Respiratory System F07

8/10/2019 Respiratory System F07

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Respiratory System

Chapter 43


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Respiration

Process of air exchange

Oxygen is obtained and carbon dioxide is

eliminated

Gas exchange occurs in the alveoli


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Four parts of respiration

Ventilationmovement of air between the

atmosphere and alveoli

Perfusionblood flow through the lungs

Diffusionoxygen and carbon dioxide are

transferred between alveoli and blood

Regulationrespiratory muscles and nervous

system


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Respiratory Tract

Nose, pharynx, larynx, trachea, bronchi

Series of tubes that function as airway

passages

Filter, warm and humidify incoming air


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Pharynx

Contain the tonsilsnormal function is to

fight infection

Larynxvoice box


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Epiglottis

Flexible cartilagesupported flap that covers

the opening of the trachea or (glottis).

It automatically closes the opening to the

trachea during swallowing.

If you eat food to fast it can get lodged in the

trachea.


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Heimlich Maneuver

Used to pop food out and back into the

pharynx.


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Heimlich Maneuver - Infant


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Trachea

Trachea is lined with ciliated columnar

epithelium and mucous cells.

The chronic cough of smokers is caused by

damage to cilia.


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Cilia - Smokers


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Lungs

Right side has 3 lobes

Left side 2 lobes

Contains the lower respiratory structures


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Bronchi

Definition: The bronchi are small air

passages, composed of hyaline cartilage,

that extend from the trachea to the

bronchioles. There are two bronchi in thehuman body that branch off from the trachea.

The bronchi are lined with mucous

membranes that secrete mucus and cilia that

sweep the mucus and particles up and out of

the airways.


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Alveoli

Have a very thin membrane that allows rapid

diffusion of oxygen and carbon dioxide

between capillary blood and alveolar air

spaces. Lined with surfactant to prevent alveolar

collapse.


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Surfactant

Essential fluid that lines the alveoli and

smallest bronchioles.

Reduces surface tension of the lung allowing

the oxygen and carbon dioxide across themembrane.


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Lack of Surfactant

Premature infants can have Respiratory

Distress Syndrome due to immaturity of

lungs.

Persons with Chronic Obstructive PulmonaryDisease (COPD).


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Nervous System Role

Nervous system regulates the rate and depth

of respirations.

Medulla oblongata is the respiratory control

system of the brain.

Cough reflex is stimulated by nervous

system.


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Disorders of Respiratory System

Infections: bronchiolitis or pneumonia

Allergic disorders

Inflammatory disorders

Obstructive airway disorders Bronchial pulmonary dysplasiapremature

infants

Asthma

Chronic obstructive pulmonary diseases (COPD)

Injury to lungs


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Drugs for Asthma and

Broncho-constrictive Disorders

Chapter 44


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Asthma

Airway disorder characterized by

Hyper-reactivity to various stimuli - trigger

Broncho-constriction

Inflammation


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Clinical Manifestations - Asthma

Dyspneadifficulty breathing

Wheezing

Chest tightness

Coughchronic cough may be the only

symptom

Sputum production


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Precipitating Factors - Triggers

Viral infectionsespecially with infants and

young children

Allergies

GERDGastro Esophageal Reflux Disease

Cigarette smoke

Smoggy airsmoke from fires

Windy weatherhot and dry Santa Ana

winds


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Pathophysiology

Acute reaction to some triggerreversible

with treatment

Mast cells release substances that cause

inflammation and constriction

Broncho-constriction or bronchospasm

Spasm aggravated by inflammation, mucosal

edema and excessive mucus.


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Quick Relief

Short-acting, inhaled, beta 2 agonist, 2-5

puffs as needed.


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Albuterol, levalbuterol, Proventil

Classification Pharmacologic: adrenergic

Classification Therapeutic: bronchodilator

Action: binds to beta2 adrenergic receptors in

airway smooth muscle. Decreased

intracellular calcium relaxes smooth muscle

airways. Relaxation of airway smooth muscle

with subsequent bronchodilation. Relativelyselective for beta 2 (pulmonary) receptors.


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Beta 2 Agonist

Side effects: nervousness, restlessness,

tremor, chest pain and palpitations.

Nursing implications:

Assess lung sounds, pulse and blood pressure.

Monitor pulmonary function tests.

Observe for bronchospasmlisten for wheezing.


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Beta2 Agonist

Rescue drugshort acting beta2- adrenergic

agonist used for prevention and treatment of

bronchocontriction.

