Download Chapter 36 - Bakersfield College

MEDICAL SURGICAL NURSING II
VNRS B85
ASSESSING CLIENTS WITH RESPIRATORY DISORDERS
INTRODUCTION:
The respiratory system provides the cells of the body with oxygen and eliminates carbon
dioxide, formed as a waste product of cellular metabolism. The events in this process are
called respiration.
Although the respiratory airways and the anatomic structures where gas exchange takes
place are continuous, their components are classified anatomically and functionally as
belonging to either (1) the upper respiratory tract or (2) the lower respiratory tract.
LEARNING OUTCOMES:
Upon completion of this unit, the student will be able to:
A.
Theory
1.
Describe the anatomy, physiology, and functions of the respiratory system.
2.
Explain the mechanics of ventilation.
3.
Compare and contrast factors affecting respiration.
4.
Identify specific topics for consideration during a health history interview
of the client with health problems involving the respiratory system.
5.
Describe normal variations in assessment findings for the older adult.
6.
Identify manifestations of impairment of the respiratory system.
ASSIGNMENT:
LeMone-Burke Chapter 36
CHAPTER 36
LECTURE OUTLINE
ASSESSING CLIENTS WITH RESPIRATORY DISORDERS
The Respiratory System
• Upper Respiratory System
– Nose, sinuses, pharynx, larynx, trachea
– Passage way for air, cleanses, humidifies, warms
•
Lower Respiratory System
– Lungs, bronchi, alveoli
– Respiratory membrane for gas exchange
Mechanics of Ventilation
• Ventilation
– Inspiration
• Occurs when changes decrease interpleural pressures
• Air enters the lungs through the primary bronchus
• Oxygen and carbon dioxide are exchanged at the alveolar respiratory membrane
• Simple diffusion
– Expiration
• Occurs when changes increase interpleural pressures
• Primarily passive
• Carbon dioxide is expelled through expiration
Factors that Affect Respiration
•Changes in Volume and Capacity
–Affected by gender, age, weight, and health status
–Measured by pulmonary function tests
•Air Pressure
–Pressure changes in the thoracic cavity drive inspiration/expiration
Factors that Affect Respiration
•Oxygen, Carbon Dioxide, Hydrogen Ion Concentrations
–Affect respiratory centers in medulla oblongata, pons, medulla, carotid and aortic bodies
–
•Airway Resistance, Lung Compliance, and Elasticity
–Increase airway resistance, decreased lung compliance or decreased elasticity decrease
gas flow
–
•Alveolar Surface Tension
–Along with presence of surfactant, prevent alveolar collapse between breaths
Health History
•Current Illness
•Observe for Respiratory Compromise
•Present Health Status, Medical History, Family History, Risk Factors
•Lifestyle Questions
–Smoking history
–Exposure to environmental substances
–Exercise
–Use of recreational drugs
Age-related Changes
•Decrease in elastic recoil of the lung
•Loss of skeletal muscle strength in thorax and diaphragm
•Fibrosis in the alveoli
•Fewer functional capillaries
•Less effective cough
•Decrease in PO2
Manifestations of Possible Respiratory Disorder
•Nasal Assessment
–Asymmetry, redness, swelling, septum abnormalities, purulent drainage, changes in
ability to smell
•Frontal or Maxillary Sinus Assessment
–Tenderness
Manifestations of Possible Respiratory Disorder
•Thoracic Assessment
–Markedly increased or decreased respiratory rate, abnormal AP diameter, intercostal
retraction or bulging, asymmetric chest expansion, malposition of the trachea, changes in
tactile fremitus, dullness or hyperresonance on percussion or asymmetric diaphragmatic
excursion
•Breath Sound Assessment
–Adventitious sounds, absence of breath sounds, or malposition of normal quality breath
sounds