RESPIRATORY

SYSTEM

Billy Ray A. Marcelo, RN

Faculty
Bataan Peninsula State University
 OVERVIEW
Basic Process of Oxygenation
Ventilation- degree of compliance,
airway resistance, accessory
muscles (Respiratory System)
Diffusion- thickness of membranes
(Hematologic System)
Perfusion- integrity of transport
system (CV and Hematologic
System)
 OVERVIEW
Function: Respiratory System
Obtains O2, removes CO2
Filters particles from
incoming air
Control T and water content
Role in sense of smell
Regulates blood pH
OVERVIEW
 OVERVIEW
Upper Respiratory Tract
Filtering of air, warming, moistening
Humidification
A. Nose
Framework of cartilage
2 septum/nostril
Anastomosis of capillaries
(Keisselbach)
B. Pharynx (Throat)- organ of GI and RT
Muscular pasageway for food and air
Nasopharynx
Oropharynx
Laryngopharynx
 OVERVIEW
C. Larynx (Voicebox)
Phonation (speech production)
Cough reflex
Frameworks
Arythenoid and cricoid cartilage
Thyroid gland
Hyoid bone
Glottis
Epiglottis
Opens: passage of air
Closes: passage of food
Upper Respiratory Tract
 OVERVIEW
Lower Respiratory System
Gas exchange
A. Trachea (windpipe)
Cartilaginous rings, ‘U’ shape
Site of permanent artificial
airway (tracheostomy)
B. Carina- area of bifurcation of
brochi
C. Bronchi
R main bronchus- wider
straighter
L main bronchus
 OVERVIEW
Lower Respiratory System
D. Lungs- covered by serous
membrane
R- 3 lobes
L- 2 lobes
Pleural cavity
Parietal- with 20 cc of fluid to
prevent friction, with nerve
endings
Visceral- without nerve endings
Pleural
 OVERVIEW
Lower Respiratory System
D. Lungs
Terminal bronchioles
Alveoli (Acinar cells)- site
of gas exchange (CO2 and
O2)
Type II cells- secretes
SURFACTANT
(phospholipid lipoprotein)
→ ↓ surface tension
 PNEUMONIA
Inflammation of lung parenchyma →
pulmonary consolidation as the alveoli
are filled with exudates
Causative Agents
Streptococcus pneumoniae
(Pneumococcal pneumonia)
Hemophilus influenzae
(Bronchopneumonia)
E. Coli
Klebsiella
Pseudomonas aeruginosa
PNEUMONIA
 Predisposing Factors:
PNEUMONIA
Excessive smoking
Air pollution
Over fatigue
Prolonged immobility →
hypostatic pneumonia
Aspiration
Immunocompromised state
AIDS- Pneumocystis carinii
(taking Zidovudine or AZT)
Bronchogenic CA
 Signs and Symptoms:
PNEUMONIA
Productive cough (greenish to rusty
sputum)
Dyspnea with prolonged expiratory
grunt
Fever, chills, anorexia, N/V, weight loss
Pleuritic friction rub
Rales, crackles, Bronchial wheezing
Cyanosis
Chest pain
Abdominal distension → paralytic ileus
(most feared Cx)
 Diagnostic Procedures:
PNEUMONIA
Sputum C/S
Gram-staining C/S
Chest X-Ray- reveals
pulmonary
consolidation
ABG- ↓ pO2
CBC- ↑ WBC, ↑ ESR
 Nursing Management:
PNEUMONIA
CBR
Place pt. on semi-fowler’s
Low flow O2 as ordered
Give comfortable and humid
environment
Diet: ↑ CHON, ↑ CHO, ↑ Vit C
Force fluids to liquefy secretions
Importance of receiving
immunization as recommended
 Nursing Management:
PNEUMONIA

Administer meds as ordered

Broad spectrum antibiotics
Penicillin, Tetracycline,
Macrolides
Antipyretics
Mucolytics/ Expectorants
(Guiafenesin, Glycerine,
Guiacolate)
 Nursing Management:
PNEUMONIA

