Respiratory System2

RESPIRATORY
SYSTEM
Billy Ray A. Marcelo, RN

Faculty
Bataan Peninsula State University
OVERVIEW
 Basic Process of Oxygenation
 Ventilation- degree of compliance,
airway resistance, accessory muscles

(Respiratory System)
 Diffusion- thickness of membranes
(Hematologic System)
 Perfusion- integrity of transport
system (CV and Hematologic System)

OVERVIEW
 Function: Respiratory System
 Obtains O2, removes CO2
 Filters particles from incoming air
 Control T and water content
 Role in sense of smell
 Regulates blood pH
OVERVIEW
OVERVIEW
 Upper Respiratory Tract
 Filtering of air, warming, moistening
 Humidification
A. Nose
 Framework of cartilage
 2 septum/nostril
 Anastomosis of capillaries (Keisselbach)
B. Pharynx (Throat)- organ of GI and RT

 Muscular pasageway for food and air
 Nasopharynx
 Oropharynx
 Laryngopharynx
OVERVIEW
C. Larynx (Voicebox)
 Phonation (speech production)
 Cough reflex
 Frameworks
 Arythenoid and cricoid cartilage
 Thyroid gland
 Hyoid bone
 Glottis
 Epiglottis
 Opens: passage of air
 Closes: passage of food

Upper Respiratory Tract
OVERVIEW
 Lower Respiratory System
 Gas exchange
A. Trachea (windpipe)
 Cartilaginous rings, ‘U’ shape
 Site of permanent artificial airway

(tracheostomy)
B. Carina- area of bifurcation of brochi
C. Bronchi
 R main bronchus- wider straighter
 L main bronchus
OVERVIEW
D. Lungs- covered by serous membrane
 R- 3 lobes
 L- 2 lobes
 Pleural cavity
 Parietal- with 20 cc of fluid to

prevent friction, with nerve endings
 Visceral- without nerve endings
 Pleural
OVERVIEW
D. Lungs
 Terminal bronchioles
Alveoli (Acinar cells)- site of gas

exchange (CO2 and O2)
Type II cells- secretes
SURFACTANT (phospholipid
lipoprotein)   surface
tension
PNEUMONIA
 Inflammation of lung parenchyma  pulmonary
consolidation as the alveoli are filled with exudates
 Causative Agents
 Streptococcus pneumoniae (Pneumococcal
pneumonia)
 Hemophilus influenzae (Bronchopneumonia)
 E. Coli
 Klebsiella
 Pseudomonas aeruginosa
PNEUMONIA
Predisposing Factors:

PNEUMONIA
Excessive smoking
 Air pollution
 Over fatigue
 Prolonged immobility  hypostatic
pneumonia
 Aspiration
 Immunocompromised state
 AIDS- Pneumocystis carinii (taking
Zidovudine or AZT)
 Bronchogenic CA
Signs and Symptoms: PNEUMONIA
 Productive cough (greenish to rusty sputum)
 Dyspnea with prolonged expiratory grunt
 Fever, chills, anorexia, N/V, weight loss
 Pleuritic friction rub
 Rales, crackles, Bronchial wheezing
 Cyanosis
 Chest pain
 Abdominal distension  paralytic ileus (most
feared Cx)
Diagnostic Procedures:
PNEUMONIA
 Sputum C/S
 Gram-staining C/S
 Chest X-Ray- reveals
pulmonary consolidation
 ABG-  pO2
 CBC-  WBC,  ESR

Nursing Management:
PNEUMONIA
 CBR
 Place pt. on semi-fowler’s
 Low flow O2 as ordered
 Give comfortable and humid

environment
 Diet:  CHON,  CHO,  Vit C
 Force fluids to liquefy secretions

 Importance of receiving
immunization as recommended
Nursing Management:
PNEUMONIA
 Administer meds as ordered
 Broad spectrum antibiotics
 Penicillin, Tetracycline,
Macrolides
 Antipyretics
 Mucolytics/ Expectorants
(Guiafenesin, Glycerine,
Guiacolate)
Nursing Management:
PNEUMONIA
 Institute pulmonary toilet
 DBE
 Coughing
 Chest physiotherapy (CPT)
 Turning and repositioning
 Nebulize and suction prn

