Respiratory Fundamentals

Linda Winn, RN, MSN Ed., BA Ed.

Major Topics

• Anatomy

http://www.argosymedical.com/Respiratory/samples/animations/Respirati

on/index.html

http://www.argosymedical.com/Respiratory/samples/animations/Sherwoo

d%20Respiration/index.html

• Assessment

• Labs

• Diagnostics

• Meds

• Common Diagnoses

Activity

• Each team will be assigned one of the following topics to research and

present to the entire group:– Assessment

• Normal assessment – what makes up a complete respiratory assessment?

• Abnormal findings & significance 

– Labs• What labs are relative to respioratory status?

• Normals

• Abnormals & significance

– Diagnostics• What diagnostic tests are relative to pulmonary status?

• Normals

• Abnormals & significance

• Any significant patient care measure before, during, or after tests

– Meds• Major categories / actions of Respiratory meds

• Significant side-effects

• Nursing measures specific to meds

Respiratory Assessment

Assessment

• Screening Exam Techniques

http://depts.washington.edu/physdx/pulmonary/tech.html

http://depts.washington.edu/physdx/pulmonary/demo.html

Resp Assessment

• Breathing Pattern– I:E ratio– Kussmaul – Rate

• Dyspnea– Orthopnea– PND – Paroxysmal nocturnal dyspnea

• Cough and Sputum– Frequency– Dry / moist– Amount– Color– Thickness– Odor– Hemoptysis

Assessment (Cont.)

• Inspection– Symmetry– Skin color – lip color / finger clubbing– WOB – accessory muscles

• Auscultation– Adventitious sounds

• Chest pain

• History– Diagnoses– Smoking

• Quick, Focused Assessment

Breath Sounds Link

• Normal and Adventitious breath sounds

http://faculty.etsu.edu/arnall/www/public_html/heartlung/breathsounds/contents.html

Diagnostics & Labs

Labs

• H/H

• Sputum Analysis– C&S

– Gram Stain

– Acid-Fast smear (AFB)

– Cytology

• ABG’s

• WBC

• O2 Sats

Diagnostic Tests

• CXR

• CT Chest

• MRI

• V/Q Scan

• Bronchoscopyhttp://www.nlm.nih.gov/medlineplus/tutorials/bronchoscopy/htm/_no_50_no_0.htm

• Thoracentesis

• PFTs – Pulmonary Function Tests–Spirometry

Diagnostics

• PFR– http://www.argosymedical.com/Respiratory/samples/

animations/Peak%20Flow%20Meter/index.html

Diagnostic Tests

• Endoscopic Exams

– Bronchoscopy: direct inspection of airways

• Only __________ ___________ of airways

– Purposes:• diagnose diseases• find obstructions• obtain tissue samples• remove mucous plugs,

foreign bodies• find bleeding sources

Pulmonary Meds

Pulmonary Meds

• Oxygen (later)

• Corticosteroidshttp://www.argosymedical.com/Respiratory/samples/animations/Inhaled%20Corticosteroids/index.html

• Antibiotics

• Beta-Agonists

Respiratory Med Delivery

Metered Dose InhalersMetered Dose Inhalers

– deliver constant dose of drug directly to airways

– requires hand-lung coordination

– propellant based

– compact & portable

– relatively inexpensive

– wait 1 minute between puffs

How & Why Is the Spacer Used?

SpacerSpacer

http://www.mayoclinic.com/health/asthma/MM00608

Methods of Delivery

Dry Powder InhalersDry Powder Inhalers

– no propellants used

– breath activated easier to use

– delivers more drug to airways than MDIs

http://www.mayoclinic.com/health/asthma/MM00405

Methods of Delivery

NebulizersNebulizers

– used at home or hospital

– continuous aerosol spray with external energy source (O2)

– takes longer to deliver drug

– choice if patient unable to use MDIs

Respiratory Treatments

• Coughing and Deep Breathing (later)

• Incentive Spirometry (later)

• Oropharngeal Suctioning

• Inhaled Medication

• Oxygen Therapy (Supplementation)

Coughing & Deep Breathing

• Position for maximal lung expansion

• Splint with hand(s) or pillow

• Slow inspiration via nose, hold 3-5 seconds, exhale via mouth. Cough after 2-3 breaths.

