respiratory system diseases

primary functions of respiratory system

Provides oxygen for metabolism in the tissues

Removes carbon dioxide, the waste product of metabolism

secondary functions of respiratory system

Facilitates sense of smell

Produces speech

Maintains acid-base balance

Maintains body water levels

Maintains heat balance

upper respiratory tract includes

Nasal cavity

Sinuses

Pharyngeal tonsils

Nasopharynx

Pharynx

Larynx

Epiglottis

Esophagus

upper respiratory tract

Nasal cavity

Sinuses

Pharyngeal tonsils

Nasopharynx

Pharynx

Larynx

Epiglottis

Esophagus

nose functions

humidifies, warms & filters inspired air

sinuses

Air-filled cavities within hollow bones that surround nasal passages

Provide resonance during speech

pharynx

Located behind the oral & nasal cavities

Divided into:

-Nasopharynx, oropharynx, & laryngopharynx

Passageway for both respiratory & digestive tracts

larynx

Located above trachea & just below the pharynx

“The voice box”

Two pairs of vocal cords

Glottis = opening between the true vocal cords

glottis function

nPlays an important role in coughing, which is the most fundamental defense mechanism of the lungs

epiglottis

Leaf-shaped elastic structure attached to top of larynx

Prevents food from entering tracheobronchial tree by closing over glottis during swallowing

lower respiratory tract

1. trachea

2. bronchus

3. bronchi

4. bronchioles

trachea

Located in front of esophagus

Branches into right & left main stem bronchi at carina

main stem bronchi begins?

at carina

right bronchi

slightly wider, shorter, & more vertical than left bronchus

main stem bronchi divide into?

five secondary or lobar bronchi that enter each of five lobes of lung

bronchi are lined with?

cilia, which propel mucus up & away from the lower airway to trachea where it can be expectorated or swallowed

bronchioles branch from?

the secondary bronchi and subdivide into the small terminal and respiratory bronchioles

bronchioles contain?

no cartilage and depend on elastic recoil of lung for patency

terminal branches

contain no cilia & do not participate in gas exchange

alevoli

1. terminal bronchioles

2. alveolus

3. alveolar capillary network

Acinus (pl: acini)

term used to indicate all structures distal to terminal bronchiole

alveolar ducts branch from?

respiratory bronchioles

alveolar sacs contain?

clusters of alveoli, which are the basic units of gas exchange

cells in wall of alveoli secrete?

surfactant, a phospholipid protein that reduces surface tension in alveoli

without surfactant, what would collapse?

alveoli

how many lobes does the right lung have?

3

how many lobes does the left lung have?

2

pleurae

1. visceral

2. parietal

3. pleural fluid

lungs involve

1. right

2. left

3. pleurae

4. diaphragm

lungs are located?

in pleural cavity in thorax

lungs extend from?

just above clavicles to diaphragm, major muscle of inspiration

which lung is larger?

Right lung larger than left

Divided into 3 lobes, the upper, middle, & lowe

why is left lung narrower than right?

to accommodate the heart

-divided into 2 lobes

innervation of respiratory structures is accomplished by?

the phrenic nerve, vagus nerve, & thoracic nerves

parietal pleura lines?

inside of thoracic cavity, including upper surface of diaphragm

visceral pleura covers?

pulmonary surfaces

blood flow through lungs occurs via?

pulmonary system and bronchial system

Accessory muscles of respiration includes

Scalene muscles, which elevate the first two ribs

Sternocleidomastoid muscles

Trapezius & pectoralis muscles

pleural fluid

A thin fluid layer that is produced by the cells lining the pleura lubricates visceral and parietal pleurae, allowing them to glide smoothly & painlessly during respiration

during inspiration, Diaphragm descends into abdominal cavity, which causes?

negative pressure in lungs

negative pressure draws air from?

area of greater pressure (atmosphere) into area of lesser pressure (lungs)

in lungs, air passes through?

terminal bronchioles into alveoli to oxygenate body tissues

At the end of inspiration, diaphragm and intercostal muscles ??? and lungs ???

diaphragm and intercostal muscles relax and lungs recoil

what happens in expiration when lungs recoil?

