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Review
The Respiratory System
Nurse Licensure Examination
Review
Outline Of Review Concepts:
Review of the relevant respiratory
anatomy
Review of the relevant respiratory
physiology
The respiratory assessment
Common laboratory examinations
Outline Of Review Concepts:
Review of the common respiratory
problems and the nursing management
Review of common respiratory diseases
Upper respiratory conditions
Lower respiratory conditions
Respiratory Anatomy &
Physiology
The respiratory system consists of two
main parts - the upper and the lower
tracts
Respiratory Anatomy &
Physiology
The UPPER respiratory system consists
of:
1. nose
2. mouth
3. pharynx
4. larynx
Respiratory Anatomy &
Physiology
The LOWER respiratory system
consists of:
1. Trachea
2. Bronchus
3. Bronchioles
4. Respiratory unit
Upper Respiratory Tract
The Nose
This is the first part of the upper
respiratory system that contains nasal
bones and cartilages
There are numerous hairs called
vibrissae
There are numerous superficial blood
vessels in the nasal mucosa
The Nose
The functions of the nose are:
1. To filter the air
2. To humidify the air
3. To aid in phonation
4. Olfaction
The Pharynx
The pharynx is a musculo -
membranous tube that is composed of
three parts
1. Nasopharynx
2. Oropharynx
3. Laryngopharynx
The Pharynx
The pharynx functions :
1. As passageway for both air and
foods (in the oropharynx)
2. To protect the lower airway
The Larynx
Alsocalled the voice box
Made of cartilage and membranes and
connects the pharynx to the trachea
The Larynx
Functions of the larynx:
1. Vocalization
2. Keeps the patency of the upper
airway
3. Protects the lower airway
The Paranasal sinuses
These are four paired bony cavities that
are lined with nasal mucosa and ciliated
pseudostratified columnar epithelium
Named after their location - frontal,
ethmoidal, sphenoidal and maxillary
The Paranasal sinuses
Thefunction of the sinuses:
Resonating chambers in speech
The Lower Respiratory System
The lower respiratory system consists of
1. Trachea
2. Main bronchus
3. Bronchial tree
4. Lungs- 3R/ 2L
The trachea to the terminal bronchioles
is called the conducting airway
The respiratory bronchioles to the
alveoli is called the respiratory acinus
The Trachea
A cartilaginous tube measures 10-12
centimeters
Composed of about 20 C-shaped
cartilages, incomplete posteriorly
The Trachea
The function of the trachea is to
conduct air towards the lungs
The mucosa is lined up with mucus and
cilia to trap particles and carry them
towards the upper airway
The Bronchus
The right and left primary bronchi begin
at the carina
The function is for air passage
The Primary Bronchus
RIGHT BRONCHUS LEFT BRONCHUS
Wider Narrower
Shorter Longer
More Vertical More horizontal
The Bronchioles
The primary bronchus further divides
into secondary, then tertiary then into
bronchioles
The terminal bronchiole is the last part
of the conducting airway
The Respiratory Acinus
The respiratory acinus is the chief
respiratory unit
It consists of
1. Respiratory bronchiole
2. Alveolar duct
3. alveolar sac
The Respiratory Acinus
The respiratory acinus is the chief
respiratory unit
The function of the respiratory acinus is
gas exchange through the respiratory
membrane
The Respiratory Acinus
The respiratory membrane is composed
of two epithelial cells
1.The type 1 pneumocyte - most
abundant, thin and flat. This is where
gas exchange occurs
2. The type 2 pneumocyte - secretes
the lung surfactant
The Respiratory Acinus
A type III pneomocyte is just the
macrophage that ingests foreign
material and acts as an important
defense mechanism
Accessory Structures
The PLEURA
Epithelial serous membrane lining the
lung parenchyma
Composed of two parts- the visceral
and parietal pleurae
The space in between is the pleural
space containing a minute amount of
fluid for lubrication
Accessory Structures
The Thoracic cavity
The chest wall composed of the
sternum and the rib cage
The cavity is separated by the
diaphragm, the most important
respiratory muscle
Accessory Structures
The Mediastinum
The space between the lungs, which
includes the heart and pericardium, the
aorta and the vena cavae.
