Respiratory
system review &
physiology
system review &
physiology
Respiration and Ventilation
Respiration: process of gas exchange between air and blood (cellular level)
Pneumonia/flu/covid
Anemia
PE
malnutrition
Ventilation: movement of air in and out via diaphragm
pneumonia/flu/covid
COPD
Asthma
Emphysema
Cancer/tumor
Steps
History
Describe symptom
Rate and rhythm
Posture
Shape and symmetry
Sounds
Palpation
ABG interpretation, including causes, lab values, signs/symptoms
Respiratory acidosis
o Causes: pulmonary edema, aspiration, pneumothorax, OD on
sedatives
o S/S: elevated HR/RR/BP, confusion, decreased LOC
o Treat the cause
Respiratory alkalosis
o S/S: seizures, deep rapid resp, confusion, hyperventilation,
hypokalemia
o Causes: hyperventilation, PE, mechanical ventilation
Oxygen therapy: Goal and Discontinue
Goal
Saturation of 90-93
Discontinue
Only 100% O2 is used in code situations
Discontinue gradually
Avoid oxygen toxicity
Nasal cannula: 1-6L
Simple mask: 5-8
Non-rebreather: 10-15
Venturi: 10-12
Pulmonary embolism
Obstruction of pulmonary artery or branch by an embolus
Causes:
Blood clot, air, fat, amniotic fluid, sepsis, normally originates from DVT
Assessment
Sudden onset of dyspnea, chest pain, tachypnea
Nursing interventions
Oxygen therapy, fluids, assess bleeding risk, monitor for complications
Pulmonary diffusion and perfusion
Systemic perfusion
Pulmonary diffusion and perfusion
Oxygen and CO2 diffusion across alveolar membrane
Blood flow in lungs
Systemic perfusion
Blood flow to body
Want ventilation to equal perfusion
Risk Factors
Smoking
Family history
Exposure to allergens, environmental hazards, occupation hazards
Dietary
HIV
Sputum culture & sensitivity collection
Patient should rinse mouth with water, clear nasal mucus, take 2-3 deep
breaths and cough deeply from diaphragm, expectorate into a sterile
specimen container
Atelectasis: collapse of alveoli
Causes: foreign body, tumor, retained secretions
Assessment
o Diminished breath sounds, fine crackles, low O2
o Severe: dyspnea, cyanosis, tachypnea
Nursing interventions
o Use measure to expand lungs: turn, cough, deep breathe,
incentive spirometry
o Early ambulation
o Pain management
o Avoid excessive sedation
o Encourage fluids
Lung Cancer: causes, small cell and non-small cell
Inhaled carcinogens
Risks: asbestos, heavy metals, family history
Non-small cell
Most common
Occurs in peripheral masses or nodules and often metastasizes
Small cell
Very aggressive, grows quickly, early metastasis to lymph and blood,
very poor prognosis
Hypoxia & hypoxemia: early and late signs/symptoms
Hypoxemia: decreased O2 in blood
o Early: increased resp., HR, BP, resp distress, restlessness, pale
skin
o Late: decreased resp, HR, BP, become confused
Hypoxia: decreased O2 in tissues
o Results from prolonged hypoxemia
o Acute: headache, fatigue, SOB, dyspnea
o Chronic: altered LOC
Ventilation: Perfusion lung scan: uses
PFT: Measure arterial blood oxygen saturation
X-ray: detects densities produced by fluid, tumors, foreign bodies, and
other pathologic conditions
CT: can distinguish fine tissue densities and detect abnormalities not
seen with x-ray
MRI: better able to distinguish normal vs abnormal
Ventilation perfusion scan: assesses air flow and blood flow of the lungs,
used to rule out a PE
Pneumonia: affects ventilation and diffusion
Assessment: tachypnea, chills, dyspnea, cough
Nursing interventions
o Antibiotics
o Airway clearance
o Nutrition
o Positioning
o Prevention with vaccines
Lung Cancer: Symptoms
Often asymptomatic till late
Cough or chronic cough
Dyspnea
Chronic upper resp infections
Hemoptysis
Recurrent fever
Chest or shoulder pain
Ventilation: Perfusion ratio: causes of low & high ratios
High: ventilation greater than perfusion: not enough blood for gas
exchange (MI, PE)
Low: perfusion greater than ventilation: not enough air for gas exchange
(atelectasis)
Silent: no blood blow, no air flow (pneumothorax)
Bronchoscopy: nursing care pre- and post-procedure, expected assessment vs. s/s complications
Diagnose and treat lung conditions
Preprocedure: informed consent, NPO, meds to sedate and suppress
gag reflex
Post op: NPO until gag reflex returns, VS till stable
Monitor for complications: infection, pneumothorax, aspiration,
laryngospasm
Lung Cancer: Nursing Interventions
Managing symptoms
Support
Prevent complications
Promote deep breathing and pursed lip breathing
Encourage smoking cessation
Oxyhemoglobin dissociation curve concepts in general
impact of low
hemoglobin on oxygenation
Normal level: greater than 70
Relatively safe: 45-70
Dangerous: less than 40