Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 18 NURSING CARE OF THE CLIENT: RESPIRATORY SYSTEM Respiratory System Its primary function is delivery of oxygen to the lungs and removal of carbon dioxide from the lungs. Thoracic Cavity The inside of the chest cage is called the thoracic cavity. Contained within the thoracic cavity are the lungs, cone-shaped, porous organs encased in the pleura, a thin, transparent double-layered serous membrane lining the thoracic cavity. The Physiology of the Lungs The right lung is larger than the left and is divided into three sections or lobes: upper, middle, and lower. The left lung is divided into two lobes: upper and lower. The upper portion of the lungs is the apex; the lower portion is the base. Conducting Airways The conducting airways are tubelike structures that provide a passageway for air as it travels to the lungs. The conducting airways include the nasal passages, mouth, pharynx, larynx, trachea, bronchi, and bronchioles. Pharynx The conducting airways that connect nasal passages and mouth to the lower parts of the respiratory tract. Larynx The passageway for air entering and leaving the trachea and containing the vocal cords. Trachea Commonly known as the windpipe, this tube is composed of connective tissue mucosa and smooth muscle supported by C-shaped rings of cartilage. Bronchi Two tubes, the right and left primary bronchi, that each pass into its respective lung. Bronchioles Within the lungs, the bronchi branch off into increasingly smaller diameter tubes until they become the terminal bronchioles. Respiration A process of gas exchange necessary to supply cells with oxygen for carrying on metabolism, and to remove carbon dioxide produced as a waste by-product. Two types of respiration: external and internal. External Respiration The exchange of gases between the inhaled air and the blood in the pulmonary capillaries. Internal Respiration The exchange of gases at the cellular level between tissue cells and blood in systemic capillaries. Assessment Health History (allergies, occupation, lifestyle, health habits) Inspection (client's color, level of consciousness, emotional state) (Rate, depth, quality, rhythm, effort relating to respiration) Palpation and Percussion Auscultation (Listening for Normal and Adventitious Breath Sounds) Adventitious Breath Sounds Abnormal sounds and some conditions associated with them: Fine crackles (dry, highpitched popping…COPD, CHF, pneumonia) Coarse crackles (moist, low-pitched gurgling…pneumonia, edema, bronchitis) Sonorous wheezes (lowpitched snoring…asthma, bronchitis, tumor) Sibilant wheezes (highpitched, musical … asthma, bronchitis, emphysema, tumor) Pleural friction rub (creaking, grating… pleurisy, tuberculosis, abscess, pneumonia) Stridor (crowing…croup, foreign body obstruction, large airway tumor). Common Diagnostic Tests for Respiratory Disorders Laboratory Tests (Hemoglobin; Arterial blood gases; Pulmonary Function Tests; Sputum Analysis). Radiologic Studies (Chest X-ray; Ventilationperfusion scan; CAT scan; Pulmonary angiography). Other (Pulse oximetry; Bronchoscopy; Thoracentesis; MRI). Upper Respiratory Tract Infections/Inflammatory Disorders Rhinitis (coryza, common cold) Allergic rhinitis Sinusitis Pharyngitis Tonsillitis Laryngitis Pneumonia A lung infection wherein infectious secretions accumulate in the air passages and interfere with gas exchange. Clients with chronic pulmonary disorders or problems of immobility are at increased risk of developing pneumonia. Tuberculosis Pulmonary TB is an infection of the lung tissue caused by the Mycobacterium tuberculosis. Treatment of TB requires the long-term administration of pharmacological agents. Pleurisy/Pleural Effusion Pleurisy is a painful condition that arises from inflammation of the pleura, or sac that encases the lung. Pleural effusion occurs when the inflamed pleura secretes increased amounts of pleural fluid into the pleural cavity. Atelectasis A common respiratory tract disorder associated with immobility and the administration of anesthetic agents. Clients at risk are encouraged to cough and breathe deeply to aid in preventing atelectasis. Pulmonary Embolism Obstruction of a pulmonary artery by a bloodborne substance. Deep vein thrombosis is a common cause of pulmonary embolism. Pulmonary Edema A life-threatening condition characterized by a rapid shift of fluid from plasma into the pulmonary interstitial tissue and the aveoli, resulting in markedly impaired gas exchange. Can result from severe left ventrical failure, rapid administration of I.v. fluids, inhalation of noxious gases, or opiate or barbiturate overdose. Adult Respiratory Distress Syndrome A life-threatening condition characterized by severe dyspnea, hypoxemia, and diffuse pulmonary edema. Usually follows major assault on multiple body systems or severe lung trauma. Acute Respiratory Failure Conditions wherein there is a failure of the respiratory system as a whole. This condition occurs as a result of the client’s literally becoming too tired to continue the “work” of breathing. Chronic Obstructive Pulmonary Disease A collective term used to refer to chronic lung disorders wherein air flow into or out of the lungs is limited. Disorders associated with COPD are asthma, chronic bronchitis, emphysema, and bronchiectasis. Asthma A condition characterized by intermittent airway obstruction in response to a variety of stimuli. Bronchitis An inflammation of the bronchial tree accompanied by hypersecretion of mucus. Emphysema A complex and destructive lung disease wherein air accumulates in the tissues of the lungs. Bronchiectasis A chronic dilation of the bronchi. Main causes of this disorder are pulmonary TB infection, chronic upper respiratory tract infections, and complications of other respiratory disorders of childhood, particularly cystic fibrosis. Pneumothorax/Hemothorax Traumatic disorders of the respiratory tract wherein the underlying lung tissue is compressed and eventually collapses. Neoplasms of the Respiratory Tract Benign neoplasms. Lung cancer. Cancer of the larynx. Epistaxis A hemorrhage of the nares or nostrils. May be unilateral (most common) or bilateral. Blood loss can be minimal to severe. Smoking Cigarette smoking is indicated as a major causative factor in the development of respiratory disorders, such as lung cancer, cancer of the larynx, emphysema, and chronic bronchitis.