n351 - respiratory disease

primary functions

provides oxygen for metabolism in the tissues

removes carbon dioxide, the waste product of metabolism

secondary functions

facilittes sense of smell

produces speech

maintains acid-base balance

maintains body water levels

maintains heat balance

respiratory anatomy

trachea, right primary bronchus, left primary bronchus, right lung, left lung

upper respiratory tract includes

nasal cavity

sinuses

pharyngeal tonsils

nasopharynx

pharynx

larynx

epiglottis

esophagus

upper respiratory tract: nose

humidifies, warms, filters inspired aiar

upper respiratory tract: sinuses

air-filled cavities within hollow bones that surround nasal passages

provide resonance during speech

upper respiratory tract: pharynx

located behind oral & nasal cavities

passageway for both respiratory & digestive tracts

pharynx divides into

nasopharynx, oropharynx, laryngopharynx

upper respiratory tract: larynx

above trachea, below pharynx

voice box

2 pairs of vocal cords

glottis

glottis

opening betwen true vocal cords

• important role in coughing c

coughing

most fundamental defense mechanisms of 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 includes

trachea, bronchus, bronchi, bronchioles

lower respiratory tract: trachea

in front of esophagus

branches into right & left main stem bronchi at carina

lower respiratory tract: main stem bronchi

begin at carina

main stem bronchi: right bronchus

wider, shorter, more vertical than left

main stem bronchi divide into

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

• lined with cilia (propel mucous to trachea to be expectorated or swallowed)

lower respiratory tract: bronchioles

branch from secondary bronchi and subdivide into small terminal and respiratory bronchioles

• no cartilage, depend on elastic recoli of lung

terminal bronchioles

no cilia, do not participate in gas exchange

alveoli are made up of

terminal bronchioles, alveolus, alveolar capillary network

acinus (acini)

used to indicate all structures distal to terminal bronchiole

alveolar ducts branch from

respiratory bronchioles

alveoli sacs contain

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

cells in walls of alveoli secrete

surfactant - phospholipid protein that reduces surface tension in alveoli

without surfactant,

alveoli would collapse

lungs: right

3 lobes

lungs: left

2 lobes

lungs: pleura (out to in)

visceral, parietal, pleural fluid

lungs are located in

pleural cavity in thorax

extend from just above clavicles to diaphragm

diaphragm

major muscle of inspiration

right lung larger than left

left lung narrower to accomodate heart

innervation of respiratory structure

phrenic nerve, vagus nerve, thoracic nerve

parietal pleua

lines inside of thoracic cavity, including upper surface of diaphgram

visceral pleura covers

pulmonary surfaces

pleural fluid

lubricates visceral and parietal pleurae, allowing gliding during respiration

blood flow through lungs via

pulmonary and bronchial system

accessory muscles of respiration includes

scalene muscles

sternocleidomastoid

trapezius & pectoralis muscles

respiratory process: inspiration

flattening of diaphragm as it contracts

• negative pressure in lungs draws air from atms into lungs

air passes through terminal bronchioles into alveoli to oxygenate body tissue

respiratory process: expiration

passive process

elevation of diaphragm as it recoils

pressure within lungs becomes greater than atmospheric pressure → air moves from alveoli to atmos

respiratory process: risk factors

smoking, allergies, frequent respiratory illnesses

chest injury, surgery, exposure to pollutants, family history

geographic residence

chest x-ray

CXR

CXR: description

provides info regarding anatomic location & appearance of lungs

CXR: pre-procedure

remove jewelry & other metal objects from chest

assess ability to inhale & hold breath

pregnancy questions

CXR: post-procedure

assist client to dress

sputum specimen

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

sputum specimen: pre-procedure

determine specific purpose of collection - check policy

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

obtain 15 ml of sputum

collect before antibiotics

sputum specimen: instruct

rinse mouth w water prior collection, take several deep breaths

cough deeply to obtain sputum

sputum specimen: post-procedure

if prescribed, transport specimen to lab immediately

assist with mouth care

bronchoscopy: description

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

bronchoscopy: pre procedure

informed consent, NPO midnight prior

obtain vitals, monitor coagulation (if bleed risk)

remove dentures, eyeglasses

administer med for sedation as prescribed

have emergency resuscitation equip avaiable

post-procedure: bronchoscopy

monitor vital signs, semi-fowler’s position

assess gag reflex (NPO until reflex returns)

emesis basin, monitor for bloody sputum, respiratory status

notify MD if fever or difficulty breathing

bronchoscopy complications

bronchospasm, bacteremia, bronchial perforation indicated by facial or neck crepitus, dysrhythmias, fever, hemorrhage, hypoxemia, pneumothorax

pulmonary angiography: description

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

pulmonary angiography: pre-procedure

informed consent, assess for allergies to iodine, seafood, other radiopaque dyes

NPO 8 hours prior, monitor vitals, coagulation studies

establish IV access, administer sedation

emergency resuscitation equipment available

pulmonary angiography: instruct clients

must lie still during procedure

may feel urge to cough, experience flush, nausea, or salty taste following injection of dye

pulmonary angiography: post-procedure

monitor vital signs, avoid taking BP in extremity used for injection for 24 hrs

monitor peripheral neurovascular status, assess insertion site for bleeding

monitor for delayed reaction to dye

thoracentesis: description

removal of fluid or air from pleural space via transthoracic aspiration

thoracentesis: pre-procedure

informed consent, baseline vitals, coagulation studies

ultrasound or CXR ir prescribed

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

• if cannot, place lying in bed on unaffected side with head of bed elevated 45 degrees

don’t cough, breathe deeply or move during procedure

thoracentesis: post-procedure

monitor vital signs, respiratory status

apply pressure dressing and assess puncture site for bleeding and crepitus

monitor for pneumothorax, air embolism, pulmonary edema

pulmonary function tests (PFTs)

