(supplemental/reinforcement discussion)

• The respiratory system works in concert with the cardiovascular system
• The respiratory system is responsible for ventilation and diffusion,
• and the cardiovascular system is responsible for perfusion

• The visceral pleura covers the lungs
• The parietal pleura lines the thorax
• Physiologic dead space - about 150 mL of air contained in the conducting airways that does
not participate in gas exchange (in the tracheobronchial tree)
• The lungs - made up of about 300 million alveoli, could cover 70 square meters—the size of a tennis court.
• The pulmonary circulation is considered a lowpressure system because the systolic blood pressure in the pulmonary artery is 20 to 30 mm
Hg and the diastolic pressure is 5 to 15 mm Hg.

• A nurse in a provider's office is preparing to auscultate and percuss a client's thorax as part of a comprehensive physical examination. Which of the following findings should the nurse expect?
(Select all that apply)
A. Rhonchi
B. Crackles
C. Resonance
D. Tactile fremitus
E. Bronchovesicular sounds

• C. Resonance
D. Tactile fremitus
E. Bronchovesicular sounds

• Which of the following best describes findings associated with fremitus?
A. Fremitus is more pronounced on the anterior chest than on the posterior.
B. The intensity of the fremitus decreases as you progress down the chest wall.
C. A female will present with greater intensity of fremitus than a male.
D. Increased fremitus is associated with an increase of air in the tissues of the lung.

• B. The intensity of the fremitus decreases as you progress down the chest wall.

• Which of the following is an abnormal assessment finding of the respiratory system?
a. Inspiratory chest expansion of 1 inch b. Percussion resonance over the lung bases c. Symmetric chest expansion and contraction d. Bronchial breath sounds in the lower lung fields

• d. Bronchial breath sounds in the lower lung fields

• The lungs excrete 13,000 to 30,000 mEq/day of volatile hydrogen in the form of carbonic acid as carbon dioxide (CO
2
).
• Monitor the client’s respiratory status closely
• In acidosis, the respiratory rate and depth increase in an attempt to exhale acids.
• In alkalosis, the respiratory rate and depth decrease; CO
2 is retained to neutralize and decrease the strength of excess bicarbonate.

• Any condition that causes an obstruction of the airway or depresses the respiratory system can cause respiratory acidosis.
• Ex.: > Asthma
> Atelectasis
> Brain trauma
> Bronchiectasis
> Emphysema and COPD
> Administering high oxygen levels per nasal cannula to clients who are CO
2 retainers (i.e., emphysema & COPD)
> Hypoventilation
> Pneumonia
> Pulmonaryedema
> Pulmonary emboli

• If the client has a condition that causes overstimulation of the respiratory system, monitor the client for respiratory alkalosis.
• Initially the hyperventilation and respiratory stimulation cause abnormal rapid respirations
(tachypnea); in an attempt to compensate, the kidneys excrete excess circulating bicarbonate into the urine.
• Causes: Fever, Hyperventilation, Hypoxia,
Hysteria, Overventilation by mechanical ventilators, Pain.

• Chest X-Ray (Radiograph)
– A no-no for pregnant women
– Pre.: remove jewelry/metallic objects from chest area
– Post.: assist in dressing
• Sputum Collection
– Pre.: Obtain an early morning sterile specimen by suctioning or expectoration after a respiratory treatment if a treatment is prescribed, Instruct the client to rinse the mouth with water before collection, Obtain 15 mL of sputum.
– Instruct the client to take several deep breaths and then cough deeply to obtain sputum.
– Always collect the specimen before the client begins antibiotic therapy.
– Post.: If a culture of sputum is prescribed, transport the specimen to the laboratory immediately, Assist the client with mouth care

• Laryngoscopy and bronchoscopy
– Pre.: Maintain NPO status as prescribed, b. Assess the results of coagulation studies, Remove dentures and eyeglasses, Establish an intravenous (IV) access as necessary and administer medication for sedation as prescribed, Have emergency resuscitation equipment readily available.
– Post.: Maintain the client in a semi-Fowler’s position,
Assess for the return of the gag reflex, Maintain NPO status until the gag reflex returns, Monitor for bloody sputum, Monitor respiratory status, particularly if sedation has been administered, Monitor for complications, such as bronchospasm or bronchial perforation, indicated by facial or neck crepitus, dysrhythmias, hemorrhage, hypoxemia, and pneumothorax, Notify the health care provider (HCP) if signs, of complications occur.

• Endobronchial ultrasound (EBUS)
1. Tissue samples are obtained from central lung masses and lymph nodes, using a bronchoscope with the help of ultrasound guidance.
2. Tissue samples are used for diagnosing and staging lung cancer, detecting infections, and identifying inflammatory diseases that affect the lungs, such as sarcoidosis.
3. Postprocedure, the client is monitored for signs of bleeding and respiratory distress.

• Pulmonary angiography
A fluoroscopic procedure in which a catheter is inserted through the antecubital or femoral vein into the pulmonary artery or 1 of its branches
Involves an injection of iodine or radiopaque contrast material
2. Pre.: a. Assess for allergies to iodine, seafood, or other radiopaque dyes.
b. Maintain NPO status as prescribed.
c. Assess results of coagulation studies.
d. Establish an IV access.
e. Administer sedation as prescribed.
f. Instruct the client to lie still during the procedure.
g. Instruct the client that he or she may feel an urge to cough, flushing, nausea, or a salty taste following injection of the dye.
h. Have emergency resuscitation equipment available.
3. Post.: a. Avoid taking blood pressures for 24 hours in the extremity used for the injection.
b. Monitor peripheral neurovascular status of the affected extremity.
c. Assess insertion site for bleeding.
d. Monitor for reaction to the dye.

• Thoracentesis
- Removal of fluid or air from the pleural space via transthoracic aspiration
- Pre.: a. Prepare the client for ultrasound or chest radiograph, if prescribed, before procedure.
b. Assess results of coagulation studies.
c. Note that the client is positioned sitting upright, with the arms and shoulders supported by a table at the bedside during the procedure

d. If the client cannot sit up, the client is placed lying in bed toward the unaffected side, with the head of the bed elevated.
e. Instruct the client not to cough, breathe deeply, or move during the procedure.
3. Postprocedure a. Monitor respiratory status.
b. Apply a pressure dressing, and assess the puncture site for bleeding and crepitus.
c. Monitor for signs of pneumothorax, air embolism, and pulmonary edema

• Tests used to evaluate lung mechanics, gas exchange, and acid-base disturbance through spirometric measurements, lung volumes, and arterial blood gas levels
• Preprocedure a. Determine whether an analgesic that may depress the respiratory function is being administered.
b. Consult with the HCP regarding withholding bronchodilators before testing.
c. Instruct the client to void before the procedure and to wear loose clothing.
d. Remove dentures.
e. Instruct the client to refrain from smoking or eating a heavy meal for 4 to 6 hours before the test
• 3. Postprocedure: Client may resume a normal diet and any bronchodilators and respiratory treatments that were withheld before the procedure