Respiratory

Conditions
1
2
 Functions
• Primary
–Ventilation -
in 4 out of
gases
↳ molecules t pressure
Filtration = →
t pressure

–Alveolar Diffusion =

exchange of
gases
¥
↳ molecules =P concentration → bconontmtio

3
Centers i 1° -

Medulla
Oblongata
-

coz
zo
-

ping -

02

Muscles : 10 =

Diaphragm
20 =

Accessory
 P Wa
b
M .
Oblongata
1. Phrenic
name
-

v4
Diaphragm
b
Rib expansion
to
Fluids = 10 no ml
-

widening of pleural space air -

✗
A

H µ
760 mmmltg
fÉg.
,
Air

1-2) 760
 02 -

Elastase -

inflation
coz
-

Anti
deflation
-

elastase

02
PA ,

PA .
?⃝
Hw t V02 →
Hzwz
 THI -

back of head
- -

✗ a) thypi dishrags global

=
.

✗
b)
"
depression 610

c)
"
arrest
d) "
failure
• Secondary
–Sense of smell -

CN # 2

–Speech =
larynx
A :B
1:21
-

–A-B Balance ⇐

3
 A :B =
1:20 .

Regpi lungs)
.
=
Pa Wy =
35 -4s mmHg
( carbonic acid )
Li
Hyo HIM
→
t V2
1.153 mtaolh
Renal 1 kidneys ) =
Conserve Hwz
↳
Metabolic
122 26 mtq / L )
-

24
Diagnostic Studies/
Therapies

4
 Chest X-ray
• Radiographic visualization of the chest
• Ideal frequency:
Every 6 MOS

• Contraindication:
pregnancy
• Instructions:
• Hold his breath
• Remove metals from the chest

5
 Lung Scan / YQ Scan
• Measures blood perfusion through the
lungs.

• To confirm pulmonary embolism or other

blood-flow abnormalities.

• After an injection with a radioisotope, scans

are taken.

• Remain still during the procedure.

6
 Bronchography
↳ Rishi
allergy h aspiration
• Radiopaque medium is instilled directly to the
trachea or any part of the bronchial tree to be
visualized through x-ray.

• Before the procedure are:

o Informed consent
o Check for allergy
o NPOA

7
o Pre-op meds:
o Atropine SO4 =
Anticholinergic =
b salivation
↳ ✗
aspirations
o Valium =
minor tranquilizer =
* vasognl response
1 bradycardia )
o Topical anesthesia and anesthesia
suppress the reflex prevent resistance
gag =

o O2, antispasmodic agents at bedside

Epinephrine
7
O

8
• After the procedure are:
o Position : side -

lying

o NPO until cough, gag reflex return

↳ Petrini 2- 4°

o DBCT -

Deep Breathing 4 coughing Techniques

o Low-grade fever is common
9
 Bronchoscopy -

aspiration
perforation
-

• Direct visualization

① Diagnostic
/
• Uses:
\
② Therapeutic

10
 consent
• Before the procedure:
-
o Same with bronchography Pneop mug

o Position:
Before Supine
: t the neck $ lightly hyper extended

During :
Neutral
After : side lying
-

13
-

11
12
 Thoracentesis
• Aspiration of fluid or air from the pleural cavity

• Uses:
• Diagnostic
• Therapeutic

• Before the procedure:

o Secure consent
expose the base
o Take initial VS
✓
o Position: Ortho .pnei ,
o Instruct to remain still 15
16
17
• After the procedure:
o Position:
Unaffected
-

prevent leakage

o Bed rest

o Check for expectoration of blood

RR
o Monitor VS -
'
b BP

18
Arterial Blood Gas Studies
• Purposes: 1. Ventilation = Pa z sa 02
,
2. A
-

B Balance =
pH , Paula , ltwz
• Common site of blood extraction =
Radial artery
Alternative Ulnar
↳ Allen 's Test
:
artery
• 10 ml pre-heparinized syringe

• Container with ice

A :B
? 1:20
19
 ABG Analysis H L

pH 7.35-745 B
-

pnuoz 35-45 mmHg A

B
Hn } 22-26 Mtg / L B A
/ E- Amitosis compensation
•

Analyze the pH
__\B= Alkalosis Uncompensated
-

Patoz Mpi compensated

-

System
:
2. /
law, -

- Metabolic
-

Partially
-

tiny
 715 b. A. Uncompensated
pit
=

pawn $1 PA Papi . Acidosis

Koz
=
3223 N

patina compensated
pH
=
751 P B '

