Oxygen – a clear, odorless gas that constitutes approximately
PULMONARY VENTILATION – first process of the
21% of the air we breathe, is necessary for proper functioning
of all living cells. Absence of oxygen can lead to cellular,
tissue, and organism death.
Respiration – is the process of gas exchange between the
individual and the environment.
4 COMPONENTS:
1. Ventilation or breathing, the movement of air in and
out of the lungs as we inhale and exhale
2. Alveolar-capillary gas exchange, which involves the
diffusion of oxygen and carbon dioxide between the
alveoli and the pulmonary capillaries
3. Transport of oxygen and carbon dioxide between the
tissues and the lungs
4. Movement of oxygen and carbon dioxide between
the systemic capillaries and the tissues.
4 PROCESSES of the respiratory system:
1. pulmonary ventilation
2. alveolar gas exchange transport of oxygen
3. carbon dioxide
4. systemic diffusion.
Respiratory System
A. Upper Respiratory (mouth, nose, pharynx, and
larynx compose the upper respiratory system)
B. Lower respiratory (trachea and lungs, with the
bronchi, bronchioles, alveoli, pulmonary capillary
network, and pleural membranes)
Sneeze reflex – initiated by irritants in nasal passages; large
volume of air rapidly exits through the nose and mouth during
a sneeze, helping to clear nasal passages.
Cough reflex – (vagus nerve) triggered by irritants in the
larynx, trachea, or bronchi; foreign particles are then swept
upward toward the larynx and throat by cilia, tiny hairlike
projections on the epithelial cells
Mucous blanket – traps pathogens and microscopic
particulate matter
respiratory membrane (alveolar/ capillary membrane) - gas
exchange occurs between the air on the alveolar side and the
blood on the capillary side; not more than 0.0004 mm thick
pleura – outer surface of the lungs is covered by a thin, double
layer of tissue
A. parietal pleura – lines the thorax and surface of the
diaphragm
B. visceral pleura – covers external surface of the
lungs
pleural fluid - a serous lubricating solution; prevents friction
during the movements of breathing and serves to keep the
layers adherent through its surface tension.
A.
respiratory system, ventilation of the lungs, is
accomplished through the act of breathing.
a. Inspiration (inhalation) – air flows into the lungs
b. Expiration (exhalation) – air moves out of the lungs
Factors:
Clear airways
1. An intact central nervous system and respiratory
center
2. An intact thoracic cavity capable of expanding
and contracting
3. Adequate pulmonary compliance and recoil.
medulla and pons – respiratory centers; control breathing
severe head injury, opiates or barbiturates – affect the
respiratory centers
intrapleural pressure (pressure in the pleural cavity
surrounding the lungs) – always slightly negative in relation
to atmospheric pressure; it creates the suction that holds the
visceral pleura and the parietal pleura together as the chest
cage expands and contracts.
intrapulmonary pressure (pressure within the lungs) -
always equalizes with atmospheric pressure; inspiration
occurs when the diaphragm and intercostal muscles contract,
increasing the size of the thoracic cavity.
COPD – reduce this elasticity result in forced expirations and
may impair the body’s ability to expel carbon dioxide.
tidal volume – 500 mLof air is inspired and expired with each
breath
Lung compliance - the expansibility or stretchability of lung
tissue, plays a significant role in the ease of ventilation; for
normal inspiration
Atelectasis - collapse of a portion of the lung
lung recoil – the continual tendency of the lungs to collapse
away from the chest wall; for normal expiration
Surfactant – a lipoprotein produced by specialized alveolar
cells, acts like a detergent, reducing the surface tension of
alveolar fluid
B. ALVEOLAR GAS EXCHANGE - the second phase of
the respiratory process—the diffusion of oxygen from the
alveoli and into the pulmonary blood vessels.
Diffusion – is the movement of gases or other particles from
an area of greater pressure or concentration to an area of
lower pressure or concentration
partial pressure - the pressure exerted by each individual RESPIRATORY REGULATION - includes both neural
gas in a mixture according to its concentration in the mixture and chemical controls to maintain the correct
of oxygen PO2 concentrations of oxygen, carbon dioxide, and hydrogen
ions in body fluids.
a. in the alveoli - 100 mmHg
b. in the venous blood of the pulmonary arteries –
Emphysema - oxygen concentrations, not carbon
60 mmHg.
dioxide concentrations, play a major role in regulating
PCO2 respiration

