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Respiratory
System
 Respiratory System :
Upper & Lower airways
 •Gas Diffusion

The 3 process of respiration

/oxygenation - the act of
breathing
Pulmonary ventilation
/breathing

Gas Diffusion

Gas Perfusion
 •Gas Diffusion

Pulmonary Ventilation
/Breathing
The movement as inflow and
outflow of the air between the
atmosphere and the alveoli
of the lungs (300-500 cc of
air tidal volume )
 •Gas Diffusion

Gas Diffusion

Takes along the alveoli capillary

membrane to the pulmonary capillaries.

Diffusion process is the exchange of gases or

movement of gases from the area of higher
pressure to lower pressure concentration.
 •Gas Diffusion

Gas Perfusion

The availability & movement of the blood for

transport of gases, nutrients, and

Metabolic waste products. The process of gas

transport is the function of the cardiovascular system
– the heart pumps oxygen rich blood via the blood
vessels as the transportation network. As (arteries,
arterioles, veins, capillaries .to the tissues.)
Nursing Process
Assessment
 •Gas Diffusion

Nursing Assessment

Present Health History – aside from

biographic data of the client .
It also includes or focuses on the physical &
functional problem .the effect of this problem
to the patient, including the ability to carry
out ADL. (Activities of Daily Living)
 •Gas Diffusion

Nursing Assessment

IN addition the chief complaints / or reason in

seeking health care. The nurse also determine
when the health problem or symptoms started &
how long it lasted In seeking health care.
Information about precipitating factors, duration,
severity, & associated symptoms as; dyspnea,
cough, sputum production, chest pain, wheezing
and hemoptysis.
 •Gas Diffusion

PAST HEALTH HISTORY

Previous diseases acquired by the

patient prior to seeking consultation,
includes childhood illness,
immunization, hospitalization,&
medication maintenance.
 •Gas Diffusion

Family History of Illness

Parents , grandparents current health or cause

of death, nearest kin. it also reveals for
certain diseases as DM, HPN, OBESITY,
CA,OBESITY and respiratory impairment as
asthma. Lung ca. History of cystic fibrosis &
COPD ( chronic obstructive pulmonary
diseases ).
 •Gas Diffusion

Social History

Psychosocial factors include

anxiety, role changes, family
relationship, financial
problems, employment
status.
 •Gas Diffusion

Physical Assessment

Respiratory System General

Appearance- The nurse inspects
for clubbing of fingers and skin
color as cyanosis as signed of
tissue hypoxia . Lungs & Thorax
( IPPA )
 •Gas Diffusion

Inspection -Look for this

characteristics in patient
respiratory system : as “ CRAMP “
 •Gas Diffusion

CRAMP
C –chest wall asymmetry ,
R- respiratory rate
A – accessory muscle used.
M- Masses or scars present
P – paradoxical movement of
the chest ( uneven )
Note : Observe the position of the scapulae, the shape &
configuration of the chest wall.
 •Gas Diffusion

Observe use of accessory muscles to

assist in breathing not usually used,
instead diaphragm is the major muscle at
work.

= Inspect for client positioning – client

should be sitting up & relaxed. Not in tripod
position commonly seen in COPD.

= the nurse also observes the –

Rate, depth ( volume of
breathing )
 •Gas Diffusion

THE RHYTHM &

QUALITY OF
BREATHING
Breathing patterns : includes =
rate, the normal respiratory rate is
12- 20 in adult (Eupnea)
 •Gas Diffusion

TACHYPNEA = rapid marked

by quick, shallow breaths
BRADYPNEA = abnormally slow
breathing ; seen in patient with brain
injury like CVA / STROKE.
APNEA = cessation of breathing.
Ex.obstructive sleep apnea as temporarily
only related to transient upper airway
obstruction.
 •Gas Diffusion

Volume of Breathing /
Depthness

Hyperventilation
Hypoventilation
 •Gas Diffusion

Hyperventilation
An increase in the amount of
air in the lungs characterized
by Prolong & deep breaths
associated with anxiety,
stress.
 •Gas Diffusion

Hypoventilation

Reduction in the amount

of air in the lungs,
characterized by shallow
respiration. Ex – COPD
 •Gas Diffusion

Rhythm
CHEYNE –STOKES BREATHING

Respiration is from very deep to very

shallow breathing and temporary
apnea, often associated with cardiac
failure, ICP/ brain damage. Ex; COPD.
 •Gas Diffusion

Rhythm
BIOTS RESPIRATION

Refers to sequences of
uniformly deep gaps,
followed by “apnea”
 •Gas Diffusion

Chest Movements
 •Gas Diffusion

Intercostal Retraction

In drawing between the

ribs
 •Gas Diffusion

Substernal Retraction

In drawing beneath the

breastbone
 •Gas Diffusion

Suprasternal Retraction

In drawing above the

clavicles
 •Gas Diffusion

Tracheal Tug

In drawing & down ward full

of the trachea during
inspiration
 •Gas Diffusion

FLAIL CHEST
The ballooning out of the
chest walls. Thru injured rib
spaces resulting to
Paradoxical Breathing.
 •Gas Diffusion

Abnormal Breathe Sounds /

Adventitious Sounds.
(Auscultation)
 •Gas Diffusion

CRACKLES /RALES
Intermittent, nonmusical loud low
pitched, gurgling sounds heard
During early inspiration & possible
during expiration. Simulated by
Rolling a lock of hair near the ear.
 •Gas Diffusion

WHEEZING / WHEEZES

Continuous sounds musical, high

pitched, whistling sounds
predominantly heard during expiration
but also occur during inspiration.
Associated with airway narrowing /or
partial obstruction
 •Gas Diffusion

STRIDOR

Loud, high pitched crowing sound

can be heard on inspiration / usually
no need of stethoscope, Caused
by “ upper airway obstruction
 •Gas Diffusion

STERTOROUS
BREATHS
Snoring or sonorous respiration,
usually due to partial obstruction
of upper airway. seen in
“unconscious patient
 •Gas Diffusion

PLEURAL FRICTION RUB

Low pitched grating sound

produced by the rubbing
together of inflamed pleura.
 •Gas Diffusion

ASSESSMENT
ACCORDING TO
SECRETIONS /
COUGHING
 •Gas Diffusion

Hemoptysis - presence of
blood in the sputum
Productive cough & Non –
productive cough
 •Gas Diffusion

CHEST PAIN /
DISCOMFORT
 •Gas Diffusion

May be due to pulmonary or cardiac

diseases. Utilized the mnemonic point
of assessment as;” COLDSPA” chest
pain may occur with pneumonia,
pulmonary embolism, with lung
infarction. Bronchogenic ca.
 •Gas Diffusion

May be due to pulmonary or cardiac

diseases. Utilized the mnemonic point
of assessment as;” COLDSPA” chest
pain may occur with pneumonia,
pulmonary embolism, with lung
infarction. Bronchogenic ca.
 •Gas Diffusion

Non-invasive
Diagnostic
Assessment
 •Gas Diffusion

•Radiographic or chest x-ray

•Direct visualization
•PFT’s
•Broncho Spirometry
•Ventilation Therapy
•Sputum analysis or microscopy
•Pulse oximeter
•Smoke analyzer
•Fagerstrom Test
 •Gas Diffusion

Invasive Procedures

•Pulmonary Bronchoscopy
•ABG (Arterial Blood
Gases)
•Thoracentesis
•Pulmonary Angiography
•Biopsy
•Laboratory Studies
 •Gas Diffusion

End of Lesson
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