Anatomy and Physiology:

RESPIRATORY
SYSTEM
CHRISTIAN DIOR L. AMARANTO, MAN
Instructor I
ANATOMY OF THE RESPIRATORY SYSTEM
ANATOMY OF THE RESPIRATORY SYSTEM

NASAL CAVITY

PHARYNX (THROAT)

LARYNX

TRACHEA

BRONCHI

LUNGS
BEHAVIOR OF GASES AND VENTILATION
MUSCLES OF RESPIRATION AIR PRESSURE GRADIENT

MUSCLES OF INSPIRATION PRESSURE AND VOLUME

PRESSURE GRADIENTS AND

MUSCLES OF EXPIRATION
AIRFLOW
BEHAVIOR OF GASES AND VENTILATION
MUSCLES OF RESPIRATION

MUSCLES OF INSPIRATION

MUSCLES OF EXPIRATION
BEHAVIOR OF GASES AND VENTILATION
MUSCLES OF RESPIRATION

MUSCLES OF INSPIRATION

MUSCLES OF EXPIRATION
BEHAVIOR OF GASES AND VENTILATION
AIR PRESSURE GRADIENT

PRESSURE AND VOLUME

PRESSURE GRADIENTS AND

AIRFLOW
 MEASUREMENT OF LUNG FUNCTION
PULMONARY VOLUMES AND CAPACITIES

PULMONARY VOLUMES PULMONARY CAPACITIES

1. Tidal Volume 1. Inspiratory/Expiratory Capacity

2. Expiratory Reserve Volume 2. Vital Capacity

3. Inspiratory Reserve Volume 3. Functional Residual Capacity

4. Residual Volume 4. Total Lung Capacity

 PULMONARY VOLUMES
8000

7000

6000

5000

4000

3000

2000

1000

0
 PHYSIOLOGY OF RESPIRATORY SYSTEM
DALTON’S LAW BOYLE’S LAW HENRY’S LAW
The total pressure exerted by a mixture of If a given amount of gas has a constant To predict how gasses will dissolve in the
gases is equal to the sum of the partial temperature, increasing its volume decreases alveoli and bloodstream during gas exchange.
pressures of the gases in the mixture. its pressure, and vice-versa.
 RISK FACTORS
▪ Environmental allergies
▪ Chest injury
▪ Crowded living conditions
▪ Exposure to chemicals and environmental pollutants
▪ Family history of infectious disease
▪ Frequent respiratory illnesses
▪ Geographical residence and travel to foreign countries
▪ Smoking
▪ Surgery
▪ Use of chewing tobacco
▪ Viral syndromes
 DIAGNOSTIC TESTS
CHEST X-RAY
Provides information regarding the anatomical location and appearance of
the lungs.

Pre-procedure
1.Remove all jewelry and other metal objects from the chest area.
2.Assess the client's ability to inhale and hold his or her breath.

Post-procedure
Help the client get dressed.
 DIAGNOSTIC TESTS
SPUTUM SPECIMEN
Specimen obtained by expectoration or tracheal suctioning to assist in the
identification of organisms or abnormal cells.

Pre-procedure
1. Determine the specific purpose of collection and check institutional
policy for the appropriate method for collection.
2. Obtain an early morning sterile specimen by suctioning or
expectoration after a respiratory treatment if a treatment is prescribed.
3. Instruct the client to rinse the mouth with water before collection.
4. Obtain 15 mL of sputum.
 DIAGNOSTIC TESTS
SPUTUM SPECIMEN
Pre-procedure (cont.)
5. Instruct the client to take several deep breaths and then cough deeply
to obtain sputum.
6. Collect the specimen before the client begins antibiotic therapy. If
already started on antibiotic therapy, ensure the laboratory can utilize
an antimicrobial removal device when analyzing the specimen.

Post-procedure
1. If a culture of sputum is prescribed, transport the specimen to the
laboratory immediately.
2. Assist the client with mouth care.
11 12 13
Compute for the following:
19. TV=

16 20. TLC=

21. IRV=

15
22. ERV=

23. RV=
14

24. VC=
18

25. FRC=
17
11

IRV IC
TV Compute for the following:
13
12
19. TV= 500 ml

VC 20. TLC= 6 000 ml

15
16 21. IRV= 2 300 ml

TLC
22. ERV= 1000 ml
14

23. RV= 1 200 ml

18
ERV
24. VC= 3 800 ml
FRC
25. FRC= 2 200 ml
17 RV
 DIAGNOSTIC TESTS
LARYNGOSCOPY AND BRONCHOSCOPY
Direct visual examination of the larynx, trachea, and bronchi with a
fiberoptic bronchoscope.

