MICU MDH

8/22/2019 MICU MDH

1/32

MANILA TYTANA COLLEGESManila Doctors College of NursingPres. Diosdado Macapagal Blvd.,Metropolitan Park, Pasay City

Acute Respiratory Failuresecondary to

Acute Pulmonary Congestion

Submitted By:Aranda, JulieBayrante, Kim

Coballes, AlexisGulla, Lanie

Marciano, TreshaNilo, Chester Nicole

GROUP 7A

CON IV-A02

8/22/2019 MICU MDH

2/32

INTRODUCTION

Respiratory failure may be further classified as either acute or chronic. Although acuterespiratory failure is characterized by life-threatening derangements in arterial blood gases andacid-base status, the manifestations of chronic respiratory failure are less dramatic and may notbe as readily apparent.

Acute hypercapnic respiratory failure develops over minutes to hours; therefore, pH is less than7.3. Chronic respiratory failure develops over several days or longer, allowing time for renalcompensation and an increase in bicarbonate concentration. Therefore, the pH usually is onlyslightly decreased.

The distinction between acute and chronic hypoxemic respiratory failure cannot readily be madeon the basis of arterial blood gases. The clinical markers of chronic hypoxemia, such aspolycythemia or cor pulmonale, suggest a long-standing disorder.

Arterial blood gases should be evaluated in all patients who are seriously ill or in whomrespiratory failure is suspected. Chest radiography is essential. Echocardiography is not routinebut is sometimes useful. Pulmonary functions tests (PFTs) may be helpful. Electrocardiography(ECG) should be performed to assess the possibility of a cardiovascular cause of respiratoryfailure; it also may detect dysrhythmias resulting from severe hypoxemia or acidosis. Right-heartcatheterization is controversial (see Workup).

Hypoxemia is the major immediate threat to organ function. After the patients hypoxemia is

corrected and the ventilatory and hemodynamic status have stabilized, every attempt should bemade to identify and correct the underlying pathophysiologic process that led to respiratoryfailure in the first place. The specific treatment depends on the etiology of respiratory failure

8/22/2019 MICU MDH

3/32

II. Nursing Health History

A. Biographic Data

Patients Initial:Mrs. L.L

Gender:Female

Age:77 yrs old

Date of Birth:April 21, 1935

Educational Attainment:High school graduate

Occupation:None Order of

Admission:Stretcher

Place of Birth:Malabon, Rizal

Date of Admission:December 12, 2012

No. of in Hospital:6 days

Source ofInformation:

Daughter

B. Chief Complaint(s)

- Hindi ako makahingang sobra, kaya isinugod na nila ako dito sa ospitalas verbalized by

the patient. The patient had experienced severe nausea and fatigue.

C. History of present illness-

D. Childhood Illness(es)

Childhood illness(es)Adult illness

- Cannot recall- Difficulty of Breathing

Childhood/adultimmunization(s)

Cannot Recall

Accidents and Injuries N/A

Previous

hospitalization/surgery

St. Michael Hospital (December 6, 2012), Clipping

AneurismMedication prior toconfinement

N/A

E. Family History

Name Relation Age Gender OccupationEducationalAttainment

Disease/Disorder

E.L.S Daughter 50 Female SecretaryCollege

GraduateNone

N.L.G Daughter 48 Female NoneCollege

GraduateNone

J.L.P Son 47 Male NoneHigh schoolGraduate

None

R.L.P Daughter 42 Female NoneHigh schoolGraduate

None

8/22/2019 MICU MDH

4/32

F. Heredo-Familial Illnesses

a. PATERNAL: NONE

b. MATERNAL: ASTHMA, High Blood

G. Developmental History

Theorist Age Task Patients Description

Erik Erikson -Theory ofpsychosocialdevelopment.

77 years old Integrity vs. Despair cceptance of worthand uniqueness ofones own life andacceptance of death.Sense of loss.Contempt for others.

Sigmund Freud -Theory of psychosexualdevelopment

77 years old Genital Phase he client decidesindependently. She ishappy with her family

and grandsons anddaughter and orsignificant others.

Jean Piaget -Cognitivedevelopment theory

77 years old Formal operation phase he client doesnt haveany difficulty onlearning things, shegets it right away. Shehad set her family as apriority.

Lawrence Kohlberg -Moral developmenttheory

77 years old Universal EthicalPrinciple

Decision and behaviorsare based oninternalized rules, onconscience rather than

social laws, and on self-chosen ethical andabstract principles thatare universal,comprehensive, andconsistent.

Fowlers - SpiritualDevelopment Theory

77 years old IndividuatingReflective

he client is a catholicshe goes to church withher family she prays atnight together withhem. According to her

she also has sets ofbeliefs that were

influenced by thepeople around her.

H. Environmental History

The client resident in bacoor, cavite. They are located near the communitys chapel and market

which makes it accessible for her. Their water supply comes from nawasa and garbage are being

8/22/2019 MICU MDH

5/32

collected every other day. According to the informant she is friendly neighbor and stated that she has a

lot of friends in the said place.

III. GORDONS TYPOLOGY OF 11 FUNCTIONAL HEALTH PATTERN

A. Health Perception- Health management

Before confinement:

Since the client is having difficulty in talking we used her eldest daughter as our informant, the

informant perceives her mothers health as unhealthy individual and she rate the health of her mom as

5/10 one of her reason why she feel that way is that the patient eats only small amount of food because

there are many foods that the patient should avoided even if she is not on the hospital. According to them

having a healthy lifestyle is important to keep their mother healthy and one thing that she do to maintain

her body in good condition was to follow the doctors order in taking her drug maintenance such as

losartan and winsta for her hypertension.The patient is performing her daily grooming such as taking a

bath, frequently trimming her nails, wearing slippers even inside the house and most importantly is

frequently wash her hands before and after eating and going to the comfort room also included in the

routine of the patient was having an every year annual physical examination at St.Michael Hospital in

Bacoor Cavite but she is not having checkups with dentist since the patient is wearing dentures. The

informant honestly confirmed that the patient use to smoke during her younger years and she utilize 10

sticks per day hence the patient is only drinking alcohol if there is an occasion.

During confinement:

At present the informant rate her mothers health as 7/10 because she thinks that though their

mom is ill since she is now admitted to the Manila Doctors Hospital they know that what ever there mother

priority needs in order for her to recover are being provided by the ICU medical team for faster recovery

from her current complication. The family feels that being here in the hospital help her mother to feel

much better than time that they are staying on the other hospital namely St. Michael Hospital in which for

them it was not been diagnosed easily and treated by the health care provider on the said institution.

