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THE RESPIRATORYSYSTEM
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ESPIRATORY SYSTE
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ATOM
AND YSIOL
OGY
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UPPER RESPIRATORY
Nose
Paranasal Sinuses
Pharynx
Larynx
Trachea
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LOWER RESPIRATORY
LUNGS
PLEURA
MEDIASTINUM
LOES
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Thelungs
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A l v e o l i
A l v e o l a r D u c t s
B R O N C H I O L E S
T E R T I A R Y B R O N C H U S
S E C O N D A R Y B R O N C H U S
( i n L e ! t l u n g " # i n R I g h t l u n $ %
& R I ' A R Y B R O N C H I
T R A C H E A
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The Al#eoli o$ %he Lun&s
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S%ruc%ures o$ %heRes'ira%ory (one
ASE)CHANE
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!HEST
WALL
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The &leura
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)unc%ion o$
Res'ira%orySys%e*
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O)YEN TRANS&ORT
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*ENTILATI
ON
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'echanics o! Breathing*entilation is the +ove+ent o! air into an$ out o!
the lungs, Air +oves !ro+ an area o! higher-ressure to an area o! lo.er -ressure,
Ins'ira%ion occurs .hen the $ia-hrag+contracts an$ the e/ternal intercostal +uscles li!tthe ri0cage" thus increasing the volu+e o! thethoracic cavit1,
Ex'ira%ion occurs .hen the $ia-hrag+ rela/esan$ the internal intercostal +uscles $e-ress theri0cage" thus $ecreasing the volu+e o! thethoracic cavit1,
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'echanics o! Breathing
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'echanics o! BreathingLungs ten$ to colla-se 0ecause o! the
elas%ic recoil o! the connective tissue"
an$ sur!ace %ension o! the 2ui$ lining thealveoli,
The lungs nor+all1 $o not colla-se
0ecause sur$ac%an% re$uces the sur!acetension o! the 2ui$ lining the alveoli" an$the visceral -leura ten$s to a$here to the-arietal -leura,
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GA
SE+
!HAN
GE
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PULMONARY DI))USION
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ASSESSMENT
• HEALTH HISTORY
• &HYSICAL E)A'INATION
• LABORATORY3 DIANOSTIC TEST
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HEALTH HISTORY A, &resenting &ro0le+4 Su05ective Data
6, Nose3 nasal sinuses
, Throat#, Lungs
a, Cough
0, D1s-nea
c, 7hee8ing
$, Chest -ain
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, Li$es%yle - s*o.in&/ occu'a%ion/
!, Nu%ri%ion 0 1ie% -
D, Pas% *e1ical his%ory
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&HYSICAL E)A'INATION
A, Ins-ection !or con9guration o! the chest
B, Rate an$ -attern o! 0reathing
C, &al-ate s:in" su0cutaneous structures" ;+uscle !or te/ture" te+-erature" ; $egree o!$evelo-+ent,
D, &al-ate !or tracheal -osition" res-irator1
e/cursion an$ !re+itusE, &ercuss !or lung 9el$s
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S1+-to+s o! &ul+onar1 DiseaseD1s-nea
Sensation o! 0reathlessness that is e/cessive
!or an1 given level o! -h1sical activit1,&aro/1s+al nocturnal $1s-nea
Ina--ro-riate 0reathlessness at night,
Ortho-neaD1s-nea on recu+0enc1,
&lat1-neaD1s-nea on the u-right -osition relieve$ 01
recu+0enc1,
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S1+-to+s o! &ul+onar1 Disease&ersistent cough
Al.a1s a0nor+al
Chronic -ersistent cough +a1 0e cause$ 01cigarette s+o:ing" asth+a" 0ronchiectasis orCO&D,
'a1 also 0e cause$ 01 $rugs" car$iac$isease" occu-ational agents an$-s1chogenic !actors,
!o*'lica%ions inclu$e (6% .orsening o!0ronchos-as+" (% vo+iting" (#% ri0!ractures"
