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Anatomy & Physiology
* Upper Respiratory Tract
* Nose & sinuses
* Pharynx
* Larynx
* Lower Respiratory Tract
* Airways
* Trachea
* Bronchi
* Bronchioles
* Alveolar tracts
Accessory Muscles of Respiration
* Scalene muscles
* Sternocleidomastoid muscles
* Trapezius
* Pectoralis muscles
* Various back and abdominal muscles
Oxygen delivery
* Hemoglobin binds with O2 molecules at the alveolar level and is pumped to the tissues
* Hemoglobin dissociates oxygen to the tissues as needed
* It is harder for O2 to dissociate from the hemoglobin in O2 rich tissue
* 50% of Hemoglobin is dissociated of O2 when the oxygen tension is 26mmg Hg
* O2 starved tissue causes hemoglobin to release O2 faster
* Increased temperature
* Increased CO2 concentration
* Increased tissue concentration of glucose metabolites
* Decreased tissue pH (acidosis)
Respiratory changes with Age
* Change
* Alveolar
* lung
* Pulmonary vasculature
* Exercise intolerance
* Muscle strength
* Susceptibility to infection
* Interventions
* Pulmonary hygiene
* Assessment, health maintenance
* Consciousness and cognition
* Manifestations of hypoxia
* Maintain activity
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Assessment
* History
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Work & home
Family
Respiratory Hx
Drug Use
* What prescribed meds can affect?
Nutrition
Chief complaint
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Cough
* Sputum production
* Hemoptysis
Chest pain
* Dyspnea
* Paroxysmal nocturnal dyspnea
* Orthopnea
Physical Assessment
* Lungs & Thorax
* Inspection
* Movement, landmarks, lesions, shape
* Retractions
* Palpation
* Fremitus, crepitus
* Percussion
* Auscultation
Auscultation
* What causes normal breath sounds?
* Location, pitch, intensity, duration
* Positions
* Adventitious sounds
* Crackles, wheezes, rhonchus, friction rub
Other assessment findings
* Skin & mucous membranes
* Nail bed
* Overall body structure
* Endurance
Psychosocial
* Anxiety
* Stress
* Altered role
* Altered coping
Diagnostic
* Lab
* CBC – Hemoglobin
ABG pg 240 Fig 8-5
* Identify abnormals
* Sputum analysis
* Identify organism
* Imaging
* Chest X-ray
* CT
* Other
* Pulse Oximetry
* Capnometry
Pulmonary Function Test
* Eval lung function & breathing, lung volumes, capacities, resistance
* Compare patient data with expected norms
* Prep – no smoking 6-8 hrs prior, may withhold bronchodilators
* Procedure – performed by RT
Bronchoscopy
* Prep – consent, NPO, Premed
* Procedure – performed in endo suite or ICU
* Follow-up – monitor for effects of sedation & return of gag reflex
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Pleural Effusion
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Pleural space is partially filled with fluid
* Diminished or absent lung sounds in the area
* SOB, pain or signs of infection if fluid is a result of infection
* Thoracentesis
Thoracentesis – aspiration of pleural fluid
* Proper positioning
* Procedure
* Follow-up – chest x-ray
Pneumothorax
* Partial or complete collapse of lung
* Risk within first 24 hours following thoracentesis
* Worsening pain
* Tachycardia
* Shallow respirations
* Affected side does not move with inspiratory effort