Nursing Care
Management 112
Shiela Marie Amacio
lecturer
1: Anatomy
And
Physiology
2
Upper Respiratory Tract
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Lower Respiratory Tract
primaryfunctions
provides O2 for
oxygen metabolism
in the tissues
secondaryfunctions
facilitates sense of smell
removes CO2, the waste
product of cellular
metabolism
produces speech
maintains acid-base balance
maintains body water
balance
maintains heat balance
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Respiratory
Process
•
Terminology:
1. external respiration
2. Internal respiration
3. Cellular respiration
Factors that affect
Gas Exchange
• The magnitude of partial
pressure gradient
• The thickness of
respiratory membrane
• Alveolar surface
Lungvolumes
Tidal Volume: amount of air breathe during a quiet breathing; 500 ml andcapacities
Total Lung Capacity - is the volume of air in the lungs upon the
maximum effort of inspiration.
Inspiratory Reserve Volume: amount of extra air inhaled beyond TV;
2000-3000 ml
Expiratory Reserve Volume: extra air that can be exhaled after a
forced breath; 1200 ml
Vital Capacity: amount of air moved on deepest inspiration and
expiration; 3000-5000 ml
Inspiratory Capacity: maximum amount of air an individual can inspire
after a normal expiration; 2500-3500 ml
Residual Volume: amount of air that cannot be forcefully expired;
1000-1200 ml
Minimal Air: amount of air that remains in the alveoli even if the lung
has collapsed maybe because of trauma; 40% of RV
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0
Muscles of respiration
muscles of the thoracic cage
diaphragm
accessorymuscles
scalene
sternocleidomastoid
trapezius
pectoralis
rectus abdominis
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1
nursingcaremngt112:
respiratorysystem
2: assessment
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I: interview assessment
• Cough
• Sputum Production
• Shortness of Breath
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I: interview
assessment
•
Chest Pain with Breathing
•
Past History of Respiratory
Infection
•
Smoking History
•
Environmental Exposure
•
Self Care Behaviors
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II: physical assessment
•
Posterior Thorax and Lungs
• A. Inspection
• Color
• Spine and mobility and any structural deformity
• Symmetry of the posterior chest and posture and
mobility of the thorax on respiration
• Note any bulges or retractions of the costal
interspaces on respiratory movement
• Note the anteroposterior diameter in relation to
the lateral diameter of the chest
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II: physicalassessment
Posterior Thorax and Lungs
B. Palpation
• Identify any areas of
tenderness, masses and
inflammation
• Palpate the ribs for symmetry,
mobility and tenderness and the
spine for tenderness and
vertebral position
• Check for symmetric chest
expansion
• Check the tactile fremitus
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II: physical assessment
• Posterior Thorax and Lungs
• Percussion
• Percuss the entire lung fields
• Assess diaphragmatic
excursion
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II: physicalassessment
Tone
Description
Flat
soft intensity, high pitch, short
duration
*bones, large pleural effusion
Resonance
loud intensity, low pitch, long
duration
*normal lung
Dull
medium intensity, medium
pitch and duration
*liver, pneumonia, tumor,
pleural effusion
Hyperresonance
very loud, low pitch, longer duration
*emphysema, pneumothorax
Tone
Description
II: physical assessment
• Posterior Thorax and Lungs
• D. Auscultation
• Assess breath sounds
• Assess voice sounds
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II: physical assessment
•
Anterior Thorax and Lungs
• A. Inspection
• Inspect for symmetry of the thorax,
ribs and clavicles
• Inspect skin color, lesions, hair
distribution and note width of costal
angle
• Note manner of breathing and any
signs of respiratory difficulty
• Assess the respiratory rate, depth and
symmetry
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II: physical assessment
•
Anterior Thorax and Lungs
• B. Palpation
• General Palpation
• Symmetrical Chest Expansion
• Assess Tactile Fremitus
• C. Percussion
• D. Auscultation
• Assess Breath Sounds
• Assess Voice Sounds
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