Unit 12 Drugs and Body Systems - Respiratory System
Objectives
1. Identify the major structures and functions of the respiratory system.
2. Describe the mechanisms of breathing.
3. Explain how gases are exchanged in the lungs.
4. List the normal respiratory rate.
S. Describe the major respiratory disorders.
6. List and describe common signs and symptoms of respiratory disorders using correct medical terms.
7. Describe the actions; give examples, nursing care and side effects for these drug groups: antihistamines, decongestants, and bronchodilators.
8. Explain and demonstrate how to administer medication through a meter dose inhaler.
9. Explain and demonstrate how to administer medication using a nasal inhaler. 10. See Appendix - Medication Classification
11. See Performance Evaluation - Drug Card - Sample
12. See Appendix - Inhaler Therapy
13. See Appendix - Nasal Inhaler Therapy
14. See Appendix - Nebulizer Therapy
15. See Appendix - Oxygen Therapy
Refer to your textbook Ch 11
Respiratory system Refer to your textbook pg 270-271.
Video on the respiratory system Click Here
See more about the respiratory system Click Here
Major structures
Nose-warms, moistens and filters inhaled air.
Pharynx (throat)--passageway for air. Shared with the digestive system. Both food and air go through it.
Epiglottis-thin, leaf-shaped structure located in the throat, at the base of the tongue. It covers the larynx during swallowing to prevent food, fluids from entering the airway.
Larynx (voice box)--Contains the vocal cords and makes vocal sounds.
Trachea (wind pipe)--A tube that extends from the larynx to the bronchi. It conveys air to the lungs.
Lungs-main component of the respiratory system. Oxygen and carbon dioxide exchange occur here. There are two lungs, right and left; each is further defined into lobes. The right lung is composed of three lobes. The left lung is composed of two lobes with an indentation for the heart.
Bronchi-two airway branches that carry air to the lungs.
Bronchioles-smaller bronchial tubes that carry air deeper into the lungs into the alveoli.
Alveoli-air sacs of the lungs where gas exchange takes place. Oxygen and carbon dioxide are exchanged from the blood circulation through the walls of the alveoli.
Major functions-the exchange of oxygen from the air with carbon dioxide and water, byproducts of metabolism from the body carried by the blood.
Cells of the body use oxygen for energy and produce carbon dioxide as waste.
Carbon dioxide alerts the brain to trigger inspiration (breathing in of air).
Mechanisms of breathing
Intercostal muscles-muscles around and between the ribs.
Diaphragm- membranous wall separating the abdomen from the chest cavity. Shaped like an upside down bowl.
With each inspiration, it flattens and allows the lungs to fill with air.
It also assists with defecation and parturition (giving birth) because of its ability to cause an increase in intra-abdominal pressure with exhalation.
The diaphragm contracts spasmodically with hiccoughs and sneezes.
Brain-control center for respiration.
As carbon dioxide builds in the blood it triggers the lower mid-brain to stimulate inspiration.
Mucus-sticky fluid secreted by membranes and glands.
Consists of mucin, leukocytes, inorganic salts, water, and epithelial cells.
Its continual production within the lungs helps flush the lungs of various cellular debris upward to the pharynx where it can be coughed up or swallowed.
Rate-of normal respiration is 12 to 25 breaths per minute.
Disorders of the respiratory system Refer to your textbook pg 271-276
Asthma-airway inflammation resulting in airflow obstruction. Symptoms may include wheezing, noisy respirations, breathlessness, shortness of breath and coughing.
May be a part of allergic response.
Molds or pollen may trigger allergic response, which may then lead to an acute "attack”.
Respiratory infection may also trigger an acute episode.
Allergies-inflammatory response to an allergen (may include release of histamine) which may result in a series of responses by the body, including the lining of the lungs.
Swelling of tissues in the lungs may occur. Fluid may build up in the lung tissues causing obstructed air flow.
Some allergens include foods, drugs, animals, insects, pollen, mold or dust.
Is it a common cold or allergies? Watch this video. Click Here
Emphysema-abnormal permanent enlargement of the airspaces at the end of the bronchioles with destruction of the walls of the bronchioles. Interference of the exchange of gases occurs.
These physical changes are one way the lung reacts to damage.
Symptoms include shortness of breath, cough and unequal or enlarged chest expansion.
Workplace exposure to toxins can also contribute to lung damage, leading to emphysema.
Major cause of emphysema is chronic tobacco/cigarette smoking.
What is emphysema? Watch this video to find out more. ClickHere
Bronchitis-inflammatory response of the bronchi, a specific structural part of the anatomy of the lungs.
