Ventilation Powerpoint 1217856570738773 8

7/30/2019 Ventilation Powerpoint 1217856570738773 8

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OXYGENATIONRESPIRATORY

SYSTEM


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TERMINOLOGIESVENTILATION MOVEMENT OF AIR IN & OUT OF THE

LUNGS

RESPIRATION EXCHANGE OF GASES : EXTERNAL &INTERNAL

EXTERNAL BET. ALVEOLI & PULMONARY CAPILLARIES

INTERNALBET. SYSTEMIC CAPILLARIES

PERFUSION AVAILABILITY & MOVEMENT OFCAPILLARY BLOOD FOR EXCHANGE OF GASES


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CASE STUDY At the emergency room, patient Anna, 39

y.o,came, in respiratory distress, shouting forhelp, because of massive hemoptysis that

she is presently experiencing

Vital signs are:

RR = 30,

HR= 105,

BP=130/80,

T= 36 C


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CASE STUDY Her skin is cold and clammy

You provided oxygen via nasal prong

What other nursing actions would you

do?

What nursing history would you extract?


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CASE STUDY You learned that patient has been experiencing

night sweats, easy fatiguability for about 1

month.

There was on & off cough and fever, and

patient self-medicated with low dose

Amoxycillin


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CASE STUDY With the above history, in which ward is

your patient be admitted?

What are the possible diagnostics herphysician would order?

What are your proposed nursing plan forthe patient?


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REVIEW OF ANATOMYDivisions of the RespiratorySystem

Air Conducting System -

nose . terminal bronchioles

Gas-exchanging lung units

respiratory bronchioles alveolar ducts

alveolar sacs alveoli


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REVIEW OF ANATOMYOrgans of the RespiratorySystem

Each lung has 3 primary components:

Air passages

Blood vessels pulmonary artery (majorsupply), bronchial arteries

Elastic connective tissue

PLEURA Parietal and Visceral


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REVIEW OF PHYSIOLOGY Functions of the Respiratory System

Parameters in the process of breathing

Atmospheric O2 is 21%, normal atmosphericpressure 760 mmHg

Adequate ventilation or perfusion of the

alveoli Inspiration

Expiration


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REVIEW OF PHYSIOLOGY Parameters in the process of breathing

Permeable alveoli-capillary membrane

Adequate pulmonary and systemic circulationSystemic

circulation

Pulmonary

Circulation

Decrease pO2 Vasodilatation vasoconstriction

Mechanism More time for

gas exchange

Shunting of

blood to better

ventilated

arteries


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REVIEW OF PHYSIOLOGY Parameters in the process of breathing

Ability of the blood to transportO2 and CO2 between the

lungs and the tissues Ability of the cells to utilize O2 and eliminate CO2

Neural Control of Respiration

1. Medullary Rhythmicity Area

2. Apneustic Area prolong and deepen respiration3. Pneumotaxic Area inhibit inspiration

Pulmonary Volumes and Capacity


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NURSING PATIENTS WITH THREATSTO VENTILATIONNursing History

Cough

Secretions sputum, phlegm

Dyspnea activity, time of the day, duration,

posture, onset & precipitating factor

Chest pain

Cyanosis

Voice quality

Stridor


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CYANOSIS TYPES

1. Peripheral extremities, nailbeds

2. Central lips, tongue, face and mucous

membrane

3. Differential


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CYANOSIS

Factors that alter the presence of Cyanosis

1. Pigmentation and thickness2. Type of light used during assessment

natural light is desirable

3. Absolute amount of reduced hemoglobin4. Observers perception

1. Activity

2. Duration 3. Distribution


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NURSING PATIENTS WITH THREATSTO VENTILATIONPhysical Assessment

Inspection deformities, rate and rhythm of

breathing

Palpation - fremitus Percussion - resonance

Auscultation

Normal breath sounds

1. Vesicular most of the lung

2. Bronchovesicular mainstem bronchi

3. Bronchial/Tubular - trachea


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NURSING PATIENTS WITH THREATSTO VENTILATIONPhysical Assessment