Chest Physiotherapy
Nursing Management:
PNEUMONIA
 Institute postural drainage as ordered
 Pt is placed on various positions to promote
drainage of secretions, stay for 20-30 minutes

 Best done before breakfast, or 2-3 hrs p.c.
 Pt. should be well hydrated, knows how to
cough
 Prone with pillow on abdomen- drains
lower part of the lungs

 Supine with buttocks up- drains upper
part of the lungs

Postural Drainage
Postural Drainage
Nursing Management:
PNEUMONIA
 Institute postural drainage as ordered
 Monitor VS, breath sounds
 Administer bronchodilators 15-30 minutes
prior
 Encourage DBE
 Stop if pt can’t tolerate the procedure
 Give oral care post procedure
 No to pt with: hemoptysis, unstable VS, 
ICP,  IOP
Nursing Management:
PNEUMONIA
 Discharge Health Teaching
Stop smoking
Regular adherence to meds
Dietary modification
Follow-up care
Prevent Cx: atelectasis and
meningitis
PULMONARY TUBERCULOSIS
 Or Koch’s Disease
 Causative agent: MTB- acid-fast, non-motile
 Predisposing Factors
 Malnutrition
 Overcrowding
 Alcoholism
 Ingestion of affected cattle (with M. bovis)
 Virulence of the microorganism

Signs and Symptoms: PTB
 Productive cough- yellowish secretions > 2
wks
 Dyspnea
 Low grade afternoon fever- Pathognomonic
Sign
 Night sweats- Classical Sign
 Anorexia, general body malaise
 Weight loss
 Chest pain
 Hemoptysis
Diagnostic Procedures: PTB
 Mantoux Test- skin
test, injection of PPD
 Reading: after 48-72
hrs
 (+) exposure to PTB:
 DOH: 8-10 mm
induration
 WHO: 10-14 mm
induration
Diagnostic Procedures: PTB
 Sputum AFB-
(+) MTB
 Chest X-ray-
pulmonary
infiltrates
(caseous
necrosis)
 CBC-  WBC
 Nursing Management
 CBR
 Comfortable environment
 O2 inhalation as ordered
 Force fluids to liquefy secretions
 NO CPT, only DBE and coughing
 Place on semi-fowler’s
 Diet:  CHON,  CHO,  Vit C

 Short Course Chemotherapy
 I. Intensive Phase
 INH- given for 4 mos., taken a.c.
 S/E: peripheral neuritis- give Vit B6
 Rifampicin- given for 4 mos., taken a.c.
 S/E: all body secretions turned red-orange
 PZA- given for 2 mos., taken p.c.
 S/E: skin rashes, nephro and hepatotoxicity
 PZA is replaced by Ethambutol
 S/E: optic neuritis (visual disturbance)

 Short Course Chemotherapy
 II. Standard Regimen
 Streptomycin IM (Aminoglycoside)
 S/E: Ototoxicity due to damage
to CN VIII temporary hearing

loss
 Nephrotoxicity- monitor BUN
and Crea levels

 Avoid precipitating factors
 Take meds religiously
 If missed 1 day’s meds, NEVER  the
dose on the next day, simply let the pt

continue taking the meds
 Prevent Cx: Atelectasis and Miliary TB
 Follow-up care
HISTOPLASMOSIS
 Acute fungal
infection
characterized by
inhalation of
contaminated dust
with Histoplasma
capsulatum from
bird’s manure
HISTOPLASMOSIS
 S/Sx: PTB, Pneumonia-like
 Productive cough
 Dyspnea
 Cyanosis
 Hemoptysis
 Fever, chills, anorexia, general body malaise
 Chest and joint pain

