repiratory system

7/29/2019 repiratory system

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RESPIRATORY SYSTEM and

OXYGENATION

By: Tom Labonete


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REMEMBER!!!

NOWSOON


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THE RESPIRATORY

SYSTEM


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The Respiratory system

Upper respiratory

Filters airWarms and moistens

Humidifies


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Consists of:

Nose

passageway of air Sinus resonating chamber

Pharynx

connects the nasaland oral cavity into the larynx

Larynx

connects thepharynx and the trachea

Glottis vocal apparatus


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Lower Respiratory airway

GAS EXCHANGE IS THE MAIN

FUNCTIONConsists of:

Trachea

Bronchus right and left

Lungs right (3) and left (2)

Bronchioles Alveoli

Pleura parietal and visceral


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Device LPM O2 % Must knows

Nasal Canula

Face mask

Partial

Rebreathermask

Non-

rebreather

mask

Venturi Mask

Face tent


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Partial

PRB


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Non rebreather mask


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Jets of the Venturi Blue

24%

White 28%

Orange

31% Yellow 35%

Rid

40% Green 60%


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1. Mouth-to-Mouth

4. Mouth-to-Stoma

3. Mouth-to-Mouth and Nose

2. Mouth-to-Nose

WAYS TO VENTILATE THE LUNGS

BLS 33


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5. Mouth-to- Mask

7. Bag Mask Device

D i LPM O2 % M t k


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Device LPM O2 % Must knows

Nasal Canula 1-6 24 45%

Face mask 5- 8 40- 60%

Partial Rebreather

mask

6- 10 60- 90%

Non- rebreather mask 10- 15 95- 100%

Venturi Mask 4-10 Depende sakulay

Face tent 4- 8 30- 50%


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ommon Upper tract disorders

Sinusitis

Croup

Tonsilitis andadenoiditis


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SINUSITIS

Inflammation of ths sinuses

Causes:

streptococcus pneumonia, H.

Pylori and Moraxella


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MANAGEMENT

ACUTE SINUSITIS

Heat mist

Saline irrigation Nasal and oral

decongestantAntibiotics

Antihistamines


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CHRONIC

SINUSITIS

Caldwell-Luc

procedure Used to removed

diseased tissue


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P t


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Post- op

Position to side to prevent

aspiration and swallowing of

bloody drainage

AIRWAY Maintenance is alwaysthe priority after operation

Administer cool mist via face tent,or provide humidifierFowlers

position


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Encourage fluid intake

WOF CSF LEAK

WOF FeverWOF Complains of

pain over areaWOF Decreased visual


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WOF Excessive bleeding

Advise patient toexpectorate secretions

Avoid blowing the nose,Avoid lifting

Expect black tarry stools

for few days (NORMAL)

CROUP (b ki


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CROUP (barkingcough)

acute viral infection of

the upper airway

leading to swellinginside the throat,

which interferes with

normal breathing and

produces the classical

s m toms of a


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CROUP FAQs


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CROUP FAQ s

When does the croup attack

happen?

ANSWER: At night

What age group commonlycroup affects people?

ANSWER: Infants and children

(under 6)

What is the characteristic of the

breath sounds on children

M t SWEAT


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Management - SWEAT

Steroids (use withcaution)

Warm steaminhalation

Epinephrine

Antibiotics

TONSILLITIS d ADENOIDITIS


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TONSILLITIS and ADENOIDITIS

Tonsils - Lymhoid tissues located

at the back of the throat on either

side of the oropharynx

Adenoids - Located high in the

throat behind the nose and roofof the mouth


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SIGNS AND SYMPTOMS

Sore throat

Fever

Snoring

Dysphagia

Mouth breathing Fouls smelling breath

Voice impairment Grading of tonsils


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Grading of tonsils

Grade 1+ Tonsils are visible

Grade 2+ Tonsils are between the pillarsof the uvula

Grade 3+ Tonsils are touching the uvula

Grade 4+ tonsils extend to the midline of


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MANAGEMENT


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MANAGEMENT

Force fluids Rest

Analgesics/antibiotics

Gargle warm

saline

POST TONSILLECTOMY


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POST TONSILLECTOMY

Prone head turned to side

Semi fowlers if the patient is awake Watch out for bleeding; FATS

Frequent swallowing

Anxiety

Throat clearing

Shock symptomsDIET

Cool, clear liquid, non- irritating foods

Avoid red/ brown colored foods

MUST KNOWS!!!


