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RESPIRATORY FUNCTION
Stacie Pigues, MSN, RN
NWCC NUR 1117
Foundations of Nursing
STRUCTURES OF THE RESPIRATORY
SYSTEM
STRUCTURES OF THE
RESPIRATORY SYSTEM
Upper Airway:
– Mouth
– Nose
– Pharynx
STRUCTURES OF THE
RESPIRATORY SYSTEM
Lower Airway:
– Trachea
– Bronchi
– Bronchioles
– Alveoli
– Lungs
NORMAL RESPIRATORY FUNCTION
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Ventilation
Gas diffusion
Gas transport
Control of ventilation
Defenses of the respiratory system
Normal breathing pattern
NORMAL RESPIRATORY FUNCTION
• Ventilation, or breathing, is the process of
moving air into and out of the lungs so that
gas exchange can take place.
• Gas Diffusion refers to the movement of
oxygen between the alveoli and the blood.
GAS DIFFUSION
p. 736
NORMAL RESPIRATORY FUNCTION
• Gas Transport occurs when oxygen
crosses the alveolar-capillary membrane
into the blood where blood transports it to
the tissues.
• Control of Ventilation, this process is
controlled through neural pathways.
NORMAL RESPIRATORY FUNCTION
• Normal Breathing Pattern depends on
age, normal breathing is smooth, even, and
regular.
DEFENSES OF THE RESPIRATORY
SYSTEM
Upper Airway functions to:
• Warm and humidify inspired air while maintaining
the fluid character of the lower airway
• Clean inspired air
• Protect lower airway from infection and injury
due to aspiration
DEFENSES OF THE RESPIRATORY
SYSTEM
Lower Airway functions to:
• Further clean inspired air
• “Mucus Blanket” –protects
• “Mucociliary Elevator”- helps remove bacteria
PROTECTIVE REFLEXES
• Coughing
• Sneezing
FACTORS THAT AFFECT
BREATHING
• Age
• Activity level
• Life style
NORMAL BREATHING PATTERN
Normal Parameters of Respiratory Rates
• effortless, smooth, even and regular
• average adult moves ½ L of air per breath
NORMAL BREATHING PATTERN
Newborns and infants
• Rapid breathers
• Breathe 30-60 times per minute
• Surfactant replacement therapy
NORMAL BREATHING PATTERN
Toddler and Preschooler
• Breathing even and smoother
• By age three, 20-30 breaths per min.
• Risk for aspiration
NORMAL BREATHING PATTERN
Child and Adolescent
• Breathing steadily slows
• Breathe 12-20 times per minute
• Adolescence smoking and tobacco use
NORMAL BREATHING PATTERN
Adults
• Breathe 12-20 times per minute
• Structural and functional changes:
Thoracic wall is more rigid
Lungs do not stretch as well
Gas exchange is affected
Protective functions are impaired
Cough is less effective
NORMAL BREATHING PATTERN
Older Adults (60 years and older)
• Breathe 16-25 times per minute
• Factors that affect older adults respiratory
changes contribute to:
 Activity intolerance
 Increased
HISTORY
• Do you have a cough?
• Common causes:
Histamines
Borderline heart failure
Nervous habit
“Common” cough-only concerned if it
changes
HISTORY
• Are you coughing up sputum?
How much? Teaspoon, tablespoon or ½ cup
What is the color of the sputum? Clear,
yellow, bloody (hemoptysis)
Consistency? Thick or thin
HISTORY
• Are you experiencing shortness of breath
(dyspnea)?
• Possible causes:
Lung disease
CHF
Anxiety
HISTORY
• Are you having any chest pain?
• Possible causes:
Infection
Inflammation
Pneumonia
Bronchitis
HISTORY
• What is your normal breathing pattern?
• When and how often do the breathing problems
occur?
• Identify any exposures putting the patient at
risk.
