The Respiratory System & Oxygenation

1. The Respiratory System & Oxygenation Lisa B. Flatt, RN, MSN, CHPN

2. Anatomy & Physiology • Nose • Pharynx • Larynx • Tracheobronchial Tree • Right & Left Bronchus • Bronchioles • Alveoli • Lungs • Cilia • Diaphragm • Pleural Cavity

3. Breathe Deeply…….. • The pharynx is the passageway for _air_into the lungs and _food __into the __esophagus_. • The left lung has __2___lobes. • The right lung has __3____lobes. • The smallest structure in the lungs is the _alveoli_ . • The _alveoli__is the gas-exchange unit. • What warms air _cilia____ and in conjunction with mucus traps dust, allergens, particles…

4. The Alveoli What and how they do it….. Out into the body…… • Are encased in parchment thin capillary filled sacks • O2 & CO2 are exchanged by diffusion (movement of particles from area of higher to lower concentration) • O2 combines with hemoglobin (goes to the tissue as oxyhemoglobin) • CO2 is exhaled after the venous system returns oxygen depleted blood to the lungs

5. The Need to Breathe • The goal is to move air in and out of the lungs • You need physics and gas pressures and must equalize the pressure inside and out • Breathing is automatic • Breathe in and diaphragm goes __down__ so the pressure inside your chest is __greater_than outside. • Need for oxygen & to get rid of excess CO2

6. What would cause an increased demand for oxygen? • Name some disease states • __stress, anxiety__________ • ___anemia, lung diseases_________ • Name some illnesses • ____infection, sepsis_________ • ____fever_________ • What about others? Pg. 57 • ___activity__________ • ___age related, shape you’re in!__________

7. Lung function, capacity and elasticity are measured by: • Tidal volume-amt. you breath in and breath out • Vital capacity-maximum amt. of air you breath out after the maximum amt of air you breath in • Total lung capacity-max amt of air in lungs after max inspiratory effort • Residual volume-amt of air left in lungs after forced exhalation • Expiratory reserve volume-amt of air forcefully exhaled after normal TV exhalation • Inspiratory reserve volume-amt of air forcefully inhaled after your normal TV • Pulmonary Function Test (PFT) – measures all of above, tells us about overall lung function and if they are congruent with functioning

8. Disease States • Asthma • Sudden Infant Death Syndrome • Emphysema • COPD • Posture : kyphosis • Cancer • Bronchitis

9. Smoking…… • What does it do to our bodies • Cilia – decreased motility, get stuck to the sides • Mucus – gross colors, sticky and thick, increased and cough it up • Air exchange – poor, decreased, deprives the body

10. Fun facts…. • Narcotics effect on breathing___suppress, no effect/increase in O2 usage: Morphine, suppresses respiration, decreases the myocardial consumption of oxygen___ • Lung cancer and predisposing occupations • ___asbestosis, construction, radiation___________ • ___farmers, agriculture, chemical exposure___________ • ___coal mining, second hand smoke, smokers__________ • Physical conditions that can affect oxygenation • ___activity, breathing patterns___________ • ___body habitus, stress, illness___________ • ___age, pain, crying-depression/psychological state___________

11. Respirations • Normal rate adults:_12-20bpm___infants:_30-60??___ • Rapid rate is called_tachypnea___________ • Reasons:__spesis, pain, fever, activity, metabolic acidosis_________________________ • Decreased rate is called___bradypnea_______ • Reasons:__medication, brain injury, psychological state, metabolic states___ • Excessive amount of air in lungs__hyperventilation___ • Inadequate amount of air in lungs_hypoventilation___ • Difficult or labored breathing__dyspnea________

12. Respirations cont’d • Labored or difficult breathing __dyspnea_______ • Must sit upright to breath___orthopnea_____ • Apnea is _not breathing____________________ • Breathing pattern with periods of apnea lasting __10-60 sec. is called___cheyne-stokes__ • Gasping breathing associated with diabetes__kussmaul’s___

