PULMONARY SYSTEM
1.
2.
Making breathing easier
Preventing transmission of infection (airborne,
droplet)
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.
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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
S&S OF RESPIRATORY
PROBLEMS (EARLY)
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Increased RR
SOB
Anxiety/ Restlessness
S&S OF RESPIRATORY
DISTRESS (LATE)
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Color changes
Skin changes
Respiratory arrest!!
INSUFFICIENT OXYGEN IN BLOODSTREAM
Patients 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
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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.
Indicator of person’s PERIPHERAL circulation
and how well tissues are being nourished with O2
S&S OF DECREASED
OXYGENATION
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RR below 12 or above
20
Cyanosis
Cool, clammy skin
SOB
Noisy breathing
Changes in mental
status
Wheezing
S&S OF INADEQUATE
BREATHING
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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
Infants and children do NOT have energy reserve
so they become ill (respiratory distress) very
quickly!!!
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Assess for S&S of respiratory distress (???)
High fowler’s position
Rest between ADL activities
Note VS, especially RR
After surgery:
Breathe deeply
Splint abd.
Help pt. cough and deep breathe to
expectorate sputum
Incentive spirometer
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
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 chemicals
Increase risk of developing pneumonia
Causes strain on heart
Symptoms
Headache- most common d/t increased CO2
levels
Fatigue
SOB
Chronic low oxygen levels
Loss of appetite
Weight loss
Prolonged inflammation in bronchi
S&S
Persistant “wet cough”
Sputum production (phlegm from lungs)
SOB w/ exertion
Constriction of muscles of BRONCHIOLES w/
swelling of respiratory membranes, production of
large amounts of mucous that fill the narrowed
airways.
S&S
Labored breathing
Tightness in chest
Wheezing
Frequent coughing
URI– Upper respiratory infection
Pneumonia– Inflammation/infection in lungs.
Most pneumonia is treatable with antibiotics
Respiratory Positions:
--High Fowler’s
--Orthopneic- makes thorax larger on
inspirations, allowing pt. to inhale more air
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.
2. Incentive Spirometer- Apparatus to
encourage better ventilation and prevent
atalectasis (collapse of alveoli) and pneumonia.
3. Nebulizer- delivers moisture and medications
into lungs
1.
2.
3.
4.
5.
General
Assist with breathing techniques (purse-lip)
Good nutrition
Pace ADL activities
Encourage fluid intake
Encourage deep breathing and coughing
(relationship between pneumonia/coughing)
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Breathe deeply
Splint abd.
Help pt. cough and deep breathe to EXPECTORATE
Purse- lip breathing
1.
2.
Tracheostomy (pg. 671)- external opening on skin surface
(STOMA) that provides airway for people requiring a ventilator
or respirator or need suctioning. RN responsibility
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