Res SN Full Vid on Resp- cut

Role of the Respiratory System

  • The primary role is to inspire oxygen from the atmosphere which is then delivered to the tissues to produce energy.
  • A byproduct of energy production is carbon dioxide, which the body needs to eliminate. Thus, the respiratory system also functions to exhale carbon dioxide.
  • Other roles include:
    • Cleaning the inspired air to remove pathogens like viruses, bacteria, and fungi.
    • Humidifying and heating the inspired air to facilitate adequate gas exchange in the lungs.
  • The cardiovascular system works intimately with the respiratory system to transport gases (oxygen and carbon dioxide).
  • The respiratory tract also plays a role in sound production and resonation.

Parts of the Respiratory Tract

The pathway of air from the atmosphere to the lungs involves several anatomical structures:

  • Nasal Cavity: Air enters through the nasal cavity.
  • Pharynx: Air then moves to the pharynx, located at the back of the throat. It has three parts:
    • Nasopharynx (nasal portion)
    • Oropharynx (oral portion)
    • Laryngopharynx (next to the larynx)
  • Oral Cavity: Air can also be inspired through the mouth and enter through the oral cavity.
  • Larynx: Following the pharynx, air passes through the larynx.
  • Upper Respiratory Tract: The nasal cavity, pharynx (nasopharynx, oropharynx, laryngopharynx), and larynx constitute the upper respiratory tract. Upper respiratory tract infections involve these components.
  • Trachea: Air then passes through the trachea.
  • Bronchi: The trachea bifurcates (splits) into the left and right main stem bronchi.
  • Lungs: The right lung has three lobes (upper, middle, lower), while the left lung has two lobes (upper, lower). The left lung has a cardiac notch to accommodate the heart.
  • Clinical Significance: The right stem bronchus is wider and more vertical, making it more likely for inhaled substances to lodge there.
  • Bronchioles and Alveoli: The bronchi branch about 23 times, leading to smaller bronchioles and eventually alveoli, which are the site of gas exchange.
  • Lower Respiratory Tract: The trachea, bronchi, and lungs (including alveoli) form the lower respiratory tract. Lower respiratory tract infections involve these components.

Important Points

  • Nasal Cavity: Contains turbinates which:
    • Spin the air to throw particulates onto the mucus to prevent them from entering the lungs
    • Warm and humidify the air to make gas exchange more beneficial
  • Pharynx: Includes the nasopharynx, oropharynx, and laryngopharynx.
  • Larynx: Contains the vocal cords (voice box). The Adam's apple, or laryngeal prominence, is cartilage. Both males and females have one. Underneath is a soft portion, an accessory airway if the superior airway is blocked.
  • Trachea: Cartilage keeps the trachea open (patent). Without it, negative pressure from air movement could cause it to collapse, similar to sucking on a straw with a blocked end.
  • Bronchioles: As you move through the trachea to the bronchi and the smaller bronchioles, cartilage diminishes and muscle increases, thus allowing the muscle to constrict (clinical application: asthma)
  • Alveoli: Tiny air sacs with a surface area about the size of a tennis court, allowing for a huge area for gas exchange to occur
    • Inspired oxygen jumps into the bloodstream, carbon dioxide jumps out and is expired

Respiratory Cycle

The respiratory cycle involves bringing air into and out of the lungs via muscles and pressure changes.

  • Inspiration (Inhalation):
    • Muscles contract, increasing the volume of the lungs.
    • Diaphragm: Contracts and pulls down, increasing the size of the thoracic cavity
    • External Intercostals: Contract up and out, increasing the size of the thoracic cavity
    • Boyle's Law: As volume increases, pressure decreases (P
      V = k). This creates a pressure difference, with air moving from high to low pressure.
    • Gas moves from high pressure to low pressure
  • Expiration (Exhalation):
    • Relaxation: Diaphragm and external intercostals relax, lung tissue snaps back due to elasticity, pushing air out. Most of the air is removed by this relaxation.
    • Forced Expiration: Requires more muscles.
      • Internal Intercostals: Bring the rib cage in and down, reducing thoracic volume.
      • Abdominal Muscles: Contract, further reducing thoracic volume.