Abnormal Breath Sounds

1. Rales moisture in the tracheobronchial tree;heard on inspiration

2. Wheeze continuous, musical sound heard

with movement of air through narrowed

passage; heard on expiration

3. Friction Rubs grating sound from inflammed

pleura


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NURSING PATIENTS WITH THREATSTO VENTILATIONDiagnostic AssessmentRADIOGRAPHIC

1. Chest Xray2. Tomography

3. Fluoroscopy

4. Pulmonary Angiography pulmonary embolism

EVALUATION

5. Bronchography size,shape and number of

bronchi

6. Pulmonary

Scintiphotography

7. Sinus Xray


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NURSING PATIENTS WITH THREATSTO VENTILATIONDiagnostic Assessment

EXAMINATION BY DIRECT

1. Rhinoscopy

2. Laryngoscopy indirect,

direct

3. Bronchoscopy

4. Bronchofiberoscopy

VISUALIZATION

5. Mediastinoscopy

6. Transillumination

7. Lung Biopsy

transtracheobronchial,

transthoracic8. Pleural Biopsy


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LABORATORY STUDIES

1. Hematologic

2. Cytological sputum, tracheobronchial

secretions, pleural fluid

3. Bacteriological studies

1. sputum studies : C & S, cytology

2. thoracentesis

3. skin test for TB


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THORACENTESIS

Site :

Air : 2nd

/3rd

ICS, MCL Fluid : 7th/8th ICS,

PAL

Position :

over a bed table

straddling in achair,

seated in bedwith affectedhand raisedover the head

NursingManagement


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SKIN TEST FOR P.T.B.

1. Mantoux test

2. PPD

3. Multiple Puncture Test

4. Von Pirquet Scratch Test

5. Volmer Patch Test


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NURSING PATIENTS WITH THREATSTO VENTILATIONASSESSMENT OF PULMONARY

FUNCTION

1. SPIROMETRY2. ARTERIAL BLOOD GAS

1. Ph

2. pCO23. pO2

4. H2CO3


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NURSING PATIENTS WITH THREATSTO VENTILATIONSPIROMETRY

PULMONARY FUNCTION TEST

LUNG CAPACITIES Vital Capacity

Normal Lung Capacity

Total Lung Capacity

Inspiratory Capacity

Functional Residual Capacity


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NURSING PATIENTS WITH THREATSTO VENTILATIONPULMONARY FUNCTION TEST

LUNG VOLUMES

Tidal Volume

Inspiratory Reserve Volume

Expiratory Reserve Volume

Residual Volume Minute Volume


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NURSING PATIENTS WITH THREATSTO VENTILATIONPlanning

1. Planning for Health Promotion

2. Planning for Health Restoration and

Maintenance1. Maintaining Patent Airway

1. Coughing techniques

2. Suctioning2. Reducing Metabolic Demands

3. Preventing and Controlling Infection


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4. Oxygen Therapy

5. Incentive Spirometry

6. Aerosol Therapy7. IPPB (Intermittent Positive Pressure Breathing)

8. Artificial Airway

9. Mechanical Ventilation10.Chest Surgery

11.Chest Drainage


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OXYGEN THERAPY

Hypoxemia

Hypoxia Types : Hypoxic hypoxia

Anemic hypoxia

Ischemic hypoxia

Histotoxic hypoxia


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OXYGEN THERAPY

Assessment for need for oxygen

Planning for oxygen therapy Promoting psychological and physical comfort

Promoting safety

Maintaining Adequate Oxygen Supply : Low flow system nasal cannula, face mask

High Flow system non-rebreathing mask, Venturrimask

Other ways: tracheostomy, portable oxygen, special

room, hyperbaric oxygen


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AEROSOL THERAPY

1. Distilled water and NSS

2. Detergents

3. Mucolytics

4. Others : bronchodilators, steroids

Devices used to generate aerosols :

1. Nebulizer

2. Humidifier


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ARTIFICIAL AIRWAY

Types:

1. Oropharyngeal Airway2. Endotracheal : orotracheal, nasotracheal

3. Tracheostomy : 3 main principles of care:

1. Maintain patent airway ( signs of occlusion)

2. Prevent Infection

3. Prevent drying and crusting of the mucosa


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MECHANICAL VENTILATION THERAPY

TYPES:

1. Pressure Cycled2. Volume Cycled

ACCESSORY ATTACHMENTS

1. Intermittent Mandatory Ventilation2. Continuous Positive Airway Pressure

3. Positive End Expiratory Pressure


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CHEST SURGERY

CHEST DRAINAGE

Principle of negative pressure (NP)

Vacuum is needed to reestablish NP

Closed water-sealed drainage

Types: 1- bottle, 2-bottle, 3-bottle Purpose: remove air and fluid, lung

reexpansion


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CHEST DRAINAGE

Nursing Resposibilities

1-BOTTLE operates by gravity only, fluctuation/oscillation stops : lung has

reexpanded, or tube is kinked

intermittent bubbling normal with expiration

Continuous bubbling air leak Rapid bubbling consid loss of air

Chest Xray - reexpansion


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CHEST DRAINAGE

Nursing Responsibilities

2 OR 3 BOTTLE SYSTEM Suction necessary

Periodic emptying of fluid/ bubbling in the

control tube indic proper fxning No Fluctuation with expiration in water-

sealed bottle

Continuous bubbling air leak


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CHEST DRAINAGE

REMOVAL OF CATHETER

1. Premedication

2. During expiration or end of inspiration

3. Wound covered with skin

clips/PETROLEUM GAUZE

PLEUREVAC


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COMMON REPIRATORYPROBLEMS - NOSENOSE

Epistaxis

causes : picking of the nose, DHF, HPN,

cancer, sinusitis, deviated/perforated septum

mgt: elevate, promote vasoconstriction, external

control. Ice collar, drugs - neosynephrine

Nasal Polyp - overgrowth of mucous membranecauses : allergy, chronic sinusitis

Deviated Septum


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COMMON REPIRATORYPROBLEMS - SINUSES,THROAT

SINUSES

Sinusitis

causes

s/sx : pain, nasal congestion,general malaise,fever

treatment : bed rest, medications,

surgery : Caldwell-Luc operation

THROAT Tonsilitis

S/Sx

Mgt

Surgery : Tonsillectomy


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TONSILLECTOMYNursing Care

PRE-OP: no fever,evaluate hemostasis,ATROPINESULFATE

POST-OP1. Patient may have postnasal pack

2. HOB 45 degreeslocal; prone with head to 1 side

general

3. Temp axilla, rectal4. Avoid clearing of throat or cough bleeding

5. Aspirin, narcotics, ice collar

6. Vomiting small amnt of blood


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TONSILLECTOMY7. Blood trickling down the throat/ FREQUENT

SWALLOWING Hemorrhage

8. If conscious, no acidic drinks (burning sensation),give ice chips and cold liquids

9. NO STRAW sucking can cause bleeding

10.Alkaline mouthwash


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COMMON REPIRATORYPROBLEMS - LARYNXLARYNX

Laryngitis

Cancer of the Larynx Predisposing factor : heavy smoking and

drinking, family hx, chronic laryngitis, vocal

abuse

S/Sx persistent hoarseness -1ST AND EARLY,cough,enlarged cervical LN, pain in the Adams

apple that radiates to the ear


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COMMON REPIRATORYPROBLEMS - LARYNX Cancer of the Larynx

Diagnostics : Laryngoscopy, biopsy

Mgt : Early : LaryngofissureAdvanced : Laryngectomy, Radiation


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TOTAL LARYNGECTOMYNURSING CARE PreOp- Assist the physician in telling the patient:1. He will loose the following :

1. voice,

2. normal means of breathing,

3. sense of smell, blowing of nose,4. blowing of air from mouth,

5. sip soup,sucka straw,

6. gargle,

7. whistle

8. lift heavy object2. Breath through a permanent tracheostomy

3. Know other methods of speech

4. Visit a speech therapist

5. Tube feedings after surgery,temporary


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TOTAL LARYNGECTOMYNURSING CARE Post Op1. Constant attendance; no IV for the dominant arm

