NCM 112 – Lecture Epiglottis- a small, movable "lid" just above the larynx that

Anthony Estolas prevents food and drink from entering the windpipe.
8 hrs/ week  Angle of the right bronchi is more vertical- so
possible ingested
 Remove segment-segmental resection
Orientation  Remove lungs- pneumonectomy
Criteria for Assessment TOTAL – 100%  Life support- ecmo
 Attendance- 5%  Wedge resection- segment
 Group Activity / Presentation- 10%  Lobectomy- lobe removal
o Presentations should be Face to Face
 Pneumonectomy- total removal of lungs
 Class Performance and Attitude- 10%  Tracheal deviation happens when your trachea is
o Assignments/ research etc pushed to one side of your neck by abnormal pressure
 Minor Examination (Quizzes)- 25% in your chest cavity or neck. (especially when there is
 Major Examination (Midterms and Finals) – 50% a problem in one side of the lungs)
o Midterm – 9th week  When using AMBU bag- connect it oxygen supply
o Artificial Mechanical Breathing Unit-
What is the lung with 3 lobes? AMBU
 Right lung- because left lung should save space for
the heart Boyle’s Law
- in a closed space, pressure and volume are inversely
D5w- hypertonic related
- When it is metabolized, it becomes hypotonic - pressure up= volume down
- Anything containing dextrose- hyper - pressure down= volume up
- Only saline- isotonic
Inspiration and Expiration
Fluids and Electrolytes - pressure- kilopascal, cm of H2O
- Most abundant positively charged ion- potassium - transfer of gases- same gases
- Most abundant negatively charged ion- phosphorus o higher to lower concentration
- Outside- sodium and chloride o higher to lower pressure
o oxygen to oxygen
Reading List:
 Brunner and Suddarth’s Textbook of Medical 3 ELEMENTS OF RESPIRATORY PROCESS
Surgical Nursing, Janice L. Hinke, Kerry H. Cheever 1. External Respiration or Ventilation
14th edition a. body, oxygen is taken into the lungs by
inhalation and carbon dioxide is expelled
Lesson 1 from the lungs by exhalation
Oxygenation Problems b. encompasses the mechanical processes
related to breathing: contraction and
relaxation of the diaphragm and accessory
1.1 Anatomic and Physiologic Review, Assessment, muscles, as well as breathing rate- hypernea/
Diagnostic Evaluation tachypnea/ tachycardia.
1.2 Management of Upper and Lower RTD 2. Internal Respiration
1.3 Management of COPD 3. Cellular respiration, either aerobic or anaerobic
1.4 Respiratory Care Modalities a. Glycolysis
Anatomy and Physiology b. tricarboxylic acid cycle/ Krebs Cycle
c. oxidative phosphorylation

 Outside thorax- supraglottic (epiglottis), glottic Hypoglycemic- cold, clammy

(airway opening to trachea), and infraglottic (trachea)
 Infrathoracic airway- includes the trachea, two
bronchi, bronchi and bronchioles that conduct air to
the alveoli - reduced chest wall compliance -results from increase
calcification of costal cartilage, decreased strengths
Capillaries- smallest blood vessel where there is the of intercostals, accessory muscled, and diaphragm
connection of the venules and arterioles that serves as - reduced breathing capacity
exchange of gases - increased residual volume
  Crackles/ rales- high,
soft,crackling, popping
1. History (rolling strand of hair
2. Chief Complaint between fingers
o I have chest pain and difficulty of breathing  Crackles- bubbling,
o Dyspnea gurgling (sound like
o Cough opening Velcro fastener)
o Sputum production (paying)
o Hemoptysis  Pleural Friction
o Wheezing  Wheezing
o Stridor-6-noisy
Ps ofrespiration
Dyspnea  Asthma- total occlusion
o Chest Pain- pleuritic of the pathways
 Cardiac- substernal  Status asmathicus
 Egophony- fibrotic
 Whispered pectoriloquy
– increased loudness of
 Possible foreign body whispering noted during
 Pulmonary bronchial constriction auscultation (saying 99)
 Pulmonary Embolus  Bronchophony- abnormal
 Pneumothorax- pneumo= air in the pleural space transmission of sounds ,
o Empyema thorasis/ pyothorax- pus change in the character of
o Hemothorax- blood spoken voice (high-pitch
and less-muffled)
o Hydrothorax/ Pleural Effusion Altered Breathing Patterns (at-uh-LEK-
 Atelectasis
 Pump Failure
tuh-sis) is a complete or
 Pneumonia
partial collapse of the
entire lung or area (lobe)
3. Past Medical History
of the lung
 Childhood/ Infectious Diseases
 Respiratory Immunization
 Major Illnesses/ hospitalizations
 Medications  Cheyne-Strokes Breathing- progessive deeper,
 Allergies- Allergologist faster, followed by gradual decrease that results in a
temporary stop in breathing called apnea
4. Family History  Kussmaul’s Breathing- deep and labored (severe
5. Psychosocial History / Lifestyle metabolic acidosis, diabetic ketoacidosis, kidney
o Occupational/ Environment al Exposure failure)- fprm of hyperventilation
o Geographic Location o Diabetic T1- insulin dependent
o Personal Habits  Hypoventilation- occurs in inadequate ventilation to
6. Physical Examination perform needed gas exchange
o Inspection o Causes more CO2 (hypercapnia) and
 S/S of respiratory distress respiratory diseases
 Speech pattern o Lethargy (sleepiness)
Physiologic Changes
 Chest wall During Aging
configuration  Biot’s Breathing- ataxic characterized by variable
 Chest movement- put both palms to Diagnostic Test
tidal volume, random apneas, no regularity
the back(scapula)  Apneustic Breathing- breathing of a dying person by
 Fingers and Toes- check for deep, gasping inspiration with a pause at full
clubbing inspiration followed by a brief, insufficient release
o Palpation
 Normal – normopnea
o Percussion
 Tactile Fremitus