Pre-procedure
1. Maintain NO (nothing by mouth) status as prescribed.
2. Assess the results of coagulation studies.
3. Remove dentures and eyeglasses.
4. Establish an intravenous (IV) access as necessary and administer
medication for sedation as prescribed.
5. Have emergency resuscitation supplies readily available.
 DIAGNOSTIC TESTS
LARYNGOSCOPY AND BRONCHOSCOPY
Post-procedure
1. Maintain the client in a semi-Fowler's position.
2. Assess for the return of the gag reflex.
3. Maintain NO status until the gag reflex returns.
4. Monitor for bloody sputum.
5. Monitor respiratory status, particularly if sedation has been administered.
6. Monitor for complications, such as broncho-spasm or bronchial
perforation, indicated by facial or neck crepitus, dysrhythmias,
hemorrhage, hypoxemia, and pneumothorax.
7. Notify the primary health care provider (PHCP) if signs of complications
occur.
 DIAGNOSTIC TESTS
ENDOBRONCHIAL ULTRASOUND
1. Tissue samples are obtained from central lung masses and lymph nodes,
using a bronchoscope with the help of ultrasound guidance.
2. Tissue samples are used for diagnosing and staging lung cancer,
detecting infections, and identifying inflammatory diseases that affect the
lungs, such as sarcoidosis.
3. Post-procedure, the client is monitored for signs of bleeding and
respiratory distress.
 DIAGNOSTIC TESTS
PULMONARY ANGIOGRAPHY
▪ A fluoroscopic procedure in which a catheter is inserted through
the antecubital or femoral vein into the pulmonary artery or 1 of its
branches.

▪ Involves an injection of iodine or radiopaque contrast material.

 DIAGNOSTIC TESTS
PULMONARY ANGIOGRAPHY
Pre-procedure
1. Assess for allergies to iodine, seafood, or other radiopaque dyes.
2. Maintain NO status as prescribed.
3. Assess results of coagulation studies.
4. Establish an IV access.
5. Administer sedation as prescribed.
6. Instruct the client to lie still during the procedure.
7. Instruct the client that he or she may feel an urge to cough, flushing,
nausea, or a salty taste following injection of the dye.
8. Have emergency resuscitation equipment available.
 DIAGNOSTIC TESTS
PULMONARY ANGIOGRAPHY
Post-procedure
1. Avoid taking blood pressure for 24 hours in the extremity used for the
injection.
2. Monitor the peripheral neurovascular status of the affected extremity.
3. Assess the insertion site for bleeding.
4. Monitor for reaction to the dye.
 DIAGNOSTIC TESTS
THORACENTESIS
Removal of fluid or air from the pleural space via transthoracic aspiration.

Pre-procedure
1. Prepare the client for ultrasound or chest radiograph, if prescribed.
before the procedure
2. Assess results of coagulation studies.
3. Note that the client is positioned sitting up right, with the arms and
shoulders supported by a table at the bedside during the procedure.
4. If the client cannot sit up, the client is placed lying in bed toward the
unaffected side, with the head of the bed elevated.
5. Instruct the client not to cough, breathe deeply, or move during the
procedure.
 DIAGNOSTIC TESTS
THORACENTESIS
Post-procedure
1. Monitor respiratory status.
2. Apply a pressure dressing, and assess the puncture site for bleeding and
crepitus.
3. Monitor for signs of pneumothorax, air embolism, and pulmonary edema.
 DIAGNOSTIC TESTS
PULMONARY FUNCTION TEST
▪ Tests used to evaluate lung mechanics, gas exchange, and acid-base
disturbance through spirometric measurements, lung volumes, and arterial
blood gas levels.
 DIAGNOSTIC TESTS
PULMONARY FUNCTION TEST
Pre-procedure
1. Determine whether an analgesic that may depress the respiratory function
is being administered.
2. Consult with the PHCP regarding withholding bronchodilators before
testing, or alternatively if the testing will be done prior to and after
administration of a bronchodilator.
3. Instruct the client to void before the procedure and to wear loose clothing.
4. Remove dentures.
5. Instruct the client to refrain from smoking or eating a heavy meal for 4 to 6
hours before the test.
 DIAGNOSTIC TESTS
PULMONARY FUNCTION TEST
Post-procedure
1. The client may resume a normal diet and any bronchodilators and
respiratory treatments that were withheld before the procedure.
 DIAGNOSTIC TESTS
LUNG BIOPSY
▪ A transbronchial biopsy and a transbronchial needle aspiration may be
performed to obtain tissue for analysis by culture or cytological
examination.

▪ An open lung biopsy is performed in the operating room.

 DIAGNOSTIC TESTS
LUNG BIOPSY
Pre-procedure
1. Maintain NPO status as prescribed
2. Inform the client that a local anesthetic will be used for needle biopsy, but
a sensation of pressure during needle insertion and aspiration may be felt.
3. Administer analgesics and sedatives as prescribed.
 DIAGNOSTIC TESTS
LUNG BIOPSY
Post-procedure
1. Apply a dressing to the biopsy site and monitor for drainage or bleeding.
2. Monitor for signs of respiratory distress, and notify the PHCP if they occur.
3. Monitor for signs of pneumothorax and air emboli, and notify the PHCP if
they occur.
4. Prepare the client for chest radiography if prescribed.
 DIAGNOSTIC TESTS
V/Q LUNG SCAN

▪ The perfusion scan evaluates blood flow to the lungs.

