What is Respiratory System and its function
- 1. RESPIRATORY SYSTEM Is responsible for drawing air into the lungs, exchanging oxygen for carbon dioxide, and removing carbon dioxide in exchange for oxygen
- 2. RESPIRATION • Is the exchange of gases between a person’s external environment and the body’s internal cells. • Ventilation (breathing) • Gas exchange (in the alveoli of the lungs and in the cells of the body) • Oxygen and carbon dioxide transportation (for metabolism,body processes, and waste removal)
- 3. FUNCTIONS OF THE RESPIRATORY SYSTEM OXYGEN-CARBON DIOXIDE EXCHANGE • Takes in oxygen from outside air • Exchanges carbon dioxide for oxygen in the lungs • Exchanges oxygen for carbon dioxide at the cellular level • Eliminates carbon dioxide from the body
- 4. FUNCTIONS OF THE RESPIRATORY SYSTEM ACID-BASE BALANCE • Assists in regulating the body’s pH • Eliminates some water PROTECTION • Warms and moistens air before it enters the lungs • Mucus in nose traps foreign particles • Coughing and sneezing dislodge foreign particles • Yawning and swallowing help equalize pressures inner ear and atmosphere
- 5. FUNCTIONS OF THE RESPIRATORY SYSTEM SPEECH PRODUCTION • Air passes over vocal cords to produce sound.
- 6. STRUCTURE AND FUNCTION UPPER RESPIRATORY TRACT • Noses • Sinuses • Pharynx • Larynx • Trachea
- 7. NOSE • Air begins it’s journey into the body through the right and left external nares or nostrils • Nasal septum, a structure consisting of bone and cartilages,divides the internal nose into two sides or cavities. • The nerve endings in the septum and in the nasal passages are responsible for sense of smell.
- 8. NOSE • Olfactory nerve (cranial nerve I) • Hair at the entrance of the nostrils and cilia(tiny hair-like projections) on the membranes serves as filters to remove some foreign particles that otherwise might be carried to the lungs
- 9. NOSE Three small bones • Turbinates or conchae- projects into the nasal cavity to increase the surface area of the mucus membrane. This increased surface area helps to warm,filter,and moisten room air before it enters the lungs • Nasolacrimal ducts or tear ducts- from the eyes,open into the upper nasal cavities. “runny nose” often accompanies crying
- 10. SINUSES • Four cavities are found on each side of the nasal area (total of 8 sinuses) • Mucosa that is continuous with nasal mucosa lines these sinuses • Lighten the skull and provide resonance for the voice • Two largest sinuses are the frontal sinuses (one on each side above the eye socket)
- 11. SINUSES • Maxillary sinuses (one on each side of the nose, in conjunction to maxillary bone) • Ethmoidal sinuses lie between the eyes • Sphenoidal sinuses lie on each side of the nasal cavity in the area of the orbit (eye socket)
- 12. REMEMBER THIS! • The sinuses drain directly into the nasal cavities,which drain into the throat. Because of the direct connection between sinus cavities and the nasal mucosa,infection in one area can easily spread to the other.
- 13. PHARYNX • Air travels from the nose to the pharynx • A tube-shaped passage for air and food. Nasopharynx- the section of the pharynx that extends from the nares to the uvula. - It is a passageway for air only - In childhood, it contains the adenoids (pharyngeal tonsils). - Adenoids are located in the posterior wall of the nasopharynx and,along with the tonsils,assist the body in it’s immune response to foreign invaders.
- 14. PHARYNX • Enlargement of the adenoids can cause snoring or obstruction of the upper airway. • In adulthood,adenoids usually atrophy (waste away) • During the act of swallowing, the soft palate and uvula elevate to block the nasal cavity,preventing food from entering the respiratory system.
- 15. PHARYNX • The auditory (eustachian)tubes connect the nasopharynx with the middle ear. These eustachian tubes permit air to enter or to leave the middle ear cavities,permitting proper functioning of the tympanic membranes (eardrums) Oropharynx- the part of the pharynx extending from the uvula to the epiglottis (throat). -carries food to the esophagus and air to the trachea -two tonsils: 2 palatine tonsils (posteriorly) on each side of oral cavity. The ones commonly removed during tonsillectomy -lingual tonsils (base of the tongue) -their function is to destroy foreign substances that are inhaled or ingested.
- 16. PHARYNX • Laryngopharynx- the lowest portion of the pharynx. -it extends from epiglottis to the openings of larynx and esophagus. The division provides separates passageway for food and air.
- 17. LARYNX (VOICE BOX) • From the pharynx, air passes into larynx • A boxlike structure made of cartilages held together by ligaments. • Functions of these cartilages is to keep the airway open at all times. • The largest and most prominent cartilage is the thyroid cartilage (adam’s apple) • Located in the midline of the neck
- 18. LARYNX (VOICE BOX) • Serves as an air passageway between pharynx and trachea • Only air is allowed to pass • Lid or cover of cartilage called the EPIGLOTTIS (“trap door cartilage”)-guards the entrance -automatically closes when you swallow,preventing food from entering the lower respiratory passage. -glottis is the opening on either side of the vocal cords. • If a portion of food accidentally becomes lodged in the larynx,coughing can dislodge it. If not,the air passage may be blocked.
- 19. LARYNX (VOICE BOX) • Vocal cords – within the larynx -two triangular-shaped membranous folds that extend from the front to back. -as air leaves the lungs and pass over,the cords vibrate, and vibration produces sound. -size of vocal cords and larynx varies accounting for the difference in people’s voices.
- 20. REMEMBER THIS! • In the event of a blocked airway,a tracheotomy may be needed. This is an artificial opening, either temporary or permanent,into the trachea.
- 21. TRACHEA (WINDPIPE) • Air passes from the layrnx into trachea • A tube approximately 4.5 inches (11cm) long and 1 inch in diameter in adults. • It consists of cartilage and connective tissue and extends from the lower end of the larynx into the chest cavity behind the heart. • Esophagus- posterior to the larynx and trachea,which transport food from the pharynx to the stomach • Horseshoe-shape cartiliginous rings provide sufficient rigidity to keep it open at all times for air to pass through. The rings are flexible enough, however, to permit bending the neck.
