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.