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CONCEPT OF
OXYGENATION
BY: ROMMEL LUIS C. ISRAEL III
BY: ROMMEL LUIS C. ISRAEL III
1
OBJECTIVES
•Review the structure and function of
the respiratory function.
•Describe the process of ventilation
and respiration.
•Explain the role and function of the
respiratory system in transporting
oxygen and carbon dioxide to and
from body tissues
BY: ROMMEL LUIS C. ISRAEL III
2
• Identify factors influencing respiratory function.
• Identify common manifestations of impaired
respiratory function
• Identify and describe nursing measures to
promote respiratory function and oxygenation.
• Explain the use of therapeutic measures such as
medications, inhalation therapy, oxygen therapy,
artificial airways and chest drainage to promote
respiratory function
BY: ROMMEL LUIS C. ISRAEL III
3
•The concept of oxygenation
is a dynamic one that
involves the transportation of
oxygen to blood cells and
removal of carbon dioxide.
BY: ROMMEL LUIS C. ISRAEL III
4
•When atmospheric oxygen is
taken into the lungs, it is
picked-up by the blood and
transported to the cellular levels
through a network of blood
vessels.
BY: ROMMEL LUIS C. ISRAEL III
5
• The heart pumps
that moves the
blood thru the
lungs where
oxygen and
carbon dioxide are
exchanged.
BY: ROMMEL LUIS C. ISRAEL III
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•The oxygenated
blood returns to
the lungs and to
the body tissues
BY: ROMMEL LUIS C. ISRAEL III
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OXYGEN
•Clear, odorless gas that constitutes
approximately 21% of the air we
breathe
•Absence of oxygen can lead to
DEATH.
BY: ROMMEL LUIS C. ISRAEL III
8
RESPIRATION
•The process of gas exchange
between the individual and
the environment.
BY: ROMMEL LUIS C. ISRAEL III
9
2 COMPONENTS OF
RESPIRATION
• Pulmonary ventilation or breathing; the
movement of air between the
atmosphere and the alveoli of the lung
• Diffusion of oxygen and carbon dioxide
between the alveoli and pulmonary
capillaries.
BY: ROMMEL LUIS C. ISRAEL III
10
STRUCTURE OF
RESPIRATORY SYSTEM
BY: ROMMEL LUIS C. ISRAEL III
11
UPPER RESPIRATORY
SYSTEM
• Or the upper tract
• Or upper airway
• Warms and filters inspired
air so that the lower
respiratory tract (the lungs)
can accomplish gas
exchange.
BY: ROMMEL LUIS C. ISRAEL III
12
NOSE
• Composed of external and internal portion.
• External portion protrudes from the face
and is supported by the nasal bones and
cartilage.
• Anterior nares (nostrils) are the external
openings of the nasal cavities.
BY: ROMMEL LUIS C. ISRAEL III
13
• Internal portion of the nose is a hollow cavity
separated into left and right nasal cavities by a
narrow vertical divider, the SEPTUM.
• Each nasal cavity is divided into three passageways
by the projections of the turbinates (CONCHAE)
from the lateral walls.
• Nasal cavities are lined with highly vascular ciliated
mucus membranes called NASAL MUCOSA.
BY: ROMMEL LUIS C. ISRAEL III
14
• The nose serves:
• as a passageway for air to pass to and
from the lungs
• Filters impurities
• Humidifies the air
• Warms the air
• Responsible for olfaction (smell) because
olfactory nerves are located in nasal
mucosa
BY: ROMMEL LUIS C. ISRAEL III
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PARANASAL SINUSES
• Are named by their location
• Frontal
• Ethmoidal
• Sphenoidal
• Maxillary
• Its prominent function is to serve as a
RESONATING CHAMBER IN SPEECH.
BY: ROMMEL LUIS C. ISRAEL III
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•Common site
for infection.
•It traps
particles.
BY: ROMMEL LUIS C. ISRAEL III
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PHARYNX
•Or THROAT
•Tube-like structure that connects the
nasal and oral cavities to the larynx.
•Functions as the PASSAGEWAY FOR
THE RESPIRATORY AND DIGESTIVE
TRACTS
BY: ROMMEL LUIS C. ISRAEL III
18
LARYNX
•Known as the “VOICE BOX”
•Major function: VOCALIZATION
•Protects the lower airway from
foreign substances and facilitates
coughing.
BY: ROMMEL LUIS C. ISRAEL III
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• Consists of:
• Epiglottis – covers the opening to the larynx
during swallowing
• Glottis – opening between the vocal cords in
the larynx
• Thyroid cartilage – largest of the cartilage
structures, forms the ADAM’S APPLE
• Vocal cords – ligaments controlled by
muscular movements that produce sounds
BY: ROMMEL LUIS C. ISRAEL III
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TRACHEA
•Or “WINDPIPE”
•Serves as the passage between
the larynx and the bronchi
BY: ROMMEL LUIS C. ISRAEL III
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LOWER RESPIRATORY
SYSTEM
BY: ROMMEL LUIS C. ISRAEL III
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LUNGS
•Paired elastic structures enclosed in
thoracic cage
•Composed of 3 lobes on right side
and 2 lobes on left side
•Covered by PLEURA
BY: ROMMEL LUIS C. ISRAEL III
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PLEURA
• Serous membrane
that lines the lungs
and wall of thorax
• Visceral pleura-
covers the lungs
• Parietal pleura-
lines the thorax
BY: ROMMEL LUIS C. ISRAEL III
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PLEURAL FLUID
•Serves to lubricate the thorax
and lungs and permit smooth
motion of the lungs within the
thoracic cavity with each
breath.
BY: ROMMEL LUIS C. ISRAEL III
25
BRONCHI AND
BRONCHIOLES
• They are formed by
branching if trachea
• Right main
bronchus – larger
and more vertical
than left
BY: ROMMEL LUIS C. ISRAEL III
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•Bronchioles
branch into
terminal
bronchioles
which end in
alveoli
BY: ROMMEL LUIS C. ISRAEL III
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ALVEOLI
• Arranged in clusters
• Site for GAS
EXCHANGE
• SURFACTANT-
reduces surface
tension to keep
alveoli from
collapsing
BY: ROMMEL LUIS C. ISRAEL III
28
FUNCTION OF THE
RESPIRATORY SYSTEM
BY: ROMMEL LUIS C. ISRAEL III
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• The cells of the body derive energy they need
from the oxidation of carbohydrates, fats and
proteins.
• Certain vital tissues, such as those of the brain
and heart, cannot survive for long without a
continuing supply of oxygen.
• As a result of oxidation in the body tissues,
carbon dioxide is produced and must be removed
from cells to prevent build-up of acid wastes.
BY: ROMMEL LUIS C. ISRAEL III
30
OXYGEN TRANSPORT
•Oxygen is supplied to, and carbon
dioxide is removed from, cells by way
of circulating blood.
•Cells are in close contact with
capillaries, whose thin walls permit
easy passage or exchange of oxygen
and carbon dioxide.
BY: ROMMEL LUIS C. ISRAEL III
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• Oxygen diffuses from the capillary through
the capillary wall to the interstitial fluid.
• At this point, it diffuses through the
membrane of tissue cells, where it is used
by mitochondria for cellular respiration.
• The movement of carbon dioxide occurs by
diffusion in the opposite direction – from
cell to blood.
BY: ROMMEL LUIS C. ISRAEL III
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BY: ROMMEL LUIS C. ISRAEL III
33
RESPIRATION
•The whole process of gas exchange
between the atmospheric air and the
blood and between the blood and
cells of the body
•After tissue capillary exchanges, blood
enters the systemic veins (where it is
called VENOUS BLOOD)
BY: ROMMEL LUIS C. ISRAEL III
34
•The oxygen concentration in blood
within the capillaries of the lungs is
lower that in the lungs’ air sacs
(alveoli). Therefore, oxygen diffuses
from the alveoli to the blood.
•Carbon dioxide, which has the higher
concentration in the blood than in the
alveoli, diffuses from the blood into
the alveoli.
BY: ROMMEL LUIS C. ISRAEL III
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•Movement of air in and out of the
airways (ventilation) continually
replenishes the oxygen and removes
the carbon dioxide from the airways in
the lung.
BY: ROMMEL LUIS C. ISRAEL III
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VENTILATION
• Movement of air in and out of the lungs
• Adequate ventilation depends on several factors:
• Clear airways
• An intact CNS and respiratory center
• An intact thoracic cavity capable of expanding
and contracting
• Adequate pulmonary compliance and recoil
BY: ROMMEL LUIS C. ISRAEL III
37
• 2 PHASES:
• Inspiration – involves the contraction and
descent of the chest is increased and the
pressure in the air passages and alveoli
decreases, secreting sub-atmospheric pressure
so that air goes into the respiratory area until
the pressure gradient is equalized.
• Expiration – a passive process that results in
the expulsion of air when the components of
the thoracic cage relax.
BY: ROMMEL LUIS C. ISRAEL III
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•Physical factors that govern the air
flow in and out of the lungs are
collectively referred to as the
mechanics of ventilation and includes
•Muscle structure
•Interpleural pressure
•Lung compliance
•Airway resistance
BY: ROMMEL LUIS C. ISRAEL III
39
MUSCLE STRUCTURE
•Muscle bundles that influence
respiration:
•Intercostal muscles
•Anterior neck muscles such as
Scalene, sternocleidomastoid
•Muscles of abdomen
BY: ROMMEL LUIS C. ISRAEL III
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INTRAPLEURAL PRESSURE
•Pressure in the pleural cavity
surrounding the lungs
•Always slightly negative in
relation to atmospheric pressure
•INTRAPULMONARY PRESSURE
(pressure within the lungs)
BY: ROMMEL LUIS C. ISRAEL III
41
LUNG COMPLIANCE
• Is the measure of the elasticity,
expandability and distensibility of the lungs
and thoracic structures
• Factors that determine lung compliance are
the SURFACE TENSION of the ALVEOLI
(normally low with the presence of
surfactant) and the connective tissue
(collagen and elastin) of the lungs.
