Title: The Respiratory System Correlated to the Roy Adaptation Model and Nursing Process
1The Respiratory SystemCorrelated to the Roy
Adaptation Model and Nursing Process
- Sandy Marks, RN, BSN, MS(HCA)
- N212 Medical Surgical Nursing 1
- Spring 2008
2Journey through Roy Adaptation Model(RAM)
- Roy Adaptation Model ?
- Patients primarily with alterations in
- physiological mode ?
- oxygenation ?
- respiratory system
3Objectives - 1
- Review the anatomy and physiology of the
respiratory system - Describe the respiratory changes associated with
aging
4Objectives - 2
- Discuss the purpose and interventions
(preparation, explanation, procedure, postcare)
for the following diagnostic tests - X-rays chest, bronchogram, CT, lung scan
- Direct visualization bronchoscopy
- Sputum specimen
- Thoracentesis
- Pulmonary function tests (PFT)
- Oximetry
- Magnetic resonance imaging (MRI)
- Cultures
5Objectives - 3
- Describe the nursing assessment of the following
cardinal signs and symptoms - cough
- sputum
- dyspnea
- Discuss the pathophysiology, nursing assessment,
interventions, and evaluation for Pneumonia
6The Art of Caring
7Respiratory Review
- Purpose
- provide oxygen for tissue metabolism (O2)
- remove carbon dioxide (CO2)
- Influences functions of
- acid-base balance
- speech
- sense of smell
- fluid balance
- temperature control
8Review the anatomy and physiology of the
respiratory system
trachea
- upper respiratory tract
- lower respiratory tract
- divided by trachea (windpipe)
- bronchi
- bronchioles
- alveolar ducts
- alveoli
bronchi
bronchioles
alveoli
9Gas Exchange
- occurs at alveolar capillary membrane
- occurs by diffusion
- Pulmonary edema
- excess fluid fills alveoli spaces
- impairs exchange of O2 and CO2
capillary
10Normal lung tissue
- 300 million alveoli
- surface area tennis court
- Right bronchus
- slightly wider
- shorter
- more vertical
- increases problems with
- intubation
- aspiration
11Physiologic changes associated with aging
12Alveoli
- alveolar surface area decreases
- diffusion capacity decreases
- elastic recoil decreases
- bronchioles and alveolar ducts dilate
- ability to cough decreases
- airways close early
13Lungs
- residual volume increases
- vital capacity decreases
- efficiency of oxygen and carbon dioxide exchange
decreases - elasticity decreases
14Pharynx and Larynx
- muscles atrophy
- vocal cords become slack
- laryngeal muscles lose elasticity and cartilage
15Pulmonary Vasculature
- increased vascular resistance to blood flow
through pulmonary vascular system occurs - pulmonary capillary blood volume decreases
- risk of hypoxia increases
16Exercise Tolerance andMuscle Strength
- Exercise Tolerance
- bodys response to hypoxia and hypercapnea
decreases - Muscle Strength
- respiratory muscle strength, especially the
diaphragm and intercostals, decreases
17Susceptibility to Infection
- effectiveness of the cilia increases
- immunoglobulin A decreases
- alveolar macrophages are altered
18Chest Wall
- anteroposterior (AP) diameter increases
- thorax becomes shorter
- progressive kyphoscoliosis occurs
- chest wall compliance (elasticity) decreases
- mobility may decrease
- osteoporosis is possible
19Summary on effects of aging
- ? recoil and compliance
- ? AP diameter
- ? functional alveoli
- ? in Pa02
- Respiratory defense mechanisms less effective
- Altered respiratory controls
- More gradual response to changes in O2 and Co2
levels in blood
20Diagnostic Tests
- X-rays chest, bronchogram, CT, lung scan
- Direct visualization bronchoscopy
- Sputum specimen and Cultures
- Thoracentesis
- Pulmonary function tests (PFT)
- Oximetry
- Magnetic resonance imaging (MRI)
21Chest X-Ray
- Screen, diagnose, evaluate treatment
- Instructions
22X-ray Positions
23Chest X-Ray (Cont.)
