1 Anatomy of respiratory system12/11/2017 Mr.Homood Alharbi Respiratory module

2 Function of respiratory systemOxygen transport: exchange of O2 &CO2 “diffusion” , increase O2 sat Ventilation: flow of air in &out of the lung, clear CO2, RR,TV Mechanism of spontaneous breathing : diaphragm movement& atmospheric pressure Inhalation (-ve pressure), exhalation (+ve pressure) 12/11/2017 Mr.Homood Alharbi Respiratory module

3 Positioning &lung perfusion : Airway resistance : any change on the airway diameter which effects airway flow to/ out the lung. Compliance :elasticity, expandability of the lung. Effected by age, disease, surfectant, lung tissue (collagen, elastin) Positioning &lung perfusion : Upper right position : lower part perfused more due to low PAP Lateral position: one side perfused more than other 12/11/2017 Mr.Homood Alharbi Respiratory module

4 Inhaled air consists of Nitrogen 78% Oxygen 21% CO2 .04% Vapor water .05% Helium Argon Oxygen carried in form of: Dissolved in the Plasma (PaO2) mmhg With hemoglobin in RBC (O2 sat) 90% 12/11/2017 Mr.Homood Alharbi Respiratory module

5 Control of ventilationCentral Chemoreceptors in Medulla & Pons which are sensivitive to PH, CO2, O2 controls rate &depth of ventilation through phrenic nerve. Pripheral : in Aortic Arch, carotid arteries. 12/11/2017 Mr.Homood Alharbi Respiratory module

6 Assessment of respiratory systemDyspnea Difficult breathing, shortness of breath Due to decreased lung compliance, high airway pressure Effect RV due to high resistance Sudden dyspea in a healthy person may indicate pneumothorax, ARDS, respiratory obstruction In immobilized person may indicate Pulmonary emboli Orthopnea indicates heart disease. Rx: treat causes, O2 administer 12/11/2017 Mr.Homood Alharbi Respiratory module

7 Irritation of mucus membrane in respiratory tract Cough : Irritation of mucus membrane in respiratory tract From infection, airborne irritants (smoke, dust) Serve as natural protection Night cough due to Lt side heart failure, bronchial asthma Morning cough due to brochitis Supine cough due to sunusitis Sputums production: Thick, (yellow, green) indicates bacterial infection Thin indicates viral infection Pink indicates lung tumour Fouel smelling indicates lung abscess Rx: if pt able to expactorate, hydation, inhalation of aerosolized solutions (spray to humidify air) 12/11/2017 Mr.Homood Alharbi Respiratory module

8 RT bronchoconstriction, narrowing airways Rx: bronchodilatorsWheezing RT bronchoconstriction, narrowing airways Rx: bronchodilators Clubbing fingers RT hypoxia 12/11/2017 Mr.Homood Alharbi Respiratory module

10 Physical assessment of respiratoryNose/ Sinuses Inspect nose for color, bleeding, discharges Palpate sinuses for tender Phrynx/ Mouth: Inspect mouth for color, symmetry, exudates, ulceration Use tongue depression to inspect pharynx 12/11/2017 Mr.Homood Alharbi Respiratory module

11 Palpate and inspect for symetery or deviation (tension pneumotharx)Trachea Palpate and inspect for symetery or deviation (tension pneumotharx) Breathing patterns& respiratory rates Eupnea : normal breathing rate bpm Bradypnea: slow breathing, less than 12bpm Tachypnea: fast breathing, more than 18bpm Hypoventilation: shallow breathing Hyperventilation: deep breathing, to correct acidosis, athelets Apnea: cessation of breathing 12/11/2017 Mr.Homood Alharbi Respiratory module

12 Palpate for tendernessThoracic palpataion Palpate for tenderness Respiratory excursion To determine symmetry Of expirartion Pulse oximeter To determine O2 sat 12/11/2017 Mr.Homood Alharbi Respiratory module

13 Thoracic auscultation12/11/2017 Mr.Homood Alharbi Respiratory module

14 Adventitious Breath SoundsAbnormal sounds and some conditions associated with them: Sibilant wheezes (high-pitched, musical … asthma, bronchitis, emphysema, tumor) Pleural friction rub (creaking, grating… pleurisy, tuberculosis, abscess, pneumonia) Stridor (crowing…croup, foreign body obstruction, large airway tumor). Fine crackles (dry, high-pitched popping…COPD, CHF, pneumonia) Coarse crackles (moist, low-pitched gurgling…pneumonia, edema, bronchitis) Sonorous wheezes (low-pitched snoring…asthma, bronchitis, tumor)

15 Upper respiratory tractRhinitis Inflammation of nose by viral , obstructive ,allergic reaction. Clinical manifestations Rhinorrhea “ excessive nasal drainage” Nasal congestion, Itching ,& sneezing Headache may occur Medical Management Treatment of cause “antibiotics” Decongestant agents Antihistamine In severe cases corticosteroids 12/11/2017 Mr.Homood Alharbi Respiratory module