GENERAL FUNCTIONS OF THE
Respiratory System
Gas exchange through ventilation,
external respiration and cellular
respiration
Oxygen and carbon dioxide transport
The Assessment
HISTORY
Reason for seeking care
Present illness
Previous illness
Family history
Social history
The Assessment
PHYSICAL EXAMINATION
Skin- cyanosis, pallor
Nail clubbing
Cough and sputum production
Inspect - palpate - percuss - auscultate
the thorax
The Assessment
LABORATORY EXAMINATION
1. ABG analysis
2. Sputum analysis
3. Direct visualization - bronchoscopy
4. Indirect visualization - CXR, CT and
MRI
5. Pulmonary function test
ABG Analysis
This
test helps to evaluate gas
exchange in the lungs by measuring the
gas pressures and pH of an arterial
sample
ABG Analysis
Pre-test: choose site carefully, perform
the Allen’s test, secure equipments-
syringe, needle, container with ice
Intra-test: Obtain a 5 mL specimen from
the artery (brachial, femoral and radial)
Post-test: Apply firm pressure for 5
minutes, label specimen correctly, place
in the container with ice
ABG Analysis
ABG normal values
PaO2 80-100 mmHg
PaCO2 35-45 mmHg
pH 7.35- 7.45
HCO3 22- 26 mEq/L
O2 Sat 95-99%
Sputum Analysis
Thistest analyzes the sample of
sputum to diagnose respiratory
diseases, identify organism, and identify
abnormal cells
Sputum Analysis
Pre-test: Encourage to increase fluid intake
Intra-test: rinse mouth with WATER only,
instruct the patient to take 3 deep breaths
and force a deep cough, steam nebulization,
collect early morning sputum
Post-test: provide oral hygiene, label
specimen correctly
Pulse Oximetry
Non-invasive method of continuously
monitoring the oxygen saturation of
hemoglobin
A sensor or probe is attached to the
earlobe, forehead, fingertip or the
bridge of the nose
Bronchoscopy
A direct inspection of the trachea and
bronchi through a flexible fiber-optic or
a rigid bronchoscope
Done to determine location of
pathologic lesions, to remove foreign
objects, to collect tissue specimen and
remove secretions/aspirated materials
Bronchoscopy
Pre-test: Consent, NPO x 6h, teaching
Intra-test: position supine or sitting upright in
a chair, administer sedative, gag reflex will be
abolished, remove dentures
Post-test: NPO until gag reflex returns,
position SEMI-fowler’s with head turned to
sides, hoarseness is temporary, CXR after
the procedure, keep tracheostomy set and
suction x 24 hours
Thoracentesis
Pleural fluid aspiration for obtaining a
specimen of pleural fluid for analysis,
relief of lung compression and biopsy
specimen collection
Thoracentesis
Pre-test: Consent
Intra-test: position the patient sitting with arms
on a table or side-lying fowler’s, instruct not to
cough, breathe deeply or move
Post-test: position unaffected side to allow
lung expansion of the affected side, CXR
obtained, maintain pressure dressing and
monitor respiratory status
Pulmonary Function Tests
Volume and capacity tests aid
diagnosis in patient with suspected
pulmonary dysfunction
Evaluates ventilatory function
Determines whether obstructive or
restrictive disease
Can be utilized as screening test
Pulmonary Function Test
Lung Volumes
Tidal volume
Inspiratory reserve volume
Expiratory reeve volume
Residual volume
Pulmonary Function Test
Lung capacities
Inspiratory capacity
Vital capacity
Functional residual capacity
Total lung capacity
Pulmonary Function Test
Pre-test: Teaching, no smoking for 3 days,
only light meal 4 hours before the test
Intra-test: position sitting, bronchodilator,
nose-clip and mouthpiece, fatigue and
dyspnea during the test
Post-test: adequate rest periods, loosen tight
clothing
Common Respiratory Problems
and the common interventions
Dyspnea
Breathing difficulty
Associated with many
conditions- CHF, MG, GBS,
Muscular dystrophy,
obstruction, etc…
Dyspnea
General nursing interventions:
1. Fowler’s position to promote
maximum lung expansion and promote
comfort. An alternative position is the
ORTHOPNEIC position
2. O2 usually via nasal cannula
3. Provide comfort and distractions
Cough and sputum production
Cough is a protective reflex
Sputum production has many stimuli
Thick, yellow, green or rust-colored
bacterial pneumonia
Profuse, Pink, frothy pulmonary
edema
Scant, pink-tinged, mucoid Lung
tumor
Cough and sputum production
General nursing Intervention
