• Upper airway
• Lower airway
• Bronchospasm

• Located above the larynx, includes the nasal passages, mouth, and pharynx
• Located below the larynx, includes the trachea, bronchi, and bronchioles
• Spasm of the smooth muscles on the walls of the bronchi, and bronchioles

• alveolar cells
• Surfactant

• Type I: the gas exchange cells
• Type II: produce surfactant
• Surfactanct: A lipoprotein that lowers the surface tension within alveoli to allow them to inflate during breathing.

Lung Compliance

Refers to the ease of lung inflation.

• The resistance to airflow within the airways.
• The larger the diameter of the airway, the more easily air moves through it.
• Nomally, airway resistance is very low

• External respiration (Alveolar-capillary gas exchange)
• Internal respiration (Capillary-tissue gas exchange)

• Occurs in the alveoli of the lungs. Oxygen diffuses across the alveolar-capillary membrane into the blood of the pulmonary capillaries; carbon dioxide diffuses out of the blood and into the alveoli to be exhaled.
• Occurs in body organs and tissues. Oxygen diffueses from the blood through the capillary-cellular membrane into the tissue cells, where it is used for metabolism.

• Chemoreceptors
• Lung Receptors

• located in the medulla of the brainstem, the carotid arteries, and the aorta.
• detect changes in blood pH, O2, and CO2 levels, and they send messages back to the central respiratory center in the brain stem.
• The respiratory center increases or decreases ventilation to maintain normal blood levels of pH, O2 (Po2), and CO2 (Pco2).
• located in the lung and chest wall
• are sensitive to breathing patterns, lung expansion, lung compliance, airway resistance, and respiratory irritants

• Characterized by widespread atelectasis (collapse of alveoli)
• Together with hypoventilation, this leads to hypercarbia (high CO2 blood levels) and hypoxemia.

• characterized by a change in the consistency of the lung tissue, especially at the alveolar level
• Alveoli become stiff and difficult to ventilate, and gas exchange is impaired
• Pulmonary edema, acute respiratory distress syndrome (ARDS), and pulmonary fibrosis

Breathing Patterns:

• Eupnea
• Kussmaul's Respirations
• Biot's Respirations
• Cheyne-Stokes Respirations

• Eupnea: Normal respirations, with equal rate and depth, 12-20 breath/min
• Kuss.: Respirations that are regular but abnormally deep and increased in rate
• Biot's: Irregular respirations of variable depth (usually shallow), alternating with periods of apnea
• Cheyne: Gradual increase in depth of respirations, followed by gradual decrease and then a period of apnea.

Sputum Color/Appearance & Significance

• White or Clear
• Yellow or Green
• Black
• Rust colored
• Hemoptysis
• Pink and frothy

• White or Clear - Usually in viral infections (common cold, viral bronchitis), often requiring only supportive care
• Yellow or Green - A sign of infection
• Black - Caused by coal dust, smoke, or soot inhalation
• Rust colored - Associated with pneumococcal pneumonia, tuberculosis, and possibly the presence of blood
• Hemoptysis - The coughing up of blood or bloody sputum. May range from small streaks of blood to large amounts of frank blood.
• Pink and frothy - Associated with pulmonary edema

• Partial pressure of oxygen (PO2)
• Saturation of oxygen (SaO2)
• Fraction of inspired oxygen (FiO2)
• Partial pressure of carbon dioxide (PCO2)

• PO2: The amount of oxygen available to combine with hemoglobin to make oxyhemoglobin
• SaO2: Reflects oxygen that is actually bound to hemoglobin
• FiO2: The percentage of oxygen in the air the patient is inhaling (21%)
• PCO2: A measure of the CO2 dissolved in the blood. normal arterial PCO2 is 35 to 45 mm Hg

Measures the amount of air that can be exhaled with forcible effort. Asthmatics use this to monitor subtle changes in their condition. Expressed in liters per minute.

• Green= all clear: Baseline peak flow-peak flow is within 80% to 100% of personal best baseline.
• Yellow=Caution: Peak flow is 50% to 80% of usual or "normal" rate.
• Red= Medical alert: Peak flow is less than 50% of personal best baseline. Severe reduction in peak flow.

