Respiratory Anatomy
- Nasal Cavity
- Hair Filters
- Mucus Filters and Moistens
- Capillaries Warm
- Pharynx (Throat)
- Larynx (Voice Box)
- Cilia Expel Mucus and Dust
- Trachea
- Bronchi
- Alveoli
Physiologic Dead Space (VD)
- Tidal Volume (VT)
- Partial pressure of arterial CO2 (PaCO2)
- Partial pressure of CO2 in expired air (PECO2)
- VD = TV x (PaCO2-PECO2) / PaCO2
Alveolar Gas Exchange
- Pulmonary Artery Blood is O2-Poor, CO2-Rich
- Two-Cell Thick Air-Blood Barrier
- CO2 Diffuses Into Air
- O2 Diffuses Into Blood
- Gases Equilibrate
- Pulmonary Vein is O2-Rich, CO2-Poor
- Thermoregulation
Alveolar Gas Equation
- Partial Pressure of Alveolar Oxygen (PAO2)
- Partial Pressure of Oxygen in the Inspired Air (PIO2)
- PIO2 Normally Approximated = 150 mmHg
- Arterial Partial Pressure of CO2 (PaCO2)
- Respiratory Quotient (R)
- R Normally Approximated = 0.8
- PAO2 = PIO2 - (PaCO2/R)
Lung Sounds - Wheezes
- Throughout Lung
- High Pitched
- Musical
- Air Moving through Narrowed Airways
Lung Sounds - Rhonchi
- Trachea and Bronchi
- Low Pitched Rumbling
- Gurgling
- Narrowed Airway
- Secretions or Bronchospasm
Lung Sounds - Crackles
- Lower Lobes
- Fine/Coarse
- Fine: Twisting Hair through Fingers
- Coarse: Velcro
- Collapsed Small Airways and Alveoli "Popping Open"
Lung Sounds - Pleural Friction Rub
- Anterior Lateral Lung
- Dry, Rubbing, or Squeaking
- Rubbing a Balloon with Finger
- Inflamed Pleura
Hypoxia (Early Symptoms)
- Diaphoresis
- Restlessness
- Tachypnea
- Dyspnea on Exertion
- Tachycardia
- Hypertension
- Arrhythmias
- Decreased Urine Output
- Unexplained Fatigue
Hypoxia (Late Symptoms)
- Cyanosis
- Cool, Clammy Skin
- Use of Accessory Muscles
- Retractions
- Hypotension
- Arrhythmias
Respiratory Acidosis
- Hypoventilation
- Increased PaCO2 > 45
- Barbiturates Depress Central Respiratory Center of Brain
- Opioids Depress Central Respiratory Center of the Brain
- Airway Obstruction
- Respiratory Muscle Weakness/Paralysis
Respiratory Acidosis Interventions
- Improve Respiration
- Bronchodilators
- Respiratory Stimulants
- Drug Antagonists
- Oxygen
- Assisted Ventilation
- Prevent Complications
Respiratory Alkalosis
- Hyperventilation
- High Altitude
- Aspirin
- Restrictive Lung Disease
- Pulmonary Embolism
- Pregnancy
- Progesterone
- Rib Fracture
- Anxiety
Respiratory Alkalosis Interventions
- Treat Underlying Cause
- Decrease Tidal Volume and/or Respiratory Rate
- Give Adequate Pain Control and Sedation
- Sedatives
- Antidepressants
- Compensatory Drop in Serum Bicarbonate
- Calming Breathing Exercises
- Correct CO2 Slowly
Obstructive Lung Disease
- Blocked Airflow
- Increased residual volume
- V/Q Mismatch
- Decreased forced vital capacity (FVC)
- Decreased FEV1/FVC ratio
- Asthma
- Bronchiectasis
- Chronic bronchitis
- Emphysema
Restrictive Lung Diseases
- Poor Breathing Mechanics
- Interstitial Lung Diseases
- Goodpasture's Syndrome
- Eosinophilic Granuloma
- Granulomatosis with Polyangiitis
- Sarcoidosis
- Pneumoconiosis
- Idiopathic Pulmonary Fibrosis
- Drug Toxicity
- Acute Respiratory Distress Syndrome (ARDS)
- Neonatal Respiratory Distress Syndrome
Restrictive vs. Obstructive Lung Diseases
- Restrictive Lung Disease
- Decreased Lung Volume
- FEV1/FVC Ratio Normal to Increased
- Obstructive Lung Disease
- Increased Lung Volume
- Decreased FEV1/FVC Ratio
Chronic Bronchitis
- Chronic Inflammation of Bronchi
- Early-Onset Cyanosis
- Blue Bloaters
- Productive Cough
- Wheezing
- Chronic Obstructive Pulmonary Disease (COPD)
- Late-Onset Dyspnea
- Crackles
- Reid Index > 50%
Chronic Bronchitis Assessment
- Chronic Productive Cough
- > 3 Months for 2 Years
- Increased Mucus Production
- Dyspnea
- Cyanosis
- Wheezes
- Right Side Heart Failure
- Jugular Venous Distention (JVD)
- Peripheral Edema
Chronic Bronchitis Interventions
- Tripod Position
- Humidified Oxygen
- Pursed Lip Breathing
- Increase Fluid Intake
- ABGs
- Early Detection of Exacerbation
