Lecture 9 Respiratory System.pptx

Assessment & Management for the Patient
With
Respiratory System Disorders
June, 2023

Session Objectives
At the end of this session learners will be able to:
 Describe anatomy and physiology overview of respiratory
system
 Explain the diagnostic tests used to evaluate respiratory
disorder
 Apply appropriate diagnostic methods for each disorder,
medical and nursing managements for each disorders
2

Respiratory System (Overview, anatomy)
 The respiratory system is the network of organs and tissues that help you breathe.
Organs involved include:
 Mouth and nose: Openings that pull air from outside of the body to inside.
 Sinuses: Hollow areas between the bones in head that help regulate the
temperature and humidity of the air we inhale.
 Pharynx (throat): Tube that delivers air from mouth and nose to the trachea.
 Trachea: Passage connecting throat and lungs.
 Bronchial tubes: Tubes at the bottom of trachea that connect into each lung.
 Lungs: Two organs that remove oxygen from the air and pass it into blood.

1. Structurally:
 Upper respiratory system: includes the nose, pharynx,
larynx; trachea and associated structures.
 Known as the upper airway, warms and filters inspired air
 Lower respiratory system: lungs, which contain the
bronchial and alveolar structures
 Accomplish gas exchange or diffusion
4

 Functionally:
 Conducting zone
 Nose, pharynx, larynx, trachea, bronchi, bronchioles, and
terminal bronchioles
 Their function is to filter, warm, and moisten air and conduct it
into the lungs.
 Respiratory zone
 Consists of tissues within the lungs where gas exchange occurs.
 Respiratory bronchioles, alveolar ducts, alveolar sacs, and
alveoli
 They are the main sites of gas exchange between air and blood
5

Respiratory System (Overview, functions)
 Allows you to talk and to smell
 Warms air to match your body temperature and
moisturizes it to the humidity level your body needs
 Delivers oxygen to the cells in your body
 Removes waste gases, including carbon dioxide, from the
body when you exhale, maintaining acid base balance,..
 Protects your airways from harmful substances and
irritants

Mechanics of Ventilation
 Ventilation or breathing is the movement of air through the
conducting passages between the atmosphere and the
lungs.
 The air moves through the passages because of pressure
gradients that are produced by contraction of the
diaphragm and thoracic muscles.

Pulmonary ventilation (breathing)
 It is the process of air flowing into the lungs during inspiration (inhalation) and
out of the lungs during expiration (exhalation).
 Air flows because of pressure differences between the atmosphere and the gases
inside the lungs.
 Muscular breathing movements and recoil of elastic tissues create the changes in
pressure that result in ventilation.
 Pulmonary ventilation involves three different pressures:
 Atmospheric pressure (the pressure of the air outside the body)
 Intraalveolar (intrapulmonary) pressure (inside the alveoli of the lungs)
 Intrapleural pressure (within the pleural cavity)

Inspiration (inhalation)(taking air in to the lung)
 It is the active phase of ventilation because it is the result of muscle contraction.
 During inspiration, the diaphragm contracts and the thoracic cavity increases in
volume.
 This decreases the intraalveolar pressure so that air flows into the lungs.
 Inspiration draws air into the lungs.
Expiration(exhalation) (letting air out of lung)
 During expiration, the relaxation of the diaphragm and elastic recoil of tissue
decreases the thoracic volume and increases the intraalveolar pressure.
 Expiration pushes air out of the lungs.

Respiratory Volumes and Capacities (Average adults breath = 12-15bpm)
 A breath is one complete respiratory cycle that consists of one inspiration and one
expiration.
 An instrument called a spirometer is used to measure the volume of air that
moves into and out of the lungs, and the process of taking the measurements is
called spirometry.
 Respiratory (pulmonary) volumes are an important aspect of pulmonary function
testing because they can provide information about the physical condition of the
lungs.
 Respiratory capacity (pulmonary capacity) is the sum of two or more volumes.
 Factors such as age, sex, body build, and physical conditioning have an influence
on lung volumes and capacities.
 Lungs usually reach their maximum in capacity in early adulthood and decline
with age after that.

