V/Q Ratio: Occurs when perfusion exceeds ventilation, leading to inadequate oxygenation of blood. Conditions such as chronic obstructive pulmonary disease (COPD) and asthma can cause a low V/Q ratio. IMBALANCE VENTILATION-PERFUSION (V/Q) RATIO Low V/Q Ratio: Occurs when perfusion exceeds ventilation, leading to inadequate oxygenation of blood. Conditions such as chronic obstructive pulmonary disease (COPD) and asthma can cause a low V/Q ratio.  IMBALANCE VENTILATION-PERFUSION (V/Q) RATIO Oxyhemoglobin Dissociation Curve The oxyhemoglobin dissociation curve is a graphical representation that describes the relationship between the partial pressure of oxygen (PaO₂) and the percentage saturation of hemoglobin with oxygen (SaO₂). The curve is sigmoidal (S-shaped), reflecting hemoglobin’s affinity for oxygen under different physiological conditions.  IMBALANCE VENTILATION-PERFUSION (V/Q) RATIO Key Features of the Curve: Left Shift: Indicates increased hemoglobin affinity for oxygen, making it more difficult to release oxygen to tissues. Causes include alkalosis, hypothermia, and decreased levels of 2,3-diphosphoglycerate (2,3-DPG).  IMBALANCE VENTILATION-PERFUSION (V/Q) RATIO Key Features of the Curve: Right Shift: Indicates decreased hemoglobin affinity for oxygen, facilitating oxygen release to tissues. Causes include acidosis, hyperthermia, and increased levels of 2,3- DPG.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Oxygen partial pressure (PaO₂) is the measure of the pressure exerted by oxygen dissolved in the blood and is a crucial parameter in assessing oxygenation status. Normal range: Adult: 80-100 mm Hg Newborns: 60-70 mmHg It is usually measured in arterial blood gases (ABGs) and is expressed in millimeters of mercury (mm Hg)  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Disorders Associated with PaO2 Imbalances 1. Hypoxemia (Low PaO₂)Hypoxemia is a condition characterized by abnormally low levels of oxygen in the blood. Definition: PaO₂ < 80 mmHg in adults.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Causes: Chronic Obstructive Pulmonary Disease (COPD): Impaired gas exchange due to obstructed airways and damaged alveoli. Pulmonary Edema: Fluid in the lungs hampers oxygen diffusion.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Causes: Pulmonary Embolism: A blockage in the pulmonary artery reduces blood flow to the lungs, decreasing oxygenation. High Altitude: Reduced atmospheric oxygen pressure leads to lower PaO₂.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Causes: Acute Respiratory Distress Syndrome (ARDS): Severe inflammation in the lungs causes stiff alveoli, reducing oxygen transfer.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Causes: 2. Hyperoxemia (High PaO₂)Hyperoxemia refers to an abnormally high PaO₂, which is generally less common and occurs in specific clinical scenarios.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations 2. Hyperoxemia (High PaO₂)Hyperoxemia refers to an abnormally high PaO₂, which is generally less common and occurs in specific clinical scenarios. PaO2 > 100mmHg  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Causes: Oxygen Therapy: Excessive oxygen administration, particularly in patients receiving mechanical ventilation, can elevate PaO₂ to dangerous levels.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Causes: Hyperbaric Oxygen Therapy: Treatment involves breathing pure oxygen in a pressurized chamber, significantly increasing PaO₂.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Related Abbreviations: PaO₂: Partial pressure of oxygen in arterial blood. Normal Range: 80-100 mm Hg This value reflects the amount of oxygen dissolved in the arterial blood and is a critical measure of how well oxygen is being transferred from the lungs to the blood.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Related Abbreviations: SaO₂: SpO₂:  Oxygen Partial Pressure (PaO₂) and Related Abbreviations SaO₂ (Arterial Oxygen Saturation) SaO₂ represents the percentage of hemoglobin molecules in the blood that are saturated with oxygen in arterial blood. It is determined through an arterial blood gas (ABG) test. Normal Range: 95-100%  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Key Points: SaO₂ is directly measured from arterial blood, providing a precise assessment of oxygenation. Oxygen Partial Pressure (PaO₂) and Related Abbreviations Key Points: It is typically used in critical care settings, operating rooms, and for detailed respiratory evaluations.