Respiratory Lecture 1

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Respiratory Lecture 1

• Dr. Kathleen Ethridge
• Northeast Texas Community College

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Upper Airway

• Nasal passages
• Nasopharynx
• Oropharynx

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Lower Airway

• Larynx
• Trachea
• Lungs
• Bronchi
• Alveoli
• Pleura

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Function of the Respiratory System

• Ventilation
• the movement of air in and out of the lungs
• Compliance
• Surface Tension
• Muscular Effort
• Resistance

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Ventilation Perfusion

• Shunting
• When perfusion exceeds ventilation
• Dead Space
• When ventilation exceeds perfusion

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Oxyhemoglobin Dissociation

• Oxygen affinity is related to
• pH
• PCO2
• Body Temperature
• 2,3,DPG

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Geriatric Considerations

• Changes in respiratory structure
• decreased elasticity
• decreased vital capacity

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Assessment of the Respiratory System
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Chest Deformities

• Barrel chest
• Pigeon chest
• Funnel chest
• Kyphoscoliosis

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Assess Fingers and Toes

• Clubbing
• occurs when a chronic hypoxia is present
• normal nail bed angle 160 degrees

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Chest Wall Assessment

• Thoracic Excursion
• As the client inhales, the hands move up and out
  symmetrically
• Abnormal - hands move asymmetrical
• Tactile Fremitus
• Palpation as the client says words that produce
  vibrations

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Chest Percussion

• Various sounds are described as
• Resonant sounds
• Hyperresonant sounds
• Dull sounds
• Flat sounds
• Tympanic sounds

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Sequence of Auscultation

• Assess
• character of breath sounds
• presence of abnormal sounds
• identify the sequence for auscultation over all
  areas of the lungs
• from right to left
• posterior
• lateral
• anterior

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Location of Normal Breath Sounds

• Anterior
• Posterior
• (see picture)

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Auscultation of Lungs

• Bronchial (tracheal)
• high pitch
• Bronchovesicular
• moderate pitch
• Vesicular
• low, soft

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Abnormal Breath Sounds

• Crackles
• fine
• coarse
• Pleural friction rub
• Wheeze (rhonchi)
• high-pitch
• low-pitch

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Voice Sounds

• Bronchophony
• Egophony
• Whispered pectoriloquy

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Diagnostic Tests

• Pulmonary function tests (PFT)
• Pulse Oximetry
• Capnography
• measures exhaled carbon dioxide for a client on a
  ventilator
• Arterial Blood Gas
• Scans
• MRI

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Bronchoscopy

• Provides for direct visualization
• Client is NPO for 6 hours prior
• Preop med is given airway is anesthetized
  topically
• After the exam, evaluate for return of gag reflex
  
• Observe for complications (possible pneumothorax)

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Pulmonary Angiography

• Contrast material is injected into the pulmonary
  arteries
• Conducted in X-ray department
• Watch for complications
• cardiac dysrhythmias
• reaction to dye

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Thoracentesis

• Withdrawal of fluid from the pleural cavity
• Used for diagnostic and therapeutic reasons
• Nurse responsible for
• explain procedure
• position client
• give support
• monitor vital signs

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Management of Airway Disorders
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Tracheostomy

• A surgical opening into the trachea
• Used to maintain airway over an extended period
  of time
• Must establish method of communication
• Maintain safety
• Assess breathing
• Maintain cuff pressure appropriately

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Cancer of the Larynx

• A malignancy of the larynx
• Glottic Tumor
• Supraglottic Tumor
• Subglottic Tumor

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Clinical Symptoms of Laryngeal Cancer

• Warning Signs
• voice changes
• a lump
• a cough or sore throat that does not get well
• coughing up bloody sputum
• earache
• swelling that causes difficult swallowing and/or
  breathing

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Diagnosing Laryngeal Cancer

• Direct or indirect laryngoscopy
• Biopsy for tumor staging
• T measure tumor
• N lymph nodes involved
• M mestatasis
• MRI
• CT scan

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Treatment for Laryngeal Cancer

• Ablation
• Radiation
• Chemotherapy
• Laser surgery

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Partial Laryngectomy

• Only part of the larynx is removed
• Swallowing difficulties
• Vocal cords preserved

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Complications of Surgery

• Page 1666
• 1. Airway Obstruction
• 2. Hemorrhage
• 3. Carotid Artery Rupture
• (watch for pulsating trach tube)
• 4. Fistula Formation

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Total Laryngectomy

• Clients most often have a permanent tracheostomy
• Complete loss of normal speech and smell

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Total Laryngectomy

• Nursing management
• preop
• emotional needs
• artificial speech/method of communication
• postop
• respiratory status
• pain
• complications

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Client Teaching Guide

• Covering and Cleaning stoma
• No swimming/ no smoking
• Loss of smell - use smoke detectors
• ID bracelet

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Radical Neck Dissection

• May have radical change in appearance
• May have lack of sensation
• Range of motion exercises are essential

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Laryngospasm

• Laryngospasm
• spasm of the laryngeal muscles
• may occur
• after anesthesia
• after intubation
• after extubation
• treatment
• oxygen
• brochodilators

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Other Disorders of Larynx

• Laryngeal paralysis
• Trauma or Injury

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The End