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MUST KNOWS!!!

Black stools after operation is normal

Throat discomfort 8 hours afteroperation is normal

Avoid clearing, sneezing, andblowing

LOWER RESPIRATORY TRACT


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LOWER RESPIRATORY TRACT

DISORDERS

ACUTE RESPIRATORYDISTRESS SYNDROME

DEFINITION: ARDS occurs

when there is a hindrance

between oxygen and carbondioxide exchange such as:

- RISK FACTORS


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RISK FACTORS

Localized infection / sepsis Trauma

Surgery

Embolism

CAUSES


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CAUSES

Edema (inflammatory

exudates) which increases the

capillary space between the

oxygen and the blood,impairing gas exchange

leading to hypoxia Low surfactant production

ma cause the alveoli to MANIFESTATIONS


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MANIFESTATIONS

Severe dyspnea

Hypoxemia untreated with oxygen Retractions/ Restlessness

MANAGEMENT

Mechanical ventilation and or high flow

oxygen Chest physiotherapy

Position to semi fowlers

Positive end ex irator ressure PEEP -to

BRONCHIAL ASTHMA


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BRONCHIAL ASTHMA

DEFINITION: Inflammation of the mucosal

lining of the bronchial tree and constrictionof the bronchial smooth muscles

(bronchoconstriction)RISK FACTORS OF BRONCHIAL ASTHMA

EXTRINSIC INTRINSICAllergens Stress

Molds Anxiety

Feathers/ Furs GeneticsPollens Emotions

Fumes and smoke

Dustmite

most common

Pathophysiology of bronchial asthma


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Pathophysiology of bronchial asthma

Triggers

Histamine production Leukotrines

goblet cells

Bronchoconstriction Inflammation

Mucous production

Airway Obstruction

INTERVENTIONS


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INTERVENTIONS

AVOID the triggers Semi fowlers position

Take frequent rest andincrease fluid intake

Humidification/ oxygen

therapy

MEDICATIONS


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MEDICATIONS

Mast cell inhibitors: cromolyn sodium

(used to prevent allergic symptoms) Leukotrine antagonist: montelukast

(leukotrines- are fatty compoundsproduced by the immune system that

cause inflammation)

Bronchodilators: theophylline,

aminophylline

Corticosteroids: prednisone

CARBON MONOXIDE


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CARBON MONOXIDE

POISONINGDEFINITION: When

carbon monoxidecombines with

hemoglobin more readily

than oxygen does


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MANAGEMENT


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MANAGEMENT

Remove patient from area of

poisoning Give 100% oxygen via a tight fitting

NON REBREATHER MASK Hyperbaric oxygen therapy (HBOT)

(used to increase oxygen

concentration and accelerateformation of carbon dioxide, whichcan be exhaled)

CHRONIC BRONCHITIS


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CHRONIC BRONCHITIS

DEFINITION: Chronic inflammation of

the lower respiratory tract due toinfection characterized by excessive

mucous secretion, cough, dyspnea

associated with recurring infections of

the lower respiratory tract

PREDISPOSING FACTORS:

SMOKING Most common cause


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SIGNS AND SYMPTOMS

Excessive mucous secretion Cough

Dyspnea on exertion Recurring infections of the

lower respiratory tract

COMPLICATION: Pulmonary


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COMPLICATION: Pulmonary

hypertension/ cor pulmonale

SADs: (screenings, assessments,

dianostics) Pulmonary function test or

spirometry Increased WBCs

Chest X- ray revealing


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NURSING

CONSIDERATIONS: Chest physiotherapy

Oxygen therapy Rest

Drugs antibiotics,bronchodilators

Sto smokin steam Chronic smoking


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g

Increased mucous production leading to

thickening and inflammation of the bronchial

wall

Impaired ciliary function

Impaired defense

Airway obstruction

Leading to collapsed airway and air trapping at


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g p y pp g

distal lung areas

Hypoxia, lessened ventilation of alveoli, thus

decreasing alakalinity (acidosis)

Polycythemia, cyanosis, breathing difficulty

Cor pulmonale right sided heart failure

WHATs THE FACT!?


