NURSING
APPLICATION WEEK 9:
THE RESPIRATORY
SYSTEM
BNUR2002
ANATOMY OF THE
RESPIRATORY SYSTEM
• Two lungs
• Conducting airways
• Associated blood vessels
PRESENTATION TITLE 2
SIGNS AND SYMPTOMS OF RESPIRATORY DISEASE
• Dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea (PND)
• Cough
• Sputum
• Hemoptysis
• Breathing patterns
• Hypoventilation and Hyperventilation
• Cyanosis
• Clubbing
• Pain
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ASTHMA
Assessment
• Identify triggers
• Restlessness
• Wheezing/crackles
• Diminished lung sounds
• Prolonged exhalation
• Decreased airflow
Interventions
• Bronchodilators and corticosteroids
• Oxygen
• Monitor lung sounds and sputum
• Client education
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CHRONIC OBSTRUCTIVE • A group of pulmonary diseases
PULMONARY DISEASE • Characterized by increased resistance to airflow
(COPD) • Consists of emphysema and bronchitis
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CHRONIC BRONCHITIS
• Chronic productive cough of at least 3
months/year for 2 years
• Inflammatory response in large and small
airways
• Increase in bronchial mucosa
• Increased mucous production, cyanosis, nail
bed clubbing, use of accessory muscles
• Nursing Interventions
• Document sputum characteristics
• Pharmacological interventions
• Chest physiotherapy
• Nutrition
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EMPHYSEMA
• Breakdown of elastin and collagen whereby
alveoli enlarge
• Leads to formation of larger than normal air
spaces
• Lungs do not fully deflate
• Nursing Interventions
• Positioning
• Purse lipped breathing
• What else?
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DIFFERENTIATE BETWEEN EMPHYSEMA AND CHRONIC BRONCHITIS
PRESENTATION TITLE 8
PEDIATRICS: CROUP
• Assessment
• “barking cough”
• Retractions
• Inspiratory stridor
• Intervention
• Maintain patent airway
• Cool mist oxygen
• Corticosteroids to decrease
inflammation
• Epinephrine nebulizer
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QUICK QUIZ!
A 10-year-old child with asthma is treated for an acute exacerbation in the
emergency department. The nurse caring for the child should monitor for
which sign, knowing that it may indicate a worsening of the condition?
a) Warm, dry skin
b) Sudden absence of wheezing
c) Pulse of 90 BPM
d) Respirations of 19 breaths per minute
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QUICK QUIZ!
Which position should the nurse instruct the client diagnosed with emphysema
to assume during dyspneic periods?
a) Sitting up in bed
b) Side lying in bed
c) Sitting in a recliner chair
d) Sitting up and leaning on an over-bed table
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• Assessment
• Paradoxical respirations FLAIL CHEST
• Asymmetrical chest
• Decreased breath sounds
• Pain
• Interventions
• Pharmacological interventions
• Oxygen
• Mechanical ventilation
• Surgery
• Fowler’s position
• Monitor for increasing respiratory distress
• DB&C (with splinting)
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FLAIL CHEST
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• Closed vs. Open vs. Tension pneumothorax
PNEUMOTHORAX
• Assessment
• Sharp chest pain
• Absent breath sounds on the affected side
• Respiratory distress
• Subcutaneous emphysema
• TP: Midline shift
• Intervention
• Apply non-porous dressing over an open chest wound
• O2
• Chest tube placement
• HOB elevated
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TENSION PNEUMOTHORAX
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Assessment
PLEURAL EFFUSION
• Progressive dyspnea
• Decreased movement of chest wall on
affected side
• Pleuritic pain – sudden, intense,
burning, sharp, stabbing
• Dullness to percussion and decreased
breath sounds
Interventions
• Treat underlying cause
• Monitor respiratory status
• Encourage DB&C
• Thoracentesis
• Intrapleural medication
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THORACENTESIS
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PLEURAL SPACE DISORDERS
Empyema Hemothorax Chylothorax
• Pus collection within the • Hemorrhage into the pleural • Chyle
pleural space space • Milky fluid containing
• Causes: • Causes: lymph and fat
• Microorganisms • Traumatic injury, surgery, • Collects in the pleural
• Debris of infection rupture of vessel, space instead of through
malignancy the appropriate lymph
• Tx:
• Tx: ducts
• Antibiotics
• Stop the bleed • Causes: traumatic injury,
• Chest tube
• Chest tube infection
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QUICK QUIZ!
A client who was not wearing a seat belt was involved in a motor vehicle crash (MVC).
The client now exhibits crepitus and decreased breath sounds on the left, reports
shortness of breath, and has a respiratory rate of 34/min. Which assessment findings
are of the most concern to the nurse?
a) Temperature of 37.6 degrees Celsius and a productive cough
b) ABG with a PaO2 of 92 and PaCO2 of 40 mmHg
c) Trachea deviating to the right
d) Barrel-chested appearance
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QUICK QUIZ!
After a change-of-shift report, which client would the nurse assess first?
a) A client with possible lung cancer who is scheduled for bronchoscopy
b) A client with left pleural effusion who is scheduled for a thoracentesis
c) A client with hospital- acquired pneumonia and decreased breath sounds
d) A client with an acute asthma exacerbation and 85% oxygen saturation
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QUICK QUIZ!
During the evening after a thoracentesis, the client reports anxiety. Which action
should the nurse take first?
a) Administer the prescribed analgesic
b) Listen to the client’s breath sounds
c) Give the client the prescribed PRN lorazepam
d) Ask the client about specific concerns or worries
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QUIZ #2
Next week: November 20th at the beginning of class
20q: 2/3 Foundational Science, 1/3 Nursing Application
Respiratory focus
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