(=% urinar1 incontinence" an$ (>% s1nco-e,
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S1+-to+s o! &ul+onar1 DiseaseS%ri1or!ro2in& soun1 1urin&3rea%hin&,
Cause$ 01 tur0ulent air2o. through anarro2e1 u''er air2ay,
Ins'ira%ory s%ri1or i+-lies ex%ra%racheal#aria3le air.a1 o0struction,
Ex'ira%ory s%ri1or i+-lies in%ra%racheal#aria3le air.a1 o0struction,
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S1+-to+s o! &ul+onar1 DiseaseWhee4in&
Continuous musical or whistling noises
cause$ 01 tur0ulent air2o. through narro2e1in%ra%horacic air2ays,'ost" 0ut not all" are $ue to asth+a,
He*o'%ysisE/-ectoration o! 0loo$,O!ten the 9rst in$ication o! serious
0roncho-ul+onar1 $isease,'assive he+o-t1sis4 coughing u- o! +ore %han
566 *l o$ 3loo1 in 78 hours,
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Signs o! &ul+onar1
DiseaseTachy'nea
Ra-i$" shallo. 0reathing,Ar0itraril1 $e9ne$ as a res-irator1 rate in
e/cess o! ?3+in,
ra1y'neaSlo. 0reathing,
Hy'er'neaRa-i$" $ee- 0reathing,Hy'er#en%ila%ion
Increase in the a+ount o! air entering thealveoli,
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Signs o! &ul+onar1
Disease9uss*aul res'ira%ion :air hun&er;
Dee'/ re&ular si&hin& res'ira%ion" .hetherthe rate 0e nor+al slo. or !ast,
Occurs in 1ia3e%ic .e%oaci1osis an1 ure*ia"as an e/aggerate$ !or+ o! 0ra$1-nea,
!heyne
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Signs o! &ul+onar1
Diseaseio% 3rea%hin&
Unco++on variant o! Che1ne@Sto:es res-iration,
&erio$s o! a-nea al%erna%e irre&ularly 2i%hseries o$ 3rea%hs o$ e=ual 1e'%h %ha%%er*ina%e a3ru'%ly,
'ost o!ten seen in *enin&i%is,
!yanosisBluish $iscoloration o! s.in or *ucous
*e*3ranes,&resents as either central or -eri-heral c1anosis
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Signs o! &ul+onar1
DiseasePercussion soun1s (resonance"
$ullness" h1-erresonance%
Auscul%a%ory soun1s (vesicular"0ronchial" 0ronchovesicular%
A1#en%i%ious soun1sA0nor+al soun$s on auscultation
'a1 0e classi9e$ as continuous (.hee8es"rhonchi% or $iscontinuous (crac:les"cre-itations%
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Signs o! &ul+onar1
DiseaseWhee4es
Hi&h
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Signs o! &ul+onar1
Disease!rac.les
enerate$ 01 the sna''in& o'en o$ s*allair2ays 1urin& ins'ira%ion,
Fine crackles are hear$ in interstitial$iseases" early pneumonia or pulmonaryedema, patchy atelectasis an$ in so+e-atients .ith asth+a or 0ronchitis,
!oarse crac.les are hear$ la%e in thecourse o! pulmonary edema or pneumonia.
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Signs o! &ul+onar1
Disease)re*i%us
Voice vibrations on the chest wall.
Locali8e$ re$uction in !re+itus occurs overareas o! air or >ui1 accu+ulation in the lungs,
Increase$ !re+itus suggests lung consoli$ation,
Broncho-hon1Increase1 in%ensi%y an1 clari%y o$ %hes'o.en 2or1 $uring auscultation,
Hear$ over areas o$ consoli1a%ion or lun&co*'ression,
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Signs o! &ul+onar1
Disease7his-ere$ -ectorilou1
Ex%re*e !or+ o! 0roncho-hon1 in .hichso$%ly s'o.en 2or1s are rea1ily hear101 auscultation,
Ego-hon1
Auscultation o! an ?a@ soun1 .hen the-atient s-ea:s an ?e@ soun1,
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La3ora%ory0Dia&nos%ic
Tes%s
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Arterial Bloo$ asesA +easure+ent o! oxy&en/ !O7/ an1 %he 'H o$%he 3loo1 %ha% 'ro#i1es a *eans o$assessin& %he a1e=uacy o$ #en%ila%ion
:Paco7;/ oxy&ena%ion :PaO7%,Allo.s assess+ent o! the aci1
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Inter-ret AB values 01 loo:ing at the !ollo.ing
(nor+al values are liste$%4• &aO-artial -ressure o! arterial o/1gen :6 %o
B66 ** H&;
• &aco-artial -ressure o! arterial car0on $io/i$e
:C %o 8 ** H&;• Saoarterial o/1gen saturation : F;
• -Hh1$rogen ion concentration" or $egree o!