BY: ROMMEL LUIS C. ISRAEL III
42
• Determined by examining the volume-
pressure relationship in the lungs and the
thorax.
• NORMALLY, the lungs and thorax easily
stretch and distend when pressure is
applied.
• HIGH or increased compliance occurs when
the lungs have lost their elasticity and the
thorax is overdistended.
BY: ROMMEL LUIS C. ISRAEL III
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•When lungs and thorax are “stiff”,
there is LOW or decreased
compliance.
•Conditions associated with this
include pneumothorax,
hemothorax, pleural effusion,
pulmonary edema, atelectasis,
pulmonary fibrosis and ARDS.
BY: ROMMEL LUIS C. ISRAEL III
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AIRWAY RESISTANCE
•Refers to the relationship
between airflow and pleural
pressure
BY: ROMMEL LUIS C. ISRAEL III
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REQUIREMENTS FOR EFFECTIVE
VENTILATION
•Patent airway
•Elastic, expansible lungs and
tracheo-bronchial tree
•Adequate musculo-skeletal
apparatus of chest wall
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BY: ROMMEL LUIS C. ISRAEL III
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BY: ROMMEL LUIS C. ISRAEL III
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FACTORS AFFECTING
RESPIRATORY FUNCTION
BY: ROMMEL LUIS C. ISRAEL III
49
AGE
• At birth, fluid-filled lungs drain, partial
pressure of carbon dioxide rises, neonate
takes a first breath.
• Lungs reaches full inflation by 2 weeks of
age
• Changes of aging that affect the
respiratory system are infection, physical or
emotional stress, surgery, anesthesia and
other procedures
BY: ROMMEL LUIS C. ISRAEL III
50
•Respiratory rates are HIGHEST and
mist variable in NEWBORNS.
• Because of rib cage structure, infants
rely almost exclusively on
DIAPHRAGMATIC MOVEMENT for
breathing.
BY: ROMMEL LUIS C. ISRAEL III
51
CHANGES IN ELDERLY
• Chest wall and airways become more rigid and
less elastic
• The amount of exchanged air is decreased
• The cough reflex and cilia action are decreased
• Mucus membranes become drier and more
fragile
• Decrease in muscle strength and endurance
BY: ROMMEL LUIS C. ISRAEL III
52
• If osteoporosis is present, adequate lung
expansion may be compromised.
• A decrease in efficiency on the immune
system occurs.
• Gastroesophageal reflux disease is more
common in older adults and increases the
risk of aspiration. The aspiration of
stomach contents into the lungs often
causes bronchospasm by setting up an
inflammatory response.
BY: ROMMEL LUIS C. ISRAEL III
53
ENVIRONMENT
LIFESTYLE
HEALTH STATUS
MEDICATIONS
STRESS
BY: ROMMEL LUIS C. ISRAEL III
54
PHYSICAL ASSESSMENT
AND
HEALTH HISTORY
BY: ROMMEL LUIS C. ISRAEL III
55
• The health history focuses on the physical and
functional problems of the patient and the effect
on these problems on his or her life.
• Reason patient is seeking health care is often
related to:
• Dyspnea
• Pain
• Accumulation of mucus
• Wheezing
• Hemoptysis
• Edema of ankles and feet
• Cough
• Fatigue and weakness
BY: ROMMEL LUIS C. ISRAEL III
56
SUBJECTIVE DATA
• ASSESSMENT INTERVIEW
• Have you noticed any changes in your
breathing pattern?
• If so, which of your activities might cause these
symptoms?
• How many pillows do you use to sleep at
night?
• Have you had any medical conditions
experienced before?
BY: ROMMEL LUIS C. ISRAEL III
57
• How frequently have these occurred? How
long did they last? And how were they
treated?
• Do you smoke? If so, how much?
• Does any of our family member smoke?
• Do you use alcohol? If so, how many drinks
do you usually have per day or per week
• Describe your exercise patterns.
BY: ROMMEL LUIS C. ISRAEL III
58
• How often and how much do you cough?
• Is it productive, accompanied by sputum or
non productive cough?
• When is the sputum produced?
• What is the amount, color, thickness, odor?
• Is it tinged with blood?
• Ask for any occurrence of chest pain, risk
factors and medication history
BY: ROMMEL LUIS C. ISRAEL III
59
OBJECTIVE DATA
• Major signs and symptoms of respiratory disease are:
• Dyspnea
• Cough
• Sputum production
• Chest pain
• Wheezing
• Clubbing of the fingers
• Hemoptysis
• Cyanosis
BY: ROMMEL LUIS C. ISRAEL III
60
DYSPNEA
• Difficult or labored breathing
• Shortness of breath
• A common symptom to many pulmonary
and cardiac disorders.
• Right ventricle of the heart will be affected
ultimately by lung disease because it must
pump blood through the lungs against
greater resistance.
BY: ROMMEL LUIS C. ISRAEL III
61
CLINICAL SIGNIFICANCE
• Sudden dyspnea in HEALTHY PERSON may
indicate pneumothorax or ARDS.
• In IMMOBILIZED PATIENTS, sudden dyspnea
may denote pulmonary embolism.
• ORTHOPNEA (inability to breathe easily
except in an upright position) may be found
in patients with COPD
BY: ROMMEL LUIS C. ISRAEL III
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•NOISY BREATHING may result from
a narrowing of the airway or
localized obstruction of a major
bronchus by a tumor or foreign
body.
•Wheezing usually signifies asthma.
BY: ROMMEL LUIS C. ISRAEL III
63
RELIEF MEASURES
• The management of dyspnea is aimed at
identifying and correcting its cause.
• Relief of the symptom sometimes is
achieved by placing the patient at rest with
the head elevated (high Fowler’s position).
• In severe cases, administering oxygen.
BY: ROMMEL LUIS C. ISRAEL III
64
COUGH
•Results from irritation of the
mucus membranes anywhere in
the respiratory tract.
•Patient’s chief protection against
the accumulation of secretions in
the bronchi and bronchioles.
BY: ROMMEL LUIS C. ISRAEL III
65
CLINICAL SIGNIFICANCE
•May indicate serious pulmonary
diseases.
•The nurse needs to evaluate the
character of the cough – dry, hacking,
brassy, wheezing, loose or severe.
• Time of coughing is also noted.
BY: ROMMEL LUIS C. ISRAEL III
66
•DRY & IRRITANT COUGH –
characteristic of an upper respiratory
tract infection of viral origin.
•LARYNGOTRACHEITIS – causes an
irritative, high-pitched cough.
•TRACHEAL LESIONS – produce a
brassy cough
•BRONCHOGENIC CARCINOMA –
severe and changing cough
BY: ROMMEL LUIS C. ISRAEL III
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TRACHEAL LESIONS
BY: ROMMEL LUIS C. ISRAEL III
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•Coughing at NIGHT may herald the
onset of LEFT-SIDED HEART
FAILURE or BRONCHIAL ASTHMA.
•Cough in MORNING WITH SPUTUM
PRODUCTION may indicate
BRONCHITIS.
BY: ROMMEL LUIS C. ISRAEL III
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BRONCHIAL ASTHMA
BY: ROMMEL LUIS C. ISRAEL III
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BRONCHITIS
BY: ROMMEL LUIS C. ISRAEL III
71
•A cough that worsens when the
patient is SUPINE suggests
SINUSITIS (postnasal drip).
•Coughing AFTER food intake may
indicate aspiration of material into
tracheo-bronchial tree.
BY: ROMMEL LUIS C. ISRAEL III
72
SPUTUM
PRODUCTION
•The color of sputum or phlegm,
which is the mucus and sometimes
pus discharge expectorated from the
respiratory tract, is often an
indication of the type of respiratory
disease that gives rise to sputum
production.
BY: ROMMEL LUIS C. ISRAEL III
73
•By examining the type of sputum and
noting the color as well as the
presenting signs and symptoms, a
differential diagnosis may be reached
prior to laboratory tests and
examination (sputum culture).
•A thorough case history and complete
physical examination is also necessary.
BY: ROMMEL LUIS C. ISRAEL III
74
MEANING OF DIFFERENT
SPUTUM COLORS
BY: ROMMEL LUIS C. ISRAEL III
75
CLEAR, WHITE, GRAY
SPUTUM
•Clear sputum is considered as normal,
however, there are many conditions
that may cause excessive sputum
production.
•A profuse amount of clear sputum
should therefore be considered as
abnormal.
BY: ROMMEL LUIS C. ISRAEL III
76
•Pulmonary edema (fluid in the lungs) –
clear, white or pink frothy sputum
•Viral respiratory tract infections – clear
to white (acute)
•Chronic bronchitis (COPD) – clear to
gray
•Asthma – white to yellow (thick)
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CHRONIC BRONCHITIS
BY: ROMMEL LUIS C. ISRAEL III
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CHRONIC BRONCHITIS
BY: ROMMEL LUIS C. ISRAEL III
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YELLOW SPUTUM
•Yellow colored sputum is due to the
presence of white blood cells,
particularly neutrophils and
eosinophils.
•These cells are often present in chronic
inflammation, allergic and infectious
causes.
BY: ROMMEL LUIS C. ISRAEL III
80
•With INFECTIONS, it is often in the
acute setting that yellow sputum is
evident due to the presence of live
neutrophils.