2. Avoid:1. raising tone of voices

2. completing sentences verbally that the patient started towrite

3. talking nervously and excessively

3. Elevate HOB to:

1. promote drainage2. facilitate respiration

3. prevent strain on suture line

4. minimize edema


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TOTAL LARYNGECTOMY4. Avoid dusts or fumes , tracheostomy stoma has no

mechanism for filtering and cooling air neck bib

5. Observe post-op complications:1. Fistula formation

2. carotid artery rupture3. Stenosis of tracheostomy

4. Atelectasis and pneumonia

5. Shock

6. Hemorrhage

6. IV,tube feeding, analgesic, antibiotic

7. Care of Gomco or Hemovac drainage catheter:remove fluid from potetial deadspace (space for larynx)

8. If catheter not used, ressure dressin .


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TOTAL LARYNGECTOMY9. Minimal postop pain; narcotics contraindicated

in Head & neck surgery

10.Self care teachings:

1. NGT, instruct self-feeding.2. Instruct removing and replacing laryngostomy

tube : breath in, hold, insert and resume normal

resp.

3. Caution when shaving : it takes 6 months for cut

nerve endings to regenerate

Laryngostomy tube stays for 3-8 wks until stoma becomes

permamnently formed


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TOTAL LARYNGECTOMY11.Rehabilitation : aeg wear ID stating he has no

vocal cord

12. Not smoke

13. Speech Rehab- A.S.A. mucous membrane

and muscles are completely healed

14. Artificial Respiration :

mouth to neck stoma breathing

O2 administration to tracheostomy

patients head should not be turned- may obstruct

trach


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CONDITIONS AFFECTINGTHE CHEST2 CLASSIFICATIONS :

1. OBSTRUCTION in the pathways of normalalveolar ventilation by:

1. spasm2. mucus secretions

3. morphologic changes

2. RESTRICTION in the movement of thorax orlungs associated with :

1. Pathologic factors

2. Neurologic factors


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All Im asking for is a beautiful hair cut


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CHRONIC OBSTRUCTIVEPULMONARY DISEASE (COPD)1. EMPHYSEMA

2. BRONCHIAL ASTHMA

3. BRONCHIECTASIS

4. CHRONIC BRONCHITIS


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C.O.P.D. - EMPHYSEMAStretching and overdistention of the alveoli

Loss of intralveolar septa, pulmonary elasticity

and alveolar capillary surface

Loss of pulmonary compliance + partial obstruction

No effective inhalation


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C.O.P.D. - EMPHYSEMAPredisposing Factors :

1. Cigarette smoking

2. Pollution

3. Chronic long term infection

S/Sx1. Cough

2. Weakness

3. Lethargy

4. Barrel chest5. Bronchospasms

6. Asthma

7. Forced expirations

C O P D -


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C.O.P.D. - BRONCHIALASTHMA Viral respiratory Infection/ allergens Bronchial spasm and bronchial constriction

STATUS ASTHMATICUS

S/Sx :

dyspnea,

cough,

wheezing

prolonged expiration


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These lungs appear essentially normal, but arenormal-appearing because they are the hyperinflated

lungs of a patient who died with status asthmaticus.


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This cast of the bronchial tree is formed of inspissated

mucus and was coughed up by a patient during anasthmatic attack. The outpouring of mucus from

hypertrophied bronchial submucosal glands, the

bronchoconstriction, and dehydration all contribute to the

formation of mucus plugs that can block airways in

asthmatic patients.


