Post on 22-Dec-2015
Nose and nasal cavities: mm, ciliated, vascular
Pharynx: posterior to nasal & oral cavity Nasopharynx=air passage way, eustachian tubes from middle ears
Trachea: 4-5in tube from larynx to bronchi. Ciliated
Bronchial tree: air passage ways within lungs
Lungs: lobes 3=R 2=L
PULMONARY
Gases move in and out due to pressure in atmosphere. Lungs stay inflated due to pressure around them which is less than pressure within them.
Alveolar level: sacs exchange CO2 and O2 Surfactant must be present for alveoli to function correctly
continue
Diaphragm: does 80% of the work of breathing
Intercostals Accessory Involuntary control of breathing: Medulla
oblongata Voluntary control of breathing: Cerebral
cortex
Pulmonary muscles/CNS
Process of moving air in & out of the lungs:◦ Compliance◦ Surfactant◦ Airway resistance
Perfusion: moving blood to & from alveolar-capillary membrane for gas exchange◦ Pulmonary circulation◦ Distribution
Diffusion: > to < concentration
Ventilation & Perfusion
Heart=pump 4 chambers-R atrium-tricuspid valve-R
ventricle-pulmonic valve-pulmonary artery-lungs
Return via pulmonary veins to L atrium- bicuspid valve-L ventricle-aortic valve out to aorta
Electrical conductive system
CARDIOPULMONARY SYSTEM
Impulse begins in SA node located in R atrium (pacemaker)
Travels thru both atrium ( A=contracts) Thru mid heart called AV node To the Bundle of His Down the R and L bundles To purkinje fibers which stimulate the V to
contract
Electrical Conduction of Heart
Cerebral cortex: voluntary Medulla oblongata: involuntary Chemical: is based on the amount of CO2,
hydrogen, and O2 present in blood at any given moment. Chemoreceptors in aortic arch and carotids sense the chemical content and adjusts rate and depth of respirations to meet needs.
Neural and Chemical Regulation of Respiration
Decreased hemoglobin: will > HR & RR Decreased inspiration: will > HR Hypovolemia: will > HR & RR Increased metablolism: will > HR & RR Chest wall movements: can decrease
ventilation yet may see > RR but more shallow
Factors affecting O2
Pregnancy Obesity Musculoskeletal abnormalities
◦ Trauma◦ Muscle or musculoskeletal disease: scoliosis◦ CNS diseases: ALS (Lou Gehrings)◦ COPD, other pulmonary disorders
Chest Wall Movements
Age: premature, children, elderly Nutrition: obesity & malnutrition Exercise: with CV fitness enhances O2
exchange Smoking: increases HR and RR Substance Abuse: depresses resp centers Anxiety: increases metabolic=>>02
demand Environmental—Smog, hi altitude, dust,etc
Additional factors
Hyperventilation: ventilation in excess of that required to maintain normal CO2 levels in tissues. CO2 is expired in greater amounts
Hypoventilation: depressed resp rate causing retention of CO2=hypercapnia
Hypoxia: state of inadequate oxygenation from deficient delivery or utilization of O2 at the cellular level.
Alteration in Respiratory Functioning
Rate, Rhythm, Work of breathing Dyspnea: deals with work of breathing Wheezing: narrowed air passages, hi-pitched Pain: evaluate, onset, location, duration, radiation,
effects on respirations Cough: Secretions+characteristics of Lung sounds: bilateral chest assessment Risk factors:family Hx of lung CA, pulmonary ds, smoking Medical history of respiratory infections, smoking
Nursing Assessment
Maintain lung expansion◦ Positioning
Semi-fowlers, Fowlers, orthopneic Change position frequently
◦ Breathing exercises Pursed lip Diaphragmatic breathing Incentive spirometry
Nursing Interventions
Mobilization of pulmonary secretions:◦ TCDB every 2 hours◦ Hydration to thin secretions◦ Humidify environment to moisten mm◦ Postural drainage & chest precussions to mobilize
secretions
Continued
Vital signs: pulse rate, respiratory rate Color: cyanosis, pink, dusky, ruddy Dyspnea: the difficulty and work of
breathing Restlessness/anxiousness Retractions O2 saturation/ABG’s Mental alertness/awareness
Evaluate Effectiveness
Room air=21% Nasal 1L=21%-24% 2L=24%-28% 3L=28%-32% 4L=32%-36% 6L=40%-44% = max O2 level for Nasal O2
Administration of O2
5-6 L = 40% O2 6-7 L = 50% O2 7-10 L= 60% O2 Simple mask: 40% to 60% (varies) Venturi mask: 24%=50% with O2 flow rate
of 4L to 10L (more exact) Non-rebreathing mask: up to 80%-90% Partial rebreathing mask: 60-90%
Mask
Gauge pressure(psi) X cylinder factor (0.28)/liter flow per minute
Example: 900 X 0.28/3 liters per min
=84 minO2 in cylinder will last 84 min
Calculate the correct amount of O2 in a ‘E’ cylinder
Correct liter flow System on then to patient Correct positioning of cannula or mask No smoking-signs and remove ashtrays Avoid use of electrical equipment-avoid
sparks, razors, electric hand held games
Safety Measures