Mechanics of ventilation
 Physical factors that govern airflow in and out of the lungs
 Includes:
 Air pressure variances
 Resistance to airflow
 Lung compliance
12

Air Pressure Variances
 Air flows from a region of higher pressure to a region of lower pressure.
 During inspiration
 Enlarge the thoracic cavity and thereby
 Lower the pressure inside the thorax
 As a result, air is drawn into the alveoli.
 During expiration
 The diaphragm relaxes and the lungs recoil, resulting in a decrease in
the size of the thoracic cavity.
 The alveolar pressure then exceeds atmospheric pressure, and air flows
from the lungs into the atmosphere.
13

Airway Resistance
 Determined by the radius, or size of the airway through which the air
is flowing, as well as by lung volumes and airflow velocity.
 Any process that changes the bronchial diameter or width affects
airway resistance and alters the rate of airflow
 With increased resistance, greater-than normal respiratory effort is
required to achieve normal levels of ventilation
14

Compliance
 Is the elasticity and expandability of the lungs and thoracic structures.
 Compliance allows the lung volume to increase when the difference in
pressure between the atmosphere and the thoracic cavity (pressure
gradient) causes air to flow in
 Increased compliance occurs if the lungs have lost their elastic recoil and
become overdistended
 Decreased compliance occurs if the lungs and the thorax are “stiff.”
 Lungs with decreased compliance require greater-than-normal energy
expenditure by the patient to achieve normal levels of ventilation
15

Diagnostic Procedures
Common Diagnostic Procedures In Respiratory System
– History
– Pulmonary Function Tests
– Arterial Blood Gas Studies
– Pulse Oximetry
– Cultures
– Sputum Studies
– Imaging Studies : CTScan, MRI, CXR
– Endoscopic Procedures: Bronchoscopy, Thoracoscopy
– Biopsy
16

History : Dyspnea and Cough (cardinal signs)
 Patients with obstructive lung disease often complain of “chest
tightness” or “inability to get a deep breath,” whereas patients with
congestive heart failure more commonly report “air hunger” or a sense
of suffocation.
 Acute shortness of breath is usually associated with sudden physiologic
changes, such as laryngeal edema, bronchospasm, myocardial
infarction, pulmonary embolism, or pneumothorax.
 Patients with COPD and idiopathic pulmonary fibrosis (IPF) experience
a gradual progression of dyspnea on exertion, punctuated by acute
exacerbations of shortness of breath.
 In contrast, most asthmatics have normal breathing the majority of the
time with recurrent episodes of dyspnea that are usually associated
with specific triggers, such as an upper respiratory tract infection or
exposure to allergens.

History : Dyspnea and Cough
 Cough generally indicates disease of the respiratory system.
 The clinician should inquire about the duration of the cough, whether or not it is
associated with sputum production, and any specific triggers that induce it.
 Acute cough productive is often a symptom of infection of the respiratory system,
including: sinusitis, tracheitis, bronchitis, bronchiectasis, and pneumonia.
 Both the quantity and quality of the sputum, including whether it is blood-
streaked or frankly bloody, should be determined.
 Chronic cough is commonly associated with obstructive lung diseases,
particularly asthma and chronic bronchitis, as well as “non respiratory” diseases,
such as gastroesophageal reflux.

Physical Examination
 Inspection: Patients may be in distress, often using accessory muscles of
respiration to breathe, Severe kyphoscoliosis can result in restrictive
pathophysiology.
 Palpation: can demonstrate subcutaneous air in the setting of barotrauma. It
can also be used as an adjunctive assessment to determine whether an area of
decreased breath sounds is due to consolidation (increased tactile fremitus) or a
pleural effusion (decreased tactile fremitus).
 Percussion: of the chest is used to establish diaphragm excursion and lung size.
In the setting of decreased breath sounds, it is used to distinguish between
pleural effusions (dull to percussion) and pneumothorax (hyper-resonant note).
 Auscultation: wheezing, rhonchi, crackles,….