▪ The ventilation scan determines the patency of the pulmonary airways
and detects abnormalities in ventilation
▪ A radionuclide may be injected for the procedure.
 DIAGNOSTIC TESTS
V/Q LUNG SCAN
Pre-procedure
1. Assess the client for allergies to dye, iodine, or seafood.
2. Remove jewelry around the chest area.
3. Review breathing methods that may be required during testing.
4. Establish an IV access.
5. Administer sedation if prescribed.
6. Have emergency resuscitation equipment available.
 DIAGNOSTIC TESTS
V/Q LUNG SCAN
Post-procedure
1. Monitor the client for reaction to the radionuclide.
2. Instruct the client that the radionuclide clears from the body in about 8
hours.
3. Encourage increased fluid intake to clear the dye from the body if there is
no fluid restriction.
 DIAGNOSTIC TESTS
COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY
▪ The scan visualizes the pulmonary arteries and blood flow.
▪ Its main use is to diagnose pulmonary embolism and is the preferred
method.
▪ A contrast dye is injected.
 DIAGNOSTIC TESTS
COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY
Pre-procedure
▪ Similar to the V/Q lung scan; in addition, renal function should be
adequate and dosing of the contrast should be done by a pharmacist.

Post-procedure
▪ Similar to the V/Q lung scan
 DIAGNOSTIC TESTS
SKIN TESTS
▪ A skin test uses an intradermal injection to help diagnose various
infectious diseases.

✓ Determine hypersensitivity or previous reactions to skin tests.

✓ Use a skin site that is free of excessive body hair, derma-titis, and blemishes.
✓ Apply the injection at the upper third of the inner surface of the left arm.
✓ Circle and mark the injection test site.
✓ Document the date, time, and test site.
✓ Advise the client not to scratch the test site to prevent infection and possible abscess formation.
✓ Instruct the client to avoid washing the test site.
✓ Assess the reaction at the injection site 24 to 72 hours after administration of the test antigen.
✓ Assess the test site for the amount of induration (hard swelling) in millimeters and for the
presence of erythema and vesiculation (small blister-like elevations).
 DIAGNOSTIC TESTS
ARTERIAL BLOOD GAS
▪ Measurement of the dissolved oxygen and carbon dioxide in the arterial
blood helps indicate the acid-base state and how well oxygen is being
carried to the body.
 CHEST INJURIES
1. RIB FRACTURE

▪ Results from direct blunt chest trauma and causes a potential for
intrathoracic injury, such as pneumothorax, hemothorax, or pulmonary
contusion.

▪ Pain with movement, deep breathing, and coughing results in impaired

ventilation and inadequate clearance of secretions.
 CHEST INJURIES
1. RIB FRACTURE (cont.)
Assessment
• Pain and tenderness at the injury site that increases with inspiration.
• Shallow respirations
• Client splints chest
• Fractures noted on chest x-ray
 CHEST INJURIES
1. RIB FRACTURE (cont.)
Interventions
1. Note that the ribs usually reunite spontaneously.
2. Open reduction and internal fixation of the ribs (rib plating) may be done.
3. Place the client in a Fowler's position.
4. Administer pain medication as prescribed to maintain adequate ventilatory
status.
5. Monitor for increased respiratory distress.
6. Instruct the client to self-splint with the hands, arms, or a pillow.
7. If the pain is severe, prepare the client for an intercostal nerve block as
prescribed.
 CHEST INJURIES
2. FLAIL CHEST

▪ It occurs from blunt chest trauma associated with accidents, which may
result in hemothorax and rib fractures.

▪ The loose segment of the chest wall becomes paradoxical to the

expansion and contraction of the rest of the chest wall.
 CHEST INJURIES
2. FLAIL CHEST (cont.)
Assessment
▪ Paradoxical respirations (inward movement of a segment of the thorax
during inspiration with outward movement during expiration)
▪ Severe pain in the chest
▪ Dyspnea
▪ Cyanosis
▪ Tachycardia
▪ Hypotension
▪ Tachypnea, shallow respirations
▪ Diminished breath
 CHEST INJURIES
2. FLAIL CHEST (cont.)
Interventions
1. Maintain the client in Fowler's position.
2. Administer oxygen as prescribed.
3. Monitor for increased respiratory distress.
4. Encourage coughing and deep breathing
5. Administer pain medication as prescribed.
6. Maintain bed rest and limit activity to reduce oxygen demands.
7. Open reduction and internal fixation of the ribs (rib plating) may be done.
8. Prepare for intubation with mechanical ventilation, with positive end-
expiratory pressure (PEEP) for severe flail chest associated with
respiratory failure and shock.
 CHEST INJURIES
2. PULMONARY CONTUSION

▪ Characterized by interstitial hemorrhage associated with intra-alveolar

hemorrhage, resulting in decreased pulmonary compliance.

▪ The major complication is acute respiratory distress syndrome.

