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					                       Alterations
                            in
                   Respiratory Function

                              Study Guide

                               Nursing 102




Note: This study guide is intended to assist you in your personal study. It is
not intended to be filled out during lecture. Please, use it while you are doing
your required reading.

                        Gloria McGregor, RN, MSN


NUR 102/Respiratory/gmcgregor/2011                                             1
                     Alterations in Respiratory Function
                                    Nursing 102

Instructor: Gloria McGregor, RN, MSN Phone: 682-6674
Office: Wenatchi Hall 2221M, by appt. E-mail: http://www.gmcgregor@wvc.edu
Website: http://commons.wvc.edu/gmcgregor
Required Reading:
 You may use any pathophysiology book and review the anatomy & physiology.

Ignatavicius & Workman (2010). Medical-Surgical Nursing (6th ed.). Unit 7: Problems
of Oxygenation. Chapters 29-33
ATI Adult Medical-Surgical Nursing RN. Unit 2: Chapters 3-16.
Due to instructor scheduling, Lecture 3 will come before Lecture 2 Winter 2011
Lectures:
Lecture One: Structure & Function, Focused Respiratory Assessment, Diagnostics and
Oxygen Delivery Systems. Chapter 29 & 30. Bring your stethoscope to lecture one
Lecture Two: Upper Respiratory Problems: Facial Trauma, Airway Problems, Asthma.
Chapter 31.
Lecture Three: Lower Respiratory Problems: COPD, Pulmonary Hypertension, Fibrosis,
Tuberculosis. Chapter 32 & 33.

Pre-test: A Pre-test will be included with your addendum. This needs to be done and
handed in by day of lecture one. It is worth 15 points. A point will be deducted for
each day late.
Tests: There will be an 85 point final exam. Taking the exam at a time other than
the day scheduled will result in the loss of up to 5% from your test score. See your
student handbook.

                                    Assignments
       Assignments                   Day Due                       Points
         Pre-test                  Lecture Day 1                  15 Points
          Exam                         Day 4                      85 Points
          Total                        Points                    100 Points




NUR 102/Respiratory/gmcgregor/2011                                                 2
                     Alterations in Respiratory Function
“A human being is only breath and shadow.” Sophocles

“And God formed man from the dust of the earth and breathed into his nostrils the
breath of life. And man became a living soul.” The Bible

What is the purpose of the respiratory system?

What other body functions does the respiratory system influence?

Upper Respiratory Tract
Nose & Sinuses:
Anatomy-
Function-
Pharynx:
Anatomy-
Function-
Larynx:
Anatomy-
       Glottis-
       Epiglottis-
Vocal cords-
Function-

Upper Respiratory Problems:
Fracture of the nose-
Assessment-

Rhinoplasty-
Nasoseptoplasty-

Epistaxis-
Assessment-
Interventions-

Nasal Polyps:
Assessment-
Intervention-

Cancer of the nose or sinuses:
Assessment-
Intervention-




NUR 102/Respiratory/gmcgregor/2011                                                  3
Maxillofacial Trauma:
LeFort Fractures-

Assessment-

Intervention-

Disorders of the Pharynx and Tonsils:
Obstructive Sleep Apnea-
Assessment-

Interventions-

Vocal Cord Paralysis-
Assessment-

Interventions-

Nodules or Polyps of the Vocal Cords-
Assessment-

Intervention-

Laryngeal Trauma
Dyspnea-

Aphonia-

Subcutaneous emphysema-

Hemoptysis-

Upper Airway Obstruction
Assessment-

Intervention-

Cricothyroidotomy-

Endotracheal Intubation-




NUR 102/Respiratory/gmcgregor/2011      4
Tracheostomy-
Operative Procedure-

Post-operative care and complications-
Tube obstruction-
Tube dislodgement-
Bleeding-
Infection-

Tracheostomy Tubes:
Double lumen-
Single lumen-
Cuffed-
Uncuffed-

Troubleshooting-

Suctioning through a tracheostomy-
Procedure-

Complications-
Hypoxia-

Tissue Trauma-

Infection-

Vagal stimulation-

Tracheostomy Care-
Assessment-
Cleaning-
Changing-
Securing-

Other considerations:
Nutrition-
Communication-
Emotions and Body Image-
Weaning-
Patient Education- What are the pieces of patient education needed prior to
discharge.




NUR 102/Respiratory/gmcgregor/2011                                            5
Lower Respiratory System
Trachea:
      Anatomy-
      Function-

Mainstream Bronchi:

Lobar, Segmental & Subsegmental Bronchi:

Bronchioles:

Alveolar Ducts & Alveoli:
Anatomy-
Acinus-

Surfactant-

Atelectasis-

Function-
Pulmonary capillaries-

Explain gas exchange –

Lungs:
Diaphragm-

Accessory muscles-

Hilum-

Pleura-
Parietal-
Visceral-

Chronic Airflow Limitation
Asthma:
Pathophysiology-

Assessment-
History-

Physical Assessment-

Breath Sounds-



NUR 102/Respiratory/gmcgregor/2011         6
Laboratory diagnostics-

Pulmonary Function Tests-
FVC-
FEV-
PEF-
Other Diagnostics-
Interventions-

Drug Therapy-

Client Education-

Status Asthmaticus


Chronic Obstructive Pulmonary Disease
Emphysema:
Pathophysiology-

Classification-

Interaction of Emphysema and Chronic Bronchitis-

Etiology-
Cigarette smoking-
Alpha-antitrypsin deficiency-
Air pollution-

Complications-
Hypoxemia and acidosis-

Respiratory Tract Infections-

Cardiac Failure-

Cor pulmonale-

Cardiac dysrhythmias-
Assessment-
History-

Physical Assessment-
General Appearance




NUR 102/Respiratory/gmcgregor/2011                 7
Respiratory symptoms and breath sounds-