HISTOPLASMOSIS
 Diagnostic Procedure
 (+) Histoplasmin skin test
 (+) agglutination test
  WBC
 ABG-  pO2
 CXR- (+) infiltrates

HISTOPLASMOSIS
 CBR, semi Fowler’s position
 O2 inhalation as ordered
 Force fluids
 Encourage coughing & DBE

HISTOPLASMOSIS
 Antifungal agent: Amphotericin B (Fungizone)
 S/E: nephrotoxicity and hypoK+
 Corticosteroids
 Antipyretics
 Antihistamines
 Mucolytics/expectorants
HISTOPLASMOSIS
 Spraying of breeding places
 Prevent Cx: Atelectasis and
Bronchietasis
SEVERE ACUTE RESPIRATORY
SYNDROME (SARS)
 Cause: Coronavirus
 Begins with fever, body aches, mild
respiratory Sxs
 After 2-7 days, dry cough & dyspnea
develops
 MOT: close person-to-person contact (direct
contact with infectious secretions and soiled
articles)
 Prevention: avoiding contact with those
suspected of having SARS, avoiding travel to
countries with SARS outbreak, frequent
hand washing
INHALATION INJURIES:
CO poisoning
 CO: colorless, Blood Assessment
odorless, tasteless, Level
with affinity for Hgb 1-10% Impaired visual acuity
200X greater than
O2, forming 11-20% Flushing, HA
carboxyHgb tissue 21-30% N/, impaired dexterity
hypoxia
31-40% Vom,dizziness,syncope
41-50% HR, RR
>50% Coma, death

INHALATION INJURIES:
CO poisoning
 Interventions
 Remove victim from exposure
 Administer 100% O2
 Assess need for CPR
 Monitor VS and CO levels

OCCUPATIONAL LUNG
DISEASE: SILICOSIS
 Or Asbestosis or Coal Workers’
Pneumoconiosis
 Fibrotic lung disease caused by
inhalation or organic dusts over

long periods of time
 Common among miners &
sandblasters
OCCUPATIONAL LUNG
DISEASE: SILICOSIS
 S/Sx
 Uncomplicated or simple:
asymptomatic with evidence of
fibrosis on CXR
 Chronic complicated: malaise, A/,
wt loss, severe dyspnea on

exertion, massive fibrosis on CXR
OCCUPATIONAL LUNG
DISEASE: SILICOSIS
 Interventions
 Eliminate the toxic substance

 O2 as ordered
 Coughing and DBE
 Administer antitussives for cough
& anti-TB meds as ordered (Cx:

PTB)
COPD
Types
 Chronic Bronchitis
 Bronchial Asthma
 Bronchiectasis
 Pulmonary Emphysema
COPD-Chronic Bronchitis
 Inflammation
of bronchi
hyperplasia of
goblet mucus-
producing cells
 narrowing of
smaller airways
 Predisposing
Factors
 Excessive,
chronic
smoking
 Air pollution
 S/Sx
 Dyspnea at exertion
 Prolonged expiratory grunt
 Scattered rales, rhonchi
 Cyanosis- Blue Bloaters
 Feeling of breathlessness
 Pulmonary HTN leading to peripheral edema
and Cor Pulmonale (most feared Cx)

Cor Pulmonale
COPD-Bronchial Asthma
 Reversible inflammatory disorder of
lung tissue due to hypersensitivity to
allergens  narrowing of smaller
airways
 Predisposing Factors (based on 3 types)
 Extrinsic (Atopic/Allergic)
 Pollen, dust, furs, fumes, gases,
smoke, danders, lints

 Intrinsic (Non-Atopic/Non-Allergic)
 Hereditary
 Drugs: ASA, Pen, Phenylbutazone, Beta blockers
 Foods: seafoods, eggs, chicken, chocolate, milk
and its products

 Food additives- nitrates (also can cause CA)
 Sudden change in T, air pressure and humidity
 Extreme emotion
 Physical stress
 Mixed- combination of the 2