According to the informant one thing that helps her mother to be on a stable situation are the use of the

assistive device such as 02 and being nebulized for at least every 4 hours and she has been strictly

monitored by the health care provider this statement shows that the patient is now experiencing and

showing alleviation of what symptoms and discomfort she feel prior to confinement. Since it shows that

the patient has an determination to feel better and knows that she must be compliance on the doctors

order to avoid any further complication.

Analysis:

Health perceptions (or perceived health status) are subjective ratings by the affected individual ofhis or her health status. Some people perceive themselves as ill despite suffering from one or morechronic diseases, while others perceive themselves as healthy when no objective evidence of diseasecan be found.

It is the client's perceived pattern of health and well-being and how health is managed (Gordon's 11functional health patterns, D. Ladd).

8/22/2019 MICU MDH

6/32

Interpretation:

The client percieves herself as a healthy person when she was confined in the MDH because the

doctor and nurse monitor her.

B. Nutritional-Metabolic Pattern

Before Confinement:

The informant define the patients daily food intake prior to be hospitalized she is not being choosy

on the food that she will eat but somehow she preferred foods with sarsa and a lutong bahay in terms of

what food she dont want to eat only tilapia is one thing that been remember by the informant. The patient

is eating everyday with her husband and two granddaughters and she set 500.00 as an daily allowance

for food. Because of being hypertensive the patient tends to control her rice intake for only a cup every

meal. According to the informant the patient has problem in terms of drinking water because most of the

time she is having difficulty in drinking water as estimated she is only drinking 4-5 glass of water per day.

They stated that the patient has no problem when it comes to wound healing because they know that

there mother has no diabetes .The patient also wears dentures both upper and lower part of the teeth

During confinement:

At present the food intake of the patient was serve through the nasogastric tube (NGT) as order

by the attending physician since she is having a hard time to ingest food. The formula that has been use

for NGT feeding was the vanilla essence of the enerva it is the powder type solution that has been

dissolve to the 200cc of warm water this solution has been recognized by the dietician section in which

this serve as the primary nutritional supplement of the patient. Hence the physician already allowed the

patient to zip small amount of water and shall be served with the soft gelatin if the patient will be able to

tolerate.

Analysis:

Vitamin and mineral deficiencies affect virtually all of the organs, and gastro intestinal systems,organ functioning, and mental processes are diminished from a lack of proper nutrition. Additionally, theimpact of poor nutrition can increase further abuse.

Reference:

The Health Risks of Poor Nutrition Nutrition In Drug Rehab Choosehelp.com

Interpretation:

The client is not particular when it comes to foods that she eats and she drinks 4 to 5 glasses ofwater a day. But because of her diet and her water intake, the client is malnourished and at risk of poornutrition and has a chance to be dehydrated and has a dry skin.

C. Elimination Pattern

8/22/2019 MICU MDH

7/32

Before confinement:

The client has no problems when it comes to urinary and bowel elimination. The clients urine is

usually light yellow in color. The client voids for 5x times a day and the client usually defecates once

everydays, with brownish-yellowish stool color and with a formed consistency, depending on the food

taken.

During Confinement:

The client is with a Foley catheter since in the ICU we are required to drain the urine every hour

and for the whole 8 hours the patient urinary output that has been drain has not been less that to 110cc

the patient has no reports of discomfort she has a urine color of light yellow to brownish amber. The

Client eliminates bowels once a day with color yellow and claims to have a harder consistency. She also

dont perspire too much especially this time she stay in the hospital in which its fully air conditioned room

and the thing that he do in able to have perspiration was performing ROM at the level that he can tolerate

Analysis:

The healthy body maintains a balance between the amount of fluid ingested and the amount offluid eliminated. When the amount of fluid intake increases, therefore, the output normally increases.

(Kozier and Erbs, Fundamental of Nursing Eight Edition, Vol. II. Page 1288)

Interpretation:

The client urinates many times because of her fluid intake is also increase and due to her IV fluids to help

her balance her electrolytes.

D. ACTIVITY EXERCISES PATTERN

BEFORE

The client daily activity upon waking up was frequently visiting her garden and sprinkling herflowerwith water after she finish her task to her garden the patient doesnt have any activity instead shewill just go up and down to their house. She thinks that she has sufficient energy and doesnt easily gettired and she can fully take care of himself and can do anything that she needs to perform for her daily lifewithout asking for any assistance in such activity like taking a bath, eating and even putting on and off herclothes. The client spends her spare time to their house such as watching TV and she also fun of going tothe roof tap of their house wherein there are so many lovebirds that her husband is taking care off.

During Confinement

The client is only staying at her bed and she has been turned every 2 hours and she is taking

medicine at start of 8am and will be continue to receive based on the doctors order of hours. Since she isat the ICU there are no alternative activity available since TV is not been provided in the ICU and no

relative is allowed to stay for longer hours of time for the allotted visiting hours which is 10am -11am and

5pm-6pm thats only the time they will have a chance to talk with their family. Although the client just

perform the ROM as been instructed and guided by the nurse the client still no able to perform her

primary care such as taking a bath. The client also experiences difficulty in getting up and in walking

because of the apparatus thehas been connected to her body.

8/22/2019 MICU MDH

8/32

Analysis:

Persons routine of exercise, activity, leisure and recreation. It include activity of daily living that

requires energy expenditure such as work, home maintenance, quality and quantity of exercises. (Kozier

and Erbs, Fundamental of Nursing Eight Edition, Vol. II. Page 1106)

Interpretation:

The clients activity of daily living is limited and wasnt able to engage herself in her previous daily routine

E. Sleep-Rest Pattern

Before confinement

Before she got sick, the informant said that her mother usually get an 7-9 hrs sleeps she usually

go to bed by 7-8 in the evening and wakes up at 4:00 in the morning. According to her, this is her usualwake up and sleeping time. She feels satisfied regarding her sleep and the patients family added that

they feel happy when they saw their mother energized and refreshed every time she wakes up. The

patient does not have any sleep discomforts or nightmares but in some instances if her sleep has been

disturbed she is having an hard time to go back to sleep again. In the afternoon, she takes nap for about

30 minutes 1 hour afterwards. It is also one way of her self- relaxation.