Onset 15 to 30 minutes Peak 60 to 90 minutes

Duration 3-6 hours


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How Provided

Provided in extended-release tablet

Albuterol syrup

Nebulizer or dry powder inhaler

Often used in exercise induced asthma

Take 15 minutes before exercise


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Albuterol INH - Nebulizer


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Directions for use of inhaler

Shake well

Exhale (breathe out) through your nose whilekeeping mouth shut

Close lips around mouth piece Take slow, deep breath through the

mouthpiece as you press down on containerto release the medication

Hold breath for 5-10 seconds

Exhale slowly


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Teaching

May give up to 3 treatments at 20 minute

intervals

If no relief need to call PMD or go to ED


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Long Term Control

Mild-intermittent

Symptoms 2 days/week or less

Treat acute exacerbations with

Beta 2 agonist

Short course of systemic corticosteroid

prednisone.


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Moderate Persistent Asthma

Daily symptoms

Inhaled corticosteroids

Long-acting beta 2 agonist

Leukotriene or theophylline


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Corticosteroids

Long term control of asthma

Inhaled by Nebulizer or metered dose inhaler

For an infant hold the Nebulizer with a firm fitting

mask to the infant or small childs face Metered dosehave client rinse and spit after

dose to avoid developing thrush


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Action of Corticosteroids

Suppress inflammation in the airways by

inhibiting

Movement of fluid and protein into tissues

Migration and function of neutrophils andeosinophilsWBCs

Synthesis of histamine in mast cells

Production of pro-inflammatory substances


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Uses

Severe asthmaused when multiple doses

of inhaled beta2 agonists are not beneficial

POprednisone

IVmethyl prednisone

In chronic asthmainhaled

COPDnot as effective as the acute /

chronic asthma


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When to call MD or go to ED

Tight chestwheezingdifficulty breathing

Symptoms not relieved by home meds.

3 treatments with short-acting beta 2 agonist

such as albuterol with no relief.


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Emergency Treatment

Epinephrine IV or Sub Q

For life threatening asthma when inhaled

short acting beta 2 drugs have been tried

either prior to coming to the ED or in the ED.

IV corticosteroidsmethyl prednisone or

Solu-medrol.


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Epinephrine 1 to 10,000 or 0.1 mg/mL


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Epinephrine 1:1000 - 1 mg/mL


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Methylprednisone

Adult dosing: 40 to 250 mg every 4 to 6 hours

Pediatric dosing: 2 mg / kg / dose in asthma.


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Diagnostics

History

Peak expiratory flow measurements: used to

document severity as well as to serve as a

baseline to measure improvement. Pulse Oximetry

WBC: eosinophils will be elevated if allergy

Arterial blood gas

Chest x-ray


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Peak Flow Meter


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Hyper-inflated Lungs in Asthma


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COPD - Chronic Bronchitis

COPDmore of a chronic disease due to

long-term exposure to airway irritants such as

smoking.

Broncho-constriction and inflammation aremore constant and less reversible.

Changes have occurred over the years.

Blue Bloaters they are often cyanotic.

h


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COPD - Emphysema

Loss of elasticity of the lung tissue

Destruction of structures supporting the

alveoli and capillaries feeding the alveoli

Air trapping at the alveolar level

Pink Puffers hyperventilate to maintain

adequate oxygen levelsthis prevents

hypoxia

COPD


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COPD

E h


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Emphysema

COPD Cli i l M if i


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COPD - Clinical Manifestations

Dyspneadifficulty breathing

Activity intolerance

Cough and sputum production

Progressive

Mild COPD


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Mild COPD

Short acting beta 2 agonist

Cessation of smoking

Immunization against flu

M d COPD


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Moderate COPD

Add one or more long-acting bronchodilators

such as salmeterol

Inhaled Anticholinergic drugs such as

Atrovent PO Theophylline

S l l


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Salmeterol

Brand name: Serevent

Classification Pharmacologic: adrenergic

Classification Therapeutic: bronchodilator

Action: Produces accumulation of cyclic

adenosine monophosphate (cAMP) at the

beta 2-adrenergic receptors.

Use with caution: Cardiovascular disease,diabetes, glaucoma

S l l S


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SalmeterolSerevent

Indication: long-term control of reversible

airway obstruction due to asthma and for

maintenance treatment of asthma.

Onset in 10 to 25 minutes Peak in 3-4 hours

Duration 12 hours

I i A


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Ipratropium or Atrovent

Therapeutic classification: allergy, cold andcough remedies, bronchodilators

Pharmacologic classification: anticholinergic

Action: inhibits cholinergic receptors inbronchial smooth muscle, resulting indecreased levels of cGMP.