•With ALLERGIC CONDITIONS,
particularly airway hypersensitivity,
the yellowish sputum is due to the
presence of eosinophils.
BY: ROMMEL LUIS C. ISRAEL III
81
Acute bronchitis – white to yellow
Acute pneumonia – white to yellow
Asthma – white to yellow (thick)
BY: ROMMEL LUIS C. ISRAEL III
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GREEN SPUTUM
•Green mucus is indicative of a long-
standing, possibly chronic, infection.
•The color is a result of the breakdown
of neutrophils and the release of
verdoperioxidase / myeloperioxidase,
an enzyme that is present within these
cells.
BY: ROMMEL LUIS C. ISRAEL III
83
• It may also be seen in long standing non-
infectious inflammatory conditions.
• With infections, the green sputum will be
more purulent (large amounts of pus).
• While in non-infectious inflammatory
conditions, the green sputum will be more
mucoid (large amounts of mucus).
BY: ROMMEL LUIS C. ISRAEL III
84
•Pneumonia – white, yellow or green
•Lung abscess – green, sudden
accumulation of large amount of
sputum if the abscess ruptures
•Chronic bronchitis – clear, grey to
green (infection)
•Bronchiectasis, cystic fibrosis – green
BY: ROMMEL LUIS C. ISRAEL III
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LUNG ABCESS
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BRONCHIECTASIS
BY: ROMMEL LUIS C. ISRAEL III
87
BROWN, BLACK SPUTUM
• Brown or black sputum is an indication of
‘old blood’ and the color may be due to the
breakdown of red blood cells thereby
releasing hemosiderin (from hemoglobin).
• Certain organic and non-organic dusts may
also cause a brown to black discoloration of
the sputum.
BY: ROMMEL LUIS C. ISRAEL III
88
•Chronic bronchitis – green, yellow,
brown (infection)
•Chronic pneumonia – white, yellow,
green to brown
•Coal worker’s pneumoconiosis –
brown to black
•Tuberculosis – red to brown or black
•Lung cancer – red to brown to black
BY: ROMMEL LUIS C. ISRAEL III
89
COAL WORKER’S PNEUMOCONIOSIS
• SIMPLE COAL WORKER’S
PNEUMOCONIOSIS
• PROGRESSIVE FIBROSIS COAL
WORKER’S PNEUMOCONIOSIS
BY: ROMMEL LUIS C. ISRAEL III
90
RED, PINK RUST-COLORED
SPUTUM
•Red sputum is usually an indication of
whole blood that is more profuse than
bleeding in pink colored sputum.
•It may completely discolor the mucus
or appear as streaks or spots.
BY: ROMMEL LUIS C. ISRAEL III
91
•Pink sputum is also a sign of bleeding
but usually of smaller quantities that
may stain or streak the sputum.
•Rust colored sputum is also due to the
bleeding although the clotting process
process may have commenced and
the red blood cells may have broken
down.
BY: ROMMEL LUIS C. ISRAEL III
92
•Pneumococcal pneumonia – rusty-red
•Lung cancer - pink to red (frothy)
progressing to brown or black
•Tuberculosis – bright red streaks
progressing to fully red sputum
(hemoptysis)
•Pulmonary embolism – bright red
blood (acute)
BY: ROMMEL LUIS C. ISRAEL III
93
LUNG CANCER
BY: ROMMEL LUIS C. ISRAEL III
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MEANING OF DIFFERENT
TYPES OF SPUTUM
BY: ROMMEL LUIS C. ISRAEL III
97
CLEAR SPUTUM
• slightly sticky and a bit viscous (thicker than
water) is accepted as normal sputum.
• It is produced and secreted in moderate amounts
to moisten the respiratory tract and trap dust and
microorganisms (mucus) and lubricate the mouth
and aid with chewing, swallowing and digestion
(saliva).
• While any expectorated sputum is considered to
be abnormal, small amounts of sputum can be
coughed up or spat out with effort even in the
absence of any respiratory pathology.
BY: ROMMEL LUIS C. ISRAEL III
98
• However, in certain conditions, particularly
related to irritation of the respiratory tract,
the amount of sputum may become
excessive.
• In these pathological cases, the color,
texture and even odor of the sputum may
change.
• These variations may give an indication of
the possible cause.
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99
SEROUS
• Normal, clear sputum is a serous discharge.
• Large amounts of clear, frothy or pink sputum
that is of a similar consistency as normal sputum
may be a sign of pulmonary edema, which is an
accumulation of fluid in the lungs.
• If it extremely profuse and lasting for weeks or
months, then it may be due to lung cancer.
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100
•Frothy sputum is caused by
surfactant in the lung alveoli which
reduces the surface tension of the
sputum.
•It indicates that the sputum had
contact with the lung alveoli or
originated from this site.
BY: ROMMEL LUIS C. ISRAEL III
101
MUCOPURULENT
•Mucoid, mucopurulent or purulent
sputum is thicker and often more
sticky than normal sputum.
•This is partly due to the greater
mucus production coupled with pus
in the purulent types.
BY: ROMMEL LUIS C. ISRAEL III
102
•Mucoid sputum is a sign of non-
infectious airway disease like chronic
bronchitis (COPD) and asthma or may
occur in the early stages of infection.
•Mucopurulent sputum is an indication
of infection of the respiratory tract,
particularly of the bronchi or lungs –
acute bronchitis and pneumonia.
BY: ROMMEL LUIS C. ISRAEL III
103
BLOOD-STAINED
•Sputum may be blood stained where
the normal sticky or mucopurulent
thick consistency becomes thinner
due to the presence of varying
amounts of blood.
BY: ROMMEL LUIS C. ISRAEL III
104
•In severe cases involving the coughing
up of large amounts of blood
(hemoptysis), the consistency of the
sputum may be the same viscosity as
blood and little or no sputum may be
visible. Blood stained sputum may be
due to tuberculosis, bronchiectasis,
pulmonary embolism or lung cancer.
BY: ROMMEL LUIS C. ISRAEL III
105
CHEST PAIN
•May be associated with pulmonary or
cardiac diseases.
•Chest pain associated with pulmonary
conditions may be SHARP, STABBING
and INTERMITTENT
•May be DULL, ACHING, PERSISTENT
BY: ROMMEL LUIS C. ISRAEL III
106
•May occur with PNEUMONIA,
PULMONARY EMBOLISM with LUNG
INFARACTION, PLEURISY
•LATE SYMPTOM – bronchogenic
carcinoma
•CARCINOMA – pain may be dull and
persistent because the carcinoma has
invaded the chest wall, mediastinum
or spine
BY: ROMMEL LUIS C. ISRAEL III
107
•The nurse assesses the quality,
intensity and radiation of pain.
•Identifies and explores precipitating
factors, along with the relationship of
the patient’s position.
BY: ROMMEL LUIS C. ISRAEL III
108
RELIEF MEASURES
•Analgesic medications may be
effective in relieving chest pain.
•Non-steroidal anti-inflammatory
drugs (NSAIDs) used for pleuritic
pain
BY: ROMMEL LUIS C. ISRAEL III
109
WHEEZING
• A high-pitched, musical sound heard mainly on
expiration.
• Major finding in a patient with
bronchoconstriction or airway narrowing.
• Can be heard with or without a stethoscope,
depending on location
BY: ROMMEL LUIS C. ISRAEL III
110
BY: ROMMEL LUIS C. ISRAEL III
111
BY: ROMMEL LUIS C. ISRAEL III
112
RELIEF MEASURES
• Oral or inhalant
bronchodilator
medications
reverse wheezing
in most instances.
BY: ROMMEL LUIS C. ISRAEL III
113
CLUBBING OF FINGERS
• A sign of lung
disease found in
patients with
chronic hypoxic
conditions, chronic
lung infections and
malignancies of the
lung.
BY: ROMMEL LUIS C. ISRAEL III
114
•Manifested
initially as
sponginess of
the nail-bed
and loss of the
nail-bed angle.
BY: ROMMEL LUIS C. ISRAEL III
115
BY: ROMMEL LUIS C. ISRAEL III
116
HEMOPTYSIS
• Expectoration of blood from the respiratory
tract
• Symptom of both pulmonary and cardiac
disorders.
• Its onset is usually sudden, may be
intermittent or continuous.
• The amount of blood produced is not
always proportional to the seriousness of
the cause.
BY: ROMMEL LUIS C. ISRAEL III
117
DIAGNOSTIC EVALUATION
•Chest
angiography
•Chest x-ray
•Bronchoscopy
BY: ROMMEL LUIS C. ISRAEL III
118
POINTS TO CONSIDER WHEN
DOCUMENTING BLEEDING EPISODE:
•Bloody sputum from the nose or
the nasopharynx is usually
preceded by considerable sniffing,
with blood possibly appearing on
the nose.
BY: ROMMEL LUIS C. ISRAEL III
119
• Blood from the lung is usually bright red, frothy,
mixed with sputum.
• Initial symptoms include a tickling sensation in
the throat, a salty taste, a burning or bubbling
sensation in the chest and perhaps chest pain.
• The term “hemoptysis” is reserved for the
coughing up of blood arising from a pulmonary
hemorrhage.
• This blood has an alkaline pH (greater than 7.0)
BY: ROMMEL LUIS C. ISRAEL III
120
•If the hemorrhage is in the stomach,
the blood is vomited (hematemesis)
rather than coughed up.
•Blood that has been in contact with
gastric juice is sometimes so dark that
it is referred to as “coffee grounds”.
This blood has an acid pH (less than
7.0).
BY: ROMMEL LUIS C. ISRAEL III
121
CYANOSIS
•Bluish discoloration of the skin
•VERY LATE indicator of hypoxia.
