20
The Respiratory System
1. Define important words in this chapter
alveoli
tiny, grape-like sacs in the lungs where the exchange of oxygen
and carbon dioxide occurs.
asthma
a chronic and episodic inflammatory disease that makes it
difficult to breathe and causes coughing and wheezing.
bronchi
branches of the passages of the respiratory system that lead
from the trachea into the lungs.
bronchiectasis
a condition in which the bronchi become permanently dilated
(widened) and damaged.
20
The Respiratory System
1. Define important words in this chapter
bronchitis
an irritation and inflammation of the lining of the bronchi.
chest percussion
clapping the chest to help lungs drain with the force of gravity.
chronic obstructive pulmonary disease (COPD)
a chronic, progressive, and incurable lung disease that causes
difficulty breathing.
emphysema
a chronic, incurable lung disease in which the alveoli in lungs
become filled with trapped air; usually results from smoking
and chronic bronchitis.
20
The Respiratory System
1. Define important words in this chapter
expiration
the process of exhaling air out of the lungs.
hemoptysis
the coughing up of blood from the respiratory tract.
inspiration
the process of breathing air into the lungs.
lungs
main organs of respiration responsible for the exchange of
oxygen and carbon dioxide.
20
The Respiratory System
1. Define important words in this chapter
multidrug-resistant TB (MDR-TB)
disease that occurs when the full course of medication is not
taken for tuberculosis (TB).
oxygen therapy
the administration of oxygen to increase the supply of oxygen
to the lungs.
pneumonia
acute inflammation in the lung tissue caused by a bacterial,
viral, or fungal infection and/or chemical irritants.
respiration
the process of inhaling air into the lungs and exhaling air out of
the lungs.
20
The Respiratory System
1. Define important words in this chapter
sputum
mucus coughed up from the lungs.
trachea
an air passage that goes from the throat (pharynx) to the
bronchi; also called the windpipe.
tuberculosis (TB)
a contagious lung disease caused by a bacterium that is
transmitted through the air; causes coughing, difficulty
breathing, fever, and fatigue.
20
The Respiratory System
2. Explain the structure and function of the respiratory system
Define the following terms:
trachea
an air passage that goes from the throat (pharynx) to the
bronchi; also called the windpipe.
bronchi
branches of the passages of the respiratory system that lead
from the trachea into the lungs.
alveoli
tiny, grape-like sacs in the lungs where the exchange of oxygen
and carbon dioxide occurs.
lungs
main organs of respiration responsible for the exchange of
oxygen and carbon dioxide.
20
The Respiratory System
2. Explain the structure and function of the respiratory system
Define the following terms:
inspiration
the process of breathing air into the lungs.
expiration
the process of exhaling air out of the lungs.
respiration
the process of inhaling air into the lungs and exhaling air out of
the lungs.
20 The Respiratory System
Transparency 20-1: The Respiratory System
20
The Respiratory System
2. Explain the structure and function of the respiratory system
Remember these points about the respiratory system:
• The epiglottis shuts off the larynx during the swallowing
process.
• The larynx enables humans to speak.
• Respiration, the body’s taking in of oxygen and removing of
carbon dioxide, involves inspiration (breathing in) and
expiration (breathing out).
20
The Respiratory System
2. Explain the structure and function of the respiratory system
Functions of the respiratory system:
• Serves as an air filter, cleaning inhaled air
• Supplies oxygen to body cells
• Removes carbon dioxide from cells
• Produces the sounds associated with speech
20
The Respiratory System
2. Explain the structure and function of the respiratory system
Normal changes of aging in the respiratory system:
• Lung strength decreases.
• Alveoli become less elastic and decrease in number.
• Airways become stiff and less elastic.
• Lung capacity decreases.
• Rib cage changes and chest muscles become weaker.
• Cough reflex becomes less effective and cough becomes
weaker.
• Oxygen in the blood decreases.