- 22. LOWER RESPIRATORY TRACT • Bronchi • lungs
- 23. BRONCHI • As the trachea enters the chest cavity,it divides into two smaller tubes • There is an indented areas called the hilum,where each bronchus enter the lung and branches off. • The right bronchus is shorter,straighter,and wider than the left bronchus,which is makes it more common site for aspiration of foreign objects.
- 24. REMEMBER THIS! • Because the right bronchus is shorter and wider than the left,it is more accessible. Therefore, the right bronchus is more susceptible to aspiration of fluids or foreign objects
- 25. THE TRACHEOBRONCHIAL TREE • Each bronchus continue to divides into smaller branches to form what commonly called the bronchial tree or tracheobronchial tree • It spreads throughout the lung tissue • As the bronchi become smaller, their walls become thinner, the amount of cartilages decreases, and they become known as bronchioles. • Bronchi and bronchioles continue to be lined with ciliated mucous membrane
- 26. THE TRACHEOBRONCHIAL TREE • Bronchioles branch first into alveolar ducts,which look like stems • End in many alveolar sacs,which looks like a clusters of grapes • Each lungs contains millions of these alveoli • It gives the lungs their spongy appearance • SURFACTANT-the walls of alveoli are composed of a single layer of cells and are line with a chemical, which helps to prevent the alveolar walls from collapsing between breaths
- 27. SURFACTANT • Is a substance secreted by the great alveolar cells (type II cells) of the lungs • Is a mixture of phospholipids (fat that contains phosphate) • Lecithin and sphingomyelin-main phospholipids in surfactant • The surfactant in the lungs acts to break up the surface tension in the pulmonary (lung) fluids. This reduces friction and preserves the elastic property of lung tissue, thus preventing collapse of the alveolar walls between breaths
- 28. REMEMBER THIS! • Surfactant does not form until after the seventh gestational month. Premature newborns may have insufficient surfactant,which results in collapse of the alveoli.A newborn with this problem called respiratory distress syndrome (RDS) or hyaline membrane disease must exert tremendous energy to breathe. As a result, the infant may die due to fatigue of the respiratory muscles and inadequate ventilation. Treatment involves the use of mechanical ventilation and administration of synthetic surfactant
- 29. LUNGS • Humans have two cone-shaped lungs that fill the chest cavity • The station where blood picks up oxygen and drops off its load of carbon dioxide • Apex – the top of each triangular cone • Base- the lower,wide portion that fits over diaphragm • Spongy tissue filled with alveoli,nerves,and blood and lymph vessels
- 30. LUNGS • Separated by the heart, the large blood vessels,the esophagus, and other contents of the mediastinum,the area lying between the lungs in the thorax (chest) • Lobes- lungs are divided into sections • The right lung has 3 lobes, the left lung has 2 lobes • Right lung: right upper lobe,right middle lobe, right lower lobe • Left lung: left upper lobe and left lower lobe
- 31. PLEURA • The lower respiratory tract contains a smooth double- layered sac of serous membrane • Visceral pleura-covers the lungs • Parietal pleura- outer layer lines the chest cavity • Surfaces are in constant and are moist because they secrete serous lubricating fluid. • Allows the lungs to move without causing pain or friction against the chest wall • Pleural cavity or pleural space- space between the two layers of pleura
- 32. REMEMBER THIS! • Pleurisy is an inflammation of the pleura produced by infection,injury,or tumor that causes difficult and painful breathing. In addition, air or fluid accumulation in the pleural space can cause partial or total lung collapse.
- 33. SYSTEM PHYSIOLOGY • BREATHING ventilation (breathing) or pulmonary ventilation: is the mechanical process of respiration that moves air to and from the alveoli. • Inhalation and exhalation • Inhalation (inspiration)- breathing in • Exhalation (expiration)- breathing out • Adults usually average between 12-20 respirations per minute • Newborn – 30-60 bpm (breaths per minute)
- 34. SYSTEM PHYSIOLOGY • EUPNEA- normal breathing • DYSPNEA-abnormal breathing • Normal breathing occurs as result of nervous stimulation of the respiratory center in the brain’s medulla. • Lungs cannot move by themselves, the actions of the muscles surrounding them inflate and deflate them. • Medulla sends impulses to the diaphragm is a dome- shaped muscle separating the thoracic and abdominal cavities. It contracts and flattens to increase chest space and create a vacuum.
- 35. SYSTEM PHYSIOLOGY • Intercostal muscles- are located between the ribs;they contract to lift and spread the ribs during inhalation, adding to the vacuum. • On inspiration,the chest cavity increase in size. Air goes into the lungs when intrathoracic (within the thoracic cavity) pressure is below that of the surrounding atmosphere (subatmospheric pressure). • Expiration is a passive process. On expiration, the muscles of the chest wall and lung relax. Movements of the diaphragm and the intercostal muscles cause the volume of the thoracic cavity to become smaller. Air rushes out when the pressures within thoracic cavity arise above that of the atmosphere. The reduced size of the thoracic cavity forces the air out.
- 36. REMEMBER THIS! • Any interruption in the closed chest can be immediately life-threatening because it disrupts the vacuum necessary for inspiration. Therefore, puncture wound or other opening into the chest must immediately closed to prevent death.
- 37. REGULATION OF RESPIRATION • Medulla’s respiratory center automatically controls the depth and rate of respirations without requiring a person’s conscious thought. • Pons-has centers that work with the medulla to produce a normal breathing rhythm. • Cerebral cortex- allows some voluntary control over breathing when talking,singing,eating,or changing the rate of breathing. • Chemoreceptors (medulla)stimulate the muscles of respiration primarily in response to changes in carbon dioxide level. • Carbon dioxide not oxygen is the major regulator of respiration.
- 38. REMEMBER THIS! • An excess of carbon dioxide in the blood of a healthy person lowers the pH of the blood. This drop in pH leads to stimulation of the medulla to increase respirations, which provides a means for blowing off the excess carbon dioxide.
