Assesment of RESPIRATORY SYSTEM .pptx

Msc. Nursing

1. ASSESSMENT OF RESPIRATORY SYSTEM PREPARED BY MR. RAJESH CHANDRA MISHRA M.Sc. Nursing 1 st year

2. GENERAL OBJECTIVES Define the term of respiratory system. Explain the Anatomy of respiratory system. Describe the physiology of respiratory system. Elaborate the assessment of respiratory system. ASSESSMENT OF RESPIRATORY SYSTEM

3. GENERAL OBJECTIVES conti …. Illustrate the Assessment. Discuss the Diagnostic test. Explain the Nursing responsibility. ASSESSMENT OF RESPIRATORY SYSTEM

4. INTRODUCTION Gas exchange is the primary function of the respiratory system. The respiratory system takes oxygen from the atmosphere, transports oxygen to the lungs, exchanges oxygen for carbon dioxide in the alveoli, and returns carbon dioxide to the air. ASSESSMENT OF RESPIRATORY SYSTEM

5. Anatomical overview of respiratory system Upper airway structures consist of the Nose Paranasal sinuses P harynx, tonsils Larynx Trachea   ASSESSMENT OF RESPIRATORY SYSTEM

6. Upper airway function Major functions of the upper airway are Air conduction to the lower airway for gas exchange. Protection of the lower airway from foreign matter and Warming, filtration, and humidification of inspired air. ASSESSMENT OF RESPIRATORY SYSTEM

7. nose The nose serves as a passageway for air to pass to and from the lungs. It filters impurities and humidifies and warms the air as it is inhaled. ASSESSMENT OF RESPIRATORY SYSTEM

8. Nose conti … The nose is composed of an external and an internal portion. The external portion protrudes from the face and is supported by the nasal bones and cartilage. ASSESSMENT OF RESPIRATORY SYSTEM

9. ASSESSMENT OF RESPIRATORY SYSTEM

10. Paranasal Sinuses The paranasal sinuses include four pairs of bony cavities that are lined with nasal mucosa and ciliated pseudostratified columnar epithelium. These air spaces are connected by a series of ducts that drain into the nasal cavity.   ASSESSMENT OF RESPIRATORY SYSTEM

11. Paranasal Sinuses Conti… The sinuses are named by their location: Frontal, Ethmoid, Sphenoid, and Maxillary. A prominent function of the sinuses is to serve as a resonating chamber in speech. ASSESSMENT OF RESPIRATORY SYSTEM

12. Pharynx ASSESSMENT OF RESPIRATORY SYSTEM

13. Pharynx The pharynx, or throat, is a tubelike structure that connects the nasal and oral cavities to the larynx. It is divided into three regions: Nasal, Oral, and Laryngeal. The nasopharynx is located posterior to the nose and above the soft palate. ASSESSMENT OF RESPIRATORY SYSTEM

14. Pharynx CONTI.. The oropharynx houses the faucial, or palatine tonsils. The laryngopharynx extends from the hyoid bone to the cricoid cartilage. The epiglottis forms the entrance to the larynx.  ASSESSMENT OF RESPIRATORY SYSTEM

15. Pharynx CONTI.. The pharynx functions as a passageway for the respiratory and digestive tracts.  ASSESSMENT OF RESPIRATORY SYSTEM

16. Tonsils The tonsils, the adenoids, and other lymphoid in the chain of lymph nodes guarding the body from invasion tissue encircle the throat. These structures are by organisms entering the nose and the throat. ASSESSMENT OF RESPIRATORY SYSTEM

17. Diagram of pharyngeal tonsil ASSESSMENT OF RESPIRATORY SYSTEM

18. Larynx The larynx, or voice box, is a cartilaginous epithelium-lined organ that connects the pharynx and the trachea and consists of the following: Epiglottis : A valve flap of cartilage that covers the opening to the larynx during swallowing. ASSESSMENT OF RESPIRATORY SYSTEM

19. Glottis Glottis : The opening between the vocal cords in the larynx. ASSESSMENT OF RESPIRATORY SYSTEM

20. cartilage ASSESSMENT OF RESPIRATORY SYSTEM

21. CARTILAGE Thyroid cartilage : The largest of the cartilage structures; part of it forms the Adam's apple. Cricoid cartilage : T he only complete cartilaginous ring in the larynx (located below the thyroid cartilage). Arytenoid cartilages : It is used in vocal cord movement with the thyroid cartilage. Vocal cords : ligaments controlled by muscular movement . ASSESSMENT OF RESPIRATORY SYSTEM

22. trachea ASSESSMENT OF RESPIRATORY SYSTEM

23. Trachea The trachea is composed of smooth muscle with C-shaped rings of cartilage at regular intervals. The cartilaginous rings are incomplete on the posterior surface and give firmness to the wall of the trachea, preventing it from collapsing. ASSESSMENT OF RESPIRATORY SYSTEM