During confinement:

When she got sick, her sleeping hours doesnt change and but she tends to wake up in the

middle of the night because of the staff nurses that need to assess her vital signs ang give medicines to

her if needed and prescribed. The client stated that takes nap whenever she can in the afternoon. The

client show alleviated of pain and and symptoms that she feel upon waking up from the nap that shetakes.

Analysis:

All people need a sleeping environment with minimal noise, a comfortable room

temperature, appropriate ventilation, and appropriate lightning. (Kozier and Erbs, Fundamental of

Nursing Eight Edition, Vol. II. Page 1177)

Interpretation:

the client has no regular sleep every night in the hospital because of concurrent awakenings

from the nurses to do some test

F. Cognitive-Perceptual Pattern

Before Confinement:

The clients daughter stated that wala siya problema sa pandinig at mata. The client is not using

a hearing aid and has no problem with her vision and she is not even using an eyeglasses and she can

be able to read even a letter from a newspaper. The patient is not having a hard time to concentrate and

8/22/2019 MICU MDH

9/32

follow command but there is one thing that the patient is having a hard it is talking because a year ago

she suffer from stroke.

Analysis:

Adults cognitive and intellectual abilities change very little. Cognitive processes include reaction time,

memory, perception, learning, problem solving and creativity. Learning continues and can be enhancedby increased motivation at this time in life. (Kozier and Erbs Fundamentals of Nursing, Vol.1 page 399,

983

.

G. Self-Perception Pattern

Before confinement

The informant described her mother as a jolly and a healthy person. Also, she stated that Kaya

nya gawin lahat ng gawain. But the patient has never been easily irritated and mad till the day she feel

some pain and discomfort but she dont tell her childrens immediately, but in terms of problem with her

family problem and if she feel something is wrong with her family she will easily approach her eldest child.

Generally, the client appear so good person and generous to all people not only to her family but also to

her neighbor maybe she might be called ms. Friendship because all people in their place know here

because she is a manicurist for a long time

During confinement

Now that the client has been hospitalized, as what the daughter said the client feels a little sad

and weak. she stated that Malaking epekto ang pagkakasakit ko, malaking kawalan at walang

patutunguhan. she is now afraid of whats currently happening to her and theres a lot of restriction

because of her health condition. Since the day she got sick, there family tend not to lost hope and faith

for there mom to have strength in facing her condition and follow treatment when it comes to her health

and family.

Analysis:

Individuals with a positive self-concept are better able to develop and maintain interpersonal

relationships and resist psychologic and physical illness. (Kozier and Erb's Fundamentals of Nursing 8th

Edition, Vol. II page 1003.)

Interpretation:

Client is known to have short patience thats why she should avoid stress in h er life.

H. Roles and Relationship Pattern

Before confinement

The client has a extended of family. She lives with her husband and two grandchildren. Theinformant said that nakadepende na ang nanay niya sa kanila mga anak niya ngayong matanda na silathe informant also stated that her family is well managed and she said that walang masyadong problemamaayos kami. And she said that there is no problem with their mom because she fulfills her goal as a

8/22/2019 MICU MDH

10/32

mother. The client has no social groups and she doesnt feels lonely when there is nothing to do becauseshe is much happy with her family and enjoying staying at home and gardening.

During confinement

Now that the client has been confined in Manila doctors hospital , she can no longer participate to

the activities of her family Her family feels that they should now be the one taking care of her health. Her

family feels bad for her current condition but since they are one family they do not loose hope and let

everyone be down by the different challenges in life. They want him to feel better as soon as possible.

Analysis:

Family is the basic unit of the society. cultural values can determine communication within family

group, the norm for family size, and the roles of specific family member. Decision making within the family

includes different alternatives to family problems. (Kozier and Erb's Fundamentals of Nursing 8th Edition,

Vol I page 319.)

Interpretation:

Clients relationship with her family is one of the most important, she enjoys andcomfortable being with them.

I. Sexuality Reproductive Pattern

The informant cannot provide information for the sexuality and reproductive of the patient in due

respect to them we dont insist to have this data but in relating to the age and condition of patient at

present The client no longer performs sexual activities with his partner.

Analysis:

Sexual activity is common, establishes own lifestyle and values, homosexual; identity usually

established by mid- 20s. Many couples share financial obligations and household tasks.(Kozier and Erb's

Fundamentals of Nursing 8th Edition, Vol II page 1020.)

J. Coping Stress Tolerance

Before confinement

The client doesnt really complain about their condition in life and stated that she was satisfied

with what they have. Although arguments at home are inevitable, their family patches up things easily by

talking about their problems and solving it all together.

During confinement

With the clients confinement, the only thing that she does now is to lie down, sleep and eat. The

client feels tensed and anxious most of the time because of her health condition. She usually verbally

expressing her true feeling to other when her feel anxious and feels pain.

8/22/2019 MICU MDH

11/32

Analysis:

Coping strategies vary among individuals and are often related to the individuals perception of

the stressful event. Three approaches to coping with stress are to alter the stressor, adapt to the stressor,

or avoid the stressor. (Fundamentals of Nursing, Kozier, 7th edition pg. 1020)

Reference:

Fundamentals of Nursing, Kozier, 7th edition pg. 1020 and Fundamentals of Nursing, Kozier, 7th

edition pg. 1065.

Interpretation:

The client may be feeling stressed, but she still knows how to deal it through the help of

her family and friends

K. Values Belief Pattern

Before confinement

The informant thinks that they provided everything that their mother needs in life and she

performed her role being a good mother. Before she got sick, faith and religion is very important to her.

Roman Catholic is the religion of the patient and she believes that when problems arise, she will just pray

to their God and have faith to them and nothing is impossible to happen

During confinement

The informant stated that religion is still important in her life right it. They believe that through

Gods grace their mother will be stated. The only thing that she wants right now is for her to hopefully get

well.

Analysis:

Spiritual beliefs and practices are coping resources for persons, understanding how such beliefs

and practices help or hinder a clients heal th is vital.

Reference:

Kozier and Erbs Fundamentals of Nursing 8th

edition, Volume 2 page 1042

Interpretation:

The patient is originally a Catholic.