Diagnostic Procedures: Chest x-ray
 Normal pulmonary tissue is radiolucent because it consists
mostly of air and gases; therefore, densities produced by fluid,
tumors, foreign bodies, and other pathologic conditions can be
detected by x-ray examination
 The routine chest x-ray consists of two views:
posteroanterior projection and lateral projection.
20

Diagnostic Procedures: Chest x-ray
 Chest x-rays are usually obtained after full inspiration
because the lungs are best visualized when they are well
aerated.
 In addition, the diaphragm is at its lowest level and the
largest expanse of lung is visible.
 Patients, therefore, need to be able to take a deep breath
and hold it without discomfort.
 Chest x-rays are contraindicated in pregnant women
21

Diagnostic Procedures: Computed Tomography
 A CT is an imaging method in which the lungs are scanned
in successive layers by a narrow-beam x-ray.
 The images produced provide a cross sectional view of the
chest
 Can distinguish fine tissue density.
 Used to define pulmonary nodules and small tumors
adjacent to pleural surfaces that are not visible on routine
chest x-rays
24

Diagnostic Procedures: Computed Tomography
 Contraindications
 Allergy to dye
 Pregnancy
 Morbid obesity
 Whereas potential complications include acute kidney
injury and acidosis secondary to contrast.
25

Diagnostic Procedures: MRI
 MRI is similar to a CT scan except that magnetic fields and
radiofrequency signals are used instead of radiation.
 MRI is able to better distinguish between normal and abnormal
tissues than CT
 Used to characterize pulmonary nodules; to help stage
bronchogenic carcinoma
 Contraindications for MRI include: morbid obesity, confusion
and agitation, and having implanted metal or metal support
devices that are considered unsafe
27

Diagnostic Procedures: Bronchoscopy
 Is the direct inspection and examination of the larynx, trachea, and
bronchi through either a flexible fiberoptic bronchoscope or a rigid
bronchoscope.
 The purposes of diagnostic bronchoscopy are:
 To examine tissues or collected secretions
 To determine the location and extent of the pathologic process and
to obtain a tissue sample for diagnosis (by biting or cutting forceps,
curettage, or brush biopsy)
 To determine whether a tumor can be resected surgically
 To diagnose bleeding sites (source of hemoptysis)
29

Therapeutic bronchoscopy is used to:
 Remove foreign bodies from the tracheobronchial tree
 Remove secretions obstructing the tracheobronchial tree when
the patient cannot clear them
 Treat postoperative atelectasis
 Destroy and excise lesions.
 To insert stents to relieve airway obstruction that is caused by
tumors or that occurs as a complication of lung transplantation
30

Fiberoptic bronchoscope
 Is a thin, flexible bronchoscope that can be directed into the
segmental bronchi.
 Because of its small size, its flexibility, and its excellent optical
system, it allows increased visualization of the peripheral
airways and is ideal for diagnosing pulmonary lesions
31

Rigid bronchoscope
 Is a hollow metal tube with a light at its end.
 It is used mainly for removing foreign substances, investigating the
source of massive hemoptysis, or performing endobronchial surgical
procedures.
 Rigid bronchoscopy is performed in the operating room, not at the
bedside
32

Diagnostic Procedures: Pulmonary function test
 Are a group of tests that measure how well:
 The lungs work
 The lungs take in and exhale air out
 Efficiently they transfer oxygen into the blood
34

Indications/purposes
 Detect disease
 It serve as a diagnostic tool
 Evaluate severity, extent and monitor the course of disease
 Evaluate treatment
 Measure effects and result of treatment exposures
35

 Performed by a technician using a spirometer
 Spirometer volume-collecting device attached to a recorder
that demonstrates volume and time simultaneously
 PFT results are interpreted on the basis of the degree of
deviation from normal, taking into consideration the
patient’s height, weight, age, and gender.
36

/Procedure /
 Sit up straight
 Get a good seal around the mouth piece
 Rapidly inhale maximally
 Without any delay blow out as hard as fast as possible (blast out)
 Continue the exhale until the patient can`t blow no more
 Expiration should continue at least 6sec (in adult) and 3 sec (children
under 10yrs)
 Repeat at least 3 technically acceptable times (without cough, air leak and
false start)
37

