ADULT 1 Study Guide for Exam 2 1

RESPIRATORY SYSTEM
Upper Respiratory System
Passageway for air moving into the lungs and for carbon dioxide moving out.
Air is cleaned, filtered, humidified, and warmed.
o Nose
o Mouth
o Pharynx
o Larynx
o Trachea

Lower Respiratory System

o Lungs
o Bronchi
o Bronchioles

Decongestants:
o promote vasoconstriction
o Decrease inflammation/edema of nasal mucosa = relieve nasal congestion
o Rapid Effect, short duration can be habit forming!

Antihistamines:
o Relieve systemic effects of histamine
o Dry respiratory secretions through an anticholinergic effect (block involuntary muscle
movements)

Pulmonary Function Tests (PFTs)

Measure respiratory volumes and capacities
DO NOT use bronchodilators for 24 hrs. prior FALSE READINGS
o Total Lung Capacity (TLC)
Total Volume of the lungs at their maximum inflation
o Tidal Volume (TV)
Volume inhaled/exhaled with normal quiet breathing
o Vital Capacity (VC)
Total amount of air that can be exhaled after maximum inspiration
IRV = maximum inspiration normal
ERV = max out after normal exhalation

PHYSICAL ASSESSMENT
o Nasal: change in size, shape, color, nasal cavity, smell
o Sinus: palpate - should not be tender or inflamed
o Thoracic: RR (respiratory rate) 12-22 is normal
Tachypnea: rapid RR seen in pneumonia, asthma, pleural effusion,
pneumothorax, CHF, anxiety, response to pain
ADULT 1 Study Guide for Exam 2 2
Atelectasis = collapse of lung tissue following obstruction of the bronchus or
bronchioles
o Bradypnea: low RR seen in damage to brain stem, circulatory disorders, lung
disorders, SE of meds
o Apnea: cessation of breathing (sec. to min.) Seen in strokes, head trauma, meds,
airway obstruction
o Percussion:
Resonance = normal lung tissue
Dullness = atelectasis, pneumonia, pleural effusion
Hyper-resonance = chronic asthma, emphysema, pneumothorax

BREATH SOUNDS
o Vesicular: soft, low pitched, inspiration > expiration
o Bronchovesicular: medium pitch/medium intensity, inspiration = expiration
o Bronchial: loud, high-pitched, expiration > inspiration

Surfactant: a lipoprotein produced by the alveolar cells, interferes with the

adhesiveness of the water molecules, reducing surface tension and helping expand
lungs

PNEUMONIA
o Inflammation of the lung parenchyma (the bronchioles and alveoli)
o Community Acquired (CAP): strep, mycoplasma, influenza pneumonia
o Healthcare Associated (HAP): staph, pseudomonas, E. coli
TX:
o antibiotics to eradicate infection
o bronchodilators to reduce bronchospasm/improved ventilation
o Immunization: single-dose lifetime immunity
o O2 therapy
o Chest Physiotherapy: percussion, vibration, postural drainage
o complementary therapies: echinacea, goldenseal (ephedra = bad)
Nursing DX: ineffective airway clearance/breathing pattern, activity intolerance

TB
No. 95 Mask; Negative Pressure Room
o Chronic, recurrent infectious disease, affects lungs and organs
o Slow growing, resistance to destruction
o Transmitted by droplet nuclei (airborne droplets) coughs, sneezes, speaking,
singing can remain in the air for several hours
o increased risk if immune suppressed; age; disease (HIVs/AIDs)
DX:
o PPD (purified protein derivative) = test to screen for TB
Amount of induration determines infection
< 5mm = Negative
ADULT 1 Study Guide for Exam 2 3
> 15mm = Positive
o Sputum Test: 3 consecutive EARLY morning specimens
Use PPEs, room with airflow control, UV light
o Do these before treatment with drug therapy
Chest X-ray
Liver Functions
Vision exam
Audiometric exam
TX:
o prophylactic treatment is used to prevent TB (PPD from negative to positive)
or in case household contact with positive person
single drug therapy effective
Active treatment always involves two or more drugs (chemotherapeutic)
INH/BCG vaccine (6+ months of treatment)
Newly DX TB = 4 anti-tubercular drugs
INH (isoniozid)
Rifampin
Pyrozinamide
Ethambutol (daily for the first two months)
HIV patients = TX 9+ months