IV. Physical assessment

a. General survey

8/22/2019 MICU MDH

12/32

Body built:

-short

Grooming/hygiene:

-Good

hygiene/grooming

Posture and gait:

-normal

Body odor and

breath:

-none

Signs of distress:

-anxiety

Obvious signs of illness(s):

-DOB

Orientation: well oriented

TimeTuesday DateDec. 18 2012

Place Hospital

Level of consciousness:

-alert

Affect:Smiley

Mood:Euthymic

Quantity and quality of speech:

-clear

- normal pitch

-normal pace

Organization of thoughts:-weakness

** Euthymic pertains to a normal mood in which the range of emotions is neither depressed nor highly elevated.

b. Anthropometric measurement

Height: Weight:

c. Vital signs

Temperature: 37.6

celcius

Pulse rate: 89 beats

per minute

Respiratory rate: 24

cycle per minute

Blood pressure:130/80

mmhg

d. Physical examination

Body Part Method ofAssessment

Normal Findings Actual Findings Analysis andInterpretation

SKIN

Skin Inspection Light to darkcomplexion

Light to darkcomplexion

The client hashematoma

8/22/2019 MICU MDH

13/32

HairDistribution

Skin Turgorand Mobility

Skintemperatureand Moisture

Skin lesions

Nail shape

Nail contour

Nail beds

Inspection

Palpation

Palpation

Palpation

Inspection

Palpation

InspectionPalpation

(depending onrace)

Sun exposed isdarker

Normal localizedvariations: moles,freckles, patches,striae

Smooth and even

Distribution andquantities varieswith age and race

No balding patternor hair loss

Fine texture

Moves easily when

lifted and returnsback to its positionimmediately

Warm to touch withample moist

No lesions

Smooth, nail baseis 160

Flat, slightly

rounded

No cyanosis,pinkish

Brisk capillary refill Nail plate should be

attached to the nailbed

Evenly coloredskin tone

Smooth and evenskin

she has mole inleft scapula

hematoma on leftarm near axillary

Hair of the skin isequally distributed

No balding pattern

Skin pinch easilyand return to itsoriginal position

immediately

Warm to touch

No lesions

Flat

Pinkish Poor capillary refill

Nail plate isattached to thenail bed

because ofaspiration ofblood collection.

No significantfindings


Poor capillaryrefill because lowblood circulation

low oxygensupply

8/22/2019 MICU MDH

14/32

HEAD

Skull

Scalp/Hair

Face

EYE/ VISION

Eyebrows

Conjunctiva

Palpation

InspectionPalpation

InspectionPalpation

Inspection

Inspection

Generally roundwith prominencesin the frontaloccipital area(normocephalic)

No tenderness ormasses noted uponpalpation

Can be moist oroily

Free from lice, nits,dandruff

No lesions shouldbe noted

Hair can be black,

brown or burgundydepending on race

Hair is evenlydistributed andcovers the wholescalp

Hair may be thickor thin, coarse orsmooth

Shape maybe ovalor round

Symmetrical No involuntary

movements Ne tenderness, no

masses

Symmetrical In lined with each

other and hair isevenly distributed

Both conjunctivaeare pinkish

With presence ofmany minutes ofcapillaries

Moist, no ulcer andforeign bodies

Normocephalic

No tendernessand masses inpresence uponpalpation

Moist No scars or

lesions Colored hair Hair is thick and

evenly distributed

Round shaped,symmetrical andno involuntary

movement No tenderness

and no masspresent

Symmetrical, botheyebrows canraise without anydifficulty

Both conjunctivaeare shiny, moistand pale in color


Normal

Normal

Pale conjunctivaebecause of agingand low blood

8/22/2019 MICU MDH

15/32

Sclera

Cornea

Pupils

Lacrimal

apparatus

Ears andNose

Ears

Inspection

Inspection

Inspection

InspectionPalpation

InspectionPalpation

White in color andno yellowishdiscoloration

Transparent,smooth and moist

Papillary sizeranges from 3-7mm and are equalin size

Equally round Constrict briskly/

sluggishly whenlight is directed intothe eye, bothdirectly consensual

Pupils dilate whenlooking at distantobjects andconstrict whenlooking nearerobjects

No tenderness ordischarge whenpressure is applied

The earlobes arebean-shaped,parallel andsymmetrical

The upper portionof the earlobe is

parallel with theouter canthus ofthe eye

Skin is same as incolor complexion

No lesions ordischarged

The auricles havefirm cartilage onpalpation

White and clear

Transparent andmoist

Round ,symmetrical,constrict withincreasing lightandaccommodation

Able to move eyesin full range ofdirection

Pupils equally

round and reactiveto light andaccommodation(PERRLA)

No tenderness ordischarge

Parallel,symmetrical,proportional to thesize of the head

Bean-shaped,helix is in line withthe outer canthus

No pain ortenderness upon

circulation





8/22/2019 MICU MDH

16/32

Nose

Lips/Mouth

Lips

Voice test

InspectionPalpation

InspectionPalpation

The pinna recoilswhen folded

No pain ortenderness onpalpation of theauricles and themastoid process

Ear canal hasnormal cerumenupon inspection

Client will be ableto hear and repeatwhispered wordsfrom one to twofeet

Nose is in themidline

No discharges Both nares are

patent Nasal septum is in

the midline and notperforated

Nasal mucosa ispinkish to red incolor

No bone and

cartilage deviationon palpation

With visible margin Symmetrical in

appearance andmovement

Pinkish in color No edema

Pinkish in color

No bleeding andreceding gums

32 for adults White to yellowish

in color Without dental

palpation Skin is same in

color as thesurrounding area

Ear canal ispinkish with scantycerumen and fewcilia

Client was able tohear and repeatwords

Nose is in themidline,symmetrical andpatent

No discharges orlesions noted

Nares are cleanand dark pink withmany cilia

Lips are brownish

Gums are dark

No swelling anddischarge



Dark lips andgums because

patient issmoking.