P A Metabolic Alkalosis
Pawz = 49

Hwy =
33 P B
pH: 739 NBA
Fully compensated
Pawz : 48 PA pegpi .
Acidosis
HwÉ 35
④ 7:35
-

745
7400¥
pH±= 7. SI T B MM

31 dB Mixed Alkalosis
Pnloz
'

combined
Hoog -_
31 p B
 PB
pH 751

}
=

Error
Paco ,
=
49 PA /
1$ ↳ µ
False
=

1%3 rending

ABM ☒
BABA
BABA .
Post-Test
 Number 1

The nurse understands that in the

child, as in the adult, respiratory
patterns are controlled by the:

A. Medulla oblongata
B. Cerebellum
C. Hypothalamus
D. Cerebral cortex

23
 Number 2

When a client returns from a

bronchoscopy, the nurse should
withhold food and fluid for several
hours to prevent:

A. Aspiration
B. Dysphasia
C. Projectile vomiting
D. Abdominal distention

24
 Number 3

A client is for bronchoscopy and he will be

awake during the procedure. As part of the
health teaching prior to the procedure the
nurse will instruct him that before the
insertion of the scope, he will be positioned:

A. Semi-Fowler’s with neck in a neutral

position
B. Supine with neck hyperextended
C. Semi-Fowler’s with neck flexed
D. Supine with neck in a neutral position

25
 Number 4

Care for a client post-bronchoscopy

includes:

A. Throat irrigations q4h

B. Suctioning PRN
C. NPO until gag reflex returns
D. Avoiding talking for several
days post-procedure

26
 Number 5

Immediately following a thoracentesis,

which clinical manifestations indicate that a
complication has occurred that needs the
physician’s attention?

A. Serosanguinous drainage from the

puncture site
B. Increased Temp and BP
C. Increased PR and RR with pallor
D. Hypotension and hypothermia

27
 Number 6

Which of the following information must be

included in the health teaching of a client
scheduled for bronchoscopy?

A. Client will be exposed to x-ray only for a very

short period of time.
B. Pre-medications will be given
C. Patient’s position is either supine with neck
flexed or semi-Fowler’s in a doctor’s clinic
with neck flexed.
D. A surgical incision will be made at the 2nd or
3rd tracheal rings for the insertion of the
bronchoscope.

28
 Number 7

After bronchoscopy, which nursing

action is appropriate?

A. Place client supine for 8 hours

B. Administer analgesic p.o. for pain
C. Check ability to swallow
D. Monitor RR and hemoptysis for
possible rupture of pulmonary
capillaries and alveoli

29
 Number 8

A client is scheduled for thoracentesis for pleural

effusion. The basis for pre-operative health
teaching for the client is knowledge of procedure.
Which of the following information is not accurate
regarding this procedure?

A. Removal of air and fluids is done in an

aseptic area.
B. Site of needle insertion is at the base of the
lungs.
C. Client is told not to cough during the
insertion of the needle.
D. The tip of the needle is at the alveolar area.

30
 Number 9

The purpose of anesthesia

injected to the bronchoscopy is:

A.To suppress the gag reflex

B.To prevent aspiration
C.To avoid pain during the
insertion
D.All of the above

31
 Number 10

The best during during

bronchoscopy is:

A. Supine with the neck

hyperextended
B. Semi-Fowler’s with the neck on
neutral position
C. To the unaffected side
D. To the affected side

32
PNEUMOTHORAX
• It is the accumulation of air in the
pleural space
• Primary complication:
24
Types
1. Tension

2. Secondary

3. Spontaneous
Symptoms:

o Pleuritic pain

o Increased RR

o Dyspnea

o Asymmetry of chest wall

o Decreased breath sounds

o Trachea deviating to the injury site

o Major complication:
Nursing Interventions:
• Monitor V/S, signs of shock

• Observe respirations

• Semi-Fowler’s position

• Administer oxygen if necessary

• Analgesics as ordered
• Chest tube:
o Maintain
o asepsis
o patency

o Evaluate:
o amount of fluid
o breath sounds
 Suction Patient
Apparatus
PLEURAL
EFFUSION
• Refers to an abnormal accumulation of fluid
in the pleural cavity.
Types:
• Hydrothorax (Transudate)

• Empyema (Exudates)

• Hemothorax (Blood)

• Chylothorax (Chyle)
Symptoms:
▪ Dyspnea
▪ Pleuritic pain
▪ Constant discomfort

Levels of severity:
o Minimal (300-500cc)

o Moderate (500-1000 cc)

o fills
o decreased breath sounds and hypovolemia

o Large (1000 cc or more)

o fills 1/2 or more
o atelectasis and hypovolemic shock
 Situation

Following a gang fight, 19-year old

James Walther was taken to a hospital
because of severe chest pain and
shortness of breath. His color was dusky
and respirations were rapid, shallow and
complains of chest pain upon
inspiration. X-ray reveals multiple rib
fractures and pneumothorax on the right
side.