Respiratory Medications

• Bronchodilators
• Respiratory Anti-inflammatory agents
• Nasal decongestants
• Antihistamines
• Cough preparations

• Bronchodilators: Relax the smooth muscles lining the airways; Can be administered as oral or inhaled medicines.
• Beta-2 adrenergic agonists, Anticholinergics, Methylxanthine
• Respiratory Anti-inflammatory agents: Combat inflammation in the airways; Important in treating and controlling respiratory conditions characterized by hypersensitive airways and airway inflammation (asthma)
• Corticosteroids, cromolyn, leukotriene modifiers
• Nasal decongestants: Relieve stuffy, blocked nasal passages by constricting local blood vessels through stimulation of alpha-I adrenergic nerve receptors in the vessels. Although the desired effect is on the nasal mucosa, these medications can have systemic adrenergic effects causing elevated blood pressure, tachycardia, and palpitations, especially in those with a history of cardiovascular conditions.
• Ephedrine, Pseudoephedrine, Phenylephrine
• Antihistamines: Prevent the effects of histamine release; Used to treat upper respiratory and nasal allergy symptoms.
• Diphenhydramine (Benadryl), Chlorpheniramine (Chlor-Trimeton), Loratadine (Claritin), etc...
• Cough preparations: Antitussives (cough suppressants) reduce the frequency of an involuntary, hacking, non productive cough; Expectorant help make coughing more productive; the goal is to reduce the frequency of dry, unproductive coughing while making voluntary coughing more productive
• These agents are often found mixed together in one preparation to achieve both desirable effects with one medication

1. Ask about tobacco use and document tobacco use status for every patient at every visit.
2. Advise to quit.
3. Assess willingness to make a quit attempt at this time.
4. Assisst in a quit attempt.
5. Arrange follow-up. make follow-up contacts beginning the first week after the quit date.

• Oropharyngeal airways
• Nasopharyngeal airways

• Oro: Should be used only in unconscious patients because they are likely to trigger gagging, vomiting, or laryngospasm in responsive patients with intact airway reflexes.
• C-shaped, hard plastic devices available in infant, pediatric, and adult sizes
• Naso: Flexible rubber tubes that are inserted through a nostril into the pharynx.
• Semiconscious patients can tolerate because they do not stimulate gag reflex. available in pediatric and adult sizes.

• Hemothorax
• Pneumothorax

• Accumulation of fluid and blood in the pleural space.
• Interferes with lung expansion, ventilation, and gas exchange.
• Air in the pleural space
• Creates positive pressure, causing lung tissue to collapse.

A life threatening complication. Occurs when positive pressure builds up in the pleural space and pushes the lungs, great vessels, and heart toward the other side of the chest.

• Baroreceptors located in the walls of the heart and blood vessels are sensitive to pressure changes.
• When they sense even a small drop in pressure, they send messages to the brain stem centers to stimulate the sympathetic nervous system to increase heart rate and induce vasoconstriction.

• Used therapeutically to slow the heart rate or reduce the force of myocardial contraction. May reduce cardiac output and impair tissue oxygenation.
• Beta-adrenergic blocking agents (bisoprolol fumarate [zebetal]) are used therapeutically to reduce the work load of the heart, to control abnormal heart rhythms, and to control hypertension.Slow the heart rate and decrease the strength of myocardial contraction.
• Calcium channel blocking agents (nifedipine [Procardia]) block the flow of calcium into cells of the heart and blood vessels. They decrease blood pressure and the strength of myocardial contraction, slow the heart rate, and dilate the arteries and arterioles.

• Reflects what the nerves are telling the heart muscle to do, but not what the heart muscle is actually doing in response.
• P wave- represents the firing of the SA node and conduction of the impulse through the atria. In the healthy heart, this leads to atrial contraction.
• QRS Complex- represents ventricular depolarization and leads to ventricular contraction
• T wave- represents the return of the ventricles to an electrical resting state so they can be stimulated again (ventricular repolarization).

Dysrhythmias

• Tachydysrhythmias
• Bradydysrhythmias
• Ectopy
• Supraventricular
• Junctional
• Ventricular

• Tachydysrhythmias- Rates > 100 beats/min
• Bradydysrhythmias-Rates < 60 beats/min
• Ectopy- Extra beats
• Supraventricular-Above the ventricles
• Junctional-Within the AV node
• Ventricular-In the ventricles

• Thrombus
• Embolus

• Thrombus- A stationary clot adhering to the wall of a vessel
• Embolus- A clot that travels in the blood stream

• Beta-adrenergic agents- block stimulation of beta receptors, which are located primarily in the heart, lungs, and blood vessels. Used to treat angina, acute myocardial infarction, and congestive heart failure.
• They decrease heart rate, slow conduction through AV node, and decrease myocardial oxygen demand by reducing myocardial contractility.
• Positive inotropes- increase cardiac contractility. Used therapeutically to make the heart a more effective pump. Two main classes are cardiac glycosides and phosphodiesterase inhibitors.