RESPIRATORY FUNCTION

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RESPIRATORY FUNCTION
RNSG 1413 Amy C. Chavarria, RN, MSN, MBA, HCM, CCE
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Function of the Respiratory System

• The function of the respiratory system is ____
  __________
• Oxygen from inspired air diffuses from _______in
  the lung into the ______ in the pulmonary
  capillaries
• __________ produced during cell metabolism
  diffuses from the blood into the alveoli and is
  exhaled.

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NORMAL RESPIRATORY FUNCTION

• STRUCTURE
• Mouth
• Nose
• Pharynx
• Trachea
• Lobar Bronchi
• Segmental bronchi
• Bronchiole

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Structures of the Respiratory System

• Upper Respiratory Tract
• Mouth
• Nose
• Pharynx
• Larynx

• Lower Respiratory Tract
• Trachea
• Bronchi
• Bronchioles
• Alveoli
• Pulmonary capillary network
• Pleural membranes

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• STRUCTURE (cont.)
• Alveoli
• Lungs

Review on own in text. You are responsible for
knowing.
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FUNCTION OF RESPIRATORY SYSTEM

• Breathing or Ventilation
• The physical process of moving gases (__ and __)
  in and out of the lungs.
• Results from volume and _____ changes in the
  chest cavity.

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Process of Breathing

• Inspiration
• Air flows ____ lungs
• Expiration
• Air flows ___ of lungs

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• On inhalation/inspiration - diaphragm and
  intercostal muscles _______.
• This enlarges the thorax volume and ___
  intrathoracic pressure.
• The lower intrathoracic pressure pulls air ______
  the lungs.

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• On exhalation/expiration the process reverses.
• The diaphragm and intercostal muscles _____.
• The thorax returns to it _____ resting size.
• Pressure in the chest ? (more than atmospheric
  pressure).
• Forcing air ___ of the lungs.

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Process of Breathing
O2
CO2
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• Breathing or Ventilation (cont.)
• Normally, little _____ is required to draw air in
  through the airway passage (nasal cavity,
  pharynx, larynx, trachea, bronchus, bronchioles,
  alveolar ducts).
• Cartilage give structure to the _____ and _______
  and prevents them from collapsing.
• Smooth muscle ____ helps keep the bronchioles
  open.

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• Gas Diffusion
• Diffusion - molecules move from an area of ______
  concentration or pressure to an area of _____
  concentration or pressure.

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• Gas Diffusion (cont.)
• Continuous breathing replenishes the lungs
  oxygen supply.
• This keeps the partial pressure of oxygen (____)
  in the alveoli ____.
• It also blows off the CO2 which keeps the partial
  pressure of carbon dioxide (____) ___ in the
  alveoli.

The pressure exerted by each individual gas in
a mixture according to its concentration in the
mixture.
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• Gas Diffusion (cont.) - ALSO
• Blood ____ to the lungs from the bodys tissues
  has ____ oxygen content and ___ carbon dioxide
  levels.
• Oxygen diffuses from the alveoli into the blood
  because the PO2 is ____ in alveoli than in the
  capillary blood.
• Likewise, the CO2 is ____ in the capillary blood
  and it diffuses into the alveoli because CO2 is
  lower there.

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• Gas Transport
• As O2 crosses the alveolar- capillary membrane
  into the blood, the blood transports it to the
  tissues in two forms.
• Small amounts of O2 are dissolved in the _______.
• ___ of the O2 is attached to the hemoglobin
  molecules on ___s.
• Called _________.

Is the oxygen-carrying red pigment in the RBC.
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• Gas Transport (cont.)
• Factors that affect the rate of O2 transport from
  the lungs to the tissues are
• Cardiac output (__)
• Number of erythrocytes (__) and blood
  hematocrit
• Exercise (O2 transport _____ with regular
  exercise)

The amount of blood ejected by the heart with
each ventricular contraction. The proportion
of RBC to the total blood volume.
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• Gas Transport (cont.)
• The blood carries CO2 in several forms.
• In dissociated form (___).
• It is carried inside the ___.
• It chemically combines with ___ and forms into
  bicarbonate ions (HCO3).
• CO2 H2O ? HCO3 H

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• Gas Transport (cont.)
• The blood carries CO2 in several forms (cont.)
• ___ of CO2 combines with __________ as
  carbhemoglobin (or carbaminohemglobin) for
  transport.
• __ combines with ____ and transports as carbonic
  acid.
• CO2 H2O ? H2CO3

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• Control of Ventilation
• Respirations are regulated via _____ and
  ______controls to maintain balance between O2 and
  CO2.
• The respiratory center is actually a group of
  neurons located in the _________ and ____ of the
  brain (brain stem) called the reticular
  formation.