FACTORS AFFECTING
RESPIRATORY FUNCTION
• Environment
• Lifestyle and habits
• Body position
• Increased work of breathing
ENVIRONMENT
•
•
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Weather
Geographical location
Air pollution
Pollens and allergens
LIFESTYLE AND HABITS
• Smoking: pack-years
• Drugs and alcohol
• Nutrition
INCREASED WORK OF BREATHING
Restricted lung movement
• Atelectasis
• May be chronic or acute due to:
• Smoke inhalation
• Pulmonary fibrosis
• Resp. distress syndrome
• Pneumonia
INCREASED WORK OF BREATHING
Restricted lung movement
•Obesity
•Chest or abdominal binders
•Abdominal distension caused by gas/fluid
•Meds/anesthesia
•Rib injuries
•Musculoskeletal chest deformities
•Severe weakness
•Neuromuscular disorders
INCREASED WORK OF BREATHING
Airway Obstruction
• Any process that reduces the diameter of the
airways causing increased airway resistance which
requires more effort to breath because air is
moving through a narrower passage
INCREASED WORK OF BREATHING
Airway Obstruction
• Possible causes of airway obstruction are:
• Foreign bodies aspiration
• Excessive mucus
Chronic bronchitis
Cystic Fibrosis
Asthma
Croup
Epiglottis
• Abnormal growths in the airway
ASSESSMENT - INSPECTION
Body position
• Assess how your patient is sitting or lying
• Upright posture (high Fowler’s) allows
for better lung expansion
• Reposition patient
ASSESSMENT - INSPECTION
• What is the rate?
• How hard are they working to breathe?
• Describe breathing pattern.
 Hypoxemia-low oxygen levels in the blood
 Hypercapnia-abnormally high carbon
dioxide in the blood
 Hyperventilation- excessive elimination of
carbon dioxide causing dizziness and resp.
alkalosis
ASSESSMENT - INSPECTION
Assessing color:
• Cyanosis- bluish skin discoloration caused
by a desaturation of oxygen on the
hemoglobin
– Central cyanosis-mucus membranes
blue around mouth and eyes - indicates
SEVERE oxygenation problems
ASSESSMENT - INSPECTION
• Clubbing- round and enlarged fingers and
toes
• Chest deformities- barrel chest
• Wounds
• Masses
ASSESSMENT - INSPECTION
Other signs of respiratory distress:
• Gasping
• Panting
• Wheezing
• Nasal flaring
• Retractions
ASSESSMENT - PULSE OXIMETRY
Pulse Oximetry
ASSESSMENT - PULSE OXIMETRY
Pulse Oximetry - O2 Saturation
•
Any changes in a patient’s level of consciousness, dizziness,
restlessness, agitation, etc.—check pulse oximeter-may be due
to hypoxia! If oxygen level normal—check glucose level.
• Normal Oxygen sat 95-100% with O2 intervention generally
required if < 93%
• Patients with sleep apnea may need to bring their machines to
the hospital. These patients are at high risk for hypoxia and
respiratory arrest especially post-op.
• Higher altitudes= less oxygen available for gas diffusion =
SOB & activity intolerance (p. 738)
ASSESSMENT- AUSCULTATION
Anterior
Posterior
AUSCULTATION-CRACKLES
AUSCULTATION-WHEEZES
DIAGNOSTIC TESTS AND PROCEDURES
• Sputum culture- Culture & Sensitivity
 Thick and sticky
 Yellow or green
 Putrid or musty odor
 Blood streaked
 Frankly red, bloody (hemoptysis)
DIAGNOSTIC TESTS AND PROCEDURES
Arterial blood gas (ABG) monitoring
• Arterial blood levels of oxygen, carbon dioxide
and PH are the best indicator of gas exchange.
• Hyperventilation
• Hypoventilation
DIAGNOSTIC TESTS AND PROCEDURES
• Chest x-ray
• Pulmonary function tests (PFT)
• Bronchoscopy
• Lung scan/CT/MRI
DIAGNOSTIC TESTS AND PROCEDURES
• Throat culture
• Sputum specimens
• Cytology
• Thoracentesis
• Skin tests
– PPD given to test TB exposure
– Allergy tests identify airway
hypersensitivity in asthmatics
NURSING DIAGNOSES
• Ineffective Breathing Pattern-monitor the patient
and encourage slow, deep breathing, turning and
coughing
• Ineffective Airway Clearance-ensure adequate
hydration, instruct on how to cough effectively
• Impaired Gas Exchange- monitor cognitive
changes, ABG, O2 Saturation, S & S of
respiratory failure.
OUTCOMES IDENTIFICATION AND
PLANNING
• Knowledge regarding prevention of respiratory
dysfunction
• Adequate oxygenation
• Mobilize pulmonary secretions
• Cope with changes in self-concept and lifestyle
IMPLEMENTATION
Health promotion
• Preventing respiratory infections
• Encouraging smoking cessation
• Reducing allergens
• Monitoring peak flow
IMPLEMENTATION
Health promotion
• Providing adequate hydration
• Positioning and ambulation
• Deep breathing and coughing
• Assisting with incentive spirometry
NURSING INTERVENTIONS
Coughing
• Deep cough
• Stacked cough
• Low-flow (huff) cough
• Quad cough
NURSING INTERVENTIONS
• Pursed-lip breathing
• Chest physiotherapy
– Percussion
– Vibration
– Postural drainage
NURSING INTERVENTIONS
Aerosol Therapy
– Aerosol medications-a suspension of liquid droplets in air or oxygen.