 CHEST INJURIES
2. PULMONARY CONTUSION (cont.)
Assessment
▪ Dyspnea
▪ Restlessness
▪ Increased bronchial secretions
▪ Hypoxemia
▪ Hemoptysis
▪ Decreased breath sounds
▪ Crackles and wheezes
 CHEST INJURIES
2. PULMONARY CONTUSION (cont.)
Interventions
1. Maintain a patent airway and adequate ventilation.
2. Place the client in a Fowler's position.
3. Administer oxygen as prescribed.
4. Monitor for increased respiratory distress.
5. Maintain bed rest and limit activity to reduce oxygen demands.
6. Prepare for mechanical ventilation with PEEP if required.
 CHEST INJURIES
3. PNEUMOTHORAX
▪ Accumulating atmospheric air in the pleural space results in increased
intrathoracic pressure and reduced vital capacity, or the greatest amount
of air expires from the o lungs after taking a deep breath.
▪ The loss of negative intrapleural pressure results in the collapse of the
lung.
▪ A spontaneous pneumothorax occurs when a pulmonary bleb, or small air-
containing spaces deep in the lung, ruptures.
▪ An open pneumothorax occurs when an opening through the chest wall
allows positive atmospheric air pressure into the pleural space.
▪ A tension pneumothorax occurs when a positive pressure buildup occurs
in the pleural space, either from a blunt chest injury or mechanical
ventilation with PEEP.
 CHEST INJURIES
3. PNEUMOTHORAX
Assessment
▪ Absent or markedly decreased breath sounds on the affected side
▪ Cyanosis
▪ Decreased chest expansion unilaterally
▪ Dyspnea
▪ Hypotension
▪ Sharp chest pain
Subcutaneous emphysema as evidenced by crepitus on palpation
▪ Sucking sound with an open chest wound
▪ Tachycardia
▪ Tachypnea
▪ Tracheal deviation to the unaffected side with tension pneumothorax
 CHEST INJURIES
3. PNEUMOTHORAX
Interventions
1. Diagnosis of pneumothorax is made by chest x-ray.
2. Apply a nonporous dressing over an open chest wound.
3. Administer oxygen as prescribed.
4. Place the client in a Fowler's position.
5. Prepare for chest tube placement, remaining in place until the lung has
expanded fully.
6. Monitor the chest tube drainage system.
7. Monitor for subcutaneous emphysema.
 ACUTE RESPIRATORY FAILURE
▪ Occurs when insufficient oxygen is transported to the blood or inadequate
carbon dioxide is removed from the lungs, and the client's compensatory
mechanisms fail
▪ Causes include a mechanical abnormality of the lungs or chest wall, a
defect in the respiratory control center in the brain, or an impairment in the
function of the respiratory muscles.
▪ In oxygenation failure or hypoxemic respiratory failure, oxygen may reach
the alveoli but cannot be absorbed or used properly, resulting in a PaO2
lower than 60 mm Hg, arterial oxygen saturation (SaO2) lower than 90%,
or partial pressure of arterial carbon dioxide (PaCO2) greater than 50mm
Hg occurring with acidemia.
 ACUTE RESPIRATORY FAILURE
▪ Respiratory failure can be hypoxemic, hypercapnia, or both. The
mechanism behind failure is inadequate gas exchange. Arterial oxygen,
carbon dioxide, or both are not kept at normal levels, resulting in failure.
▪ Many clients experience both hypoxemic and hypercapnic respiratory
failure and retained carbon dioxide in the alveoli displaces oxygen,
contributing to the hypoxemia.
▪ Manifestations of respiratory failure are related to the extent and rapidity of
change in PaO2 and PaCO2.
 ACUTE RESPIRATORY FAILURE
Assessment
▪ Dyspnea
▪ Restlessness
▪ Confusion
▪ Tachycardia
▪ Hypertension
▪ Dysrhythmias
▪ Decreased level of consciousness
▪ Alterations in respirations and breath sounds
▪ Headache (less common)
 ACUTE RESPIRATORY FAILURE
Intervention
1. Identify and treat the cause of the respiratory failure.
2. Administer oxygen to maintain the PaO2 level above 60 to 70mm Hg.
3. Place the client in a Fowler's position.
4. Encourage deep breathing.
5. Administer bronchodilators as prescribed.
6. Prepare the client for mechanical ventilation if supplemental oxygen
cannot maintain acceptable PaO2 and PaCO2 levels.
 ACUTE RESPIRATORY DISTRESS SYNDROME
▪ A form of acute respiratory failure that occurs as a complication caused by
a diffuse lung injury or critical illness and leads to extravascular lung fluid.
▪ The major site of injury is the alveolar-capillary membrane.
▪ The interstitial edema causes compression and obliteration of the terminal
airways, leading to reduced lung volume and compliance.
▪ The ABG levels identify respiratory acidosis and hypoxemia that do not
respond to an increased percentage of oxygen.
▪ The chest X-ray shows bilateral interstitial and alveolar infiltrates;
interstitial edema may not be noted until the fluid content increases by
30%.
▪ Causes include sepsis, fluid overload, shock, trauma, neurological injuries,
burns, DIC, drug ingestion, aspiration, and inhalation of toxic substances.
 ACUTE RESPIRATORY DISTRESS SYNDROME
Assessment
▪ Tachypnea
▪ Dyspnea
▪ Decreased breath sounds
▪ Deteriorating ABG levels
▪ Hypoxemia despite high concentrations of delivered oxygen
▪ Decreased pulmonary compliance
▪ Pulmonary infiltrates
 ACUTE RESPIRATORY DISTRESS SYNDROME
Interventions
1. Identify and treat the cause of the acute respiratory distress syndrome.
2. Administer oxygen as prescribed.
3. Place the client in a Fowler's position.
4. Restrict fluid intake as prescribed.
5. Provide respiratory treatments as prescribed.
6. Administer diuretics, anticoagulants, or corticosteroids as prescribed
7. Prepare the client for intubation and mechanical ventilation using PEEP.
 ASTHMA
1. Chronic inflammatory disorder of the airways that causes varying degrees
of obstruction in the airways
2. Marked by airway inflammation and hyper-responsiveness to a variety of
stimuli or triggers.
3. It causes recurrent episodes of wheezing, breathlessness, chest
tightness, and coughing associated with airflow obstruction that may
resolve spontaneously; it is often reversible with treatment.
4. Severity is classified based on the clinical features before treatment.
5. Status asthmaticus is a severe life-threatening asthma episode that is
refractory to treatment and may result in pneumothorax, acute cor-
pulmonale, or respiratory arrest.
 ASTHMA
Assessment
▪ Restlessness
▪ Wheezing or crackles
▪ Absent or diminished lung sounds
▪ Hyperresonance
▪ Use of accessory muscles for breathing
▪ Tachypnea with hyperventilation
▪ Prolonged exhalation
▪ Tachycardia
▪ Pulsus paradoxus
▪ Diaphoresis
▪ Cyanosis
▪ Decreased oxygen saturation
▪ Pulmonary function test results that demonstrate decreased airflow rates
 ASTHMA
Interventions
1. Monitor vital signs.
2. Monitor pulse oximetry.
3. Monitor peak flow.
4. During an acute asthma episode, provide interventions to assist with
breathing.
5. To identify possible triggers and measures to prevent episodes
6. About the management of medication and proper administration
7. About the correct use of a peak flowmeter
8. About developing an asthma action plan with the physician and what to do
if an asthma episode occurs.
 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

