Module 3

Visceral pleura

covers the lungs

Parietal pleura

lines the chest wall

Pleural cavity

The space or cavity between the visceral and parietal layers of the lung

Intercostal muscles

muscles between your ribs that help your chest expand and contract

Surfactant

slippery substance made in the lungs. It coats the alveoli (tiny air sacs) and keeps them from collapsing when you breathe out

Atelectasis

part or all of the lung collapses and can't expand

Ventilation

movement of air in and out of your lungs

Perfusion

The flow of blood through the lungs. Blood comes in low on oxygen and picks up fresh oxygen from the alveoli.

Chemoreceptors

detect changes in O₂ and CO₂ and send signals to adjust how fast and deep you breathe

Peripheral chemoreceptors

in your aorta and carotid arteries

Central chemoreceptors

in the medulla oblongata

Lung compliance

how easily the lungs expand when air pressure increases

Airway resistance

how much the airways fight against airflow

Tidal volume

The amount of air inspired and expired with each breath

Inspiratory reserve volume (IRV)

The amount of additional air that is breathed in after a typical inspiration

Expiratory reserve volume (ERV)

The amount of additional air that is expelled after a typical expiration

Residual volume (RV)

The amount of air remaining in the alveoli after expiration

Vital capacity (VC)

The maximum amount of air that is expelled after maximal inspiration

Forced vital capacity (FVC)

air you can force out in 1 second after a deep breath

Total lung capacity (TLC)

The amount of air remaining in the lung after maximal inspiration

Cardiac Output (CO)

the amount of blood the heart pumps in 1 minute

Cardiac Output (CO) Formula

CO = HR × SV (Heart Rate × Stroke Volume)

Normal Cardiac Output (CO)

about 4–6 liters per minute in resting adults

Stroke Volume (SV)

amount of blood pumped out of the left ventricle with each beat

Preload In Stroke Volume (SV)

The blood remaining in the left ventricle at the end of diastole causing it to stretch

Afterload In Stroke Volume (SV)

The amount of resistance or force that occurs when the heart release blood from the left ventricle

Contractility In Stroke Volume (SV)

The force required to eject blood from the left ventricle

Signs of Chronic Pulmonary Disease

• Clubbing

• Barrel chest

• Tripod position

Clubbing

Rounded, enlarged fingertips

Tripod position

Placement of the arms against the legs or examination table while seated

Jugular Vein Distention (JVD)

When the veins in your neck look swollen or bulging. It usually means there’s increased pressure in the vein, often caused by heart problems like heart failure.

How to check Jugular Vein Distention (JVD)

• Recline client at 30°– 45°

• Turn head slightly away

• Measure from the sternal notch to the highest point of the jugular pulsation

• More than 1.5 inches is abnormal

Tactile fremitus

A vibration felt in the chest wall during palpation or auscultation found when speaking

Pleural effusion

A buildup of fluid in the pleural space

1+ Edema Scale

Barely noticeable, quick rebound

2+ Edema Scale

Slight, rebounds in a few secs

3+ Edema Scale

Deeper, rebounds in 10–20 secs

4+ Edema Scale

Very deep, rebounds in >30 secs

Bronchial (Normal Sounds)

over trachea/bronchi (louder, higher-pitched)

Vesicular (Normal Sounds)

over lung tissue (softer, lower-pitched)

Crackles

Popping/crackling sounds

Wheezing

High-pitched musical whistling on exhalation

Rhonchi

Rattling/snoring-like noise

Stridor

Harsh, high-pitched on inhalation (EMERGENCY!)

Documentation on Lung Sounds

• Type

• Location

• Side (left/right)

Aortic Location

2nd ICS, right sternal border

Pulmonic Location

2nd ICS, left sternal border

Tricuspid Location

4th–5th ICS, left sternal border

Mitral Location

5th ICS, midclavicular line (left side)

S1 ("lub")

closure of mitral/tricuspid (start of systole)

S2 ("dub")

closure of aortic/pulmonic (end of systole)

Murmurs Documentation

• Location

• Pitch (low, medium, high)

• Quality (harsh, blowing)

• Intensity (grade 1–6)

S3 Sound

“Ken-tuck-y”

S4 Sound

“Ten-nes-see”

Ventilation

Movement of air in and out

Perfusion

Blood flow to alveoli

Hypoxemia

Low amount of oxygen in the blood

Hypoxia

Below the expected level of oxygen in body tissue

Hyperventilation

An increase in the rate and depth of breathing that leads to excessive loss of carbon dioxide from the blood

Hypoventilation

Shallow breathing with a lower than expected respiratory rate

Atrial Fibrillation

Irregular, rapid heartbeat from atria

Ventricular Fibrillation

Rapid, erratic impulses

Regurgitation (Insufficiency)