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Key Points: SaO₂ is often correlated with PaO₂; as PaO₂ increases, SaO₂ also increases, but this relationship is not linear. The oxygen- hemoglobin dissociation curve illustrates this non-linear relationship  Oxygen Partial Pressure (PaO₂) and Related Abbreviations SpO₂ (Peripheral Oxygen Saturation) SpO₂ is an estimate of the arterial oxygen saturation (SaO₂) derived from a non-invasive measurement using a pulse oximeter, a device typically placed on a patient's fingertip or earlobe. Normal Range: 95-100%  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Key Points: SpO2 is widely used in clinical settings for continuous monitoring of patient’s oxygenation status  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Key Points: While SpO2 is generally accurate, it can be affected by various factors such as poor circulation, skin pigmentation, nail polish, and movement.  Oxygen Partial Pressure (PaO₂) and Related Abbreviations Key Points: SpO2 is less accurate at a vary high or very low oxygen saturation levels compared to SaO2. Disorders Associated with Abnormal SaO2 and SpO2 1. Hypoxemia (Low SaO2/SpO2) Chronic Respiratory Diseases: Conditions like COPD, asthma, or interstitial lung disease can lead to low oxygen saturation. Disorders Associated with Abnormal SaO2 and SpO2 1. Hypoxemia (Low SaO2/SpO2) Acute Respiratory Conditions: Pneumonia, ARDS, and pulmonary embolism can cause a sudden drop in oxygen levels. Disorders Associated with Abnormal SaO2 and SpO2 1. Hypoxemia (Low SaO2/SpO2) Congenital Heart Disease: Defects that affect oxygenation can result in low SaO₂/SpO₂. Disorders Associated with Abnormal SaO2 and SpO2 1. Hypoxemia (Low SaO2/SpO2) Anemia: Reduced hemoglobin levels mean less oxygen can be carried, even if SaO₂/SpO₂ appears normal. Disorders Associated with Abnormal SaO2 and SpO2 2. Hyperoxemia (High SaO2/SpO2) SaO₂/SpO₂ > 100% (not typically encountered naturally, but can be seen in hyperbaric oxygen therapy or with excessive supplemental oxygen). Disorders Associated with Abnormal SaO2 and SpO2 2. Hyperoxemia (High SaO2/SpO2) Excessive Oxygen Supplementation: In critically ill patients, over-supplementation can lead to excessively high oxygen levels. Disorders Associated with Abnormal SaO2 and SpO2 2. Hyperoxemia (High SaO2/SpO2) Hyperbaric Oxygen Therapy: Used to treat conditions like carbon monoxide poisoning, this therapy can cause very high SaO₂/SpO₂ readings. Nursing Assessment of the Respiratory System 1. Patient History 2. Physical Examination 3. Diagnostic Tests  Patient History Gathering a detailed history is the first step in respiratory assessment. This helps identify potential risk factors, underlying conditions, and the nature of the current respiratory issue.  Patient History Chief Complaint: What brings the patient in today? Common complaints include shortness of breath, cough, chest pain, and wheezing.  Patient History History of Present Illness (HPI): Onset: When did the symptoms start? Duration: How long have the symptoms been present? Severity: How severe are the symptoms? Use scales (e.g., 0-10 for pain). Triggering/Alleviating Factors: What makes the symptoms better or worse?  Patient History Past Medical History: Respiratory diseases: History of asthma, COPD, tuberculosis, pneumonia, etc. Surgeries: Any thoracic or respiratory surgeries? Allergies: Allergic reactions, particularly those affecting breathing.  Patient History Medications: Current medications: Especially bronchodilators, steroids, or antibiotics. Inhaler or nebulizer use: Frequency and type  Patient History Family History: History of respiratory diseases such as asthma or cystic fibrosis.  Patient History Social History: Smoking: Pack years (number of packs per day × years of smoking). Occupational exposures: Exposure to dust, chemicals, or pollutants. Travel history: Recent travel that might suggest exposure to endemic infections  Physical Examination 2. Physical Examination The physical examination of the respiratory system involves inspection, palpation, percussion, and auscultation.  