Anil Kantiwal ( OM Nursing Academy )

Introductions :-

Respiration एक ऐसी Process ह� �जसम� Oxygen शरीर म� ली जाती ह� और CO2 शरीर से छोड़ीजाती ह� ।

Normal Respiratory Rate in different Age Groups

Newborn : 30-60/minute

Early Childhood : 20-40/minute

Late Childhood : 15-25/minute

Adult : 12-16/minute

Anatomy of Respiratory System :-

1. Upper Respiratory System :- इसम� Nose, Pharynx and Other Associated Structures

2. Lower Respiratory System :- इसम� Larynx, trachea, Bronchi, Bronchioles & lungs.

Nose is the first organ of Respiratory tract.

Larynx also Known as Voice Box.

Glottis :- Opening between True Vocal Cord

Adam's Apples :- इसे laryngeal prominence के नाम से भी जानते ह� जो Thyroid Cartilageका larger Prominent Part ह� जो सामा�यतः प�ुष� म� देखा जाता ह� ।

Respiratory System

OM Nursing Academy

Anil Kantiwal

Anil Kantiwal ( OM Nursing Academy )

Epiglottis यह flexible Cartilage ह� जो खाना खाते व�त food को Trachea म� जाने से रोकता ह�

Trachea को Wind Pipe के नाम से भी जानते ह�, Trachea क� length 10-12 cm. होती ह� �जसम�16-20 Incomplete (C - Shaped) क� Rings पायी जाती ह� जो Hyline Cartilage से बनी होती ह�

Carina :- वह Point जहँा पर Trachea दो Bronchi म� बटं जाता ह� ।

Bronchi

1. Right Bronchi :- यह Left Bronchi क� तलुना म� Wide, Short & Vertical होती ह� इस�लएइसम� Left Bronchi क� तलुना म� �यादा Obstructed होने के chance होते ह� ।

2. Left Bronchi :- यह Right Bronchi क� तलुना म� Narrow, longer एवं Horizontal होती ह� ।

Respiratory Unit :- यह Respiratory Bronchioles, alveolar duct, Alveolar Sac एवं Alveolus से�मलकर बनी होती ह�, जो Gases Exchange ह� वो Respiratory Unit म� ही होता ह� ।

Alveoli :- Smallest Unit of Respiratory Tract.

Lungs म� लगभग 300 �म�लयन Alveoli पायी जाती ह� जो gas exchange के �लए 70 मीटर2

Surface Area �दान करवाती ह� ।

Types of Alveolar Cells :- ( Pneumocytes )

1. Type-1 Alveolar Cells :- ये लगभग 95% Cells ह� जो Gas exchange म� help करती ह� ।

2. Type-2 Alveolar Cells :- ये लगभग 5% cells होती ह� Surfactant secreation का काम करती ह� ।

Surfactant :- Surfactant ये Phospholipid के बने होते ह� जो Expiration के दौरान Lungs कोcollapse होने से बचाते ह�,

Note :- Surfactant का secreation fetal life के 24 से 28th Week पर शु� हो जाता ह� और 35th weekतक अ�धकांशतः Babies म� पया��त देखने को �मलते ह� ।

Anil Kantiwal ( OM Nursing Academy )

Antrum - Space incide the Alveoli Sac.

Left Lung यह Right lung क� तलुना म� थोड़ा छोटा होता ह� इसके साथ ही इसम� �सफ� 2 Lobe पायेजाते ह� �य��क Heart Left Midline का कुछ part occupie करके रखता ह� ।

Pleura - Pleura यह Lungs पर पाये जाने वाली covering ह� जो एक Serous membrane ह� ।

Diaphragm :- Diaphragm यह Respiration क� Main muscle ह� , Diaphragm को NerveSupply Phrenic Nerve करती ह� ।

Pulmonary Function Test are mostly done by Using Spirometer.

Normal Value of Pulmonary Ventilation - 6000 ml/min

Normal Value of Dead Space is - 150 ml.

Partial Pressure of Gases :-

Gases1 Oxygenated Blood Deoxygenated Blood

Oxygen 100 mmHg 40 mmHg

Carbon di Oxide 40 mmHg 44 mmHg

Nitrogen 573 mmHg 573 mmHg

Total Partial Pressure of Gases is 760 mmHg.

Composition of Inspired and Expired Air :-

Gases Inspired Gas Expired Gas

Oxygen 21 % 16 %

CO2 0.04 % 4 %

Anil Kantiwal ( OM Nursing Academy )

● Rhinitis :- Inflammation of the Mucous membranes of the Nose.