- 39. MECHANICS OF BREATHING INSPIRATION 1.Inspiratory muscles contract (diaphragm descends;rib cage rises). 2. Thoracic cavity volume increases 3.Lungs are stretched;intrapulmonary volume increases 4.Intrapulmonary pressure drops (to -1mmHg) 5.Air (gases) flows into lungs down its pressure gradient until intrapulmonary pressure is 0 ( equal to atmospheric pressure)
- 40. MECHANICS OF BREATHING EXPIRATION 1.Inspiratory muscles relax (diaphragm rises;rib cage descends due to recoil of costal cartilages) 2.Thoracic cavity volume decreases 3.Elastic lung recoil passively intrapulmonary volume decreases 4.Intrapulmonary pressure rises (to +1mmHg) 5.Air (gases) flows out of lungs down its pressure gradient until intrapulmonary pressure is 0
- 41. CLINICAL TERMS • Adult Respiratory Distress Syndrome (ARDS) • Adenoidectomy (adenotonsillectomy) • Aspiration • Bronchoscopy • Cheyne-Stoke breathing • Deviated septum • Endotracheal tube • Epistaxis • Nasal polyps • Orthopnea • Otorhinolaryngology • Pneumonia • Pulmonary embolism • Stuttering • Sudden infant death syndrome (SIDS) • Tracheotomy
- 42. CLINICAL TERMS • Aletectasis • Pneumothorax • Hypoxia • Anemic hypoxia • Ischemic hypoxia • Histotoxic hypoxia • Hypoxemic hypoxia • Tachypnea • Bradypnea • Hyperpnea • Dyspnea • Paroxysmal nocturnal dyspnea • Trepopnea • Platypnea • Hyperventilation • Kussmaul breathing
- 43. LUNG VOLUME AND CAPACITIES • Lung capacities varies with sex,physical condition, and age. • Pulmonary disease and other diseases limit expansion of the chest cavity greatly influence a person’s comfort and ability to survive. • Ability of the lungs and thorax to expand also influences lung volume and capacities
- 44. REMEMBER THIS! • It is important to note that,even after expiration,some air (residual) remains in the lungs. This is the basis for the Heimlich manuever used in choking victims
- 45. LUNG VOLUME AND LUNG CAPACITIES Lung volume: • Tidal volume (VT or TV) - description:the volume of air inhaled and exhaled with each breath -normal value: 500ml or 5-10 ml/kg -significance: the tidal volume may not vary, even with severe disease.
- 46. • Inspiratory reserve volume (RSV) -D: the maximum volume of air that can be inhaled after normal inhalation -NV: 3,000 ml -S: a sigh take advantage of the IRV potential
- 47. • Expiratory reserve volume (ERV) -D: the maximum volume of air that exhaled forcibly after normal exhalation -NV: 1,100 ml -S: expiratory reserve volume is decreased in restrictive disorders, such as obesity, ascites, pregnancy
- 48. • Residual volume (RV) -D: the volume of air remaining in the lungs after maximum exhalation -NV: 1,200 ml -S: residual volume may be increased in obstructive disease
- 49. Lung capacities • Vital capacities (VC) -D:the maximum volume of air exhaled from the point of maximum inspiration VC=TV+IRV+ERV -NV: 4,600ml -S: a decrease in vital capacity may be found in neuromuscular disease, generalized fatigue, atelectasis, pulmonary edema, and COPD
- 50. • Inspiratory capacities (IC) -D: the maximum volume of air inhaled after normal expiration IC=TV+IRV -NV: 3,500ml -S: a decrease in inspiratory capacity may indicate restrictive disease
- 51. • Functional residual capacity (FRC) -D: the volume of air remaining in the lungs after normal expiration FRC=ERV+RV -NV: 2,300 ml -S: functional residual capacity may increased in COPD and decreased in ARDS
- 52. • Total lung capacities (TLC) -D: the volume of air in the lungs after a maximum inspiration TLC=TV+IRV+ERV+RV -NV: 5,800 ml -S: total lung capacities may be decreased in restrictive disease (atelectasis, pneumonia) and increased in COPD
- 53. INTERNAL (TISSUE) AND EXTERNAL (PULMONARY) RESPIRATION • Two types of respiration -internal -external External respiration- the exchange of oxygen for carbon dioxide within the alveoli of the lungs (pulmonary respiration) Internal respiration-the exchange of oxygen for carbon dioxide within the cells (cellular respiration or cell breathing)
- 54. REMEMBER THIS! • Respiration is the exchange of gases between a person’s external environment and internal cells • External respiration is gas exchange at the lung level • Internal respiration is gas exchange at the cellular level
- 55. REGULATION OF ACID-BASE BALANCE • The primary function of the respiratory system is the exchange of gases. • Regulation of the pH of all body fluids • Respiratory and renal systems interact to maintain homeostasis • Carbon dioxide can alter pH because it reacts with water to form carbonic acid.
- 56. REMEMBER THIS! • The respiratory system is the major mechanism for excretion and elimination of carbon dioxide from the body. (carbon dioxide is constantly being produced by the body as a by- product of metabolism) • If a person has a breathing disorder,carbon dioxide can build up in the body,dangerously lowering the blood pH. This condition, called respiratory acidosis, can be caused by disorders such as emphysema, severe pneumonia, asthma, and pulmonary edema. Untreated respiratory acidosis is life-threatening. Too little carbon dioxide in the blood is called respiratory alkalosis and is most commonly caused by hyperventilation (excessively rapid,deep breathing)
- 57. RESPIRATORY REFLEXES • Coughing and sneezing are protective reflexes needed to dislodge materials from the respiratory passages • The bronchi and trachea have sensory receptors that initiate a cough in response to foreign particles or irritating substances • Sneezing- source of irritation is the nasal passages • Yawning is another reflex- is a response to lack of oxygen or accumulation of carbon dioxide - Also equalizes pressure between the middle ear and the outside atmosphere, helping a person to maintain balance
- 58. EFFECTS OF AGING ON THE RESPIRATORY SYSTEM Functional capacity decrease because of: • Increased rigidity of the thorax and diaphragm Result: more energy needed to breathe Midwife implication: -encourage good ventilation with daily exercise such as walking
- 59. • Decreased numbers of alveoli and diffusion ability Result: less ability to compensate for respiratory needs in stress and illness Midwife implication: advise older person to avoid contact with children or others with respiratory tract infections
- 60. • Decreased in strength in breathing and coughing Result: hypoventilation leading to respiratory problems and pneumonia Possible dyspnea (SOB) with exertion Morning coughing common ( decreased ability to eliminate secretions) Midwife implication: advise client to see physician early if symptoms occur -encourage changing position slowly to avoid orthostatic vital signs changes -advise to change position at least every 2 hours
- 61. • The size of the chest wall decreases as a result of kyphosis and osteoporosis Result: difficulty in breathing deeply Midwife implication: encourage client not to smoke -help client know his or her own ability
- 62. • Immobility is common Result: increased risk in pneumonia Midwife implication: encourage client to receive pneumonia immunization Encourages moving, coughing, and deep breathing
- 63. REMEMBER THIS! • Smoking can decrease the efficiency of the respiratory system. Nicotine causes a decrease in bronchial diameter, constriction of blood vessels, a decrease in ciliary function ( which assists in moving foreign particles out of the respiratory tract), and can destroy lung tissue itself over time. These factors can all result in a decrease in gas exchange. In addition, may tobacco products contain substances (such as tars) that can build up in the lungs. It is also known that smoking causes lung cancer.
