Respiratory

• Alveoli


  Bulbs where gas exchange occurs – 300-500 million
• Surfactant


  Phospholipid that prevents alveolar collapse
• Type of cells in alveoli

  • TYPE 1: epithelial cells (cell walls)
  • TYPE 2: secrete surfactant (important in ARDS/COVID)
  • TYPE 3: phagocytic, macrophage cells
• Ventilation

  Movement of air in and out of the airways
• Inspiration

  Diaphragm contracts along with the external intercostal muscles, expanding the cavity and decreasing pressure. Decreased pressure draws air into the airways into the lungs.
• Expiration


  The diaphragm relaxes, decreasing the cavity and increasing pressure in the lungs. The air is pushed out of the lungs. This requires elastic recoil
• Normally, inspiration is 1/3 of the cycle and expiration is 2/3
• Respiration


  Process of gas exchange between atmospheric air and blood at the alveoli, and between blood and the cells in the body

  
• Respiration occurs because of differences in partial pressures of particles (O2/CO2)

  
• V/Q Ratio (ventilation/perfusion)


  Adequate gas exchange depends on an adequate V/Q ratio, a match of ventilation and perfusion
• Normal V=Q
• Ventilation


  Movement of air in and out of the lungs
• Perfusion


  Filling of the pulmonary capillaries that surround the alveoli with blood
• Shunting


  Occurs when there is an imbalance, resulting in hypoxia (V<Q)
• Adding O2 will do little in shunting
• Causes of shunting


  • atelectasis (obstructive and compressive), pneumonia, tumor, pulmonary edema, VSD, Neuromuscular D/O
• Dead Space


  V>Q, low cardiac output (ex: PE)
• Silent Unit

  No V, no Q (ex: pneumothorax, severe ARDS)
• Lung capacities

  • TIDAL VOLUME (TV): air volume of each breath (500mL)
  • INSPIRATORY RESERVE VOLUME (IRV): max volume that can be inhaled after a normal inhalation (3000mL)
  • EXPIRATORY RESERVE VOLUME (ERV): max volume exhaled after a normal exhalation (1100mL)
  • VITAL CAPACITY (VC): the max volume of air exhaled from a maximal inspiration (VC=TV+IRV+ERV, 4600mL)
  • FORCED EXPIRATORY VOLUME (FEV): volume exhaled forcefully over time in seconds. Time is indicated as a subscript, usually 1 second (80% of VC)
• Aging impact on respiratory system

  • Decreased lung elasticity (collagen deposition in the alveolar walls)
  • Reduced responsiveness to hypoxemia and hypercapnia
  • Decreased FEV
  • Decreased chest wall compliance and muscle strength
  • Decreased cough effectiveness
  • Diminished # of cilia
  • Diminished cardiopulmonary reserve
• Arterial Blood Gas (ABG)


  Measurement of arterial oxygenation and carbon dioxide levels and acid-base balance
• ABG assesses the adequacy of alveolar ventilation and the ability of the lungs to provide oxygen and remove CO2
• ABG assesses kidney's ability to maintain and compensate for acid-base balance
• ABG determines if respiratory or metabolic issue exists
• Pulse oximetry


  Noninvasive method to monitor the amount of oxygen in the blood
• Concern if pulse oximetry < 90-92%
• Bronchoscopy


  Camera is used to view the inside of the lungs
• Nursing interventions for bronchoscopy

  • Ensure signed consent
  • NPO
  • Remove dentures
  • Relieve anxiety
  • Sedation – monitor respirations and airway patency
  • After procedure: monitor for dyspnea (pneumothorax possible), NPO until cough reflex and ability to swallow return
• Thoracoscopy - biopsy


  Procedure to obtain a lung biopsy
• Nursing interventions for thoracoscopy

  • Monitor for dyspnea (pneumothorax)
  • Monitor chest tube if inserted after the procedure
  • Monitor for subcutaneous emphysema
• Thoracentesis


  Removal of fluid from the pleural cavity for analysis
• Nursing interventions for thoracentesis

  • CXR prior
  • Signed consent
  • Educate, support and reassure patient
  • Light sedation
  • Ensure positions
  • Ensure sterile technique
  • After needle is withdrawn, apply pressure with airtight dressing
  • Post procedure CXR
  • Record and document fluid drawn – send to lab
  • Monitor airway – dyspnea, hemoptysis, hypoxia
• Nursing interventions for lung biopsies

  • Provide adequate oxygenation
  • Monitor for bleeding, infection, dyspnea
  • Emotional support
• Locations of laryngeal cancer

  • SUPRAGLOTTIC: false vocal cords above the vocal cord
  • GLOTTIC: true vocal cords
  • SUBGLOTTIC: below the vocal cords
• Symptoms of laryngeal cancer

  • Hoarseness
  • Persistent cough
  • Sore throat or pain and burning in the throat
  • Lump in the neck
  • Visualization in the throat
  • LATER: dysphagia, dyspnea, unilateral nasal obstruction, persistent ulceration, foul breath
  • GENERAL: weight loss, debilitation, lymphadenopathy, and radiating pain to the ear
• Potential problems with laryngeal cancer

  • respiratory distress, hemorrhage, infections, wound breakdown, aspiration