Acid-Base Balance

  • The respiratory system plays a role in maintaining acid-base balance by regulating the levels of carbon dioxide (CO_2) in the body.
  • Respiratory Acidosis: Occurs when there is a slow respiratory rate so: CO_2 is retained, making the blood more acidic. Common causes include:
    • Sleep apnea
    • Head trauma
    • Post-operative state (anesthesia)
    • CNS depressants (opioids, alcohol, benzodiazepines)
    • Impaired gas exchange (pneumonia, COPD, asthma attacks)
  • Manifestations of Respiratory Acidosis: The patient will present with mental status changes and elevated PaCO2 is: > 45 mm Hg. Elevated HCO3 (bicarbonate) to compensate.
  • Compensation for Respiratory Acidosis: The kidneys will excrete hydrogen ions and retain bicarbonate to balance the acid overload
  • Respiratory Alkalosis: Occurs when there is a fast respiratory rate (hyperventilation). Common causes includes:
    • Panic attack
  • Manifestations of Respiratory Alkalosis: The patient will present with low PaCO2: < 35 mm Hg because the patient is breathing too fast. Also, low HCO3 levels. To treat it, correct the underlying cause (anxiety).
  • Compensation for Respiratory Alkalosis: The kidneys excrete less hydrogen ions and reabsorb less bicarbonate.

Oxygen Delivery Equipment

  • Nasal Cannula: Delivers 1-6 liters per minute, providing 25-45% oxygen. Used for short-term low oxygen needs (post-surgery) or long-term use (with humidification).
  • Face Masks:
    • Simple Face Mask: Delivers 6-10 liters per minute, providing 40-60% oxygen.
    • Partial Rebreather: Delivers 6-10 liters per minute, providing 35-60% oxygen. Similar to non-rebreather but lacks flutter valves.
    • Non-Rebreather (NRB): Delivers 10-15 liters per minute, providing 60-100% oxygen. Used in medical emergencies, such as carbon monoxide poisoning. Monitor the reservoir bag and valves to ensure the bag is more than halfway full. Increase oxygen flow if the bag is fully deflated on inspiration.
    • Venturi Mask: Delivers 4-10 liters per minute (FiO_2). This is the most precise oxygen delivery device. Used for patients with unstable COPD who cannot tolerate changes in oxygen concentration from other devices.
    • Face Tent: Used for facial trauma and burns, providing high humidification.
  • BiPAP: Typically, the last line oxygen device before ET tube or endotracheal intubation. Most commonly used for clients with worsening COPD who have high levels of carbon dioxide retention, leading to that respiratory acidosis due to that decreased gas exchange. The BiPAP is that positive pressure machine that forcefully pushes air deep into the lungs, giving much needed oxygen while expelling carbon dioxide (CO_2).
  • Intubation (Endotracheal Intubation): Used as a last resort to keep the airway patent. A tube is inserted into the trachea to ventilate the patient manually or via a ventilator. Complications include ventilator-associated pneumonia (VAP). Prevented by:
    • Repositioning the client side to side every two hours
    • Oral care with chlorhexidine every two hours followed by oral suctioning
    • Monitoring for signs of infection, e.g., positive sputum culture, fever, chest X-ray with new infiltrates

Key Terms

  • Ventilation: Inspiration and expiration (breathing).
  • Hypercapnia: Increased CO2 levels in the blood (PaCO2 > 45 mm Hg). Can lead to respiratory failure.
  • Hypocapnia: Low CO_2 levels, caused by hyperventilation. Pushes the body into respiratory alkalosis.
  • Gas Exchange: Exchange of CO2 and O2 between alveolar air and blood in the capillaries.
  • Hypoxemia: Decreased oxygen in the blood (PaO_2 < 80 mm Hg). Early signs include mental status changes, restlessness, agitation, and confusion. Late signs: tachypnea, tachycardia, hypertension can be normal for low gas exchange patients. Very late signs include bradypnea, bradycardia, hypotension, cyanosis, ECG dysrhythmias as the body gets hypoxia.

Respiratory Assessment

  • Normal Anatomy:
    • Right lung: 3 lobes
    • Left lung: 2 lobes
    • Listening location: Intercostal space, between the ribs.
    • The system looks like an upside-down tree comprising the trachea, bronchus, bronchi, bronchioles and alveolar apples (sacs).
    • During gas exchange we breathe out CO2 and breathe in O2.
    • Alveolar acids exchanged at the capillary beds of each alveolus.
  • Factors Dependents Regarding Respiratory Process:
    • Clear Airway
    • Intact CNS
    • Central Nervous Brain Stem (Impulse to breathe)
    • Intact Thoracic Cavity
    • Diaphragm helps to expands the lungs to get O_2 in
  • Enternal Respiration:
    • The exchange of O2 and CO2 from alveoli and pulmonary blood.
  • Environmenal Factors in Respiratory System:
    • Pollution, elevation, temperature
  • Lifestyle Factors in Respiratory System:
    • Smoking, Stress, and Sedentary lifestyle: the tree s leading to decreased lung compliance.
  • Medication Factors in Respiratory System:
    • Opioids leading to shallow breaths in vitals.
  • Advanced Age Factors in Respiratory System:
    • Weak respiratory muscles increases work of breathing.
    • Decreased cough reflux
    • Increased risk for respiratory infections such as pneumonia. Also decrease Lung capacities.
  • Auscultation:
    • Place patients upright in High fowlers positions when checking lungs.
    • Normal breth is known: Vesicular breath sounds or those soft and low pitched breezy sounds, This need to be need to know.