It is carried out
by using a
spirometer
38

 Spirometry measures two key factors:
 Expiratory forced vital capacity (FVC)
 Is the greatest total amount of air you can forcefully breathe
out after breathing in as deeply as possible.
 Forced expiratory volume in one second (FEV1).
 The amount of air you can force out of your lungs in one
second
 The FEV1/FVC ratio is a number that represents the
percentage of your lung capacity you’re able to exhale in one
second
39

Lung Volumes and Lung Capacities
42

Pulse Oximetry
 Is a noninvasive method of continuously monitoring the
oxygen saturation of hemoglobin (SaO2).
 The sensor detects changes in oxygen saturation levels by
monitoring light signals generated by the oximeter and
reflected by blood pulsing through the tissue at the probe
 Normal oxygen saturation values are greater than 95% in
a healthy individual on room air
 Values less than 90% indicate that the tissues are not
receiving enough oxygen.

45

Working Principles
 Pulse Oximetry consists of Red(R) and Infrared(IR) light emitting LEDs
and a photo detector.
 Oxygenated and deoxygenated hemoglobin have different light
absorption rate.
 Oxygenated hemoglobin absorbs more infrared light
 Deoxygenated hemoglobin absorbs more red light
46

 Measuring blood oxygenation with pulse oximetry reduces the need
for invasive procedures, such as drawing blood for analysis of
oxygen levels.
47

Lab Studies: ABG, Thoracentesis, Sputum Analysis
48

Arterial Blood Gas
 ABG: Is a blood test that measures the acidity, or pH, and the
levels of oxygen (O2) and carbon dioxide (CO2) from an artery
 The arterial oxygen tension (partial pressure or PaO2) indicates
the degree of oxygenation of the blood
 The arterial carbon dioxide tension (partial pressure or PaCO2)
indicates the adequacy of alveolar ventilation
50

Arterial Blood Gas
 ABG studies aid in assessing
 The ability of the lungs to provide adequate oxygen and remove
carbon dioxide
 The ability of the kidneys to reabsorb or excrete bicarbonate
ions to maintain normal body PH.
 ABG levels are obtained through an arterial puncture at the radial,
brachial, or femoral artery or through an indwelling arterial
catheter.
51

Components of ABG
 PH: 7.35-7.45
 Partial pressure of oxygen (PaO2): 75 to 100 mmHg
 Partial pressure of carbon dioxide (PaCO2): 35-45 mmHg
 Bicarbonate (HCO3): 22-26 mEq/L
 Oxygen saturation (O2 Sat): 95-100%
52

Indication
 Lung Failure
 Kidney Failure
 Shock
 Trauma
 Uncontrolled diabetes
 Asthma
 Hemorrhage
 Chronic Obstructive Pulmonary
Disease (COPD)
 Drug Overdose
 Metabolic Disease
 Chemical Poisoning
 To check if lung condition treatments
are working
53

ABG Interpretation
PH CO2 HCO3
Respiratory acidosis
Decrease Increase Normal
Respiratory alkalosis
Increase Decrease Normal
Compensated respiratory acidosis
Decrease Increase Increase
Compensated respiratory alkalosis
Increase Decrease Decrease
54

The Relationship between pH and CO2
 Use ROME acronym.
 Respiratory Opposite -- In respiratory disorders, the pH and CO2
arrows move in opposite directions.
 Metabolic Equal -- In metabolic disorders, the PH and CO2 arrows
will move in the same direction.
55

Thoracentesis
 Aspiration of fluid and air from the pleural space
 Is performed for diagnostic or therapeutic reasons.
Purposes of the procedure include:
 Removal of fluid and air from the pleural cavity
 Aspiration of pleural fluid for analysis
 Pleural biopsy
 Instillation of medication into the pleural space
56

Thoracentesis: Indication
 Traumatic pneumothorax
 Hemopneumothorax
 Spontaneous pneumothorax
 Bronchopleural fistula
 Pleural effusion
57