• Pulmonary disease: exhale via pursed lips & cough after expiration started

• More frequent coughing if productive

• Coughing contraindicated: post-eye, ear, brain

or neck surgery

Incentive Spirometry

• Prevents atelectasis & PNA

– Position for maximal lung expansion

– Exhale completely

– Close mouth around mouthpiece

– Inhale slow & deep, watching meter for flow rate

– Make inspiration last for 3-5 seconds

– 10 X Q/hr WA

Respiratory Diagnoses

• Asthma

• COPD– Chronic Bronchitis– Emphysema

• Pneumonia

Major Pulmonary Diagnoses

• COPD– http://video.about.com/copd/Emphysema.htm – http://video.about.com/copd/COPD.htm

• Pneumonia

– CAP vs HAP

Major Pulmonary Diagnoses

• Asthma

– http://www.argosymedical.com/Respiratory/samples/animation

s/Asthma%20TLC_AZ/index.html

– http://www.argosymedical.com/Respiratory/samples/animation

s/Asthma/index.html

• Sleep Apnea

– http://www.argosymedical.com/Respiratory/samples/animation

s/CPAP%20Sleep%20Apnea/index.html

Pneumonia Collaborative Care

• Appropriate antibiotic therapy

• Increased fluid-- 3 liters/day

• Good nutrition--1500 cal/day

• analgesics

• Reduced activity and rest

• Antipyretics

• Supplemental oxygen

• Vaccine prophylaxis

• CORE Measure

Assessment Findings

• Fever, restlessness, fatigue, splinting painful chest

• (New) cough with or without sputum

• Shortness of breath, RR & HR

• Pleuritic chest pain

• Infiltrates on CXR

• Crackles or bronchial sounds in the peripheral lung fields

Collaborative Care

• Appropriate antibiotic therapy

• Increased fluid-- 3 liters/day

• Good nutrition--1500 cal/day

• Analgesics

• Oxygen

• Reduced activity and rest

• Antipyretics

• Supplemental oxygen

• Vaccine prophylaxis

• CORE Measure

Oxygen

• Medication– Requires MD order– Side Effects

• Highly combustible gas– Clear– Odorless

• Set-up is part of initial room check

Indications for O2 therapy

• Goal– Prevent or relieve hypoxia

• Keep SaO2 > 90%

– Reduce work of breathing– Room Air / FIO2 = 21%

• Used with hypoxia due to:– Respiratory Disorders– Cardiovascular disorders– Central nervous system disorders

Safety Precautions

• O2 sign posted

• No smoking or flames

• Electrical equipment grounded

• Check tank level before transport

• No oil-based lubricants / lotions

Delivery Devices

• Nasal Cannula• Masks

– Simple face– Partial rebreathing– Non-rebreathing– Venturi (Venti Mask)

• Tracheostomy– Collar

• Ventilator• Flow Meter• Humidification

Oxygen Safety

Nasal Cannula

• Advantages– Safe, simple, tolerated well– Allows eating and drinking– Can humidify

• Disadvantages– Easily dislodged

• Check regularly

– Skin breakdown• Check regularly

• O2 Concentrations– 1L/min = 24%– 2L/min = 28%– 3L/min = 32%

Simple Face Mask

• RA enters via side holes

• Advantages– Humidified

• Disadvantages– Imprecise FIO2– High FIO2 needed to prevent rebreathing CO2

• Concentrations– 5-6L/min = 40%– 6-7L/min = 50%– >7L/min = 60%

Non-rebreather Mask

• Use– Valve prevents air from flowing

back into bag– Last step, usually, before intubation

• Advantages– High O2 concentrations– Accurate

• Disadvantages– Can’t use high humidity– uncomfortable

Venturi Mask

• Venti-mask– High flow– Adjustable

• Advantages– Very precise– Mask of choice for

COPD

• Disadvantages– uncomfortable

O2 and COPD

• Historically…– Never give O2 >2L/min to COPD pts.

• However…

“There has been concern regarding the dangers of administering O2 to COPD pts and reducing their drive to

breath.”

“This has been a pervasive myth but is not a serious threat.”

“In fact, not providing adequate O2 to these patients is much more detrimental.”

Lewis, p. 643 (7th ed.)

Patient Education

• Monitor color of sputum

• Self care: at-home meds & treatments; avoid triggers

• Prevention– Pneumococcal vaccine, flu shot

• Frequent oral hygiene

• Encourage fluids

• Environmental hazards– altitude, smog, allergies, smoke

• Follow up medical care

• American Lung Association– www.lungusa.org