 Most common type (90% of cases)
Pathophysiology
Allergens
Release of IgE by B-lymphocytes
IgE + mast cells (respiratory tract)
Damage to mast cells
Release of chemical mediators
(histamine, bradykinin, serotonin, prostaglandin)
vasodilatation
Hypotension blood congestion
shock
increased capillary permeability

escape of colloids
edema decreased blood vol.
 S/Sx
 Non-productive cough
 Dyspnea
 Wheezing on expiration
 Slight cyanosis
 Mild restlessness and apprehension
 Tachycardia and palpitation
 Diaphoresis
 Diagnostic Procedures
 ABG- pO2
 PFT-  vital lung capacity (max.
vol. of air that can be exhaled

with the deepest breath possible)
Bronchodilators- inhalation or
metered dose inhaler (pump)

Corticosteroids
Mucolytics/Expectorants
Anti-histamine
 O2 as ordered
 Force fluids
 Comfortable and humid
environment
 Avoid precipitating factors
 Regular adherence to meds
 Sudden withdrawal to corticosteroids 
status asthmaticus
 Prevent Complications
 Emphysema
 Status asthmaticus- Drug of Choice:
Epinephrine
COPD-Bronchiectasis
 Permanent
dilatation of
bronchus 
destruction of
elastic and
muscular tissues
of the alveolar
walls
COPD-Bronchiectasis
 Recurrent URTI and LRTI
 Congenital anomalies
 Lung tumor
 Signs and Symptoms

 Dyspnea
 Cyanosis
 Hemoptysis
COPD-Bronchiectasis
 Diagnostic Procedures
 ABG-  pO2
 Bronchoscopy
COPD-Bronchiectasis
 Bronchoscopy: Nursing Management
 Pre-op: informed consent, maintain on
NPO, monitor VS
 Post-op
 Feed when gag reflex returns
 Avoid talking, coughing, smoking 
chronic irritation
 Monitor for S/ of gross/frank bleeding
 WOF laryngospasm and edema 
DOB, SOB  prepare trache set at

bedside
COPD-Bronchiectasis
 Same as in pulmonary emphysema
 Assist in surgical procedure
 Pneumonectomy
 Position post-op: lie on affected
side
 Segmental wedge lobectomy
 Position post-op: lie on
unaffected side
Pneumonectomy vs. Lobectomy
COPD-Pulmonary Emphysema
 Irreversible, end-stage stage of
COPD characterized by inelasticity
of alveolar wall  air trapping 
maldistribution of gases  over
distension of thoracic cavity  
A:P diameter (Barrel-chest)
 Excessive, chronic smoking
 Allergy
 Air pollution
 Hereditary- deficiency of alpha-1 anti-
trypsin  elastase/elastin  alveolar

recoil (Northern European origin)
 Elderly- high risk group
 Types
 Centrilobular/Panlobular
 Blue Bloaters
 pCO2 , pO2 , resp. acidosis with
hypoxemia
 Centriacinar/Panacinar
 Pink Puffers
 pCO2 , pO2 , resp. alkalosis with
hyperoxemia
Blue Bloater vs. Pink Puffer
The Blue Bloater
 Dyspnea at rest
 On lung percussion- resonance to
hyperresonance
 (+) nasal flaring
 rales, rhonchi
  breath sounds, vocal fremiti
 Barrel chest- Pathognomonic
Sign
 (+) pursed-lip breathing
 CBR
Bronchodilator
Corticosteroid
Antibiotics
Mucolytics/expectorants
 Low flow, Fixed concentration O2
inhalation as ordered not to remove the