Thoracentesis: Contraindication
 An uncooperative patient
 Coagulation disorder
 Atelectasis
 Only one functioning lung
 Emphysema(pulmonary enlargement)
 Severe cough or hiccups
58

Thoracentesis: Complication
 Pulmonary edema
 Respiratory distress
 Air embolism
 Bleeding
 Infection
 Dyspnea and cough
 Atelectasis(lung collapse)
59

Sputum analysis
 It is a secretion that is produced in the lungs and the bronchi.
 This mucus-like secretion may become infected, bloodstained, or
contain abnormal cells that may lead to a diagnosis
 Sputum is obtained for analysis to identify pathogenic organisms
and to determine whether malignant cells are present.
 Sputum samples ideally are obtained early in the morning before
the patient has had anything to eat or drink
 Expectoration is the usual method for collecting a sputum
specimen.
 The patient is instructed to clear the nose and throat and rinse
the mouth 61

Sputum analysis
 After taking a few deep breaths, the patient coughs (rather than
spits), using the diaphragm, and expectorates into a sterile
container
 If the patient cannot expel an adequate sputum sample,
 Coughing can be induced by administering an aerosolized
hypertonic solution via a nebulizer.
 Endotracheal or transtracheal aspiration or bronchoscopic
removal.
 The nurse should label the specimen and send it to the laboratory
as soon as possible to avoid contamination
62

Sputum analysis (Cont..)
White & Mucoid
 Chronic bronchitis
 Bronchial Asthma
 Pulmonary Tuberculosis
Viscid & yellow
 Acute bronchitis
 Bronchiectasis
 Lung abscess
64

Microbiological Examination
65
Knowledge of flora of mouth and pharynx necessary before analyzing

Examination for Acid Fast Bacilli
 Zeihl Neelson Staining (AFB stain)
Reporting guidelines:
 Mycobacteria appear as bright red, slightly curved or red beaded rods, 2-4 µm in
length and 0.2 to 0.5 µm wide, against a blue green background.
 At least 100 fields should be examined before declaring negative.
67

Common Respiratory Management Modalities
 Numerous treatment modalities are used when caring for
patients with respiratory conditions.
 The choice of modality is based on the oxygenation disorder and
whether there is a problem with gas ventilation, diffusion, or
both.
 Therapies range from:
 Simple and noninvasive (oxygen and nebulizer therapy, chest
physiotherapy [CPT], breathing retraining) to
 Complex and highly invasive treatments (intubation,
mechanical ventilation, surgery).
68

A. Non Invasive Respiratory Therapies
1. Oxygen Therapy:
 Is the administration of oxygen at a concentration greater than that found in the
environmental atmosphere.
 At sea level, the concentration of oxygen in room air is 21%.
Goal : To provide adequate transport of oxygen in the blood while decreasing the
work of breathing and reducing stress on the myocardium.
69

Oxygen Therapy: Indications
A change in the patient’s respiratory rate or pattern.
 These changes may result from hypoxemia or hypoxia.
 Hypoxemia, a decrease in the arterial oxygen tension in the blood
 Hypoxemia usually leads to hypoxia
 Hypoxia: a decrease in oxygen supply to the tissues and cells that
can also be caused by problems outside the respiratory system.
 Severe hypoxia can be life threatening
 The need for oxygen is assessed by ABG analysis, pulse
oximetry, and clinical evaluation
70

Hypoxia
 Hypoxia can occur from:
 Severe pulmonary disease (inadequate oxygen supply) or
 From extrapulmonary disease (inadequate oxygen delivery)
affecting gas exchange at the cellular level.
71

Types of hypoxia
– Hypoxemic hypoxia: decreased oxygen level in the blood
resulting in decreased oxygen diffusion into the tissues
– Circulatory hypoxia: inadequate capillary circulation
– Anemic hypoxia: decreased effective hemoglobin concentration
– Histotoxic hypoxia: when toxic substance interferes with the
ability of tissues to use available oxygen
72

Complications of oxygen therapy
 Oxygen Toxicity
 Absorption Atelectasis
 Suppression of Ventilation
73

