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upper and lower of respiratory system


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upper and lower of respiratory system

  1. 1. ANATOMY AND PHYSIOLOGY upper and lower respiratory :-tracts. Prepared by Dr / amany lotfy
  2. 2. Describe the structures andfunctions of the upper and lower.respiratory tractsDescribe ventilation, perfusion,. 2diffusion, shunting, and therelationship of pulmonary.circulation to these processesDiscriminate between normal. 3.and abnormal breath sounds
  3. 3. Use assessment parameters. 4appropriate for determining thecharacteristics and severity ofthe major symptoms of.respiratory dysfunctionIdentify the nursing. 5implications of the variousprocedures used fordiagnostic evaluation of.respiratory function
  4. 4. NORMAL ANATOMY AND PHYSIOLOGYThe respiratory system consists of-the nose, nasal cavities, pharynx,larynx, trachea, bronchial tree, lungs,.and respiratory musclesThe parts outside the chest cavity-are collectively called the upperrespiratory tract, and those within thechest cavity make up the lower respiratory tract-
  5. 5. Anatomic and Physiologic OverviewANATOMY OF THE UPPERRESPIRATORY TRACTUpper airway structuresconsist of the nose, sinuses,and nasal passagespharynx, tonsils and adenoids,.larynx, and trachea
  6. 6. ANATOMY OF THE LOWER RESPIRATORY TRACTLUNGSThe lower respiratory tract consistsof the lungs, which containthe bronchial and alveolar structures.needed for gas exchangeThe lungs are the site of gasexchange between the air and theblood; the rest of the system movesair into and out of the lungs
  7. 7. FUNCTION OF THE RESPIRATORY SYSTEMOxygen TransportOxygen is supplied to, and carbondioxide is removed from, cellsby way of the circulating blood.Cells are in close contact withcapillaries, whose thin walls permiteasy passage or exchange of.oxygen and carbon dioxide
  8. 8. RespirationAfter these tissue capillary exchanges,blood enters the systemic veins (whereit is called venous blood) and travels tothe pulmonary. circulationThe oxygen concentration in bloodwithinthe capillaries of the lungs is lower).than in the lungs’ air sacs (alveoliBecause of this concentration gradient,oxygen diffuses from the alveoli to the.blood
  9. 9. Mechanism of BreathingVentilation is the term for the-1movement of air into and out ofthe alveoli. Air moves from high-pressure to low-pressure areas(pressure gradients), some ofwhich are created by therespiratory muscles, which in turnare controlled by the nervous. system
  10. 10. VentilationDuring inspiration, air flowsfrom the environment into thetrachea, bronchi, bronchioles,and alveoli. During expiration,alveolar gas travels the same.route in reverse
  11. 11. InhalationInhalation, also called inspiration,-occurs when motor impulses fromthe medulla cause contraction of the.respiratory musclesExhalationNormal exhalation is a passive-process that begins when motorimpulses from the medulla decreaseand the diaphragm and external .intercostals muscles relax
  12. 12. Transport of Gases in the BloodOxygen is carried in the blood by-iron in the hemoglobin (Hgb) of redblood cells (RBCs). The iron-oxygen bond is formed in thelungs, where the partial pressure ofoxygen (PO2) is high. In tissueswhere the PO2 is low, hemoglobin.releases much of its oxygen
  13. 13. Causes of Increased Airway ResistanceCommon phenomena that mayalter bronchial diameter, which:affects airway resistance, includeContraction of bronchial- 1•smooth muscle—as in asthmaThickening of bronchial mucosa-2•—as in chronic bronchitis•
  14. 14. Causes of Increased Airway ResistanceObstruction of the airway—by- 3mucus, a tumor, or a foreignbodyLoss of lung elasticity—as in- 4•emphysema, which is characterizedby connective tissue encircling theairways, thereby keeping them openduring both inspiration and expiration
  15. 15. Partial Pressure AbbreviationsP = pressurePO2 = partial pressure of oxygenPCO2 = partial pressure of carbondioxidePAO2 = partial pressure of alveolaroxygenPACO2 = partial pressure ofalveolar carbon dioxidePaO2 = partial pressure of arterialoxygen
  16. 16. Partial Pressure AbbreviationsPaCO2 = partial pressure of arterialcarbon dioxidePv–O2 = partial pressure of venousoxygenPv–CO2 = partial pressure of venouscarbon dioxideP50 = partial pressure of oxygen whenthe hemoglobin is 50%saturated