13. Thermoregulation – body maintaining a ‘normal’ temperature 98.6 Hyperthermia Hypothermia • Increased respiratory rate • Increased VS • Vasodilation • Diaphoretic • seizures • Decreased respiratory rate • Shiver • Pupillary changes • Vasoconstriction • Heart, vs decrease

14. Hemoglobin Contains and carrier iron Low hgb treated with __iron____Side effects of Iron: constipation, dk stools, GI upset______ Hgb can be decreased from __CO poisoning, hemorrhage, GIB_____

15. How do the following affect breathing? • Age – lung capacity decreases as you age • Sex – men have increased lungs/bigger chests • Cigar/cigarette smoking – decrease lung compliance, damage structures • Cultural/spiritual or religious background – peace pipes, smoking, incense

16. More…… And More………. • Activity – good, increases lung capacity and compliance • Diet – healthy, iron • Body weight - appropriate • Height - OK • Aerobic exercise – increase respiratory rate, air exchange and burning calories • Stress – (like aerobic exercise!), bad stuff

17. ….. And More…… • Environmental Factors - toxins • Altitudes- higher thinner air, less O2 • Ventilation of space – air movement, clean • Occupations – breathing in harmful substances • Air temperature and humidity – hot and cold, painful, humid - stuffy • Alternative and Holistic therapies – hypnosis, etc…

18. 3 Areas of Altered Respiratory Function • Movement of air in or out of the lungs (altered O2 intake and supply) • Diffusion of O2 and CO2 (between alveoli and pulmonary capillaries) • Transport of O2 and CO2 (altered cellular demand for O2)

19. Movement of air in or out of the lungs (altered O2 intake and supply) • Oxygen intake needs exceed what they can take in – blockage (nasal) • Tumor, food, mucus, anything….

20. Diffusion of O2 and CO2 (between alveoli and pulmonary capillaries) • Diffusion is movement of particles from an area of higher concentration to lower concentration • Anemia, BMT failures, lung diseases

21. Transport of O2 and CO2 (altered cellular demand for O2) • More hgb=greater O2 capacity • Sepsis, fever, exercise

22. Oxygen Safety • No smoking • No flames • No fires • Tripping over stuff, like tubing and cannisters • Humidifier with NS – keeps nasal mucosa moist

23. Oxygen delivery methods • BVM – bag valve mask • Ventilator – endotracheal tube • Nasal cannula – 2-6 L • Face Mask – varying amounts of oxygen • Nonrebreather mask – 100% - 2/3 on inspiration – completely collapses? = breath CO2 • Face tent – rarely used • Transtracheal oxygen – O2 via trach • CPAP • BiPAP

24. Oxygen • Oxygen saturation – amount/percent of O2 in RBC – used by pulse ox • FiO2 – fracional concentration of oxygen

25. Blood Products • Plasma – volume expander, clotting factors • RBC – H/H and iron • IVIG – intravenous immune globulins • Platelets- clotting • Cryoprecipitate – clotting factors / frozen product from plasma • Albumin – promotes intravascular fluid absorption • Prolastin – for alpha-one antitrypsin disease (enzyme deficiency)

26. S/S Transfusion Reaction • Chills • Fever • Headache • Backache • Hematuria • Clammy • SOB

27. Others… • Circulatory overload – vein distention, cough, crackles, tachycardia, HTN – go slow, titrate up and check VS!

28. Nursing Promotions • Percussion • Postural drainage • Nasopharyngeal suctioning • Incentive Spirometer • Coughing and deep breathing • Medications • Pursed lip breathing – fish face • Hydration • Pulmonary toileting

29. Medications • Bronchodilators • Expectorants • Antitussives • Some cardiac drugs can be used to increase respiration and oxygens: NTG, calcium channel blockers, etc.. See page 71

30. Blood gases • See handout I gave you!

31. Care Plan