Institute pulmonary toilet

DBE
Coughing
Chest physiotherapy (CPT)
Turning and repositioning
Nebulize and suction prn
Chest Physiotherapy
 Nursing Management:
PNEUMONIA
Institute postural drainage as ordered
Pt is placed on various positions to
promote drainage of secretions, stay
for 20-30 minutes
Best done before breakfast, or 2-3 hrs
p.c.
Pt. should be well hydrated, knows
how to cough
Prone with pillow on abdomen-
drains lower part of the lungs
Supine with buttocks up- drains
upper part of the lungs
Postural Drainage
Postural Drainage
 Nursing Management:
PNEUMONIA
Institute postural drainage as ordered
Monitor VS, breath sounds
Administer bronchodilators 15-30
minutes prior
Encourage DBE
Stop if pt can’t tolerate the
procedure
Give oral care post procedure
No to pt with: hemoptysis, unstable
VS, ↑ ICP, ↑ IOP
 Nursing Management:
PNEUMONIA

Discharge Health Teaching

Stop smoking
Regular adherence to
meds
Dietary modification
Follow-up care
Prevent Cx: atelectasis
PULMONARY TUBERCULOSIS
Or Koch’s Disease
Causative agent: MTB- acid-fast, non-
motile
Predisposing Factors
Malnutrition
Overcrowding
Alcoholism
Ingestion of affected cattle (with M.
bovis)
Virulence of the microorganism
PULMONARY TUBERCULOSIS
Signs and Symptoms: PTB

Productive cough- yellowish

secretions > 2 wks
Dyspnea
Low grade afternoon fever-
Pathognomonic Sign
Night sweats- Classical Sign
Anorexia, general body malaise
Weight loss
Chest pain
Hemoptysis
Diagnostic Procedures: PTB
Mantoux Test- skin
test, injection of PPD
Reading: after 48-
72 hrs
(+) exposure to
PTB:
DOH: 8-10 mm
induration
WHO: 10-14 mm
induration
Diagnostic Procedures: PTB
Sputum
AFB- (+)
MTB
Chest X-ray-
pulmonary
infiltrates
(caseous
necrosis)
CBC- ↑ WBC
PULMONARY TUBERCULOSIS
Nursing Management
CBR
Comfortable environment
O2 inhalation as ordered
Force fluids to liquefy secretions
NO CPT, only DBE and coughing
Nebulize and suction prn
Place on semi-fowler’s
Diet: ↑ CHON, ↑ CHO, ↑ Vit C
PULMONARY TUBERCULOSIS
Short Course Chemotherapy
I. Intensive Phase
INH- given for 4 mos., taken a.c.
S/E: peripheral neuritis- give Vit B6
Rifampicin- given for 4 mos., taken a.c.
S/E: all body secretions turned red-
orange
PZA- given for 2 mos., taken p.c.
S/E: skin rashes, nephro and
hepatotoxicity
PZA is replaced by Ethambutol
S/E: optic neuritis (visual disturbance)
PULMONARY TUBERCULOSIS
Short Course Chemotherapy
II. Standard Regimen
Streptomycin IM
(Aminoglycoside)
S/E: Ototoxicity due to
damage to CN VIII→
temporary hearing loss
Nephrotoxicity- monitor
BUN and Crea levels
PULMONARY TUBERCULOSIS
Discharge Health Teaching
Avoid precipitating factors
Take meds religiously
If missed 1 day’s meds,
NEVER ↑ the dose on the
next day, simply let the pt
continue taking the meds
Prevent Cx: Atelectasis and
Miliary TB
Follow-up care
SEVERE ACUTE RESPIRATORY
SYNDROME (SARS)
Cause: Coronavirus
Begins with fever, body aches, mild
respiratory Sxs
After 2-7 days, dry cough & dyspnea
develops
MOT: close person-to-person contact
(direct contact with infectious
secretions and soiled articles)
Prevention: avoiding contact with
those suspected of having SARS,
avoiding travel to countries with
SARS outbreak, frequent hand
washing
 INHALATION INJURIES: CO
poisoning
CO: colorless, Blood Assessment
odorless, Level
tasteless, with 1-10% Impaired visual
affinity for Hgb acuity
200X greater 11- Flushing, HA
than O2, 20%
forming 21- N/, impaired
carboxyHgb→ 30% dexterity
tissue hypoxia 31- Vom,dizziness,sync
40% ope
41- ↑HR, ↑RR
50%
 INHALATION INJURIES: CO
poisoning
Interventions
Remove victim from
exposure
Administer 100% O2
Assess need for CPR
Monitor VS and CO
levels
 OCCUPATIONAL LUNG
DISEASE: SILICOSIS
Or Asbestosis or Coal
Workers’ Pneumoconiosis
Fibrotic lung disease
caused by inhalation or
organic dusts over long
periods of time
Common among miners &
sandblasters
 OCCUPATIONAL LUNG
DISEASE: SILICOSIS
S/Sx
Uncomplicated or simple:
asymptomatic with
evidence of fibrosis on CXR
Chronic complicated:
malaise, A/, wt loss, severe
dyspnea on exertion,
massive fibrosis on CXR
 OCCUPATIONAL LUNG
DISEASE: SILICOSIS
Interventions
Eliminate the toxic
substance
O2 as ordered
Coughing and DBE
Administer antitussives for
cough & anti-TB meds as
ordered (Cx: PTB)
 COPD
Types
Chronic Bronchitis
Bronchial Asthma
Bronchiectasis
Pulmonary
Emphysema
COPD-Chronic Bronchitis
Inflammation
of bronchi→
hyperplasia of
goblet mucus-
producing
cells →
narrowing of
smaller
airways
COPD-Chronic Bronchitis
Predisposin
g Factors
Excessive,
chronic
smoking
Air
pollution
COPD-Chronic Bronchitis
S/Sx
Productive cough
Dyspnea at exertion
Prolonged expiratory grunt
Scattered rales, rhonchi
Anorexia, general body malaise
Cyanosis- Blue Bloaters
Feeling of breathlessness
Pulmonary HTN leading to
peripheral edema and Cor
Pulmonale (most feared Cx)
Cor Pulmonale
COPD-Bronchial Asthma
Reversible inflammatory
disorder of lung tissue due to
hypersensitivity to allergens →
narrowing of smaller airways
Predisposing Factors (based on
3 types)
Extrinsic (Atopic/Allergic)
Pollen, dust, furs, fumes,
gases, smoke, danders, lints
COPD-Bronchial Asthma
Intrinsic (Non-Atopic/Non-Allergic)
Hereditary
Drugs: ASA, Pen, Phenylbutazone, Beta
blockers
Foods: seafoods, eggs, chicken, chocolate,
milk and its products
Food additives- nitrates (also can cause CA)
Sudden change in T, air pressure and
humidity
Extreme emotion
Physical stress
Mixed- combination of the 2
Most common type (90% of cases)
 Pathophysiology
Allergens
Release of IgE by B-lymphocytes
IgE + mast cells (respiratory tract)
Damage to mast cells
Release of chemical mediators
(histamine, bradykinin, serotonin,
prostaglandin)
 vasodilatation
Hypotension blood congestion
shock