•Assessment of cyanosis is affected by
room lighting, the patient’s skin color
and the distance of the blood vessels
from the surface of the skin.
BY: ROMMEL LUIS C. ISRAEL III
122
• In pulmonary condition, central cyanosis is
assessed by observing the color of the tongue
and lips.
• This indicates a decrease in oxygen tension in the
blood.
• Peripheral cyanosis results from decreased blood
flow to a certain area of the body, as in
vasoconstriction of the nailbeds or earlobes from
exposure to cold, and DOES NOT necessarily
indicate a central systemic problem.
BY: ROMMEL LUIS C. ISRAEL III
123
PHYSICAL ASSESSMENT OF LOWER
RESPIRATORY STRUCTURE AND
BREATHING PATTERNS
BY: ROMMEL LUIS C. ISRAEL III
124
CHEST CONFIGURATION
• Normally, the ratio of the anteroposterior diameter
to the lateral diameter is 1:2.
• There are four main deformities of the chest
associated with respiratory disease that alter this
relationship:
• Barrel chest
• Funnel chest (pectus excavatum)
• Pigeon chest (pectus carinatum)
• kyphoscoliosis
BY: ROMMEL LUIS C. ISRAEL III
125
BARREL CHEST
• Due to over-
inflation of the
lungs.
• There is an increase
in the
anteroposterior
diameter of the
thorax.
BY: ROMMEL LUIS C. ISRAEL III
126
• In patient with
emphysema, the
ribs are more
widely spaced and
the intercostal
spaces tend to
bulge on expiration.
BY: ROMMEL LUIS C. ISRAEL III
127
• The appearance of the
patient with advanced
emphysema is thus
quite characteristic
and often allows the
observer to detect its
presence easily, even
from a distance.
BY: ROMMEL LUIS C. ISRAEL III
128
FUNNEL CHEST
(PECTUS EXCAVATUM)
• Occurs when there is a
depression in the
lower portion of the
sternum.
• This may compress the
heart and great vessels
resulting in
MURMURS.
BY: ROMMEL LUIS C. ISRAEL III
129
•Funnel chest may
occur with rickets
or Marfan’s
syndrome.
BY: ROMMEL LUIS C. ISRAEL III
130
BY: ROMMEL LUIS C. ISRAEL III
131
PIGEON CHEST
( PECTUS CARINATUM)
•Occurs as a result
of displacement
of sternum.
BY: ROMMEL LUIS C. ISRAEL III
132
BY: ROMMEL LUIS C. ISRAEL III
133
BY: ROMMEL LUIS C. ISRAEL III
134
KYPHOSCOLIOSIS
• Characterized by
elevation of the
scapula and
corresponding S-
shaped spine.
BY: ROMMEL LUIS C. ISRAEL III
135
• This deformity
limits lung
expansion within
the thorax.
• It may also occur
with osteoporosis
and other skeletal
disorders that affect
the thorax.
BY: ROMMEL LUIS C. ISRAEL III
136
BY: ROMMEL LUIS C. ISRAEL III
137
BY: ROMMEL LUIS C. ISRAEL III
138
NORMAL BREATH SOUNDS
BY: ROMMEL LUIS C. ISRAEL III
139
• Distinguished by their location over a specific
area of the lung:
• Vesicular
• Bronchovesicular
• Bronchial (Tubular)
• Tracheal
• The LOCATION, QUAILITY and INTENSITY of
breath sounds are determined during
auscultation.
BY: ROMMEL LUIS C. ISRAEL III
140
ADVENTITIOUS SOUNDS
-Discrete, Noncontinuous Sound
-Continuous Musical Sound
(Wheezes)
-Friction Rubs
BY: ROMMEL LUIS C. ISRAEL III
141
DISCRETE, NONCONTINUOUS
SOUND
BY: ROMMEL LUIS C. ISRAEL III
142
CRACKLES
• Formerly referred to as RALES
• Result form delayed opening of deflated
airways.
• Friction rubs result from inflammation of
the pleural surfaces that induces a
crackling, grating sound usually heard in
inspiration and expiration.
BY: ROMMEL LUIS C. ISRAEL III
143
•May or may not be cleared by
coughing
•Reflect underlying inflammation or
congestion
•Present in conditions as pneumonia,
bronchitis, heart failure,
bronchiectasis, and pulmonary fibrosis
BY: ROMMEL LUIS C. ISRAEL III
144
FINE CRACKLES
•Usually audible at the end of
inspiration and originate from alveoli
•Sound is like rubbing several pieces of
hair next to one’s ear.
BY: ROMMEL LUIS C. ISRAEL III
145
COARSE CRACKLES
•A gross, moist sound produced in the
large bronchi and are audible in early
and mid-inspiration.
BY: ROMMEL LUIS C. ISRAEL III
146
CONTINUOUS SOUNDS (WHEEZES)
BY: ROMMEL LUIS C. ISRAEL III
147
SIBILANT WHEEZES
•Caused by air
passing thru
narrowed
tracheo-bronchial
tree
• Found in asthma
or airway
obstruction
BY: ROMMEL LUIS C. ISRAEL III
148
• Originate in brochi
and bronchioles
• “Whistling” sound
• Musical noise during
inspiration or
expiration
• Louder during
expiration
• May be cleared with
coughing
BY: ROMMEL LUIS C. ISRAEL III
149
SONOROUS WHEEZES
•Called “GURGLES” or “RONCHI
SOUNDS”
•Deep, low-pitched rumbling sound
heard primarily during expiration.
BY: ROMMEL LUIS C. ISRAEL III
150
•Caused by the movement of air
through the airways that are partially
obstructed or narrowed airways
•Such as in tumors or mucosal swelling
BY: ROMMEL LUIS C. ISRAEL III
151
FRICTION RUBS
BY: ROMMEL LUIS C. ISRAEL III
152
PLEURAL FRICTION RUBS
•Harsh, crackling sound, like two
pieces of leather rubbed together
•Heard during inspiration alone or
during both inspiration and
expiration.
BY: ROMMEL LUIS C. ISRAEL III
153
•May subside when patient holds
breath.
•Coughing will NOT clear sound
•It is secondary to inflammation
and loss of lubricating pleural
fluid.
BY: ROMMEL LUIS C. ISRAEL III
154
VOICE SOUNDS
BY: ROMMEL LUIS C. ISRAEL III
155
•Vocal resonance
•The sound heard through the
stethoscope as the patient speaks
•The vibrations produced in the
larynx are transmitted to the chest
wall as they pass through the
bronchi and alveolar tissue.
BY: ROMMEL LUIS C. ISRAEL III
156
•Voice sounds are assessed by
having the patient repeat “ninety-
nine” or “eee” while the nurse
listens with the stethoscope in
corresponding areas of the chest.
BY: ROMMEL LUIS C. ISRAEL III
157
• BRONCHOPHONY
• Describes vocal resonance that is more
INTENSE and CLEARER than normal.
• EGOPHONY
• Describes the voice sounds that are distorted.
• Best appreciated by having the patient repeat
the letter “E”
• The distortion produced by consolidation
transforms the sounds into a clearly heard “A”
rather than “E”
BY: ROMMEL LUIS C. ISRAEL III
158
BREATHING PATTERNS
AND
RESPIRATORY RATES
BY: ROMMEL LUIS C. ISRAEL III
159
EUPNEA
•Normal, easy, quiet breathing
•Respirations are regular in depth
and rhythm
BY: ROMMEL LUIS C. ISRAEL III
160
DYSPNEA
•TYPES:
•Orthopnea – shortness of breath
when lying down
•Paroxysmal nocturnal dyspnea –
sudden dyspnea at night while
lying down
BY: ROMMEL LUIS C. ISRAEL III
161
APNEA
• Varying periods of cessation of breathing
• May occur briefly during other disorders,
such as with sleep apnea
• This can be life-threatening is sustained.
BY: ROMMEL LUIS C. ISRAEL III
162
BRADYPNEA
• Slow breathing
• Slower than normal rate (<10 breaths per
minute), with normal depth and rhythm
BY: ROMMEL LUIS C. ISRAEL III
163
TACHYPNEA
•Rapid, shallow breathing
>24 breaths per minute
BY: ROMMEL LUIS C. ISRAEL III
164
BIOT’S RESPIRATION
• Cluster breathing
• Cycles of breaths that vary in depth and
have varying periods of apnea.
• Periods of normal breathing (3-4 breaths)
followed by a varying period of apnea
(usually 10 seconds to 1 minute)
BY: ROMMEL LUIS C. ISRAEL III
165
•Seen in some central nervous
system disorder.
BY: ROMMEL LUIS C. ISRAEL III
166
CHEYNE-STOKES
•Regular cycle where the rate and
depth of breathing increase, then
decrease until apnea (usually 20
seconds) occurs.
•Characterized by rhythmic and
waning of depth of respiration
BY: ROMMEL LUIS C. ISRAEL III
167
•Seen typically in severe heart failure
and coma caused by neurologic
disorder.
•Near death breathing pattern
BY: ROMMEL LUIS C. ISRAEL III
168
KUSSMAUL’S BREATHING
• Or hyperventilation
• Or polypnea
• Marked by increase in rate and depth
• Associated with severe diabetic acidosis or renal
origin
BY: ROMMEL LUIS C. ISRAEL III
169
HYPOVENTILATION
•Or oligopnea
•Abnormally low amount of air that
enters the lungs
•Shallow, irregular breathing
BY: ROMMEL LUIS C. ISRAEL III
170
INTERRUPTED
•Cogwheel or Waxy respiration
•Jerky breathing pattern
•Respiratory and expiratory sounds are
clearly split into two or more sounds.