Hypoxic Drive
 Force fluids
 Diet:  CHON,  Vit & min., 
CHO
 DBE- pursed-lip, cascade
coughing, CPT
 Nebulize and suction secretions
prn
 Stop smoking
 Regular adherence to meds
 Prevent Complications
 Atelectasis
 Cor Pulmonale
 CO2 narcosis- severe
disorientation/confusion  coma
 Pneumothorax
 Follow-up care
Restrictive Lung Disorders
Pneumothorax
 Partial/complete
collapse of the
lungs due to
accumulation of
air in the pleural
space
Pneumothorax
 3 types
 Spontaneous- without obvious cause
 e.g. rupture of bleb (alveolar fluid sac) in
recurrent lung inflammation and infection

 Open- thru chest opening
 e.g. stab, gunshot wounds
 Tension- from blunt chest injury or from mech.
vent. With PEEP air enters pleural space with

each inspiration and cannot escape  thoracic
cavity  mediastinal shift
 E.g. flail chest (with paradoxical
breathing)
Pneumothorax
 Chest trauma
 Recurrent inflammatory lung
condition
 Lung tumors
Pneumothorax
 Cool, moist skin (beginning of shock)
 Sharp, chest pain
 Unexplained dyspnea
  breath sounds  lung collapse
  lung expansion
 Cyanosis
Pneumothorax
 Mild restlessness/apprehension
 On lung percussion- resonance to
hyperresonance
 SQ emphysema (crepitus on palpation)
 Tracheal deviation to unaffected side

Pneumothorax
 Diagnostic Procedure
 ABG-  pO2
 Chest X-ray- partial or complete lung
collapse
Nursing Management:
Pneumothorax
 Assist in intubation
Narcotic analgesic
Antibiotics
Nursing Management:
Pneumothorax
 Assist in thoracentesis/ chest tube
thoracostomy
 Remove air- insert at 2nd-3rd ICS
 Remove fluid- insert laterally near
base, posteriorly at 8th-9th ICS

 Pt position: struggling to a chair, pt
exhales and hold breath during

insertion (under local anesthesia)
Thoracentesis
Nursing Management:
Pneumothorax
Attach tube to water-seal drainage
Objectives:
To reestablish (-) pressure in
the lungs
To promote lung expansion
To drain air, fluid and blood
and to prevent it reflux

Nursing Management:
Water Seal Drainage
 Monitor VS, I/O, breath sounds
 DBE
 Maintain strict asepsis

Nursing Management:
Water Seal Drainage
 Prepare at bedside:
vaselinized gauze
Hemostan clamp
Extra bottle with water

Nursing Management:
Water Seal Drainage
 Monitor for oscillation and fluctuation
 N- (+) intermittent bubbling,  with
inspiration,  expiration
 Check for leakage
 If (-) bubbling: check for kinks,
obstruction- milk towards drainage

bottle, or lungs are fully expanded
Water Seal Drainage
Nursing Management:
Water Seal Drainage
 3 parameters to remove chest tube
 (-) bubbling/fluctuations
 (+) symmetrical breath sounds
 Chest X-ray confirms full lung
expansion
Nursing Management:
Water Seal Drainage
 Before, During and After Removal of Chest
Tube
 Encourage DBE
 Monitor VS, breath sounds
 Give analgesic prior to removal
 Instruct pt to perform Valsalva maneuver
for easy removal and to prevent air entry to

pleural space
 Apply vaselinized occlusive dressing, WOF
bleeding
PLEURAL EFFUSION
 Collection of fluid in the pleural space
 S/Sx
 Pleuritic pain that is sharp &  with inspiration
 Dyspnea on exertion
 Dry, nonproductive cough caused by bronchial
irritation or mediastinal shift
 HR, T
  breath sounds
 CXR: confirms the dx & shows mediastinal shift
PLEURAL EFFUSION
 Interventions
 Identify & tx the underlying
cause
 Monitor breath sounds
 High Fowler’s position
 Coughing & DBE
 Prepare the pt for thoracentesis

