CONCEPT OF OXYGENATION

CONCEPT OF
OXYGENATION
BY: ROMMEL LUIS C. ISRAEL III
1

OBJECTIVES
•Review the structure and function of
the respiratory function.
•Describe the process of ventilation
and respiration.
•Explain the role and function of the
respiratory system in transporting
oxygen and carbon dioxide to and
from body tissues
2

• Identify factors influencing respiratory function.
• Identify common manifestations of impaired
respiratory function
• Identify and describe nursing measures to
promote respiratory function and oxygenation.
• Explain the use of therapeutic measures such as
medications, inhalation therapy, oxygen therapy,
artificial airways and chest drainage to promote
respiratory function
3

•The concept of oxygenation
is a dynamic one that
involves the transportation of
oxygen to blood cells and
removal of carbon dioxide.
4

•When atmospheric oxygen is
taken into the lungs, it is
picked-up by the blood and
transported to the cellular levels
through a network of blood
vessels.
5

• The heart pumps
that moves the
blood thru the
lungs where
oxygen and
carbon dioxide are
exchanged.
6

•The oxygenated
blood returns to
the lungs and to
the body tissues
7

OXYGEN
•Clear, odorless gas that constitutes
approximately 21% of the air we
breathe
•Absence of oxygen can lead to
DEATH.
8

RESPIRATION
•The process of gas exchange
between the individual and
the environment.
9

2 COMPONENTS OF
RESPIRATION
• Pulmonary ventilation or breathing; the
movement of air between the
atmosphere and the alveoli of the lung
• Diffusion of oxygen and carbon dioxide
between the alveoli and pulmonary
capillaries.
10

STRUCTURE OF
RESPIRATORY SYSTEM
11

UPPER RESPIRATORY
SYSTEM
• Or the upper tract
• Or upper airway
• Warms and filters inspired
air so that the lower
respiratory tract (the lungs)
can accomplish gas
exchange.
12

NOSE
• Composed of external and internal portion.
• External portion protrudes from the face
and is supported by the nasal bones and
cartilage.
• Anterior nares (nostrils) are the external
openings of the nasal cavities.
13

• Internal portion of the nose is a hollow cavity
separated into left and right nasal cavities by a
narrow vertical divider, the SEPTUM.
• Each nasal cavity is divided into three passageways
by the projections of the turbinates (CONCHAE)
from the lateral walls.
• Nasal cavities are lined with highly vascular ciliated
mucus membranes called NASAL MUCOSA.
14

• The nose serves:
• as a passageway for air to pass to and
from the lungs
• Filters impurities
• Humidifies the air
• Warms the air
• Responsible for olfaction (smell) because
olfactory nerves are located in nasal
mucosa
15

PARANASAL SINUSES
• Are named by their location
• Frontal
• Ethmoidal
• Sphenoidal
• Maxillary
• Its prominent function is to serve as a
RESONATING CHAMBER IN SPEECH.
16

•Common site
for infection.
•It traps
particles.
17

PHARYNX
•Or THROAT
•Tube-like structure that connects the
nasal and oral cavities to the larynx.
•Functions as the PASSAGEWAY FOR
THE RESPIRATORY AND DIGESTIVE
TRACTS
18

LARYNX
•Known as the “VOICE BOX”
•Major function: VOCALIZATION
•Protects the lower airway from
foreign substances and facilitates
coughing.
19

• Consists of:
• Epiglottis – covers the opening to the larynx
during swallowing
• Glottis – opening between the vocal cords in
the larynx
• Thyroid cartilage – largest of the cartilage
structures, forms the ADAM’S APPLE
• Vocal cords – ligaments controlled by
muscular movements that produce sounds
20

TRACHEA
•Or “WINDPIPE”
•Serves as the passage between
the larynx and the bronchi
21

LOWER RESPIRATORY
SYSTEM
22

LUNGS
•Paired elastic structures enclosed in
thoracic cage
•Composed of 3 lobes on right side
and 2 lobes on left side
•Covered by PLEURA
23

PLEURA
• Serous membrane
that lines the lungs
and wall of thorax
• Visceral pleura-
covers the lungs
• Parietal pleura-
lines the thorax
24

PLEURAL FLUID
•Serves to lubricate the thorax
and lungs and permit smooth
motion of the lungs within the
thoracic cavity with each
breath.
25