1. Provide adequate hydration
2. Administer aerosolized solutions
3. advise smoking cessation
4. oral hygiene
Cyanosis
Bluishdiscoloration of the skin
A LATE indicator of hypoxia
Appears when the unoxygenated
hemoglobin is more than 5 grams/dL
Central cyanosis observe color on the
undersurface of tongue and lips
Peripheral cyanosis observe the nail
beds, earlobes
Cyanosis
Interventions:
Check for airway patency
Oxygen therapy
Positioning
Suctioning
Chest physiotherapy
Check for gas poisoning
Measures to increased hemoglobin
Hemoptysis
Expectoration of blood from the
respiratory tract
Common causes: Pulmo infection, Lung
CA, Bronchiectasis, Pulmo emboli
Bleeding from stomach acidic pH,
coffee ground material
Hemoptysis
Interventions:
Keep patent airway
Determine the cause
Suction and oxygen therapy
Administer Fibrin stabilizers like
aminocaproic acid and tranexamic acid
Epistaxis
Bleeding from the nose caused by rupture
of tiny, distended vessels in the mucus
membrane
Most common site- anterior septum
Causes
1. trauma
2. infection
3. Hypertension
4. blood dyscrasias , nasal tumor, cardio
diseases
Epistaxis
Nursing Interventions
1. Position patient: Upright, leaning
forward, tilted prevents swallowing and
aspiration
2. Apply direct pressure. Pinch nose
against the middle septum x 5-10 minutes
3. If unrelieved, administer topical
vasoconstrictors, silver nitrate, gel foams
4. Assist in electrocautery and nasal
packing for posterior bleeding
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections
1. Rhinitis- allergic, non-allergic and
infectious
2. Sinusitis- acute and chronic
3. Pharyngitis- acute and chronic
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections
1. Rhinitis- Assessment findings
Rhinorrhea
Nasal congestion
Nasal itchiness
Sneezing
Headache
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections
2. sinusitis- Assessment findings
Facial pain
Tenderness over the paranasal sinuses
Purulent nasal discharges
Ear pain, headache, dental pain
Decreased sense of smell
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections
3. Pharyngitis- Assessment findings
Fiery-red pharyngeal membrane
White-purple flecked exudates
Enlarged and tender cervical lymph nodes
Fever malaise ,sore throat
Difficulty swallowing
Cough may be absent
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections- Laboratory
tests
1. CBC
2. Culture
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections: Nursing Interventions
1. Maintain Patent Airway
Increase fluid intake to loosen secretions
Utilize room vaporizers or steam inhalation
Administer medications to relieve nasal
congestion
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections: Nursing
Interventions
2. Promote comfort
Administer prescribed analgesics
Administer topical analgesics
Warm gargles for the relief of sore
throat
Provide oral hygiene
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections: Nursing
Interventions
3. Promote communication
Instruct patient to refrain from speaking
as much as possible
Provide writing materials
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infections: Nursing
Interventions
4. Administer prescribed antibiotics
Monitor for possible complications like
meningitis, otitis media, abscess
formation
5. Assist in surgical intervention
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infection: Tonsillitis
Infection and inflammation of the tonsils
Most common organism- Group A- beta
hemolytic streptococcus (GABS)
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infection: Tonsillitis
ASSESSMENT FINDINGS
Sore throat and mouth breathing
Fever
Difficulty swallowing
Enlarged, reddish tonsils
Foul-smelling breath
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infection: Tonsillitis
Laboratory test
1. CBC
2. throat culture
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infection: Tonsillitis
MEDICAL management
1. Antibiotics- penicillin
2. Tonsillectomy for chronic cases and
abscess formation
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infection: Tonsillitis
NURSING INTERVENTION for
tonsillectomy
1. Pre-operative care
Consent
Routine pre-op surgical care
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infection: Tonsillitis
NURSING INTERVENTION for
tonsillectomy