  17. 17. Assessment :HEALTH HISTORYThe health history focuses on thephysical and functional problemsof the patient and the effect ofthese problems on his or her life. :dyspnea (shortness of breath),pain, accumulation of mucus,wheezing, hemoptysis (blood spitup from the respiratory tract),edema of the ankles and feet,cough, and general fatigue and
  18. 18. Signs and SymptomsThe major signs and symptoms of,respiratory disease are dyspneacough, sputum production, chestpain, wheezing, clubbing of the.fingers, hemoptysis, and cyanosisThese clinical manifestationsare related to the duration and.severity of the disease
  19. 19. Clinical Significance for SPUTUM PRODUCTIONA profuse amount of purulentsputumthick and yellow, green, or rust-(colored) or a change in color ofthe sputum probably indicates abacterial infection. Thin, mucoidsputum frequently results from viralbronchitis. A gradual increase ofsputum over time may indicate thepresence of chronic bronchitis or.bronchiectasis
  20. 20. CHEST PAINChest pain or discomfort may beassociated with pulmonary orcardiac disease or pulmonaryconditions may be sharp,stabbing, and intermittent, or itmay be dull, aching, and.persistent
  21. 21. CLUBBING OF THE FINGERSis a sign of lung disease found inpatients with chronic hypoxicconditions, chronic lung infections, andmalignancies. This finding may bemanifested initially assponginess of the nail bed and loss ofthe nail bed angle
  22. 22. HEMOPTYSISPulmonary infection•Carcinoma of the lung•Abnormalities of the heart or•blood vesselsPulmonary artery or vein•abnormalitiesPulmonary emboli and infarction•
  23. 23. CYANOSISCyanosis, a bluish coloring of theskin, is a very late indicator ofhypoxia. The presence or absenceof cyanosis is determined by theamount of unoxygenated.hemoglobin in the blood
  25. 25. Thoracic PalpationThe nurse palpates the thorax for-1tenderness, masses, lesions,respiratory excursion, and vocalfermatas. If the patient has reportedan area of pain or if lesions areapparent,2- the nurse performs directpalpation with the fingertips (for skinlesions and subcutaneous masses) orwith the ball of the hand (for deepermasses or(.generalized flank or rib discomfort-3
  26. 26. Abnormal (Adventitious) Breath SoundsCrackles Soft, high-pitched,discontinuous popping sounds that occur during inspirationSonorous wheezes (rhonchi) Deep,-2low-pitched rumbling sounds heardprimarily during expiration; caused byair moving through narrowedtracheobronchial passages
  27. 27. Diagnostic EvaluationPULMONARY FUNCTION TESTSARTERIAL BLOOD GAS STUDIESPULSE OXIMETRYPulse oximetry is a noninvasivemethod of continuously monitoringthe oxygen saturation of).hemoglobin (SpO2 or SaO2
  28. 28. CULTURESThroat cultures may be performed toidentify organisms responsiblefor pharyngitis. Throat culture may alsoassist in identifying organisms responsible.for infection of the lower respiratory tractSPUTUM STUDIESSputum is obtained for analysis to identifypathogenic organisms and to determine.whether malignant cells are present
  29. 29. ThoracoscopyThoracoscopy is a diagnosticprocedure in which the pleuralcavity is examined with anendoscope (Fig. 21-16(. Smallincisions are made into thepleural cavity in an intercostalspace; the location of the incision
  30. 30. Upper airway infectionDr / Amany lotfy
  31. 31. Upper Airway InfectionsUpper airway infections arecommon conditions that affectmost people on occasion.Some infections are acute, withsymptoms that last several;days
  32. 32. VIRAL RHINITIS (COMMON ”).COLD) (“the fluThe term “common cold” often is usedwhen referring to anupper respiratory tract infectionthat is self-limited and caused bya virus (viral rhinitis). Nasal,congestion, rhinorrhea, sneezingsore throat, and general malaise.characterize it
  33. 33. Clinical ManifestationsSigns and symptoms of viralrhinitis are nasal congestion,runny nose, sneezing, nasaldischarge, nasal itchiness,,tearing watery eyesscratchy” or sore throat,“general malaise, low-grade,fever, chills
  34. 34. Medical ManagementManagement consists of symptomatic therapy. Some measures includeproviding adequate fluid intake-1, encouraging rest-2preventing chilling, 4-increasing-3intake of vitamin C, 5- using xpectorants.6-Warm salt-water gargles soothe thesore throat 7- nonsteroidal anti-inflammatory agents (NSAIDs) such asaspirin or ibuprofen relieve the aches,. pains, and fever in adultsAntihistamines to relieve sneezing, -8.rhinorrhea,and nasal congestion
  35. 35. Preventing and Managing Upper Respiratory InfectionsIdentify strategies to prevent infectionand, if infected, to prevent spread of ✓ ✓ infection to othersPerform hand hygiene oftenUse disposable tissuesAvoid crowds during the flu seasonAvoid individuals with colds orrespiratory infectionsObtain influenza vaccination, ifrecommended (especially if elderly or