48
 Number 1

After James is admitted for observation

and treatment, a nurse observes that his
chest expansion is less on the right side
than on the left. The incomplete expansion
on James’s right side is due to:

A. Decreased intrapleural space

B. Increased intrapleural space
C. Pain caused by the fractured ribs
causing fear of pain
D. Contusions of the lung

49
 Number 2

James’ respiratory problems worsen. A

chest tube is inserted into the pleural space
to decompress the region. The most
important purpose of this procedure is to
prevent which of the following
complications?

A. Hypoventilation
B. Pneumonia
C. Atelectasis
D. Mediastinal shift

50
 Number 3

James asks the nurse what is pneumothorax.

The best answer by the nurse is:

A. It is an inflammation of bronchioles that

impairs airflow.
B. Refers to collapse of previously expanded
lung tissue; a shrunken airless state of
the alveoli.
C. It is the accumulation of air in the pleural
space, which results in partial or complete
lung collapse.
D. All of the above

51
 Number 4

Which of the following statements best describe

spontaneous pneumothorax?

A. It is a condition where air enters but can’t

leave pleural space.
B. It is a condition where air enters the pleural
space as a result of injury to the chest wall,
respiratory structures or esophagus
C. It is a condition where air enters the pleural
space when air-filled blebs on the lung
surface rupture.
D. None of the above

52
 Number 5

A client is admitted with severe dyspnea

related to Pneumothorax. The nurse would
expect to hear:

A. Bronchial breath sounds on consolidated

areas on auscultation
B. Hyper-resonance on auscultation
C. Absence of breath sounds on auscultation
D. Tactile Fremitus

53
 Situation

Situation: Mr. Francis, 27, was admitted

because of sudden dyspnea. His
diagnosis was pleural effusion. He
immediately underwent an emergency
surgery for insertion of a chest tube.
After the surgery, Mr. Francis was
admitted to the RR.

54
 Number 6

As a result of pleural effusion, a

client may develop:

A. Atelectasis
B. Scoliosis
C. Pneumonia
D. Hiatus Hernia

55
 Number 7

Mr. Francis’ RR is 30/min and shows mild

intercostals retractions. He does not exhibit
cyanosis. The nurse’s action would be correct is
she:

A. Connect the chest tube to the water-seal

drainage
B. Flush the chest tube with 30-60 cc of sterile
NSS q6h.
C. Milk the chest tube in the direction of the
patient.
D. Place client on semi-Fowler’s position

56
 Number 8

The drug of choice for the pain in

pleural effusion is:

A. Morphine sulfate
B. Demerol
C. Codeine
D. Fentanyl

57
 Number 9

Mr. Francis was transferred out to the unit.

The next day, the unit nurse found the chest
tube dislodged from his chest. Which is
correct emergency nursing intervention?

A. Insert the dislodged tube back.

B. Get a sterile chest tube and insert it
back immediately
C.Cover the insertion site, preferably with
a petrolatum gauze
D.Suction the site where the chest tube
was dislodged

58
 Number 10

The best position during emergency

to a patient like Mr. Francis is:

A. High-Fowler’s
B. Reverse Trendelenburg
C. Semi-Fowler’s
D. Lithotomy

59
Chronic
Obstructive
Pulmonary
Disease
41
 Asthma Bronchitis Bronchiectasis Emphysema

COLD

COPD

CALS

42
Diagnosis: Impaired Gas Exchange
ASTHMA
ASTHMA
Other names:

Disorder:

Reversibility / Predisposing factors:

Involvement:
ASTHMA
Pathophysiology:
ASTHMA
Hallmark:

Other symptoms:
 BRONCHITIS
✓ inflammation of the bronchioles that impairs airflow
BRONCHITIS

Other names:

Disorder:

Reversibility / Predisposing factor:

Involvement:
BRONCHITIS
Pathophysiology:
54
`

58
BRONCHITIS
Hallmark:

Other symptoms:
EMPHYSEMA
EMPHYSEMA
Other names:

Disorder:

Reversibility / Predisposing factor:

Involvement:
EMPHYSEMA
Pathophysiology:
EMPHYSEMA
Hallmark:

Other symptoms:
Common Signs & Symptoms:
Over coughing
Laborious breathing
Dyspnea
Feeling of breathlessness
Anorexia
Tiredness (fatigue)
Increased RR
Greater breathing depth
Unusual irritability
Excessive weight loss ]
Management
 Bronchodilators
Beta2 - Adrenergic Xanthine Derivatives
Agonists

Examples

Route

Advantage
 Respiratory Therapy
1. Liquefy / Loosen

2. Dislodge
3. Expel / Expectorate
 Oxygen therapy

• Administration:

• Common methods:
▪Nasal cannula
▪Venturi mask
Nutrition (Diet)
Coping and relaxation
High-Fowler’s / Orthopneic position
 Intermittent Positive
Pressure Breathing /
Ventilation (IPPB / IPPV)
Avoidance of allergens
 Lung exercises
a. Diaphragmatic breathing
b. Pursed-lip breathing

I - E Ratio:
 Cromolyn Na
(Mast cell stabilizer)
Administer medications, as ordered
Remove pulmonary irritants
Encourage rest
Post-Test
 Situation

Situation: Nurse Sai is

assigned to Mr. Sanchez, 67
years old who was
diagnosed to have COPD.

97
 Number 1

Nurse Sai is confronted with a lot of

symptoms occurring to her patient. The
most common indication specific for
emphysema is:

A. Dyspnea
B. Barrel- shaped chest
C. Chronic productive cough present on
most days for at least 3 months of the
year
D. Wheezing sound

98
 Number 2

The most important parameter to

check for the oxygen concentration
of a patient is the evaluation of:

A. ABG values
B. Tidal volume
C. CVP
D. Serum electrolytes

99
 Number 3

Intervention for the COPD includes the

following, except:

A. To maintain a patent airway of

relieving bronchospasm and
clearing excess or retained
secretions
B. Maintain effective gas exchange
C. Prevent infection
D. Prevent status asthmaticus

100
 Number 4

The leading cause of COPD is:

A. Alcoholism
B. Cigarette smoking
C. Malnutrition
D. Infection

101
 Number 5

Extrinsic asthma is often caused by allergens.

To prevent any instances of allergic reaction
to a parentally administered drug, it safest to:

A. Perform a skin test before administering

it
B. Review the entire medical history of the
patient, especially in the area of allergy
C. Give an antihistamine immediately before
administering the drug
D. Monitor the vital signs prior to the
administration of the drug

102
 Situation

Situation: Mr. Taolin, a 65-year-old

retired steel mill worker, is admitted to
the unit with dyspnea upon exertion. He
has a long history of smoking. Initial
assessment findings include barrel
chest, ankle edema, persistent cough
with copies sputum production and
variable wheezing on expiration.

103
 Number 6

The physician prescribes oxygen at 2L/min via nasal

cannula. Which statement best describes why Mr.
Taolin’s oxygen therapy is maintained at this
relatively low level?

A. Prolonged exposure to high oxygen environmental

causes structural damage to the lung.
B. Increased oxygen concentrations of inspired air
can cause alveoli to collapse
C. Oxygen therapy can eliminate the stimulus for
breathing in a patient with chronic lung disease
D. Oxygen therapy may affect the eyes, causing
tearing, edema and visual impairment

104
 Number 7

The physician orders an aminophyline

(Aminophyline) IV drip for Mr. Taolin,
the nurse should be alert for which
sign of drug toxicity?

A. Depression
B. Lethargy
C. Tachycardia
D. Cyanosis

105
 Number 8

After the aminophyline drip is started, Mr.

Taolin’s breathing pattern improves. This
occurs because aminophyline:

A. Allows more air to enter the lungs

B. Decreases respiratory rate and
depth
C. Helps the patient cough up thick
secretions
D. Increases respiratory rate and depth

106
 Number 9

Which of the following disorders have

ventilation involvement? Select all that apply

A. Asthma
B. Emphysema
C. Bronchitis
D. Diabetes

107
 Number 10

Mr. Taolin is unable to exhale

efficiently and becomes short of
breath. The best nursing
intervention would be to teach him.

A.Pursed lip breathing

B.Postural Drainage
C.Coughing technique
D.Relaxation techniques

108