BY: ROMMEL LUIS C. ISRAEL III
171
ORTHOPNEA
•Inability to breath except
when the trunk is in upright
position
BY: ROMMEL LUIS C. ISRAEL III
172

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CONCEPT OF OXYGENATION

  • 1. CONCEPT OF OXYGENATION BY: ROMMEL LUIS C. ISRAEL III BY: ROMMEL LUIS C. ISRAEL III 1
  • 2. OBJECTIVES •Review the structure and function of the respiratory function. •Describe the process of ventilation and respiration. •Explain the role and function of the respiratory system in transporting oxygen and carbon dioxide to and from body tissues BY: ROMMEL LUIS C. ISRAEL III 2
  • 3. • Identify factors influencing respiratory function. • Identify common manifestations of impaired respiratory function • Identify and describe nursing measures to promote respiratory function and oxygenation. • Explain the use of therapeutic measures such as medications, inhalation therapy, oxygen therapy, artificial airways and chest drainage to promote respiratory function BY: ROMMEL LUIS C. ISRAEL III 3
  • 4. •The concept of oxygenation is a dynamic one that involves the transportation of oxygen to blood cells and removal of carbon dioxide. BY: ROMMEL LUIS C. ISRAEL III 4
  • 5. •When atmospheric oxygen is taken into the lungs, it is picked-up by the blood and transported to the cellular levels through a network of blood vessels. BY: ROMMEL LUIS C. ISRAEL III 5
  • 6. • The heart pumps that moves the blood thru the lungs where oxygen and carbon dioxide are exchanged. BY: ROMMEL LUIS C. ISRAEL III 6
  • 7. •The oxygenated blood returns to the lungs and to the body tissues BY: ROMMEL LUIS C. ISRAEL III 7
  • 8. OXYGEN •Clear, odorless gas that constitutes approximately 21% of the air we breathe •Absence of oxygen can lead to DEATH. BY: ROMMEL LUIS C. ISRAEL III 8
  • 9. RESPIRATION •The process of gas exchange between the individual and the environment. BY: ROMMEL LUIS C. ISRAEL III 9
  • 10. 2 COMPONENTS OF RESPIRATION • Pulmonary ventilation or breathing; the movement of air between the atmosphere and the alveoli of the lung • Diffusion of oxygen and carbon dioxide between the alveoli and pulmonary capillaries. BY: ROMMEL LUIS C. ISRAEL III 10
  • 11. STRUCTURE OF RESPIRATORY SYSTEM BY: ROMMEL LUIS C. ISRAEL III 11
  • 12. UPPER RESPIRATORY SYSTEM • Or the upper tract • Or upper airway • Warms and filters inspired air so that the lower respiratory tract (the lungs) can accomplish gas exchange. BY: ROMMEL LUIS C. ISRAEL III 12
  • 13. NOSE • Composed of external and internal portion. • External portion protrudes from the face and is supported by the nasal bones and cartilage. • Anterior nares (nostrils) are the external openings of the nasal cavities. BY: ROMMEL LUIS C. ISRAEL III 13
  • 14. • Internal portion of the nose is a hollow cavity separated into left and right nasal cavities by a narrow vertical divider, the SEPTUM. • Each nasal cavity is divided into three passageways by the projections of the turbinates (CONCHAE) from the lateral walls. • Nasal cavities are lined with highly vascular ciliated mucus membranes called NASAL MUCOSA. BY: ROMMEL LUIS C. ISRAEL III 14
  • 15. • The nose serves: • as a passageway for air to pass to and from the lungs • Filters impurities • Humidifies the air • Warms the air • Responsible for olfaction (smell) because olfactory nerves are located in nasal mucosa BY: ROMMEL LUIS C. ISRAEL III 15
  • 16. PARANASAL SINUSES • Are named by their location • Frontal • Ethmoidal • Sphenoidal • Maxillary • Its prominent function is to serve as a RESONATING CHAMBER IN SPEECH. BY: ROMMEL LUIS C. ISRAEL III 16
  • 17. •Common site for infection. •It traps particles. BY: ROMMEL LUIS C. ISRAEL III 17
  • 18. PHARYNX •Or THROAT •Tube-like structure that connects the nasal and oral cavities to the larynx. •Functions as the PASSAGEWAY FOR THE RESPIRATORY AND DIGESTIVE TRACTS BY: ROMMEL LUIS C. ISRAEL III 18
  • 19. LARYNX •Known as the “VOICE BOX” •Major function: VOCALIZATION •Protects the lower airway from foreign substances and facilitates coughing. BY: ROMMEL LUIS C. ISRAEL III 19
  • 20. • Consists of: • Epiglottis – covers the opening to the larynx during swallowing • Glottis – opening between the vocal cords in the larynx • Thyroid cartilage – largest of the cartilage structures, forms the ADAM’S APPLE • Vocal cords – ligaments controlled by muscular movements that produce sounds BY: ROMMEL LUIS C. ISRAEL III 20
  • 21. TRACHEA •Or “WINDPIPE” •Serves as the passage between the larynx and the bronchi BY: ROMMEL LUIS C. ISRAEL III 21
  • 22. LOWER RESPIRATORY SYSTEM BY: ROMMEL LUIS C. ISRAEL III 22
  • 23. LUNGS •Paired elastic structures enclosed in thoracic cage •Composed of 3 lobes on right side and 2 lobes on left side •Covered by PLEURA BY: ROMMEL LUIS C. ISRAEL III 23
  • 24. PLEURA • Serous membrane that lines the lungs and wall of thorax • Visceral pleura- covers the lungs • Parietal pleura- lines the thorax BY: ROMMEL LUIS C. ISRAEL III 24
  • 25. PLEURAL FLUID •Serves to lubricate the thorax and lungs and permit smooth motion of the lungs within the thoracic cavity with each breath. BY: ROMMEL LUIS C. ISRAEL III 25
  • 26. BRONCHI AND BRONCHIOLES • They are formed by branching if trachea • Right main bronchus – larger and more vertical than left BY: ROMMEL LUIS C. ISRAEL III 26
  • 27. •Bronchioles branch into terminal bronchioles which end in alveoli BY: ROMMEL LUIS C. ISRAEL III 27
  • 28. ALVEOLI • Arranged in clusters • Site for GAS EXCHANGE • SURFACTANT- reduces surface tension to keep alveoli from collapsing BY: ROMMEL LUIS C. ISRAEL III 28
  • 29. FUNCTION OF THE RESPIRATORY SYSTEM BY: ROMMEL LUIS C. ISRAEL III 29
  • 30. • The cells of the body derive energy they need from the oxidation of carbohydrates, fats and proteins. • Certain vital tissues, such as those of the brain and heart, cannot survive for long without a continuing supply of oxygen. • As a result of oxidation in the body tissues, carbon dioxide is produced and must be removed from cells to prevent build-up of acid wastes. BY: ROMMEL LUIS C. ISRAEL III 30
  • 31. OXYGEN TRANSPORT •Oxygen is supplied to, and carbon dioxide is removed from, cells by way of circulating blood. •Cells are in close contact with capillaries, whose thin walls permit easy passage or exchange of oxygen and carbon dioxide. BY: ROMMEL LUIS C. ISRAEL III 31
  • 32. • Oxygen diffuses from the capillary through the capillary wall to the interstitial fluid. • At this point, it diffuses through the membrane of tissue cells, where it is used by mitochondria for cellular respiration. • The movement of carbon dioxide occurs by diffusion in the opposite direction – from cell to blood. BY: ROMMEL LUIS C. ISRAEL III 32
  • 33. BY: ROMMEL LUIS C. ISRAEL III 33
  • 34. RESPIRATION •The whole process of gas exchange between the atmospheric air and the blood and between the blood and cells of the body •After tissue capillary exchanges, blood enters the systemic veins (where it is called VENOUS BLOOD) BY: ROMMEL LUIS C. ISRAEL III 34
  • 35. •The oxygen concentration in blood within the capillaries of the lungs is lower that in the lungs’ air sacs (alveoli). Therefore, oxygen diffuses from the alveoli to the blood. •Carbon dioxide, which has the higher concentration in the blood than in the alveoli, diffuses from the blood into the alveoli. BY: ROMMEL LUIS C. ISRAEL III 35
  • 36. •Movement of air in and out of the airways (ventilation) continually replenishes the oxygen and removes the carbon dioxide from the airways in the lung. BY: ROMMEL LUIS C. ISRAEL III 36
  • 37. VENTILATION • Movement of air in and out of the lungs • Adequate ventilation depends on several factors: • Clear airways • An intact CNS and respiratory center • An intact thoracic cavity capable of expanding and contracting • Adequate pulmonary compliance and recoil BY: ROMMEL LUIS C. ISRAEL III 37
  • 38. • 2 PHASES: • Inspiration – involves the contraction and descent of the chest is increased and the pressure in the air passages and alveoli decreases, secreting sub-atmospheric pressure so that air goes into the respiratory area until the pressure gradient is equalized. • Expiration – a passive process that results in the expulsion of air when the components of the thoracic cage relax. BY: ROMMEL LUIS C. ISRAEL III 38
  • 39. •Physical factors that govern the air flow in and out of the lungs are collectively referred to as the mechanics of ventilation and includes •Muscle structure •Interpleural pressure •Lung compliance •Airway resistance BY: ROMMEL LUIS C. ISRAEL III 39