Oxygen administration devices
74

2. Incentive Spirometry (Sustained Maximal Inspiration)
 An incentive spirometer is a device used to help your lungs
recover after surgery or a lung illness
 Is a method of deep breathing that provides visual feedback to
encourage the patient to inhale slowly and deeply to maximize
lung inflation and prevent or reduce atelectasis.
 The purpose of an incentive spirometer is to ensure that the
volume of air inhaled is increased gradually as the patient takes
deeper and deeper breaths
75

Indications
 Incentive spirometry is used:
 After surgery, especially thoracic and abdominal
surgery
 To promote the expansion of the alveoli
 To prevent or treat atelectasis
76

3. Small-Volume Nebulizer (Mini-Nebulizer)Therapy
 Is a handheld apparatus that disperses a moisturizing agent or medication,
such as a bronchodilator and delivers it to the lungs as the patient inhales.
Indications:
 Difficulty in clearing respiratory secretions
 Reduced vital capacity with ineffective deep breathing and coughing
 Unsuccessful trials of simpler and less costly methods for clearing secretions
 Delivering aerosol, or expanding the lungs
 The patient must be able to generate a deep breath.
 Diaphragmatic breathing is a helpful technique to prepare for proper use of
the small-volume nebulizer.
78

4.Chest Physiotherapy
 Includes : postural drainage, chest percussion and vibration,
and breathing retraining, educating the patient about effective
coughing technique .
 Goals : To remove bronchial secretions, improve ventilation,
and increase the efficiency of the respiratory muscles
79

Chest Percussion and Vibration
 Thick secretions that are difficult to cough up may be loosened by
tapping (percussing) and vibrating the chest.
 Chest percussion and vibration help dislodge mucus adhering to the
bronchioles and bronchi.
 Chest percussion is carried out by cupping the hands and lightly
striking the chest wall in a rhythmic fashion over the lung segment
to be drained
 Vibration is the technique of applying manual compression and
tremor to the chest wall during the exhalation phase of respiration
80

B. Airway Management (Invasive)
 Endotracheal Intubation
 Tracheostomy
 Mechanical Ventilation
82

Mechanical Ventilator
 A mechanical ventilator is a machine that generates a controlled
flow of gas into a patient’s airways
 Is a positive- or negative-pressure breathing device that can
maintain ventilation and oxygen delivery for a prolonged period
84

Positive-pressure Ventilators
 Inflate the lungs by exerting positive pressure on the
airway, pushing air in, similar to a bellows mechanism, and
forcing the alveoli to expand during inspiration.
 Endotracheal intubation or tracheostomy is necessary
85

Classification of positive-pressure ventilators
 Ventilators are classified according to how the inspiratory phase
ends (3 of them)
 Volume cycled
 Pressure cycled
 High frequency oscillatory support (time)
86

Indications of MV..
 Laboratory Values
 PaO2 <55 mm Hg
 PaCO2 >50 mm Hg and
pH <7.32
 Vital capacity <10 mL/kg
 Negative inspiratory
force <25 cm H2O
 FEV1 <10 mL/kg
 Clinical Manifestations
 Apnea or bradypnea
 Increased work of breathing not
relieved by other interventions
 Confusion with need for airway
protection
 Circulatory shock
 Multiple trauma
 Multi system failure
87

Nursing care of patients on mechanical ventilation
 Pulmonary auscultation and interpretation of arterial blood gas measurements.
 Promote optimal gas exchange
 Monitors for adequate fluid balance
 Promoting effective airway clearance
 Preventing trauma and infection
 Promoting optimal level of mobility
 Promoting optimal communication
 Promoting coping ability
 Monitoring and managing potential complications
88

Weaning the Patient from the Ventilator
 Respiratory weaning: the process of withdrawing the patient
from dependence on the ventilator, takes place in three stages.
 The patient is gradually removed from the ventilator
 Then from either the endotracheal or tracheostomy tube
 Finally from oxygen
89

Weaning the Patient from the Ventilator
Weaning is started when the patient is:
 Physiologically and hemodynamically stable
 Demonstrates spontaneous breathing capability
 Recovering from the acute stage of medical and surgical
problems
 When the cause of respiratory failure is sufficiently reversed
90

Acute Respiratory Failure
■ Acute respiratory failure occurs when the lungs cannot release
enough oxygen into the blood, which prevents the organs from
properly functioning.
■ It also occurs if the lungs cannot remove carbon dioxide from the
blood.
■ Respiratory failure happens when the capillaries, or tiny blood
vessels surrounding the air sacs, cannot properly exchange
carbon dioxide and/or oxygen.
■ There are two types of respiratory failure: acute and chronic.

