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Chemoreceptors --> located in the medulla, the carotid arteries, and the aorta, detect changes in blood pH, O2, and CO2 levels.

Lung receptors --> located in the lung and chest wall, are sensitive to breathing patterns, lung expansion, lung compliance, airway resistance, and respiratory irritants.

The respiratory center then uses feedback from the chemoreceptors and lung receptors to adjust ventilation.

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Higher risk of Atelectasis!

⬇ Lung expansion & alveolar inflation

Costal cartilage begins to calcify

lungs have less recoil ability

alveoli lose elasticity

⬇ Immune response

⬇ Cardiac function

⬇ Diaphragm strength

exhalation becomes less efficient, which causes air trapping

⬇ Effective cough reflex

difficulty expelling mucus & foreign material

drier mucus membranes

less cilia in airways

Chemoreceptors respond slower - making hypoxia more likely when breathing problems occur

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--> Can be given PO or by inhalation

--> They relax the smooth muscle, opening up the airways

EXAMPLES:

Beta-2 adrenergic agonists (Albuterol)

Anticholinergics (Diphenhydramine -- Benadryl)

Methylxanthine

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Prevent inflammation in the airways.

Important in treating and controlling respiratory conditions like asthma .

EXAMPLES:

Corticosteroids

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Relieve stuffy, blocked nasal passages by constricting local blood vessels

**Can cause elevated blood pressure, tachycardia, and palpitations, especially in those with a history of cardiovascular conditions

EXAMPLES:

Ephedrine

Pseudoephedrine (Sudafed)

Phenylephrine

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Prevent histamine release during an allergic reaction

Used to treat upper respiratory and nasal allergy symptoms

EXAMPLES:

Benadryl

Dramamine

Zyrtec

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Antitussives (cough suppressants)

Expectorants help make coughing more productive

The goal is to reduce the frequency of dry, unproductive coughing while making voluntary coughing more productive

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Hypoxemia—Low Arterial Blood Oxygen Levels

Hypoxia—Inadequate Oxygenation of Organs and Tissues

Hypercarbia (Hypercapnia)—An Excess of Dissolved CO2 in the Blood (Hypoventilation)

Hypocarbia (Hypocapnia)—A Low Level of Dissolved CO2 in the Blood (Hyperventilation)

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Structural Abnormalities - include anything that restricts or limits the free movement of the chest wall (i.e. fractured ribs), interruptions that inhibit inflation of the lungs (i.e. pneumothorax), or a collection of fluid (blood, lymph, pus) in the pleural space.

Airway Inflammation and Obstruction - Allergic reactions or irritation from smoke or other irritants (asthma) may cause airway inflammation. Obstruction due to a mechanical reason, or due to a foreign body, or spasm (laryngospasm)

Alveolar–Capillary Membrane Disorders - A change in the consistency of the lung tissue. The alveoli become stiff and difficult to ventilate, and gas exchange is impaired. Examples include pulmonary edema, acute respiratory distress syndrome (ARDS), and pulmonary fibrosis.

Atelectasis - Anything that reduces ventilation (tumor, obstructed airway) can cause atelectasis, or alveolar collapse

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If the patient is short of breath, provide an overbed table to lean forward on. If patient is a fall risk, you can put patient in high-fowler's position (90 degree angle) in bed. Patients with impaired respiratory function adopt a tripod position to allow maximum expansion. They may need to rest their arms on an overbed table.

When the patient is lying on her side, provide pillows to support the upper arm.

Assist with frequent position changes to keep all areas of the lungs well ventilated, and ambulate as often as possible without creating fatigue

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Teach deep breathing and coughing!!

Example: Treating and preventing pneumonia or post op pneumonia

Maintain hydration to keep pulmonary fluids thin!!

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O2 delivered at 1-6L (low flow)

Humidification can be added at 4L and above to prevent drying of membranes

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Fit snug over mouth and nose, with a metal piece to adjust to nose.

5-10L

Can be uncomfortable and confining for patients, also creates a barrier for communication, eating, and obstructs coughing.

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Simple mask w reservoir bag

Must inflate the bag!!

10-15L

Risk of CO2 retention

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Used to deliver a constant concentration of O2

Particularly useful for patients with COPD, can prevent hypercapnia

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An infection in the lungs caused by bacteria, viruses, and fungi. Pneumonia has a mortality rate of 50% in adults over 65 years old.

3 types of Pneumonia: Bacterial, viral, chemical, or foreign body

Risk Factors --> sedentary lifestyle, post operative, comorbidities, patients in the hospital, patients on ventilators, pain (when coughing)

Assessment --> Cough, fatigue, chest pain from coughing, dark/yellow sputum, fever, chills, dyspnea, elevated white blood cell counts, crackles heard when auscultating breath sounds. Lung sounds = diminished/crackles/wheezing

Interventions --> Bronchodilators, antibiotics, push fluids, supplemental O2 PRN, incentive spirometer, sputum culture.

Healthcare-Associated Pneumonia: patients in long term care facilities and who have had a long hospital stay are at higher risk of developing pneumonia.

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Extra, abnormal sounds of breathing

Wheezing- when air passes through swollen, constricted airways. Mucus secretions, edema, caused by allergies or asthma

Crackles- popping high-pitched sounds heard in inspiration. Fluid in longs causes this. Fluid overload, viral/bacteria secretions. Treated with diuretics for fluid overload. An expectorant for viral/bacterial secretions.

Stridor- high pitch; blockage or narrowing of the airways. Heard over the vocal chords.

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Chart the work of breathing, use of accessory muscles, and retractions

Labored breathing

Chest rise and fall. Unequal if atelectasis is present.

Respiratory rhythm, rate, depth (WNL --> 12-20 breaths/min)

Assess vital signs

Note LOC, restlessness early signs of hypoxia; decreased LOC

Capillary refill time, if skin is cyanotic (peripheral early stage, central late-stage). Pallor

Any sputum? What color?

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Inflammatory lung disease

May cause CO2 retention

Assessment

Increased rate & depth of breathing to expel excess CO2

Inhale may be longer then exhale

Orthopnea (cannot lie down & breathe adequately)

Barrel chest

Malnutrition

Depression

Fatigue

It can be acute or chronic

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When addressing the needs of a patient you first want to ensure their airway is secure and intact!!

For example: ensure proper positioning (high fowler's, tripod, head tilt chin lift

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In a patient that is experiencing SOB or low O2 saturation levels; provide patient with O2 if necessary. Promote deep breathing, and coughing (teach patient splinting while coughing if there is pain). Encourage and educate incentive spirometer use.

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Monitor heart rate, blood pressure, and cap refill to assess circulation!

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Wilkinson, J., & Treas, L. (2020). Fundamentals of Nursing: Vol. Volume 1 (4th Edition, pp. 955–994) [Review of Fundamentals of Nursing].

Quizlet Inc. (2024). Quizlet. Quizlet. https://quizlet.com/

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A video created by the American Lung Association.