  • 40. MUSCLE STRUCTURE •Muscle bundles that influence respiration: •Intercostal muscles •Anterior neck muscles such as Scalene, sternocleidomastoid •Muscles of abdomen BY: ROMMEL LUIS C. ISRAEL III 40
  • 41. INTRAPLEURAL PRESSURE •Pressure in the pleural cavity surrounding the lungs •Always slightly negative in relation to atmospheric pressure •INTRAPULMONARY PRESSURE (pressure within the lungs) BY: ROMMEL LUIS C. ISRAEL III 41
  • 42. LUNG COMPLIANCE • Is the measure of the elasticity, expandability and distensibility of the lungs and thoracic structures • Factors that determine lung compliance are the SURFACE TENSION of the ALVEOLI (normally low with the presence of surfactant) and the connective tissue (collagen and elastin) of the lungs. BY: ROMMEL LUIS C. ISRAEL III 42
  • 43. • Determined by examining the volume- pressure relationship in the lungs and the thorax. • NORMALLY, the lungs and thorax easily stretch and distend when pressure is applied. • HIGH or increased compliance occurs when the lungs have lost their elasticity and the thorax is overdistended. BY: ROMMEL LUIS C. ISRAEL III 43
  • 44. •When lungs and thorax are “stiff”, there is LOW or decreased compliance. •Conditions associated with this include pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis and ARDS. BY: ROMMEL LUIS C. ISRAEL III 44
  • 45. AIRWAY RESISTANCE •Refers to the relationship between airflow and pleural pressure BY: ROMMEL LUIS C. ISRAEL III 45
  • 46. REQUIREMENTS FOR EFFECTIVE VENTILATION •Patent airway •Elastic, expansible lungs and tracheo-bronchial tree •Adequate musculo-skeletal apparatus of chest wall BY: ROMMEL LUIS C. ISRAEL III 46
  • 47. BY: ROMMEL LUIS C. ISRAEL III 47
  • 48. BY: ROMMEL LUIS C. ISRAEL III 48
  • 49. FACTORS AFFECTING RESPIRATORY FUNCTION BY: ROMMEL LUIS C. ISRAEL III 49
  • 50. AGE • At birth, fluid-filled lungs drain, partial pressure of carbon dioxide rises, neonate takes a first breath. • Lungs reaches full inflation by 2 weeks of age • Changes of aging that affect the respiratory system are infection, physical or emotional stress, surgery, anesthesia and other procedures BY: ROMMEL LUIS C. ISRAEL III 50
  • 51. •Respiratory rates are HIGHEST and mist variable in NEWBORNS. • Because of rib cage structure, infants rely almost exclusively on DIAPHRAGMATIC MOVEMENT for breathing. BY: ROMMEL LUIS C. ISRAEL III 51
  • 52. CHANGES IN ELDERLY • Chest wall and airways become more rigid and less elastic • The amount of exchanged air is decreased • The cough reflex and cilia action are decreased • Mucus membranes become drier and more fragile • Decrease in muscle strength and endurance BY: ROMMEL LUIS C. ISRAEL III 52
  • 53. • If osteoporosis is present, adequate lung expansion may be compromised. • A decrease in efficiency on the immune system occurs. • Gastroesophageal reflux disease is more common in older adults and increases the risk of aspiration. The aspiration of stomach contents into the lungs often causes bronchospasm by setting up an inflammatory response. BY: ROMMEL LUIS C. ISRAEL III 53
  • 55. PHYSICAL ASSESSMENT AND HEALTH HISTORY BY: ROMMEL LUIS C. ISRAEL III 55
  • 56. • The health history focuses on the physical and functional problems of the patient and the effect on these problems on his or her life. • Reason patient is seeking health care is often related to: • Dyspnea • Pain • Accumulation of mucus • Wheezing • Hemoptysis • Edema of ankles and feet • Cough • Fatigue and weakness BY: ROMMEL LUIS C. ISRAEL III 56
  • 57. SUBJECTIVE DATA • ASSESSMENT INTERVIEW • Have you noticed any changes in your breathing pattern? • If so, which of your activities might cause these symptoms? • How many pillows do you use to sleep at night? • Have you had any medical conditions experienced before? BY: ROMMEL LUIS C. ISRAEL III 57
  • 58. • How frequently have these occurred? How long did they last? And how were they treated? • Do you smoke? If so, how much? • Does any of our family member smoke? • Do you use alcohol? If so, how many drinks do you usually have per day or per week • Describe your exercise patterns. BY: ROMMEL LUIS C. ISRAEL III 58
  • 59. • How often and how much do you cough? • Is it productive, accompanied by sputum or non productive cough? • When is the sputum produced? • What is the amount, color, thickness, odor? • Is it tinged with blood? • Ask for any occurrence of chest pain, risk factors and medication history BY: ROMMEL LUIS C. ISRAEL III 59
  • 60. OBJECTIVE DATA • Major signs and symptoms of respiratory disease are: • Dyspnea • Cough • Sputum production • Chest pain • Wheezing • Clubbing of the fingers • Hemoptysis • Cyanosis BY: ROMMEL LUIS C. ISRAEL III 60
  • 61. DYSPNEA • Difficult or labored breathing • Shortness of breath • A common symptom to many pulmonary and cardiac disorders. • Right ventricle of the heart will be affected ultimately by lung disease because it must pump blood through the lungs against greater resistance. BY: ROMMEL LUIS C. ISRAEL III 61
  • 62. CLINICAL SIGNIFICANCE • Sudden dyspnea in HEALTHY PERSON may indicate pneumothorax or ARDS. • In IMMOBILIZED PATIENTS, sudden dyspnea may denote pulmonary embolism. • ORTHOPNEA (inability to breathe easily except in an upright position) may be found in patients with COPD BY: ROMMEL LUIS C. ISRAEL III 62
  • 63. •NOISY BREATHING may result from a narrowing of the airway or localized obstruction of a major bronchus by a tumor or foreign body. •Wheezing usually signifies asthma. BY: ROMMEL LUIS C. ISRAEL III 63
  • 64. RELIEF MEASURES • The management of dyspnea is aimed at identifying and correcting its cause. • Relief of the symptom sometimes is achieved by placing the patient at rest with the head elevated (high Fowler’s position). • In severe cases, administering oxygen. BY: ROMMEL LUIS C. ISRAEL III 64
  • 65. COUGH •Results from irritation of the mucus membranes anywhere in the respiratory tract. •Patient’s chief protection against the accumulation of secretions in the bronchi and bronchioles. BY: ROMMEL LUIS C. ISRAEL III 65
  • 66. CLINICAL SIGNIFICANCE •May indicate serious pulmonary diseases. •The nurse needs to evaluate the character of the cough – dry, hacking, brassy, wheezing, loose or severe. • Time of coughing is also noted. BY: ROMMEL LUIS C. ISRAEL III 66
  • 67. •DRY & IRRITANT COUGH – characteristic of an upper respiratory tract infection of viral origin. •LARYNGOTRACHEITIS – causes an irritative, high-pitched cough. •TRACHEAL LESIONS – produce a brassy cough •BRONCHOGENIC CARCINOMA – severe and changing cough BY: ROMMEL LUIS C. ISRAEL III 67
  • 68. TRACHEAL LESIONS BY: ROMMEL LUIS C. ISRAEL III 68
  • 69. •Coughing at NIGHT may herald the onset of LEFT-SIDED HEART FAILURE or BRONCHIAL ASTHMA. •Cough in MORNING WITH SPUTUM PRODUCTION may indicate BRONCHITIS. BY: ROMMEL LUIS C. ISRAEL III 69
  • 70. BRONCHIAL ASTHMA BY: ROMMEL LUIS C. ISRAEL III 70
  • 71. BRONCHITIS BY: ROMMEL LUIS C. ISRAEL III 71
  • 72. •A cough that worsens when the patient is SUPINE suggests SINUSITIS (postnasal drip). •Coughing AFTER food intake may indicate aspiration of material into tracheo-bronchial tree. BY: ROMMEL LUIS C. ISRAEL III 72
  • 73. SPUTUM PRODUCTION •The color of sputum or phlegm, which is the mucus and sometimes pus discharge expectorated from the respiratory tract, is often an indication of the type of respiratory disease that gives rise to sputum production. BY: ROMMEL LUIS C. ISRAEL III 73
  • 74. •By examining the type of sputum and noting the color as well as the presenting signs and symptoms, a differential diagnosis may be reached prior to laboratory tests and examination (sputum culture). •A thorough case history and complete physical examination is also necessary. BY: ROMMEL LUIS C. ISRAEL III 74
  • 75. MEANING OF DIFFERENT SPUTUM COLORS BY: ROMMEL LUIS C. ISRAEL III 75
  • 76. CLEAR, WHITE, GRAY SPUTUM •Clear sputum is considered as normal, however, there are many conditions that may cause excessive sputum production. •A profuse amount of clear sputum should therefore be considered as abnormal. BY: ROMMEL LUIS C. ISRAEL III 76
  • 77. •Pulmonary edema (fluid in the lungs) – clear, white or pink frothy sputum •Viral respiratory tract infections – clear to white (acute) •Chronic bronchitis (COPD) – clear to gray •Asthma – white to yellow (thick) BY: ROMMEL LUIS C. ISRAEL III 77
  • 78. CHRONIC BRONCHITIS BY: ROMMEL LUIS C. ISRAEL III 78
  • 79. CHRONIC BRONCHITIS BY: ROMMEL LUIS C. ISRAEL III 79
  • 80. YELLOW SPUTUM •Yellow colored sputum is due to the presence of white blood cells, particularly neutrophils and eosinophils. •These cells are often present in chronic inflammation, allergic and infectious causes. BY: ROMMEL LUIS C. ISRAEL III 80