2. POST-operative care
Position: Most comfortable is PRONE,
with head turned to side
Maintain oral airway, until gag reflex
returns
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infection: Tonsillitis
NURSING INTERVENTION for
tonsillectomy
2. POST-operative care
Apply ICE collar to the neck to reduce
edema
Advise patient to refrain from talking and
coughing
Ice chips are given when there is no
bleeding and gag reflex returns
CONDITIONS OF THE UPPER
AIRWAY
Upper airway infection: Tonsillitis
NURSING INTERVENTION for
tonsillectomy
2. POST-operative care
Notify physician if
a. Patient swallows frequently
b. vomiting of large amount of bright red or
dark blood
c. PR increased, restless and Temp is
increased
Laryngeal Cancer
A malignant tumor of the larynx
More frequent in men
50-70 years old
RISK FACTORS
1. Smoking
2. Alcohol
3. Exposure to chemicals
4. Straining of voice
5. chronic laryngitis
6. Deficiency of Riboflavin
7. family history
Laryngeal Cancer
Growth can be anywhere in the larynx
1. Supraglottic- above the vocal cords
2. glottic- vocal cord area
3. infraglottic- below the vocal cords
Hemilaryngectomy
Total laryngectomy
Laryngeal Cancer
NURSING MANAGEMENT: PRE-operative
1. Provide the patient pre-operative
teachings
Clarify misconceptions
Tell that the natural voice will be lost
Teach communication alternatives
Collaborate with other team members
Laryngeal Cancer
NURSING MANAGEMENT
2. reduce patient ANXIETY
Provide opportunities for patient and
family members to ask questions
Referrals to previous patients with
laryngeal cancers and cancer groups
Laryngeal Cancer
NURSING MANAGEMENT: POST-op
3. Maintain PATENT Airway
Position patient: Semi or High Fowler’s
Suction secretions
Encourage to deep breath, turn and cough
Laryngeal Cancer
NURSING MANAGEMENT: POST-op
4. Administer care of the laryngectomy
tube
Suction as needed
Cleanse the stoma with saline
Administer humidified oxygen
Laryngectomy tube is usually removed
within 3-6 weeks after surgery
Laryngeal Cancer
NURSING MANAGEMENT: POST-op
5. Promote alternative communication
methods
Call bell or hand bell
Magic Slate
Hand signals
Collaborate with speech therapist
Laryngeal Cancer
NURSING MANAGEMENT: POST-op
6. Promote adequate Nutrition
NPO after operation
No foods or drinks per orem for 10 days
IVF, TPN are alternative nutrition routes
Start oral feedings with thick liquids, avoid
sweet foods
Laryngeal Cancer
NURSING MANAGEMENT: POST-op
7. Promote positive body image and self-
esteem
Encourage verbalization of feelings
Allow independence in self-care
Laryngeal Cancer
NURSING MANAGEMENT: POST-op
8. Monitor for COMPLICATIONS
Respiratory Distress
Suction
Disequilibrium between
ELASTASE & ANTIELASTASE (alpha-1-antitrypsin)
Exudative effusion:
accumulation of protein rich
fluid
Pleural Effusion
Assessment findings
1. Dyspnea, dullness over affected
area upon percussion, absent or
decreased breath sounds over
affected area, pleural pain, dry
cough, pleural friction rub
2. Pallor, fatigue, fever, and night
sweats (with empyema)
Pleural Effusion
Assessment findings
3. Diagnostic tests
a. Chest x-ray positive if greater than
250 cc pleural fluid
b. Pleural biopsy may reveal
bronchogenic carcinoma
c. Thoracentesis may contain blood if
cause is cancer, pulmonary infarction,
or tuberculosis; positive for specific
organism in empyema.
Pleural Effusion
Nursing interventions: In general:
1. Assist with repeated thoracentesis.
2. Administer narcotics/sedatives as
ordered to decrease pain.
3. Assist with instillation of medication
into pleural space (reposition client every
15 minutes to distribute the drug within
the pleurae).
4. Place client in high-Fowler’s position to
promote ventilation.
Pleural Effusion
Medical management
1. Identification and treatment of the
Underlying cause
2. Thoracentesis
3. Drug therapy
a. Antibiotics: either systemic or inserted
directly into pleural space
b. Fibrinolytic enzymes: trypsin,
streptokinase-. streptodornase to decrease
thickness of pus and dissolve fibrin clots
4. Closed chest drainage
5. Surgery: open drainage
Pneumonia
An inflammation of the alveolar spaces
of the lung, resulting in
consolidation of lung tissue as the
alveoli fill with exudates
The various types of pneumonias are
classified according to the offending
organism.