1. Also known as chronic obstructive lung disease and chronic airflow limitation
2. Chronic obstructive pulmonary disease is a disease state characterized by airflow
obstruction.
3. Chronic bronchitis and emphysema are progressive lung diseases that fall under
the general category of chronic obstructive pulmonary disease.
4. Chronic bronchitis is when the bronchial tubes become inflamed, and excessive
mucus production occurs due to irritants or injury.
5. Emphysema is when the air sacs in the lungs are damaged and enlarged, resulting
in hyperinflation and breathlessness.
6. Progressive airflow limitation occurs, which is associated with an abnormal
inflammatory response of the lungs that is not completely reversible.
7. Chronic obstructive pulmonary disease (COPD) leads to pulmonary insufficiency,
pulmonary hypertension, and cor pulmonale.
 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Interventions
1. Monitor vital signs.
2. Administer a concentration of oxygen based on
ABG values and oxygen saturation by pulse oximetry as
prescribed
3. Monitor pulse oximetry.
4. Provide respiratory treatments and CPT.
5. Instruct the client in diaphragmatic or abdominal breathing
techniques, tripod positioning, and pursed-lip breathing
techniques, which increase airway pressure and keep air
passages open, promoting maximal carbon dioxide expiration.
 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Interventions (cont.)
6. Record the color, amount, and consistency of sputum.
7. Suction the client's lungs, if necessary, to clear the airway and
prevent infection.
8. Monitor weight.
9. Encourage small, frequent meals to maintain nutrition and
prevent dyspnea.
10. Provide a high-calorie, high-protein diet with supplements.
11. Encourage fluid intake up to 3000 ml/day to keep secretions thin
unless contraindicated.
 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Interventions (cont.)
12. Place the client in a Fowler's position and lean forward to aid
breathing.
13. Allow activity as tolerated.
14. Administer bronchodilators as prescribed, and instruct the client
to use oral and inhalant medications.
15. Administer corticosteroids as prescribed for exacerbations.
16. Administer mucolytics as prescribed to thin secretions.
17. Administer antibiotics for infection if prescribed.
 PNEUMONIA

▪ Infection of the pulmonary tissue, including the interstitial spaces,

the alveoli, and the bronchioles
▪ The inflammation-related edema stiffens the lung, decreases lung
compliance and vital capacity, and causes hypoxemia.
▪ Pneumonia can be community-acquired or hospital-acquired. The
chest x-ray film shows lobar or segmental consolidation,
pulmonary infiltrates, or pleural effusions.
▪ A sputum culture identifies the organism.
▪ The white blood cell count and the erythrocyte sedimentation rate
are elevated.
 PNEUMONIA