Abnormal Lung Sounds

Remember it is advised to cross with the following information

  • Crackles (Crazy Fluid): Crackles will sound like velcro and is mostly heard at the lower based of the lungs meaning Heavy Fluid. Some of theses include:
    • Pneumonia
    • Heart Failure
    • Treadment for Pneumonia can be antibiotics.
    • Treatment for Heart Failure is diuretics.
  • Rhonchi (Rumble/Snoring): Rumbles are obstruction from Bronchi that sounds like a Snoring. Some of theses include:
    • Cystic Fibrosis
    • Pneumonia
    • Vibrate the mucus off th chest to use vest and loosen mucus.
  • Wheezes (Whistle): wheezes is High pitches sounds, This mostly occurs during expiration. Some of These Include:
    • Asthma Attacks
    • Air get trapped.
    • Intervention include AIM: A=Albuterol, I=Ipratropium, M =Methylprednisolone.
  • Pleural Friction Rub - (Pebbles Grinding): Pleural Friction Rubs is a Low pitched dry rubbing from the lining of the lungs occurs with worsting of Pneumonia. Intervention include:
    • IS Incentive Spirometer
    • Antibiotics
  • Stridor:
    • The serious Squeaks is a Medical Emergence Airway Obstruction.
    • Inflammation blocking near your voice box or the Trachae. Intervention include surgery.
    • Medical Emergency, blockage of the larynx or Trachea during inhalation.
      *Intervention include: Et. Tube. (Anaphylactic, Thyroid Surgery, Choking)
  • Key terms that would be noted during a assessment
    • Wheezes - Narrowing Air away occurs during Asthma and COPD.
    • Crackles - Fluid in Lungs occurs during Heart Failure and Pneumonia.
    • Stridor: Is medical emergence.
      • Rhonchi: Snoring, obstruction mucus. (In lungs)
      • Pleural Friction Rub - Indicate Worsening of (Pneumonia). Rubbing together causing grinding sounds.
        Key interventions of worsening pneumonia can be infection in deep breath. TCDB. And use of ISO incentive spirometer.

Respiratory Assessment

  • Auscultation Locations: We have anterior, which is the front chest. Posterior on the back where we mostly assess lungs. The way we do thing is on that point.
  • We Position the patient upright in high Fowler's position in between ribs. Point the diaphragm big portion downward and places it in the portion between ribs.
    Normally vesicular breath sounds. Or soft and low pitches. Important need to know.
    Front (Anterior/ Chest)
    At the top right side clavicle top to collarbone.
    1 full inhalation/ full exhalation Compare depths qualities and extra sound.
    2ND ICS.
    Mid of Collabial.
    Quality Depth and breath sounds ICS 3RD COMPARE DOWNWARDS
    Sixth. Ics Mid Axillary: Assess the lower Lobes. Basilar portions of the lungs. Base locations to assess from failure. Check lung sounds for crackles. The memory trick for this will be (Crackles crazily fluid)

Auscultation Posterior.
To get a clean without muffling. Forward leaning. Hands in Lap. To separate the shoulders blades, START by listening top opposite side compared. The working down and comparing, and again till completely done with listening.

Inspection

We are going to review the lung and respiratory assessment

  • Inspection-What are we Looking At?

    • First and Formost LOC

  • Level of consciousness

    *Alert /Confused?

Skin Colour: Pink

  • Is the is skin tone pink? We look at a skin that looks like this.
    *Pallor:
    (1/2 Deoxygenations.
    Cytosis:
    Late Deoxygenatios
    Conditions of the Nail; Profile, shape. One sixty to angle. If not with a club One eighty. We have clubbing from hypoxia.
    Rate Regular.
    12-20-Respiratory.
    Meds Opioids: Makes VITALS LOW.
    Tachypnea: Too fast on vitals.
    Meds Brady: Meaning Slow-lungs
    Effort;

  • Shape Of Diaphragm/Posterior

Work effort/ how much exert with patient breathing

  • AOB
    Muscle that they are using.

Palpation:
Symmetric. Chest expansion.
Feeling for Bilateral for symmetry Chest Expansion

  • Palpate the T9 for the expansion in the location of where they are*

  • Palapating for tender parts, masses, growths coming out side chest- Cavity
    Tell the to repeat 99 for each test