BRONCHI AND
BRONCHIOLES
• They are formed by
branching if trachea
• Right main
bronchus – larger
and more vertical
than left
26

•Bronchioles
branch into
terminal
bronchioles
which end in
alveoli
27

ALVEOLI
• Arranged in clusters
• Site for GAS
EXCHANGE
• SURFACTANT-
reduces surface
tension to keep
alveoli from
collapsing
28

FUNCTION OF THE
RESPIRATORY SYSTEM
29

• The cells of the body derive energy they need
from the oxidation of carbohydrates, fats and
proteins.
• Certain vital tissues, such as those of the brain
and heart, cannot survive for long without a
continuing supply of oxygen.
• As a result of oxidation in the body tissues,
carbon dioxide is produced and must be removed
from cells to prevent build-up of acid wastes.
30

OXYGEN TRANSPORT
•Oxygen is supplied to, and carbon
dioxide is removed from, cells by way
of circulating blood.
•Cells are in close contact with
capillaries, whose thin walls permit
easy passage or exchange of oxygen
and carbon dioxide.
31

• Oxygen diffuses from the capillary through
the capillary wall to the interstitial fluid.
• At this point, it diffuses through the
membrane of tissue cells, where it is used
by mitochondria for cellular respiration.
• The movement of carbon dioxide occurs by
diffusion in the opposite direction – from
cell to blood.
32

33

RESPIRATION
•The whole process of gas exchange
between the atmospheric air and the
blood and between the blood and
cells of the body
•After tissue capillary exchanges, blood
enters the systemic veins (where it is
called VENOUS BLOOD)
34

•The oxygen concentration in blood
within the capillaries of the lungs is
lower that in the lungs’ air sacs
(alveoli). Therefore, oxygen diffuses
from the alveoli to the blood.
•Carbon dioxide, which has the higher
concentration in the blood than in the
alveoli, diffuses from the blood into
the alveoli.
35

•Movement of air in and out of the
airways (ventilation) continually
replenishes the oxygen and removes
the carbon dioxide from the airways in
the lung.
36

VENTILATION
• Movement of air in and out of the lungs
• Adequate ventilation depends on several factors:
• Clear airways
• An intact CNS and respiratory center
• An intact thoracic cavity capable of expanding
and contracting
• Adequate pulmonary compliance and recoil
37

• 2 PHASES:
• Inspiration – involves the contraction and
descent of the chest is increased and the
pressure in the air passages and alveoli
decreases, secreting sub-atmospheric pressure
so that air goes into the respiratory area until
the pressure gradient is equalized.
• Expiration – a passive process that results in
the expulsion of air when the components of
the thoracic cage relax.
38

•Physical factors that govern the air
flow in and out of the lungs are
collectively referred to as the
mechanics of ventilation and includes
•Muscle structure
•Interpleural pressure
•Lung compliance
•Airway resistance
39

MUSCLE STRUCTURE
•Muscle bundles that influence
respiration:
•Intercostal muscles
•Anterior neck muscles such as
Scalene, sternocleidomastoid
•Muscles of abdomen
40

INTRAPLEURAL PRESSURE
•Pressure in the pleural cavity
surrounding the lungs
•Always slightly negative in
relation to atmospheric pressure
•INTRAPULMONARY PRESSURE
(pressure within the lungs)
41

LUNG COMPLIANCE
• Is the measure of the elasticity,
expandability and distensibility of the lungs
and thoracic structures
• Factors that determine lung compliance are
the SURFACE TENSION of the ALVEOLI
(normally low with the presence of
surfactant) and the connective tissue
(collagen and elastin) of the lungs.
42

• Determined by examining the volume-
pressure relationship in the lungs and the
thorax.
• NORMALLY, the lungs and thorax easily
stretch and distend when pressure is
applied.
• HIGH or increased compliance occurs when
the lungs have lost their elasticity and the
thorax is overdistended.
43

•When lungs and thorax are “stiff”,
there is LOW or decreased
compliance.
•Conditions associated with this
include pneumothorax,
hemothorax, pleural effusion,
pulmonary edema, atelectasis,
pulmonary fibrosis and ARDS.
44

AIRWAY RESISTANCE
•Refers to the relationship
between airflow and pleural
pressure
45