  • 81. •With INFECTIONS, it is often in the acute setting that yellow sputum is evident due to the presence of live neutrophils. •With ALLERGIC CONDITIONS, particularly airway hypersensitivity, the yellowish sputum is due to the presence of eosinophils. BY: ROMMEL LUIS C. ISRAEL III 81
  • 82. Acute bronchitis – white to yellow Acute pneumonia – white to yellow Asthma – white to yellow (thick) BY: ROMMEL LUIS C. ISRAEL III 82
  • 83. GREEN SPUTUM •Green mucus is indicative of a long- standing, possibly chronic, infection. •The color is a result of the breakdown of neutrophils and the release of verdoperioxidase / myeloperioxidase, an enzyme that is present within these cells. BY: ROMMEL LUIS C. ISRAEL III 83
  • 84. • It may also be seen in long standing non- infectious inflammatory conditions. • With infections, the green sputum will be more purulent (large amounts of pus). • While in non-infectious inflammatory conditions, the green sputum will be more mucoid (large amounts of mucus). BY: ROMMEL LUIS C. ISRAEL III 84
  • 85. •Pneumonia – white, yellow or green •Lung abscess – green, sudden accumulation of large amount of sputum if the abscess ruptures •Chronic bronchitis – clear, grey to green (infection) •Bronchiectasis, cystic fibrosis – green BY: ROMMEL LUIS C. ISRAEL III 85
  • 86. LUNG ABCESS BY: ROMMEL LUIS C. ISRAEL III 86
  • 87. BRONCHIECTASIS BY: ROMMEL LUIS C. ISRAEL III 87
  • 88. BROWN, BLACK SPUTUM • Brown or black sputum is an indication of ‘old blood’ and the color may be due to the breakdown of red blood cells thereby releasing hemosiderin (from hemoglobin). • Certain organic and non-organic dusts may also cause a brown to black discoloration of the sputum. BY: ROMMEL LUIS C. ISRAEL III 88
  • 89. •Chronic bronchitis – green, yellow, brown (infection) •Chronic pneumonia – white, yellow, green to brown •Coal worker’s pneumoconiosis – brown to black •Tuberculosis – red to brown or black •Lung cancer – red to brown to black BY: ROMMEL LUIS C. ISRAEL III 89
  • 90. COAL WORKER’S PNEUMOCONIOSIS • SIMPLE COAL WORKER’S PNEUMOCONIOSIS • PROGRESSIVE FIBROSIS COAL WORKER’S PNEUMOCONIOSIS BY: ROMMEL LUIS C. ISRAEL III 90
  • 91. RED, PINK RUST-COLORED SPUTUM •Red sputum is usually an indication of whole blood that is more profuse than bleeding in pink colored sputum. •It may completely discolor the mucus or appear as streaks or spots. BY: ROMMEL LUIS C. ISRAEL III 91
  • 92. •Pink sputum is also a sign of bleeding but usually of smaller quantities that may stain or streak the sputum. •Rust colored sputum is also due to the bleeding although the clotting process process may have commenced and the red blood cells may have broken down. BY: ROMMEL LUIS C. ISRAEL III 92
  • 93. •Pneumococcal pneumonia – rusty-red •Lung cancer - pink to red (frothy) progressing to brown or black •Tuberculosis – bright red streaks progressing to fully red sputum (hemoptysis) •Pulmonary embolism – bright red blood (acute) BY: ROMMEL LUIS C. ISRAEL III 93
  • 94. LUNG CANCER BY: ROMMEL LUIS C. ISRAEL III 94
  • 95. BY: ROMMEL LUIS C. ISRAEL III 95
  • 96. BY: ROMMEL LUIS C. ISRAEL III 96
  • 97. MEANING OF DIFFERENT TYPES OF SPUTUM BY: ROMMEL LUIS C. ISRAEL III 97
  • 98. CLEAR SPUTUM • slightly sticky and a bit viscous (thicker than water) is accepted as normal sputum. • It is produced and secreted in moderate amounts to moisten the respiratory tract and trap dust and microorganisms (mucus) and lubricate the mouth and aid with chewing, swallowing and digestion (saliva). • While any expectorated sputum is considered to be abnormal, small amounts of sputum can be coughed up or spat out with effort even in the absence of any respiratory pathology. BY: ROMMEL LUIS C. ISRAEL III 98
  • 99. • However, in certain conditions, particularly related to irritation of the respiratory tract, the amount of sputum may become excessive. • In these pathological cases, the color, texture and even odor of the sputum may change. • These variations may give an indication of the possible cause. BY: ROMMEL LUIS C. ISRAEL III 99
  • 100. SEROUS • Normal, clear sputum is a serous discharge. • Large amounts of clear, frothy or pink sputum that is of a similar consistency as normal sputum may be a sign of pulmonary edema, which is an accumulation of fluid in the lungs. • If it extremely profuse and lasting for weeks or months, then it may be due to lung cancer. BY: ROMMEL LUIS C. ISRAEL III 100
  • 101. •Frothy sputum is caused by surfactant in the lung alveoli which reduces the surface tension of the sputum. •It indicates that the sputum had contact with the lung alveoli or originated from this site. BY: ROMMEL LUIS C. ISRAEL III 101
  • 102. MUCOPURULENT •Mucoid, mucopurulent or purulent sputum is thicker and often more sticky than normal sputum. •This is partly due to the greater mucus production coupled with pus in the purulent types. BY: ROMMEL LUIS C. ISRAEL III 102
  • 103. •Mucoid sputum is a sign of non- infectious airway disease like chronic bronchitis (COPD) and asthma or may occur in the early stages of infection. •Mucopurulent sputum is an indication of infection of the respiratory tract, particularly of the bronchi or lungs – acute bronchitis and pneumonia. BY: ROMMEL LUIS C. ISRAEL III 103
  • 104. BLOOD-STAINED •Sputum may be blood stained where the normal sticky or mucopurulent thick consistency becomes thinner due to the presence of varying amounts of blood. BY: ROMMEL LUIS C. ISRAEL III 104
  • 105. •In severe cases involving the coughing up of large amounts of blood (hemoptysis), the consistency of the sputum may be the same viscosity as blood and little or no sputum may be visible. Blood stained sputum may be due to tuberculosis, bronchiectasis, pulmonary embolism or lung cancer. BY: ROMMEL LUIS C. ISRAEL III 105
  • 106. CHEST PAIN •May be associated with pulmonary or cardiac diseases. •Chest pain associated with pulmonary conditions may be SHARP, STABBING and INTERMITTENT •May be DULL, ACHING, PERSISTENT BY: ROMMEL LUIS C. ISRAEL III 106
  • 107. •May occur with PNEUMONIA, PULMONARY EMBOLISM with LUNG INFARACTION, PLEURISY •LATE SYMPTOM – bronchogenic carcinoma •CARCINOMA – pain may be dull and persistent because the carcinoma has invaded the chest wall, mediastinum or spine BY: ROMMEL LUIS C. ISRAEL III 107
  • 108. •The nurse assesses the quality, intensity and radiation of pain. •Identifies and explores precipitating factors, along with the relationship of the patient’s position. BY: ROMMEL LUIS C. ISRAEL III 108
  • 109. RELIEF MEASURES •Analgesic medications may be effective in relieving chest pain. •Non-steroidal anti-inflammatory drugs (NSAIDs) used for pleuritic pain BY: ROMMEL LUIS C. ISRAEL III 109
  • 110. WHEEZING • A high-pitched, musical sound heard mainly on expiration. • Major finding in a patient with bronchoconstriction or airway narrowing. • Can be heard with or without a stethoscope, depending on location BY: ROMMEL LUIS C. ISRAEL III 110
  • 111. BY: ROMMEL LUIS C. ISRAEL III 111
  • 112. BY: ROMMEL LUIS C. ISRAEL III 112
  • 113. RELIEF MEASURES • Oral or inhalant bronchodilator medications reverse wheezing in most instances. BY: ROMMEL LUIS C. ISRAEL III 113
  • 114. CLUBBING OF FINGERS • A sign of lung disease found in patients with chronic hypoxic conditions, chronic lung infections and malignancies of the lung. BY: ROMMEL LUIS C. ISRAEL III 114
  • 115. •Manifested initially as sponginess of the nail-bed and loss of the nail-bed angle. BY: ROMMEL LUIS C. ISRAEL III 115
  • 116. BY: ROMMEL LUIS C. ISRAEL III 116
  • 117. HEMOPTYSIS • Expectoration of blood from the respiratory tract • Symptom of both pulmonary and cardiac disorders. • Its onset is usually sudden, may be intermittent or continuous. • The amount of blood produced is not always proportional to the seriousness of the cause. BY: ROMMEL LUIS C. ISRAEL III 117
  • 119. POINTS TO CONSIDER WHEN DOCUMENTING BLEEDING EPISODE: •Bloody sputum from the nose or the nasopharynx is usually preceded by considerable sniffing, with blood possibly appearing on the nose. BY: ROMMEL LUIS C. ISRAEL III 119
  • 120. • Blood from the lung is usually bright red, frothy, mixed with sputum. • Initial symptoms include a tickling sensation in the throat, a salty taste, a burning or bubbling sensation in the chest and perhaps chest pain. • The term “hemoptysis” is reserved for the coughing up of blood arising from a pulmonary hemorrhage. • This blood has an alkaline pH (greater than 7.0) BY: ROMMEL LUIS C. ISRAEL III 120