■ Acute respiratory failure happens suddenly and is fatal if not treated timely.
■ It occurs due to a disease or injury that interferes with the ability of the lungs to
deliver oxygen or remove carbon dioxide.
■ Chronic respiratory occur when the airways narrow or become damaged over
time
■ It can also occur with conditions that cause the respiratory muscles to weaken
over time.
■ Some causes of chronic respiratory failure include:
– damaged and/or narrow airways, which can occur in conditions like:
■ chronic obstructive pulmonary disease (COPD), bronchiectasis, asthma
– lung fibrosis, which can occur in conditions like:
■ pneumonia
■ interstitial lung disease
– respiratory muscle weaknesss

■ There are two types of acute and chronic respiratory
failure: hypoxemic and hypercapnic.
■ Both conditions can trigger serious complications, and
they often occur together.
■ Hypoxemic respiratory failure, or hypoxemia, occurs
when you do not have enough oxygen in your blood.
■ Hypercapnic respiratory failure, or hypercapnia, happens
when there is too much carbon dioxide in your blood.

Acute Respiratory Failure (causes)
■ Obstruction
– When something lodges in your throat, you may have trouble getting
enough oxygen into your lungs.
– Obstruction can also occur in people with COPD or asthma when an
exacerbation causes the airways to narrow.
■ Injury
– An injury that impairs or compromises respiratory system can negatively
affect the amount of oxygen or carbon dioxide in blood.
– For instance, a spinal cord or brain injury can immediately affect
breathing.
– If the brain cannot relay messages to the lungs, the lungs may not
function properly.
– Rib or chest injuries can also affect breathing.

Acute Respiratory Failure (causes)
■ Acute respiratory distress syndrome
– is a serious condition that causes fluid to build up in your lungs.
– It results in low oxygen in the blood.
– People who develop ARDS typically have an underlying health condition, such as:
■ pneumonia
■ pancreatitis
■ sepsis
■ trauma to the head or chest
■ blood transfusions
■ lung injuries related to inhaling smoke or chemical products
■ Drug or alcohol use
■ Chemical inhalation
■ Stroke
■ Infection

Who is at risk for acute respiratory failure?
■ smoke tobacco products
■ drink alcohol excessively
■ have a family history of respiratory disease or conditions
■ have an injury to the spine, brain, or chest
■ have a compromised immune system
■ have chronic respiratory conditions, such as lung cancer, COPD, or
asthma

Acute Respiratory Failure (sign and symptoms)
■ People with low oxygen may experience:
– shortness of breath
– a bluish coloration on lips, fingertips, or toes
– drowsiness
– difficulty performing routine activities, such as dressing or climbing stairs,
due to extreme tiredness
■ People with high carbon dioxide levels may experience:
– rapid breathing
– confusion
– blurred vision
– headaches

Acute Respiratory Failure (Diagnosis)
■ performing a physical exam
■ asking questions about personal or family health history
■ checking body’s oxygen and carbon dioxide levels with a pulse
oximetry device and an arterial blood gas test
■ ordering a chest X-ray of lungs

Complications
■ Pulmonary complications, or those affecting the lungs, can include:
– pulmonary embolism
– pulmonary fibrosis
– pneumonia
– pneumothorax (collapsed lung)
– gastrointestinal hemorrhage
– renal (kidney) failure
– hepatic (liver) failure

Management
■ Antipain (if pain exists)
■ Breathing tube
■ Supplemental oxygen
■ Tracheostomy
■ Exercise therapy
■ Education
■ Counseling

Pneumonia
 It is the infection that inflames air sacs in one or both lung.
 It is the cause of more than 10% of hospital admissions
each year and is the most common cause of death from
infection.

