Assessment of Respiratory Function

1. Assessment of Respiratory Function Prepared by Dr. Iman Abdullah

2. Out Line • Anatomy of the upper and lower respiratory tract. • Function of the respiratory system. • Assessment • Health history • Risk factors for respiratory disease • Major signs and symptoms of respiratory disease: • Dyspnea • Cough • Sputum Production • Chest pain • Wheezing • Clubbing of the Fingers • Hemoptysis • Cyanosis • Diagnostic Evaluation

3. Learning Objectives On completion of this section, the student will be able to: • Describes the structures and functions of the upper and lower respiratory tract. • Describe ventilation, perfusion, diffusion, shunting, and the relationship of pulmonary circulation to these processes. • Identify the major signs and symptoms of respiratory disease. • Identify the various procedures used for diagnostic evaluation of respiratory function.

4. Anatomic and Physiologic Overview • The respiratory system is composed of the upper and lower respiratory tracts. Together, the two tracts are responsible for ventilation. • The upper tract, known as the upper airway, warms and filters inspired air so that the lower respiratory tract ( the lungs ) can accomplish gas exchange.

5. Function of the Respiratory System • The cells of the body derive the energy they need from the oxidation of carbohydrates, fats, and proteins. As with any type of combustion, this process requires oxygen. • Certain vital tissues, such as those of the brain and the heart, cannot survive for long without a continuous supply of oxygen. • However, as a result of oxidation in the body tissues, carbon dioxide is produced and must be removed from the cells to prevent the buildup of acid waste products. • The respiratory system performs this function by facilitating life sustaining process such as: • oxygen transport, • respiration and ventilation, • and gas exchange.

6. Lung Volumes and Capacities Lung function, which reflects the mechanics ventilation, is viewed in terms of lung volumes and lung capacities. Lung volumes are categorized as: • Tidal volume ( TV ) ( 500 mL or 5 – 10 mL/kg ) • Inspiratory reserve volume ( IRV ) ( 3000 mL ) • Expiratory reserve volume ( ERV ) ( 1100 mL ) • Residual volume. ( RV ) ( 1200 mL ) Lung capacity is evaluated in terms of: • Vital capacity ( VC = TV + IRV + ERV ) ( 4600 mL ) • Inspiratory capacity ( IC = TV + IRV ) ( 3500 ) • Functional residual capacity ( FRC = ERV + RV ) ( 2300 ) • Total lung capacity (TLC = TV + IRV + ERV + RV) (5800)

7. Cont. • Diffusion and Perfusion • Ventilation and Perfusion (Balance and Imbalance) • Gas Exchange • Carbon Dioxide Transport

8. Gerontologic Considerations • A gradual decline in respiratory function begins in early to middle adulthood and effects the structure and function of respiratory system. • With aging ( 40 years and older ), changes occur in the alveoli that reduce the surface area available for the exchange of oxygen and carbon dioxide. • At approximately 50 years of age, the alveoli begin to lose elasticity. A decrease in vital capacity occurs with loss of chest wall mobility, which restricts the tidal flow of air. • Elderly people have a decreased ability to rapidly move air in and out of the lungs. • Despite these changes, in the absence of chronic pulmonary disease, elderly people are able to carry out activities of daily living, but they may have decreased tolerance for and require additional rest after prolonged or vigorous activity.

9. Assessment • Health history • Physical assessment of the upper respiratory structures • Physical assessment of the lower respiratory structures and breathing • Diagnostic evaluation

10. The Major Signs and Symptoms of Respiratory Disease • Dyspnea • Cough • Sputum Production • Chest pain • Wheezing • Clubbing of the Fingers • Hemoptysis • Cyanosis

11. Diagnostic Evaluation A wide range of diagnostic studies, may be performed in patients with respiratory conditions. • Pulmonary function tests • Arterial blood gas studies • Pulse oximetry • Cultures • Sputum studies • Imaging studies ( x-rays, CT, MRI ) • Endoscopic procedures ( bronchoscopy, thoracoscopy, ) • Thoracentesis • Biopsy ( pleural biopsy, lung biopsy procedures, lymph node biopsy ).