REQUIREMENTS FOR EFFECTIVE
VENTILATION
•Patent airway
•Elastic, expansible lungs and
tracheo-bronchial tree
•Adequate musculo-skeletal
apparatus of chest wall
46

47

48

FACTORS AFFECTING
RESPIRATORY FUNCTION
49

AGE
• At birth, fluid-filled lungs drain, partial
pressure of carbon dioxide rises, neonate
takes a first breath.
• Lungs reaches full inflation by 2 weeks of
age
• Changes of aging that affect the
respiratory system are infection, physical or
emotional stress, surgery, anesthesia and
other procedures
50

•Respiratory rates are HIGHEST and
mist variable in NEWBORNS.
• Because of rib cage structure, infants
rely almost exclusively on
DIAPHRAGMATIC MOVEMENT for
breathing.
51

CHANGES IN ELDERLY
• Chest wall and airways become more rigid and
less elastic
• The amount of exchanged air is decreased
• The cough reflex and cilia action are decreased
• Mucus membranes become drier and more
fragile
• Decrease in muscle strength and endurance
52

• If osteoporosis is present, adequate lung
expansion may be compromised.
• A decrease in efficiency on the immune
system occurs.
• Gastroesophageal reflux disease is more
common in older adults and increases the
risk of aspiration. The aspiration of
stomach contents into the lungs often
causes bronchospasm by setting up an
inflammatory response.
53

ENVIRONMENT
LIFESTYLE
HEALTH STATUS
MEDICATIONS
STRESS
54

PHYSICAL ASSESSMENT
AND
HEALTH HISTORY
55

• The health history focuses on the physical and
functional problems of the patient and the effect
on these problems on his or her life.
• Reason patient is seeking health care is often
related to:
• Dyspnea
• Pain
• Accumulation of mucus
• Wheezing
• Hemoptysis
• Edema of ankles and feet
• Cough
• Fatigue and weakness
56

SUBJECTIVE DATA
• ASSESSMENT INTERVIEW
• Have you noticed any changes in your
breathing pattern?
• If so, which of your activities might cause these
symptoms?
• How many pillows do you use to sleep at
night?
• Have you had any medical conditions
experienced before?
57

• How frequently have these occurred? How
long did they last? And how were they
treated?
• Do you smoke? If so, how much?
• Does any of our family member smoke?
• Do you use alcohol? If so, how many drinks
do you usually have per day or per week
• Describe your exercise patterns.
58

• How often and how much do you cough?
• Is it productive, accompanied by sputum or
non productive cough?
• When is the sputum produced?
• What is the amount, color, thickness, odor?
• Is it tinged with blood?
• Ask for any occurrence of chest pain, risk
factors and medication history
59

OBJECTIVE DATA
• Major signs and symptoms of respiratory disease are:
• Dyspnea
• Cough
• Sputum production
• Chest pain
• Wheezing
• Clubbing of the fingers
• Hemoptysis
• Cyanosis
60

DYSPNEA
• Difficult or labored breathing
• Shortness of breath
• A common symptom to many pulmonary
and cardiac disorders.
• Right ventricle of the heart will be affected
ultimately by lung disease because it must
pump blood through the lungs against
greater resistance.
61

CLINICAL SIGNIFICANCE
• Sudden dyspnea in HEALTHY PERSON may
indicate pneumothorax or ARDS.
• In IMMOBILIZED PATIENTS, sudden dyspnea
may denote pulmonary embolism.
• ORTHOPNEA (inability to breathe easily
except in an upright position) may be found
in patients with COPD
62

•NOISY BREATHING may result from
a narrowing of the airway or
localized obstruction of a major
bronchus by a tumor or foreign
body.
•Wheezing usually signifies asthma.
63

RELIEF MEASURES
• The management of dyspnea is aimed at
identifying and correcting its cause.
• Relief of the symptom sometimes is
achieved by placing the patient at rest with
the head elevated (high Fowler’s position).
• In severe cases, administering oxygen.
64

COUGH
•Results from irritation of the
mucus membranes anywhere in
the respiratory tract.
•Patient’s chief protection against
the accumulation of secretions in
the bronchi and bronchioles.
65

CLINICAL SIGNIFICANCE
•May indicate serious pulmonary
diseases.
•The nurse needs to evaluate the
character of the cough – dry, hacking,
brassy, wheezing, loose or severe.
• Time of coughing is also noted.
66