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Chronic bronchitis causes decreasedventilation, leading to CYANOSIS

(BLUE), and also cor pulmonaleleading to right side heart failurewhich causes edema (bloat). Thus the

symptoms CYANOSIS and EDEMA EMPHYSEMA


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DEFINITION: Destruction of the alveolar walls,

leading to permanent/ irreversible condition

characterized by:

Over distention/ expansion of air spaces (barrelchest)

Inelasticity of alveoli

Air trapping

Maldistribution of gases


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Pathophysiology


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p y gy

Chronic smoking and other factors

Destruction of alveolar walls

Increased elasticity and decreased recoil ability ofthe alveoli

Destruction of elastic recoil

Increased alveolar distention and airway collapse

while expiration

Carbon dioxide unable to be released


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acidosis and hypoxia follows (accompanied by

recurrent infections)

MANAGEMENT

Chest physiotherapy Oxygen therapy must not exceed up to 3 LPM,

the safest is 2 LPM

Pursed lip breathing Humidification (steam inhalation)

High fowlers position

Increase fluid intake

Whats the FACT!?


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Emphysema clients are called PINK PUFFERS

because they have a

strong hypoxic drive, meaning theyre struggling

to breath always.

They appear pink because at the early stages of

the disease their

blood is still oxygenated.

BRONCHITIS DIFFERENTIALS EMPHYSEMA


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Smoking MOST COMMON

CAUSE

Smoking

Lower respiratory

airway

AREA

AFFECTED

Alveolar walls

Inflammation MECHANISM OFDISEASE

Over expansion,stretching

Blue bloater TERMS Pink puffer

Respiratory

acidosis

LUNG PH Respiratory

acidosis

Impaired

breathing pattern

NURSING

DIAGNOSIS

Impaired

breathing pattern

FLAIL CHEST


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DEFINITION: Fracture of 2 or moreadjacent

ribsCAUSES

Trauma

CompressionSIGNS AND SYMPTOMS

Dyspnea

Hypercapnea too much C02 in theblood

Paradoxical chest movement

(chest is depressed during

MANAGEMENT


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MANAGEMENT

Cover with dressing taped on 3

sides

Analgesics

Deep breathing after analgesic

administration

Semi fowlers position with

affected side supported


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PNEUMOTHORAX


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DEFINITION:Air enters the pleural cavitycausing a lung to collapse partially or

completely, this is a medical emergency SIGNS AND SYMPTOMS

Absent breath sound on the affected side

Pleuritic chest pain PMI is displaced from the original site

Hypertympany upon percussion

Mediastinal shiftingPMI is displaced from the original site

Tracheal deviation to the unaffected side

Thoracic assymetry


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MANAGEMENT


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MANAGEMENT

Chest tubedrainage

Oxygen therapy Occlusive

dressing

PLEURAL EFFUSION


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Hemothorax - blood in

the pleural cavity Hydrothorax -

noninflammatory fluid in

the pleura. Pyothorax / empyema -

pus within the pleura

Hemopneumothorax

blood and air in the

pleura

NURSING CONSIDERATIONS:


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NURSING CONSIDERATIONS:

Thoracentesis evacuation of

fluid from the lung parenchyma

Closed chest drainage

draining of fluid from the pleura

CLOSED CHEST TUBE DRAINAGE


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CLOSED CHEST TUBE DRAINAGE(THORACOSTOMY TUBE)

CHEST TUBE/ WATER SEAL DRAINAGEDEFINITION: Insertion of catheter into

intrapleural space to maintain constant

NEGATIVE PRESSURE when air or fluidhas accumulated

PURPOSES:

To remove air and/ or fluids from the

pleural space PRINCIPLES


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GRAVITY

Allows fluid and air flow from higherlevel to lower level

SUCTION

Applied if air leaking in the pleural

space is faster than it can be removed

by water seal apparatus

Speeds up removal of air from pleural

WATER


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WATER

WATERacts as a seal; provides barrier

between atmospheric air andsubatmospheric intrapleural pressure

Must be AIRTIGHT

Leak can go back into the pleural

space, causing POSITIVE PRESSURE

Must have AIRVENT Provides escape route for air, prevent

builds up in water seal chamber


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MUST KNOWS FOR THE DRAINAGE


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BOTTLE

Keep at least 2 to 3 feet below thechest

NEVER raise the bottle above heart

level COLOR: bloody drainage during the

first 24 hours

OUPUT: 500

1000 ml during the first24 hours

FLUID DRAINAGE: the tube is inserted

MUST KNOWS FOR THE WATER SEALBOTTLE


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BOTTLE

Immerse tip of the tube in 2- 3 cm of sterile

NSS to create water seal

COMMON OBSERVATION:

INTERMITTENT BUBBLING/

FLUCTUATIONS/ OSCILLATION/ TIDALLING(rise on inspiration, fall during expiration)

NO FLUCTUATIONS

Obstruction

check and milk the tubingwith CAUTION

Low suction

MUST KNOWS FOR SUCTION


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CHAMBER

Immerse the tube of the suctioncontrol bottle in 10 to 20 cm ofsterile NSS

COMMON OBSERVATIONS

CONTINUOUS GENTLE BUBBLING(indicates adequate suction

control)


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EMERGENCY SITUATION


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EMERGENCY SITUATION

DISLODGE

AT BEDSIDE: vaselinized gauze

Palm pressure

DISCONNECTIONAT BEDSIDE:

Extra bottle immersed in sterile water

Clamp (Hemostat)

RESPIRATORY TRACT PROCEDURES


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BRONCHOSCOPY

Chest X- ray


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Considerations: Instruct patient to remove all

metal jewelries

CXR is contraindicated to

pregnant patients

CHESTPHYSIOTHERAPY


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PURPOSE: Used to mobilize

secretions

TECHNIQUES:

PERCUSSION clapping withcupper hands

Place towel Time: 1 2 minutes per area

3 5 minutes thick secretions VIBRATION flat hands pressed firmly over


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the chest wall

Done during 5 exhalationNURSING CONSIDERATIONS:

Doctors order is needed

Before meals or 2 3 hours after meals or

In the morning upon awakening and at

bedtime Bronchodilators given about 20 to 30

minutes prior

Remove constrictin clothin


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CONTRAINDICATIONS:

Pregnant Pulmonary embolism

Abdominal surgery With chest injuries

Tumors/ malignancies

Increased ICP Tuberculosis

MECHANICAL VENTILATION


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DEFINITION: A positive- or negative-

pressure breathing device that supportsventilation and oxygenation

For people unable to maintain normallevels of O2 and CO2 such as: CHANT

COPD

Hypoxemia

ARDS

Neuromuscular disease HIGH PRESSURE ALARM means

OBSTRUCTION h


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OBSTRUCTION such as:

Client biting on the tube Bronchospasm

Water in the tube

Kinked tube

Mucus plug suction

Patient breathing against the incomingmechanical breath

LOW PRESSURE ALARM SOUND

means LEAK such as:

SPUTUM COLLECTION


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Must be early in the morning

Gargle with WATER ONLY as

mouth care before expectorating

Deep breath and cough upSPUTUM from the lungs

15 mL Instruct patient to

EXPECTORATE not SPIT


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TRACHEOBRONCHIAL SUCTIONING


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suction removal of secretions from the

tracheobronchial trees using sterilecatheter inserted into the airway

Purpose:

Maintain patent airway

Substitute for effective coughing

Obtain specimen for analysis

BEFORE:


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POSITION: semi to highfowlers

Use STERILE gloves Hyperoxygenate patient

UNCONCSCIOUS: self-

inflating bag

DURING:


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Insert 3 to 5 inches of the catheter

using gloved hands duringINSPIRATION

Apply INTERMITTENT suctionupon withdrawal by covering the

thumb control

Withdraw catheter in a rotating

motion not longer than 10 seconds

AFTER: WHAT ARE THE FACTS?!

The human lung covers as much surface area


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The human lung covers as much surface area

as a tennis court!

People whose mouth has a narrow roof are

more likely to snore!

The average cough comes out of the mouth at

60 mph!

The right lung is larger than the left one, the

left one makes room for the heart!

In 1918 and 1919, a world epidemic of simple

influenza (flu) killed 20 million people in the

U it d St t d E !

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repiratory system