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The Respiratory System and Assessment Learning Outcomes 1. 2. 3. 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 4. 5. 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 TABLE 21-1 (continued) Common Laboratory Tests and Studies 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 TABLE 21-2 (continued) Imaging Studies 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