•DRY & IRRITANT COUGH –
characteristic of an upper respiratory
tract infection of viral origin.
•LARYNGOTRACHEITIS – causes an
irritative, high-pitched cough.
•TRACHEAL LESIONS – produce a
brassy cough
•BRONCHOGENIC CARCINOMA –
severe and changing cough
67

TRACHEAL LESIONS
68

•Coughing at NIGHT may herald the
onset of LEFT-SIDED HEART
FAILURE or BRONCHIAL ASTHMA.
•Cough in MORNING WITH SPUTUM
PRODUCTION may indicate
BRONCHITIS.
69

BRONCHIAL ASTHMA
70

BRONCHITIS
71

•A cough that worsens when the
patient is SUPINE suggests
SINUSITIS (postnasal drip).
•Coughing AFTER food intake may
indicate aspiration of material into
tracheo-bronchial tree.
72

SPUTUM
PRODUCTION
•The color of sputum or phlegm,
which is the mucus and sometimes
pus discharge expectorated from the
respiratory tract, is often an
indication of the type of respiratory
disease that gives rise to sputum
production.
73

•By examining the type of sputum and
noting the color as well as the
presenting signs and symptoms, a
differential diagnosis may be reached
prior to laboratory tests and
examination (sputum culture).
•A thorough case history and complete
physical examination is also necessary.
74

MEANING OF DIFFERENT
SPUTUM COLORS
75

CLEAR, WHITE, GRAY
SPUTUM
•Clear sputum is considered as normal,
however, there are many conditions
that may cause excessive sputum
production.
•A profuse amount of clear sputum
should therefore be considered as
abnormal.
76

•Pulmonary edema (fluid in the lungs) –
clear, white or pink frothy sputum
•Viral respiratory tract infections – clear
to white (acute)
•Chronic bronchitis (COPD) – clear to
gray
•Asthma – white to yellow (thick)
77

CHRONIC BRONCHITIS
78

CHRONIC BRONCHITIS
79

YELLOW SPUTUM
•Yellow colored sputum is due to the
presence of white blood cells,
particularly neutrophils and
eosinophils.
•These cells are often present in chronic
inflammation, allergic and infectious
causes.
80

•With INFECTIONS, it is often in the
acute setting that yellow sputum is
evident due to the presence of live
neutrophils.
•With ALLERGIC CONDITIONS,
particularly airway hypersensitivity,
the yellowish sputum is due to the
presence of eosinophils.
81

Acute bronchitis – white to yellow
Acute pneumonia – white to yellow
Asthma – white to yellow (thick)
82

GREEN SPUTUM
•Green mucus is indicative of a long-
standing, possibly chronic, infection.
•The color is a result of the breakdown
of neutrophils and the release of
verdoperioxidase / myeloperioxidase,
an enzyme that is present within these
cells.
83

• It may also be seen in long standing non-
infectious inflammatory conditions.
• With infections, the green sputum will be
more purulent (large amounts of pus).
• While in non-infectious inflammatory
conditions, the green sputum will be more
mucoid (large amounts of mucus).
84

•Pneumonia – white, yellow or green
•Lung abscess – green, sudden
accumulation of large amount of
sputum if the abscess ruptures
•Chronic bronchitis – clear, grey to
green (infection)
•Bronchiectasis, cystic fibrosis – green
85

LUNG ABCESS
86

BRONCHIECTASIS
87

BROWN, BLACK SPUTUM
• Brown or black sputum is an indication of
‘old blood’ and the color may be due to the
breakdown of red blood cells thereby
releasing hemosiderin (from hemoglobin).
• Certain organic and non-organic dusts may
also cause a brown to black discoloration of
the sputum.
88

•Chronic bronchitis – green, yellow,
brown (infection)
•Chronic pneumonia – white, yellow,
green to brown
•Coal worker’s pneumoconiosis –
brown to black
•Tuberculosis – red to brown or black
•Lung cancer – red to brown to black
89

COAL WORKER’S PNEUMOCONIOSIS
• SIMPLE COAL WORKER’S
PNEUMOCONIOSIS
• PROGRESSIVE FIBROSIS COAL
WORKER’S PNEUMOCONIOSIS
90