• Decreased lung capacity causes voice to weaken.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Define the following terms:
chronic obstructive pulmonary disease (COPD)
a chronic, progressive, and incurable lung disease that causes
difficulty breathing.
bronchitis
an irritation and inflammation of the lining of the bronchi.
sputum
mucus coughed up from the lungs.
emphysema
a chronic, incurable lung disease in which the alveoli in lungs
become filled with trapped air; usually results from smoking
and chronic bronchitis.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Think about these questions:
• How does it feel to take a deep breath and to be able to fill
your lungs completely with oxygen?
• How would it feel to not be able to get enough air?
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Know these points about chronic obstructive pulmonary
disease (COPD):
• Cause: obstruction of airways
• Includes chronic bronchitis and emphysema
• Chronic bronchitis occurs when lining of the bronchial tubes
becomes inflamed, causing scarring.
• Symptoms of chronic bronchitis: excessive mucus production,
long-lasting cough
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Points about COPD (cont’d.):
• Treatment of chronic bronchitis: reducing triggers, quitting
smoking, medications
• Symptoms of emphysema: shortness of breath, coughing,
difficulty breathing
• Treatment for emphysema: providing comfort, relieving
symptoms, quitting smoking, oxygen, medication, respiratory
therapy
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Know the general symptoms of COPD:
• Coughing or wheezing
• Dyspnea
• Shortness of breath
• Cyanosis
• Chest pain or tightness
• Confusion
• Weakness
• Weight loss or loss of appetite
• Fear and anxiety
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Remember these care guidelines for COPD:
• Be supportive, calm, and empathetic.
• Use pillows to help residents sit up or lean forward.
• Be supportive of residents who are quitting smoking.
• Encourage healthy diet.
• Offer fluids.
• Encourage rest.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Care guidelines for COPD (cont’d.):
• Use proper infection prevention practices.
• Report signs of colds or flu immediately.
• Residents must take medication as ordered.
• Follow safety guidelines for oxygen therapy.
• Report fever, confusion or changes in mental state, refusal of
medications, change in breathing patterns, change in color or
consistency of mucus or sputum, chest pain, inability to
sleep, anxiety or fear.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Define the following term:
asthma
a chronic and episodic inflammatory disease that makes it
difficult to breathe and causes coughing and wheezing.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Know these points about asthma:
• Chronic, episodic disorder in which irritants, allergens,
infections and cold air cause inflammation and swelling in the
air passages in the lungs
• Can be worsened by exercise or stress
• Symptoms: heavy wheezing, coughing, tight feeling in chest
• Treatment: medication, avoidance of triggers, reducing stress
levels
• Report: changes in vital signs, especially respiratory rate;
wheezing, shortness of breath or dyspnea; cyanosis; chest
pain or tightness; refusal to use inhaler
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Define the following terms:
bronchiectasis
a condition in which the bronchi become permanently dilated
(widened) and damaged.
chest percussion
clapping the chest to help lungs drain with the force of gravity.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Remember these points about bronchiectasis:
• Condition in which the bronchi become permanently dilated
• Causes: infection of the airways, cystic fibrosis, presence of
tumors, inhaling foreign material
• Symptoms: chronic coughing, shortness of breath, wheezing,
weight loss, cyanosis, coughing up blood, respiratory
infections, halitosis
• Treatment: postural drainage, chest percussion
• Report: fever, chest pain, change in mucus or phlegm
production
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Define the following term:
pneumonia
acute inflammation in the lung tissue caused by a bacterial,
viral, or fungal infection and/or chemical irritants.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Know these points about pneumonia:
• Inflammation of the lungs
• Causes: viral, bacterial, or fungal infection; chemical irritants
• Symptoms: high fever, chest pain, coughing, difficulty
breathing, shortness of breath, chills, rapid pulse, thick
secretions coughed up from the lungs
• Treatment: antibiotics and other medication, inhaler, special
diet, increased fluid intake
• Report if resident is not taking medication.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Define the following terms:
tuberculosis (TB)
a contagious lung disease caused by a bacterium that is
transmitted through the air; causes coughing, difficulty
breathing, fever, and fatigue.
hemoptysis
the coughing up of blood from the respiratory tract.
multidrug-resistant TB (MDR-TB)
disease that occurs when the full course of medication is not
taken for tuberculosis (TB).
