Learning Outcomes • Describe the structure and functions of the respiratory tract. • Explain the mechanics of respiration. • Conduct and appropriately document a focused assessment of the upper and lower respiratory systems, demonstrating sensitivity and respect for individual concerns, values, and preferences.
Learning Outcomes • Provide appropriate nursing care and teaching for patients undergoing diagnostic tests and procedures related to the respiratory system. • Monitor diagnostic test results, recognizing and communicating abnormal or unexpected findings within the interprofessional team.
Structure and Function of the Upper Respiratory Tract • Air moves into lungs. • Carbon dioxide moves out of body through upper respiratory tract. • Upper airway • Cleans, humidifies, warms air • Needs to be open for effective breathing
Figure 21-1. (A) Structures of the upper respiratory system. (B) The sinuses.
Noses and Sinuses • Nose • Begin respiratory system • Filter and warm air • Nares separated by septum • Sinuses • Openings in facial bones • Lighten skull • Assist in speech • Produce mucus
Pharynx • Nasopharynx • Oropharynx • Laryngopharynx
Larynx • Connects laryngopharynx to trachea • Routes air and food to proper passageway
Structure and Function of the Lower Respiratory System • Lungs and bronchi • Respiration • Ventilation • External respiration • Gas transport • Internal respiration
Figure 21-2. The lower respiratory system, showing the lungs, the mediastinum, and layers of the visceral and parietal pleura.(Source: Patrick Watson, Pearson Education.)
Lungs • Separated by mediastinum • Composed of elastic connective tissue • Divided into lobes which are further divided into segments
Bronchi and Alveoli • Trachea divides into right and left mainstem bronchi. • Bronchi continue to branch and get smaller (bronchioles) and end as alveoli. • Air moves through passageways to alveoli where gas exchange occurs.
Figure 21-3. The functional tissue of the lungs, including the respiratory bronchioles and alveoli.(Source: Pearson Education.)
Pulmonary Circulation • Pulmonary arteries • Blood from body tissues, via right heart, to lungs • Pulmonary veins • Oxygenated blood to left heart • Pulmonary capillary network
Pleura • Double-layered membrane that covers lungs • Parietal • Visceral • Hold lungs out to chest wall
Rib Cage and Intercostal Muscles • Protect lungs • 12 pairs ribs • Intercostal muscles are between ribs • Assist with process of breathing
Mechanics of Respiration • Ventilation • Divided into inspiration and expiration • Normal is 12–20 breaths per minute • Inspiration • Lasts 1–1.5 seconds • Diaphragm contracts and flattens • Intercostal muscles contract • Increases size of chest cavity
Mechanics of Respiration • Inspiration • Lungs stretch and volume increases • Pressure in lungs slightly less than atmospheric • Causes air to rush in • Expiration • Lasts 2 to 3 seconds • Passive • Muscles relax
Mechanics of Respiration • Expiration • Diaphragm rises • Ribs descend • Lungs recoil • Pressure in chest cavity increases, compressing alveoli. • Pressure in lungs higher than atmospheric causes gases to flow out of the lungs.
Factors Affecting Respiration • Respiratory center of the brain • Chemoreceptors in the brain, aortic arch, and carotid arteries • Other factors • Airway resistance • Compliance • Elasticity • Surface tension of alveoli
Respiratory Changes Associated with Aging • Cartilage that connects ribs to sternum and spinal cord calcifies • Anterior-posterior diameter of chest increases • Respiratory muscles weaker • Cough and laryngeal reflexes less effective
Respiratory Changes Associated with Aging • Size of lungs decreases • Alveoli less elastic • Older patient at greater risk for developing respiratory infections
Assessment • Subjective data • Current complaint or existing condition • Onset or duration of symptoms • Ability to maintain ADL • Nasal congestion, nosebleeds • Sore throat, difficulty swallowing • Changes in voice quality • Difficulty breathing, orthopnea • Pain on breathing
Assessment • Subjective data • Presence of cough frequency, duration, productive or unproductive • Sputum amount, color, and consistency • Exposure to infections • Colds or influenza • History of chronic lung conditions • Occupational exposure to chemicals, smoke, asbestos
Assessment • Subjective data • History of previous respiratory problems • Allergies to medication or environmental allergens • Use of tobacco, chewing tobacco, marijuana, cocaine, injected drugs, or alcohol
Assessment • Physical examination • Assess state of health • Color • Ease of breathing • Note respiratory rate and pattern • Observe nasal flaring • Use of accessory muscles for breathing • Listen for hoarseness in patient's speech
Assessment • Physical examination • Inspect mucosa of nose, mouth, and oropharynx • Inspect neck, position of trachea • Inspect anterior/posterior diameter of chest • Palpate lips for nodules, chest for tenderness or swelling
Assessment • Physical examination • Auscultate breath sounds, note absence or presence and quality • Note adventitious breath sounds • Wheezing or crackles
Diagnostic Tests • Sputum and tissue specimens • Throat or nose swab • Sputum specimen • Culture and sensitivity • Gram stain • Acid-fast stain • Cytology
TABLE 21-1 Common Laboratory Tests and Studies continued on next slide
Diagnostic Tests • Imaging techniques • X-rays • CT scans • Ventilation–perfusion scans • Nursing care and patient teaching • If contrast used remember to ask about allergies, especially iodine and seafood.
TABLE 21-2 Imaging Studies continued on next slide
Diagnostic Tests • Pulmonary function tests • Measure lung volume and capacity • Smoking, caffeine, and bronchodilators interfere with results • Nursing care and patient teaching • Instruct patient to stop bronchodilators 4–6 hours prior to test • Instruct patient not to smoke or drink caffeinated drinks prior to test
Figure 21-9. The relationship of lung volumes and capacities. Volumes shown are for an average adult male.
Diagnostic Tests • Direct visualization • Direct or indirect laryngoscopy • Used to identify and evaluate laryngeal tumors • Nursing care and patient teaching • Make sure consent form has been signed. • Remove dentures, partial plates, bridges prior to procedure. • NPO before procedure
Diagnostic Tests • Direct visualization • Nursing care and patient teaching • NPO after procedure until gag reflex returns • Fiberoptic bronchoscopy • Visualize trachea, bronchi and bronchioles • Tumors and structural disorders
Diagnostic Tests • Direct visualization • Fiberoptic bronchoscopy • Obtain tissue biopsy • Obtain sputum specimen • Removal of foreign body • Nursing care and teaching