pressure within lungs becomes greater than atmospheric pressure, causing air, (which now contains the cellular waste products of carbon dioxide and water) to move from alveoli in lungs to atmosphere

expiration is which type of process

passive

risk factors for respiratory disease

Smoking

Use of chewing tobacco

Allergies

Frequent respiratory illnesses

Chest injury

Surgery

Exposure to chemicals and environmental pollutants

Crowded living conditions

Family history of infectious disease

Geographic residence and travel to foreign countries

chest x ray

nProvides information regarding anatomic location & appearance of lungs

pre procedure of chest x ray

Remove all jewelry & other metal objects from chest area

Assess ability to inhale & hold breath

Question women regarding pregnancy or possibility of pregnancy

post procedure chest Xray

Assist client to dress

sputum specimen description

specimen obtained by expectoration or tracheal suctioning to assist in identification of organisms or abnormal cells

preprocedure for sputum specimen

Determine specific purpose of collection - check institutional policy

Early morning sterile specimen from suctioning or expectoration after a respiratory treatment, if a treatment is prescribed

Obtain 15 ml of sputum

Instruct

-Rinse mouth with water prior to collection

-Take several deep breaths

-Cough deeply to obtain sputum

Always collect specimen before starting antibiotics

post procedure sputum specimen

If culture of sputum is prescribed, transport specimen to laboratory immediately

Assist with mouth care

bronchoscopy

Direct visual examination of larynx, trachea, & bronchi with fiberoptic bronchoscope

pre procedure bronchoscopy

Informed consent

NPO midnight prior

Obtain vital signs

Monitor coagulation studies

Remove dentures or eyeglasses

Prepare suction equipment

Administer medication for sedation as prescribed

Have emergency resuscitation equipment readily available

procedure for post bronchoscopy

Monitor vital signs

Semi-fowler's position

Assess gag reflex

NPO until gag reflex returns

Emesis basin

Monitor for bloody sputum

Monitor respiratory status, particularly if sedation was administered

Monitor for complications

notify MD if fever or difficulty breathing

bronchoscopy complicaitions

Bronchospasm

bacteremia

bronchial perforation indicated by facial or neck crepitus

dysrhythmias

fever

hemorrhage

hypoxemia

pneumothorax

pulmonary angiography

An invasive fluoroscopic procedure following injection of iodine or radiopaque or contrast material through a catheter inserted through the antecubital or femoral vein into the pulmonary artery or one of its branches

pre procedure pulmonary angiography

Informed consent

Assess for allergies to iodine, seafood, other radiopaque dyes

NPO 8 hours prior

Monitor vital signs

Monitor coagulation studies

Establish an IV access

Administer sedation

instruct pts

emergency resuscitation available

instruct clients for pulmonary angiography:

Must lie still during procedure

May feel an urge to cough or experience flushing, nausea, or a salty taste following injection of dye

for pulmonary angiography, NPO how many hours prior?

8 hours prior

for pulmonary angiography, assess for allergies to?

iodine

seafood

other radiopaque dyes

for bronchoscopy, NPO prior?

NPO midnight prior

for bronchoscopy, NPO post?

Assess gag reflex

NPO until gag reflex returns

bronchscopy post position

semi fowlers position

throacentesis

Removal of fluid or air from pleural space via transthoracic aspiration

thoracentesis preprocedure

Informed consent

Baseline vital signs

Ultrasound or CXR if prescribed prior to procedure

Assess coagulation studies

Positioned sitting upright, with arms & head supported by table at bedside during procedure

If client cannot sit up, client is placed lying in bed on unaffected side with HOB elevated 45 degrees

Inform client not to cough, breathe deeply, or move during the procedure

pre thoracentesis, position?