Psychosocial impact-

Diagnostics-

Labwork-

Radiographic diagnostics-

Pulmonary Function Tests-
Vital Capacity-
Residual Volume-
Total Lung Capacity-
FEV
FVC

Interventions-
Oxygen-
Drug Therapy-

Breathing Exercises-

Controlled coughing-

Chest physiotherapy and postural drainage-

Suctioning-

Positioning-

Hydration-

Other Considerations-
Anxiety and air hunger-

Activity Intolerance-

What are the top nursing diagnoses for COPD?


What would be included in a patient education plan for a patient with COPD?




NUR 102/Respiratory/gmcgregor/2011                                            8
Cystic Fibrosis-
Pathophysiology-

Assessment-

Non-pulmonary manifestations-

Pulmonary manifestations-

Interventions-
Non-surgical-
Surgical-
Nursing Care Considerations-

Primary Pulmonary Hypertension
Pathophysiology-

Interventions-

Interstitial Pulmonary Diseases
Definition-

Sarcoidosis
Pathophysiology-
Etiology-

Granulomas-

Alveolitis-

Cor pulmonale-
Assessment-

Interventions-

Idiopathic Pulmonary Fibrosis
Pathophysiology-

Assessment-

Interventions-




NUR 102/Respiratory/gmcgregor/2011   9
Occupational Pulmonary Disease
Definition-
Occupational Asthma
Silicosis
Coal Miners’ Pneumoconiosis
Asbestosis
Talcosis
Berylliosis

Lung Cancer
Pathophysiology-

Etiology-

Staging-

Assessment-

History-

Physical assessment-

Diagnostics-

Intervention-

Curative-
Chemotherapy-

Radiation-

Thoracotomy-
Procedure-
Pre-operative care-

Post-operative care-

Chest tubes-
Rationale-

Set-up

Troubleshooting-




NUR 102/Respiratory/gmcgregor/2011   10
Palliation
Oxygen-

Drug therapy-

Dyspnea management

Pain management-

Thoracentesis and pleuradesis-

Psychosocial –

Hospice and End-of-Life care-

Infectious Respiratory Disease
Rhinitis and Sinusitis-

Pharyngitis
Viral-

Bacterial-

Tonsillitis

Peritonsillar Abcess

Laryngitis

Influenza

Intervention-
Primary-
Secondary-
Tertiary-

Pneumonia
Pathophysiology- Note risk factors

Community acquired

Hospital acquired (nosocomial)
Septicemia-
Empyema-
Atelectasis-
Consolidation-


NUR 102/Respiratory/gmcgregor/2011   11
Assessment-
History-
Physical Assessment and breath sounds-

Laboratory diagnostics-

Radiographic assessment-

Collecting a sputum specimen-

Tuberculosis
Pathophysiology-
Etiology-

Assessment-

History-

Physical Assessment-

Diagnostic Assessment-

Interventions-

Drug Therapy-

Describe Airborne precautions-

Community considerations & resources-

Lung Abcess

Pulmonary Empyema

Airway Adjuncts
Describe the following methods of delivering oxygen and what percentage of oxygen
delivered by each
Nasal Cannula-
Oxygen Mask-
Venti-mask-
Non-rebreather Mask-
Mouth-to-mouth -
Ambu-bag -
Ventilator-




NUR 102/Respiratory/gmcgregor/2011                                             12
Arterial Blood Gas Interpretation
ABGs are obtained mainly in respiratory situations. They are drawn from an
artery. There are four major components to the blood gas.

pH – This shows the acid-base balance. If it is within normal range, it is called
compensated, out of normal is uncompensated. Below 7.35 is acidosis. Above 7.45 is
alkalosis.

PaO2- This is the partial pressure of arterial oxygen or the amount of oxygen
dissolved in the arterial blood and attached to hemoglobin. Remember, oxygen and
carbon dioxide have a reverse relationship. When one goes up, the other goes down.
Review the oxyhemoglobin dissociation curve.

PaCO2- This is the carbon dioxide level. Retention of carbon dioxide is the only
mechanism for respiratory acidosis. This is the compensatory element for HCO3.

HCO3- This is the bicarbonate level and is alkaline (base). It is an indicator of
metabolic acid-base disturbances. This is the compensatory element for carbon
dioxide.

Now, let’s look at the following ABG:

pH 7.33      It is less than 7.35, so it is acidosis

PaO2 75      This is slightly lower than the normal

PaCO2 54     This is higher than normal, indicator of respiratory acidosis

HCO3 26      This is high normal


In respiratory acidosis, the pH is low, the PaCO2 is high and the HCO3 is normal.
This ABG shows respiratory acidosis.

Put together the picture of the patient with the results of the ABGs. What is the
primary diagnosis or disease process of the patient, what are the physical findings
and breath sounds?

Potassium levels are elevated in acute respiratory acidosis and low or normal in
chronic respiratory acidosis (COPD).

You can review chapter 16 in Iggy or do an online tutorial for extra practice.




NUR 102/Respiratory/gmcgregor/2011                                                    13

				
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