increased capillary
permeability
escape of colloids
edema decreased blood
vol.
COPD-Bronchial Asthma
COPD-Bronchial Asthma
S/Sx
Non-productive cough
Dyspnea
Wheezing on expiration
Slight cyanosis
Mild restlessness and
apprehension
Tachycardia and palpitation
Diaphoresis
COPD-Bronchial Asthma
Diagnostic Procedures
ABG- ↓pO2
PFT- ↓ vital lung capacity
(max. vol. of air that can
be exhaled with the
deepest breath possible)
COPD-Bronchial Asthma
Nursing Management
Administer meds as ordered
Bronchodilators- inhalation
or metered dose inhaler
(pump)
Corticosteroids
Mucolytics/Expectorants
Anti-histamine
O2 as ordered
COPD-Bronchial Asthma
COPD-Bronchial Asthma
Nursing Management
Force fluids
Nebulize and suction prn
Comfortable and humid
environment
 COPD-Bronchial Asthma
Discharge Health Teaching
Avoid precipitating factors
Regular adherence to meds
Sudden withdrawal to
corticosteroids→ status
asthmaticus
Prevent Complications
Emphysema
Status asthmaticus- Drug of Choice:
Epinephrine
 COPD-Bronchiectasis
Permanent
dilatation of
bronchus →
destruction
of elastic and
muscular
tissues of the
alveolar walls
 COPD-Bronchiectasis
Predisposing Factors
Recurrent URTI and LRTI
Congenital anomalies
Lung tumor
Signs and Symptoms
Productive cough
Dyspnea
Anorexia, general body malaise
Cyanosis
Hemoptysis
 COPD-Bronchiectasis
Diagnostic Procedures
ABG- ↓ pO2
Bronchoscopy
 COPD-Bronchiectasis
Bronchoscopy: Nursing
Management
Pre-op: informed consent,
maintain on NPO, monitor VS
Post-op
Feed when gag reflex returns
Avoid talking, coughing,
smoking → chronic irritation
Monitor for S/ of gross/frank
bleeding
WOF laryngospasm and edema
→ DOB, SOB → prepare trache
 COPD-Bronchiectasis
Nursing Management
Same as in pulmonary
emphysema
Assist in surgical procedure
Pneumonectomy
Position post-op: lie on
affected side
Segmental wedge lobectomy
Position post-op: lie on
unaffected side
Pneumonectomy vs.
Lobectomy
COPD-Pulmonary Emphysema
Irreversible, end-stage
stage of COPD
characterized by
inelasticity of alveolar
wall → air trapping →
maldistribution of gases →
over distension of thoracic
cavity → ↑ A:P diameter
(Barrel-chest)
COPD-Pulmonary Emphysema
COPD-Pulmonary Emphysema
Predisposing Factors
Excessive, chronic smoking
Allergy
Air pollution
Hereditary- deficiency of
alpha-1 anti-trypsin →
elastase/elastin → alveolar
recoil (Northern European
origin)
Elderly- high risk group
COPD-Pulmonary Emphysema
Types
Centrilobular/Panlobular
Blue Bloaters
pCO2 ↑, pO2 ↓, resp.
acidosis with hypoxemia
Centriacinar/Panacinar
Pink Puffers
pCO2 ↓, pO2 ↑, resp.
alkalosis with hyperoxemia
Blue Bloater vs. Pink Puffer
The Blue Bloater
COPD-Pulmonary Emphysema
Signs and Symptoms
Productive cough
Dyspnea at rest
Anorexia, general body
malaise
On lung percussion-
resonance to
hyperresonance
COPD-Pulmonary Emphysema
Signs and Symptoms
(+) nasal flaring
rales, rhonchi
↓ breath sounds, vocal
fremiti
Barrel chest-
Pathognomonic Sign
(+) pursed-lip breathing
COPD-Pulmonary Emphysema
Nursing Management
CBR
Administer meds as
ordered
Bronchodilator
Corticosteroid
Antibiotics
Mucolytics/expectorants
COPD-Pulmonary Emphysema
Nursing Management
Low flow, Fixed concentration
O2 inhalation as ordered not
to remove the Hypoxic Drive
COPD-Pulmonary Emphysema
Nursing Management
Force fluids
Diet: ↑ CHON, ↑ Vit &
min., ↓ CHO
DBE- pursed-lip, cascade
coughing, CPT
Nebulize and suction
secretions prn
COPD-Pulmonary Emphysema
Discharge Health Teaching
Stop smoking
Regular adherence to meds
Prevent Complications
Atelectasis
Cor Pulmonale
CO2 narcosis- severe
disorientation/confusion →
coma
Pneumothorax
Restrictive Lung Disorders