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

pulmonary function tests (PFTs): pre-procedure

determine if analgesic that may depress respiratory function is being administered

consult w physician about holding bronchodilators prior to testing

pulmonary function tests (PFTs); instruct client

void prior to procedure

wear loose clothing

remove dentures

refrain from smoking or eating heavy meal 4-6 hrs prior

pulmonary function tests (PFTs): post-procedure

resume normal diet, bronchodilators and respiratory treatments held prior to procedure

lung volumes & capacities: obstructive process

normal VC, decreased FEV1

FEV

forced expiratory volume - how much you exhale over a second

lung volumes & capacities: restrictive process

decreased Vc, normal FEV1

lung volumes & capacities measured in

mL

tidal volume

norm volume breathed in and out when not exerting

inspiratory reserve volume (IRV)

breath in, take that breath and hold it

expiratory reserve volume (ERV)

breathing out, empty lung volume

residual volume

what’s left in lungs

FEV1

75-80% VC

Lung Biopsy

percutaneous, performed to obtain tissue for analysis by culture or cytologic examination

• needle biopsy done to identify pulmonary lesions, changes in lung tissue, cause of pleural effusion

lung biopsy: pre-procedure

informed consent, NPO prior, inform client about local anesthetic (but sensation of needle insertion & aspiration may be felt)

administer analgesics & sedatives as prescribed

lung biopsy: post-procedure

monitor vitals, apply dressing to biopsy site and monitor for drainage or bleeding

monitor signs of respiratory distress, pneumothorax, air emboli (notify physican if occurs)

prepare client for chest x-ray if prescribed

ventilation-perfusion lung scan

perfusion scan: blood flow to lungs is evaluated

ventilation scan: determines patency of pulmonary airways and detects abnormalities in ventilation

radionuclide may be injected for procedure

ventilation-perfusion lung scan: pre-procedure

informed consent, assess for allergies to dye, iodine, seafood

remove jewelry from chest

review breathing methods, establish IV access

administer sedation if prescribed, emergency resuscitation equipment avaiable

ventilation-perfusion lung scan: post-procedure

monitor for reaction to radionuclide

skin tests

intradermal injection used to assist in diagnosing various infectious diseases

ex: TB

skin test: procedure

use test site free of excessive body hair, dermatitis, blemishes

apply at upper 1/3 of inner surface of left arm

circle & mark injection test site

document date, time, test site

skin test: pre-procedure

determine hypersensitivity or previous reactions to skin test

skin test: post-procedure

avoid scratching (infection & abcess may form)

interpret reaction at injection site 24-72 hours later

assess test site for induration (hard swelling in mm), erythema & besiculation (small blister-like elevations)

arterial blood gases (ABG)

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

allen test prior to abg

occlude radial and ulnar artery - see how it pinks up

if one is not picking up compared to other, avoid that site to not comprimsie arterial flow

normal ABG values: pH

7.35-7.45

normal ABG values: PCO2

35-45 mm HG

normal ABG values: HCO3

22-27 mEq

normal ABG values: PO2

80-100 mmHg

normal ABG values: O2 saturation

96-100%

arterial blood gases: pre-procedure

perform allen’s tests on both wrists prior

client rest for 30 min prior

avoid suctioning prior, do not turn off oxygen unless blood gases are ordered to be drawn at room air

arterial blood gases: post-procedure

place specimen on ice, note client temp + O2 + type of ventilation

apply pressure to puncture site for 5-10 min; longer if client on anticoagulatn therapy or has bleeding disorder

transport specimen to lab within 15 min

pulse oximetry

noninvasive test that registers oxygen saturation of client’s hemoglobin

pulse ox norm

95-100%

• but thrown off by sunlight, nail polish, cold extremities

after hypoxic client uses up readily available O2 (PaO2 on ABG testing)

reserve O2 attached to hemoglobin (SaO2) is drawn on to provide oxygen to tissues

Pulse oximeter reading alerts

hypoxemia before clinical signs occur

pulse ox measures

percentage of hemoglobin saturation

pulse ox procedure

sensor on part (usually finger) to measure oxygen sat.

• don’t select extremity w an impediment to blood flow

maintain transducer at heart level

pulse ox: less than 91%

immediate treatment necessary

pulse ox: SaO2 below 85%

body tissues having difficult time becoming oxygenated

• respiratory failure → respiratory arrest

pulse ox: SaO2 below 70%

life-threatening

• death