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• Control of Ventilation (cont.)
• A chemosensitive center in the medulla oblongata
  is highly sensitive to ___ in ___ or hydrogen ion
  concentration.
• Increase in these components will increase ___
  and _____ of respirations.

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• Control of Ventilation (cont.)
• Neuroreceptors in the in the carotid bodies and
  aortic bodies are sensitive to _____ in _____
  concentration.
• ______ in _____ concentrations in these areas
  will stimulate the respiratory center to ________
  ventilation.

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• Control of Ventilation (cont.)
• Of all 3 blood gases (H, O, CO2) that trigger
  respiratory response,
• an __ in ___ concentration normally stimulates
  respirations ___ strongly.

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• Defenses of the Respiratory System
• _______ and _____ air
• Maintains fluid for mucous membranes
• Nose cilia ______ irritants
• Epiglottis prevents ________ (opens-shuts)
• Sneeze and cough expels irritants

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Factors that Influence Respiratory Function

• Age
• Environment
• Lifestyle
• Health status
• Medications
• Stress

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NORMAL RESPIRATORY RATES

• Newborn-Infant 30-60/Min
• 1-__ Years __-__/Min
• 6-10 Years 15-25/Min
• Teen Years 15-20/Min
• Adult Years 12-20/Min
• Older Adult (gt70 years) 15-20/Min

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LIFESPAN CONSIDERATIONS

• Newborn Infant
• Not until the _____ week of gestation are the
  fetus lungs ________ enough to function outside
  of utero.
• Surfactant is necessary for lung _______ and to
  have enough of it, it takes another __ weeks or
  more for fully functional lungs.

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• Newborn (NB) Infant (cont.)
• NB breath rapidly (___).
• ______ NB breath more slower than smaller ones.
• Occasional _____ between breaths of several
  seconds (can last up to 3 months). Irregular
  respirations are ______.
• True apnea is ________.

Cessation of breathing for 20 seconds or more.
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• Toddler Preschooler
• Pattern evens out.
• Respiratory rate slows down (___-___).
• By ___ year respirations rhythm is smooth regular.

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• Toddler Preschooler (cont.)
• No hard _____.
• Cut up food in _____ pieces.
• Give large toys.
• No eating on the ___.
• Risk for aspiration r/t putting things in mouth.

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• Child Adolescent
• Childs rate _____ closer to adult rate.
• Usually good respiratory health during this
  period.
• During adolescence some experiment with _____
  usually occurs.

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• Child Adolescent (cont.)
• Smoke___ tobacco has increased in popularity.
• A physically fit athlete breathes ______.
• Lots of teaching.

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• Adult Older Adult
• Thoracic wall more _____.
• Lungs less able to ______.
• ___ significant decrease in total lung capacity.

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• Adult Older Adult (cont.)
• Protective functions diminish
• ____ in ciliary activity
• Cough is less ______ and effective to clear
  airway.
• Gas Exchange is decreased
• PO2 _____ by 10-15.
• These changes contribute to _______ incidence of
  respiratory _______ and activity _________.

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FACTORS AFFECTING RESPIRATORY FUNCTION

• Body Position
• _______ position best because it allows for
  fullest lung expansion.
• Supine position more difficult because the
  abdominal contents ______ against the diaphragm.

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• Environment
• FIO2 remains stable at around 21 when breathing
  in room air (no supplemental O2).

Means forced inspired oxygen concentration and
is the percentage of oxygen humans breath.
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• Environment (cont.)
• At _____ altitudes there is ______ O2 pressure
  which means ____ O2 available.
• What does this do to respirations?
• COPD have more difficulty in ___ and _______
  conditions.

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• Air Pollution
• Interfere with oxygenation
• Damaging lungs (hydrocarbons and oxidants from
  cars/factories).
• Carbon monoxide (CO3) ______ O2 attachment onto
  the hemoglobin.
• Act as irritants to respiratory track and
  ________ mucus production (asthma and
  bronchitis).
• Dusts in work environments can lead to lung
  damage.
• Also, includes _______ hand smoke.
• Prone to develop severe breathing problems

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• Pollens/Allergens
• Allergic responses cause _________ response which
  leads to tissue damage.
• Almost ___ substance can be an allergen (pollen,
  dust, and foods are common triggers).
• May lead to _____________.

Substances that trigger an inflammatory
response.
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• Lifestyles and Habits
• Smoking
• More likely to acquire emphysema, chronic
  bronchitis, lung cancer, bladder cancer, CV
  disease and oral cancer.
• Inhibits mucous ________.
• Can cause airway ______ and promote bacterial
  colonization and _______
• Smokers usually breathe more ______.