– Aerosols can be uses for several reasons:
• Adds moisture to oxygen
• Hydrates mucus to prevent mucus plugs
• Used to administer drugs, such as:
 Bronchodilator
 Corticosteroids
 Antibiotics
METERED-DOSE INHALERS (MDI’S)
HANDHELD NEBULIZERS
OXYGEN THERAPY ADMINISTRATION
• Oxygen therapy can be used to accomplish three
fundamental goals in patient care:
• Improves tissue oxygenation allowing for better
healing to occur- when in the healing process, the
body’s metabolic demand for oxygen is increased.
• Helps decrease work of breathing in patients with
shortness of breath or dyspnea
• Decreases the work of the heart in patients with cardiac
diseases
OXYGEN THERAPY ADMINISTRATION
• Oxygen flow is ordered in liters per minute. General rule
in the use of O2 therapy is to use the lowest amount
possible to achieve an acceptable blood oxygen level.
• You will find that most patients’ will have an order for
Oxygen if the SaO2 is below 93%. Oxygen is used to
help stabilize the patient and then they will be slowly
weaned off O2 therapy. You will monitor for color,
alertness, heart rate, O2 Sat, and breathing effort.
• *ENSURE THAT THE APPROPRIATE AMOUNT OF
OXYGEN PRESCRIBED IS BEING DELIVERED!
SELECTION OF OXYGEN SYSTEMS
• Various devices are available for providing
oxygen at different flow rates and
concentrations
• Device used depends on patients oxygenation
status
• Best oxygen device is provided with
consideration of comfort for the patient
OXYGEN THERAPY
Nasal Cannula
• By Nasal Cannula(BNC)
• Flow Rate- 1L to 6L per minute
• Oxygen concentration range 22%-44%
• Oxygen concentration varies with breathing patterns
OXYGEN THERAPY
Venturi mask
• Flow rate- 3L to 8L per minute
• Oxygen concentration range- 24% to 50%
OXYGEN THERAPY
Simple mask
• Flow rate- 6 to 10L per minute
• Oxygen conc. range 40%-60%
• Oxygen conc. varies with breathing patterns
OXYGEN THERAPY
Reservoir (Non-rebreather) mask
• Flow rate- 10 to 15L per minute
• Oxygen concentration range 90%+
• Used for critically ill patients
OXYGEN SAFETY
• Oxygen is a drug; an order is required
• Monitor flow rate to ensure accurate amount is
being administered
• Normal range for oxygen saturation is 95100%; O2 for <93%
• Teach the importance of wearing oxygen device
• Smoking is prohibited
OXYGEN SAFETY
• Review the Safety Alerts in Craven regarding COPD & oxygen
• The normal drive to breath is high carbon dioxide level
(hypercapnia); however, the patient with COPD has become
accustomed to this, therefore their drive to breath is hypoxemia (low
oxygen level).
• Patients with COPD must be maintained with low concentrations of
oxygen.
• Oxygen therapy requires physician order-may see oxygen initiated,
changed and discontinued without a written order on the chart if
respiratory therapy utilizes oxygen protocol. This protocol has
medical staff approval.
NURSING INTERVENTIONS
• Dyspnea management
• Hyperventilation management
• Assisted ventilation
– BiPAP (Bilevel positive airway pressure)
– CPAP (Continuous positive airway
pressure)
NURSING INTERVENTIONS
Artificial Airways
• Oral or Nasal Pharyngeal Airways
• Endotracheal Tubes
• Tracheostomy
PHARYNGEAL AIRWAYS
Oral Airways
Nasal Trumpets
ENDOTRACHEAL TUBE
TRACHEOSTOMY
Uncuffed
Cuffed
SUCTIONING
Suction catheter kit
Yankauer
CHEST TUBES
• Pneumothorax- air in the pleural space
• Hemothorax-blood in the pleural space
VENTILATORS
DISCHARGE NEEDS
• Infection control
• Medications
• Home oxygen systems
• Energy conservation
• Fostering self-esteem
REFERENCES
• Craven, R, Hirnle, C. & Jensen, S.(2013).
Fundamentals of Nursing (7 th ed.). Philadelphia:
Wolters Kluwer/Lippincott Williams & Wilkins.
Chapter 25.