8/22/2019 MICU MDH

17/32

Gums

Teeth

Tongue

Uvula

Tonsils

Neck

Thorax/Chest

Inspection

Inspection

InspectionPalpation

Inspection

Inspection

InspectionPalpation

carries No halitosis

Pinkish with whitetaste buds on thesurface

Free from lesions Moist Frenulum is

centered No mass and

tenderness

Positioned in themidline

Pinkish to red incolor

No swelling Moves up and back

when to say ah

In the midline

Proportion to thebody size and head

Symmetrical and

straight No palpable lumps,

masses ortenderness

Shape of the thoraxin a normal adult iselliptical

Anterior-posteriordiameter to lateraldiameter is at aratio of 1:2

Does not usetrapezius musclesto assist breathing

No chest retractionas this suggestDOB

Respiration arerelaxed, effortlessand quiet with therate of 12-20 per

Dentures

Tongue is pinkish,slightly rough ontop, smooth alongthe lateral margins

Moist, freelymovable and withstrength

Frenulum iscentered

Gag reflex ispresent

Uvula is at thecenter

Freely movable Pinkish

In midline

Proportion,symmetrical andno lumps, massesor tenderness

Trachea is in themidline

Bradypnea

all teeth areextracted poororal care

No significant

findings

No significant

findings


8/22/2019 MICU MDH

18/32

Inspection

Palpation

Percussion

Auscultation

minute in adult No bulging or

retractions at ICSmust be noted asthis may be anobstruction onexpiration,abnormal massesor cardiomegaly

Use of accessorymuscles(sternocleidomastoid) is not seen

No masses ortenderness or pain

Tactile fremitusshould bebilaterally

symmetrical Chest expansion is

symmetrical

Resonance toneover normal lungtissue

Excursions shouldbe equal bilaterallyin adults

Broncho-vesicular(medium pitch) onlarger airwayblowing bronchial(high pitch, loud) ontrachea, vesicular(low pitch)

Small apicalimpulse 2.5 cm at

medial to the leftmidclavicular lineat fourth of fifthICS

Pulsation of theapical impulse felt

8/22/2019 MICU MDH

19/32

Heart

Abdomen

Inspection

Palpation

Auscultation

Inspection

vibrations arepalpated in theareas of the apex,left sternal boarderor base

Cardiac rate rangesfrom 60-100 bpm

S1 and S2 can beheard at allanatomic site

No abnormal heartsound can beheard (eg.,murmurs)

Counter mayberounded, flat or

scapoid Must be uniform in

color No rashes or

lesions Bruits are not

normally heardover abdominalaorta or renal iliacor femoral arteries

Audible bowel

sounds must beheard (highpitched) 5-30 timesper minute

Must be tympanicover the stomach

No tenderness orpain

Fine hairs equallydistributed

Warm, dry andelastic uponpalpation

Palms are pinkish,warm

Presence of S1and S2 sounds

No lesions Bruits is not heard

Flat abdomen

Audible bowelsound heard uponauscultation

Tympanic soundsover stomach

There is no painwhen palpating

the abdomen

Equally distributed Warm and dry Five fingers on

each hand No varicose veins Symmetrical

muscles





No significant

8/22/2019 MICU MDH

20/32

UpperExtremitiesand LowerExtremities

Auscultation

Percussion

Palpation

InspectionPalpation

Both shoulders,arms, elbows,hands and wristcan be moved indifferent range ofmotion

Absence ofvaricose veins onlower extremities

Muscles aresymmetrical

Sole and dorsalsurface is smooth

Both leg, knee,ankle and toe canbe moved indifferent range ofmotion

Sole and dorsalsurface is smoothand pinkish incolor

Five toes in eachfoot

Upper extremitiesand lowerextremities can bemoved in slowmovements

findings


Slow movementbecause of age

Analysis and Interpretation Reference: Weber Guide to Physical Examination and History

V. LABORATORY RESULTS AND INTERPRETATION

Hemato log y (12-15-12)

Normal Result Interpretation

Hemoglobin: (female)125-160 g/l

98 Normal

Hematocrit:(female)0.36-0.47

0.32Normal

RBC:4.2-5.4 x 10

12/1

4.22Normal

WBC: 4.5-11 x 109/1 16.51

Increased WBC usuallyidentifies infection, tissue

inflammation or tissuenecrosis

Differential Count:Neutrophils

Segmenters:0.55-0.65

0.83Increased Neutrophils

during a bacterial infection

8/22/2019 MICU MDH

21/32

Lymphocyte0.24-0.44

0.10Lymphocytes are lowered

in Immunodeficiencydiseases

Monocytes0.02-0.012 0.07

Low monocytes

Elevated phosphorus means excessive protein breakdown in body tissues.

The most common cause of elevated phosphorus levels (hyperphosphatemia) in the blood is decreased

kidney function. Rarely, it's caused by excess intake of phosphorus or vitamin D, which increases

absorption of phosphorus from the small intestine. It's important to note that children normally have higher

blood levels of phosphorus than adults do.

As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poorclearance of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possiblemalfunction or failure of the kidneys. It is for this reason that standard blood tests routinely check theamount of creatinine in the blood.

There are many possible causes for an abnormally high neutrophil count. A neutrophil level that is morethan 8000 is considered to be abnormally high. One basic cause of a high neutrophil count is when a highlevel of stress is placed on the body. The stress can due to many factors such as nervousness, exercise,or seizures (involuntary muscle movements due to overexcitement of nerve cells in the brain). Anothercause is a sudden infection from bacteria. Damage or inflammation of tissues can also lead to a highneutrophil count. Examples would be burn injuries and a heart attack.

Sudden kidney failure can cause a high neutrophil count. The kidneys are two organs located on each

side of the spine, behind the stomach. The kidneys filter (remove) wastes from the blood. A conditionknown as ketoacidosis can also cause a high neutrophil count. Ketoacidosis is a condition in which acidsand poisonous chemical substances known as ketones are produced by the body. Ketones are producedwhen the body has a difficult time breaking down fats.

Urinalysis (12-15-12)

Normal Value Result Interpretation

Color: pale to dark yellow oramber Light yellow Normal

Character: clearCloudy

Cloudy urine indicates

presence of excessive

cellular material or high

levels of sediments due to

certain urinary tract

infections
http://www.medicinenet.com/script/main/art.asp?articlekey=10419http://www.medicinenet.com/script/main/art.asp?articlekey=10419http://www.buzzle.com/articles/dark-yellow-urine-causes.htmlhttp://www.buzzle.com/articles/dark-yellow-urine-causes.htmlhttp://www.medicinenet.com/script/main/art.asp?articlekey=10419

8/22/2019 MICU MDH

22/32

Reaction/ph: 4.6-8.05.5 Normal

Specific gravity: 1.002 -1.035 1.020 Normal

Sugar: NegativeNegative Normal

Protein: None0.3

*MicroscopicPus cells

2-4 HPF Normal

RBC 0.00-11.0 20.0 UL Normal

Epithelial cells 0.00-17.00 6.7 Normal

Bacteria 0.05-170.0 56117.7

Bacteria are common in

urine specimens because ofthe abundant normalmicrobial flora of the vagina

in the female

GRAM STAIN

Pus cells = 32.42 /OIF

Gram negative bacilli = numerous

IMMUNOLOGY

TEST CUT-OFF VALUE PATIENT VALUE RESULT

HBsAG 1.0 0.41 NONREACTIVE

Anti-HBS 10.0 128.69 REACTIVE

Anti-HBc-IgG 1.0 0.47 NONREACTIVE

Anti-HCV 1.0 0.06 NONREACTIVE

A "positive" or "reactive" HBsAb (or anti-HBs) test result indicates that a person has successfully

responded to the hepatitis B vaccine or has recovered from an acute hepatitis B infection. This result

means that you are immune to future hepatitis B infection and you are not contagious. This test is not

routinely included in blood bank screenings.