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• Drugs and Alcohol
• Barbiturates, narcotics, and some sedatives
  ______ CNS resulting in _____ in respirations.
• Alcohol in large doses can do the ____.
• If person is really impaired the is danger of
  ______ when they begin to vomit.

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• Nutrition
• Without proper diet the body cant produce plasma
  _____ and ___
• The respiratory musculature requires _____ and
  _____ to work.
• Resulting in diminished strength and makes it
  harder to breath.

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• Nutrition (cont.)
• Adequate ______ are needed to ___ secretions so
  they can be expectorated.
• A healthy diet is necessary to maintain a
  competent _____system.

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• Nutrition (cont.)
• At risk
• ______ restricts lung capacity and ______ O2
  demands.
• Alcoholics are drinking their ______ and
  receiving ___ nutrients.

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• Increased Work of Breathing
• Restricted Lung Movement
• Lungs _____ or restrict movement of chest.
• Alveoli collapse, called _______, and space
  available for gas exchange ______, which leads to
  ____ O2 available in blood and _____ up of CO2.

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• Increased Work of Breathing (cont.)
• Airway Obstruction
• Can be caused by ______ body, _____ or ______.
• Altered ____, inflammation chronic diseases cause
  airway to become constricted and narrowed.

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TERMS/SYMPTOMS TO KNOW

• Adventitious Breath Sounds - abnormal breath
  sounds from air passing through narrowed
  passageways.
• Crackling (rales)
• Gurgles (rhonchi)
• Wheezes
• Friction rub (pleural friction rub)
• Stridor

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• Crackles (rales)
• Fine ____-pitched or low-pitched popping or
  crackling sounds that are short and discontinuous
  (_________).
• Alveolar rales are high pitched best heard on
  inspiration but can be heard on both inspiration
  and expiration.
• May ___ be cleared by coughing.
• Caused by air passing thru _____ or mucus in any
  air passage.
• Most commonly heard in the _____ of the lower
  lung lobes (or smaller passageways).
• Heard in pneumonia, heart failure, atelectasis,
  and emphysema.

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• Gurgles (rhonchi)
• Continuous, ___-pitched, coarse, gurgling, harsh,
  louder sounds with a moaning or ______ quality.
• Best heard on expiration but can be heard on both
  inspiration and expiration.
• May be _______ by coughing.
• Caused by air passing thru ______ airways that
  have narrowed air passage as a result of
  secretions, swelling, tumors.
• Hear over most lung areas but predominately over
  the ______ and _________.
• Heard in COPD, bronchospasm, and pneumonia.

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• Wheeze
• ____________, high-pitched, squeaky musical
  sounds or ____________ sound.
• Can be heard throughout inspiration and
  expiration. Best heard on expiration.
• ____ usually altered by coughing.
• Air passing through a narrowed or constricted
  bronchus or other narrowed passages as a result
  of secretions, swelling, tumors.
• Can be heard over ___ lung fields.
• Heard in airway obstruction, bronchospasm,
  asthma, COPD.

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• Friction rub (pleural friction rub)
• Superficial _______, scratching or creaking
  sounds heard during inspiration and expiration.
• Heard best at ____ of lung at end of _________.
• Heard most often in areas of greater thoracic
  expansion (lower anterior and lateral chest).
• ___ relieved by coughing.
• Caused by rubbing together of inflamed pleural
  surfaces.
• Heard in inflamed pleura and pulmonary infarction.

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• Stridor
• A ______, high-pitched, _____ sound.
• Usually heard on ___________.
• Heard in obstruction in the trachea or larynx
  edema of the glottis asthma, diphtheria, and
  laryngospasm.

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• Normal breath sounds include
• Broncho-vesicular
• Bronchial (tubular)
• Vesicular

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• Broncho-vesicular BS
• Moderate-intensity and moderate-pitched _________
  sounds
• Created by air moving thru larger airway
  (______).
• Heard between the scapula and lateral to the
  sternum at the _____ and _____ intercostal spaces.

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• Bronchial (tubular) BS
• High-pitched, ____, harsh sounds.
• Created by air moving thru the _______.
• Heard over the trachea.
• Not normally heard over lung tissue.
• ______ than vesicular sound.

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• Vesicular BS
• ____-intensity, low-pitched, gentle ________
  sounds.
• Created by air moving through _______ airways
  (bronchioles and alveoli).
• Heard over _________ lung.
• Best heard at base of lung.

