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Physiology Neurological Control

1.Medulla is primary stimulus in healthy person to breathe
-senses increase of CO2 and H+ ion
2. Chemoreceptors-measure O2 receptors
-aortic arch and carotid bodies
-sense decrease O2 levels
3. Proprioceptors
-respond to body movement and increase ventilation
- usually seen w/ increased activity

Chronic CO2 levels seen in COPD
-retain CO2, so have high levels, medulla eventually quits
-then chemoreceptors take over, making stimulus to breathe O2 when it's normally CO2

Essential for Normal Respiratory Function

-airway system integrity
-properly functioning alveolar-capillary system
-properly functioning cardiovascular & hematological systems
-healthy tissues

Steps in Gas Exchange

1. Ventilation- air moves in & out of lungs
2. Diffusion (Alveolar-> capillary)
-gas moves from areas of high to low concentration. Alveolar surface area, alveolar capillary membrane integrity affect it.
3. Perfusion- amt. of blood flow
-influenced by position and activity level
4. Gas Transport
-Oxygen-3% plasma bound, 97% oxyhemoglobin
-CO2- 5-10% plasma bound, 5-30% carboxyhemoglobin, 60-90% bicarbonate
5. Diffusion (Capillary-> Tissue)
-influnced by quality of RBCs and tissue chemistry

Factors Affecting Respiratory FX

Levels of health- renal disease, heart damage, lung disease, neuromuscular disease, brain injury, anema, skeletal problems, obesity
Lifestyle- activity levels, smoking
Enviornment- air pollution, occupational exposure

Developmental Considerations

-infant-short airways, aspiration risk
-Children- eustachian tubes, bronchi, and bronchioles elongated and less angular; frequent colds and infections
-Older Adults- stiffer lung tissues, decrease muscle strength, skeletal alterations, digestive changes


1. Narcotics & sedatives- decrease stimulus to breathe
2. ACE inhibitors- dry cough
3. Amiodarone- pulmonary fibrosis
4. Bronchodilators- dilate bronchioles
5. Oxygen- need order

Nursing Assessment

defer if evidence of distress
usual breathing pattern
chest pain
weight loss

Physical Exam

Inspect- skin, chest, RR and rhythm


-decreased O2
Restlessness (early sign)
altered LOC
Behavioral Changes
Respiratory arrest (late sign)

Noninvasive Diagnostic tests

Pulse Ox- measure SaO2
normally 95-99%
Treat if <92%
Must know Hgb
Chest Xray
Sputum for Cytology

Pulmonary Fx Studies

-group of test that measure lung volumes, identify gas exhange problems, evaluate neuromuscular problems and dyspena

Spirometry- lung volume and airflow
Peak Expiratory Flow- evaluates asthma, records highest flow

Invasive Diagnostic Tests

1. ABGs.
pO2- O2 in blood, btwn 80-100
2. Bronchoscopy- scope to respiratory tract
-visualize structures, remove susbtances, NPO before (4-8 hrs), no food or fluids until gag returns
3. CT scan
-check iodine allergy if contrast to be used
-check metformin level
-if allergic to iodine, get certain prep; steroids and benedryl
4. Ventilation- Perfusion Scan
-radioactive substance injected and inhaled
-measure to blood flow and airflow
-8 hrs to eliminate
5. Skin Tests
-evaluate antigen-antibody reactions


-usually @ bedside
-needle or catheter inserted into intrapleural space to aspirate fluid
-monitor respirations after- improve or distress?
-may puncture lung and cause pneumothorax


1. Teaching
-stop smoking, avoid pollutants
2. Promote Optimal Function
-control anxiety, nutrition, vaccines, balance activity and rest, pulmonary rehab

Promote Comfort

Positioning- semi-fowlers or fowlers position
Adequate fluids- 2-3L/24 hrs
Humidified Air- breeds bugs, changed every 24 hrs

Promote Proper Breathing

Deep breathing
Incentive Spirometry- forces deep breathing by intake
Purse Lip breathing- sitting or walking, helps Co2 retainers get rid of CO2
Abdominal Breathing

Promote or Control Coughing

Voluntary- cough and deep breathe
-Expectorant- loosen secretions (Robitussin)
-Suppressant- cough suppressent (Codeine, Robitussin DM)
-Lozenges- tickles for back in throat. Local anesthetic

Perform Chest PT

Cup hands, pad areas on position or chest to loosen secretions


-Device to clear secretions
-Can relieve or promote respiratory distress
-suction 10-15 seconds, wait 1 minute inbetween, done 3x only

Respiratory Medications

1. Bronchodilators- open narrowed airways
-albuterol (Proventil)
-montelukast (Singulair)
-theophylline (Slo-bid)
-tiotropium (Spriva)
2. Steroids
-budesonide (pulmicort)
3. Mast Cell stablizers- inhibits histamine release from mast cells
-Cromolyn sodium (instal, Nasalcrom)
4. Antihistamines- inhibit histamines
-Diphenhydramine (Benadryl)
-Loratadine (claratin)
-Cetrizine (zyrtec)

Types of Inhalers

1. Nebulizer
2. Metered Dose Inhaler (MDI)
3. Dry power Inhaler (has tablet or capsule that is punctured in inhaler and released)
steps vary
bronchodilatort first-> opens up more surface area

Supplemental Oxygen

Benefits: increase oxygen, reduces work of breathing, decreases work of heart
Risks: damages pulmonary tissue, impairs stimulus to breathe, constricts retinal blood vessels, combustion, increase infection
Therapeutic goal:
-Arterial pO2 btwn 80-100 mmHg
-Arterial pCO2 < 45 mmHg
Desired Response:
Normal HR and rhythm
Normal RR
A & O
Normal Color

Nasal Cannula


1L= 24%
2L= 28%
3L= 32%
4L= 36%
5L= 40%
6L= 44%
-may need humdification
-check pressure points and pad them

Simple Face Mask

-delivers 35-60% O2 @ 6-10L/min
-less comfortable

Partial Non-Rebreather

-Reservoir bag mixes 100%O2 w/ some expired air
-70-90% O2
0Partial bag deflation indicates optimal fx
-flow meter set at 10-15 L/min


-exhale through side ports
-inhale only oxygen from reservoir
-60-100% O2
-set flow meter at 15L/min

Venturi Mask

-adjust dial to change diameter of tube and size of side ports
-set flow meter according to dial
-delivers precise oxygen concentration
-most precise O2 concentration delivered by mask

Interventions related to O2 Therapy

Assess- RR, pulse ox, skin, mm
Use NC w/ meals if possible- must be able to convert btwn O2 devices
Hygiene- face, nares, mask

Artifical Airways

-endotracheal- intubated for 14 days

must have no gag reflex

Trach Care

-Cleaning- inner cannula, insertion site skin
-Tube security
-Emergency Equipment- obturator at bedside, spare trach tube at bedside

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