- 64. KEY POINTS TO REMEMBER! • The pathway for external breathing is nose-pharynx- larynx-trachea-bronchi-bronchioles-alveoli (where oxygen is exchanged for carbon dioxide) • The pathway for oxygen distribution and carbon dioxide return (internal breathing) is alveoli-capillaries (hemoglobin combines oxygen)-cells-capillaries (carbon dioxide exchange)-alveoli. The deoxygenated blood moves to the lungs via general circulation and the pulmonary circuit. In the alveoli of the lungs, carbon dioxide is exchanged for oxygen and carbon dioxide is exhaled
- 65. KEY POINTS TO REMEMBER! • The pharynx is divided into three areas: nasopharynx, oropharynx, and laryngopharynx • The trachea and esophagus are both located in the pharynx • Epiglottis is a protective flap that covers the trachea during swallowing to prevent foreign matter from entering the respiratory system • Nasal hairs, mucus, and cilia are protective structures of the respiratory system • Sneezing,coughing, and yawning are protective reflexes of the respiratory system
- 66. RESPIRATORY DISORDERS • Diagnostic tests - Laboratory test 1.Sputum specimen -help to determine presence of organisms or blood in a person’s sputum -best early in the morning
- 67. REMEMBER THIS! • Take precautions in the care and disposal of sputum. Wear gloves when collecting specimens and wash hands after contact with them. Wear mask and eye shield if splashing is likely. Discard all used facial tissues as contaminated material.
- 68. 2.Lavage specimen - If the client is unable to cough up sputum - Obtain specimen by bronchoalveolar lavage - Sterile saline is instilled into bronchus. Then, cells and fluid from the bronchioles and alveoli are removed by endoscopy along with the saline. - Analyzed in the laboratory - Most often diagnose pulmonary tuberculosis (TB)
- 69. 3.Throat culture - A sample of both mucus and secretions from the back of the client’s throat can be obtained on a cotton-tipped applicator and applied to a slide or culture medium, which is then incubated in the laboratory to determine the presence of organisms
- 70. 4.Blood gas determination -the best indicator of oxygen deficiency is the level of arterial blood gases (ABGs) -partial pressure of oxygen (PaO2) -partial pressure of carbon dioxide (PaCO2) -pulse oximetry
- 71. • X-ray and flouroscopy examination - Chest xray (CXR) - CT scan (computed tomography scan) Series of xray films taken to provide a cross- sectional view of the chest or other body part Valuable in the diagnosis of TB,lung abscess, or tumors
- 72. • Lung scan • Lung perfusion scan • Pulmonary angiography • Other diagnostic tests -magnetic resonance imaging (MRI) Can used to diagnose disorders in the lungs and bronchi -non invasive -allows the physician to distinguish among cancerous, trauma-induced, and normal tissues because it gives information about their chemical composition -Pulmonary function test (PFT)- measures how much air a client inhales (inspiration) and exhales (expiration) in one breath and assesses the client’s general respiratory status -the machine used for these tests is the spirometer
- 73. • Used to diagnose disorders and to assess effectiveness of the therapy • Helps in determining pulmonary pathology at an early stage and indicates whether the person has a cardiac or a respiratory disease - Bronchoscopy Is an invasive procedure in which a bronchoscope (a lighted endoscope) is advanced through the pharynx into trachea and bronchi The purpose of this test may be to observe lung tissue, obtain biopsy or bronchial washings, remove mucous plugs or foreign objects, or determine the location and extent of a mass (tumor)
- 74. • Most bronchoscopy procedures are done on the outpatient basis, be sure to teach the client and family to be alert for possible complications,especially the following: -swelling of the throat -difficulty swallowing -difficulty breathing -bleeding
- 75. • Skin tests -commonly used to determine if a person has been exposed to tuberculosis or other disorders, such as histoplasmosis -the procedure is the same as that administering test to determine allergies to medication or other allergens
- 76. • Purified protein derivative (PPD) tuberculin test -also known as the mantoux tuberculin skin test -indicates whether a person has ever exposed to the tubercle bacillus • Tine test -different method of injecting the tuberculin serum -often used in mass screening -pressed into the person’s skin
- 77. COMMON MEDICAL TREATMENTS • Postural drainage- uses position and gravity to drain secretions and mucus from the individual’s lungs • Procedure often done by respiratory therapist
- 78. COMMON SURGICAL TREATMENT • Thoracentesis -involves puncturing the chest wall to remove excess fluid or air from the pleura cavity. -done for diagnostic purposes or to relieve breathing difficulties in clients with TB, cancer of the lung, pleural effusion, pulmonary edema, and chest injuries. • Thoracotomy -lung surgery -an incision into the thorax or chest cavity
- 79. CARING FOR THE CLIENT AFTER CHEST SURGERY • Teach the client deep-breathing techniques • ROM exercises,before chest surgery • Post operative exercise can be vital to recovery and help prevent complications • Provide routine preoperative and postoperative care • Immediate postoperative concern for the person who has a lung surgery is to maintain an adequate airway. Direct care at preventing respiratory complications • Record vital signs frequently • Turn the client often to prevent complications of immobility • Encourage the client to breathe deeply and to cough at least every 2-4 hours and to use incentive spirometer
- 80. • Coughing is easiest if the person is in upright position and he or she splints the incision with a pillow • Client must exercise soon after surgery because many muscles are incised during chest surgery, and function must be restored • Exercise also prevents complications related to immobility • Discontinue any exercise that cause pain or great resistance • Do not overextend or overtire the client’s muscles
- 81. REMEMBER THIS! • If a person with any disorder of the respiratory system is receiving a narcotic, be particularly watchful for respiratory depression. Depressed respirations can be undesirable side effect in anyone, but the situation is most dangerous for the client whose respiratory function is already compromised.