RED, PINK RUST-COLORED
SPUTUM
•Red sputum is usually an indication of
whole blood that is more profuse than
bleeding in pink colored sputum.
•It may completely discolor the mucus
or appear as streaks or spots.
91

•Pink sputum is also a sign of bleeding
but usually of smaller quantities that
may stain or streak the sputum.
•Rust colored sputum is also due to the
bleeding although the clotting process
process may have commenced and
the red blood cells may have broken
down.
92

•Pneumococcal pneumonia – rusty-red
•Lung cancer - pink to red (frothy)
progressing to brown or black
•Tuberculosis – bright red streaks
progressing to fully red sputum
(hemoptysis)
•Pulmonary embolism – bright red
blood (acute)
93

LUNG CANCER
94

95

96

MEANING OF DIFFERENT
TYPES OF SPUTUM
97

CLEAR SPUTUM
• slightly sticky and a bit viscous (thicker than
water) is accepted as normal sputum.
• It is produced and secreted in moderate amounts
to moisten the respiratory tract and trap dust and
microorganisms (mucus) and lubricate the mouth
and aid with chewing, swallowing and digestion
(saliva).
• While any expectorated sputum is considered to
be abnormal, small amounts of sputum can be
coughed up or spat out with effort even in the
absence of any respiratory pathology.
98

• However, in certain conditions, particularly
related to irritation of the respiratory tract,
the amount of sputum may become
excessive.
• In these pathological cases, the color,
texture and even odor of the sputum may
change.
• These variations may give an indication of
the possible cause.
99

SEROUS
• Normal, clear sputum is a serous discharge.
• Large amounts of clear, frothy or pink sputum
that is of a similar consistency as normal sputum
may be a sign of pulmonary edema, which is an
accumulation of fluid in the lungs.
• If it extremely profuse and lasting for weeks or
months, then it may be due to lung cancer.
100

•Frothy sputum is caused by
surfactant in the lung alveoli which
reduces the surface tension of the
sputum.
•It indicates that the sputum had
contact with the lung alveoli or
originated from this site.
101

MUCOPURULENT
•Mucoid, mucopurulent or purulent
sputum is thicker and often more
sticky than normal sputum.
•This is partly due to the greater
mucus production coupled with pus
in the purulent types.
102

•Mucoid sputum is a sign of non-
infectious airway disease like chronic
bronchitis (COPD) and asthma or may
occur in the early stages of infection.
•Mucopurulent sputum is an indication
of infection of the respiratory tract,
particularly of the bronchi or lungs –
acute bronchitis and pneumonia.
103

BLOOD-STAINED
•Sputum may be blood stained where
the normal sticky or mucopurulent
thick consistency becomes thinner
due to the presence of varying
amounts of blood.
104

•In severe cases involving the coughing
up of large amounts of blood
(hemoptysis), the consistency of the
sputum may be the same viscosity as
blood and little or no sputum may be
visible. Blood stained sputum may be
due to tuberculosis, bronchiectasis,
pulmonary embolism or lung cancer.
105

CHEST PAIN
•May be associated with pulmonary or
cardiac diseases.
•Chest pain associated with pulmonary
conditions may be SHARP, STABBING
and INTERMITTENT
•May be DULL, ACHING, PERSISTENT
106

•May occur with PNEUMONIA,
PULMONARY EMBOLISM with LUNG
INFARACTION, PLEURISY
•LATE SYMPTOM – bronchogenic
carcinoma
•CARCINOMA – pain may be dull and
persistent because the carcinoma has
invaded the chest wall, mediastinum
or spine
107

•The nurse assesses the quality,
intensity and radiation of pain.
•Identifies and explores precipitating
factors, along with the relationship of
the patient’s position.
108

RELIEF MEASURES
•Analgesic medications may be
effective in relieving chest pain.
•Non-steroidal anti-inflammatory
drugs (NSAIDs) used for pleuritic
pain
109

WHEEZING
• A high-pitched, musical sound heard mainly on
expiration.
• Major finding in a patient with
bronchoconstriction or airway narrowing.
• Can be heard with or without a stethoscope,
depending on location
110

111

112

RELIEF MEASURES
• Oral or inhalant
bronchodilator
medications
reverse wheezing
in most instances.
113

CLUBBING OF FINGERS
• A sign of lung
disease found in
patients with
chronic hypoxic
conditions, chronic
lung infections and
malignancies of the
lung.
114