Assessment
▪ Chills
▪ Elevated temperature
▪ Pleuritic pain
▪ Tachypnea
▪ Rhonchi and wheezes
▪ Use of accessory muscles for breathing
▪ Mental status changes
▪ Sputum production
 PNEUMONIA

Interventions
1. Administer oxygen as prescribed.
2. Monitor respiratory status.
3. Monitor for labored respirations, cyanosis, and cold and clammy
skin.
4. Encourage coughing and deep breathing and use of the incentive
spirometer.
5. Place the client in a semi-Fowler's position to facilitate breathing
and lung expansion.
6. Change the client's position frequently and ambulate as tolerated
to mobilize secretions.
 PNEUMONIA

Interventions (cont.)
7. Provide CPT.
8. Perform nasotracheal suctioning if the client is unable to clear
secretions.
9. Monitor pulse oximetry.
10. Monitor and record color, consistency, and amount of sputum.
11. Provide a high-calorie, high-protein diet with small, frequent
meals.
12. Encourage fluids, up to 3 L/day, to thin secretions unless
contraindicated.
 PNEUMONIA

Interventions (cont.)
13. Provide a balance of rest and activity, increasing activity
gradually.
14. Administer antibiotics as prescribed.
15. Administer antipyretics, bronchodilators, cough suppressants,
mucolytic agents, and expectorants as prescribed.
16. Prevent the spread of infection by hand washing and the proper
disposal of secretions.
 INFLUENZA

▪ Also known as the flu; highly contagious acute viral respiratory

infection.
▪ It may be caused by several viruses, usually known as types A, B,
and C.
▪ Yearly vaccination is recommended to prevent the disease,
especially for those older than 50 years of age, individuals with
chronic illness or who are immunocompromised, those living in
institutions, and healthcare personnel providing direct care to
clients.
 INFLUENZA

Assessment
• Acute onset of fever and muscle aches
• Headache
• Fatigue, weakness, anorexia
• Sore throat, cough, and rhinorrhea
 INFLUENZA

Interventions
1. Encourage rest.
2. Encourage fluids to prevent pulmonary complications (unless
contraindicated).
3. Monitor lung sounds.
4. Provide supportive therapy such as antipyretics or antitussives
as indicated.
5. Administer antiviral medications as prescribed for the current
strain of influenza.
 PLEURAL EFFUSION

▪ Pleural effusion is the collection of fluid in the pleural space.

▪ Any condition that interferes with the secretion or drainage of this
fluid will lead to pleural effusion.
 PLEURAL EFFUSION

Assessment
▪ Pleuritic pain that is sharp and increases with inspiration
▪ Progressive dyspnea with decreased movement of the chest wall
on the affected side
▪ Dry, nonproductive cough caused by bronchial irritation or
mediastinal shift
▪ Tachycardia
▪ Elevated temperature
▪ Decreased breath sounds over the affected area
▪ Chest x-ray film shows pleural effusion and a mediastinal shift
away from the fluid if the effusion is more than 250 ml.
 PLEURAL EFFUSION

Interventions
1. Identify and treat the underlying cause.
2. Monitor breath sounds.
3. Place the client in a Fowler's position.
4. Encourage coughing and deep breathing.
5. Prepare the client for thoracentesis.
6. If pleural effusion is recurrent, prepare the client for pleurectomy
or pleurodesis as prescribed.
 PLEURAL EFFUSION

Interventions
Pleurectomy
1. It consists of surgically stripping the parietal pleura away from the
visceral pleura.
2. This produces an intense inflammatory reaction that promotes
adhesion formation between the two layers during healing.
 PLEURAL EFFUSION

Interventions
Pleurodesis
1. Involves the instillation of a sclerosing substance into the pleural
space via a thoracotomy tube.
2. The substance creates an inflammatory response that scleroses
tissue together.
 EMPYEMA

▪ Collection of pus within the pleural cavity.

▪ The fluid is thick, opaque, and foul-smelling.
▪ The most common cause is pulmonary infection and lung abscess
caused by thoracic surgery or chest trauma, in which bacteria are
introduced directly into the pleural space.
▪ Treatment focuses on treating the infection, emptying the
empyema cavity, re-expanding the lung, and controlling the
infection.
 EMPYEMA

Assessment
▪ Recent febrile illness or trauma
▪ Chest pain
▪ Cough
▪ Dyspnea
▪ Anorexia and weight loss
▪ Malaise
▪ Elevated temperature and chills
▪ Night sweats
▪ Pleural exudate on chest
 EMPYEMA

Interventions
1. Monitor breath sounds.
2. Place the client in a semi-Fowler's or high-Fowler's position.
3. Encourage coughing and deep breathing.
4. Administer antibiotics as prescribed.
5. Instruct the client to splint the chest as necessary.
6. Assist with thoracentesis or chest tube insertion to promote
drainage and lung expansion.
7. If marked pleural thickening occurs, prepare the client for
decortication if prescribed; this surgical procedure involves the
removal of the restrictive mass of fibrin and inflammatory cells.
 PLEURISY

