1. ANATOMY AND PHYSIOLOGY
upper and lower respiratory
:-tracts. Prepared by
Dr / amany lotfy

2. Describe the structures and
functions of the upper and lower
.respiratory tracts
Describe ventilation, perfusion,. 2
diffusion, shunting, and the
relationship of pulmonary
.circulation to these processes
Discriminate between normal. 3
.and abnormal breath sounds

3. Use assessment parameters. 4
appropriate for determining the
characteristics and severity of
the major symptoms of
.respiratory dysfunction
Identify the nursing. 5
implications of the various
procedures used for
diagnostic evaluation of
.respiratory function

4. NORMAL ANATOMY AND
PHYSIOLOGY
The respiratory system consists of-
the nose, nasal cavities, pharynx,
larynx, trachea, bronchial tree, lungs,
.and respiratory muscles
The parts outside the chest cavity-
are collectively called the upper
respiratory tract, and those within the
chest cavity make up the lower
respiratory tract
-

5. Anatomic and Physiologic
Overview
ANATOMY OF THE UPPER
RESPIRATORY TRACT
Upper airway structures
consist of the nose, sinuses
,and nasal passages
pharynx, tonsils and adenoids,
.larynx, and trachea

6. ANATOMY OF THE LOWER
RESPIRATORY TRACT
LUNGS
The lower respiratory tract consists
of the lungs, which contain
the bronchial and alveolar structures
.needed for gas exchange
The lungs are the site of gas
exchange between the air and the
blood; the rest of the system moves
air into and out of the lungs

10. FUNCTION OF THE
RESPIRATORY SYSTEM
Oxygen Transport
Oxygen is supplied to, and carbon
dioxide is removed from, cells
by way of the circulating blood.
Cells are in close contact with
capillaries, whose thin walls permit
easy passage or exchange of
.oxygen and carbon dioxide

11. Respiration
After these tissue capillary exchanges,
blood enters the systemic veins (where
it is called venous blood) and travels to
the pulmonary
. circulation
The oxygen concentration in blood
within
the capillaries of the lungs is lower
).than in the lungs’ air sacs (alveoli
Because of this concentration gradient,
oxygen diffuses from the alveoli to the
.blood

12. Mechanism of Breathing
Ventilation is the term for the-1
movement of air into and out of
the alveoli. Air moves from high-
pressure to low-pressure areas
(pressure gradients), some of
which are created by the
respiratory muscles, which in turn
are controlled by the nervous
. system

13. Ventilation
During inspiration, air flows
from the environment into the
trachea, bronchi, bronchioles,
and alveoli. During expiration,
alveolar gas travels the same
.route in reverse

14. Inhalation
Inhalation, also called inspiration,-
occurs when motor impulses from
the medulla cause contraction of the
.respiratory muscles
Exhalation
Normal exhalation is a passive-
process that begins when motor
impulses from the medulla decrease
and the diaphragm and external
.intercostals muscles relax

15. Transport of Gases in the Blood
Oxygen is carried in the blood by-
iron in the hemoglobin (Hgb) of red
blood cells (RBCs). The iron-
oxygen bond is formed in the
lungs, where the partial pressure of
oxygen (PO2) is high. In tissues
where the PO2 is low, hemoglobin
.releases much of its oxygen

16. Causes of Increased Airway
Resistance
Common phenomena that may
alter bronchial diameter, which
:affects airway resistance, include
Contraction of bronchial- 1•
smooth muscle—as in asthma
Thickening of bronchial mucosa-2•
—as in chronic bronchitis
•

17. Causes of Increased Airway
Resistance
Obstruction of the airway—by- 3
mucus, a tumor, or a foreign
body
Loss of lung elasticity—as in- 4•
emphysema, which is characterized
by connective tissue encircling the
airways, thereby keeping them open
during both inspiration and expiration

18. Partial Pressure Abbreviations
P = pressure
PO2 = partial pressure of oxygen
PCO2 = partial pressure of carbon
dioxide
PAO2 = partial pressure of alveolar
oxygen
PACO2 = partial pressure of
alveolar carbon dioxide
PaO2 = partial pressure of arterial
oxygen

19. Partial Pressure Abbreviations
PaCO2 = partial pressure of arterial
carbon dioxide
Pv–O2 = partial pressure of venous
oxygen
Pv–CO2 = partial pressure of venous
carbon dioxide
P50 = partial pressure of oxygen when
the hemoglobin is 50%
saturated

20. Assessment :HEALTH HISTORY
The health history focuses on the
physical and functional problems
of the patient and the effect of
these problems on his or her life. :
dyspnea (shortness of breath),
pain, accumulation of mucus,
wheezing, hemoptysis (blood spit
up from the respiratory tract),
edema of the ankles and feet,
cough, and general fatigue and