8/22/2019 MICU MDH

23/32

VI. DRUG STUDY

Brand Name: ASA Drug Classification: Anti-coagulant

GENERIC NAME:Aspirin Frequency: OD

Date Ordered: 12-11-12 Dosage: 80 mg, 1 tab

IndicationsMechanism of

ActionContraindications Side Effects

Nursing

Responsibilities

For pain onintegumentarystructures,myalgia,

neuralgia,headache,dysmenorrhea, gout.

Arthritis, SLE,acuterheumaticfever

Exhibitsantipyretic, anti-inflammatory andanalgesic effects.The antipyretic

effect is due to anaction on the

hypothalamus,

resulting in heatloss by

vasodilation of

peripheral bloodvessels. Anti-

inflammatoryeffects are

mediated by a

decrease inprostaglandin

synthesis. It also

decreases plateletaggregation.

Hypersensitivity tosalicylates, severeanemia, history of

blood coagulationdefects, vitamin K

deficiency, 1 weekbefore and after

surgery,pregnancy in the

last trimester

GI: dyspepsia,heartburn,anorexia, nausea,epigastricdiscomfort,potentiation ofpeptic ulcerAllergic:

Bronchospasm,asthma-likesymptoms,

anaphylaxis, skinrashes, urticariaHematologic:prolongation ofbleeding time,

thrombocytopenia,leucopenia,Other: Thirst,

fever, dimness ofvision

Prevent blood

coagulation due tohypertension(narrow blood

vessels may causeblood to

aggregate)

Brand Name: Plavix Drug Classification: Anti-platelet

Generic Name: Clopidogrel bifulfate Frequency: OD

Date Ordered: 12-11-12 Dosage: 75 mg/tab



Nursing

Responsibilities

Treatment of

patients atrisk forischemiceventshistory of MI,ischemicstroke,peripheralarterydisease

Inhibits plateletaggregation byblocking ADPreceptors on

platelets,preventingclumping of

platelets

Contraindicatedwith allergy to

clopidogrel, activepathological

bleeding such aspeptic ulcer or

intracranialhemorrhage,

lactation

CNS: Headache,dizziness,weakness,syncope, flushingCV:Hypertension,edemaDermatologic:Rash, pruritusGI: Nausea, GIdistress,

Assess forsymptoms ofstroke, MIduringtreatment

Monitor liverfunctionstudies: AST,ALT, bilirubin,creatinine ifpatient is on

8/22/2019 MICU MDH

24/32

Treatment ofpatients withacutecoronarysyndrome

constipation,diarrhea, GIbleedOther: Increasedbleeding risk

long-termtherapy

Monitor bloodstudies:CBC,Hgb,Hct, protime,

cholesterol ifthe patient ison long-termtherapy;thrombocytopenia andneutropeniamay occur.

Precautions:bleeding disorders,

recent surgery,hepatic impairment,

pregnancy

Brand Name: Fluimicil Drug Classification:Mucolytic agent

Generic Name: Acetylcysteine Frequency: BID

Date Ordered: 12-11-12 Dosage:1 sachet of Acetylcysteine 200 mg



Nursing

Responsibilities

Treatment ofrespiratoryaffections

characterized bythick and viscoushypersecretions:acute bronchitis,chronic bronchitis

and itsexacerbations;

pulmonaryemphysema,

mucoviscidosisand

bronchiectasis.

Exerts mucolyticaction through its

free sulfhydrylgroup whichopens up the

disulfide bonds inthe mucoproteins

thus loweringmucous viscosity.

The exactmechanism of

action inacetaminophen

toxicity isunknown. It is

thought to act byproviding

substrate forconjugation with

the toxicmetabolite.

Use with cautionin patients > 60

years of age. Usewith caution in

patients with Highblood pressure,ischemic heart

disease, diabetes,increasedintraocular

pressure, GI orGU obstruction,asthma, thyroid

disease, orprostatic

hypertrophy

Hypersensitivity

reactions havebeen reported inpatients receivingacetylcysteine,includingbronchospasm,angioedema,rashes andpruritus, mayoccur. Otheradverse effectsreported includenausea and

vomiting, fever,syncope,sweating,arthralgia, blurredvision,disturbances ofliver function.Contraindication:MAO inhibitortherapy within 14

Monitoreffectiveness of therapyand adventofadverse/allergic effects.Instructpatient inappropriate

use andadverseeffects toreport.

8/22/2019 MICU MDH

25/32

days initiatingtherapy; severehypertension;severe. Coronaryartery disease,hypersensitivity topseudoedephrine,acrivastine or anycomponent; renalimpairment.

Brand Name: Pantoloc Drug Classification: Anti-ulcer agents

Generic Name: Pantroprazole Sodium Frequency: TID

Date Ordered: 12-11-12 Dosage: 40 mg IV



Nursing

Responsibilities

Erosiveesophagitis

associated withGERD. Decreaserelapse rates of

daytime andnighttimeheartburn

symptoms onpatients with

GERD. Pathologicgastric

hypersecretoryconditions.

Chemical Effect:Binds to anenzyme in thepresence of acidicgastric pH,preventing thefinal transport ofhydrogen ions intothe gastric lumen.

Therapeuticeffect: Diminishedaccumulation ofacid in the gastriclumen, withlessened acidreflux. Healing ofduodenal ulcersand esophagitis.Decrease acidsecretion inhypersecretoryconditions.

Hypersensitivity.

Lactation.

Use cautiously inpregnancy andchildren (safety

not established).

Headache,

abdominal pain,diarrhea,

eructation,flatulence,

hyperglycemia

May causeabnormal liverfunction tests,including increaseAST, ALT,alkalinephosphate, andbilirubin.

Patients receiving

pantoprazole IVshould beconverted to POdosing as soon aspossible.