▪ Inflammation of the visceral and parietal membranes may be

caused by pulmonary infarction or pneumonia.
▪ The visceral and parietal membranes rub together during
respiration and cause pain.
▪ Pleurisy usually occurs on one side of the chest, usually in the
lower lateral portions of the chest wall.
 PLEURISY

Assessment
▪ Knife-like pain aggravated by deep breathing and coughing
▪ Dyspnea
▪ Pleural friction rub heard on auscultation
 PLEURISY

Interventions
1. Identify and treat the cause.
2. Monitor lung sounds.
3. Administer analgesics as prescribed.
4. Apply hot or cold applications as prescribed.
5. Encourage coughing and deep breathing.
6. Instruct the client to lie on the affected side to splint the chest.
 PULMONARY EMBOLISM

▪ It occurs when a thrombus forms (most commonly in a deep vein),

detaches, travels to the right side of the heart, and then lodges in
a branch of the pulmonary artery.
▪ Clients prone to pulmonary embolism are those at risk for deep
vein thrombosis, including those with prolonged immobilization,
surgery, obesity, pregnancy, heart failure, advanced age, or a
history of thromboembolism.
▪ Fat emboli can occur as a complication following a fracture of a
long bone and can cause pulmonary emboli.
▪ Treatment is aimed at prevention through risk factor recognition
and elimination.
 PULMONARY EMBOLISM

Assessment
▪ Apprehension and restlessness
▪ Blood-tinged sputum
▪ Chest pain
▪ Cough
▪ Crackles and wheezes on auscultation
▪ Cyanosis
▪ Distended neck veins
▪ Dyspnea accompanied by anginal and pleuritic pain, exacerbated by inspiration
▪ The feeling of impending doom
▪ Hypotension
▪ Petechiae over the chest and axilla
▪ Shallow respirations
▪ Tachypnea and tachycardia
 PULMONARY EMBOLISM

Interventions
1. Notify the Rapid Response Team and primary health care
provider (PHCP).
2. Reassure the client and elevate the head of the bed.
3. Prepare to administer the oxygen.
4. Obtain vital signs and check lung sounds.
5. Prepare to obtain an arterial blood gas.
6. Prepare for the administration of heparin therapy or other
therapies.
7. Document the event, interventions, and the client's response to
treatment.
 HISTOPLASMOSIS

▪ Pulmonary fungal infection caused by sports of Histoplasma

capsulatum.
▪ Transmission occurs by the inhalation of spores which commonly
are found in contaminated soil.
▪ Spores also are usually found in bird droppings.
 HISTOPLASMOSIS

Assessment
▪ Similar to pneumonia
▪ Positive skin test for histoplasmosis
▪ Positive agglutination test
▪ Splenomegaly, hepatomegaly
 HISTOPLASMOSIS

Interventions
1. Administer oxygen as prescribed.
2. Monitor breath sounds.
3. Administer antiemetics, antihistamines, anti-pyretics, and corticosteroids
as prescribed.
4. Administer fungicidal medications as prescribed.
5. Encourage coughing and deep breathing.
6. Place the client in a semi-Fowler's position.
7. Monitor vital signs.
8. Monitor for nephrotoxicity from fungicidal medications.
9. Instruct the client to wear a mask and spray the floor with water before
sweeping the barn and chicken coops.
 SARCOIDOSIS

▪ Presence of epithelioid cell tubercles in the lung.

▪ The cause is unknown, but a high titer of Epstein-Barr virus may
be noted.
▪ Viral incidence is highest in African Americans and young adults.
 SARCOIDOSIS

Assessment
▪ Night sweats
▪ Fever
▪ Weight loss
▪ Cough and dyspnea
▪ Skin nodules
▪ Polyarthritis
▪ Kveim test: Sarcoid node antigen is injected intradermally and
causes a local nodular lesion in about one month.
 SARCOIDOSIS

Interventions
1. Administer corticosteroids to control symptoms.
2. Monitor temperature.
3. Increase fluid intake.
4. Provide frequent periods of rest.
5. Encourage small, frequent, nutritious
 TUBERCULOSIS

▪ Highly communicable disease caused by Mycobacterium

tuberculosis.
▪ M. tuberculosis is a nonmotile, nonsporulating, acid-fast rod that
secretes niacin; it multiplies freely when the bacillus reaches a
susceptible site.
▪ Because M. tuberculosis is an aerobic bacterium, it primarily
affects the pulmonary system, especially the upper lobes with the
highest oxygen content. Still, it also can affect other body areas,
such as the brain, intestines, peritoneum, kidney, joints, and liver.
 TUBERCULOSIS