•Manifested
initially as
sponginess of
the nail-bed
and loss of the
nail-bed angle.
115

116

HEMOPTYSIS
• Expectoration of blood from the respiratory
tract
• Symptom of both pulmonary and cardiac
disorders.
• Its onset is usually sudden, may be
intermittent or continuous.
• The amount of blood produced is not
always proportional to the seriousness of
the cause.
117

DIAGNOSTIC EVALUATION
•Chest
angiography
•Chest x-ray
•Bronchoscopy
118

POINTS TO CONSIDER WHEN
DOCUMENTING BLEEDING EPISODE:
•Bloody sputum from the nose or
the nasopharynx is usually
preceded by considerable sniffing,
with blood possibly appearing on
the nose.
119

• Blood from the lung is usually bright red, frothy,
mixed with sputum.
• Initial symptoms include a tickling sensation in
the throat, a salty taste, a burning or bubbling
sensation in the chest and perhaps chest pain.
• The term “hemoptysis” is reserved for the
coughing up of blood arising from a pulmonary
hemorrhage.
• This blood has an alkaline pH (greater than 7.0)
120

•If the hemorrhage is in the stomach,
the blood is vomited (hematemesis)
rather than coughed up.
•Blood that has been in contact with
gastric juice is sometimes so dark that
it is referred to as “coffee grounds”.
This blood has an acid pH (less than
7.0).
121

CYANOSIS
•Bluish discoloration of the skin
•VERY LATE indicator of hypoxia.
•Assessment of cyanosis is affected by
room lighting, the patient’s skin color
and the distance of the blood vessels
from the surface of the skin.
122

• In pulmonary condition, central cyanosis is
assessed by observing the color of the tongue
and lips.
• This indicates a decrease in oxygen tension in the
blood.
• Peripheral cyanosis results from decreased blood
flow to a certain area of the body, as in
vasoconstriction of the nailbeds or earlobes from
exposure to cold, and DOES NOT necessarily
indicate a central systemic problem.
123

PHYSICAL ASSESSMENT OF LOWER
RESPIRATORY STRUCTURE AND
BREATHING PATTERNS
124

CHEST CONFIGURATION
• Normally, the ratio of the anteroposterior diameter
to the lateral diameter is 1:2.
• There are four main deformities of the chest
associated with respiratory disease that alter this
relationship:
• Barrel chest
• Funnel chest (pectus excavatum)
• Pigeon chest (pectus carinatum)
• kyphoscoliosis
125

BARREL CHEST
• Due to over-
inflation of the
lungs.
• There is an increase
in the
anteroposterior
diameter of the
thorax.
126

• In patient with
emphysema, the
ribs are more
widely spaced and
the intercostal
spaces tend to
bulge on expiration.
127

• The appearance of the
patient with advanced
emphysema is thus
quite characteristic
and often allows the
observer to detect its
presence easily, even
from a distance.
128

FUNNEL CHEST
(PECTUS EXCAVATUM)
• Occurs when there is a
depression in the
lower portion of the
sternum.
• This may compress the
heart and great vessels
resulting in
MURMURS.
129

•Funnel chest may
occur with rickets
or Marfan’s
syndrome.
130

131

PIGEON CHEST
( PECTUS CARINATUM)
•Occurs as a result
of displacement
of sternum.
132

133

134

KYPHOSCOLIOSIS
• Characterized by
elevation of the
scapula and
corresponding S-
shaped spine.
135

• This deformity
limits lung
expansion within
the thorax.
• It may also occur
with osteoporosis
and other skeletal
disorders that affect
the thorax.
136

137

138

NORMAL BREATH SOUNDS
139

• Distinguished by their location over a specific
area of the lung:
• Vesicular
• Bronchovesicular
• Bronchial (Tubular)
• Tracheal
• The LOCATION, QUAILITY and INTENSITY of
breath sounds are determined during
auscultation.
140

ADVENTITIOUS SOUNDS
-Discrete, Noncontinuous Sound
-Continuous Musical Sound
(Wheezes)
-Friction Rubs
141

DISCRETE, NONCONTINUOUS
SOUND
142

CRACKLES
• Formerly referred to as RALES
• Result form delayed opening of deflated
airways.
• Friction rubs result from inflammation of
the pleural surfaces that induces a
crackling, grating sound usually heard in
inspiration and expiration.
143

