Respiratory/Pneumonia

• Inspiration
• Expiration

• Occurs when changes decrease intrapleural pressure
• Air enters the lungs through primary bronchi
• O2 and CO2 are exchanged in the alveoli
• Simple diffusion

• Occurs when changes increase intrapleural pressure
• Primarily passive
• CO2 expelled

• Changes in volume and capacity affected by gender, age, weight, and health status
• Changes can be measured by pulmonary function tests
• Changes in air pressure in the thoracic cavity drive inspiration/expiration
• O2, CO2, and hydrogen ion concentration
• Airway resistance, lung compliance, and elasticity
• Alveolar surface tension

• Current illness
• Observe for respiratory compromise
• Present health status, medical history, family history, risk factors
• Lifestyle questions: smoking history, exposure to environmental substances, exercise, use of recreational drugs

• Vesicular
• Bronchial
• Bronchovesicular

• Adventitious sounds
• Absence of breath sounds
• Malposition of normal quality breath sounds

• Decrease in elastic recoil of the lungs
• Loss of skeletal muscle strength in thorax and diaphragm 
• Fibrosis in the alveoli
• Fewer functional capillaries
• Less effective cough
• Decrease in PO2

• Pulmonary function tests
• Arterial blood gases
• Pulse oximetry
• CBC

• Chest x-ray
• Bronchoscopy
• Lung scans

• Throat cultures
• Sputum cultures 
• Thoracentesis specimens

• To assess alterations in acid-base balance
• pH: 7.35-7.45
• PaCO2: 35-45 mmHg
• PaO2: 75-100 mmHg
• HCO3: 24-28 mEq/L
• BE: 2 mEq/L

Direct visualization of the larynx, trachea, and bronchi through a bronchoscope to identify lesions, remove foreign bodies and secretions, obtain tissue for biopsy, and improve tracheobronchial drainage.

• When x-rays do not show some areas well
• Also done to differentiate pathologic conditions (such as tumors, abscesses  and aortic aneurysms), to identify pleural effusion and enlarged lymph nodes, and to monitor treatment
• Images are shown in cross-section

• Used to evaluate or monitor oxygen saturation of the blood
• Normal: 90-100%

• Used when patient is able to cough effectively but unable to clear secretions by expectorating
• Apply suction after a patient has coughed

• Necessary when a patient with pulmonary secretions is unable to manage secretions by coughing and does not have an artificial airway present
• Sterile procedure

• Prevents obstruction of the trachea by displacement of the tongue in to the oropharynx
• Extends from the teeth ro the oropharynx

Short term artificial airway to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions

• Long term artificial airway
• A surgical incision is made into the trachea, and a short artificial airway is inserted
• Patients with a tracheostomy are unable to speak because it is inserted below the vocal cords

• Nasal cannula
• Simple face mask
• Partial rebreather mask
• Non-rebreather mask

• 1-6 L/min
• 24-44% O2
• Use with patients with chronic lung disease who need long term therapy
• Problems include nasal/ear irritation

• Minimum flow rate is 5 L/min
• 40-60% O2
• Short term therapy/emergency

• 6-11 L/min
• 60-75% O2
• Reservoir bag with no flaps

• 10-15 L/min
• 90% O2
• Reservoir bag with flaps to prevent room air from entering

• Venturi mask
• Face tent
• Aerosol mask
• Tracheostomy collar
• T-piece

Delivers the most accurate oxygen concentration

• Fits on the chin, top extends halfway over face 
• Good for facial trauma and burns

Used when high humidity is needed after extubation or upper airway surgery for thick secretions

Used to deliver high humidity and desired oxygen to tracheostomy patients

Special adaptor to deliver desired level of oxygen to a patient with a tracheostomy, laryngectomy, or endotracheal tube

Inflammation of the lung tissue (the respiratory bronchioles and alveoli)

• Inflammation by either infectious or noninfectious sources
• Domino effect starting with an organism getting beyond the respiratory system defenses:
• Organism enters respiratory tract usually via an infected person coughing, sneezing, or talking, or contaminated aerosolized water, or it may be spread to the lungs via the blood from an infection somewhere else in the body

• Reduced gas exchange
• Capillary leakage that spreads the infection 
• Organism moving into blood stream resulting in sepsis
• Infection moving into pleural cavity and a resulting empyema (pus around the pleural cavity)
• The fibrin and edema stiffening the lung=decrease vital capacity
• Atelectasis

Alveolar collapse = decreased oxygenation --> Hypoxia

Lack of air spaces as a result of solidification

Elderly, smoking, immobility, surgical procedures, use of multiple medications, malnutrition, and chronic illnesses (COPD, CAD, ect.)

• Systemic: fever and chills
• Respiratory: pleuritic chest pain, SOB, crackles and wheezes, cough, sputum production, rapid, shallow respirations, dull percussion over affected areas, bronchial breath sounds

• Respiratory acidosis as seen with ABG
• Pulse oximetry <95%
• Elevated WBC
• Chest x-ray may show consolidation
• C & S positive for microorganism (responsible organism not identified in 50% of cases)
• Hypernatremia

• Administer oxygen and monitor its effectiveness
• Ensure patent airway
• Promote lung expansion
• Mobilize secretions
• Administer antibiotics per orders
• Do ongoing focused assessment to determine effectiveness of interventions

• Adequate gas exchange
• Maintain patent airway
• Be free of invading organism