Physical Examination A. Inspection General Appearance: Assess the patient’s overall appearance, including signs of distress, cyanosis, and use of accessory muscles. Respiratory Rate and Rhythm: Count the respiratory rate and observe the pattern (normal: 12-20 breaths per minute in adults).  Physical Examination A. Inspection Work of Breathing: Note any labored breathing, retractions, or nasal flaring. Chest Shape and Symmetry: Observe the thorax for any deformities like barrel chest, pectus excavatum, or scoliosis.  Physical Examination A. Inspection Skin and Mucous Membranes: Check for cyanosis (bluish discoloration) indicating hypoxemia. Cough: Observe the type of cough (productive or non-productive) and sputum characteristics.  Physical Examination B. Palpation Tracheal Position: Ensure the trachea is midline; deviation may indicate tension pneumothorax or mass effect. Chest Expansion: Place hands on the patient’s back, thumbs together, and ask the patient to take a deep breath. Check for symmetrical movement.  Physical Examination B. Palpation Tactile Fremitus: Palpate the chest wall while the patient says "ninety-nine." Increased fremitus suggests consolidation (as in pneumonia), while decreased fremitus suggests pleural effusion or pneumothorax.  Physical Examination C. Percussion Percussion of the Chest: Tap on the chest wall to determine if underlying tissues are filled with air (resonant sound), fluid (dull sound), or solid tissue (flat sound). Normal: Resonance over the lung fields. Abnormal: Dullness (indicating consolidation or effusion), hyperresonance (suggestive of pneumothorax).  Physical Examination D. Auscultation Breath Sounds: Normal Breath Sounds: Vesicular (soft and low-pitched), bronchial (loud and high- pitched over trachea), bronchovesicular (medium pitch over major bronchi).  Physical Examination D. Auscultation Adventitious Sounds: Crackles (Rales): Indicate fluid in the alveoli, as in pneumonia, heart failure, or pulmonary fibrosis. Wheezes: High-pitched sounds caused by narrowed airways, common in asthma and COPD.  Physical Examination D. Auscultation Adventitious Sounds: Rhonchi: Low-pitched sounds due to secretions in large airways. Stridor: High-pitched, harsh sound indicative of upper airway obstruction.  Physical Examination D. Auscultation Adventitious Sounds: Pleural Friction Rub: A grating sound indicating pleuritis or pleural effusion.  Diagnostic Tests Pulse Oximetry (SpO₂): Non-invasive method to measure oxygen saturation; normal is 95- 100%. Arterial Blood Gas (ABG) Analysis: Provides information on PaO₂, PaCO₂, pH, and SaO₂.  Diagnostic Tests Chest X-Ray: Visualizes lung fields, pleural space, and chest wall abnormalities. Pulmonary Function Tests (PFTs): Measure lung volume, capacity, flow rates; useful in diagnosing obstructive and restrictive lung diseases.  Diagnostic Tests Sputum Analysis: Identifies pathogens, cancer cells, or the nature of the sputum (purulent, bloody, etc.). Computed Tomography (CT) Scan: Offers detailed images of the lungs and mediastinum, useful in diagnosing tumors, infections, or chronic lung diseases.  NANDA: Nursing Diagnoses NANDA International (NANDA-I) is an organization that develops, refines, and promotes standardized nursing terminology, particularly nursing diagnoses. It was originally known as the North American Nursing Diagnosis Association when it was founded in 1982, but it became NANDA International in 2002 to reflect its global reach and influence.  NANDA: Nursing Diagnoses Key Points About NANDA-I: Nursing Diagnoses: NANDA-I provides a comprehensive list of standardized nursing diagnoses, which are clinical judgments about individual, family, or community experiences/responses to actual or potential health problems/life processes..  NANDA: Nursing Diagnoses These diagnoses form the basis for selecting nursing interventions and achieving outcomes.  