Pneumothorax
Partial/
complete
collapse of the
lungs due to
accumulation
of air in the
pleural space
 Pneumothorax
3 types
Spontaneous- without obvious cause
e.g. rupture of bleb (alveolar fluid
sac) in recurrent lung inflammation
and infection
Open- thru chest opening
e.g. stab, gunshot wounds
Tension- from blunt chest injury or
from mech. vent. With PEEP air enters
pleural space with each inspiration
and cannot escape →↑ thoracic cavity
→ mediastinal shift

E.g. flail chest (with paradoxical

breathing)
 Pneumothorax
Predisposing Factors
Chest trauma
Recurrent inflammatory
lung condition
Lung tumors
 Pneumothorax
Signs and Symptoms
Cool, moist skin (beginning of
shock)
Sharp, chest pain
Unexplained dyspnea
↓ breath sounds → lung
collapse
↓ lung expansion
Cyanosis
 Pneumothorax
Signs and Symptoms
Mild
restlessness/apprehension
On lung percussion-
resonance to hyperresonance
SQ emphysema (crepitus on
palpation)
Tracheal deviation to
unaffected side
 Pneumothorax
Diagnostic Procedure
ABG- ↓ pO2
Chest X-ray- partial or
complete lung collapse
 Nursing Management:
Pneumothorax
Assist in intubation
Administer meds as
ordered
Narcotic analgesic
Antibiotics
 Nursing Management:
Pneumothorax
Assist in thoracentesis/ chest
tube thoracostomy
Remove air- insert at 2nd-3rd
ICS
Remove fluid- insert laterally
near base, posteriorly at 8th-9th
ICS
Pt position: struggling to a
chair, pt exhales and hold
breath during insertion (under
Thoracentesis
 Nursing Management:
Pneumothorax