- 82. NEW MEDICAL TERMINOLOGY • Anergic • Asphyxiation • Emphysema • Hemothorax • Incentive spirometer • Laryngectomy • Lobectomy • Paracentesis • Pneumonectomy • Pneumothorax • Postural drainage • Rhinitis • Rhinoplasty • Sinusitis • Strangulation • Suffocation • Thoracocentesis • Thoracotomy
- 83. ACRONYMS • ABG • ARDS • BCG • COLD • COPD • CPAP • CPT • CT • CXR • INH • IPPB • PFT • PPD • SOB • SOBOE • TB
- 84. POSSIBLE ALTERATIONS IN RESPIRATORY STATUS • Dyspnea • Orthopnea • Tachypnea • Hyperpnea • Bradypnea • Hypoventilation • Hyoerventilation • Cheyne-stokes • Biot’s respiration • Apnea • Kussmaul’s breathing
- 85. NOTING ALTERATION IN RESPIRATORY STATUS DATA COLLECTION • Carefully observe the client for changes in respiratory status • Document abnormal findings • Notify the healthcare provider of changes that indicate potential respiratory difficulties • Initial midwife’s observation with documentation establishes a baseline for future comparison and determines the presence suspected complications • Report any changes • Monitoring and charting a client’s respiratory status • Observe individual’s emotional response to the disorder or disease
- 86. MIDWIFE’S ASSESSMENT AND DATA GATHERING • Note respiratory rate,depth, and character • Determine respiratory status • Observe for signs of respiratory distress, dyspnea, or poor oxygenation • Be alert for s/s of hypoxia (lack of oxygen) • Note any symptoms such as cough,hemoptysis, cyanosis • Listen to lung sounds and breath sounds • Check results of skin tests related to tuberculosis or other lung conditions • Observe mouth and throat by visualization and palpation
- 87. ALTERATIONS IN RESPIRATORY STATUS • Dyspnea -labored or difficulty breathing;painful breathing s/s: inadequate ventilation,lowered oxygen level in blood • Orthopnea -difficulty breathing while lying down, relieved by sitting upright (orthopneic position) s/s: cardiac disorders,pulmonary emphysema, congestive heart failure
- 88. • Tachypnea –very rapid breathing s/s: high fever, pneumonia, alkalosis, salicylate overdose,brain stem lesions • Hyperpnea-increase in depth of breaths,maybe increase in rate (no feeling of increased respiratory effort) s/s: strenuous exercise • Bradypnea- respiration slower than normal, regular in rhythm s/s: normal during sleep; sign of drug overdose, disturbance in respiratory center of brain, metabolic disorder
- 89. • Hypoventilation- respirations that have a reduced rate and depth (shallow), often irregular s/s: obesity,neuromuscular disorders, affecting the thorax (ex. Multiple sclerosis, muscular dystrophy); damage to lung tissue (ex. Emphysema) • Hyperventilation- increased rate and depth of respirations often leading to decreased carbon dioxide levels ( hypocapnia) s/s: exercise, asthma, early emphysema, fever, multiple central, nervous tissue disorders,anxiety, pain
- 90. • Cheyne-stoke breathing-abnormal respiratory pattern that may starts as slow and shallow that changes to deep and rapid respirations, followed by 10-20 seconds of apnea between cycles. Each cycle may last from 45 seconds to 3 minutes s/s: brain stem lesions, heart failure, brain damage
- 91. • Biot’s respiration- abnormal respiratory pattern that may be sequences of 3-4 slow and deep or rapid and shallow breaths followed by periods of apnea, often accompanied by sighing s/s: brain stem lesions, heart failure, brain damage, overdose of hynoptic drug or narcotic drugs Meningitis or increased intracranial pressure
- 92. • Apnea- cessation of breathing Central apnea- no brain drive to breathe Obstructive apnea- no air flow due to upper airway obstruction Mixed apnea- central apnea immediately followed by obstruction Adult sleep apnea-prolonged and frequent episodes of apnea during sleep s/s: underdeveloped respiratory center in preterm, infants, adult brain, stem lesions, high spinal cord injury Foreign object in airway, excessive secretions, absent cough reflex Obstructive (tongue or throat structures relax), obesity Central (brain damage, brain lesions)
- 93. • Kussmaul’s breathing- dyspnea with rapid ( more than 20/min), gasping breaths, air hunger,panting, labored respirations • s/s: associated with diabetic ketoacidosis(metabolic acidosis), renal failure
- 94. • Aspiration -pathologic aspiration is an inhalation or movement of fluid, mucus, or another unwanted substance into the lungs. It can cause lung disorders or death • Hyperventilation-the person breathes abnormally quickly or deeply, resulting in too little carbon dioxide in the blood. -usually cause is anxiety or overexcitement -may have muscles spasms, dizziness, or faintness because of excessive oxygen and the depletion of carbon dioxide in the body. -easiest treatment is asking the client to breathe into a bag - The air the client re-breathes will contain excess carbon dioxide,replacing that which was lost
- 95. • Hypoxia- when the oxygen level in body tissues is inadequate -most obvious signs is shortness of breath (SOB) -earliest signs may be seen with shortness of breath on exertion (SOBOE) When the client expresses this feeling, SOB is called dyspnea -restlessness, apprehension,an anxious facial expression, panic, fatigue, or impaired coordination
- 96. SIGNS AND SYMPTOMS OF HYPOXIA -tachycardia -mild increase in blood pressure -cool,moist skin -confusion -delirium -difficulty in problem-solving -loss of judgement -euphoria -unruly or combative behavior -sensory impairment -mental fatigue -drowsiness -cyanosis -stupor and coma (late) -hypotension (late) -bradycardia (late)
- 97. HYPOXEMIC HYPOXIA • Is a state of decreased blood oxygen level,leading to a decreased amount of oxygen in the tissues. - Airway may be blocked - The lungs may be congested - An injury to the chest or lungs - Chronic or acute infections in the lungs - Oxygen decrease may be sudden or gradual - Most of these instances are not emergencies, the midwife can assist the person to breathe or to obtain oxygen.
