MEDICAL SURGICAL NURSING I CHAPTER 25

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MEDICAL SURGICAL NURSING ICHAPTER 25

• INTRODUCTION TO THE RESPIRATORY TRACT

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RESPIRATORY ANATOMYFig 25-1

• UPPER AIRWAY
• Nose-cilia (fine hairs) move the mucus to the
  back of the throat
• Paranasal sinuses-lighten wt of the skull
  give resonance to the voice
• Pharynx-throat- passageway for both air food
• Larynx-voicebox-contains the epiglottis,
  glottis vocal cords

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RESPIRATORY ANATOMYFig 25-3

• LOWER AIRWAY
• Trachea-a hollow tube composed of smooth muscle
  supported by C-shaped cartilage
• Bronchi
• right divides into 3 secondary bronchi
• left divides into 2 secondary bronchi
• Bronchioles smaller subdivisions of the bronchi
• Lungs paired elastic structures enclosed by the
  thoracic cage

• Alveoli-small clustered sacs that begin where the
  bronchioles end. Made up of
• type I cells line most alveolar surfaces
• type II cells product surfactant
• type III cells destroy foreign material like
  bacteria

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ACCESSORY STRUCTURES

• Diaphragm- separates the thoracic and abdominal
  cavities
• Mediastinum a wall that divides the thoracic
  cavity into 2 halves
• Pleura
• visceral pleura covers the lung surface
• parietal pleura covers the chest wall
• Pleural space contains serous fluid that
  provides lubrication between the 2 pleura

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RESPIRATORY PHYSIOLOGY

• Main function of the respiratory system is to
  exchange oxygen CO2 between the atmospheric air
  the blood between the blood the cells
• Table 25-2 terms r/t respiration

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VENTILATION

• The actual movement of air in out of the
  respiratory tract
• Mechanical fig 25-4
• inspiration diaphragm contracts flattens
  which expands increases size of thoracic cage
• expiration diaphragm relaxes lungs recoil
  to original position decreasing size of thoracic
  cage
• Neurologic controls table 25-3
• respiratory centers in medulla oblongata
  pons
• central peripheral chemoreceptors

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DIFFUSION

• Process of O2 CO2 exchange through the alveolar
  - capillary membrane
• alveolar respiration - determines the amount of
  CO2 in the body
• transport of gases oxygen transport occurs in
  2 ways
• small amounts of 02 dissolved in the plasma
• combined with hgb in the RBCs

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PULMONARY PERFUSION

• The blood supply to the lungs through which the
  lungs receive nutrients O2
• Occurs via
• bronchial circulation supplies blood to the
  trachea bronchi
• pulmonary circulation supplies blood to the
  pulmonary capillary bed alveoli

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Problems With Respiratory Physiology

• Airway Resistance restricted due to increased or
  thick mucus, bronchospasm, edema, asthma, chronic
  bronchitis, emphysema, tumors, cancer.
• Lung Compliance from decreased surfactant,
  fibrosis, edema, atelectasis or alveolar
  collapse

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ASSESSMENT

• HISTORY
• Health hx, frequency of respiratory infections
• PHYSICAL EXAMINATION
• Inspection
• Auscultate breath sounds fig 25-6

• Assess v/s, exp respiratory rate, depth effort
• Assess for normal vs abnormal breath sounds
• crackles (formerly called rales) sounds like
  rubbing 2 strands of hair together
• sibilant wheezes (formerly called wheezes)
  continuous musical sounds heard during
  inspiration expiration
• sonorous wheezes (formerly called rhonchi)
  low pitched heard in the trachea bronchi

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Common abnormalities of the chest

• KYPHOSIS-curvature of the thoracic spine-humpback
• SCOLIOSIS-S shaped curvature of the thoracic
  lumbar spine
• BARREL CHEST rounded, ribs are horizontal,
  common with emphysema aging
• FUNNEL CHEST sternum is compressed-congenital
  anomaly
• PIGEON CHEST sternum abnormally
  protrudes-congenital anomaly

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DIAGNOSTIC LAB PROCEDURES

• ABGS-determine pH, O2 carrying capacity of the
  blood, amt of O2, CO2, and bicarbonate in the
  blood see table 25-7
• TB skin test tests for infection by
  Mycobacterium tuberculosis, either active or
  dormant see nursing guidelines 25-2

• Pulmonary Fxn Studies-measures lung ventilation
  volumes using a spirometer
• Pulse Oximetry-measures oxygen content of hgb or
  SaO2 in the blood- normal should be at least 95
  noninvasive-see nursing guidelines 25-1

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MORE TESTING

• Sputum studies-checks for presence of pathogenic
  or cancer cells
• Radiography-used as screening or diagnostic for
  foreign body, infection, . CT scan-MRI-tumor or
  other lung disorders

• Pulmonary angiography-used to detect PE
• Lung scans-use radioisotopes-less than in an xray
  also known as V-Q scan good for diagnosis of PE
• perfusion scan IV contrast media
• ventilation scan inhaled radioactive gas

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MORE TESTING

• Bronchoscopy-allows direct visualization of
  structures using a flexible fiberoptic
  bronchoscope-possible complication- bronchospasm
  nursing care plan 25-1
• Laryngoscopy-direct visualization of the larynx
  using a laryngoscope

• Thoracentesis-under local anesthesia needle
  inserted into the pleural space and fluid or air
  is withdrawn nsy guidelines 25-5

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NURSING MANAGEMENTBEFORE AFTER TESTING

• Provide explanations of all procedures-brief,
  complete. Repeat as necessary
• Provide for adequate rest periods
• After procedure assess for s/s respiratory
  distress, chest pain, blood-streaked sputum,
  expectoration of blood
• Assess v/s, lung sounds