aci$@0ase 0alance :,C %o ,8;
• 0icar0onate (HCO#@% ion -ri+aril1 a +eta0olic
0uFer77 %o 75 *E=0L,
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Routine Ra$iogra-h1Integral -art o! the $iagnostic
evaluation o! $iseases involving the
-ul+onar1 -arench1+a" the -leura" an$to a lesser e/tent" the air.a1s an$ the+e$iastinu+,
Usuall1 involves a 'os%ero
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Chest Ra$iogra-h1
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Ultrasonogra-h1Use$ to assess various 3o1y
s%ruc%ures,
Use$ in con5unction .ith other-ul+onar1 $iagnostic 'roce1ure suchas %horacen%esis an$ 0io-s1 to assess>ui1 or 3ro%ic a3nor*ali%ies,
Hel-!ul in the $etection an$ locali8ationo! 'leural >ui1,
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Co+-ute$ To+ogra-h1OFers several a$vantages over
conventional ra$iogra-hs,
Use o! cross
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Co+-ute$ To+ogra-h1
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'agnetic Resonance
I+aging
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&ul+onar1
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&ul+onar1
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&ul+onar1
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Biologic S-eci+en
CollectionS'u%u* collec%ion
S-ontaneous e/-ectoration or s-utu+in$uction
Percu%aneous nee1le as'ira%ionUsuall1 carrie$ out un$er !T or ul%rasoun1
gui$ance,&otential ris:s inclu$e in%ra'ul*onary
3lee1in& an$ creation o! a 'neu*o%horax,
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Biologic S-eci+en
CollectionThoracen%esis
Insertion o! nee$les through the ches% 2allinto the -leural s-ace to o0tain a s-eci+en!or $iagnostic evaluation" re+oval o! -leural2ui$s" or to ins%ill *e1ica%ion in%o %he'leural s'ace,
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Biologic S-eci+en
Collectionronchosco'y
&rovi$es !or $irect visuali8ation o! the%racheo3ronchial %ree,
Rigid bronchoscopy is -er!or+e$ in ano-erating roo+ on a -atient un$er generalanesthesia,
Flexible bronchoscopy +a1 0e $oneun$er local anesthesia 3 se$ation,
Diagnostic uses inclu$e histologici$enti9cation or neo'las*s an$i$enti9cation o! sources o! he+o-t1sis,
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Biologic S-eci+en
Collectionronchosco'y
Thera-eutic in$ications are retrieval o!!oreign 3o1ies an1 con%rol o$ 3lee1in&,
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Biologic S-eci+en
Collection"i1eo
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ANALYSISNursing Diagnoses
a, I+-aire$ gas E/change
0, IneFective 0reathing &atternc, I+-aire$ *er0al Co++unication
$, I+-aire$ Air.a1 Clearance
e, Activit1 Intolerance
!, An/iet1g, I+-aire$ Nutrition4 Less than 0o$1reuire+ents
H, Ris: !or in!ection
&LANNIN ;
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&LANNIN ;
I'&LE'ENTATIONA$euate *entilation .ill 0e +aintaine$'aintain o! -atent air.a1
EFective 0reathing -atterns .ill 0e+aintaine$
Client .ill co++unicate in an eFective+anner
Client .ill $e+onstrate increase$ tolerance!or activit1
An/iet1 .ill 0e re$uce$
A$euate nutritional status .ill 0e +aintaine$
Clients re+ains !ree !ro+ in!ections
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INTER"ENTIONS• Chest Drainage S1ste+s
• Chest &h1siothera-1
• O/1gen Thera-1
• Tracheo0ronchial Suctioning
• &ostural Drainage
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!hes%
Physio%hera'y
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!hes% 'hysio%hera'y is the
ter+ !or a grou- o! treat+ents$esigne$ to i+-roveres-irator1 eGcienc1" -ro+ote
e/-ansion o! the lungs"strengthen res-irator1 +uscles"an$ eli+inate secretions !ro+
the res-irator1 s1ste+,
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•
Pos%ural 1raina&e Uses $orce o$ &ra#i%y to assist in
eFectivel1 $raining secretions !ro+the lungs an$ into the central air.a1
.here the1 can either 3e cou&he1u' or suc%ione1 ou%,
@ &atient is -lace$ in a hea1 or ches%
1o2n 'osi%ion an$ is :e-t in this-osition !or u- to B *inu%es,
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• Percussion
Consists o! rh1th+icall1 stri:ing
the chest .all .ith cu--e$ han$s,
Also calle$ cu''in&/ cla''in&/
or %a'o%e*en%,
To 0rea: u- thic: secretions in
the lungs,
&er!or+e$ on each lung seg+ent!or one to t.o +inutes at a ti+e,
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• "i3ra%ion
- To hel- 0rea: u- lung secretions
- Coul$ either 0e +echanical or +anual
- &er!or+e$ as the -atient 0reathes $ee-l1
- 'anual 4 -erson -er!or+ing the vi0ration-laces his or her han$s against the -atientschest an$ creates vi0rations 01 uic:l1
contracting an$ rela/ing ar+ an$ shoul$er+uscles .hile the -atient e/hales
- Re-eate$ several ti+es each $a1 !or a0out9ve e/halations
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• Turnin&
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&er+its lung e/-ansion- Hea$ o! the 0e$ can 0e elevate$ to
-ro+ote $rainage
- Criticall1 ill -atients an$ those
$e-en$ent on +echanical res-iration
are turne$ once ever1 one %o %2ohours aroun$ the cloc:,
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• !ou&hin&
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Hel-s 0rea: u- secretions in thelungs
-&atients sit u-right an$ inhale
$ee-l1 through the nose
- E/hale in short -uFs or coughs
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Re-eate$ several ti+es a $a1
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• Dee' rea%hin&
- Hel-s e/-an$ the lungs an$
!orces 0etter $istri0ution o! the
air into all sections o! the lung- Done several ti+es each $a1
!or short -erio$s
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•&t, Co+!ort•Non@restrictive clothing•
Avoi$ eating 0e!ore•'e$icate !or -ain•S-lint incisions
Nursing 'anage+ent
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•Avoi$ eating•Co+!ort•Avoi$ restrictive clothing•'e$icate•S-lint !or co+!ort•STO& c3o -ain
Nursing 'anage+ent4
&ERCUSSION an$ *IBRATION