- 98. CIRCULATION HYPOXIA • Is due to inadequate blood circulation. If blood cannot get to tissues the body’s oxygen supply cut off. - Happens in CVA, cerebrovascular accident (stroke) and thrombosis
- 99. ANEMIC HYPOXIA • Is due to reduction in the blood’s oxygen- carrying capacity. -carbon monoxide poisoning; because the carbon monoxide combines with hemoglobin, leaving no room for oxygen.
- 100. HISTOTOXIC HYPOXIA • Is due to inability of the tissues to use oxygen. -Under the influence of certain chemicals, the cells are unable to use oxygen. - Cyanide poisoning
- 101. MIDWIFE’S MANAGEMENT • Relieving respiratory distress - Orthopneic position - Turning,coughing, and deep breathing (TCDB) Vital for anyone who is in bed for a long period • Administering respiratory treatments -postural drainage -breathing exercises and incentive spirometer -oxygen • Administering nasal treatments - nasal drops and nasal sprays - Suctioning to remove oral-nasal secretions
- 102. THE INFECTIOUS RESPIRATORY DISORDERS • THE COMMON COLD ( acute rhinitis) - rhinitis- inflammation of the nasal mucous membrane - Colds are easily spread by talking, coughing, or sneezing. - Individuals are contagious 48 hours before the appearance of the first symptoms - s/s: sneezing, nasal discharges or congestion, headache,sore throat, general malaise, cough, and sometimes slight fever - Senses of smell and taste are blunted - Unpleasant condition usually last from 5 days to 2 weeks
- 103. • Treatment/management: -rest -drinking plenty of fluids -strict attention to handwashing -using disposable tissues to prevent spreading the infections to others -the client/patient should blow gently to prevent the infection from spreading to sinuses, ears, or eustachian tube -aspirin,acetaminophen,or ibuprofen helps relieve discomfort and reduce fever -vitamin C preventing and treating colds -client should use nose drops with discretion -the person should consult the physician if the fever continues for more than 2 days
- 104. • The client should immediately consult physician if he or she coughs up dark or bloody sputum • The person with chronic respiratory condition, such as asthma, should consult a physician at the first sign of a cold.
- 105. REMEMBER THIS! • Usually midwives who have colds may continue working if they feel well. However, it is essential that they follow all principles of infection control, especially handwashing. Some facilities require such midwives to wear masks and to not be assigned to high risk clients.
- 106. STREPTOCOCCAL SORE THROAT • Physical symptoms are more spread than with ordinary sore throat. -with general physical weakness and malaise -high fever -pus on the tonsils -headache Medication: penicillin (specific antibiotic) unless the person has an allergy or a penicillin-resistant streptococcal infection. -the most dangerous complications of strept throat are rheumatic fever and glomerulonephritis
- 107. INFLUENZA -commonly called flu -an active contagious respiratory disease caused by one of several strains of filterable viruses: types A,B,C,D and others -most people recover,but some die from complications such as heart disease, pneumonia, or encephalitis. -people may develop parkinsonism many years after having the flu. -most dangerous complication is pneumonia -other complications: chronic disorders such as bronchitis, sinusitis, and ear infection.
- 108. REMEMBER THIS! • Complications in fluenza Infants, older adults and immunocompromised people are at much higher risk for developing complications from influenza than are other people
- 109. INFLUENZA S/S: -becomes suddenly ill -with muscle pains - High fever (37.8-39.4 C) last for 2-3 days -headache -sensitivity to light -burning eyes -chills -sneezing,coughing ( persist longer), have nasal discharge -complain of sore throat -feel nauseous -vomit often
- 110. INFLUENZA • MIDWIFE’S MANAGEMENT/ TREATMENT -give large quantities of fluids (fruit juices and plenty of water -do not give milk because it tends to form a film in the throat -follow a regular diet ( patient is anorectic “no appetite”) -bed rest -mild analgesics (may be prescribed) -keep warm and avoid exposure to other disease -watch for signs of secondary infections
- 111. INFLUENZA • prevention: -encourage individuals to be vaccinated -during outbreak,urge people to stay away from crowds -avoid visiting others in healthcare facilities during this time
- 112. LARYNGITIS • Inflammation of the larynx • May accompany a respiratory infection or result from overuse of the voice or excessive smoking • Person cough is hoarse, and may lose the voice • Should avoid talking and smoking • Should receive high-humidity inhalation to soothe the throat’s mucous membrane. • Antibiotics may prescribed • Viral in origin,it is highly contagious; the client should avoid exposing others • Complications: sinusitis or chronic bronchitis • Must carefully examined for signs of cancer, particularly if the smoke cigarettes
- 113. BRONCHITIS • An inflammation of the bronchial tubes (bronchi) • S/s: dry cough (early symptoms),later the cough produces mucus and pus. • Fever and malaise • Treatment: bed rest, a nutritious diet, and plenty of fluids Humidifier helps by moistening the air ( dry aggravates the cough) Antibiotics are given (treat the infection) Take precautions (prevent the infection from spreading) Instruct the client to cover the mouth when coughing Dispose sputum and tissues using Standard of Precautions • Acute bronchitis (untreated) develops to chronic bronchitis
- 114. LUNG ABSCESS • Is a localized area of infection in the lung that breaks down and form a pus • It can be caused by foreign body or by aspiration of oral fluids or respiratory secretions • May follow pneumonia • S/s: chills,fever,with weight loss, and a productive cough with foul purulent sputum • Treatment: surgery (may be required) for drainage of the lung abscess,bronchoscopy (aspirated object) to remove the object. • Antibiotics (after the cause is eliminated)
- 115. PNEUMONIA • An inflammation of the lung with consolidation or solidification • The lung becomes firm as the air sacs are filled with exudate • Classified according to its causative organism • It may be bacterial,viral,fungal,or chemical in origin • May also be caused by aspiration of fluid or a foreign object into the lungs
- 116. TYPES OF PNEUMONIA • Bacterial Pneumonia Most susceptible: -persons who are in poor general health or are physically inactive, -older people -with chronic lung disorders -persons who abuse substances -prevention: pneumococcal pneumonia vaccines are given every 3-5 years
- 117. • Viral pneumonia -variant of the influenza -antibiotics are ineffective -treated symptomatically -rarely fatal -may leave the patient in weakened condition