PLEURAL EFFUSION
 Interventions
 If recurrent, prepare the pt for:
 Pleurectomy: surgically stripping

parietal away from visceral pleura to
promote adhesion of the 2 layers
during healing
 Pleurodesis: instilling sclerosing
substance into pleural space via
thoracotomy tube
EMPYEMA
 Collection of pus in the pleural cavity
(thick, opaque, foul-smelling)
 Causes: pulmonary infection, lung
abscess due to thoracic surgery or chest
trauma
 Goal of tx: emptying empyema cavity,
reexpanding the lung, controlling
infection
EMPYEMA
 S/Sx of infection +  chest wall mov’t &
pleural exudate on CXR
 Interventions
 Semi or High Fowler’s position
 Coughing and DBE
 Splint the chest if in pain
 Antibiotics as ordered
EMPYEMA
 Interventions
 Assist in chest tube insertion
 If (+) marked pleural
thickening, prepare the pt for

Decortication: surgical removal
of restrictive mass of fibrin &
inflammatory cells
PLEURISY
 Inflammation of the visceral &
parietal pleura, rubbing together
during breathing causing pain
 May be caused by pulmonary
infarction or pneumonia
 Usually occurs on one side of the
chest (lower lateral portion)

PLEURISY
 S/Sx
 Knifelike pain aggravated by
deep breathing & coughing

 Dyspnea
 Pleural friction rub on
auscultation
 Apprehension
PLEURISY
 Interventions
 Identify and tx the cause
 Hot or cold applications as ordered
 Encourage coughing & DBE
 Lie on affected side to splint the
chest
 Analgesics as ordered
ACUTE RESPIRATORY
DISTRESS SYNDROME
 A form of acute respiratory failure as a
complication of other condition, caused by
diffuse lung injury extravascular lung
fluid compression of terminal airways 
 lung vol. & compliance
 ABG= resp. acidosis & hypoxemia not
responding to  O2 concentration
 CXR= interstitial edema
ACUTE RESPIRATORY
DISTRESS SYNDROME
 Predisposing factors
 Sepsis
 Fluid overload
 Shock
 Trauma
 Neuro injuries
 Burns
 DIC
 Drug ingestion
 Toxic substance inhalation

ACUTE RESPIRATORY
DISTRESS SYNDROME
 S/Sx
  HR
 Dyspnea
  breath sounds
 Deteriorating blood gas levels
 Hypoxemia despite high O2
concentration
  pulm. compliance
 Pulm. infiltrates
ACUTE RESPIRATORY
DISTRESS SYNDROME
 Interventions
 Identify & tx the cause
 O2 as ordered
 High Fowler’s position
 Fluid restriction as ordered
 Diurretics, anticoagulants,
corticosteroids as ordered
 Prepare for intubation and mechanical
ventilation with PEEP

MECHANICAL VENTILATION
 TYPES
 1. Pressure-cycled
 The ventilator pushes air into the lungs until
an airway pressure is reached
 Used for short periods (pt in PACU & for
respiratory tx)
 2. Time-cycled
 With preset time
 Used for pedia & neonatal pt
 3. Volume-cycled
 With preset tidal volume that is delivered
regardless of the changing lung compliance

or airway resistance (from the vent. or from
the pt)
 4. Microprocessor
 Built into the vent. to allow continuous
monitoring of the vent. functions, alarms &

other parameters
 For pt with severe lung disease or required
prolonged weaning
 MODES
 1. Controlled
 With set TV & RR
 For pt who cannot initiate
respiratory effort
 Least used bec. if the pt attempts to
breathe, the vent. blocks the effort

 MODES
 2. Assist-control
 With set TV while allowing the pt control the
RR
 Most commonly used
 The vent. takes over the work of breathing for
the pt
 Responds to pt’s inspiratory effort
 If the pt’s spontaneous RR  the vent.
continues to deliver preset TV
hyperventilation & respiratory alkalosis
 MODES
 3. Synchronized Intermittent Mandatory
Ventilation (SIMV)
 With set TV and RR while allowing the pt
control own TV & RR in between the vent.
breaths
 Used as a primary vent. mode or as a weaning
mode
 The no. of SIMV breaths is  gradually until
the pt gradually resumes spont. breathing
 CONTROLS & SETTINGS
 1. TV: vol. of air that the pt receives
with each breath
 2. RR: no. of vent. breaths/min
 3. Fraction of inspired O2 (FiO2): O2
concentration delivered to the pt;
determined by pt’s condition & ABG
 4. Sighs: vols. of air 1.5-2X the set TV,
delivered 6-10X/hr, prevents atelectasis
 5. Peak airway inspiratory pressure
(PIP)
 Pressure needed by the vent. to
deliver set TV at a given compliance

