RESPIRATORY SYSTEMPULMONARY SYSTEM

Nursing care of the respiratory pt. is directed towards…

1. Making breathing easier2. Preventing transmission of infection

(airborne, droplet)

Relationship Between Heart and Lungs

O2 is delivered throughout the body by means of blood. Every cell in the body produces CO2 as it is the waste product. It is transported in veins and it is exhaled into the atmosphere when it reaches the lungs. When the body does not eliminate CO2 (whether d/t disease, distress, etc.), it creates chemical reactions causing an acid buildup in the blood. Death results if levels of acid and CO2 are too high.

The elderly have special concerns d/t:

Less muscular strength making it more difficult to recover from effects of immobility

Less lung capacity, making it more difficult to recover from effects of anesthesia and surgery

Weaker coughs so more susceptible to pneumonia

Lungs lose their elasticity so there is less lung capacity

RESPIRATORY PROBLEMS VS. DISTRESS

S&S OF RESPIRATORY PROBLEMS (EARLY)

S&S OF RESPIRATORY

DISTRESS (LATE) Increased RR SOB Anxiety/ Restlessness

Color changes Skin changes Respiratory arrest!!

HYPOXEMIA

INSUFFICIENT OXYGEN IN BLOODSTREAMPatients who are immobile, elderly, obese,

post-op or have cardiac disease are high risk for hypoxemia

Many pts. @ risk for hypoxemia are on REGULAR medical/surgical floors in the

hospital

How to assess for hypoxemia

Pulse oximeter (pg. 622)- measures saturation of level of pt.’s hemoglobin with O2. Hemoglobin is the part of the blood that carries O2 to the cells

Capillary refill (pg. 622)- indicator of person’s peripheral circulation and how well tissues are being nourished with oxygen.

Pulse Oximeter

Indicator of person’s PERIPHERAL circulation and how well tissues are being nourished with O2

S&S of Respiratory Problems

S&S OF DECREASED OXYGENATION

S&S OF INADEQUATE BREATHING

RR below 12 or above 20

Cyanosis Cool, clammy skin SOB Noisy breathing Changes in mental

status Wheezing

Movement in chest is absent/minimal

Abdominal breathing RR is too slow/rapid Respirations appear

labored Pt. unable to speak

d/t SOB Nasal flaring

Why should nurse respond STAT to these Early Symptoms???

Children and Respiratory Problems

Infants and children do NOT have energy reserve so they become ill (respiratory

distress) very quickly!!!

Nursing Interventions

Assess for S&S of respiratory distress (???) High fowler’s position Rest between ADL activities Note VS, especially RR After surgery:

Breathe deeplySplint abd.Help pt. cough and deep breathe to

expectorate sputumIncentive spirometer

Respiratory Diseases/Disorders

Chronic Obstructive Pulmonary Disease (COPD)

Group of conditions that result in CHRONIC blockage or obstruction of the respiratory system. Not reversible; (99% caused by smoking)EMPHYSEMA, CHRONIC BRONCHITIS

2 Types of COPD

1. Emphysema- air sacs become distended, lose their elasticity so patients are unable to exchange O2 and CO2. Patients can inhale easily, but difficulty exhaling. Develops after chronic obstruction of air flow to alveoli.

Caused by: smoking, exposure to chemicalsIncrease risk of developing pneumoniaCauses strain on heart

Emphysema

SymptomsHeadache- most common d/t increased CO2 levelsFatigue

SOBChronic low oxygen levelsLoss of appetiteWeight loss

Chronic Bronchitis

Prolonged inflammation in bronchi

S&SPersistant “wet cough”Sputum production (phlegm from lungs)SOB w/ exertion

Asthma

Constriction of muscles of BRONCHIOLES w/ swelling of respiratory membranes, production of large amounts of mucous that fill the narrowed airways.

S&SLabored breathingTightness in chestWheezingFrequent coughing

Other Respiratory Illnesses

URI– Upper respiratory infection

Pneumonia– Inflammation/infection in lungs. Most pneumonia is treatable with antibiotics

Nursing Care of Respiratory Patient:

Respiratory Positions:--High Fowler’s--Orthopneic- makes thorax larger on inspirations, allowing pt. to inhale

more air

Respiratory Treatments

Respiratory Treatments:1. Oxygen Therapy- Mask, nasal cannula.Need doctor’s order, know the O2 flow rate, check for proper positioning of oxygen and may need cannula while eating if mask. Monitor O2 throughout shift.

Respiratory Treatments

2. Incentive Spirometer- Apparatus to encourage better ventilation and prevent atalectasis (collapse of alveoli) and pneumonia.

Respiratory Treatments

3. Nebulizer- delivers moisture and medications into lungs

Nursing Interventions

General1. Assist with breathing techniques (purse-

lip)2. Good nutrition3. Pace ADL activities4. Encourage fluid intake5. Encourage deep breathing and coughing

(relationship between pneumonia/coughing)

NURSING INTERVENTIONSAfter Surgery…

Breathe deeply Splint abd. Help pt. cough and deep breathe to

EXPECTORATE Purse- lip breathing

Surgical Conditions

1. Tracheostomy (pg. 671)- external opening on skin surface (STOMA) that provides airway for people requiring a ventilator or respirator or need suctioning. RN responsibility

2. Chest tube (pg. 673)- Sterile plastic tubes that are inserted through skin or chest, between ribs and into spaces between plueral membrane. Used after surgery to drain bloody fluid drainage from chest. RN responsibility

CNA—Nothing should pull on tube, drainage system remains upright, below level of heart at ALL times, never twist or kink tubing