- Lowest O2 Therapy
- Assisted Ventilation
- Increased Infection Risk
COPD Overview (Chronic Obstructive Pulmonary Disease Overview)
- Inhaled Toxins
- Smoking
- AAT Deficiency
- Emphysema
- Chronic Bronchitis
- Asthma
- Spirometry
- Slow Progression
Emphysema
- Hyperinflation and Loss of Elasticity
- Pursed Lip Breathing
- Barrel Chest
- Dyspnea on Exertion
- Clubbing
- Depression and Anxiety
- Thin Appearance
- CO2 Retention
- Low Concentration of O2
- High Fowler's Position
- High Calorie, High Protein Diet
Emphysema
- Pink Puffer
- Exhale through Pursed Lips
- Barrel Chest
- Obstructive Lung Disease
- Increased Lung Compliance
- Centriacinar
- Panacinar
Asthma
- Obstructive lung disease
- Bronchial Hyperresponsiveness
- History of Atopic Disease
- Beta2 agonists
- Corticosteroids
- Curschmann's spirals
- Hypertrophy of smooth muscle
- Reversible
- Charcot Leyden crystals
- Methacholine challenge
- Wheezing
- Cough
- Initially decreased PaCO2
- Pulsus paradoxus
Persistent Mild Asthma
- Symptoms (Brochoconstriction) and Rescue Inhaler Use > 2 Days / Week
- Nighttime Awakening 3-4 / Month
- Greater or equal to 80 % of Predicted FEV1
Persistent Moderate Asthma
- Symptoms (Bronchoconstriction) and Rescue Inhaler Use Daily
- Nighttime Awakening > 1 / Week
- 60-80% Predicted FEV1
- FEV1/FVC Decreased 5%
Persistent Severe Asthma
- Symptoms (Bronchoconstriction) and Rescue Inhaler Use: Multiple/ Day
- With Minimal Activity
- Nighttime Awakening: Nightly
- < 60% Predicted FEV1
- > 5% Decrease FEV1/FVC
Asthma Assessment
- Triggers (Cold air, Dander, Dust, Infection, Mold, Pollen, Smoke)
- Shortness of Breath (SOB)
- Tachypnea and Tachycardia
- Wheezing
- Diaphoresis
- Accessory Muscles
- Decreased Pulmonary Function Tests
Stages of Asthma Treatments
- Short-acting Inhaled Beta-Agonist
- Low-Dose Inhaled Corticosteroid
- Montelukast (Leukotriene Receptor Antagonist)
- Low to Medium-dose Inhaled Corticosteroid
- Zileuton
- High-Dose Inhaled Corticosteroid
- Systemic Corticosteroids
- Omalizumab (Allergies)
Asthma Implementation and Education
- Oxygen
- Corticosteroids
- Ipratropium (Anticholinergic)
- Albuterol
- Inhaler/nebulizer
- Pulse Oximetry
- Pursed Lip Breathing
- Carry Inhaler
- Rinse Mouth after Inhaler
- Identify Trigger (Cold Air, Dander, Dust, Infection, Mold, Pollen, Smoke)
Acute Respiratory Distress Syndrome (ARDS) Assessment
- Damaged Alveolar-Capillary Membrane
- Restlessness
- Dyspnea
- Refractory Hypoxemia
- Decreased PaO2
- Diffuse Pulmonary Infiltrates
- Atelectasis
- Pulmonary Hypertension
Acute Respiratory Distress Syndrome (ARDS) Interventions
- Closely Monitor Patient
- ABG's (Arterial Blood Gases)
- Oxygen
- Assess for O2 Toxicity
- Mechanical Ventilation
- PEEP
- Assess for Pneumothorax
- Permissive Hypercapnia
- High Mortality Rate
Spontaneous Pneumothorax
- Accumulation of Air in Pleural Space
- Tall and Thin Young Males
- Bleb or Bulla Rupture
- Underlying Disease
- Hypoxemia
- Chest Pain
- Decreased Breath Sounds
- Hyperresonance
- Shortness of Breath (SOB)
Adenocarcinoma of the Lung
- Most Common Lung Cancer
- Most Common in Nonsmokers
- Peripheral Location
- KRAS, EGFR, and ALK Mutations
- Glandular Pattern
- Often Stains with Mucin
- Presents with Hemoptysis
- Clubbing
- Surgical Resection
- Chemotherapy and Radiation
A-a Gradient
- Partial pressure of alveolar oxygen (PAO2)
- Partial Pressure of Arterial O2 (PaO2)
- Normal 10 to 15 mmHg
- Hypoxemia with an Abnormal A-a Gradient
- Diffusion problem
- Shunting (Low V/Q)
- Dead space (high V/Q)
Venous Thromboembolism (DVT) Assessment
- Venous Wall Inflammation caused by Thrombus
- Tenderness
- Edema
- Warmth
- Asymmetry
- Could be Asymptomatic
- Monitor for Pulmonary Embolism
Venous Thromboembolism (DVT) Interventions
- Anticoagulants
- Prevention Education
- Frequent Ambulation
- Leg Exercises
- Compression Stockings or SCD's
- Avoid Nicotine and Oral Contraceptives
- Surgery