21. Signs and Symptoms
The major signs and symptoms of
,respiratory disease are dyspnea
cough, sputum production, chest
pain, wheezing, clubbing of the
.fingers, hemoptysis, and cyanosis
These clinical manifestations
are related to the duration and
.severity of the disease

22. Clinical Significance for SPUTUM
PRODUCTION
A profuse amount of purulent
sputum
thick and yellow, green, or rust-(
colored) or a change in color of
the sputum probably indicates a
bacterial infection. Thin, mucoid
sputum frequently results from viral
bronchitis. A gradual increase of
sputum over time may indicate the
presence of chronic bronchitis or
.bronchiectasis

23. CHEST PAIN
Chest pain or discomfort may be
associated with pulmonary or
cardiac disease or pulmonary
conditions may be sharp,
stabbing, and intermittent, or it
may be dull, aching, and
.persistent

24. CLUBBING OF THE FINGERS
is a sign of lung disease found in
patients with chronic hypoxic
conditions, chronic lung infections, and
malignancies. This finding may be
manifested initially as
sponginess of the nail bed and loss of
the nail bed angle

25. HEMOPTYSIS
Pulmonary infection•
Carcinoma of the lung•
Abnormalities of the heart or•
blood vessels
Pulmonary artery or vein•
abnormalities
Pulmonary emboli and infarction•

26. CYANOSIS
Cyanosis, a bluish coloring of the
skin, is a very late indicator of
hypoxia. The presence or absence
of cyanosis is determined by the
amount of unoxygenated
.hemoglobin in the blood

27. UPPER
RESPIRATORY STRUCTURES
PHYSICAL ASSESSMENT
For a routine examination of the
upper airway
PHYSICAL ASSESSMENT OF THE
LOWER RESPIRATORY
STRUCTURES AND BREATHING

28. Thoracic Palpation
The nurse palpates the thorax for-1
tenderness, masses, lesions,
respiratory excursion, and vocal
fermatas. If the patient has reported
an area of pain or if lesions are
apparent,2- the nurse performs direct
palpation with the fingertips (for skin
lesions and subcutaneous masses) or
with the ball of the hand (for deeper
masses or
(.generalized flank or rib discomfort-3

29. Abnormal (Adventitious) Breath
Sounds
Crackles Soft, high-pitched,
discontinuous popping sounds that
occur during inspiration
Sonorous wheezes (rhonchi) Deep,-2
low-pitched rumbling sounds heard
primarily during expiration; caused by
air moving through narrowed
tracheobronchial passages

30. Diagnostic Evaluation
PULMONARY FUNCTION TESTS
ARTERIAL BLOOD GAS STUDIES
PULSE OXIMETRY
Pulse oximetry is a noninvasive
method of continuously monitoring
the oxygen saturation of
).hemoglobin (SpO2 or SaO2

31. CULTURES
Throat cultures may be performed to
identify organisms responsible
for pharyngitis. Throat culture may also
assist in identifying organisms responsible
.for infection of the lower respiratory tract
SPUTUM STUDIES
Sputum is obtained for analysis to identify
pathogenic organisms and to determine
.whether malignant cells are present

32. Thoracoscopy
Thoracoscopy is a diagnostic
procedure in which the pleural
cavity is examined with an
endoscope (Fig. 21-16(. Small
incisions are made into the
pleural cavity in an intercostal
space; the location of the incision

33. Upper airway infection
Dr / Amany lotfy

34. Upper Airway Infections
Upper airway infections are
common conditions that affect
most people on occasion.
Some infections are acute, with
symptoms that last several
;days

35. VIRAL RHINITIS (COMMON
”).COLD) (“the flu
The term “common cold” often is used
when referring to an
upper respiratory tract infection
that is self-limited and caused by
a virus (viral rhinitis). Nasal
,congestion, rhinorrhea, sneezing
sore throat, and general malaise
.characterize it

36. Clinical Manifestations
Signs and symptoms of viral
rhinitis are nasal congestion,
runny nose, sneezing, nasal
discharge, nasal itchiness,
,tearing watery eyes
scratchy” or sore throat,“
general malaise, low-grade
,fever, chills

37. Medical Management
Management consists of symptomatic
therapy. Some measures include
providing adequate fluid intake-1
, encouraging rest-2
preventing chilling, 4-increasing-3
intake of vitamin C, 5- using xpectorants.
6-Warm salt-water gargles soothe the
sore throat 7- nonsteroidal anti-
inflammatory agents (NSAIDs) such as
aspirin or ibuprofen relieve the aches,
. pains, and fever in adults
Antihistamines to relieve sneezing, -8
.rhinorrhea,and nasal congestion