o Physiologic
Auscultation
Changes During Aging
 Bronchial
 Bronchovesicular Skin Testing
 Vesicular  If it exceeds 20 millimeters
 Adventitious BreathSounds
 30 minutes after
Chest x-ray
 One shot- anterior-posterior Transbronchial Biopsy- obtaining tissue sample with the
 Two shots- with lateral assistance of bronchoscopic procedure
Flouroscopy Thorascopic Biopsy- endoscope is inserted through the chest
Bronchogram- study with the use of scan wall into the chest cavity (VATS BIOPSY)

After: Arterial Blood Gases

a. Side lying - Assess ventilation and acid-base balance
b. NPO - Use 10 ml pre-heparinized syringe to draw blood
specimen
Bronchoscopy- direct inspection and observation of the - Place the specimen in a container with ice to prevent
larynx, trachea, and bronchi through a bronchoscope hemolysis
a. Collect secretions - Specimen: arterial blood – gas
b. Determine location of pathologic process and collect
specimens for biopsy Ph- potential of Hydrogen
c. Remove aspirated foreign objects - Acid base
d. Excise small lesions -  7.35 to 7.45, with the average at 7.40.

- Usual complains after; sorethroat PaO2- partial pressure of arterial oxygen – 75-100 mmHg
PaCO2- 35-45 mmHg
Lung Scan- most often used to diagnose and locate emboli H3CO2- 26-28
Continuation
(clots or other small tissue masses) within the blood vessels
1. Ventilation Scan When the kidney is associated the there will be metabolic
2. Perfusion Scan acidosis/ ketoacidosis.
3. VQ scan- definitive study for pulmonary embolism