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• Kussmauls body attempts to compensate for an
  _____ condition by blowing __ the ___ thru
  _____and _______ breathing.
• Biots (cluster) respirations ______ breaths
  interrupted by ____ seen in CNS disorders.

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• Cheynes-Stokes Breathing marked rhythmic ______
  and ______ of respirations from very _____ to
  very _______ breathing and temporary _____
  shallow to normal breathing and then episodes of
  apnea seen in CHF, increase intracranial
  pressure, and drug overdose.

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• Bradypnea abnormally slow respirations, usually
  lt __ bpm in adults seen in narcotics/sedative
  overdose, metabolic alkalosis, or in increased
  intracranial pressure.
• Tachypnea _____ rate seen in fevers, metabolic
  acidosis, pain, and with hypercapnea or hypoxemia.

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OTHER RESPIRATORY TERMS

• Apnea ________of respirations.
• Atelectasis _______ of alveoli.
• Apneustic Breathing - ______ inspirations
• Cyanosis - _____ discoloration of skin,
  nailbeds, mucous membranes caused by lack of ___
  and/or respiratory distress.

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• Dyspnea _____ or uncomfortable breathing
  breathing that requires marked ______.
• Eupnea ______ breathing quiet, rhythmic, and
  effortless.
• Hemoptysis expectoration of blood or ______
  sputum.
• Hypercarbia (Hypercapnia) - ? ___ in ______.

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• Hypoventilation - less ____ and not as _____
  breaths.
• Hypoxia is a condition of insufficient ___
  anywhere in the body, from the inspired gas to
  the tissues.
• Orthopnea- difficult breathing except ________.

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• SOB (shortness of breath) a feeling of being
  unable to get _______ air (_________________).
• Surfactant lipoprotein produced by specialized
  alveolar cells, acts like a detergent, ________
  the surface tension of alveolar fluid keeps the
  lungs from collapsing.
• Tidal Volume the amount of air ______ and
  ______ with each breath. In adults it is
  approximately ___ mL of air.

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Obstructed or PartiallyObstructed Airway

• _______ indicated by low-pitched snoring during
  inhalation
• __________ indicated by extreme inspiratory
  effort with no chest movement

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• PHYSICAL EXAMINATION
• __________ - rate and pattern of breaths
• __________ - extent and pattern of thoracic
  expansion
• _____________ - detect fluid or consolidated
  areas
• ___________________- determine air movement

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DIAGNOSITIC TESTS AND PROCEDURES

• VISUALIZATION PROCEDURES
• Chest X-ray - identify pathological changes in
  lung fields
• Lung scan
• Laryngoscopy
• Bronchoscopy
• Thoracentesis
• PULMONARY FUNCTION TESTS
• Measure lung size and airway capacity

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• SPUTUM CULTURE
• Culture sensitivity
• Cytology
• Acid-fast bacillus (AFB)
• Effectiveness of therapy
• ABG MONITORING
• Accurate picture of gas exchange
• PULSE OXIMETRY
• Measures arterial blood oxygen saturation Sao2
  or O2 Sat
• SKIN TESTS
• To Identify allergies and sensativities to
  certain antigens or diseases

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Nursing Measures to Promote Respiratory Function

• Ensure a patent airway
• Positioning
• Encouraging deep breathing, coughing
• Ensuring adequate hydration

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Therapeutic Measures to Promote Respiratory
Function

• Medications
• Incentive spirometry
• Chest PT
• Postural drainage
• Oxygen therapy
• Artificial airways
• Airway suctioning
• Chest tubes

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Incentive Spirometry
A
B
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Chest PT
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Oxygen Therapy
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Oxygen Therapy
Nasal cannula
Simple face mask
Partial rebreather mask
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Oxygen Therapy
Nonrebreather mask
Venturi mask
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Artificial Airways
Oropharyngeal Airway
Nasopharyngeal Airway
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Desired Outcomes

• Maintain a patent airway
• Improve comfort and ease of breathing
• Maintain or improve pulmonary ventilation and
  oxygenation
• Improve ability to participate in physical
  activities
• Prevent risks associated with oxygenation
  problems

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NURSING DIAGNOSIS

• Ineffective Airway Clearance
• Unable to clear secretions or obstructions
• Ineffective Breathing Patterns
• Inhalation /or exhalation pattern doesnt allow
  adequate. pulmonary inflation or deflation
• Impaired Gas Exchange
• Decreased passage of O2 /or CO2 between alveoli
  vascular system.

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Evaluation

• Collect data to evaluate the effectiveness of
  interventions
• If outcomes not achieved, explore the reasons
  before modifying the care plan