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Respiratory A&P and Assessment PN 132

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Objectives Identify and define the parts and functions of the upper and lower respiratory system Define common terminology associated with respiratory anatomy, physiology and assessment Identify components of a complete respiratory assessment

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Terminology Airway Obstruction Something blocks the airway Prevents air from entering or leaving lungs Anoxia Absence of oxygen Apnea Absence of spontaneous respiration SAS (sleep apnea) Asphyxia Impairment of ventilation and exchange of oxygen and carbon dioxide

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Terminology Bradypnea Abnormally slow rate of respiration

Terminology Kussmaul Respirations Deep and labored breathing Respiratory Failure Dangerously low level of oxygen (O2) in the blood OR Dangerously high level of carbon dioxide (CO2) in the blood Tachypnea Abnormally rapid rate of respiration > 20 respirations per minute

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The Respiratory System We cannot live without air. Millions of cells in our bodies need a continuous supply of oxygen.

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Respiratory System Anatomy and Physiology http://www.youtube.com/watch?v=DCVIEMNPe1E Respiratory Anatomy Video

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Structures of the Respiratory System Upper Respiratory Tract Nose Pharynx Mouth Larynx Trachea Lower Respiratory Tract Bronchial tree Lungs: alveolar ducts and alveoli

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The Pleurae Multilayered membranes that are serous and moist Surround and protect each lung Parietal Pleura: outer layer of the pleura Lines the thoracic cavity and forms the sac containing each lung. Visceral Pleura: inner layer of pleura Closely surrounds the lung tissue.

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The Pleural Space The space between the folds of the pleural membranes Contains lubricating fluid Prevents friction during respiration. Airtight vacuum Contains negative pressure Keeps the lungs inflated.

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The Diaphragm Muscle that separates the thoracic cavity from the abdomen Contracts and Relaxes Phrenic nerve Stimulates diaphragm to contract during respiration.

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BREATHING exchange of oxygen and carbon dioxide between the environment and the lungs (ventilation) and Between the alveolus and the alveolar capillaries (which are IN the lungs) External Respiration

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Exchange of oxygen and carbon dioxide cellular level AKA internal respiration Internal Respiration

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CELLULAR RESPIRATION CELLULAR RESPIRATION Exchange of gases within the cells of body organs and tissues. Exchange of gases within the cells of body organs and tissues. Oxygen passes from the bloodstream into the tissue cells as carbon dioxide passes from the tissue cells back into the blood stream. Oxygen passes from the bloodstream into the tissue cells as carbon dioxide passes from the tissue cells back into the blood stream.

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Pulmonary Circulation Superior Vena Cava Inferior Vena Cava Right LungLeft Lung Pulmonary Arteries Pulmonary Veins Aorta

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Respiratory System Function To exchange carbon dioxide (CO2) and oxygen (O2) To make oxygen (O2) available to the blood stream So that it can be picked up and used by the cells of organs and tissues in the body To remove carbon dioxide (CO2) waste from the blood stream

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Respiratory Assessment The respiratory assessment is always included in a patients physical exam. Individuals require more extensive data- gathering - chronic lung conditions - allergic reactions - trauma - recent surgery, etc.

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Lung Assessment

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SUBJECTIVE What the patient tells you OBJECTIVE What you see and hear

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Subjective Assessment Ask the patient to describe any symptoms he/she is experiencing - shortness of breath - difficulty breathing - cough - orthopnea - pain with inspiration - wheezing, etc.

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Subjective Assessment Data must include details such as - onset - duration - precipitating factors - measures that relieve the symptoms - these may be medications, positioning, oxygen, alternative measures, etc.

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Subjective Assessment Cough If present, ask for details Productive/Non-productive Frequency/sound If productive, ask for Color Amount Tenacity Use quotes from the patient whenever possible! Use quotes from the patient whenever possible!

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Productive and Non-Productive Cough

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Objective Assessment Observe the patient - Facial expressions when breathing - Chest movement - Quality of respirations - rate, rhythm, depth Normal Range = 12-20 breaths per minute

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Objective Assessment Observe for Observe for - flaring nostrils - color of lips and nailbeds - anxiety on the patients face - skin color and turgor - equality of breathing on both lungs - retractions - Dyspnea - Orthopnea

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Dyspnea and Orthopnea Dyspnea = Difficulty Breathing

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Flaring Nostrils

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Lip Cyanosis

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Cyanosis of the Nail Beds

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Lung Auscultation

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Auscultation Listening for sounds ALL Auscultate ALL lung fields Both anteriorly and posteriorly Be sure to warm your stethoscope!!

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Anterior and Posterior Lung Auscultation

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B = Bronchial BV = Bronchial Vesicular V = Vesicular

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Lung Auscultation adventitious The nurse notes the presence of any adventitious sounds (abnormal breath sounds) - wheezes - crackles - pleural friction rub - absence of breath sounds

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Normal Breath Sounds Listen: http://www.youtube.com/watch?v=-S8T2JhMrYM

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Adventitious Breath Sounds Abnormal Abnormal sounds superimposed on breath sounds Includes: C rackles (rales) C rackles (rales) Sibilant Wheezes (wheezes) Sibilant Wheezes (wheezes) Sonorous Wheezes (rhonchi) Sonorous Wheezes (rhonchi) Pleural Friction Rubs Pleural Friction Rubs

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Adventitious Breath Sounds Crackles: Crackles: - common on inspiration - interrupted crackling/bubbling sounds - brief, not continuous - can be fine, medium or coarse

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Adventitious Breath Sounds Crackles - Occurs when air is forced through respiratory passages narrowed by fluid, mucous, etc. - Inflammation or infection of the small bronchi, bronchioles, and alveoli - To simulate the sound of Crackles Take a few strands of hair between your fingers Hold it up to your ear Rub back and forth

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Adventitious Breath Sounds Wheezes: Sibilant: - Musical, high-pitched, whistling sounds. - Caused by rapid movement of air through narrowed bronchioles. - May occur during inspiration or expiration - The sound may consist of one or several notes

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Adventitious Breath Sounds Wheezes Sonorous: - Low-pitched, loud, snoring sounds. - Can be heard at any point of inspiration or expiration. - May be continuous

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Adventitious Breath Sounds http://www.youtube.com/watch?v=_nPi4-ed_Y4#t=19 Listen ..

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Adventitious Breath Sounds Pleural Friction Rub Low-pitched grating or creaking sounds Heard during both inspiration and expiration Sound does not originate in the lungs outside the lung fields I nflamed pleural surfaces rubbing together during respiration Usually indicates Pleurisy

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Adventitious Breath Sounds Pleural Friction Rub This sound occurs when inflamed pleural surfaces rub together during respiration. http://www.youtube.com/watch?v=t2QE0O_exAQListen..

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Summary Defined common terminology associated with respiratory assessment and diagnostic testing Identified components of a complete respiratory assessment Identified methods for common respiratory diagnostic testing

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Assignment Read/Review: PowerPoint Handout Student Handouts AHN Chapter 9 Pp. 373-379

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Next Class Respiratory Diagnostics and Labs Understanding ABGs Look Over AHN Chapter 9 Pp. 379-384

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QUESTIONS?