a. alveoli – 40 mHg Stimulus of response : carbon dioxide – detected by the

b. pulmonary capillaries - 45 mmHg carotid bodies
Carbon dioxide retention : decrease oxygenation
C. TRANSPORT OF OXYGEN AND CARBON DIOXIDE –
third part of the respiratory process involves the transport ASTHMA & COPD – they are given low-flow
of respiratory gases. concentration of oxygen (2-3 liters per minute)
97% combines loosely with hemoglobin Factors
hemoglobin - oxygen-carrying red pigment in the red blood 1. Age
cells (RBCs) 2. Environment
3. Lifestyle
oxyhemoglobin - the compound of oxygen and hemoglobin
4. Health status
Factors affect the rate of oxygen transport from the lungs to 5. Medication
the tissues: 6. Stress

1. Cardiac output ( damage to the heart muscle, ALTERATION IN RESPIRATORY FUNCTION

blood loss, or pooling of blood in the peripheral 1. Patency (open airway)
blood vessels ) - diminishes the amount of
2. The movement of air into or out of the lungs
oxygen delivered to the tissues
3. The diffusion of oxygen and carbon dioxide
2. No. of erythrocytes and blood hematocrit
between the alveoli and the pulmonary
a. Erythrocyte – red blood cell
capillaries
i. Men - 5 million per cubic milliliter
4. The transport of oxygen and carbon dioxide via
of blood
the blood to and from the tissue cells.
ii. Women - 4.5 million per cubic
milliliter Conditions Affecting the Airway
b. Hematocrit – percentage of the blood that
 Lower airway obstruction - Stridor,a harsh, high-
is erythrocytes
pitched sound, may be heard during inspiration
i. Men – 40% to 54%
 The client may have altered arterial blood gas levels,
ii. Women – 36% to 40%
restlessness, dyspnea, and adventitious breath
3. Exercise
sounds
Carbon dioxide
Conditions Affecting Movement of Air
a. 65% - carried inside the RBC as
Breathing patterns - refers to the rate, volume, rhythm, and
bicarbonate (HO3)
relative ease or effort of respiration
b. 30% - carbhemoglobin (also known as
carbaminohemoglobin Eupnea – normal respiration; is quiet, rhythmic, and effortless
c. 5% - in plasma and as carbonic acid (the
compound formed when carbon dioxide Tachypnea - rapid respiration; seen with fevers, metabolic
combines with water). acidosis, pain, and hypoxemia.
Bradypnea - abnormally slow respiratory rate, which may be
D. SYSTEMIC DIFFUSION – fourth process of respiration is seen in clients who have taken drugs such as morphine or
diffusion of oxygen and carbon dioxide between the sedatives, who have metabolic alkalosis, or who have
capillaries and the tissues and cells down to a increased intracranial pressure
concentration gradient similar to diffusion at the alveolar
capillary level Apnea - is the absence of any breathing
Hypoventilation - inadequate alveolar ventilation, may be
Shock – reduced blood flow states
caused by either slow or shallow breathing, or both; may lead
to increased levels of carbon dioxide (hypercarbia or nail becomes swollen and the ends of the fingers and toes
hypercapnia) or low levels of oxygen (hypoxemia). increase in size.
Hyperventilation - is the increased movement of air into and
out of the lungs; the rate and depth of respirations increase
and more CO2 is eliminated than is produced
Kussmaul’s breathing – by which the body
attempts to compensate for increased metabolic acids by
blowing off acid in the form of CO2; particular type of
hyperventilation that accompanies metabolic acidosis
Irregular rhythms:
1. Cheyne-Stokes respirations - marked rhythmic
waxing and waning of respirations from very deep to
very shallow with short periods of apnea commonly
caused by chronic diseases, increased intracranial
pressure, and drug overdose.
2. Biot’s (cluster) respirations - shallow breaths
interrupted by apnea; may be seen in clients with
central nervous system disorders.
Orthopnea – is the inability to breathe easily unless sitting
upright or standing.
Dyspnea – difficulty breathing or the feeling of being short of
breath (SOB)
Conditions Affecting Diffusion
Hypoxemia – reduced oxygen levels in the blood,may be
caused by conditions that impair diffusion at the alveolar-
capillary level such as pulmonary edema or atelectasis
(collapsed alveoli) or by low hemoglobin levels.
Hypoxia – insufficient oxygen anywhere in the body
Causes: pulmonary edema, anemia, heart failure,
embolism – thrombus is dislodged
amniotic fluid embolism (AFE) is a rare childbirth