•May or may not be cleared by
coughing
•Reflect underlying inflammation or
congestion
•Present in conditions as pneumonia,
bronchitis, heart failure,
bronchiectasis, and pulmonary fibrosis
144

FINE CRACKLES
•Usually audible at the end of
inspiration and originate from alveoli
•Sound is like rubbing several pieces of
hair next to one’s ear.
145

COARSE CRACKLES
•A gross, moist sound produced in the
large bronchi and are audible in early
and mid-inspiration.
146

CONTINUOUS SOUNDS (WHEEZES)
147

SIBILANT WHEEZES
•Caused by air
passing thru
narrowed
tracheo-bronchial
tree
• Found in asthma
or airway
obstruction
148

• Originate in brochi
and bronchioles
• “Whistling” sound
• Musical noise during
inspiration or
expiration
• Louder during
expiration
• May be cleared with
coughing
149

SONOROUS WHEEZES
•Called “GURGLES” or “RONCHI
SOUNDS”
•Deep, low-pitched rumbling sound
heard primarily during expiration.
150

•Caused by the movement of air
through the airways that are partially
obstructed or narrowed airways
•Such as in tumors or mucosal swelling
151

FRICTION RUBS
152

PLEURAL FRICTION RUBS
•Harsh, crackling sound, like two
pieces of leather rubbed together
•Heard during inspiration alone or
during both inspiration and
expiration.
153

•May subside when patient holds
breath.
•Coughing will NOT clear sound
•It is secondary to inflammation
and loss of lubricating pleural
fluid.
154

VOICE SOUNDS
155

•Vocal resonance
•The sound heard through the
stethoscope as the patient speaks
•The vibrations produced in the
larynx are transmitted to the chest
wall as they pass through the
bronchi and alveolar tissue.
156

•Voice sounds are assessed by
having the patient repeat “ninety-
nine” or “eee” while the nurse
listens with the stethoscope in
corresponding areas of the chest.
157

• BRONCHOPHONY
• Describes vocal resonance that is more
INTENSE and CLEARER than normal.
• EGOPHONY
• Describes the voice sounds that are distorted.
• Best appreciated by having the patient repeat
the letter “E”
• The distortion produced by consolidation
transforms the sounds into a clearly heard “A”
rather than “E”
158

BREATHING PATTERNS
AND
RESPIRATORY RATES
159

EUPNEA
•Normal, easy, quiet breathing
•Respirations are regular in depth
and rhythm
160

DYSPNEA
•TYPES:
•Orthopnea – shortness of breath
when lying down
•Paroxysmal nocturnal dyspnea –
sudden dyspnea at night while
lying down
161

APNEA
• Varying periods of cessation of breathing
• May occur briefly during other disorders,
such as with sleep apnea
• This can be life-threatening is sustained.
162

BRADYPNEA
• Slow breathing
• Slower than normal rate (<10 breaths per
minute), with normal depth and rhythm
163

TACHYPNEA
•Rapid, shallow breathing
>24 breaths per minute
164

BIOT’S RESPIRATION
• Cluster breathing
• Cycles of breaths that vary in depth and
have varying periods of apnea.
• Periods of normal breathing (3-4 breaths)
followed by a varying period of apnea
(usually 10 seconds to 1 minute)
165

•Seen in some central nervous
system disorder.
166

CHEYNE-STOKES
•Regular cycle where the rate and
depth of breathing increase, then
decrease until apnea (usually 20
seconds) occurs.
•Characterized by rhythmic and
waning of depth of respiration
167

•Seen typically in severe heart failure
and coma caused by neurologic
disorder.
•Near death breathing pattern
168

KUSSMAUL’S BREATHING
• Or hyperventilation
• Or polypnea
• Marked by increase in rate and depth
• Associated with severe diabetic acidosis or renal
origin
169

HYPOVENTILATION
•Or oligopnea
•Abnormally low amount of air that
enters the lungs
•Shallow, irregular breathing
170

INTERRUPTED
•Cogwheel or Waxy respiration
•Jerky breathing pattern
•Respiratory and expiratory sounds are
clearly split into two or more sounds.
171

ORTHOPNEA
•Inability to breath except
when the trunk is in upright
position
172

CONCEPT OF OXYGENATION

CONCEPT OF OXYGENATION

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