NANDA: Nursing Diagnoses Structure of Nursing Diagnoses: NANDA-I nursing diagnoses typically include three parts: Problem (P): The name or label of the diagnosis, reflecting the patient’s condition or response. Etiology (E): The cause or contributing factors leading to the nursing diagnosis. Symptoms (S): The evidence or defining characteristics that support the diagnosis.  NANDA: Nursing Diagnoses Purpose of NANDA-I Diagnoses: 1. To provide a consistent, uniform language for nursing practice. 2. To enhance communication among nurses and other healthcare professionals. 3. To promote individualized patient care. 4. To assist in research and education within the nursing profession.  NANDA: Nursing Diagnoses Categories of Nursing Diagnoses: Actual Nursing Diagnoses: These represent problems that are currently present and supported by signs and symptoms (e.g., "Ineffective Airway Clearance").  NANDA: Nursing Diagnoses Categories of Nursing Diagnoses: Risk Nursing Diagnoses: These indicate potential problems that a patient may develop, based on risk factors (e.g., "Risk for Infection").  NANDA: Nursing Diagnoses Categories of Nursing Diagnoses: Health Promotion Diagnoses: These reflect a patient’s motivation and desire to increase well-being and actualize human health potential (e.g., "Readiness for Enhanced Knowledge").  NANDA: Nursing Diagnoses Categories of Nursing Diagnoses: Syndrome Diagnoses: These are a cluster of predicted actual or high-risk diagnoses related to a certain event or situation (e.g., "Post-Trauma Syndrome").  NANDA: Nursing Diagnoses Application in Nursing Practice: Nurses use NANDA-I diagnoses during the nursing process to assess patient needs, plan care, implement interventions, and evaluate outcomes. By using standardized diagnoses, nurses can ensure that care is evidence-based and consistent.  NANDA: Nursing Diagnoses Ineffective Airway Clearance Definition: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.  NANDA: Nursing Diagnoses Related Factors 1. Excessive secretions (e.g., in chronic obstructive pulmonary disease (COPD), pneumonia) 2. Airway constriction (e.g., asthma) 3. Fatigue or decreased energy (e.g., in elderly patients or those with chronic illness) 4. Pain (e.g., post-surgical, pleuritic pain)  NANDA: Nursing Diagnoses Defining Characteristics 1. Ineffective or absent cough 2. Abnormal breath sounds (e.g., crackles, wheezing, rhonchi) 3. Dyspnea or difficulty breathing 4. Cyanosis 5. Altered respiratory rate and rhythm  NANDA: Nursing Diagnoses Goals/Outcomes 1. The patient will maintain a clear airway as evidenced by the ability to effectively cough up secretions and the presence of clear breath sounds. 2. The patient will demonstrate improved oxygenation with normal or baseline SpO₂ levels.  NANDA: Nursing Diagnoses Nursing Interventions 1. Encourage deep breathing and coughing exercises to mobilize secretions. 2. Administer prescribed bronchodilators or mucolytics to reduce airway resistance.  NANDA: Nursing Diagnoses Nursing Interventions 3. Provide adequate hydration to thin secretions. 4. Position the patient to facilitate optimal lung expansion and drainage. 5. Perform suctioning if the patient is unable to clear secretions independently.  NANDA: Nursing Diagnoses Impaired Gas Exchange Definition: Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.  NANDA: Nursing Diagnoses Related Factors 1. Ventilation-perfusion mismatch (e.g., in pulmonary embolism) 2. Alveolar-capillary membrane changes (e.g., in ARDS, pneumonia) 3. Hypoventilation (e.g., in COPD, neuromuscular disorders)  NANDA: Nursing Diagnoses Defining Characteristics 1. Abnormal arterial blood gases (ABGs), such as low PaO₂, elevated PaCO₂ 2. Cyanosis 3. Confusion or altered mental status due to hypoxia  NANDA: Nursing Diagnoses Defining Characteristics 4. Dyspnea 5. Fatigue 6. tachypnea  NANDA: Nursing Diagnoses Goals/Outcomes 1. The patient will maintain optimal gas exchange as evidenced by ABG values within the normal range or baseline for the patient. 2. The patient will experience relief from dyspnea and show signs of adequate oxygenation (e.g., normal skin color, mental alertness).  NANDA: Nursing Diagnoses Nursing Interventions 1. Monitor ABGs and SpO₂ to assess gas exchange status. 2. Administer supplemental oxygen as prescribed to correct hypoxemia. 3. Position the patient to promote lung expansion (e.g., Fowler’s position).  