Attach tube to water-seal

drainage
Objectives:
To reestablish (-) pressure
in the lungs
To promote lung expansion
To drain air, fluid and blood
and to prevent it reflux
Nursing Management: Water
Seal Drainage

Monitor VS, I/O, breath

sounds
DBE
Administer meds as
ordered
Maintain strict asepsis
Nursing Management: Water
Seal Drainage

Prepare at bedside:
vaselinized gauze
Hemostan clamp
Extra bottle with water
Nursing Management: Water
Seal Drainage
Monitor for oscillation and fluctuation
N- (+) intermittent bubbling, ↑ with
inspiration, ↓ expiration
Check for leakage
If (-) bubbling: check for kinks,
obstruction- milk towards drainage
bottle, or lungs are fully expanded
Water Seal Drainage
Nursing Management: Water
Seal Drainage
3 parameters to remove
chest tube
(-) bubbling/fluctuations
(+) symmetrical breath
sounds
Chest X-ray confirms full
lung expansion
 Nursing Management: Water
Seal Drainage
Before, During and After Removal
of Chest Tube
Encourage DBE
Monitor VS, breath sounds
Give analgesic prior to removal
Instruct pt to perform Valsalva
maneuver for easy removal and to
prevent air entry to pleural space
Apply vaselinized occlusive
dressing, WOF bleeding
 PLEURAL EFFUSION
Collection of fluid in the pleural
space
S/Sx
Pleuritic pain that is sharp & ↑ with
inspiration
Dyspnea on exertion
Dry, nonproductive cough caused by
bronchial irritation or mediastinal shift
↑HR, ↑T
↓ breath sounds
CXR: confirms the dx & shows
mediastinal shift
 PLEURAL EFFUSION
Interventions
Identify & tx the
underlying cause
Monitor breath sounds
High Fowler’s position
Coughing & DBE
Prepare the pt for
thoracentesis
 PLEURAL EFFUSION
Interventions
If recurrent, prepare the pt for:
Pleurectomy: surgically stripping
parietal away from visceral
pleura to promote adhesion of
the 2 layers during healing
Pleurodesis: instilling sclerosing
substance into pleural space via
thoracotomy tube
 EMPYEMA
Collection of pus in the
pleural cavity (thick, opaque,
foul-smelling)
Causes: pulmonary infection,
lung abscess due to thoracic
surgery or chest trauma
Goal of tx: emptying
empyema cavity,
reexpanding the lung,
 EMPYEMA
S/Sx of infection + ↓ chest
wall mov’t & pleural exudate
on CXR
Interventions
Semi or High Fowler’s position
Monitor breath sounds
Coughing and DBE
Splint the chest if in pain
Antibiotics as ordered
 EMPYEMA
Interventions
Assist in chest tube
insertion
If (+) marked pleural
thickening, prepare the pt
for Decortication: surgical
removal of restrictive
mass of fibrin &
inflammatory cells
 PLEURISY
Inflammation of the visceral
& parietal pleura, rubbing
together during breathing
causing pain
May be caused by pulmonary
infarction or pneumonia
Usually occurs on one side of
the chest (lower lateral
portion)
 PLEURISY
S/Sx
Knifelike pain
aggravated by deep
breathing & coughing
Dyspnea
Pleural friction rub on
auscultation
Apprehension
 PLEURISY
Interventions
Identify and tx the cause
Monitor breath sounds
Hot or cold applications as
ordered
Encourage coughing & DBE
Lie on affected side to splint
the chest
Analgesics as ordered
 ACUTE RESPIRATORY
DISTRESS SYNDROME
A form of acute respiratory
failure as a complication of other
condition, caused by diffuse lung
injury→ extravascular lung fluid
→compression of terminal
airways → ↓ lung vol. &
compliance
ABG= resp. acidosis &
hypoxemia not responding to ↑
O2 concentration
CXR= interstitial edema
 ACUTE RESPIRATORY
DISTRESS SYNDROME
Predisposing factors
Sepsis
Fluid overload
Shock
Trauma
Neuro injuries
Burns
DIC
Drug ingestion
Toxic substance inhalation
 ACUTE RESPIRATORY
DISTRESS SYNDROME
S/Sx
↑ HR
Dyspnea
↓ breath sounds
Deteriorating blood gas levels
Hypoxemia despite high O2
concentration
↓ pulm. compliance
Pulm. infiltrates