Etiology / causes
 BACTERIAL PNEUMONIA: The most common cause of community-acquired bacterial
pneumonia, is Streptococcus pneumoniae; also called pneumococcal pneumonia. This
organism accounts for approximately 90% of all bacterial pneumonias.
 VIRAL PNEUMONIA: Influenza viruses are the most common cause of viral pneumonia.
 FUNGAL PNEUMONIA: Candida and Aspergillus are two types of fungi that can cause
pneumonia.
 ASPIRATION PNEUMONIA: Some pneumonias are caused by aspiration of foreign
substances.
 VENTILATOR–ASSOCIATED PNEUMONIA
 HYPOSTATIC PNEUMONIA: Patients who hypoventilate because of bed rest, immobility,
or shallow respirations
 CHEMICAL PNEUMONIA: Inhalation of toxic chemicals can cause inflammation and
tissue damage

Pathophysiology
 Pneumonia is an acute infection of the lungs that occurs when an
infectious agent enters and multiplies in the lungs of a susceptible
person.
 Infectious particles can be transmitted by the cough of an infected
individual, from contaminated respiratory therapy equipment, from
infections in other parts of the body, or from aspiration of bacteria
from the mouth, pharynx, or stomach.
 When pathogens enter the body of a healthy person, normal
respiratory defense mechanisms and the immune system prevent the
development of infection.
 When the microorganisms multiply, they release toxins that induce
inflammation in the lung tissue, causing damage to mucous and
alveolar membranes.

Signs and Symptoms
 Patients with pneumonia present with fever, shaking chills, chest pain,
dyspnea, and a productive cough.
 Sputum is purulent or may be rust colored or blood tinged.
 Crackles and wheezes may be heard on lung auscultation because of the
secretions in the alveoli and airways.
 Some bacterial and many viral pneumonias cause atypical symptoms.
 The patient may experience fatigue, sore throat, dry cough, or nausea and
vomiting.
 Elderly patients may not exhibit expected symptoms of pneumonia.
 New-onset confusion or lethargy in an elderly patient can indicate
reduced oxygenation and should alert you to look for other symptoms or
request further testing.

Complications
 Pleurisy and pleural effusion
 Atelectasis (collapsed alveoli)
 Septicemia
 Meningitis
 septic arthritis
 pericarditis
 endocarditis

Diagnostic Tests
 A chest x-ray examination is done to identify the presence of pulmonary
infiltrate, which is fluid leakage into the alveoli from inflammation.
 In addition, sputum and blood cultures are obtained to identify the organism
causing the pneumonia and determine appropriate treatment.
 Cultures should be obtained before antibiotics are started to avoid altering
culture results.
 If the patient is unable to produce a sputum specimen, a nebulized mist
treatment may be ordered to promote sputum expectoration.
 If this is unsuccessful, a bronchoscopy may be done to obtain a specimen from a
very ill patient.

Management
 Broad-spectrum antibiotics are initiated before culture results are completed (be sure to
obtain the specimen before starting the antibiotics).
 Once the culture and sensitivity report is available, specific antibiotics are ordered if the
cause is bacterial.
 Many patients can be treated with oral antibiotics as outpatients, but hospitalization and
intravenous (IV) therapy may be necessary in the elderly, chronically ill, or acutely ill
individual.
 If the pneumonia is caused by a virus, rest and fluids are recommended.
 Occasionally, antiviral medications are used.
 Expectorants, bronchodilators, and analgesics may be given for comfort and symptom
relief.
 Nebulized mist treatments or metered-dose inhalers may be used to deliver broncho
dilators
 Administer oxygen if needed

Discuss ??
Nursing managements for the patient with
pneumonia???

Reading Assignment
 Acute decompesation of COPD
 Pulmonary embolism
 Pulmonary edema
 Asthma attacks (acute)

Lecture 9 Respiratory System.pptx

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