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Remember these points about tuberculosis:
• Highly contagious lung disease
• Cause: bacterium that is carried on mucous droplets
suspended in the air
• Can be spread by infected person coughing, breathing,
singing, sneezing, or laughing
• Symptoms: fatigue, loss of appetite, weight loss, slight fever
and chills, night sweats, prolonged coughing, hemoptysis,
chest pain, shortness of breath, dyspnea
• Multidrug-resistant tuberculosis (MDR –TB) can develop
when person with TB does not take all of his prescribed
medication.
20
The Respiratory System
4. Discuss common disorders of the respiratory system
Remember these care guidelines for tuberculosis:
• Follow Standard Precautions and Airborne Precautions.
• Wear PPE.
• Be careful when handling sputum.
• Resident must take all of the medication prescribed.
20
The Respiratory System
5. Describe oxygen delivery
Define the following term:
oxygen therapy
the administration of oxygen to increase the supply of oxygen
to the lungs.
20
The Respiratory System
5. Describe oxygen delivery
There are different methods of oxygen delivery:
• Piped into room through wall outlet at facility
• Compressed oxygen in cylinders
• Liquid oxygen in special reservoirs
• Oxygen concentrators
20
The Respiratory System
5. Describe oxygen delivery
The doctor determines which oxygen delivery device is the best
for a resident who needs additional oxygen.
20
The Respiratory System
5. Describe oxygen delivery
Common types of oxygen delivery devices include the following:
• Nasal cannula
This device has a set of two prongs which are placed into the
nostrils, and a plastic tube that fits behind the ears.
• Simple face mask
This plastic device is shaped to fit over the nose and mouth. It
is held in place with an elastic band that slides over the head
and above the ears.
• Oxygen concentrator
An oxygen concentrator filters oxygen from normal room air.
It delivers low-flow oxygen. It is generally used in conjunction
with a nasal cannula.
20
The Respiratory System
5. Describe oxygen delivery
Think about this question:
How would it feel to need oxygen delivered through a face mask
or nasal cannula?
20
The Respiratory System
5. Describe oxygen delivery
REMEMBER:
Oxygen is considered a drug and cannot be applied or adjusted
by nursing assistants.
20
The Respiratory System
5. Describe oxygen delivery
Think about this question:
Why is oxygen considered a drug?
20
The Respiratory System
5. Describe oxygen delivery
Remember these care guidelines for residents using oxygen:
• Perform frequent skin care.
• Observe for redness, sores, bruising, or discomfort in ear,
nose, mouth or chin area.
• Lubricate sensitive areas.
• Take vital signs as ordered.
• Check device for fit and comfort.
• Notify nurse if equipment does not seem to be working.
20
The Respiratory System
5. Describe oxygen delivery
Care guidelines for residents using oxygen (cont’d.):
• Post “No Smoking” and “Oxygen in Use” signs.
• Know location of fire alarms and extinguishers.
• Add pillows, as needed, to improve breathing.
• Encourage activity.
• Provide emotional support.
• Report sores or crusts on nasal area, dry or reddened areas
on the skin, discomfort or pain, shortness of breath, changes
in vital signs, cyanosis, and chest pain or tightness.
20
The Respiratory System
5. Describe oxygen delivery
REMEMBER:
When oxygen has been ordered for a resident, be alert to fire
hazards, such as smoking materials, flammable liquids, and open
flames, which can spark and cause fire. Remove any fire hazards.
20 The Respiratory System
Handout 20-1: Oxygen Therapy Using a Humidification Device
Oxygen administration can dry out the mucous membranes of the nose and
mouth. Because of this, humidifying devices are often added to oxygen therapy
devices. The humidifying container is filled with sterile or distilled water. The
oxygen moves through the water and collects moisture before it is transferred
to the resident.
Humidification devices are commonly pre-filled devices; nurses or respiratory
therapists will replace the humidification device when its water level is low with
a new, pre-filled container. Some facilities may use humidification devices that
have to be refilled by the nurse or the respiratory therapist when the water
level becomes low. The nursing assistant’s responsibility is to observe the
humidification device and report promptly when the water level becomes low.
