Respiratory Care Copyright © The McGraw-Hill Companies, Inc. Anatomy.

Respiratory Care

Copyright © The McGraw-Hill Companies, Inc.

Anatomy

Copyright © The McGraw-Hill Companies, Inc. Chapter 182

The Respiratory System

The primary function is to provide oxygen and remove carbon dioxide.– accomplished with the

help of the circulatory system.


Other functions include:– nonspecific defenses against invading pathogens– sounds permitting speech, singing, and nonverbal

communication– olfactory sensations to the CNS for sense of smell


Anatomy of the Respiratory System

The respiratory system consists of:– The lungs.– The respiratory

tract.


The Respiratory Tract - Nose

Nares (Nostrils)

Nasal cavities Each cavity is separated by the nasal septum.

Cilia Hairs in nose. Sinuses Warms and

moistens air

Turbinate (3) Slows air movement.


The Throat (Pharynx)

Passageway for both food and air.

Divided into 3 sections:

– Nasopharynx.– Oropharynx.– Laryngopharynx.


The Larynx (Voice Box)

Contains the vocal cords.

Supported by various structures, including 2 disks.

Joined at an angle to form the thyroid cartilage, or Adam’s apple.


The Trachea (Windpipe)

Tube that connects the larynx to the right and left bronchi.

Contains hyaline cartridge keeping the tube open.


Bronchi

passageways through which air enters the lungs.

1. Trachea 2. Carina 3. Right main bronchus 4. Right superior lobe

bronchus 5. Right middle lobe bronchus 6. Right lower lobe bronchus 7. Left main bronchus


Alveolar Organization

The adult lung contains 5,000,000 Alveoli

Gas exchange takes place here.

Covered in a fatty substance called surfactant.


The Lung Exterior

The right lung has three lobes and the left has two.

The left lobe is smaller because of the hearts position.

Surrounded by the pleura a thin membrane/sac.


Muscles for Breathing

The volume of the thoracic cavity is enlarged during inspiration and the volume decreases during expiration.

Respiratory Care


Physiology


Modes of Breathing

Quiet Breathing– Inhalation requires muscles

Contraction of diaphragm (75%), external intercostals (25%)

– Exhalation passive Lungs recoil due to elasticity

Forced Breathing– Inhalation

Accessory muscles include sternocleidomastoid and scalenes (muscles of the neck)

– Exhalation Internal intercostals, abdominal muscles


Breathing Patterns

Bradypnea – slow breathing. Tachypnea – fast breathing. Hypopnea – shallow breathing. Hyperpnea – abnormally deep breathing. Dyspnea – difficult breathing. Apnea – inability to breathe. Orthopnea – difficulty in breathing. Cheyne-Stokes respiration – irregular

breathing pattern.


Diseases and Disorders

– Bronchitis.– Asthma.– Emphysema. – Chronic

obstructive pulmonary disease (COPD).

– Hemoptysis. – Lung cancer.

–Upper respiratory infection (URI).–Epistaxis, or nosebleed.–Pneumonia.–Tuberculosis.–Anthracosis, or black lung.–Pleurisy.–Influenza.


Respiratory Diagnostic Procedures

Help assess the level of lung function.Determine whether specific types of

illness or conditions are present.


Pulmonary Function Test - Spirometer

Measures of air flow and volume to assess lung health or progression of disease process

Measured by FEV1 (Forced Expiratory Volume in One Second)

Noninvasive, painless Should have first test at 25yo. Smokers, chemical exposures,

and those with lung disease

every 3 – 5 years (NHLBI) With COPD

– FEV1 less than 70% considered mild and less than 35% severe.


Other Pulmonary Function Test

Lung Volume – measures the amount of air in the lungs without forcibly blowing out – Used with lung diseases such as emphysema, chronic bronchitis

(cause lungs to contain too much air), fibrosis of the lungs and asbestosis (make the lungs scarred and smaller so that they contain too little air.

– Normal values are based upon your age, height, ethnicity, and sex

Diffusion capacity (also called the DLCO) – allows the doctor to estimate how well the lungs move oxygen from

the air into the bloodstream.– Normal value ranges may vary slightly among different laboratories


Arterial blood gas determination

Arterial blood gas tests measure the levels of oxygen and carbon dioxide in the arterial blood and determine the acidity (pH) of the blood.

Blood is taken from an artery (Invasive)

Normal Arterial Blood Gas Values– pH 7.35-7.45– PaCO2 35-45 mmHg Pa (peripheral

arterial)– PaO2 80-95 mmHg– HCO3 22-26 mEq/LO2 HCO3 –

Bicarbonate– Saturation 95-99%– BE +/- 1 BE – Base Excess


Arterial blood gas (cont.)