RISK
1. Slight discomfort Pulse Oximetry- determine oxygen saturation in the blood
2. Allergic reaction - Below 93% should be supplemented with oxygen
3. Injury to fetus - Infrared sensors- detect how much oxygen is in your
4. Contaminate breast milk with radionuclei blood based by the way infrared and red light passes
thru finger
Sputum Examination- assess gross appearance of the sputum - Monitoring- to determine if oxygen
that may characterize specific disease conditions supplementation is effective
1. Rusty - Flat sign= not picking up= check for troubleshoot and
2. Greenish- protozoal temp of skin
3. Blood-tinged- TB - Hynotopic- norepinephrine- vasoconstrictor- impede
a. Afb training- detect PTB (3x/day) peripheries to increase blood pressure
b. Sputum C&S – done to detect that actual
microorganism causing lung infections Thoracentesis- removal of fluid in the thorax= intrapleural
space
Proper collection - Centesis- removal of fluid (mid-axillary line)
1. Collect early morning - Invasive procedure
2. Rinse mouth with plain water - Short acting
3. Use sterile container - Test tube thoracentesis
4. C&s before antibiotics - Sitting/ semi-fowlers position
5. AFB staining, collect sputum for specimen for three - Aspiration of fluid or air in the pleural space
consecutive mornings
NURSING INTERVENTIONS
Sputum Trap- connected to the suction catheter to collect the a. Secure informed, written consent
sputum using oropharyngeal or endotracheal suctioning b. Take Vs
c. Position Px in upright position (preferable because
Lung Biopsy- procedure in which sample of lung tissue is fluid remain at the bottom)
removed to determine if lung disease or cancer is present d. Instruct client to remain
- Needle biopsy- guided through the chest wall e. Prepare topical anesthetic (before IM lidocaine)- can
- Also known as closed transthoracic or percutaneous be spray or gel
(through the skin) biopsy
AFTER
a. Can be for CS, Analysis, AFB
Oxygen Therapy Tracheobronchial Suctioning- remove secretions in the
AFTER tracheobronchial structure
a. Turn the client on the unaffected side - Sterile technique
b. Bed rest Adult- 12- white, 14- green, 16- orange
c. Check expectoration of blood Pedia- 10
d. Monitor VS
Internal Hemorrhage – Hypotension-hypovolemia tachycardia How?
tachypnea 1. Assessment- auscultate for secretions and O2
saturation
2. Hyperventilate the patient with O2 before and after-
to prevent hypoxia
Oxygen therapy- deliver of oxygen to aid in respiration 3. Order- suction every 2 hrs PRN
process 4. Insert with gloved hand- one hand
- Should have the oxygen source 5. When withdrawing catheter, apply suction in rotating
motion while applying intermittent suction- because
How? it may suction mucosa (circular and open-close)
1. Assess signs and symptoms of hypoxemia/ CLOSE- suction
respiratory distress OPEN- close
a. Hypoxemia- low o2 saturation in the blood 6. Suctioning must only be 5-10 seconds (maximum of
b. Hypoxia- low 02 saturation 15 seconds)
2. Check doctor’s orders- you can remind the doctor 7. Evaluate breath sounds after giving supplemental
3. Position patient in Semi-fowlers oxygen .Assess ( auscultation) to measure the
4. Open source of oxygen before putting the oxygen effectiveness
device
5. Regulate oxygen flow accurately- can you increase Thick secretion- tracheobronchial wash as 3-5 ml with saline
the 02 liters (3 liters titrate= up to 6 liters)
6. Place a NO smoking sign at the bedside (pwede TIP
sumabog ang oxygen tank) Hold your breath while inserting the tube then if your
7. Check electrical appliances, avoid use of oil, grease, suctioning (if you feel difficult), withdraw suction
alcohol and other near the patient
8. Humidify oxygen- connect to humidifier (water)
because o2 is a dry gas can irritate mucosa
9. Provide good oronasal hygiene Incentive spirometry- use of incentive spirometer, a medical
10. Assess effectiveness of oxygen therapy device that aid the lung tissues in recovering after trauma in
11. Make relevant documentation the lungs (one that decrease the function of the lungs)
- RT/ radial therapist
- The more the better to help the lungs reoperate
- Deep breathing- inhale and exhale ( in exhale to
prevent Co2 retention)

- Used to remove air or fluids from pleural space

inserted in upper
- TYPES:
1. One- Bottle System- water seal and drainage
bottle
Tracheobronchial Suctioning 2. Two-bottle-system- 1st bottle- drainage,
a. 2nd bottle- water seal and suction
b. Continuous bubbling in the suction
Non-breather- fear of suffocation bottle
FiO2- The fraction of inspired oxygen (FiO2) is the 3. Three-bottle System- functions are separated
concentration of oxygen in the gas mixture. a. Drainage bottle (1st)
b. Water seal
Endotracheal ventilation- can be connected to mechanical c. Suction
ventilation to provide 100% O2
 Epistaxis- nose bleeding
- Usually caused by nose picking
- RISK
o Dry climates
o Winter
o Children- rare in children younger than 2 yrs
old
o Low platelet/ thrombocytopenia
o Infant- marker of child abuse
o Allergies
Principle o Cold
1. Fluid or air is drained thru gravity (thoracostomy
o Injury
bottle below the chest)
o Nose picking

Nursing Responsibilities
1. Immerse tip of the tube in 2-3cm sterile NSS
2. Keep the bottle at least 2-3 feet below chest level
3. Never raise the bottle above chest level
4. Observe for intermittent bubbling of fluid- hindi
effective or there is leak
5. Accidental break- clamp the catheter proximal to
patient to avoid pneumothorax
6. Bedside instrument- clamp
7. Documentation – indicate what you drain and how ANTERIOR VS POSTERIOR
many
8. Assessment

Modern- Acrylic- Atrium Oasis/ Pleur-Evac

Closed- chest Drainage
- Principle is the same as three-way bottle
- 3 in 1
- Not prone to be broken