In addition, if the device is not bubbling, or the bubbling decreases, report this
promptly to the nurse.
Guidelines for Oxygen Therapy using a Humidifying Device
• Check the humidification device often to make sure it is bubbling. Carefully
observe the water level in the humidification device.
Notify the nurse if the following occurs:
• Water in the humidification device stops bubbling
• Decrease in bubbling
• Water level in the humidification device becomes low
20
The Respiratory System
6. Describe how to collect a sputum specimen
Know these points about collecting a sputum specimen:
• Sputum is mucus that comes from inside the respiratory
system.
• Sputum may show evidence of cancer or bacteria.
• Some facilities do not allow nursing assistants to collect
sputum specimens; always follow facility policy.
• Early morning is the best time to collect sputum.
• Resident should rinse mouth with water but not with
mouthwash before specimen collection.
Collecting a sputum specimen
Equipment: specimen container
and lid, completed label (labeled
with resident’s name, room
number, date, and time), tissues,
plastic bag, gloves, mask, emesis
basin
1.
Identify yourself by name.
Identify the resident. Greet
the resident by name.
2.
Wash your hands.
3.
Explain procedure to
resident. Speak clearly,
slowly, and directly. Maintain
face-to-face contact
whenever possible.
4.
Provide for the resident’s
privacy with a curtain,
screen, or door.
Collecting a sputum specimen
5.
Put on mask and gloves.
If the resident has
known or suspected TB
or another infectious
disease, wear the proper
mask when collecting a
sputum specimen.
6.
Ask the resident to rinse
her mouth with water.
Assist as necessary.
Have her spit rinse water
in the emesis basin, if
she does not use the
sink.
Collecting a sputum specimen
7.
8.
Ask the resident to cough
deeply, so that sputum
comes up from the lungs.
To prevent the spread of
infectious material, give
the resident tissues to
cover his or her mouth.
Ask the resident to spit
the sputum into the
container.
When you have obtained a
good sample (about two
tablespoons of sputum),
cover the container
tightly. Wipe any sputum
off the outside of the
container with tissues.
Discard the tissues. Apply
the label and put the
container in the plastic
bag and seal the bag.
Collecting a sputum specimen
9.
Remove and discard
gloves and mask. Wash
your hands.
10. Leave call light within
resident’s reach.
11. Wash your hands.
12. Be courteous and
respectful at all times.
13. Report any changes in
the resident to the
nurse. Document
procedure using facility
guidelines. Take
specimen container and
lab slip to the designated
place promptly.
20
The Respiratory System
7. Describe the benefits of deep breathing exercises
Residents who have had surgery, such as hip replacement or
abdominal surgery, are instructed to do deep breathing exercises
to regularly expand the lungs.
20
The Respiratory System
7. Describe the benefits of deep breathing exercises
Understand these points about deep breathing exercises:
• Help expand the lungs, clear them of mucus, and prevent
infections
• The care plan may include using an incentive spirometer.
• Usually a goal volume is set and attempted for a minimum of
three seconds.
• Do not assist with these exercises if you have not been
trained to do so.
20
The Respiratory System
7. Describe the benefits of deep breathing exercises
Points about deep breathing exercises (cont’d.):
• Do not share incentive spirometers between residents.
• Make sure you and the resident wash hands prior to using the
spirometer. Don gloves before assisting with this procedure.
• Encourage, but do not force, the resident to use the incentive
spirometer.
Assisting with deep breathing and coughing exercises
Equipment: gloves, pillow,
tissues, emesis basin
1.
Identify yourself by
name. Identify the
resident. Greet the
resident by name.
2.
Wash your hands.
3.
Explain procedure to
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with a curtain,
screen, or door.
5.
Put on gloves.
Assisting with deep breathing and coughing exercises
6.
7.
8.
9.
Position resident in the
Fowler’s position with a
pillow over the
abdomen, if needed. You
may also be instructed
to position the resident
in a dangling position.
Ask her to wrap her
arms around the pillow
and hold the pillow
tightly against her
abdomen.