▪ An exudative response causes nonspecific pneumonitis and the

development of granulomas in the lung tissue.
▪ Tuberculosis has an insidious onset, and many clients are not
aware of symptoms until the disease is well advanced.
▪ Improper or noncompliant use of treatment programs may cause
the development of mutations in the tubercle bacilli, resulting in a
multidrug-resistant strain of tuberculosis (MDR-TB).
▪ Treatment aims to prevent transmission, control symptoms, and
prevent disease progression.
 TUBERCULOSIS

Risk Factors
▪ Children younger than 5 years of age
▪ Drinking unpasteurized milk if the cow is infected with bovine tuberculosis
▪ Homeless individuals or those from a lower socioeconomic group, minority group, or
refugee group
▪ Individuals in constant, frequent contact with an untreated or undiagnosed individual
▪ Individuals living in crowded areas, such as long-term care facilities, prisons, and
mental health facilities
▪ Older client
▪ Individuals with malnutrition, infection, immune dysfunction, or human
immunodeficiency virus infection; or immuno-suppressed as a result of medication
therapy
▪ Individuals who abuse alcohol or are intravenous drug users
 TUBERCULOSIS

Transmission
▪ Via the airborne route by droplet infection
▪ When infected individual coughs, laughs, sneezes, or sings, droplet nuclei
containing tuberculosis bacteria enter the air and maybe inhaled by
others.
▪ Identifying those in close contact with the infected individual is important
so they can be tested and treated as necessary.
▪ When contacts have been identified, these persons are assessed with a
tuberculin skin test and chest x-rays to determine infection with
tuberculosis.
▪ After the infected individual has received tuberculosis medication for 2 to
3 weeks, the risk of transmission is reduced greatly.
 TUBERCULOSIS

Disease Progression
▪ Droplets enter the lungs, and the bacteria form a tubercle lesion.
▪ The defense systems of the body encapsulate the tubercle, leaving a scar.
▪ If encapsulation does not occur, bacteria may enter the lymph system,
travel to the lymph nodes, and cause an inflammatory response termed
granulomatous inflammation.
▪ Primary lesions form; the primary lesions may become dormant but can be
reactivated and become a secondary infection when re-exposed to the
bacterium.
▪ In an active phase, tuberculosis can cause necrosis and cavitation in the
lesions, leading to rupture, the spread of necrotic tissue, and damage to
various parts of the body.
 TUBERCULOSIS

Client History
▪ Past exposure to tuberculosis
▪ Client's country of origin and travel to foreign countries in which
the incidence of tuberculosis is high
▪ Recent history of influenza, pneumonia, febrile illness, cough, or
foul-smelling sputum production
▪ Previous tests for tuberculosis; results of the testing
▪ Recent bacillus Calmette-Guérin (BCG) vaccine (a vaccine
containing attenuated tubercle bacilli that may be given to
persons in foreign countries or to persons traveling to foreign
countries to produce increased resistance to tuberculosis).
 TUBERCULOSIS

Client History
▪ May be asymptomatic in primary infection
▪ Fatigue
▪ Lethargy
▪ Anorexia
▪ Weight loss
▪ Low-grade fever
▪ Chills
▪ Night sweats
▪ Persistent cough and the production of mucoid and mucopurulent sputum,
which is occasionally streaked with blood
▪ Chest tightness and a dull, aching chest pain may accompany the cough.
 TUBERCULOSIS

Chest Assessment
▪ A physical examination of the chest does not provide conclusive
evidence of tuberculosis.
▪ A chest x-ray is not definitive, but multinodular infiltrates with
calcification in the upper lobes suggest tuberculosis.
▪ If the disease is active, caseation and inflammation may be seen
on the chest x-ray.
 TUBERCULOSIS

Chest Assessment
Advanced disease
▪ Dullness with percussion over-involved parenchymal areas,
bronchial breath sounds, rhonchi, and crackles indicate advanced
disease.
▪ Partial bronchus obstruction caused by endobronchial disease or
compression by lymph nodes may produce localized wheezing
and dyspnea.
 TUBERCULOSIS

QuantiFERON-TB Gold Test

• A blood analysis test by an enzyme-linked immunosorbent assay.
• A sensitive and rapid test (results can be available in 24 hours that
assists in diagnosing the client.
 TUBERCULOSIS

Sputum Cultures
▪ Sputum specimens are obtained for an acid-fast smear.
▪ A sputum culture identifying M. tuberculosis confirms the
diagnosis.
▪ After medications are started, sputum samples are obtained again
to determine the effectiveness of therapy.
▪ Most clients have negative cultures after 3 months of treatment.
 TUBERCULOSIS

The Hospitalized Client

1. The client with active tuberculosis is placed under airborne isolation
precautions in a negative pressure room; to maintain negative pressure,
the door of the room must be tightly closed.
2. The room should have at least 6 fresh air exchanges per hour and be
ventilated to the outside environment, if possible.
3. When caring for the client, the nurse wears a particulate respirator (a
special individually fitted mask) and a gown when clothing contamination
exists.
4. Thorough hand washing is required before and after caring for the client.
5. If the client needs to leave the room for a test or procedure, the client is
required to wear a surgical mask.