LUNG CANCER
o Risk Factors: increase with age, genetic predisposition (smoking), exposure to
ionizing radiation, inhaled irritants; asbestosis, exposure to radon, radioactive gas
O HEALTH ASSESSMENT
Hx (Lifestyle)
Smoking (and second hand smoke)
Medications
Work Environment
Recreational Drugs
Exercise
FAMILY Hx
Chronic Illness
Sinus Infections
Deviated Septum
Sleep Apnea
CPAP/BIPAP
Bronchitis
TB
S/SX:
Cough
SOB (Short Of Breath)
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Activity Intolerance
Complications with:
Anesthesia
CHF (congestive heart failure)
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TX:
chemotherapy, radiation bronchodilators, analgesics
complementary and alternative medicines (CAM)
herbal meds, teas, homeopathy, animal extracts, spiritual
POST OP
o Maintain patent chest tubes and a closed drainage system
Monitor chest tube output every one hour initially, then every 2 to 4 or eight
hours as indicated
Notify doctor if output exceeds 70 mL/hour and/or is bright red, warm, or
free flowing!
o Assess for signs of infection chest tube/incision
o Assist with turning and ambulate ASAP
o Assess/maintain nutritional status = frequent, small meals

ASTHMA
o Chronic inflammation disorder of airways; recurrent episodes of wheezing,
breathlessness, chest tightness, coughing
o Pathophysiology: Airways in a persistent state of inflammation
o Common triggers:
Allergens (pollen, animal dander, dust, etc.)
Respiratory tract infections
Exercise
Inhaled irritants (smoke, gases)
Emotional upsets
TX:
Long-term control
anti-inflammatory agents
corticosteroids plus nonsteroidal (mast cell stabilizers)
Cromolyn
Nedocromil
Quick Relief = anticholinergics (60-90 minutes for maximum effect), rapid acting
(fast acting, only for 4 to 6 hours)
bronchodilators, methylxanthines (adrenergic stimulants)
Albuterol
MDI - Metered Dose Inhaler
DPI - Dry Powder Inhaler
Nebulizer

UPPER RESPIRATORY INFECTIONS

o Rhinitis: inflammation of nasal cavities
allergies, common cold
Coryza = nasal inflammation; profuse nasal discharge
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o Sinusitis: inflammation of the mucous membranes of sinuses

o Influenza: transmitted by airborne droplets and direct contact

Type A (most severe): birds, pigs, whales, humans (pandemics)
Type B (less severe): humans (outbreaks NOT pandemics)
Type C (mild): humans, pigs, dogs (respiratory infections)
S/Sx: Manifestations:
Coryza
Cough, initially dry
Substernal burning
Sore throat becoming productive
Fever
Chills
Muscle aches
Fatigue
IM annual vaccination to Deltoid
ALLERGIC TO EGGS = NO SHOT

o Epiglottitis: swelling/inflammation of epiglottis; MEDICAL EMERGENCY

Blocks airway = intubation
More common in children
TX: Antibiotics & Steroids

o Laryngeal Obstruction: aspirated food or foreign objects, edema due to

inflammation, injury, anaphylaxis, a tumor
Laryngospasms: occur due to repeated or traumatic intubation attempts,
chemical irritation of hypocalcemia
S/Sx: Coughing, choking, gagging, inspiratory stridor, wheezing, cyanosis

o Laryngectomy: removal of the larynx (d/t cancer/tumors)

Partial: temporary tracheotomy = aspiration precautions
Total: trachea & esophagus permanently separated = no aspiration precautions
needed
Post Op:
Monitor airway patency
Respiratory status:
RR pattern
Lung sounds
O2 sat
Encourage deep breathing and coughing
Elevate head of bead (HOB)
Maintain humidification of inspired gasses to keep secretions moist, and fluid
intake
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Suction via tracheostomy using STERILE technique
Cleaning tracheostomy to maintain airway patency (remove secretions)
Protect stoma from particulate matter in the air (gauze)

o Epistaxis: Nose bleed (trauma, Sx, infection, drugs)

Anterior: simple first-aid; pressure, ice pack, sitting, head forward (spit out blood
= prevent N&V)
Posterior: more difficult; nasal tampon, packing, rhinoplasty (plastic splint)
Risk for respiratory/cardiovascular complications MONITOR!

LOWER RESPIRATORY
o Local Effects: cough, excess mucus production, SOB/dyspnea (laborious breathing)

o Bronchitis: inflammation of the bronchi (acute/chronic)

Acute - by impaired immune system and/or smoking
Chronic - component of COPD (infectious process)
Bronchoscopy: done to visualize and obtain tissue for biopsy from the tumor
If tumor cannot be seen the airways may be flushed with saline solution to obtain
cells for cytologic examination (bronchial washing)
Post Op:
Monitor/maintain ventilation/gas exchange
Assess for pain control
Respiratory status; color, 02, RR/depth, chest expansion, lung sounds,
decreased percussion tone, ABGs
Assist with coughing techniques
Maintain patent chest tubes and a closed-drainage system
Monitor chest tube output every one hour initially, then
every 2 to 4 for eight hours as indicated
Notify Dr. if output exceeds 70 mL/hour and/or
bright red, warm, or free flowing
Assess for signs of infection chest tube/incision
Assist with turning and ambulate ASAP
Assess/maintain nutritional status = frequent, small meals