24. Trachea CONTI… The trachea serves as the passage between the larynx and the right and left main stem bronchi, which enter the lungs through an opening called the hilus. ASSESSMENT OF RESPIRATORY SYSTEM

25. Lower Respiratory Tract ASSESSMENT OF RESPIRATORY SYSTEM

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27. Layer of lung . ASSESSMENT OF RESPIRATORY SYSTEM

28. Pleura The lungs and wall of the thoracic cavity are lined with a serous membrane called the pleura. The visceral pleura covers the lungs. T he parietal pleura lines the thoracic cavity, lateral wall with of the mediastinum, diaphragm, and inner aspects of the ribs. ASSESSMENT OF RESPIRATORY SYSTEM

29. Mediastinum Bronchi and Bronchioles The mediastinum is in the middle of the thorax, between the pleural sacs that contain the two lungs. It extends from the sternum to the vertebral column and contains all of the thoracic tissue outside the lungs (heart, thymus, the aorta and vena cava, and esophagus). ASSESSMENT OF RESPIRATORY SYSTEM

30. Mediastinum Bronchi and Bronchioles Conti… There are several divisions of the bronchi within each lobe of the lung. First are the lobar bronchi (three in the right lung and two in the left lung). ASSESSMENT OF RESPIRATORY SYSTEM

31. FUNCTION OF RESPIRATORY SYSTEM Oxygen transport. Respiration. Ventilation. Air Pressure Variances. Airway resistance. ASSESSMENT OF RESPIRATORY SYSTEM

32. Function of the Respiratory System The cells of the body derive the energy they need from the oxidation of carbohydrates, fats, and proteins. This process requires oxygen. Vital tissues, like the brain and the heart, cannot survive long without a continuous supply of oxygen.   ASSESSMENT OF RESPIRATORY SYSTEM

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34. . ASSESSMENT OF RESPIRATORY SYSTEM

35. Pulmonary Diffusion and Perfusion Pulmonary diffusion is the process by which oxygen and carbon dioxide are exchanged from areas of high concentration to areas of low concentration at the air-blood interface. The alveolar- capillary membrane is ideal for diffusion because of its thinness and large surface area. ASSESSMENT OF RESPIRATORY SYSTEM

36. Pulmonary Diffusion and Perfusion CONTI.. In the normal healthy adult, oxygen and carbon dioxide travel across the alveolar-capillary membrane without difficulty as a result of differences in gas concentrations in the alveoli and capillaries. ASSESSMENT OF RESPIRATORY SYSTEM

37. Pulmonary Diffusion and Perfusion CONTI.. Pulmonary perfusion is the actual blood flow through the pulmonary vasculature. The blood is pumped into the lungs by the right ventricle through the pulmonary artery. ASSESSMENT OF RESPIRATORY SYSTEM

38. The pulmonary artery divides into the right and left branches to supply both lungs. Normally, about 2% of the blood pumped by the right ventricle does not perfuse the alveolar capillaries. This shunted blood drains into the left side of the heart without participating in alveolar gas exchange. Pulmonary Diffusion and Perfusion CONTI.. ASSESSMENT OF RESPIRATORY SYSTEM

39. Bronchial arteries extending from the thoracic aorta also support perfusion but do not participate in gas exchange, further diluting oxygenated blood exiting through the pulmonary vein. Pulmonary Diffusion and Perfusion CONTI.. ASSESSMENT OF RESPIRATORY SYSTEM

40. Pulmonary artery pressure, gravity, alveolar pressure determine the patterns of perfusion. In lung disease, these factors vary, and the perfusion of the lung may become abnormal. Pulmonary Diffusion and Perfusion CONTI.. ASSESSMENT OF RESPIRATORY SYSTEM

41. Ventilation and Perfusion Balance and Imbalance . ASSESSMENT OF RESPIRATORY SYSTEM

42. Oxyhemoglobin Dissociation Curve The oxyhemoglobin dissociation curve shows the relationship between the partial pressure of oxygen (PaO2) and the percentage of saturation of oxygen (SaO2). The percentage of saturation can be affected by carbon dioxide, hydrogen ion concentration, temperature, and 2,3-diphosphoglycerate. ASSESSMENT OF RESPIRATORY SYSTEM

43. Oxyhemoglobin Dissociation Curve CONTI… An increase in these factors shifts the curve to the right, thus less oxygen is picked up in the lungs, but more oxygen is released. ASSESSMENT OF RESPIRATORY SYSTEM

44. ASSESSMENT OF RESPIRATORY SYSTEM

45. Carbon Dioxide Transport At the same time that oxygen diffuses from the blood into the tissues, carbon dioxide diffuses from tissue cells to blood and is transported to the lungs for excretion.   ASSESSMENT OF RESPIRATORY SYSTEM