38. Preventing and Managing Upper
Respiratory Infections
Identify strategies to prevent infection
and, if infected, to prevent spread of
✓ ✓ infection to others
Perform hand hygiene often
Use disposable tissues
Avoid crowds during the flu season
Avoid individuals with colds or
respiratory infections
Obtain influenza vaccination, if
recommended (especially if elderly or

39. Preventing and Managing Upper
Respiratory Infections
Eat a nutritious diet
Get plenty of rest and sleep
Avoid or reduce stress when possible
Exercise appropriately
Avoid smoking or second-hand smoke
and excessive intake of alcohol
Increase humidity in house, especially
during winter
Practice adequate oral hygiene
Avoid allergens, if allergies are•
associated with upper respiratory

40. Prevention and Management
Identify strategies to control the•
environment ✓ ✓ Adequately humidify
(avoid over humidifying) living quarters
Place a dehumidifier in the basement, if
appropriate
Provide central ventilation fans, air
conditioning with microstatic air filters
Reduce irritants (dust, chemical,
tobacco smoke) when possible
Limit exposure to animals and house
pets, particularly in the bedroom

41. Management
Describe strategies to relieve symptoms of
•
✓ ✓ upper respiratory infection
Gargle with salt water
Increase fluid intake, particularly of hot
liquids
Provide warm, moist air by shower or
humidifier to relieve swollen mucous
membranes
Avoid irritants (dust, chemicals,
tobacco smoke) when possible
Recognize signs and symptoms of•
infection and state when to contact a
✓ ✓ health care provider

42. Management
Upper respiratory tract signs &symptoms
Extreme red throat or white patches on
the back of the throat
Discolored drainage or foul-smelling
nasal discharge
Prolonged fever of 100.5°F (38°C) >2 days
Shortness of breath, wheezing
Swollen lymph nodes
Severe pain or tenderness around the
eyes or persistent pain in sinus areas
Severe headache

43. THE PATIENT WITH UPPER
AIRWAY INFECTION
:NURSING PROCESS
Assessment A health history may
reveal signs and symptoms of
headache, sore
throat, pain around the eyes and on
either side of the nose, difficulty
in swallowing, cough, hoarseness,
fever, stuffiness, and generalized
.discomfort and fatigue

44. Based on the assessment data, the
patient’s major nursing diagnoses
Ineffective airway clearance- 1:•
related to excessive mucus
production secondary to
retained secretions and
inflammation
Acute pain related to upper-• 2
airway irritation secondary to
an infection

45. Impaired verbal communication-3
related to physiologic changes and
upper airway irritation secondary to
infection
or swelling
Deficient fluid volume related to-4
increased fluid loss secondary to
diaphoresis associated with a fever
Deficient knowledge regarding- 5•
prevention of upper respiratory
infections, treatment regimen, surgical
procedure

46. Nursing Interventions
MAINTAINING A PATENT AIRWAY
PROMOTING COMFORT
ENCOURAGING FLUID INTAKE
PROMOTING HOME AND COMMUNITY-
BASED CARE
Teaching Patients Self-Care
MONITORING AND MANAGING
POTENTIAL COMPLICATIONS
While major complications of upper
respiratory infections are
rare, the nurse must be aware of them and
.assess the patient for them

47. Evaluation
EXPECTED PATIENT OUTCOMES
:Expected patient outcomes may include
Maintains a patent airway by managing. 1
secretions
a. Reports decreased congestion
b. Assumes best position to facilitate
drainage of secretions
Reports feeling more comfortable. 2
a. Uses comfort measures: analgesics, hot
packs, gargles, rest
b. Demonstrates adequate oral hygiene
Demonstrates ability to communicate. 3
needs, wants, level of comfort

48. Maintains adequate fluid intake-4
Identifies strategies to prevent upper airway. 5
infections and allergic reactions
a. Demonstrates hand hygiene technique
b. Identifies the value of the influenza vaccine
Demonstrates an adequate level of. 6
knowledge and performs
self-care adequately
Becomes free of signs and symptoms of. 7
infection
a. Exhibits normal vital signs (temperature,
pulse, respiratory
)rate
b. Absence of purulent drainage
c. Free of pain in ears, sinuses, and throat

49. Management of Patients with
Chest and Lower Respiratory
Disorders
Acute Bronchitis: It is an
acute inflammation of the
mucous membrane of the
bronchi often following infections
of the upper respiratory tract

50. Acute Bronchitis
:Causes
Viral infection bacterial infection-1
,(streptococcus pneumonia
(Homophiles influenza-2
Physical & chemical irritants-3
( (dust, gases smoke
Air pollution-4

51. :Clinical manifestations
Dry, irritating cough, scanty sputum *
Sternal soreness
Fever
Headache
General malaise
As the infection progresses the patient
may have profuse sputum
It is an inflammatory process of the lung ]
that is. Commonly caused by infections
agent