Respiratory System
(supplemental/reinforcement
discussion)
Overview
• 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
Fast Facts
• 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.
Sample NCLEX Question
• 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
Answer
• 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.
Answer
• 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
Answer
• d. Bronchial breath sounds in the lower lung
fields
The Respi & The Acid-Base Balance
• The lungs excrete 13,000 to 30,000 mEq/day
of volatile hydrogen in the form of carbonic
acid as carbon dioxide (CO2).
• 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; CO2 is retained to neutralize and
decrease the strength of excess bicarbonate.
Respiratory Acidosis
• 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 CO2 retainers (i.e., emphysema & COPD)
> Hypoventilation
> Pneumonia
> Pulmonaryedema
> Pulmonary emboli
Respiratory Alkalosis
• 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.
Related Procedures
• 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
• 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
Pulmonary Function Test
• 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
Oxygen Therapy
Respi-related POST-OP Complications