Pneumonia can also be classified as
COMMUNITY Acquired Pneumonia
(CAP) and Hospital acquired
pneumonia (HAP)
Pneumonia
PATHOPHYSIOLOGIC FINDINGS ARE:
HYPERTROPHY OF MUCOUS
MEMBRANE
Increased sputum production
Wheezing
Dyspnea
Cough
Rales
Ronchi
Pneumonia
PATHOPHYSIOLOGIC FINDINGS ARE:
INCREASED CAPILLARY
PERMEABILITY
Increased Fluid Exudation
Consolidation-tissue that solidifies as a
result of collapsed alveoli
Hypoxemia
Pneumonia
PATHOPHYSIOLOGIC FINDINGS ARE:
INFLAMMATION OF THE PLEURA
Chest pain
Pleural effusion
Dullness
Decreased Breath sounds
Increased tactile fremitus
Pneumonia
PATHOPHYSIOLOGIC FINDINGS ARE:
HYPOVENTILATION
Decreased Chest expansion
Respiratory acidosis
FACTORS:
Possibly caused by inhaled carcinogens
(primarily cigarette smoke but also
asbestos, nickel, iron oxides, air silicone
pollution; preexisting pulmonary disorders
PTB, COPD)
Lung Cancer
Assessment findings
Persistent cough (may be productive
or blood tinged)
chest pain
dyspnea
unilateral wheezing, friction rub,
possible unilateral paralysis of the
diaphragm
Fatigue, anorexia, nausea, vomiting,
pallor
Lung Cancer
Diagnostic tests.
a. Chest x-ray may show presence of tumor or
evidence of metastasis to surrounding
structures
b. Sputum for cytology reveals malignant cells
c. Bronchoscopy: biopsy reveals malignancy
d. Thoracentesis: pleural fluid contains
malignant cells
e. Biopsy of lymph nodes may reveal
metastasis
Lung Cancer
1. Provide support and guidance to
client as needed.
2. Provide relief/control of pain.
3. Administer medications as ordered
and monitor effects/side effects.
4. Control nausea: administer
medications as ordered, provide good
oral hygiene, provide small and more
frequent feedings.
Lung Cancer
5. Provide nursing care for a client with
a thoracotomy.
6. Provide client teaching and discharge
planning concerning
a. Disease process, diagnostic and
therapeutic interventions
b. Side effects of radiation and
chemotherapy
c. Realistic information about prognosis
Lung Cancer
Medical management
1. Radiation therapy
2. Chemotherapy: usually includes
cyclophosphamide, methotrexate,
vincristine, doxorubicin, and
procarbazine; concurrently in some
combination
3. Surgery: when entire tumor can be
removed
Lung Cancer
Quick Notes on Bronchogenic Cancer
Predisposing factors
Cigarette smoking
Asbestosis
Emphysema
Smoke from burnt wood
Types
Squamous cell Ca- with good prognosis
Adenocarcinoma- with good prognosis
Oat cell Ca- with good prognosis
Undifferentiated Ca- with poor prognosis
Lung Cancer
Quick Notes on Bronchogenic Cancer
Nursing Interventions
Patent airway
O2 / Aerosol therapy
Deep breathing exercises
Relief of pain
Protection from infection
Adequate nutrition
Chest tube management
Lung Cancer
Quick Notes on Bronchogenic Cancer
Surgery
Pneumonectomy=Removal of a lung (either left or
right)
Lobectomy=Removal of a lobe.
Segmentectomy=Removal of a segment.
Wedge resection=Removal of the entire tumor
regardless of the segment.
Decortication=Stripping off of fibrinous membrane
enclosing the lung
Thoracoplasty=Removal of rib/s. Usually done after
pneumonectomy, to reduce the size of the empty
thorax thereby prevent mediastinal shift.
Pulmonary Embolism
This refers to the obstruction of the
pulmonary artery or one of its
branches by a blood clot (thrombus)
that originates somewhere in the
venous system or in the right side of
the heart.
Most commonly, pulmonary
embolism is due to a clot or
thrombus from the deep veins of the
lower legs.
Pulmonary Embolism
Causes
Fat embolism. Air embolism
Multiple trauma
PVD’s
Abdominal surgery
Immobility
Hypercoagulability
Pulmonary Embolism
PATHOPHYSIOLOGY
The thrombus that travels from any
part of the venous system obstructs
either completely or partially. Then
the lungs will have inadequate blood
supply, with resultant increase in
dead space in the lungs
Gas exchange will be impaired or
absent in the involved area
Pulmonary Embolism
PATHOPHYSIOLOGY
The regional pulmonary vasculature
will constrict causing increased
resistance, increased pulmonary
arterial pressure and then increase
workload of the right side of the
heart.