- 118. • Pneumocytis carinii pneumonia (PCP) -pneumocystis carinii -caused by organisms that are totally known (protozoan or yeast-like) -most commonly seen as one opportunistic diseases in the person with advanced HIV/AIDS infection. -medication: co-trimoxazole (bactrim septra)
- 119. CHEMICAL PNEUMONIA • Largely associated with aspiration of a chemical substance • Be aware that a person may aspirate into lungs without any obvious evidence of vomiting • Extremely high risk: elderly,post operative clients,clients who abuse substance, delibitated and those with swallowing impairments
- 120. ASPIRATION PNEUMONIA • If the person vomits or inhales a foreign object or substances such as water or large amounts of mucus,the material may be drawn into the lungs. • Not only causes the infectious process,but it also can cause additional edema and complications because of the acidity of the gastric contents
- 121. S/S OF PNEUMONIA • Onset: severe,sharp pain in the chest • Chills • High fever (40.6-41.1C) • Painful cough, tenacious sputum • Pain on breathing • Pulse is rapid • Respiration is rapid • Expiration is difficult • Feels very ill • May be cyanotic • WBC count is high • Mental changes (delirium and anxiety) Laboratory test: blood culture,sputum culture,sensitivity test,chest xray.
- 122. TREATMENT OF PNEUMONIA • Administering appropriate antibiotic therapy • Observing respiratory status and indicators of the effectiveness of therapy • Administering oxygen • Administering adequate fluid intake to ensure hydration • Providing adequate nutrition via small, frequent meals • Positioning to aid breathing • Turning,coughing and deep breathing (TCDB) • Maintaining accurate intake and output (I&O) records • Providing frequent mouth care for comfort
- 123. MIDWIFE’S CONSIDERATION • Activity is gradually increased as body convalesces slowly and builds resistance • CXR taken to make sure that the infection in the lungs has cleared completely
- 124. TUBERCULOSIS • An infectious disease • Caused by the acid-bacillus Mycobacterium tuberculosis. This organism encases itself in a waxy coating (spore) that makes its destruction difficult. • Active TB develops when disease,poor nutrition,stress,or a multitude of other factors lower the person’s resistance • Spreads by inhalation of infected droplets that a person with an active infection releases into air. • Physical contact with an infected person and contact with contaminated utensils or equipment can spread TB.
- 125. TUBERCULOSIS • Persons with following conditions or status and who have compromised (weak) immune systems have increased risk for TB infection: -HIV -substance abuse -chronic renal failure -infants,youth,or advanced age -diabetes mellitus -unclean living conditions or crowded living conditions with one or more occupants having TB -homelessness -poor diet -immigrants from parts of the world with endemic tuberculosis
- 126. TUBERCULOSIS TYPES • Latent TB -for the majority of individuals who inhale TB bacteria to prevent it from growing and spreading. The bacteria remain in a dormant spore state (alive but inactive) Typically the individuals with latent TB -have no symptoms -do not feel sick -are not infectious to other individuals -usually have a positive skin test reaction -can develop to active TB disease
- 127. TUBERCULOSIS • Active TB -occurs if individual’s defense mechanisms become weakened, at which point the body may not be able to segregate the TB spore. -when capacity of the body’s defense is compromised (weakened) the TB bacillus will start to grow,invade,and destroy tissues especially the lungs
- 128. TUBERCULOSIS • Pulmonary TB -when bacillus enters the lungs,it precipitates an infection -mild and produces no symptoms - (+)tuberculin test - CXR reveal a small scar - The scar is the result of efforts of the WBC to surround and destroy the bacilli
- 129. TUBERCULOSIS • Pott’s disease and miliary TB -TB of bone and joints -bloodstream carry bacilli to the spine (pott’s disease) (vertebrae collapse results to spinal curvature or kyphosis/humpback) -bloodstream may carry bacilli to other bones and joints, especially hips and knees (miliary TB)
- 130. TUBERCULOSIS • S/S: -cough -lack of pain -thick sputum -(+) or (-) sputum culture -fatigue -gradual weight loss -low-grade fever, especially in the afternoon -nocturnal diaphoresis ( profuse sweating at night) -severe chest pain,persistent cough,and dyspnea
- 131. TUBERCULOSIS • Treatment: Drugs of choice for TB -isoniazid -ethambutol -pyrazinamide -rifampin (highly effective) -streptomycin The regimen for medication administration is important and must be followed faithfully. It may be necessary to treat the client with 2-4 medications for a period of 6-12 months
- 132. TUBERCULOSIS • MIDWIFE’S CONSIDERATIONS: -careful administration of medications. Follow a time schedule is important to maintain a constant blood level of the medications. Give the medication at the same time each day -teaching the client about the importance of continuing medications, even if symptoms seem to have subsided -encouraging the client to follow a well-balanced diet,high in protein, and vitamin A and C. -prevention of spread of the disease, with careful handwashing, and use of personal protective equipment -use of Transmission-based Precaution if disease is active -encouraging patient to get plenty of sleep -ensuring smoke-free environment -providing client diversionary activities
- 133. TUBERCULOSIS • PREVENTION: - Educate the public in good,general health practices - in home care,burn all the used tissue (the TB bacillus can survive for months in dried sputum). If unable to burn tissues, follow community guidelines for disposal of biohazardous waste - Trace active cases and start early treatment of contacts to stop spread of the disease - Follow up with all persons who have had active TB - Screen members of high risk group - Screen healthcare workers yearly
- 134. TUBERCULOSIS • VACCINE -BCG ( Bacille Calmette-Guerin)
- 135. EMPHYSEMA • Sometimes called pyothorax • Is a collection of purulent (pus-containing) exudate in the pleural cavity • It can be acute or chronic ACUTE EMPHYSEMA -secondary infection that may follow TB,lung abscess, or pneumonia S/s: chest pain (usually on one side), cough, fever, dyspnea,and general malaise Treatment: antibiotics, closed drainage or by thoracentesis, bed rest and sedative cough preparation, open drainage (if not successful)
- 136. EMPHYSEMA • CHRONIC EMPHYSEMA -complication of acute emphysema, or may caused by bronchopleural fistula, osteomyelitis of rib cage, or an aspirated foreign body -may also be a complication of TB or fungal infection of the lungs Treatment: soft rubber drainage, large absorbent dressings, and pads are applied.