Reconstitute eachvial with 10 mL of0.9% NaCL for a

concentration of 4mg/mL.

Reconstitutedsolution is stablefor 6hr at roomtemperature.

Brand Name: Drug Classification: Anti-hypertensive

Generic Name: Hydrochlorothiazide Frequency: OD PO

Date Ordered: 12-11-12 Dosage: 12.5 mg/tab

8/22/2019 MICU MDH

26/32



Nursing

Responsibilities

Adjunctivetherapy inedemaassociatedwith CHF,cirrhosis,corticosteroid,and estrogentherapy; renaldysfunction

Hypertensionas soletherapy or incombinationwith otherantihypertensives

Unlabeleduses:Calciumnephrolithiasis alone orwith amiloride

or allopurinolto preventrecurrencesinhypercalciuricor normalcalciuricpatients;diabetesinsipidus,especiallynephrogenicdiabetesinsipidus;osteoporosis

Inhibitsreabsorption of

sodium andchloride in distal

renal tubule,increasing theexcretion of

sodium,chloride, and

water by thekidney

Contraindicatedwith allergy tonitrates, severeanemia, headtrauma, cerebralhemorrhage,hypertrophiccardiomyopathy,narrow-angleglaucoma,

postduralhypotension

CNS: Headache,apprehension,

restlessness,weakness,vertigo,dizziness,faintness

CV:Tachycardia,retrosternaldiscomfort,palpitations,hypotension,syncope,collapse,orthostatichypotension,angina,reboundhypertension, atrialfibrillation,postduralhypertension

Dermatologic:Rash,exfoliativedermatitis,cutaneous

vasodilationwith flushing

GI: Nausea,vomiting,incontinenceof urine andfeces,abdominalpain,diarrhea

GU: Dysuria,impotence,urinary

frequencyOther: Muscle

twitching,pallor,perspiration,cold sweat,arthralgia,bronchitis

Assess forpain:duration,

timestarted,activitybeingperformed,character,intensity

Assessorthostatichypotension, bloodpressure atbaselineand duringtreatment

Precautions:pregnancy,

lactation, acuteMI, CHF, postural

hypotension,severe renal,

hepatic disease

8/22/2019 MICU MDH

27/32

Brand Name: Crestor Drug Classification:Anti-hyperlipidemic

Generic Name: Rosuvastatin calcium Frequency: OD

Date Ordered: 12-13-12 Dosage: : 20 mg 1 tab



Nursing

Responsibilities

an adjunct to dietin the treatment of

elevated totalcholesterol, mixed

dyslipidemia,atherosclerosis

A fungalmetabolite that

inhibits theenzyme (HGM-

CoA) thatcatalyzes the first

step in thecholesterol

synthesispathway, resulting

in a decreaseIn serum

cholesterol, serumLDLs (associated

with increasedrisk of coronary

arterydisease) and

either an increaseor no change in

serum HDLs(associated with

decreased)

hypersensitivity,impaired hepatic

function,alcoholism, renal

impairment,advanced age,hypothyroidism

Nausea,

dyspepsia,diarrhea,

constipation,vomiting, rhinitis,sinusitis, cough,

dyspnea,pneumonia

Arrange forproper

consultation aboutneed for diet andexercise changes Administer drug

at bed time Monitor patient

closely for signs ofmuscle injury,

especially higherdoses Provide

comfort measuresto deal with

headache, musclecramps, or

nausea Offersupport and

encouragement todeal with disease,diet, drug therapy,

and follow-upcare.

Brand Name: Epogen, Procrit Drug Classification:

Generic Name: epoetin alfa Frequency:

Date Ordered: 12-13-12 Dosage: 300 units/kg

Indications

Mechanis

m ofAction

Contraindication

s Side EffectsNursing

Responsibilities

used to treat anemia that isassociated with chronic

kidney failure in patients whoare or will be receiving renal

dialysis. It also is used totreat anemia in patients

with HIV infection who are

It causesthe bone

marrow toproduceoxygen-carrying

red blood

There are nostudies of epoetin

alfa usein pregnant

women.Polyhydramniosand intrauterine

high blood

pressure, headache

, joint-pain and

clotting at the

injection site. Rare

Monitoreffectiveness oftherapyand adventofadverse/all
http://www.medicinenet.com/script/main/art.asp?articlekey=10419http://www.medicinenet.com/script/main/art.asp?articlekey=10419http://www.medicinenet.com/script/main/art.asp?articlekey=344http://www.medicinenet.com/script/main/art.asp?articlekey=344http://www.medicinenet.com/script/main/art.asp?articlekey=263http://www.medicinenet.com/script/main/art.asp?articlekey=33915http://www.medicinenet.com/script/main/art.asp?articlekey=33915http://www.medicinenet.com/script/main/art.asp?articlekey=378http://www.medicinenet.com/script/main/art.asp?articlekey=378http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=378http://www.medicinenet.com/script/main/art.asp?articlekey=378http://www.medicinenet.com/script/main/art.asp?articlekey=33915http://www.medicinenet.com/script/main/art.asp?articlekey=33915http://www.medicinenet.com/script/main/art.asp?articlekey=263http://www.medicinenet.com/script/main/art.asp?articlekey=344http://www.medicinenet.com/script/main/art.asp?articlekey=344http://www.medicinenet.com/script/main/art.asp?articlekey=10419http://www.medicinenet.com/script/main/art.asp?articlekey=10419

8/22/2019 MICU MDH

28/32

receiving zidovudine (Retrovir) and in patients

with cancerwho arereceivingchemotherapy and

develop anemia.

cells. growth restrictionwas reported in asmall number ofpregnant women

who receivedepoetin alpha.Multiple dosevials contain

benzyl alcoholand should notbe administered

to pregnantwomen.

cases of stinging at

the injection

site,skin

rash and flu-like

symptoms (joint

and muscle pain)

have occurred

within a few hours

following

administration.

Allergic

reactions, seizures,

and thrombotic

events (for

example, heart

attacks, strokes,

and pulmonary

embolism )

ergiceffects.Instructpatient inappropriate use andadverseeffects toreport.

Brand Name: Micardis Drug Classification:Angiotensin II Antagonists/

Diuretics

Generic Name: Telmisartan Frequency:

Date Ordered: 12-13-12 Dosage:



Nursing

Responsibilities

Treatment foressentialhypertension.

Blocksvasoconstricting.