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C.O.P.D. - BRONCHIECTASIS Dilation of medium-sized bronchi Loss of bronchial elasticity

Excessive mucus

Chronic productive cough

S/Sx :

Abundant sputum maybe blood-tinged ( trauma

to bronchial walls)

C O P D


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C.O.P.D.CHRONIC BRONCHITIS Inflammation of bronchioles

Causes : infection, respiratory irritants

S/Sx : cough

Excessive mucus production and retention

Dyspnea Hyperinflated chest

Concurrent emphysema


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COPD - MANAGEMENT

IMPROVINGVENTILATION

Oxygen,

IPPB,

nebulization,

suctioning secretions

Medications:

bronchodilators, steroids

STRENGTHENING

RESPIRATORY

MUSCLES

Breathing exercises

OTHER CONCERNS : hydration,

prevention or treatment

of infection(antibiotics)

cough medications,

nutrition,

providing emotional and

physical rest

Incentive spirometry


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RESTRICTIVE DISEASESCLASSIFICATION : NEUROMUSCULAR

THORACIC DEFORMITY

RESTRICTION TO LUNG OR ALVEOLAREXPANSION

INFILTRATIVE DISEASE

OBESITY LOSS OF FUNCTIONING PULMONARY TISSUE


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RESTRICTIVE DISEASENEUROMUSCULAR DISORDERS

1. MYASTHENIA GRAVIS Generalized muscular weakness

There is difficulty in swallowing aspiration

Respiratory muscle paralysis with dse progression

Tracheostomy and mech ventilator

2. BULBAR POLIOMYELITIS

Viral infection 9th 12th CN paralysis of laryngeal musclestrach

SPINAL TYPEparalysis of respiratory muscles


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RESTRICTIVEDISEASESNEUROMUSCULAR DISORDERS3. GUILLAIN BARRE SYNDROME

Acute infectious polyneuritis

Headache, aching limbs, gend bodymalaise, fever

Progression:

numbness and tingling of digits

muscular weakness and paralysis

RESTRICTIVE DISEASES


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THORACIC DEFORMITY

1. KYPHOSCOLIOSIS

Abnormal convex curvature of the spine

2. PECTUS EXCAVATUM

funnel chest

Concave deformity resulting from

depression of the sternum


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RESTRICTIONTO LUNG and/or ALVEOLAREXPANSIONDISEASES OF THE PLEURA

1. PNEUMOTHORAX Spontaneous: primary, secondary

Traumatic Causes : unknown, pulmonary lesion, iatrogenic

Dyspnea, cough, chest pain, decreased chestmovements, mediastinal shift to affected side

2. HYDROTHORAX Serous fluid; lymphatic obstruction

3. HEMOTHORAX traumatic


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RESTRICTIONTO LUNG and/or ALVEOLAREXPANSION

4. PLEURISY

Inflammation of the pleura with changes in its

serous secretion

Types :

Pleural effusion

Empyema

Fibrinous


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PLEURISY

PLEURAL EFFUSION

Sero-fibrinous fluidDyspnea, limited movement of chest

Mediastinal shift away from affected side

TB, Pneumonia, malignancy, cardiacfailure


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PLEURISY

EMPYEMA

Purulent exudate From preexisting infections in the lung,ribs or

subphrenic space

Lung collapse of affected sideDull pain and persistent tenderness

limited chest movements


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The pleural surface at the lower

left demonstrates areas of yellow-

tan purulent exudate. Pneumonia

may be complicated by a pleuritis.Initially, there may just be an

effusion into the pleural space.

There may also be a fibrinous

pleuritis. However, bacterial

infections of lung can spread to the

pleura to produce a purulent

pleuritis. A collection of pus in the

pleural space is known as

empyema.


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PLEURISYFIBRINOUS / DRY PLEURISY

Lack of lubricating serous secretion

Fibrinous exudates causes frictionrubs

Pain

rapid shallow respiration

Restricted ventilatory efficiency


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PLEURISYFIBRINOUS / DRY PLEURISY

MANAGEMENTThoracentesis

Chest Tube

Pleurodesis


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INFILTRATIVE DISEASES

Pulmonary Tuberculosis

Bronchogenic Carcinoma OBESITY

Pickwickian Syndrome extreme obesity

Ascites -

RESTRICTION DUE TO


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LOSS OF FUNCTIONING

PULMONARY TISSUE

CHANGE IN ALVEOLAR CAPILLARY SURFACES

DECREASED SURFACES FOR BLD GASES &DECREASED PRODUCTION OF SURFACTANT

ALVEOLAR COLLAPSE

ATELECTASIS

RESTRICTION DUE TO


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LOSS OF FUNCTIONINGPULMONARY TISSUE