- 137. CHRONIC RESPIRATORY DISORDERS • Snoring (stertorous breathing) -a respiratory disorder that is common in some people when they sleep. -considered pathologic condition if the person cannot stop snoring,no matter what sleeping position he or she uses;if others can hear the snoring 2-3 rooms away; if the another person has to leave the room to be able to sleep Remedies: elevate the head of the bed,using special pillow,sewing an object such as ball on the back of the pajamas (so the person does not sleep on the back),avoiding heavy evening meals, smoking, sleeping pills, or alcohol,losing weight, and using decongestant
- 138. • SLEEP APNEA SYNDROME -causes the person to wake up many times during the night -common in middle-aged,overweight men -is more than 5 cessations of airflow for atleast 10 seconds each per hour of sleep. - The person suddenly awakens due to lack of oxygen
- 139. • S/S: -extreme tiredness -difficulty in concentration -memory loss -inability to perform one’s job -falling asleep during the day -episodes witnessed by other people • Treatment: -weight reduction -smoking cessation -avoidance of alcohol,especially before bedtime -elevation of the head of the bed -use of continuous positive airway pressure (CPAP) oxygenation
- 140. • Allergic rhinitis (hay fever) - Rhinitis is an inflammation of the nasal mucus passages -allergic rhinitis- a condition that occurs when inflammation results from allergic reaction to protein substance. S/S: edema, itchy nose, excessive sneezing, and profuse ,watery discharge from the nose and eyes. The condition worsens on windy days, and in the mornings and evenings. Treatment: avoid the offending substance,eliminate a food from the diet (that cause allergic reaction), avoiding contact with animals, avoiding dusty places, air conditioning or filtering or purifying air can also help. Antihistamines relieves symptoms,corticosteroids may be given for severe attacks Untreated allergy may lead to asthma,sinusitis, or nasal polyps
- 141. BRONCHIAL ASTHMA • Asthma- a chronic conditioned characterized by inflammation of the lining of the bronchial airways. • Cause is unknown • Is a frightening experience for the person struggling to get air into the lungs • Common chronic disease in childhood
- 142. • S/S: -coughing -wheezing -SOB -chest tightness -individual may be very pale and dyspneic (expiration) -cough up thick,white mucus (attacks subsides)
- 143. • Treatment: -main treatment in an acute attack is to relieve breathing difficulties. -include the use of several classification of medications -anti-inflammatory inhalers (moderate to severe asthma attacks)
- 144. • Midwife’s management: -goals: to decrease symptoms and complications -improve physical conditioning and emotional well-being -encouraging self-management -action plan ( crisis intervention plan) -education Teaching must includes: -use of routine(maintenance) medications and emergency (rescue) medications -use of inhalers -when to call physician -when to go to the hospital for emergency care
- 145. REMEMBER THIS! • The pregnant woman must take her medications faithfully and follow her asthma action plan. If her asthma is not under control, she is not getting enough oxygen to her lungs or to the baby’s lungs.
- 146. TRAUMA • ABSENCE OF AIR EXCHANGE Asphyxiation-the condition in which the blood lacks oxygen and blood and tissues contain excess carbon dioxide. Any form of suffocation or stoppage of breathing can cause as asphyxiation Suffocation is externally applied pressure to the throat (strangulation), drowning (aspiration), electric shock, or gases Strangulation-refers to respiratory arrest due to an obstruction of the air passage Chest trauma
- 147. REMEMBER THIS! • Cardiopulmonary resuscitation (CPR) is ineffective if the person’s airway is blocked or if there is an open chest wound. Clear and/or apply pressure to occlude an open chest wound before initiating CPR
- 148. REMEMBER THIS! • If a person is not breathing CPR is necessary. It is done with an airway and a manual breathing bag is available. RATIONALE: This is less strenuous for the rescuer and prevent the spread of infection from the client to the healthcare worker. If an airway and manual breathing bag are unvailable;mouth-to-mouth breathing is required
- 149. • Drowning/near drowning -aspiration- medical term for fluids in the lungs -aspiration pneumonia- fluids or foreign bodies aspirated into nose,throat,or the lungs during inspiration can prevent adequate air exchange in the lungs
- 150. REMEMBER THIS! • Be careful in giving fluids to a person who has difficulty swallowing or who is confused. Never give fluids by mouth to an unconscious person. Aspiration can cause pneumonia or death. If aspiration occurs, notify physician immediately and take measures to prevent complications
- 151. DISORDERS OF THE NOSE • Sinusitis -inflammation of one or more of the sinuses located in the head. -the maxillary sinus(antrum) is most frequently affected by infection spreading from the nasal passages Acute sinusitis -begins with pain and pressure -feels pain in the cheeks or upper teeth -low-grade fever,fatigue, and poor appetite -purulent discharge Treatment: increased fluids, antibiotics,analgesics, bed rest. Nose drops,antihistamines,steam inhalation or hot,moist packs to the forehead can be effective
- 152. • CHRONIC SINUSITIS -is characterized by repeated flare-ups of the infection, despite treatment. S/S: -cough,due to postnatal drip -chronic headaches in the affected area -facial pain -nasal stuffiness -fatigue
- 153. NASAL TRAUMA • Fracture • Epistaxis (nosebleeding) -irritation or injury to a small mass capillaries on the nasal septum may cause nosebleeds -are fairly common Treatment: -pack nasal cavity with gauze to create pressure on the bleeding area