Pulmonary Embolism
PATHOPHYSIOLOGY
When the work of the right side of
the heart exceeds its capacity, right
ventricular failure will result, leading
to a decrease in cardiac output
followed by decreased systemic
perfusion and eventually, SHOCK
Pulmonary Embolism
Assessment
Restlessness (cardinal initial sign)
Dyspnea
Stabbing chest pain
Cyanosis
Tachycardia
Dilated pupils
Apprehension/ fear
Diaphoresis
Dysrhythmias
Hypoxia
Pulmonary Embolism
Diagnostic Tests:
Ventilation-perfusion scan
Pulmonary arteriography
CXR
ECG
ABG
Pulmonary Embolism
Nursing Interventions
Oxygen therapy STAT
Early ambulation postop
Monitor obese patient
Do not massage legs
Relieve pain- analgesics
HOB elevated
Heparin (2 weeks) then Coumadin (3-6
months)
Pulmonary Embolism
Patient Teaching for prevention of
Pulmonary Embolism
Active leg exercises to avoid venous
stasis
Early ambulation
Use of elastic compression stockings
Avoidance of leg-crossing and sitting
for prolonged periods
Drink fluids
Surgical Aspect of Respiratory
Care
Thoracic Surgery
a. Exploratory thoracotomy: anterior or
posterolateral incision through the
fourth, fifth, sixth, or seventh intercostal
spaces to expose and examine the
pleura and lung
Surgical Aspect of Respiratory
Care
Thoracic Surgery
b. Lobectomy: removal of one lobe of a
lung; treatment for bronchiectasis,
bronchogenic carcinoma,
emphysematous blebs, lung abscesses
Surgical Aspect of Respiratory
Care
Thoracic Surgery
c. Pneumonectomy: removal of an
entire lung; most commonly done as
treatment for bronchogenic carcinoma
Surgical Aspect of Respiratory
Care
Thoracic Surgery
d. Segmental resection: removal of one
or more segments of lung; most often
done as treatment for bronchiectasis
Surgical Aspect of Respiratory
Care
Thoracic Surgery
e. Wedge resection: removal of lesions
that occupy only part of a segment of
lung tissue; for excision of small
nodules or to obtain a biopsy
Surgical Aspect of Respiratory
Care
Nursing interventions: PREOPERATIVE
1. Provide routine pre-op care.
2. Perform a complete physical
assessment of the lungs to obtain
baseline data.
3. Explain expected post-op measures:
care of incision site, oxygen, suctioning,
chest tubes (except if pneumonectomy
performed)
Surgical Aspect of Respiratory
Care
Nursing interventions: PREOPERATIVE
4. Teach client adequate splinting of
incision with hands or pillow for
turning, coughing, and deep
breathing.
5. Demonstrate ROM exercises for
affected side.
6. Provide chest physical therapy to
help remove secretions.
Surgical Aspect of Respiratory
Care
Nursing interventions: POSTOPERATIVE
1. Provide routine post-op care.
2. Promote adequate ventilation.
a. Perform complete physical assessment of
lungs and compare with pre-op findings.
b. Auscultate lung fields every 1—2 hours.
c. Encourage turning, coughing, and deep
breathing every 1—2 hours after pain relief
obtained.
Surgical Aspect of Respiratory
Care
Nursing interventions: POSTOPERATIVE
2. Promote adequate ventilation.
d. Perform tracheobronchial suctioning if
needed.
e. Assess for proper maintenance of chest
drainage system (except after
pneumonectomy).
f. Monitor ABGs and report significant
changes.
g. Place client in semi-Fowler’s position
Surgical Aspect of Respiratory
Care
Nursing interventions:
POSTOPERATIVE
If pneumonectomy is performed,
follow surgeon’s orders about
positioning, often on back or
OPERATIVE SIDE
If Lobectomy, patient is usually
positioned on the UNOPERATIVE
SIDE
Surgical Aspect of Respiratory
Care
Nursing interventions: POSTOPERATIVE
3. Provide pain relief.
a. Administer narcotics/analgesics
prior to turning, coughing, and deep
breathing.
b. Assist with splinting while turning,
coughing, deep breathing.
Surgical Aspect of Respiratory
Care
Nursing interventions:
POSTOPERATIVE
4. Provide client teaching and
discharge planning concerning
a. Need to continue with
coughing/deep breathing for 6—8
weeks post-op and to continue ROM
exercises
b. Importance of adequate rest with
gradual increases in activity levels
Surgical Aspect of Respiratory
Care
Nursing interventions: POSTOPERATIVE
4. Provide client teaching and discharge
planning concerning
c. High-protein diet with inclusion of
adequate fluids
d. Chest physical therapy
e. Good oral hygiene
f. Need to avoid persons with known upper
respiratory infection
g. Adverse signs and symptoms
h. Avoidance of crowds and poorly ventilated
areas.