 ACUTE RESPIRATORY
DISTRESS SYNDROME
Interventions
Identify & tx the cause
O2 as ordered
High Fowler’s position
Fluid restriction as ordered
Diurretics, anticoagulants,
corticosteroids as ordered
Prepare for intubation and
mechanical ventilation with
PEEP
MECHANICAL VENTILATION
TYPES
1. Pressure-cycled
The ventilator pushes air into the
lungs until an airway pressure is
reached
Used for short periods (pt in
PACU & for respiratory tx)
2. Time-cycled
With preset time
Used for pedia & neonatal pt
MECHANICAL VENTILATION
3. Volume-cycled
With preset tidal volume that is
delivered regardless of the changing
lung compliance or airway resistance
(from the vent. or from the pt)
4. Microprocessor
Built into the vent. to allow
continuous monitoring of the vent.
functions, alarms & other
parameters
For pt with severe lung disease or
required prolonged weaning
MECHANICAL VENTILATION
MODES
1. Controlled
With set TV & RR
For pt who cannot initiate
respiratory effort
Least used bec. if the pt
attempts to breathe, the
vent. blocks the effort
MECHANICAL VENTILATION
MODES
2. Assist-control
With set TV while allowing the pt
control the RR
Most commonly used
The vent. takes over the work of
breathing for the pt
Responds to pt’s inspiratory effort
If the pt’s spontaneous RR ↑ the
vent. continues to deliver preset
TV→ hyperventilation &
respiratory alkalosis
MECHANICAL VENTILATION
MODES
3. Synchronized Intermittent
Mandatory Ventilation (SIMV)
With set TV and RR while allowing
the pt control own TV & RR in
between the vent. breaths
Used as a primary vent. mode or
as a weaning mode
The no. of SIMV breaths is ↓
gradually until the pt gradually
resumes spont. breathing
MECHANICAL VENTILATION
CONTROLS & SETTINGS
1. TV: vol. of air that the pt
receives with each breath
2. RR: no. of vent. breaths/min
3. Fraction of inspired O2 (FiO2):
O2 concentration delivered to the
pt; determined by pt’s condition &
ABG
4. Sighs: vols. of air 1.5-2X the set
TV, delivered 6-10X/hr, prevents
atelectasis
MECHANICAL VENTILATION
CONTROLS & SETTINGS
5. Peak airway inspiratory
pressure (PIP)
Pressure needed by the
vent. to deliver set TV at a
given compliance
Reflects changes in
compliance of the lungs &
resistance in the vent. or
the pt
MECHANICAL VENTILATION
CONTROLS & SETTINGS
6. Continuous positive airway pressure
(CPAP)
Applied throughout the entire
respiratory cycle for spont. breathing
pt
Keeps the alveoli open during
inspiration & prevents alveolar
collapse
Used primarily as a weaning modality
since no vent. breaths are delivered,
only FiO2
MECHANICAL VENTILATION
CONTROLS & SETTINGS
7. Positive end-expiratory pressure
(PEEP)
Exerted during the expiratory phase
of ventilation
Improves oxygenation by enhancing
gas exchange & preventing
atelectasis
Used in pt with severe gas exchange
disturbance
Higher amounts of PEEP (↑15) ↑ the
chance of Cx: barotrauma tension
MECHANICAL VENTILATION
CONTROLS & SETTINGS
8. Pressure Support
Application of positive pressure
on inspiration
Eases workload of breathing
May be used in combo with PEEP
as a weaning method
 Nursing Interventions:
MECHANICAL VENTILATION
Assess the pt first before the
ventilator
Assess for VS, breath sounds,
respiratory status &
breathing patterns
Monitor skin color, pulse
oximetry, ABG
Suction secretions prn
Assess the ventilator settings
 Nursing Interventions:
MECHANICAL VENTILATION
Check level of water in
humidifier & temp. or
humidification system
Ensure that alarms are set
If cause of alarm cannot be
determine, manually
ventilate the pt
Empty ventilator tubing
when moisture collects
 Nursing Interventions:
MECHANICAL VENTILATION
Weaning: the process of
going from ventilator
dependence to spont.
Breathing
SIMV mode
T-piece
Decreasing PS
