Lung & Respiratory Overview
RESPIRATORY OVERVIEW
Concept Overview
The feature concept for this chapter is Oxygenation. This concept represents processes that facilitate and impair oxygenation to and
from tissues. Several concepts are interrelated with oxygenation and are shown in the following illustration.
Because adequate perfusion is necessary to deliver oxygenated blood to and remove metabolic wastes from tissues, this
interrelationship is foundational to all others. _______________ supports respiratory function, and ____________ is needed to
support intracranial function. __________, ______, ___________, _________, and _________ all require adequate oxygenation for
optimal function. Having an understanding of the interrelationship of these concepts helps the nurse recognize ________ and thus
increases awareness when conducting a health assessment.
Anatomy & Physiology
The primary purpose of the respiratory system is to supply _______ to cells and __________. This purpose is accomplished using the
processes of ventilation and diffusion. __________ is the process of moving gases in and out of the lungs by inspiration and
expiration. _________ is the process by which oxygen and carbon dioxide move from areas of high concentration to areas of lower
concentration.
There are three main structures within the thorax or chest: the _________ and the _______ and ___________________. The right
lung has ______ lobes, and the left has _____. Each lobe has a major, oblique fissure dividing the upper and lower portions; however,
the right lung has a lesser horizontal fissure dividing the upper lung into upper and middle lobes
External Thorax
Most of the respiratory system is protected by the thoracic cage consisting of 11 thoracic vertebrae, 12 pairs of ribs, and the sternum.
All the ribs are connected to the thoracic vertebrae posteriorly. The first seven ribs are also connected anteriorly to the sternum by the
costal cartilages. The costal cartilages of the eighth to tenth ribs are connected immediately superior to the ribs. The eleventh and
twelfth ribs are unattached anteriorly and are called floating ribs. The tips of the eleventh ribs are located in the lateral thorax, and
those of the twelfth ribs are located in the posterior thorax (see Fig. 11-3).
FIG. 11-3 Thorax and underlying structures. A, Anterior view. B, Posterior view.
Mechanics of Breathing
The _________ and the ____________ are the primary muscles of inspiration. During inspiration the diaphragm __________ and
________ the abdominal contents down while the _________muscles help to push the chest wall _________. These combined efforts
decrease the __________, which creates a __________________ within the lungs compared with the pressure ____________the
lungs. This pressure difference causes the lungs to fill with air. During expiration the muscles _______, expelling the air as the
intrathoracic pressure ________. Accessory muscles that may contribute to respiratory effort include anteriorly the
sternocleidomastoid, scalenus, pectoralis minor, serratus anterior, and rectus abdominis muscles and posteriorly the serratus posterior
superior, transverse thoracic, and serratus posterior inferior muscles
Structures of Upper Airway:
Lower Airway
Topographic Markers
Surface landmarks are helpful in locating underlying structures and describing the exact location of physical findings (Fig. 11-8, A to
C)
Health History includes assessment of what 7 General History areas?
____________________________________________________________________________________________________
Problem-Based History involves utilizing _________________ method for focus assessment.
Abnormal Breathing Patterns:
A, ___________is a respiratory rate less than 11 breaths/min. The rate and depth remain smooth and even.
B, ___________ is a respiratory rate greater than 20 breaths/min. The rate and depth remain smooth and even. ________ can be
caused by a number of factors, including fever, fear, or activity.
C,____________ is characterized by increased rate and depth of respiration.
D, When hyperventilation occurs with ketoacidosis, it is very deep and laborious and is termed _______________ breathing.
E, _________breathing pattern is characterized by irregularly interspersed periods of apnea in a disorganized and irregular pattern,
rate, or depth. It may be associated with persistent intracranial pressure, respiratory distress, or damage to the medulla.
F, _____________ is characterized by intervals of apnea interspersed with a deep and rapid breathing pattern. This may be seen in
patients with severe illness, brain damage, or drug overdose.
G, _______________is an abnormal respiratory pattern frequently seen in patients with chronic obstructive pulmonary disease. It is
characterized by rapid inspirations with prolonged, forced expirations. Air is not fully exhaled; thus it becomes trapped in the lungs,
which eventually leads to a barrel chest.
Breath sounds should be clear over the posterior and lateral thoraxes. Three types of breath sounds are expected in various parts of the
thorax: ____________,____________, and ___________.
Characteristics of Breath Sounds: (Fill in the column)
Bronchial
Bronchovesicular
Vesicular
Pitch
Intensity
Duration:
Inspiration &
Expiration
Expected Location
Abnormal Location
Characteristics of Adventitious Sounds: (Fill in Column)
Aventitious Sounds
Characteristics
Clinical Example
Fine Crackles
Medium Crackles
Coarse Crackles
Wheeze
Rhonchi
Pleural Friction Rub
Age Variations (List examples):
Infants, Children, and Adolescents
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Older Adults
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Risk Factors (List Risk Factors) for Lung Cancer
Fill In Column:
Inflammation/Infection
Clinical Findings
Clinical Manifestations
Clinical Findings
Clinical Manifestations
Clinical Findings
Clinical Manifestations
Acute Bronchitis
Pnumonia
Pleural Effusion
Tuberculosis
Chronic Pulmonary Disease
Asthma
Emphysema
Chronic Bronchitis
Acute or Traumatic Conditions
Pneumothorax
Hemothorax
Ateletasis
Lung Cancer
Case Study
C.M. is a 69-year-old female who was presents to the emergency department with shortness of breath..
Subjective data
PMH: HTN, hypothyroid
Sudden onset shortness of breath
Denies chest pain
Current smoker, one pack a day for 50 years
Objective data
Vital signs: T 37 P 72 R 18 BP 144/64
Lungs: + inspirational wheeze upper and lower
lobes, bilaterally
O2 sat = 90%
Skin cool to touch
CV = heart rate regular, positive peripheral
pulses
Nose = + erythema, clear discharge
Throat = - erythema
Medications: metoprolol 12.5 mg per day,
Synthroid 0.50 mcg once per day
1.
What other questions should the nurse ask about the shortness of breath?
2.
What other assessments are necessary for this patient?
3.
What are some of the causes of shortness of breath?
4.
Develop a problem list from objective and subjective data.
5.
What should be included in the plan of care?
6.
What risk factors are associated with this age group?
7.
Based on the readings, what is the most likely cause of shortness of breath for this patient?
Identify abnormal findings, risk factors, components of a focused assessment, and discuss immediate nursing
interventions.
Name two nursing diagnoses for this patient:
Wilson, Susan, Jean Giddens. Health Assessment for Nursing Practice, 5th Edition. Mosby, 09/2012. VitalBook file.