(obstetric) emergency in which amniotic fluid enters
the blood stream of the mother to trigger a serious
reaction.
Cyanosis -bluish discoloration of the skin, nail beds, and
mucous membranes due to reduced hemoglobin-oxygen  Anxiety related to ineffective airway clearance and
saturation; may be present with hypoxemia or hypoxia feeling of suffocation
 Fatigue related to ineffective breathing pattern
1. Circumoral – lips  Fear related to chronic disabling respiratory illness
2. Peripheral – distal  Powerlessness related to inability to maintain
3. Central - trunk independence in self-care activities because of
 The blood must contain about 5 g or more of ineffective breathing pattern
unoxygenated hemoglobin per 100 mL of blood, and  Insomnia related to orthopnea and required O2 therapy
the surface blood capillaries must be dilated.  Social Isolation related to activity intolerance and
 The cerebral cortex can tolerate hypoxia for only 3 to inability to travel to usual social activities.
5 minutes before permanent damage occurs.
Clubbing - The angle between the nail and the base of the
nail increases to more than 180 degrees; as a result of long-
term lack of oxygen in the arterial blood supply; base of the
PROMOTING OXYGENATION
Interventions by the nurse to maintain the normal
respirations of clients include:
1. Positioning the client to allow for maximum chest
expansion
2. Encouraging or providing frequent changes in
position
3. Encouraging deep breathing and coughing
4. Encouraging ambulation
5. Implementing measures that promote comfort, such
as giving pain medications.
semi-Fowler’s or high Fowler’s position – allows maximum
chest expansion in clients who are confined to bed,
particularly those with dyspnea.
1. Deep breathing and coughing – facilitate respiratory
functioning
Expectorate – spit out
2. Hydration – maintains the moisture of the respiratory
mucous membranes.
Humidifiers – are devices that add water vapor to
inspired air
3. Medications
a) Bronchodilators - including sympathomimetic
drugs and xanthines, reduce bronchospasm,
opening tight or congested airways and
facilitating ventilation
b) Anti-inflammatory drugs - such as
glucocorticoids; work by decreasing the edema
and inflammation in the airways and allowing a
better air exchange.
Bronchodilators first before anti-inflammatory
c) Leukotriene modifiers - suppress the effects of
leukotrienes on the smooth muscle of the
respiratory tract; cause bronchoconstriction,
mucous production, and edema of the
respiratory tract.
d) Expectorants - help “break up” mucus, making
it more liquid and easier to expectorate
(Guaifenesin)
digitalis glycosides act directly on the heart to
improve the strength of contraction and slow the
heart rate
Beta-adrenergic stimulating agents such as
dobutamine similarly increase cardiac output, thus
improving O2 transport
Beta-adrenergic blocking agents such as
propranolol affect the sympathetic nervous system to
reduce the workload of the heart.
INCENTIVE SPIROMETRY
Incentive spirometers - also referred to as sustained
maximal inspiration devices (SMIs); measure the flow of air
inhaled through the mouthpiece; designed to mimic natural
sighing or yawning by encouraging the client to take long,
slow, deep breaths.
to:
1. Improve pulmonary ventilation.
2. Counteract the effects of anesthesia or
hypoventilation.
3. Loosen respiratory secretions.
4. Facilitate respiratory gaseous exchange.
5. Expand collapsed alveoli.
A. Flow-oriented - consists of one or more clear plastic
chambers containing freely movable colored balls or
disks. The ball or disks are elevated as the client
inhales. The longer the inspiratory flow is
maintained, the larger the volume, so the client is
encouraged to take slow deep breaths. This type of
spirometer does not measure the specific volume of
air inhaled.
B. Volume-oriented - measure the inhalation volume
maintained by the client.
PERCUSSION, VIBRATION, AND POSTURAL DRAINAGE
(PVD)
Percussion - called clapping, is forceful striking of the skin
with cupped hands; should produce a hollow, popping sound;
avoided over the breasts, sternum, spinal column, and
kidneys.
Vibration - is a series of vigorous quivering produced by
hands that are placed flat against the client’s chest wall; used
after percussion to increase the turbulence of the exhaled air
and thus loosen thick secretions; often done alternately with
percussion.