12. Management of Patients With Chest and Lower Respiratory Tract Disorders

13. Out Line • Atelectasis • Pathophysiology • Clinical manifestation • Assessment and diagnostic findings • Preventing atelectasis and management • Pneumonia • Classification • Pathophysiology • Risk factors • Clinical manifestation • Assessment and diagnostic findings • Medical management • Complications • Nursing process the patient with pneumonia

14. Out Line • Pleural Effusion • Pathophysiology • Clinical manifestation • Assessment and diagnostic findings • Medical management • Nursing management • Pulmonary Edema • Pathophysiology • Clinical manifestation • Assessment and diagnostic findings • Medical management • Nursing management

15. Management of Patients With Chest and Lower Respiratory Tract Disorders Learning Objectives: On completion of this section, the student will be able to: • Identify patients at risk for atelectasis and nursing interventions related to its prevention and management. • Describe the pathophysiology of pneumonia. • Discuss the risk factors, clinical manifestation, assessment and diagnostic findings, medical management and complications of pneumonia. • Use the nursing process as a framework for care of the patient with pneumonia. • Describe the pathophysiology, clinical manifestation, assessment and diagnostic findings, medical management, and nursing management related to pleural effusion and pulmonary edema.

16. Atelectasis • Pathophysiology • Clinical Manifestation • Assessment and Diagnostic Findings • Preventing Atelectasis • Management

17. Pneumonia • Classification • Pathophysiology • Risk Factors • Clinical Manifestation • Assessment and Diagnostic Findings • Medical Management • Complications • Nursing Process The Patient With Pneumonia

18. Pleural Conditions Pleural conditions are disorders that involve the membranes covering the lungs ( visceral pleura ) and the surface of the chest wall ( parietal pleura ) or disorders affecting the pleural space.

19. Pleural Effusion • Pathophysiology • Clinical Manifestation • Assessment and Diagnostic Findings • Medical Management • Nursing Management

20. Pulmonary Edema • Pathophysiology • Clinical Manifestation • Assessment and Diagnostic Findings • Medical Management • Nursing Management

21. Management of Patients with Chronic Obstructive Pulmonary Disorders

22. Out Line • Chronic Obstructive Pulmonary Disease • Pathophysiology • Chronic Bronchitis • Emphysema • Risk factors for COPD • Clinical Manifestation • Assessment and Diagnostic Findings • Complications • Medical Management • Surgical Management • Nursing Management • Nursing Process the Patient With COPD

23. Out Line • Asthma • Pathophysiology • Clinical Manifestations • Assessment and Diagnostic Findings • Prevention • Complications • Medical Management • Nursing Management

24. Management of Patients with Chronic Obstructive Pulmonary Disorders Learning Objectives: On completion of this lecture, the student will be able to: • Describe the pathophysiology of COPD. • Discuss the major risk factors for developing COPD and nursing interventions to minimize or prevent thee risk factors. • Use the nursing process as a framework for care of patients with COPD. • Develop a teaching plan for patients with COPD. • Describe the pathophysiology of asthma. • Describe asthma self-management strategies.

25. Chronic Obstructive Pulmonary Disease • Pathophysiology • Chronic Bronchitis • Emphysema • Risk factors for COPD • Clinical Manifestation • Assessment and Diagnostic Findings • Complications • Medical Management • Management of Exacerbations • Oxygen Therapy • Surgical Management • Pulmonary Rehabilitation • Nursing Management • Nursing Process the Patient With COPD

26. Asthma • Asthma is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. • Pathophysiology • Clinical Manifestations • Assessment and Diagnostic Findings • Prevention • Complications • Medical Management • Nursing Management

27. Thank You