Therapeutic effects: bronchodilates without

system anticholinergic effects. Side effects: hypotension


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X hi h h lli


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Xanthines - theophylline

Brand name: Accurbron, Theo-dur, Apo-Theo

Classification Pharmacologic: xanthines

Classification Therapeutic: bronchodilators

Action: Inhibits phosphodiesterase, producingincreased tissue concentrations of cAMP. Increased

levels of cAMP result in bronchodilation, CNS

stimulation, diuresis.

Indication: Long-term control of reversible airwayobstruction caused by asthma or COPD.

X thi Th h lli


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Xanthines - Theophylline

Theophyllinemechanism of action unknown

Used in COPD and sometimes asthma

Inhibits pulmonary edema by decreasing vascular

permeability Increases ability of cilia to clear mucus

Strengthens contractions of diaphragm

Mild diuretic


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L k t i M difi


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Leukotriene Modifiers

Newest class of drugs to treat asthma

Block the production of leukotrienes and

subsequently prevent inflammation

Drugs in this class Singulairchewable tabs taken once a day in the

evening.

Accolatetake twice daily one hour before or twohours after meal.

Montelukast


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Montelukast

Brand name: Singulair

Classification Pharmacologic: leukotriene antagonist

Classification Therapeutic: allergy, cold, and cough,

bronchodilators Action: Antagonizes the effects of leukotrienes,

which mediate the following: airway edema, smooth

muscle constriction, altered cellular activity. Results

in decreased inflammatory process which is part ofasthma and allergic rhinitis.

M st C ll St biliz r


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Mast Cell Stabilizer

Cromolyn

Prevent the release of broncho-constrictive

and inflammatory substances when mast

cells are confronted with allergens and otherstimuli

Inhaled drug

Nasal form available for allergic rhinitis

To icity of Dr gs


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Toxicity of Drugs

Bronchodilators

Theophylline

Bronchodilator Overdose


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Bronchodilator Overdose

Excessive cardiac and CNS stimulation

Angina, tachycardia and palpitations

Agitation, anxiety, insomnia, seizures and

tremors

Theophylline Overdose


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Theophylline Overdose

Anorexia, nausea, vomiting, agitation,nervousness, insomnia, tachycardia, and

convulsions

Need to check serum drug levels Not use as frequently as in the past


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Antihistamines and AllergicDisorders

Chapter 45


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Action


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Action

Contraction of smooth muscle in the bronchiand bronchioles

Stimulation of vagus nervecough reflex

Increases permeability of veins andcapillaries

Increase secretion of mucous glands

Dilation of capillaries of skincausesflushing

Types of Allergic Reactions


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Types of Allergic Reactions

Type IIgE or atophyhay fever, skininflammation, food allergies, asthma

Type IImediated by IgG or IgMinternal

harder to diagnoses and treat Type IIIantigen-antibody complex

Type IVoccurs several hours after

exposureTB test

Allergic Rhinitis


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Allergic Rhinitis

Inflammation of nasal mucosa caused byType I hypersensitivity.

Two types

Seasonal Perineal or chronic

Allergic Dermatitis


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Allergic Dermatitis

Type IV by direct contact with antigens whichperson has come in contact with

Poison Ivy, cosmetics, hair dyes, metals,

drugs etc Urticariavascular reaction of skin

characterized by papules or wheals and

severe itching

Urticaria


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Urticaria

Allergic Drug Reactions


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Allergic Drug Reactions

Immunologic response

Follows ingestion of a drug

May occur from 7 to 10 days after drug

therapy

May not occur the first time drug

administered

Can occur minutes or hours afteradministration

Anaphylaxis Life-threatening allergy


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AnaphylaxisLife-threatening allergy

Serious and rapid allergic reaction

Can happen from food and nuts

Antibioticspenicillin

Dyes injected into the body in special tests

NSAIDs

Latexgloves, balloons, catheters

Bees or wasps

Anaphylaxis Symptoms


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Anaphylaxis Symptoms

Urticaria, hives

Low blood pressurefainting

Swelling in throatangioedema

Asthma symptomsbronchocontriction

Tingling in lips and mouth

Death occurs with obstruction to breathing

and low blood pressure

Emergency Treatment


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Emergency Treatment

Adrenalineepinephrine

Dose for adult 0.3 mg

Dose for child 0.15 mg

After dose given must get client to the

hospital for more definitive treatment.

Antihistamines


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Antihistamines

Antihistamines block the effects of histamineat the H1 receptor. They do not block

histamine release, antibody production or

antigen-antibody reactions. Mostantihistamines have anticholinergic properties

and may cause constipation, dry eyes, dry

mouth and blurred vision. I addition, many

antihistamines cause sedation.