 Reflects changes in compliance of the
lungs & resistance in the vent. or the

pt
 6. Continuous positive airway pressure (CPAP)
 Applied throughout the entire respiratory
cycle for spont. breathing pt

 Keeps the alveoli open during inspiration &
prevents alveolar collapse

 Used primarily as a weaning modality since
no vent. breaths are delivered, only FiO2

 RR is determined by the pt’s efforts
 7. Positive end-expiratory pressure (PEEP)
 Exerted during the expiratory phase of
ventilation
 Improves oxygenation by enhancing gas
exchange & preventing atelectasis

 Used in pt with severe gas exchange
disturbance
 Higher amounts of PEEP (15)  the chance
of Cx: barotrauma tension pneumothorax

 8. Pressure Support
 Application of positive pressure on
inspiration
 Eases workload of breathing
 May be used in combo with PEEP as a
weaning method
Nursing Interventions:
 Assess the pt first before the ventilator
 Assess for VS, breath sounds,
respiratory status & breathing patterns
 Monitor skin color, pulse oximetry,
ABG
 Suction secretions prn
 Assess the ventilator settings
 Check level of water in humidifier &
temp. or humidification system

 Ensure that alarms are set
 If cause of alarm cannot be
determine, manually ventilate the pt

 Empty ventilator tubing when
moisture collects
 Weaning: the process of going from
ventilator dependence to spont.

Breathing
 SIMV mode
 T-piece
 Decreasing PS
 Causes of Alarms
 High-Pressure Alarm
  secretions
 Wheezing, bronchospasm
 Displaced, kinked, ET
 Excess water in vent. Tubings
 Pt. coughs, gags, bites ET
 Pt is anxious, fighting the vent.

 Causes of Alarms
 Low-Pressure Alarm
 Disconnection or leak in the ventilator

 Busted airway cuff
 Pt stops spontaneous breathing

 WOF Cx
 Hupotension r/t (+) pressure increasing
intrathoracic pressure
 Pneumothorax
 SQ emphysema
 Stress ulcers
 Malnutrition
 Infection
 Muscular atrophy
 Ventilator dependence, inability to wean
CGFNS/NCLEX Question
 A pt in the ER department has multiple
fractured ribs and R-sided tension
pneumothorax. The RN should expect to
prepare the pt for which of the following
procedures?
A. Electrocardiography
B. Urinary catheter placement
C. Chest tube insertion
D. Gastric lavage
 A pt with asthma is producing thick, white
secretions. Which of the following nursing
measures would be most appropriate for the
RN to include in her plan of care?
A. increase fluid intake
B. promote exercise
C. administer O2
D. encourage coughing
 A RN education a pt on the correct use of
metered dose inhaler should instruct the pt
to
A. take several short shallow breaths before
inhaling
B. hold breath after inhaling the drug
C. cough before inhaling the drug
D. press the cartridge down before inhaling
the drug
 The MD orders a corticosteroid inhaler 4 puffs
BID for a pt with asthma. Which of the following
actions by the pt should indicate to the RN that the
pt needs further teaching?
A. taking 4 puffs in rapid succession
B. pausing for 1-2 mins. in between puffs
C. rinsing the mouth with water after inhaling
D. inhaling meds slowly
 A pt who has asthma is given
instructions about the use of inhalant
meds. Which of the following
statements, if made by the pt, indicates
that the pt understands the
instructions?
A. “I will use the steroid inhaler 1 hr
before I use the brochodilator.”
B. “I will use the bronchodilator before I
use the steroid inhaler.”
C. “I need to take these meds 1 hr after
each meal.”
D. “I need to alternate the sequence of
inhaler administration.”
 An asthmatic pt has orders for all of the
following meds. Which meds should a RN
expect to prepare when the pt shows signs
of status asthmaticus?
A. Epinephrine (Adrenaline)
B. Theophylline (Theo-Dur)
C. Erythromycin (Robimycin)
D. Cromolyn Sodium (Nasalcrom)
 Cromolyn Sodium (Intal) is ordered for a pt who
has asthma. A RN would determine that the pt
understands when to take the med if the pt makes
which of the following statements?
A. “I will use my inhaler after meals.”
B. “I will use my inhaler prior to exercise.”
C. “I will use my inhaler when I am having an
attack.”
D. “I will use my inhaler after being outside in
cold weather.”
 Prior to discharging a pt who is asthmatic, a RN
should include which of the following measures in
the teaching plan?
A. Discussing techniques for weight control while
taking steroids
B. Identifying specific environmental triggers
C. Maintaining school performance using a home
tutor
D. Keeping a record of weekly sputum testing
 A RN teaches pursed-lip breathing to a pt who has
COPD. Which of the following statements
indicates the pt understands the instructions?
A. “I will maintain a supine position during the
exercise.”
B. “I will alternate positions during the exercises.”
C. “I will exhale for twice as long as I inhale.”
D. “I will inhale and exhale thru my nose.”