  36. 36. Preventing and Managing Upper Respiratory InfectionsEat a nutritious dietGet plenty of rest and sleepAvoid or reduce stress when possibleExercise appropriatelyAvoid smoking or second-hand smokeand excessive intake of alcoholIncrease humidity in house, especiallyduring winterPractice adequate oral hygieneAvoid allergens, if allergies are•associated with upper respiratory
  37. 37. Prevention and ManagementIdentify strategies to control the•environment ✓ ✓ Adequately humidify(avoid over humidifying) living quartersPlace a dehumidifier in the basement, ifappropriateProvide central ventilation fans, airconditioning with microstatic air filtersReduce irritants (dust, chemical,tobacco smoke) when possibleLimit exposure to animals and housepets, particularly in the bedroom
  38. 38. ManagementDescribe strategies to relieve symptoms of •✓ ✓ upper respiratory infectionGargle with salt waterIncrease fluid intake, particularly of hotliquidsProvide warm, moist air by shower orhumidifier to relieve swollen mucousmembranesAvoid irritants (dust, chemicals,tobacco smoke) when possibleRecognize signs and symptoms of•infection and state when to contact a ✓ ✓ health care provider
  39. 39. Management Upper respiratory tract signs &symptomsExtreme red throat or white patches onthe back of the throatDiscolored drainage or foul-smellingnasal dischargeProlonged fever of 100.5°F (38°C) >2 daysShortness of breath, wheezingSwollen lymph nodesSevere pain or tenderness around theeyes or persistent pain in sinus areasSevere headache
  40. 40. THE PATIENT WITH UPPER AIRWAY INFECTION:NURSING PROCESSAssessment A health history mayreveal signs and symptoms ofheadache, sorethroat, pain around the eyes and oneither side of the nose, difficultyin swallowing, cough, hoarseness,fever, stuffiness, and generalized.discomfort and fatigue
  41. 41. Based on the assessment data, the patient’s major nursing diagnosesIneffective airway clearance- 1:•related to excessive mucusproduction secondary toretained secretions andinflammationAcute pain related to upper-• 2airway irritation secondary toan infection
  42. 42. Impaired verbal communication-3related to physiologic changes andupper airway irritation secondary toinfectionor swellingDeficient fluid volume related to-4increased fluid loss secondary todiaphoresis associated with a feverDeficient knowledge regarding- 5•prevention of upper respiratoryinfections, treatment regimen, surgicalprocedure
  43. 43. Nursing InterventionsMAINTAINING A PATENT AIRWAYPROMOTING COMFORTENCOURAGING FLUID INTAKEPROMOTING HOME AND COMMUNITY-BASED CARE Teaching Patients Self-CareMONITORING AND MANAGINGPOTENTIAL COMPLICATIONSWhile major complications of upperrespiratory infections arerare, the nurse must be aware of them and.assess the patient for them
  44. 44. Evaluation EXPECTED PATIENT OUTCOMES:Expected patient outcomes may includeMaintains a patent airway by managing. 1secretionsa. Reports decreased congestionb. Assumes best position to facilitatedrainage of secretionsReports feeling more comfortable. 2a. Uses comfort measures: analgesics, hotpacks, gargles, restb. Demonstrates adequate oral hygieneDemonstrates ability to communicate. 3needs, wants, level of comfort
  45. 45. Maintains adequate fluid intake-4Identifies strategies to prevent upper airway. 5infections and allergic reactionsa. Demonstrates hand hygiene techniqueb. Identifies the value of the influenza vaccineDemonstrates an adequate level of. 6knowledge and performsself-care adequatelyBecomes free of signs and symptoms of. 7infectiona. Exhibits normal vital signs (temperature,pulse, respiratory)rateb. Absence of purulent drainagec. Free of pain in ears, sinuses, and throat
  46. 46. Management of Patients with Chest and Lower Respiratory DisordersAcute Bronchitis: It is anacute inflammation of themucous membrane of thebronchi often following infections of the upper respiratory tract
  47. 47. Acute Bronchitis:CausesViral infection bacterial infection-1,(streptococcus pneumonia(Homophiles influenza-2Physical & chemical irritants-3( (dust, gases smokeAir pollution-4
  48. 48. :Clinical manifestationsDry, irritating cough, scanty sputum *Sternal sorenessFeverHeadacheGeneral malaiseAs the infection progresses the patient may have profuse sputumIt is an inflammatory process of the lung ]that is. Commonly caused by infectionsagent