Positioned sitting upright, with arms & head supported by table at bedside during procedure

If client cannot sit up, client is placed lying in bed on unaffected side with HOB elevated 45 degrees

post procedure thoracentesis

Monitor vital signs

Monitor respiratory status

Apply a pressure dressing and assess puncture site for bleeding and crepitus

Monitor for signs of pneumothorax, air embolism, and pulmonary edema

pulmonary function tests

Include a number of different tests used to evaluate lung mechanics, gas exchange, and acid-base disturbance through spirometric measurements, lung volumes, & arterial blood gases (ABGs)

spirometry

patient flow into spirometer

device measures and records max air flow, lung volume and other parameters which are important in understanding the individuals pulmonary function

PFTs pre procedure

Determine if an analgesic that may depress respiratory function is being administered

Consult with physician regarding holding bronchodilators prior to testing

Instruct client

before 24 weeks, why is it hard for premies to survive?

do not have surfactant yet

instruct clients pre PFTs

Void prior to procedure

Wear loose clothing

Remove dentures

Refrain from smoking or eating a heavy meal for 4 to 6 hours prior to the test

post PFTs

Resume normal diet & any bronchodilators and respiratory treatments that were held prior to procedure

What happens to VC and FEV₁ in obstructive lung disease?

Normal VC, Decreased FEV₁

What happens to VC and FEV₁ in restrictive lung disease?

Decreased VC, Normal FEV₁

Which type of lung disease affects the ability to exhale quickly?

Obstructive lung disease (↓ FEV₁)

Which type of lung disease is associated with limited lung expansion?

Restrictive lung disease (↓ VC)

What is VC (Vital Capacity)?

The maximum amount of air a person can exhale after a full inhalation.

What is FEV₁ (Forced Expiratory Volume in 1 second)?

The amount of air a person can forcefully exhale in the first second.

FEV₁ =

75-80% VC

lung biopsy

A percutaneous lung biopsy is performed to obtain tissue for analysis by culture or cytologic examination

A needle biopsy is done to identify pulmonary lesions, changes in lung tissue, and the cause of pleural effusion

pre lung biopsy

Informed consent

NPO prior to procedure

Inform client that local anesthetic will be used but that sensation of pressure during needle insertion & aspiration may be felt

Administer analgesics & sedatives as prescribed

pre lung biopsy NPO?

NPO prior to procedure

post lung biopsy

Monitor vital signs

Apply a dressing to the biopsy site and monitor for drainage or bleeding

Monitor for signs of respiratory distress, and notify physician if they occur

Monitor for signs of pneumothorax and air emboli, and notify physician if they occur

Prepare client for chest x-ray if prescribed

Ventilation-Perfusion Lung Scan

In the perfusion scan, blood flow to the lungs is evaluated

The ventilation scan determines the patency of the pulmonary airways and detects abnormalities in ventilation 

A radionuclide may be injected for the procedure

pre Ventilation/perfusion lung scan

Informed consent

Assess for allergies to dye, iodine, or seafood

Remove jewelry from chest area

Review breathing methods, which may be required during testing

Establish IV access

Administer sedation if prescribed

Emergency resuscitation equipment available

pre V-P lung scan, assess for allergies to:

dye

iodine

seafood

post V-P lung scan

monitor for reaction to radionuclide

skin test

An intradermal injection used to assist in diagnosing various infectious diseases

procedure for skin tests

Use test site free of excessive body hair, dermatitis, & blemishes

Apply at upper one third of inner surface of left arm

Circle & mark injection test site

Document date, time, & test site

pre skin test

Determine hypersensitivity or previous reactions to skin tests

post procedure skin tests

Instruct client

-Do not to scratch test site to prevent infection & abscess formation

-Avoid scrubbing test site

Interpret reaction at injection site 24-72 hours after

Assess test site

post skin tests: assess test site for:

Amount of induration (hard swelling) in millimeters

Presence of erythema & vesiculation (small blister-like elevations)

arterial blood gases (ABGs)

Measures the dissolved oxygen and carbon dioxide in the arterial blood and reveals the acid-base state and how well the oxygen is being carried to the body

pre ABGs

Perform Allen’s test on both wrists prior to drawing specimens

Have client rest for 30 minutes prior to specimen collection

Avoid suctioning prior to drawing blood gases

Do not turn off oxygen unless blood gases are ordered to be drawn at room air

pre ABGs, have clients rest for?

30 mins prior to specimen collection

post ABGs

Place specimen on ice

Note client’s temperature on laboratory form

Note O₂ & type of ventilation client is receiving on form

Apply pressure to puncture site for 5-10 minutes; Longer if client on anticoagulant therapy or has bleeding disorder

Transport the specimen to laboratory w/in 15 min

pulse oximetry

Noninvasive test that registers oxygen saturation of client’s hemoglobin

normal pulse ox =

95-100%