NANDA: Nursing Diagnoses Nursing Interventions 4. Encourage controlled breathing techniques, such as pursed-lip breathing. 5. Collaborate with respiratory therapy for interventions like mechanical ventilation if necessary.  NANDA: Nursing Diagnoses Ineffective Breathing Pattern Inspiration and/or expiration that does not provide adequate ventilation.  NANDA: Nursing Diagnoses Related Factors 1. Neuromuscular impairment (e.g., in spinal cord injuries, Guillain-Barré syndrome) 2. Pain (e.g., in rib fractures, post-surgery) 3. Anxiety 4. Respiratory muscle fatigue (e.g., in COPD, prolonged mechanical ventilation)  NANDA: Nursing Diagnoses Defining Characteristics 1. Altered chest excursion 2. Use of accessory muscles for breathing 3. Increased or decreased respiratory rate 4. Shallow or deep breathing 5. Dyspnea  NANDA: Nursing Diagnoses Goals/Outcomes 1. The patient will establish an effective breathing pattern as evidenced by regular respiratory rate and rhythm appropriate to the patient's condition. 2. The patient will demonstrate decreased use of accessory muscles for breathing.  NANDA: Nursing Diagnoses Nursing Interventions 1. Monitor respiratory rate, rhythm, and effort regularly. 2. Position the patient to reduce work of breathing, such as sitting upright. 3. Administer analgesics as prescribed to manage pain and facilitate easier breathing.  NANDA: Nursing Diagnoses Nursing Interventions 4. Teach the patient breathing exercises, such as diaphragmatic breathing. 5. Provide emotional support to reduce anxiety, which can exacerbate breathing difficulties.  NANDA: Nursing Diagnoses Activity Intolerance Insufficient physiological or psychological energy to endure or complete required or desired daily activities.  NANDA: Nursing Diagnoses Related Factors 1. Imbalance between oxygen supply and demand (e.g., in heart failure, COPD) 2. Generalized weakness 3. Deconditioning due to prolonged illness or immobility  NANDA: Nursing Diagnoses Defining Characteristics 1. Dyspnea on exertion 2. Fatigue 3. Increased respiratory rate with activity 4. Decreased oxygen saturation with activity 5. Verbal reports of weakness or exhaustion  NANDA: Nursing Diagnoses Goals and Outcomes 1. The patient will demonstrate improved tolerance to activity as evidenced by the ability to perform activities of daily living (ADLs) without significant dyspnea or fatigue. 2. The patient will show stable vital signs and oxygen saturation during and after activity.  NANDA: Nursing Diagnoses Nursing Interventions 1. Assess the patient’s baseline level of activity and gradually increase activity levels as tolerated. 2. Plan activities and rest periods to prevent fatigue. 3. Encourage the use of energy conservation techniques during ADLs.  NANDA: Nursing Diagnoses Nursing Interventions 4. Monitor vital signs and SpO₂ before, during, and after activity to ensure safety. 5. Collaborate with physical therapy to develop a structured exercise program.  NANDA: Nursing Diagnoses Anxiety Vague, uneasy feeling of discomfort or dread accompanied by an autonomic response..  NANDA: Nursing Diagnoses Related Factors 1. Hypoxia or dyspnea (e.g., in acute respiratory distress) 2. Unfamiliar environment or procedures (e.g., hospitalization, intubation) 3. Fear of suffocation or death  NANDA: Nursing Diagnoses Defining Characteristics 1. Restlessness 2. Tachypnea 3. Tachycardia 4. Sweating 5. Expressed concern about breathing or health status 6. Difficulty concentrating  NANDA: Nursing Diagnoses Goals/Outcomes 1. The patient will verbalize reduced anxiety and demonstrate relaxation techniques. 2. The patient will exhibit normal respiratory rate and decreased signs of autonomic arousal (e.g., sweating, tachycardia).  NANDA: Nursing Diagnoses Nursing Interventions 1. Provide clear, consistent information to the patient about their condition and treatment plan. 2. Offer reassurance and remain calm to help reduce the patient’s anxiety. 3. Encourage the use of relaxation techniques, such as deep breathing or guided imagery.  NANDA: Nursing Diagnoses Nursing Interventions 4. Ensure a supportive and calming environment, reducing unnecessary stimuli. 5. Involve the patient in decision-making processes to enhance their sense of control.