Postural drainage - is the drainage by gravity of secretions
from various lung segments.
The sequence for PVD is usually as follows:
1. Positioning
2. Percussion
3. Vibration
4. Removal of secretions by coughing or suction
Each position is usually assumed for 10 to 15 minutes.
CLRT – continuous lateral rotational therapy
MUCUS CLEARANCE DEVICES (MCD)
 is used for clients with excessive secretions such as
cystic fibrosis, COPD, and bronchiectasis
The Flutter MCD
 is a small, handheld device with a hard plastic
mouthpiece at one end and a perforated cover at the
other end.
 Inside the device is a steel ball that sits in a circular
cone shape
 Client inhales slowly and then, keeping the cheeks 2. Face Mask
firm, exhales fast through the device, causing the  cover the client’s nose and mouth may be used
steel ball to move up and down for oxygen inhalation
 This movement causes vibrations that loosen mucus i. simple face mask - delivers oxygen
from the airways and assist its movement up the concentrations from 40% to 60% at liter
airways to be expectorated flows of 5 to 8 L/min
ii. partial rebreather mask - delivers
OXYGEN THERAPY oxygen concentrations of 40% to 60%
at liter flows of 6 to 10 Lper minute
Supplemental oxygen is indicated for clients who have
iii. nonrebreather mask - delivers the
hypoxemia due to the reduced ability for diffusion of oxygen
highest oxygen concentration
through the respiratory membrane, hyperventilation, or
possible—95% to 100%—by means
substantial loss of lung tissue due to tumors or surgery other than intubation or mechanical
Oxygen is supplied in two ways in health care facilities ventilation, at liter flows of 10 to 15
L/min
1. by portable systems (cylinders or tanks) – dry, iv. Venturi mask - delivers oxygen
dehydrate the respiratory mucous membranes concentrations varying from 24% to
2. from wall outlets. 40% or 50% at liter flows of 4 to 10
Humidifying devices L/min
1. blue adapter delivers a 24%
 essential adjunct of oxygen therapy, particularly for concentration of oxygen at 4
liter flows over 4 Lper minute L/min
 provide 20%-4-% humidity 2. green adapter delivers a 35%
 prevent mucous membranes from drying and concentration of oxygen at 8
becoming irritated and loosen secretions for easier L/min
expectoration.
Limitations of masks include difficulty in achieving a proper fit
OXYGEN DELIVERY SYSTEMS and poor tolerance by some clients who may complain of
feeling hot or “smothering.”
A. Low-flow systems - deliver oxygen via small-bore
tubing. Include nasal cannulas, face masks, oxygen
tents, and transtracheal catheters
B. High-flow systems - supply all the oxygen required
during ventilation in precise amounts, regardless of
the client’s respirations. The high-flow system used
to deliver a precise and consistent FiO2
1. Cannula (nasal prongs)
 low concentration of oxygen (24% to 45%) at
flow rates of 2 to 6 L/min
 the most common and inexpensive device used
to administer oxygen.
 Does not interfere with the client’s ability to eat
or talk
 Portable, permits some freedom of movement,
and is well tolerated by the client
 2 styles: mustache and pendant
3. Face tent
 can replace oxygen masks when masks are
poorly tolerated by clients
 30% to 50% concentration of oxygen at 4 to 8
L/min
4. Transtracheal Catheter
 is placed through a surgically created tract in
the lower neck directly into the trachea
 cleans the catheter two to four times per day
 greater than 1 L/min should be humidified, and
high flow rates, as much as as 15 to 20 L/min,
can be administered
5. Noninvasive Positive Pressure Ventilation (NPPV) -
require mechanical assistance to maintain adequate
breathing
 include acute and chronic respiratory failure,
pulmonary edema, COPD, and obstructive
sleep apnea
i. CPAP - continuous positive airway
pressure
ii. BiPap - bilevel positive airway
pressure the pressure delivered during
exhalation is less than the pressure
delivered during inhalation.
Cannula
 To deliver a relatively low concentration of
oxygen when only minimal O2 support is
required
 To allow uninterrupted delivery of oxygen while
the client ingests food or fluid
Face Mask
 To provide moderate O2 support and a higher
concentration of oxygen and/or humidity than is
provided by cannula
Face Tent
 To provide high humidity
 To provide oxygen when a mask is poorly
tolerated
 To provide a high flow of O2 when attached to a
Venturi system