Posterior Anterior View
Left Lateral View
24Bronchogram
25Computed Tomography CT Scan
- Images in cross-section view
- Uses contrast agents
- Instructions
Right upper Lobe
26Lung Scan
- most to detect emboli
- no food restrictions
- breathes radioactive material through a tube for
5 minutes - 6 ventilation images taken
- radioactive injection
- same 6 images retaken
- compare images
27Ventilation- air distribution in lungPerfusion-
blood supply to within lung
28Bronchoscopy
- Diagnose problems and assess changes in bronchi /
bronchioles - Performed to remove foreign body, secretions, or
to obtain specimens of tissue or mucus for
further study
- Post-Procedure Care / Instructions
-
29Sputum Specimen
- To diagnose evaluate treatment
- Specimen ID organisms or abnormal cells
- Culture Sensitivity (CS)
- Cytology
- Gram stains
- (e.g. Acid Fast Bacilli)
30Thoracentesis
- Specimen from pleural fluid
- Treat pleural effusion
- Assess for complications
- Post-Procedure care
- Positions
- Sitting on side of bed over bedside table
chest elevated - Lying on affected side
- Straddling a chair
31Pneumothorax
32Pulmonary Function Test (PFTs)
- Evaluate lung function
- Observe for increased dyspnea or bronchospasm
- Instructions
33Pulse Oximetry
- Measures arterial oxygen saturation
- Pulse oximetry probe on ears, nose, finger, toes,
forehead - False readings
- Intermittent or continuous monitoring
- Ideal values
- When to Notify MD
34MRI
- Frontal View
- White masses Hodgkin Disease lesions
35MRI transverse view same patient
36Nursing AssessmentCardinal Signs and Symptoms
of1. Cough2. Sputum3. Dyspnea
37Cough Main Sign of Lung Disease
- how long present
- occurs at a specific time (smokers upon
wakening in AM) - related to activity
- productive vs nonproductive
- congested
- dry
- tickling
- hacking
38Sputum normally 3 oz produced/day
- important symptom associated with coughing
- Check
- duration long term, short term
- color rust colored
- consistency thick, thin, watery, frothy
- odor- foul
- amount describe in tsp, or fractions of cup and
if increasing (external or internal cause)
39Dyspnea subjective data (perception)
- difficulty in breathing or breathlessness
- Check
- onset slow or abrupt
- duration - of hours, time of day
- relieving factors position change, med, stop
activity - wheezing, crackles, rales, or stridor occur with
breathlessness - Quantify by assessing if interferes with ADL
- PND or orthopnea
40Lung sounds
- wheezing
- crackles
- stridor
- auscultation sequence pg. 534, Iggy
- bronchial trachea mainstem bronchi
- bronchovesicular branching bronchi
- vesicular small bronchiole periphery
41Pneumonia Case Study
42Nursing Student Tools
- Concept Map Pneumonia
- Medical-Surgical Map (Medimap)
- Nursing Map
43Pathophysiology
44Toxic sprinkles anyone?
45Etiology
- Cause
- bacteria (75)
- viruses
- fungi
- Mycoplasma
- parasites
- chemicals
46Classifications
- Community-acquired pneumonia (CAP)
- Onset in community or during 1st 2 days of
hospitalization (Strep. pneumoniae most common) - Hospital-acquired Pneumonia (HAP / nosocomial)
- Occurring 48 hrs or longer after hospitalization
- Aspiration pneumonia
- Pneumonia caused by opportunistic organisms
- Pneumocystis Carinii
47Risk Factors
- HAP
- Older adult
- Chronic lung disease
- ALOC
- Aspiration
- ET, Trach, NG / GT
- Immunocompromised
- Mechanical ventilation
- CAP
- Older adult
- Chronic/coexisting condition
- Recent history or exposure to viral or influenza
infections - History of tobacco or alcohol use
48Clinical Manifestations - 1
- Fevers, chills, anorexia
- Pleuritic chest pain
- SOB
- Crackles / wheezes
- Cough, sputum production
- Tachypnea
49Clinical Manifestations - 2
- Mycoplasma (Atypical)
- feeling tired or weak, headaches, sore throat, or
diarrhea. - Eventually, most develop a dry cough. They can,
also, develop fever, chills, earaches, chest pain - walking pneumonia
50Diagnosis
- Diagnosis ?
- Physical exam ? crackles, rhonchi / wheezes
- CXR ? area of increased density
- (infiltrates / consolidation)
- Sputum specimen
- Gram stain
LUL Infiltrates
51CXR- LUL Pneumonia
52Interventions and Treatment
- Treatment
- Antibiotics ? choose based on age, suspected
cause immune status - Supportive care ? IV fluids, supplemental oxygen
therapy, respiratory monitoring, cough
enhancement - may take 6-8 weeks for CXR to normalize
53Nursing Diagnoses
- Impaired gas exchange R/T Pneumonia
- Pain R/T infection in lung Pneumonia
54Complications
- Hypoxemia
- Pleural effusion
- Atelectasis
- Pleurisy
Atelectasis
Pleurisy
Pleural Effusion
55Atelectasis
- A obstruction
- B accumulation of fluid of air
56Additional learning resources
- NANDA approved nursing diagnoses specific to
respiratory system p125 of study packet - Skills Lab
- Heart and Lung Sounds Trainer
- Learning Lung Sounds, Cardionics CD
- Audio-visual material
57Resources
- Beers, M. Berkow, R. (Ed.). (2000). The Merck
Manual of Geriatrics (3rd ed.). Whitehouse
Station Merck Co., Inc. - Chabner (2007). The Language of Medicine (8th
ed.). St. Louis Saunders. - Ignatavicius, D. Workman, L. (2006).
Medical- Surgical Nursing Critical Thinking for
Collaborative Care (5th ed.). St. Louis
Elsevier Saunders. - Scherer, D. (2008). Pictures retrieved March 31
and available at dscherer.com
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