  • 121. •If the hemorrhage is in the stomach, the blood is vomited (hematemesis) rather than coughed up. •Blood that has been in contact with gastric juice is sometimes so dark that it is referred to as “coffee grounds”. This blood has an acid pH (less than 7.0). BY: ROMMEL LUIS C. ISRAEL III 121
  • 122. CYANOSIS •Bluish discoloration of the skin •VERY LATE indicator of hypoxia. •Assessment of cyanosis is affected by room lighting, the patient’s skin color and the distance of the blood vessels from the surface of the skin. BY: ROMMEL LUIS C. ISRAEL III 122
  • 123. • In pulmonary condition, central cyanosis is assessed by observing the color of the tongue and lips. • This indicates a decrease in oxygen tension in the blood. • Peripheral cyanosis results from decreased blood flow to a certain area of the body, as in vasoconstriction of the nailbeds or earlobes from exposure to cold, and DOES NOT necessarily indicate a central systemic problem. BY: ROMMEL LUIS C. ISRAEL III 123
  • 124. PHYSICAL ASSESSMENT OF LOWER RESPIRATORY STRUCTURE AND BREATHING PATTERNS BY: ROMMEL LUIS C. ISRAEL III 124
  • 125. CHEST CONFIGURATION • Normally, the ratio of the anteroposterior diameter to the lateral diameter is 1:2. • There are four main deformities of the chest associated with respiratory disease that alter this relationship: • Barrel chest • Funnel chest (pectus excavatum) • Pigeon chest (pectus carinatum) • kyphoscoliosis BY: ROMMEL LUIS C. ISRAEL III 125
  • 126. BARREL CHEST • Due to over- inflation of the lungs. • There is an increase in the anteroposterior diameter of the thorax. BY: ROMMEL LUIS C. ISRAEL III 126
  • 127. • In patient with emphysema, the ribs are more widely spaced and the intercostal spaces tend to bulge on expiration. BY: ROMMEL LUIS C. ISRAEL III 127
  • 128. • The appearance of the patient with advanced emphysema is thus quite characteristic and often allows the observer to detect its presence easily, even from a distance. BY: ROMMEL LUIS C. ISRAEL III 128
  • 129. FUNNEL CHEST (PECTUS EXCAVATUM) • Occurs when there is a depression in the lower portion of the sternum. • This may compress the heart and great vessels resulting in MURMURS. BY: ROMMEL LUIS C. ISRAEL III 129
  • 130. •Funnel chest may occur with rickets or Marfan’s syndrome. BY: ROMMEL LUIS C. ISRAEL III 130
  • 131. BY: ROMMEL LUIS C. ISRAEL III 131
  • 132. PIGEON CHEST ( PECTUS CARINATUM) •Occurs as a result of displacement of sternum. BY: ROMMEL LUIS C. ISRAEL III 132
  • 133. BY: ROMMEL LUIS C. ISRAEL III 133
  • 134. BY: ROMMEL LUIS C. ISRAEL III 134
  • 135. KYPHOSCOLIOSIS • Characterized by elevation of the scapula and corresponding S- shaped spine. BY: ROMMEL LUIS C. ISRAEL III 135
  • 136. • This deformity limits lung expansion within the thorax. • It may also occur with osteoporosis and other skeletal disorders that affect the thorax. BY: ROMMEL LUIS C. ISRAEL III 136
  • 137. BY: ROMMEL LUIS C. ISRAEL III 137
  • 138. BY: ROMMEL LUIS C. ISRAEL III 138
  • 139. NORMAL BREATH SOUNDS BY: ROMMEL LUIS C. ISRAEL III 139
  • 140. • Distinguished by their location over a specific area of the lung: • Vesicular • Bronchovesicular • Bronchial (Tubular) • Tracheal • The LOCATION, QUAILITY and INTENSITY of breath sounds are determined during auscultation. BY: ROMMEL LUIS C. ISRAEL III 140
  • 141. ADVENTITIOUS SOUNDS -Discrete, Noncontinuous Sound -Continuous Musical Sound (Wheezes) -Friction Rubs BY: ROMMEL LUIS C. ISRAEL III 141
  • 142. DISCRETE, NONCONTINUOUS SOUND BY: ROMMEL LUIS C. ISRAEL III 142
  • 143. CRACKLES • Formerly referred to as RALES • Result form delayed opening of deflated airways. • Friction rubs result from inflammation of the pleural surfaces that induces a crackling, grating sound usually heard in inspiration and expiration. BY: ROMMEL LUIS C. ISRAEL III 143
  • 144. •May or may not be cleared by coughing •Reflect underlying inflammation or congestion •Present in conditions as pneumonia, bronchitis, heart failure, bronchiectasis, and pulmonary fibrosis BY: ROMMEL LUIS C. ISRAEL III 144
  • 145. FINE CRACKLES •Usually audible at the end of inspiration and originate from alveoli •Sound is like rubbing several pieces of hair next to one’s ear. BY: ROMMEL LUIS C. ISRAEL III 145
  • 146. COARSE CRACKLES •A gross, moist sound produced in the large bronchi and are audible in early and mid-inspiration. BY: ROMMEL LUIS C. ISRAEL III 146
  • 147. CONTINUOUS SOUNDS (WHEEZES) BY: ROMMEL LUIS C. ISRAEL III 147
  • 148. SIBILANT WHEEZES •Caused by air passing thru narrowed tracheo-bronchial tree • Found in asthma or airway obstruction BY: ROMMEL LUIS C. ISRAEL III 148
  • 149. • Originate in brochi and bronchioles • “Whistling” sound • Musical noise during inspiration or expiration • Louder during expiration • May be cleared with coughing BY: ROMMEL LUIS C. ISRAEL III 149
  • 150. SONOROUS WHEEZES •Called “GURGLES” or “RONCHI SOUNDS” •Deep, low-pitched rumbling sound heard primarily during expiration. BY: ROMMEL LUIS C. ISRAEL III 150
  • 151. •Caused by the movement of air through the airways that are partially obstructed or narrowed airways •Such as in tumors or mucosal swelling BY: ROMMEL LUIS C. ISRAEL III 151
  • 152. FRICTION RUBS BY: ROMMEL LUIS C. ISRAEL III 152
  • 153. PLEURAL FRICTION RUBS •Harsh, crackling sound, like two pieces of leather rubbed together •Heard during inspiration alone or during both inspiration and expiration. BY: ROMMEL LUIS C. ISRAEL III 153
  • 154. •May subside when patient holds breath. •Coughing will NOT clear sound •It is secondary to inflammation and loss of lubricating pleural fluid. BY: ROMMEL LUIS C. ISRAEL III 154
  • 155. VOICE SOUNDS BY: ROMMEL LUIS C. ISRAEL III 155
  • 156. •Vocal resonance •The sound heard through the stethoscope as the patient speaks •The vibrations produced in the larynx are transmitted to the chest wall as they pass through the bronchi and alveolar tissue. BY: ROMMEL LUIS C. ISRAEL III 156
  • 157. •Voice sounds are assessed by having the patient repeat “ninety- nine” or “eee” while the nurse listens with the stethoscope in corresponding areas of the chest. BY: ROMMEL LUIS C. ISRAEL III 157
  • 158. • BRONCHOPHONY • Describes vocal resonance that is more INTENSE and CLEARER than normal. • EGOPHONY • Describes the voice sounds that are distorted. • Best appreciated by having the patient repeat the letter “E” • The distortion produced by consolidation transforms the sounds into a clearly heard “A” rather than “E” BY: ROMMEL LUIS C. ISRAEL III 158
  • 159. BREATHING PATTERNS AND RESPIRATORY RATES BY: ROMMEL LUIS C. ISRAEL III 159
  • 160. EUPNEA •Normal, easy, quiet breathing •Respirations are regular in depth and rhythm BY: ROMMEL LUIS C. ISRAEL III 160
  • 161. DYSPNEA •TYPES: •Orthopnea – shortness of breath when lying down •Paroxysmal nocturnal dyspnea – sudden dyspnea at night while lying down BY: ROMMEL LUIS C. ISRAEL III 161
  • 162. APNEA • Varying periods of cessation of breathing • May occur briefly during other disorders, such as with sleep apnea • This can be life-threatening is sustained. BY: ROMMEL LUIS C. ISRAEL III 162
  • 163. BRADYPNEA • Slow breathing • Slower than normal rate (<10 breaths per minute), with normal depth and rhythm BY: ROMMEL LUIS C. ISRAEL III 163
  • 164. TACHYPNEA •Rapid, shallow breathing >24 breaths per minute BY: ROMMEL LUIS C. ISRAEL III 164
  • 165. BIOT’S RESPIRATION • Cluster breathing • Cycles of breaths that vary in depth and have varying periods of apnea. • Periods of normal breathing (3-4 breaths) followed by a varying period of apnea (usually 10 seconds to 1 minute) BY: ROMMEL LUIS C. ISRAEL III 165
  • 166. •Seen in some central nervous system disorder. BY: ROMMEL LUIS C. ISRAEL III 166
  • 167. CHEYNE-STOKES •Regular cycle where the rate and depth of breathing increase, then decrease until apnea (usually 20 seconds) occurs. •Characterized by rhythmic and waning of depth of respiration BY: ROMMEL LUIS C. ISRAEL III 167
  • 168. •Seen typically in severe heart failure and coma caused by neurologic disorder. •Near death breathing pattern BY: ROMMEL LUIS C. ISRAEL III 168
  • 169. KUSSMAUL’S BREATHING • Or hyperventilation • Or polypnea • Marked by increase in rate and depth • Associated with severe diabetic acidosis or renal origin BY: ROMMEL LUIS C. ISRAEL III 169
  • 170. HYPOVENTILATION •Or oligopnea •Abnormally low amount of air that enters the lungs •Shallow, irregular breathing BY: ROMMEL LUIS C. ISRAEL III 170
  • 171. INTERRUPTED •Cogwheel or Waxy respiration •Jerky breathing pattern •Respiratory and expiratory sounds are clearly split into two or more sounds. BY: ROMMEL LUIS C. ISRAEL III 171
  • 172. ORTHOPNEA •Inability to breath except when the trunk is in upright position BY: ROMMEL LUIS C. ISRAEL III 172