Internal bleeding- 1500 in 2hrs draining

- More than 300 ml is 1 pack
- Hypovolemic decreased urine output to reabsorbed
water and sodium ANTERIOR
- No lung expansion – suction is needed 1. Steep forward to prevent aspiration
2. 5-10 minutes- pinch the nose
CTT 3. Cold ice pack application
1. PerformRespiratory Disorder activities- coughing or
drainage promotion
deep respiration Posterior
2. Range of Motion 1. Nasal Packing
3. Mark the amount of drainage at regular intervals 2. Cauterized- silver nitrate
4. Avoid milking and clamping tube
5. Removal of ct is done by physician
a. XRAY SINUSITIS
b. ABG - If there is polyps or mucus in the air-filled spaces or
6. Place client in semi-fowlers position infection
7. Instruct client to exhale deeply and do Valsalva - Viral (no treatment) and bacterial (antibiotics)
maneuver- forceful expiration on a closed airway The sinuses are air-filled spaces (cavities) near the
8. Chest XRAY must be done after the tube is removed nose. They are lined with mucous membranes.
9. Observe for: subcutaneous emphysema- air goes There are 4 different sinuses:
inside sc, and signs of respiratory distress 1. Ethmoid sinus
• Located around the bridge of the nose.
• This sinus is present at birth, and continues to grow.
2. Maxillary sinus.
• Located around the cheeks.
• This sinus is also present at birth, and continues to 2. Inflammation/ Edema of Nasal Mucosa
grow. 3. Others: Fever or tachycardia- in every degree in temp
3. Frontal sinus = + 10 per minute
• Located in the area of the forehead.
• This sinus does not develop until around age 7. Treatment
4. Sphenoid sinus.
• Located deep behind the nose. Acute Sinusitis- may get better on its own.
• This sinus does not develop until the teen years. Antibiotics- bacterial infection, if after 3 to 5 days- choose
diff antibiotics Allergy medicines- caused by allergies,
antihistamines and other allergy medicines can reduce
swelling.
•Don’t use over-the-counter decongestant nasal sprays without
There are 3 types of sinusitis: checking with your child’s healthcare provider. These sprays
1. Short-term (acute) may
a. Symptoms of this type of infection last less make symptoms worse.
than 12 weeks and get better with the correct • Recurrent sinusitis is also treated with antibiotic and allergy
treatment. medicines. Your child’s provider may refer you to an ear, nose
2. Long-term (chronic) and
a. These symptoms last longer than 12 weeks. throat doctor (ENT or otolaryngologist) for testing and
3. Recurrent treatment.
a. This means the infection comes back again
and again. CHRONIC SINUSITIS
b. It means 3 or more episodes of acute ENT specialist visit. Your child may be referred to an ENT
sinusitis in a year. doctor.
• Antibiotics. Your child may need to take antibiotics for a
BACTERIA-CAUSEING SINUSITIS longer time. If
 Streptococcus pneumonia bacteria aren’t the cause, antibiotics won’t help.
 Haemophilus influenzae • Inhaled corticosteroid medicine.
 Moraxella catarrhalis  Nasal sprays or drops with steroids are often
prescribed.
Diagnostics  Other medicines
 In most cases, not diagnose because it was viral  Nasal sprays with antihistamines and decongestants,
 Sinus X-rays. An X-ray exam of the sinuses may saline sprays or drops, or medicines
help with the diagnosis. to loosen and clear mucus may be prescribed.
 CT scan of the sinuses. A CT scan shows detailed • Allergy shots or immunotherapy.- If your child has nasal
images of any part of the body. They are more allergies, shots may help reduce his or her reaction to allergens
detailed than X-rays. such as pollen, dust mites, or mold.
 Cultures from the sinuses. A swab of discharge
from the nose may be taken. The sample is checked • Surgery. Surgery for chronic sinusitis is an option. But it is
for bacteria or other germs. not done
 Nasal Endoscopy very often in children.
 3 days- viral
FESS- Functional Endoscopic Sinus Surgery
 10 days- bacterial, antibiotic is given
- Involves insertion of camera to the nostril and sinuses
- Obstruction may be caused by:
SIGNS AND SYMPTOMS
o Swollen mucosa
• Stuffy nose
• Thick, colored drainage in the nose o Bone
• Drainage down the back of the o Polyps
throat (postnasal drip) o Deviated septum- septoplasty
• Headache o Balloon may be inflated to dilate opening of
• Cough the sinuses
• Pain or soreness over sinuses o NOTE: CT SCAN to confirm diagnosis and
• Fever assess structures
• Loss of smell
Ostia
ON EXAMINATION
1. Tenderness of the Affected Areas