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RESPIRATORY

Billy Ray A. Marcelo, RN

airway resistance, accessory muscles

system (CV and Hematologic System)

 Filters particles from incoming air

 Control T and water content

 Role in sense of smell

 Anastomosis of capillaries (Keisselbach)

B. Pharynx (Throat)- organ of GI and RT

 Arythenoid and cricoid cartilage

 Opens: passage of air

 Closes: passage of food

 Site of permanent artificial airway

 Parietal- with 20 cc of fluid to

Alveoli (Acinar cells)- site of gas

 Chest X-Ray- reveals

 CBC-  WBC,  ESR

 Low flow O2 as ordered

 Give comfortable and humid

 Force fluids to liquefy secretions

 Broad spectrum antibiotics

 Chest physiotherapy (CPT)

 Turning and repositioning

 Nebulize and suction prn

drainage of secretions, stay for 20-30 minutes

 Pt. should be well hydrated, knows how to

lower part of the lungs

part of the lungs

 Administer bronchodilators 15-30 minutes

 Stop if pt can’t tolerate the procedure

 Give oral care post procedure

 No to pt with: hemoptysis, unstable VS, 

Regular adherence to meds

Prevent Cx: atelectasis and

 Ingestion of affected cattle (with M. bovis)

 Virulence of the microorganism

 Force fluids to liquefy secretions

 NO CPT, only DBE and coughing

 Nebulize and suction prn

 Diet:  CHON,  CHO,  Vit C

 INH- given for 4 mos., taken a.c.

 S/E: peripheral neuritis- give Vit B6

 Rifampicin- given for 4 mos., taken a.c.

 S/E: all body secretions turned red-orange

 PZA- given for 2 mos., taken p.c.

 S/E: skin rashes, nephro and hepatotoxicity

 PZA is replaced by Ethambutol

 S/E: optic neuritis (visual disturbance)

 S/E: Ototoxicity due to damage

to CN VIII temporary hearing

and Crea levels

 Take meds religiously

 If missed 1 day’s meds, NEVER  the

dose on the next day, simply let the pt

 Fever, chills, anorexia, general body malaise

 Chest and joint pain

 (+) agglutination test

 CXR- (+) infiltrates

 Encourage coughing & DBE

 Nebulize and suction prn

 Antifungal agent: Amphotericin B (Fungizone)

 S/E: nephrotoxicity and hypoK+

 Prevent Cx: Atelectasis and