Use with Caution


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Use with Caution

Elderly

Pyloric obstructions

Hyperthyoidism

Cardiovascular disease

Liver disease

Use with caution in pregnancy

Uses


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Uses

Allergic rhinitis

Anaphylaxis

Allergic conjunctivitis

Drug allergies

Blood transfusion reactions

Dermatologic conditions

H1 receptor antagonists


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H1 receptor antagonists

First generation

Non-selective or sedating

CNS depression

Benadryl

diphenhydramine


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diphenhydramine

Brand name: Benadryl

Classification Pharmacologic: H1 antagonist

Classification Therapeutic: allergy, cold and

cough remedies, antihistamines, antitussive.

Action: Antagonizes the effects of histamine

at H1 receptor sites; does not bind to or

inactivate histamine. Significant CNSdepressant and anticholinergic properties.

Benadryl


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Benadryl

High incidence of drowsiness Well absorbed after oral administration

Acts within 15 minutes and lasts for 8 to 12

hours Available in combination drugs

Decongestants

Analgesics

Allergy

Cold remedies

Hydroxyzine


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Hydroxyzine

Brand name: Atarax, Vistaril

Classification Pharmacologic: CNS

depressant

Classification Therapeutic: Anti-anxiety,antihistamine, sedative, hypnotic

Action: Acts as a CNS depressant at the

subcortical level of the CNS. Hasanticholinergic, antihistamine, and antiemetic

properties.


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Nasal Decongestant, Antitussiveand Cold Remedies

Chapter 46

Common Cold


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Common Cold

Viral infection of upper respiratory tract

Adults have two to four colds per year

Children can have up to ten a year

Management of common cold


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Management of common cold

Symptoms: cough, runny nose, blocked nose,sore throat, fever, malaise, headache, loss of

appetite.

No antibiotics unless super-imposed bacterialinfectionotitis media (ear infection)

No drug therapy to cure or shorten duration

of URI. No benefit of using anti-histamines

Cold Remedies


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Co d e ed es

Antihistamines : Allegra, Benadryl, Claritin,Clarinex, Zyrtec

Decongestants: cause constriction of swollen

blood vessels in nose, sinuses and chest Sudafedmost often used in combination

Cetirizine


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Brand name: Zyrtec Classification Pharmacologic: piperzine

Classification Therapeutic: Allergy, cold and

cough remedies, antihistamine Action: Antagonizes the effects of histamine

at H1 receptor sites; does not bind to orinactivate histamine. Anticholinergic effects

are minimal and sedation is dose related. Does not make client sleepy.

Cough


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g

Coughing is a protective reflex especiallywhen secretions are copious.

Most coughs due to viral illnesscommon

cold.

Cough Remedies


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g

Centrally acting cough suppressants -antitussives

Antihistamines

Soothing remedies (syrup or lozenges) Expectorants

Mucolytic

Oral hydration

Mist therapy

Antitussive Drugs


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g

Cough Suppressants

Suppress cough by depressing the cough

center of the medulla oblongata or cough

receptors in the throat Indication: dry, hacking, nonproductive cough

that interferes with rest or sleep

Example: cough syrups with codeine

Expectorants


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p

Agents generally given orally to liquefy respiratorysecretions and allow for their easier removal.

Generic name: gualifenesin

Brand name: Robitussin

Classification Therapeutic: allergy, cold and cough

remedies, expectorants

Action: reduces viscosity of tenacious secretions by

increasing respiratory tract fluid.

Anti-histamines


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H1-receptor inhibitors

Anti-allergy

Added to cough and cold remedies as both

antitussives and to treat the nasalcongestion.

Do not have any direct antitussive effect but

may act indirectly by reducing postnasal drip.

Demulcents


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Liquid that coats the throat and soothesirritated mucous membranes.

May reduce coughing associated with a dry

throat. Some cough syrups contain 40% alcohol

may have a sedating effect.

Inexpensive Do not over use

Mucolytic Drugs


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y g

Designed to alter the viscosity of bronchialsecretions, thereby making them easier to

clear by cough or ciliary transport.

Often used when client reports they feel likethey have mucous by cant cough it up.

Mucomyst only agent used inhalant.

Clinical pearl: mucomyst used inacetaminophen or Tylenol overdose

Nasal Sprays


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p y

Nose sprays: decongestant for directapplication to nares

Has bounce back effectdo not use for more

than three days

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Respiratory System F07