16 common cold Often is used when referring to a symptoms of an upper respiratory tract infection ch.ch.by nasal congestion ,sore throat , & cough Cold referred to a febrile, infectious, acute inflammation,of the mucus membranes of the nasal cavity Clinical manifestations Nasal congestion Scratchy or sore throat Sneezing & cough Headache & muscle ache Herpes simplex sore (cold sore )

17 common cold Nursing ManagementMedical Management (symptomatic management) Fluid intake ,rest ,prevention of chills. Aqueous decongestant,anti histamin, Vit. C. Expectorant as needed Analgesic for aches ,pain , & fever. Antimicrobial to reduce incidence of complications Nursing Management Patient teaching of self care & prevention of infection & break chain of infection

18 Acute Sinusitis It is inflammation of sinuses , it is resolved promptly if their opening into nasal cavity . Clinical Manifestations Pressure , pain over the sinus area Tenderness Purulent nasal secretions Medical Management Antimicrobial agent “Amoxicillin” Oral & Topical Decongestant Heated mist or Saline irrigation

19 Meningitis &osteomylitis Brain abscess Ischemic infarctionNursing management Teaching pt. to promote drainage “inhaling steam, more intake, applying local heat” Teaching pt. about rebound effect of nasal decongestant. Complications Meningitis &osteomylitis Brain abscess Ischemic infarction 12/11/2017 Mr.Homood Alharbi Respiratory module

20 Acute Pharyngitis It is a febrile inflammation of throat ,caused by virus about 70% , uncomplicated viral infection usually subsided promptly within 3-10 days Clinical Manifestations Fiery red pharyngeal membrane& tonsils Lymphoid follicles that are swollen Enlarge tender cervical lymph node Fever & malaise Sore throat , hoarseness,& cough

21 Supportive measures for viral infection Medical Management Supportive measures for viral infection Pharmacologic therapy antibiotics for 10 days “cephalosporin”analgesic for severe sore anti tussive medications Nutritional therapy liquid or soft diet “If liquid can’t tolerated IV fluid administered “ Nursing Management (bed rest ,skin assessment, mouth care &normal saline gargle & self care teaching 12/11/2017 Mr.Homood Alharbi Respiratory module

22 Chronic Pharyngitis Common in adults who work or live in dusty surrounding ,use the voice too excess , suffer from chronic cough , & habitually use alcohol & tobacco Types of pharyngitis Hypertrophic :ch.ch.by general thickening& congestion of pharyngeal mucus membrane Atrophic : probably late stage of first type Chronic Granular : ch.ch.by numerous swollen lymph follicles on the pharyngeal wall

23 Constant sense of irritation or fullness in throat Clinical Manifestations Constant sense of irritation or fullness in throat Mucus expelled by coughing Difficulty in swallowing Medical Management Relieving symptoms Avoiding exposure to irritant Correct respiratory & cardiac conditions 12/11/2017 Mr.Homood Alharbi Respiratory module

24 Nursing Management Antihistamine drugs DecongestantControlling malaise Nursing Management Patient teaching of self care Avoid alcohol , tobacco , exposure to cold Face mask to avoid pollutant Warm fluids,&warm saline gargle 12/11/2017 Mr.Homood Alharbi Respiratory module

25 Tonsillitis The tonsils are composed of lymphatic tissue & situated on each side of the oropharynx ,they frequently are the site of acute infection (tonsillitis) Clinical Manifestations Tonsils : sore throat, fever , snoring & difficulty of swallowing Adenoids : ear ache , mouth breathing , drainage ear ,frequent cold , bronchitis, noisy respiration, foul smelling breath &voice impairment

26 Medical Management Nursing ManagementFor recurrent tonsillitis “tonsillectomy” Conservative or symptomatic therapy Antimicrobial therapy “penicillin” for 7 days Nursing Management Provide post op. care :V/S ,hemorrhage , position head turned to side,water or ice chips Teaching patient :S&S of hemorrhage Avoid too much talking or coughing Liquid or semi liquid diet for several days Alkaline mouth washing with warm saline

27 Laryngitis It is an inflammation of larynx ,often occur as a result of voice abuse or exposure to dust , chemicals , smoke , & other pollutants Common in winter & easily transmitted The cause of infection is almost virus Clinical Manifestations Hoarseness or aphonia Severe cough

28 Medical Management Resting voice & avoid smoking Inhale cool steam or an aerosol Conservative treatment Antibiotics for bacterial organisms Nursing Management Rest voice Maintain a well humidified environment Daily fluid intake

29 Sleep apnea Can be obstructive, central, or mixed Manifestations :Excessive daytime sleepiness, morning headache, personality change, mentality changes, loud snoring, restless sleep Need sleep test “cardiopulmonary status monitored during sleeping” Cause hypoxia, hypoventilation, MI, HTN, dysrythmias 12/11/2017 Mr.Homood Alharbi Respiratory module

31 Nursing process: pt with upper respiratory tractAssessment Diagnosis Planning & goals Interventions Evaluation 12/11/2017 Mr.Homood Alharbi Respiratory module

32 Conclusion Any question 12/11/2017Mr.Homood Alharbi Respiratory module