Telmisartan (Telimarketed bycadila pharma) isan AngiotensinReceptor Blocker(ARB) that showshigh affinity forthe angiotensin IItype 1 (AT1)

Pregnancy &lactation.

Cholestasis &biliary obstructivedisorders. Severe

hepatic & renalimpairment (CrCl

8/22/2019 MICU MDH

29/32

receptors, has along duration ofaction, and hasthe longest half-life of any ARB.In addition toblocking theRenin-AngiotensinSystem (RAS),telmisartan actsas a selectivemodulator ofPeroxisomeproliferator-activatedreceptor gamma(PPAR-), acentral regulatorofinsulin and

glucosemetabolism. It isbelieved thattelmisartans dualmode of actionmay provideprotectivebenefits againstthe vascular andrenal damagecaused bydiabetes andcardiovascular

disease (CVD).Telmisartan hasbinding affinity

3000 timesgreater for AT1

than AT2receptors.

Telmisartan alsohas the longesthalf life (24 hrs)

of all angiotensinII type 1 receptor

antagonists.

hypokalemia,hypercalcemia.

give IVnormalsaline, ifneeded.

For patientwhose renalfunction maydepend onthe activity ofthe renninangiotensinaldosteronesystem (suchas those withsevere heartfailure)treatmentwith ACEinhibitors andangiotensin

receptorsantagonisthas causedoliguria orprogressiveazotemia andacute renalfailure ordeath.

Instructpatient totake drugexactly asprescribed.

Tell thepatient totake drug atleast 1 hourbefore a
http://en.wikipedia.org/wiki/Angiotensin_receptorhttp://en.wikipedia.org/wiki/Renin-Angiotensin_Systemhttp://en.wikipedia.org/wiki/Renin-Angiotensin_Systemhttp://en.wikipedia.org/wiki/Renin-Angiotensin_Systemhttp://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttp://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttp://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttp://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Cardiovascular_diseasehttp://en.wikipedia.org/wiki/Cardiovascular_diseasehttp://en.wikipedia.org/wiki/Cardiovascular_diseasehttp://en.wikipedia.org/wiki/Cardiovascular_diseasehttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttp://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttp://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttp://en.wikipedia.org/wiki/Peroxisome_proliferator-activated_receptor_gammahttp://en.wikipedia.org/wiki/Renin-Angiotensin_Systemhttp://en.wikipedia.org/wiki/Renin-Angiotensin_Systemhttp://en.wikipedia.org/wiki/Renin-Angiotensin_Systemhttp://en.wikipedia.org/wiki/Angiotensin_receptor

8/22/2019 MICU MDH

30/32

meal. Advise

patient thatantacids canbe used whiletaking drugsunlessotherwisedirected byprescriber.

Brand Name: Zosyn Drug Classification: Antiinfective; Beta-lactam

antibiotic; Anti-pseudomonal penicillin

Generic Name: Piperacillin / Tazobactam Frequency: every 12hr

Date Ordered: 12-13-12 Dosage: 280 mg IVTT

IndicationsMechanism

of ActionContraindications Side Effects

Nursing

Responsibilities

Treatment of

moderate to severeappendicitis,

uncomplicated andcomplicated skin and

skin structureinfections, nosocomialor community-acquired

pneumonia causedpiperacillin-resistant,

piperacillin/tazobactamsusceptible, beta-

lactamase-producingbacteria.

It is

similar to thatof other

penicillins.Interfere withbacterial cell

wallsynthesispromotes

loss ofmembrane

integrity andleads to

death of theorganism

Hypersensitivity topenicillins,

cephalosphorins,or other drugs.

Safety in children< 12 years old,

pregnancy,lactation.

CNS: headache,

insomnia, fever

GI: diarrhea,nausea,constipation,vomiting,pseudomembranouscolitis

SKIN:hypersensitivityreactions ,rash,pruritus

- Obtain historyofhypersensitivityto penicillins,cephalosphorins, or otherdrugs prior toadministration,

- Obtainspecimen for

culture andsensitivity priorto first dose ofthe drug; startdrug pendingresults. PeriodicCBC withdifferential,platelet count,Hgb & Hgt, andserumelectrolytes.

- Monitor for

hypersensitivityresponse;discontinuedrug and notifyphysician ifallergicresponse noted.

- Monitor forhemorrhagic

8/22/2019 MICU MDH

31/32

manifestationsbecause highdose mayinducecoagulationabnormalities.

- Instructfamily/significant others toreportsignificant,unexplaineddiarrhea.

- Monitor vitalsigns becauseof cardiacarrhythmias,hypertensionand fever asadverse

reactions.- Instruct themother not tobreast feed thebaby whiletaking the drugwithoutconsultingphysician.

VII. ANATOMY AND PHYSIOLOGY

Cells in the body require oxygen to survive. Vital functions of the body are carried out as the body is

continuously supplied with oxygen. Without therespiratory systemexchange of gases in the alveoli will not

be made possible and systemic distribution of oxygen will not be made possible. The transportation of

oxygen in the different parts of the body is accomplished by the blood of the cardiovascular system.

However, it is the respiratory system that carries in oxygen to the body and transports oxygen from the

tissue cells to the blood. Thus, cardiovascular system and respiratory systemworks hand in hand with

each other. A problem in the cardiovascular system would affect the other and vice versa.

8/22/2019 MICU MDH

32/32

Functional Anatomy of the Respiratory System

Nose

The nose is the only external part of the respiratory system and is the part where the air passes through.

During inhalation and exhalation, air enters the nose by passing through the external nares or nostrils.

Nasal cavity is found inside the nose and is divided by a nasal septum. The receptors for the sense of

smell, olfactory receptors are found in the mucosa of the slit-like superior part of the nasal cavity which is

located beneath the ethmoid bone. Respiratory mucosa lines the rest of the nasal cavity and rests on a

rich network of thin-walled veins that warms the air passing by.

Important information about nose is the presence of the sticky mucus that is produced by the mucosas

gland. This important characteristic moistens the air and traps the incoming bacteria and other foreign

debris passing through the nasal cavity. Cells of the nasal mucosa are ciliated and it creates a gentle

current that moves the contaminated mucus posteriorly towards the throat, where it is swallowed anddigested by stomach juices.

In cases where the temperature of the environment is cold, the cilia become sluggish. Thus, more mucus

are allowed to accumulate in the nasal cavity and to dribble outward through the nostrils. This is the main

reason why a runny nose is noted during a cold day.

Documents

MICU MDH