Respiratory

• Learning Outcomes

  • Describe the processes of breathing (ventilation) and gas exchange (respiration)
  • Identify the factors that can affect respiratory functions
  • Identify various methods in assessing respiratory functions
  • Describe various types of therapeutic measures, with their corresponding indications, contraindications, complications and nursing management
  • Explains the indications for suctioning, describe the steps in performing oropharyngeal and nasopharyngeal suctioning
  • Illustrate the use of artificial airways & bag-valve-mask resuscitator
• Ventilation


  Movement of air between the environment and the lungs via inhalation and exhalation
• Pulmonary ventilation


  • Inspiration (Inhalation)
  • Expiration (Exhalation)
• Ventilation


  • Occurs due to the difference in atmospheric pressure (we CAN'T control)
  • Occurs due to the difference in intrapulmonary pressure (we CAN control)
• Inspiration

  1. Contraction of the diaphragm and external intercostal muscles increases the space in the thoracic cavity

  2. Lowered intrathoracic pressure causes air to enter through the airways and inflate the lungs

  3. Air flows from the environment into the trachea, bronchi, bronchioles, and alveoli
• Expiration

  1. With relaxation, the diaphragm moves up, and intrathoracic pressure increases

  2. This increased pressure pushes air out of the lungs

  3. Expiration requires the elastic recoil of the lungs

  4. Alveolar gas travels the same route of inspiration in reverse
• Ventilation


  • Requires coordination of muscular properties of the lung and thorax, intact innervation, elastic properties of the lung and thorax, and an intact central nervous system and respiratory centre
• Ventilation also plays a vital role in maintaining the normal alkaline pH of the blood (7.35 – 7.45)
• Respiration


  The process of gas exchange between the atmospheric air and the blood (external respiration) and between the blood and cells of the body (internal respiration)
• Factors affecting Respiratory Functions


  • Ventilation: The movement of air in & out of the lungs
  • Diffusion: The movement of O2 & CO2 between the air (in the alveoli) and the blood (in the capillaries)
  • Perfusion: The process of oxygenated capillary blood passes through the tissue of the body
• Factors affecting Ventilation

  • Airway Obstruction
  • Inability to have chest expansion
  • Inability to clear airways
  • Incomplete compliance of the alveoli
• Factors affecting Diffusion

  • Partial pressure difference
  • Changes in the surface area available
• Factors affecting Perfusion

  • Abnormal blood volume / component
  • Decrease cardiac function
  • Incompetent vasculature
• Other factors affecting Respiratory Functions

  • Developmental considerations
  • Environmental considerations
  • Lifestyle considerations
  • Health status & Medications
  • Stress
• Methods in assessing Respiratory Functions

  • Nursing Assessment
  • Physical examination
  • Review laboratory/ diagnostic test results
• Pulse Oximetry


  A noninvasive device that estimates a client's peripheral blood oxygen saturation (SpO2)
• Peak Expiratory Flow Rate (PEFR)


  It refers to the highest flow during forced expiration and reflects changes in the size of pulmonary airways
• Using a peak flow meter

  1. Instruct patient to inhale as deeply as possible

  2. Place mouth around the mouthpiece, forming a tight seal

  3. Have the patient blow out through the mouth as hard and fast as possible

  4. Repeat the procedure three times and record the highest value

  5. Instruct patient to clean the unit at least once weekly, following manufacturer's instructions
• Arterial Blood Gas (ABG) Test


  Blood test that provides information about pH, PaO2, PaCO2, HCo3-, base excess, & SaO2
• Visualization procedures

  • CXR
  • CT scan
  • MRI
  • Bronchoscopy
• Pulmonary Function Tests

  To establish baseline test results, assess pulmonary function, differentiate between obstructive & restrictive lung diseases, evaluate the effectiveness of drug therapy, monitor the course of an established respiratory disease, and evaluate pulmonary status before surgery
• Nursing Diagnoses

  • Ineffective airway clearance
  • Ineffective breathing pattern
  • Impaired gas exchange
• Outcome identification

  • Demonstrate improved gas exchange
  • Able to cope with the causative factors
  • Preserve cardiopulmonary functions
  • Demonstrate self-care behaviours
• Oxygen Therapy


  To prevent or relieve hypoxia (inadequate oxygen supply)
• Indications for Oxygen Therapy

  • Patients with hypoxia
  • Patients with pulmonary diseases
  • Patients with cardiovascular diseases
  • Patients undergoing cardiopulmonary resuscitation (CPR)
  • Patients under general anaesthesia (GA)
• Oxygen Therapy Safety Precautions

  • Do not smoke near the oxygen equipment
  • Make sure all electrical appliances are function properly and are electrically grounded
  • Avoid materials that generate static electricity
  • Avoid the use of volatile, flammable materials, such as alcohol, acetone near clients receiving oxygen
  • Locate fire extinguishers; know the fire procedure and the route for evacuation
• Oxygen Therapy in Client with COPD


  Normally, people rely on high serum level of CO2 to signal them to increase their breathing rate. For COPD patients, they are accustomed to high CO2 concentration, so low O2 level becomes the drive.
• Conditions requiring oxygen therapy

  • Anemia
  • Shock
  • Patients undergoing cardiopulmonary resuscitation (CPR)
  • Patients under general anaesthesia (GA)
• Oxygen


  • Highly combustible gas
• Safety precautions for oxygen therapy

  • Do not smoke near the oxygen equipment
  • Instruct clients and visitors for the hazard of smoking
  • Make sure all electrical appliances are function properly and are electrically grounded
  • Avoid materials that generate static electricity - Advice client to wear cotton fabrics
  • Avoid the use of volatile, flammable materials, such as alcohol, acetone (e.g. Nail polish remover) near clients receiving oxygen
  • Locate fire extinguishers; know the fire procedure and the route for evacuation
• Hypoxic drive


  For COPD patients, they are accustomed to high CO2 concentration, so low O2 level becomes the drive
• Maintaining hypoxaemia slightly in clients with COPD is essential
• Nursing responsibilities for oxygen therapy in COPD


  • Observe closely on their respiratory status
• Oxygen supply sources


  • Wall outlets
  • Oxygen tank/ cylinders
• Oxygen flow meter


  A regulator used to control the amount of oxygen delivered to the patient, indicates litres/minute (l/min)
• Oxygen delivery systems

  • Nasal cannula
  • Simple face mask
  • Venturi mask
  • Non-rebreather mask
• Nasal cannula


  • Most commonly used and inexpensive device
  • Provide oxygen at low flow rates (1-6 L/min)
  • Deliver oxygen concentration roughly from 24% to 44%
• Using nasal cannula


  Place prongs in nares, fit tubing around ears and under chin, adjust flow rate ≤ 6L/min
• For patients with COPD, cautious with the O2 concentration delivered using nasal cannula
• Types of face masks

  • Simple face mask (low O2 concentration)
  • Non-rebreather mask (high O2 concentration)