ARTIFICIAL AIRWAYS - are inserted to maintain a patent air
passage for clients whose airway has become or maybe come
obstructed.
4 common types:
1. Oropharyngeal
2. Nasopharyngeal
3. Endotracheal
4. Tracheostomy
Oropharyngeal and Nasopharyngeal Airways
 are used to keep the upper air passages open when
they may become obstructed by secretions or the
tongue
 these airways are easy to insert and have a low risk
of complications
 sizes vary and should be appropriate to the size and
age of the client.
 the airway should be well lubricated with water
soluble gel prior to inserting.
o Oropharyngeal airways stimulate the gag
reflex and are only used for clients with
altered levels of consciousness (e.g.,
because of general anesthesia, overdose,
or head injury).
o Nasopharyngeal airways are tolerated
better by alert clients. They are inserted
through the nares, terminating in the
oropharynx. When caring for a client with a
nasopharyngeal airway, provide frequent
oral and nares care, repositioning the
airway in the other naris every 8 hours or as
ordered to prevent necrosis of the mucosa.
Endotracheal Tubes
 most commonly inserted in clients who have had
general anesthetics or for those in emergency
situations where mechanical ventilation is required.
 An endotracheal tube is inserted by an
anesthesiologist, primary care provider, certified
nurse anesthetist (CRNA), or respiratory therapist
with specialized education
 It is inserted through the mouth or the nose and into
the trachea with the guide of a laryngoscope. The
tube terminates just superior to the bifurcation of the
trachea into the bronchi
 the client is unable to speak while it is in place.
Tracheostomy. SUCTIONING - aspirating secretions through a catheter
connected to a suction machine or wall suction outlet.
 Clients who need airway support due to a temporary
or permanent condition may have a tracheostomy 1. Oropharyngeal and nasopharyngeal suctioning
 A tracheostomy is an opening into the trachea removes secretions from the upper respiratory tract.
through the neck. 2. Nasotracheal suctioning provides closer access to
 tube is usually inserted through this opening and an the trachea and requires sterile technique
artificial airway is created
Either be:
 need to be suctioned and cleaned as often as every
1 to 2 hours. a) whistle-tipped catheter - is less irritating to
 2 techniques: respiratory tissues, although the open-tipped
o traditional open surgical method - done catheter may be more effective for removing thick
in the operating room, and a surgical mucous plugs
incision is made in the trachea just below b) open tipped
the larynx.
o percutaneous insertion - can be done at Yankauer device or oral suction tube, -is used to suction
the bedside in a critical care unit the oral cavity
 may be plastic, silicone, or metal, and cuffed,
uncuffed, or fenestrated.
COMPONENTS:
outer cannula - is inserted into the trachea and a flange
that rests against the neck and allows the tube to be
secured in place with tracheostomy tapes/twill ties or
Velcro collars
obturator - used to insert the outer cannula and is then
removed; kept at the client’s bedside in case the tube Lifespan consideration (Suctioning)
becomes dislodged and needs to be reinserted.
inner cannula - inserted and locked into place inside the
outer cannula; removed for cleaning and the outer
cannula remains in place to maintain a patent airway
Low-pressure cuffs - commonly used to distribute a low,
even pressure against the trachea, thus decreasing the risk of
tracheal tissue necrosis

Lifespan consideration (Tracheostomy or Endotracheal)

Clients with long-term tracheostomies may use a “heat

moisture exchange device known as a ‘Swedish nose’
Lifespan consideration (Tracheostomy Care)

CHEST TUBES AND DRAINAGE SYSTEMS

a) Pneumothorax - air collects in the pleural space
b) Hemothorax - is the accumulation of blood in the
pleural space
c) Pyothorax - puss
d) pleural effusion - exists when there is excessive
fluid in the pleural space
Heimlich valve
 may be used for ambulatory clients
 a one-way flutter valve that allows air to escape
from the chest cavity, but prevents air from
reentering
 not designed to collect fluid
Pneumostat
 a one-way valve
 a small built-in collection chamber
 exclusively for clients with a pneumothorax who
usually have small amounts of fluid
NOTE: STEPS, NURSING INTERVENTIONS BASA NALA
BOOK DAMO HAHA
-sherlock :<