Acidosis Poisons

– wood alcohol (methanol)– Antifreeze– large doses of aspirin

Kidney Disease Decreased respirations

– Lung disease– Muscle impairment– Nerve impairment– Medication Sedation

Alkalosis Medications

– Corticoidsteriods– Diuretics

Vomiting Diarrhea Cushing Syndrome Hyperventilation


Oximeters

Oxygenation of the blood can be monitored using a sensor placed on a finger or an earlobe

Noninvasive


Exercise tolerance

evaluates the ability of the heart and lungs to provide oxygen and remove carbon dioxide from the bloodstream before, during, and after exercise.

typically a workout on a stationary bicycle or a treadmill A pulse oximeter is placed on the earlobe or fingertip to

monitor blood oxygen levels. If arterial blood gas samples are to be taken during the

exercise, a catheter will be placed in an artery in your arm.


Radiography

Used to diagnosis cancerous masses or infiltrates.

Includes:x-rayMRICTPET ScanUltrasound


Bronchoscopy

direct visual examination of the voice box (larynx) and airways through a flexible viewing tube (a bronchoscope).

bronchoscope has a light at the end Uses:

– investigate the source of bleeding in the lungs

– specimens can be taken from any areas that look cancerous (biopsy)

– Assessment of burns and smoke injury – place drugs in specific areas of the lung – as a guide over which a tube can be

inserted to assist breathing


Lab Test - Culture, sensitivity

Culture – is when the organism causing an infection is identified by the lab, for identification purposes.

Sensitivity – List what medications will kill the organism.

Respiratory Care


Therapy


Respiratory Care Procedures

Used for the care or prevention of disease process


Oxygen Therapy

Used to increase O2 levels of patients.Reasons for Oxygen Therapy

– Low levels of oxygen in the blood (hypoxemia).

– Work demands of breathing.– Work of the heart.

Oxygen is considered a drug and must be ordered by a physician.


Oxygen Delivery Devices

Nasal Cannula

Simple Mask

NRB

Non-rebreather

Mask


Mechanical Ventilation

Reasons to use:– To keep moving enough

oxygen into the bloodstream and removing enough carbon dioxide from the lungs when other respiratory procedures fail.

– When the client has gone into respiratory arrest (stopped breathing).


Monitoring Oxygen Therapy

Improvements expected with oxygen therapy:

Client’s thinking ability should improve.Shortness of breath (SOB) should decrease.Vital signs should become closer to normal.PaO2 should rise to an acceptable level.Pulse oximetry values should improve.


Hazards of Oxygen Therapy

Oxygen toxicity – too much oxygen for too long a time.

Retinopathy of prematurity (ROP) – high oxygen levels in infants.

Atelectasis – lung collapse.


Oxygen Safety

Flammable! O2 is extremely flammable.– Signs must be posted

where canisters are kept.

– Floor staff must be aware of cut off valve.

– Must educate patients about smoking.


Medicated Aerosol Therapy

Causes airways to open up, or bronchodilate.

Has minimal side effects, since the medication travels directly into the lungs.


Types of Drugs Given by Aerosol

Nasal decongestants – Contain vasoconstrictors, drugs that decrease the blood flow to nose vessels causing nasal passages to open.

Bronchodilators – Drugs that increase the diameter of lung airways.

Antiasthmatics – Used to prevent or decrease the number of asthma attacks.

Corticosteroids – Drugs that may be inhaled and are used for anti-inflammatory maintenance.

Mucolytics – Drugs used to break down secretions within the lungs.

Antimicrobials – Used to treat a number of bacterial and fungal pulmonary infections.


Aerosol Drug Delivery System

The Metered Dose Inhaler (MDI)– The most commonly used aerosol drug

delivery system.– A small portable pressurized device that

delivers medication to the lungs.Add-on devices include: spacer, holding

chamber, and extension device.


Hyperinflation Therapy

Also known as lung expansion therapy.

Partial or full lung collapse is known as atelectasis.

Used when the client is unable to take an occasional deep breath. Incentive Spirometer

Most Common


Apply Your Knowledge

What is another name for hyperinflation therapy?

Answer:

Lung expansion therapy.

Respiratory Care


Careers


The Certified Respiratory Therapist and the Registered Respiratory Therapist

Both require a 2- or 4-year educational program approved by the Committee on Accreditation for Respiratory Care (CoARC).

Both must pass board examinations given by the National Board for Respiratory Care (NBRC).

Both work to help clients breathe more easily.


The Pulmonary Function Technologist

Respiratory therapists often qualify for positions as pulmonary function technologists.

They assess the need for therapeutic respiratory procedures.

To monitor the outcome of the therapy to determine whether the treatment objectives were met.


Pulmonologist

Education in Internal Medicine Graduation from an approved medical school Completion of an ACGME (American Council for Graduate Medical Education)

accredited internal medicine residency program, which takes a minimum of 3 years

A minimum of 2 years of meaningful patient contact and responsibility Of the 2 years, 20 months must be spent in in-patient services, ambulatory

settings, and in the services of dermatology or neurology 4 months may be taken outside the above areas, subject to program director

approval The level of responsibility for patients must increase with each year of training Education in Pulmonary Medicine A minimum of 2 years of full-time graduate training in pulmonary disease,

including instruction in the basic sciences with emphasis on molecular biology, pulmonary physiology, and pulmonary immunology

12 months of the 2 years must be spent in clinical training in diagnosis and management

Respiratory Care Copyright © The McGraw-Hill Companies, Inc. Anatomy.

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