1. PULMONARY INFARCTION

2. LUNG ABSCESS

3. BRONCHOGENIC CARCINOMA4. PULMONARY FIBROSIS

5. PNEUMOCONIOSES

6. PNEUMONIA

7. PULMONARY TUBERCULOSIS

8. PULMONARY EDEMA

PULMONARY INFARCTION


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PULMONARY INFARCTION

Loss of pulmonary tissue from occlusion ofpulmonary artery by an embolus

Long bone fracture; obstetric patients

LUNG ABSCESS

Aspiration of foreign body Lung obstruction

Pneumonia

BRONCHOGENIC CARCINOMA

Smoking, pollutants

Cough, wheeze, hemoptysis, dyspnea


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This is a rare finding that may complicate a term

pregnancy at delivery. Seen here in a pulmonary arterybranch is an amniotic fluid embolus that has layers of fetal

squames. Amniotic fluid embolization can have the same

outcome


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This is a squamous cell

carcinoma of the lung that is

arising centrally in the lung (asmost squamous cell

carcinomas do). It is

obstructing the right main

bronchus. The neoplasm isvery firm and has a pale white

to tan cut surface.


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PNEUMONIA

Acute pulmonary infection

Pneumococcus, Streptococcus, Haemophilus

Thi i l b i i


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This is a lobar pneumonia in

which consolidation of the

entire left upper lobe has

occurred. This pattern ismuch less common than the

bronchopneumonia pattern.

In part, this is due to the fact

that most lobar pneumoniasare due to Streptococcus

pneumoniae

(pneumococcus)


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PULMONARY FIBROSIS

Pathological increase in lung connective

tissue Diffuse / localized

Secondary to other pulmonary diseases


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Regardless of the etiology for restrictive lung diseases, many

eventually lead to extensive fibrosis. The gross appearance, asseen here in a patient with organizing diffuse alveolar damage, is

known as "honeycomb" lung because of the appearance of the

irregular air spaces between bands of dense fibrous connective

tissue.


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PNEUMOCONIOSES

Chronic, fibrotic

Inhalation of irritant dusts: Silica

Asbestos

Coal


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PULMONARY TUBERCULOSIS

Mycobacterium TB

Cough, hemoptysis, malaise, weight loss,low grade afternoon fever easy

fatigability, night sweats

Anti TB drugs, quadruple therapy


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Here is the gross appearance of

a lung with tuberculosis.

Scattered tan granulomas are

present, mostly in the upperlung fields. Some of the larger

granulomas have central

caseation. Granulomatous

disease of the lung grossly

appears as irregularly sizedrounded nodules that are firm

and tan. Larger nodules may

have central necrosis known as

caseation--a process of

necrosis that includes elements

of both liquefactive and

coagulative necrosis).


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On closer inspection, the

granulomas have areas of

caseous necrosis. This is very

extensive granulomatousdisease. This pattern of

multiple caseating granulomas

primarily in the upper lobes is

most characteristic of

secondary (reactivation)tuberculosis. However, fungal

granulomas (histoplasmosis,

cryptococcosis,

coccidioidomycosis) can mimic

this pattern as well.


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The Ghon complex is seen here at closer range. Primary

tuberculosis is the pattern seen with initial infection with

tuberculosis in children. Reactivation, or secondary

tuberculosis, is more typically seen in adults.


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PULMONARY EDEMA

Excessive amount of fluid in the alveoli

and pulmonary interstitial tissues Congestive Heart Failure, Chronic Renal

Failure


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MANAGEMENT RESTRICTIVE LUNG DISEASE Antibiotics

Oxygenation

Hemodynamic monitoring Diuresis /phlebotomy pulmonary edema

Ventilatory support

The nurse enters the room of a client who


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The nurse enters the room of a client who

has a chest tube attached to a water-seal

drainage system & noticed the chest tube is

dislodged from the chest. The most

appropriate nursing intervention is to:

a. Notify the physicianb. Insert a new chest tube

c. Cover the insertion site with petroleum gauze

d. Instruct client to breathe deeply until helparrives


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