46. Carbon Dioxide Transport CONTI..   The amount of carbon dioxide in transit is one of the major determinants of the acid- base balance of the body. Normally, only 6% of the venous carbon dioxide is removed in the lungs and enough remains in the arterial blood to exert a pressure of 40 mm Hg. ASSESSMENT OF RESPIRATORY SYSTEM

47. Carbon Dioxide Transport   Most of the carbon dioxide (90%) is carried by red blood cells; the small portion (5%) that remains dissolved in the plasma (partial pressure of carbon dioxide [PCO₂]) is the critical factor that determines carbon dioxide movement in or out of the blood.   ASSESSMENT OF RESPIRATORY SYSTEM

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49. Neurologic Control of Ventilation   ASSESSMENT OF RESPIRATORY SYSTEM

50. Neurologic Control of Ventilation CONTI.. . Resting respiration is the result of cyclic excitation of the respiratory muscles by the phrenic nerve. The rhythm of breathing is controlled by respiratory centers in the brain. ASSESSMENT OF RESPIRATORY SYSTEM

51. Neurologic Control of Ventilation CONTI.. T he apneustic center in the lower pons stimulates inspiratory medullary center to promote deep, prolonged inspirations. The inspiratory and expiratory centers in the medulla oblongata and pons control the rate and depth of ventilation to meet the body's metabolic demands. ASSESSMENT OF RESPIRATORY SYSTEM

52. assessment of respiratory system Health History. The health history initially focuses on the patient's presenting problem and associated symptoms. Nurse should explore. T he onset. L ocation . D uration . . ASSESSMENT OF RESPIRATORY SYSTEM

53. Conti …. A ggravating . A lleviating factors. Radiation (if relevant). T iming of the presenting problem and associated signs and symptoms. ASSESSMENT OF RESPIRATORY SYSTEM

54. Nursing responsibility The nurse should also explore how these factors ears impact the patient's activities of daily living, usual work and er), family activities, and quality of life. ASSESSMENT OF RESPIRATORY SYSTEM

55. Common Symptoms The major signs and symptoms of respiratory disease are: D yspnea C ough S putum P roduction C hest pain W heezing Hemoptysis

56. Dyspnea Dyspnea (subjective feeling of difficult or labored breathing, breathlessness, shortness of breath) is a multidimensional symptom common to many pulmonary and cardiac disorders, particularly when there is decreased lung compliance or increased airway resistance .  

57. Dyspnea conti .. Dyspnea may also be associated with allergic reactions, anemia, neurologic or neuromuscular disorders, trauma, and advanced disease, and is common at the end of life.

58. COUGH . Cough results from irritation or inflammation of the mucous when lying membranes anywhere in the respiratory tract and is associated in patients with multiple pulmonary disorders.  

59. COUGH CONTI…. Mucus, pus, blood, or chronic an airborne irritant, such as smoke or a gas, may stimulate a with an the cough reflex. Common causes of cough include asthma, with gastrointestinal reflux disease, infection, and side effects of medications, such as angiotensin-converting enzyme .

60. SPUTUM Sputum production is the reaction of the lungs to any constantly recurring irritant and often results from persistent coughing. A profuse amount of purulent sputum (thick and yellow, green, or rust colored) or a change in color of the sputum is a common sign of a bacterial infection.  

61. SPUTUM CONTI… Thin, mucoid sputum frequently results from viral bronchitis. A gradual increase of sputum over time respiratory tract. Potential tinged mucoid sputum suggests a lung tumor.

62. SPUTUM CONTI… F rothy, only witness to the episode, an may occur with chronic bronchitis or bronchiectasis, Pink- pink material, often welling up into the throat, may indicate episode, the following points pulmonary edema.

63. SPUTUM CONTI… Foul-smelling sputum and bad breath point to the presence of a lung abscess, bronchiectasis, or an infection caused by other anaerobic organisms. Bloody sputum from the preceded by considerable appearing in the nose.

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65. Chest pain Chest pain or discomfort may be associated with pulmonary, cardiac, gastrointestinal, or musculoskeletal disease or anxiety. Chest pain associated with pulmonary conditions may be sharp, stabbing, and intermittent, or it may be dull, aching and persistent.

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67. Nurses responsibility The nurse must determine the source of the bleeding, as the term hemoptysis is reserved for blood coming from the respiratory tract. Potential sources of bleeding include the gums, nasopharynx, lungs, or stomach. The nurse may be the frothy, only witness to the episode, and when evaluating the bleeding episode, the following points should be considered

68. Physical Assessment of the Respiratory System  

69. DIAGNOSIS EVALUATION Spirometry: Chest X-ray: Magnetic resonance imaging (MRI): Bronchoscopy:

70. Conti… Sputum culture.  Pulmonary function test. Computed tomography (CT) scan Pulmonary function test

71. Spirometry