D Usually an acute bronchitis is the result of infection producing increased mucus in the bronchi leading to difficulty breathing, wheezing, and coughing.
D Chronic bronchitis may be an ongoing response to allergens, toxins, or infections.
COPD (chronic obstructive pulmonary disease)-a progressive and irreversible condition characterized by impaired function of the respiratory tract due to damage to the lungs. Often emphysema and COPD are used interchangeably.
May result from chronic bronchitis, asthma, and emphysema.
Pneumonia-an acute infection of the lung including alveolar spaces and interstitial tissue.
Fluid may accumulate leading to inadequate air exchange.
All five lobes of the lung may be involved or infection may locate in a particular lobe.
What is pneumonia? Watch to find out more: Click Here
Additional Terminology
Sputum-substance expelled by coughing which contains cellular debris, mucus, blood, pus and microorganisms.
Hemoptysis-blood in sputum.
Hoarseness-a roughness of the voice usually due to irritation of vocal chords.
Coughing-forceful expiratory effort, sometimes violently forceful. Mayor may not produce sputum.
Dyspnea-shortness of breath or difficulty breathing
Orthopnea-difficulty breathing deeply unless sitting or standing. Seen in disorders such as asthma, emphysema, and pneumonia.
Related medications and treatments: Refer to your textbook pg 276-282
Antihistamines-relieve allergy symptoms such as runny nose, itchy watery eyes and sneezing. Drugs work against the effects of histamine. Dry the respiratory mucosa. Not always helpful if secretions are present, especially if they are thick and difficult to expectorate. Classification-anticholinergic. Refer to your textbook pg 277
Examples:
Azatadine (Optimine, Trinalin Repetabs)
Loratadine (Claritin)
Nursing care and side effects:
Balance intake and output, assure adequate fluids.
Watch for urinary retention, frequency, and dysuria. Immediately report to supervising licensed nurse if any of these symptoms occur.
May cause heart irregularity, palpitations, increased pulse, and hypotension.
Some medications may be given with food or milk to decrease GI upset. Others must be given on empty stomach.
Photosensitivity may occur. Protect from sunburn.
Decongestants-reduce nasal obstruction, swelling and drainage by shrinking blood vessels in the mucous membranes. Refer to your textbook pg277
Most helpful with dry, hacking, non-productive coughs.
May contain a narcotic.
If narcotic ingredient, side effects may include drowsiness, sedation, dizziness.
Gastric upset may occur.
Respiratory depression can occur with narcotic anti-tussives.
Urinary retention (watch intake/output ratio).
Rash may occur as early indicator of allergic reaction.
Safety measures to guard against falls, injury.
Expectorants-liquefy and loosen mucus making it easier to cough and expel sputum.
Example:
Guaifenesin (Benylin E, Duratuss-G, Humibid, Naldecon Senior EX, Unitussin)
Nursing care and side effects:
Adequate hydration is critical for helping thin secretions for expulsion.
Increase fluid intake for resident taking expectorant.
May cause nausea, decreased appetite.
Bronchodilators-increase the opening of the bronchi allowing more airflow to occur. The bronchioles relax and expand. Helpful in preventing and treating broncho-constriction associated with asthma, bronchitis and emphysema. Refer to your textbook pg 278
Example:
Albuterol (Proventil, Ventolin, Ventodisk)
Nursing care and side effects:
If given orally, may cause gastric upset. Give with meals or food.
Limit other stimulants such as caffeine, nicotine which can add to feeling of 'jitteriness."
Inhalation therapies-medication is delivered directly into the lungs. Resident inhales medication through mouth or nose (nasal inhaler only). Delivered by mechanical device, or pressured container that uses propellant. See Appendices.
Nursing care and side effects: Refer to your textbook pg 279
Medications used in inhalation therapies (primarily bronchodilators) may cause increased pulse rate, a feeling of “bounding" or "pounding"heart" beats.
Monitor heart rate carefully.
Use may be contraindicated in residents with cardiac arrhythmias.
Residents may be uncomfortable with and unfamiliar with how an inhaler, nebulizer works. If resident is alert and oriented, demonstrate the equipment, let him/her hold or handle the inhaler first to become familiar and comfortable. Prepare the resident for any bitter taste, burst of aerosol, mist, or other sensation that may be expected.
Spacers may be helpful for resident. Supervising licensed nurse should check with pharmacist.
Pay close attention to your textbook pg 284-286 regarding Representative Drugs for the Respiratory System
Also read the in your textbook pg 287-289 the practice procedure for instilling medications into the bladder.
Unit 12
Delivered by mechanical device, or pressured container that uses propellant. See Appendices.