Valve doesn’t close completely → backflow

Stenosis

Valve becomes narrow/stiff

Impaired Tissue Perfusion (Hypoperfusion)

the body's tissues aren't getting enough blood and oxygen

Preload Hypoperfusion

venous return to the heart

Contractility Hypoperfusion

strength of heart’s contraction

Afterload Hypoperfusion

resistance the heart pumps against

Myocardial Ischemia

Decreased oxygen delivery to the myocardium due to reduced coronary artery blood flow

Angina Pectoris (Stable Angina)

chest pain or discomfort that happens when the heart doesn't get enough oxygen-rich blood, usually during physical activity or stress

Healthy adults SpO₂

Maintain 95–100%

Ill clients SpO₂

Maintain 88–92%

Corticosteroids

Reduce inflammation in the airways

Nebulizer

Converts liquid medications into a mist for inhalation

Nasal Cannula

Oxygen Flow: 1-6 L/min

Oxygen Concentration: 24%-44%

Simple Face Mask

Oxygen Flow: 5-10 L/min

Oxygen Concentration: 35%-60%

Partial Rebreather Mask

Oxygen Flow: 10-15 L/min

Oxygen Concentration: 60%-90%

Nonrebreather Mask

Oxygen Flow: 10-15 L/min

Oxygen Concentration: 80%-95%

Venturi Mask

Oxygen Flow: 4-15 L/min

Oxygen Concentration: 24%-60%

Aerosol Mask

Oxygen Flow: Varies (used with nebulizers)

For Children < 5 Years: Use face mask.

For Children > 5 Years: Use mouthpiece.

Continuous Positive Airway Pressure (CPAP)

Continuous flow of air to keep the upper airway open and prevent collapse, particularly during sleep. Helps keep the alveoli open.

Obstructive Sleep Apnea (OSA)

partial or complete airway obstruction during sleep, leading to apneic episodes

Bilevel Positive Airway Pressure (BiPAP)

Used for clients whose airway collapses during sleep, causing difficulty with breathing

Oxygen Toxicity

occurs when oxygen is administered at high concentrations, leading to cellular damage which can also be acute or chronic

Sputum Specimen Collection

helps identify infectious organisms and determine the appropriate treatment

Chest Physiotherapy (CPT)

used to aid in clearing thick, copious secretions from the lungs and improve lung expansion

Postural Drainage

uses body positioning to facilitate the drainage of mucus from various lung lobes, helping gravity move the secretions toward the upper airways, where they can be cleared

Incentive Spirometer (IS)

helps to expand the lungs, reduce the risk of atelectasis, and encourage bronchial hygiene by improving inspiratory volume and transpulmonary pressure

Pursed-Lipped Breathing

help manage breathlessness and release air trapped in the lungs, making breathing easier

Flutter Valve

aids in clearing mucus from the lungs, which improves breathing and reduces the risk of atelectasis

Huff Coughing

involves taking a deep breath, then exhaling quickly and forcefully in short bursts (like a "huff") to move the mucus up and out of the airways

Oropharyngeal Suctioning

Purpose: Clears secretions from the mouth and pharynx.

Indication: Performed on clients who have an ineffective cough and are unable to clear oral secretions independently.

Nasopharyngeal Suctioning

Purpose: Clears secretions from the nasopharynx.

Indication: Used for clients who are unable to cough or blow their nose effectively to clear secretions.

Nasotracheal Tube (NTT)

Purpose: Used to maintain an open airway during surgery or prevent further damage in patients with neck trauma.

Indication: May be used for clients with upper airway obstruction or those undergoing head and neck surgeries.

Endotracheal Tube (ETT)

Purpose: Provides a clear airway, protects against aspiration, and ensures proper ventilation and oxygenation.

Indication: Often used for clients undergoing general anesthesia, those in respiratory failure, or patients requiring mechanical ventilation.

Tracheostomy Tube

Purpose: A tube inserted directly into the trachea to maintain an open airway.

Indication: Used for patients who need long-term ventilation or airway support.

Open Suctioning

The catheter is inserted directly into the airway and is disposed of after each use. It requires sterile technique and is typically used in patients with endotracheal tubes or tracheostomies

Closed Suctioning

A sterile, reusable catheter is enclosed within a sterile sheath, allowing for repeated suctioning without removing the catheter from the airway. This method is often used for patients on mechanical ventilation.

Suction Pressure

should be set between 80-120 mmHg for adults and lower for children

Collection Chamber

Collects the drainage from the chest tube. It allows monitoring of the amount and type of fluid being removed from the pleural space.