 Nursing Interventions:
MECHANICAL VENTILATION
Causes of Alarms
High-Pressure Alarm
↑ secretions
Wheezing, bronchospasm
Displaced, kinked, ET
Excess water in vent. Tubings
Pt. coughs, gags, bites ET
Pt is anxious, fighting the
vent.
 Nursing Interventions:
MECHANICAL VENTILATION
Causes of Alarms
Low-Pressure Alarm
Disconnection or leak in the
ventilator
Busted airway cuff
Pt stops spontaneous
breathing
 Nursing Interventions:
MECHANICAL VENTILATION
WOF Cx
Hupotension r/t (+) pressure
increasing intrathoracic pressure
Pneumothorax
SQ emphysema
Stress ulcers
Malnutrition
Infection
Muscular atrophy
Ventilator dependence, inability
to wean
CGFNS/NCLEX Question
A pt in the ER department has
multiple fractured ribs and R-
sided tension pneumothorax. The
RN should expect to prepare the
pt for which of the following
procedures?
A. Electrocardiography
B. Urinary catheter placement
C. Chest tube insertion
D. Gastric lavage
CGFNS/NCLEX Question
A pt with asthma is producing
thick, white secretions. Which of
the following nursing measures
would be most appropriate for the
RN to include in her plan of care?
A. increase fluid intake
B. promote exercise
C. administer O2
D. encourage coughing
CGFNS/NCLEX Question
A RN education a pt on the correct
use of metered dose inhaler should
instruct the pt to
A. take several short shallow
breaths before inhaling
B. hold breath after inhaling the
drug
C. cough before inhaling the drug
D. press the cartridge down
before inhaling the drug
CGFNS/NCLEX Question
The MD orders a corticosteroid inhaler 4
puffs BID for a pt with asthma. Which of
the following actions by the pt should
indicate to the RN that the pt needs
further teaching?
A. taking 4 puffs in rapid succession
B. pausing for 1-2 mins. in between
puffs
C. rinsing the mouth with water after
inhaling
D. inhaling meds slowly
CGFNS/NCLEX Question
A pt who has asthma is given
instructions about the use of
inhalant meds. Which of the
following statements, if
made by the pt, indicates
that the pt understands the
instructions?
CGFNS/NCLEX Question
A. “I will use the steroid inhaler
1 hr before I use the
brochodilator.”
B. “I will use the bronchodilator
before I use the steroid inhaler.”
C. “I need to take these meds 1
hr after each meal.”
D. “I need to alternate the
sequence of inhaler
administration.”
CGFNS/NCLEX Question
An asthmatic pt has orders for all
of the following meds. Which
meds should a RN expect to
prepare when the pt shows signs
of status asthmaticus?
A. Epinephrine (Adrenaline)
B. Theophylline (Theo-Dur)
C. Erythromycin (Robimycin)
D. Cromolyn Sodium (Nasalcrom)
CGFNS/NCLEX Question
Cromolyn Sodium (Intal) is ordered for a
pt who has asthma. A RN would
determine that the pt understands when
to take the med if the pt makes which of
the following statements?
A. “I will use my inhaler after meals.”
B. “I will use my inhaler prior to
exercise.”
C. “I will use my inhaler when I am
having an attack.”
D. “I will use my inhaler after being
outside in cold weather.”
CGFNS/NCLEX Question
Prior to discharging a pt who is asthmatic,
a RN should include which of the following
measures in the teaching plan?
A. Discussing techniques for weight
control while taking steroids
B. Identifying specific environmental
triggers
C. Maintaining school performance
using a home tutor
D. Keeping a record of weekly sputum
testing
CGFNS/NCLEX Question
A RN teaches pursed-lip breathing to a pt
who has COPD. Which of the following
statements indicates the pt understands
the instructions?
A. “I will maintain a supine position
during the exercise.”
B. “I will alternate positions during the
exercises.”
C. “I will exhale for twice as long as I
inhale.”
D. “I will inhale and exhale thru my nose.”