b.Lower airway: The lower airway comprises the
trachea, right and left mainstem bronchus, seg-
mental bronchi, and terminal bronchioles. The
major functions are conduction of air, mucocil-
iary clearance, and production of pulmonary
surfactant.
3.According to Boyle’s law, the volume of a gas at a
constant temperature varies inversely with the
pressure. Pressure in the lungs is lower than
atmospheric pressure; this condition facilitates the
movement of air into the lungs.- a.Any change in the surface area available for dif-
fusion will have a negative effect on diffusion.
b.Incomplete lung expansion or lung collapse
(atelectasis) prevents pressure changes and
exchange of gases by diffusion in the lungs.
c. Any disease or condition that results in thicken-
ing of the alveolar–capillary membrane makes
diffusion more difficult.
d.The solubility and molecular weight of the
gases are factors in diffusion. - a.It is dissolved in plasma.
b.Most oxygen (97%) is carried in the body by red
blood cells in the form of oxyhemoglobin. - a.Infant: Respiratory activity is abdominal. The
chest wall is so thin that the ribs, sternum, and
xiphoid process are easily identified.
b.Preschool and school-aged child: Some subcuta-
neous fat is deposited on the chest wall, so
landmarks are less prominent than in an infant;
preschool child’s eustachian tubes, bronchi,
and bronchioles are elongated and less angular
than in an infant, so the number of routine
colds and infections decreases until the child
enters school.
c. Older adult: Bony landmarks are more promi-
nent; kyphosis contributes to appearance of
leaning forward; barrel chest deformity may
result; senile emphysema may be present; power
of respiratory and abdominal muscles is reduced. - a.Thoracic excursion: This is measured by placing
one’s hands on the patient’s posterior thorax at
the level of the 10th rib, with both thumbs
almost touching the vertebrae. While patient
takes a few deep breaths, the nurse’s thumbs
should move 5 to 8 cm symmetrically at maxi-
mal inspiration.
b.Tactile fremitus: The nurse should place the
palm’s surface on each side of the patient’s
chest wall, avoiding bony areas; the nurse
should detect equal vibrations as the patient
says a multisyllable word.
8.Before: Collect baseline data; instruct patient to
remain still.
During: Observe patient for reactions; report any
deviation from normal color, pulse, and respira-
tory rates to physician.
After: Observe patient for changes in respirations;
chest x-ray.
9.The inhalation of cigarette smoke increases airway
resistance, reduces ciliary action, increases mucus
production, causes thickening of the alveolar–cap-
illary membrane, and causes bronchial walls to
thicken and lose their elasticity.- a.Deep breathing: The nurse instructs the patient
to make each breath deep enough to move the
bottom ribs. The patient should start slowly,
inspiring deeply through the nose and expiring
slowly through the mouth.
b.Incentive spirometry: The patient takes a deep
breath and observes the results of his/her efforts
as they register on the spirometer as the patient
sustains maximal inspiration.
c.Abdominal breathing: The patient places one
hand on the stomach and the other on the
middle of the chest. He/she then breathes
slowly in through the nose, letting the
abdomen protrude, then out through pursed
lips while contracting the abdominal muscles.
One hand should be pressing inward and
upward on the abdomen. These steps should
be repeated for 1 minute, followed by a
2-minute rest. - a.Avoid open flames in the patient’s room.
b.Place “No Smoking” signs in conspicuous places
in the patient’s room.
c. Check to see that electric equipment is in good
working order.
d.Avoid wearing and using synthetic fabrics,
which build up static electricity.
e.Avoid using oils in the area. - a.Oropharyngeal/nasopharyngeal airway: Semicir-
cular tube of plastic or rubber inserted into the
back of the pharynx through the mouth or nose
in a spontaneously breathing patient; used to
keep the tongue clear of the airway and to per-
mit suctioning of secretions
b.Endotracheal tube: Polyvinylchloride tube that
is inserted through the nose or mouth into the
trachea, using a laryngoscope as guide; used to
administer oxygen by mechanical ventilator, to
suction secretions easily, or to bypass upper air-
way obstructions
c. Tracheostomy tube: An artificial opening made
into the trachea. The curved tracheostomy tube
is inserted into this opening to replace an endo-
tracheal tube, provide a method to mechanically
ventilate the patient, bypass an upper airway
obstruction, or remove tracheobronchial
secretions. - a.A: Airway: Tip the head and check for breathing.
b.B: Breathing: If the victim does not start to
breathe spontaneously after the airway is
opened, give two slow, full breaths.
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