Tell the resident to take
a deep breath and hold
the breath for a few
seconds.
Ask the resident to
exhale for as long as
possible through lips
that are pursed.
Assisting with deep breathing and coughing exercises
10. Tell the resident to then
repeat the deep breathing
exercise a few more times.
Ideally, the deep breathing
exercise should be repeated
five times in a row.
11. Make sure the tissues are
nearby. Ask the resident to
hold the pillow tightly,
breathe in once deeply, and
then cough as forcefully as
possible. Collect any
secretions with the tissues
and dispose of tissues
temporarily in the emesis
basin.
12. Repeat the sequence above
the designated number of
times or the number of
times the resident is able to
perform the exercises.
Assisting with deep breathing and coughing exercises
13. Dispose of tissues in
nearest no-touch
receptacle.
14. Clean and store emesis
basin.
15. Remove and discard
gloves. Wash your
hands.
16. Make resident
comfortable. Remove
privacy measures.
17. Leave call light within
resident’s reach.
18. Wash your hands.
Assisting with deep breathing and coughing exercises
19. Be courteous and
respectful at all times.
20. Report any changes in
the resident to the
nurse. Document
procedure using facility
guidelines.
20
The Respiratory System
Exam
Multiple Choice. Choose the correct answer.
1. The _______ acts like a lid to shut off the larynx during the swallowing
process.
(A) Trachea
(B) Epiglottis
(C) Bronchi
(D) Alveoli
2. What is the function of the larynx?
(A) Enables speech
(B) Blocks food from entering the trachea
(C) Allows for passage of air and food
(D) Transfers air to the lungs
20
The Respiratory System
Exam (cont’d.)
3. The process of breathing in and out is called:
(A) Inspiration
(B) Respiration
(C) Expiration
(D) Expansion
4. Which of the following is a function of the respiratory system?
(A) Regulates body temperature
(B) Pumps blood throughout the body
(C) Supplies oxygen to body cells
(D) Gives the body shape and structure
20
The Respiratory System
Exam (cont’d.)
5. Normal age-related changes for the respiratory system include:
(A) Lung strength decreases
(B) Airways become more elastic
(C) Cough becomes stronger
(D) Oxygen in the blood increases
6. Residents with COPD have trouble with:
(A) Breathing
(B) Urination
(C) Losing weight
(D) Vision
20
The Respiratory System
Exam (cont’d.)
7. How should a resident with COPD be positioned?
(A) Flat on his back
(B) Sitting upright
(C) Lying on his stomach
(D) Lying on his side
8. What should a resident who has asthma avoid?
(A) Inhalers
(B) Talking
(C) Fluids
(D) Strong smells
20
The Respiratory System
Exam (cont’d.)
9. A person with ______ TB does not show symptoms and cannot infect others; a
person with ______ TB shows symptoms of the disease and can spread it to
others.
(A) Latent, active
(B) Active, latent
(C) MDR-TB, active
(D) Latent, MDR-TB
10. Why is it important for a resident with TB to take all of the prescribed
medication?
(A) The medication is very expensive.
(B) The healthcare facility loses Medicare funding if all of the medication is not
taken.
(C) Failure to finish the medication makes the person more likely to spread the
disease to others.
(D) Failure to take all of the medication prescribed can weaken the person’s
musculoskeletal system.
20
The Respiratory System
Exam (cont’d.)
11. Which of the following guidelines is true of working around oxygen
equipment?
(A) Nursing assistants should not allow open flames around oxygen.
(B) Nursing assistants should adjust oxygen levels when they are too high or too
low.
(C) Nursing assistants should replace oxygen tubing if it becomes clogged.
(D) Nursing assistants should prescribe a new oxygen delivery device if the
current one is causing skin problems.
12. The best time to collect a sputum specimen is:
(A) Early in the morning
(B) After the resident has eaten a meal
(C) Right before bedtime
(D) Right before lunch
20
The Respiratory System
Exam (cont’d.)
13. What is a possible benefit of using an incentive spirometer?
(A) Increasing heart strength
(B) Strengthening back muscles
(C) Opening nasal passages
(D) Helping clear the lungs