● Epistaxis ( Nose Bleed ) :- Nose क� Mucous membrane म� उप��थत Tiny, Distended bloodvessels म� Rupture होने के कारण होने वाली Nasal bleeding को Epistaxis कहते ह� ।

● Quincy ( Peritonsillar Abscess ) यह Tonsils के inflammation का Complication ह� �जसम�infection के कारण Tonsils पर Abscess देखने को �मलती ह� ।

● Empyema :- Collection of Pus in Pleural Cavity.

Empyema म� Frozen Chest देखने को �मलता ह� ।

COPD ( Chronic Obstructive Pulmonary Disease ) :-

A group of Lung diseases that block airflow and make it difficult to Breathe.

COPD is a Progressive Disease ( �जसम� समय के साथ मरीज क� हालत खराब होती जाती ह� )

Smoking is a Main Cause of COPD. ( AIIMS, ESIC ).

COPD Disease म� Airflow Obstruction देखा जाता ह� �जसका कारण Emphysema orChronic Bronchitis ह� ।

Chronic Bronchitis :- Presence of Cough and Sputum Production for at least 3months to 2 consecutive ( लगातार ) years.

Emphysema :- इसम� Terminal Bronchioles एवं Alveoli म� Abnormal distention केकारण Alveoli क� walls टूटने लगती ह� ।

Blue Bloaters :- Hypoxia के कारण Skin एवं Lips म� Cyanosis का होना, यह ChronicBronchitis म� देखने को �मलता ह� ।

Pink Puffers :- इसम� Patient का Face Red एवं Pink color का हो जाता ह� �य��क PatientBody क� Oxygen deemand को परूा करने के �लए तजेी से Breathing करता ह�, Pink Puffersयह Emphysema म� देखने को �मलता ह� ।

COPD म� Barrel Chest देखने को �मलता ह� ।

Asthma :-

Asthma म� Eosinophills का level बढ़ जाता ह� और इसके साथ Immunoglobulins म� IgE काlevel बढा �आ �मलता ह� ।

Status Asthmatics :- यह Severe Asthma क� ऐसी Condition ह� �जसम� एक के बाद एक �बना�के Asthmatic Attack देखे जाते ह� ।

● Medical Surgical Nursing ●

Anil Kantiwal ( OM Nursing Academy )

Pneumonia :- inflammation of Lung Parenchyma.

Nosocomial Pneumonia :- यह Hospital म� 48 hour के Admission बाद होता ह� ।

Acute lobular Pneumonia :- यह most common type का pneumonia ह� ।

o First Stage of Pneumonia - Congestion

o Last Stage of Pneumonia - Resolution

Diet in Pneumonia :- High Protein + High Calories ( Plenty of Fluids ).

Pulmonary Tuberculosis :-

Caused by Micobacterium Tuberculosis.

Diagnostic Evaluation :-

Chest X-Ray ( Nodular Calcified Patches देखने को �मलते ह� । )

Sputum test - Acid Fast test

Mantoux Test :- Reliable Test for T.B.

PCR [ Poly Chain Reaction ] यह Extra Pulmonary Tuberculosis के �लएConfirmatory test ह� ।

Antitubercular Drugs :-

Isoniazide द�ने से पहले एक Nurse को Patient का Liver Function Test करवाना चा�हये ।

Isoniazide क� Toxicity म� Vitamin B6 ( Pyridoxine ) देते ह�

Rifampicin is the safest Antitubercular drugs in Pregnancy.

Mostly Cases म� अगर कोई Patient Rifampicin ले रहा ह� तो उसम� Red Orange colorUrine & Body Secreation देखने को �मलता ह� ।

Ethambutol एक मा� Bacteriostatic Antitubercle Drug ह�,

Note - Optic Neuritis Ethambutol का Side effect ह� इस�लए अगर कोई Pt.Ethambutol ले रहा ह� तो उ�से Driving के �लये मना करना चा�हय,े �य��क Patient red एवंGreen light म� deferentiate नह� कर पाता ।

Streptomycin यह Pregnancy म� Most Contraindicated Drug ह�, �य��क Streptomycinयह Ototoxicity ( By damaging 8th Cranial Nerve ) व Nephrotoxicity का काम करती ह� ।

Robert Koch नेMycobacterium Tuberculosis क� खोज क� इस�लए इसे Koch's diseaseके नाम से भी जानते ह� ।

Anil Kantiwal ( OM Nursing Academy )

Empyema :- Pleural Cavity म� Pus or Thick Plurent Fluid का Accumulate होना । इसम� FrozenChest ( Rigid Inmobile chest ) देखने को �मलता ह� ।

Hemothorax :- Pleural Cavity म� Blood Accumulate होना ।

Hydrothorax :- Pleural Cavity म� Water Accumulate होना ।

Pneumothorax :- Pleural Space म� Atmospheric Air का Accumulation होना �जसके कारणIntrathorasic Pressure बढ़ जाता ह� एवं Vital Capacity घट जाती ह� ।

Atelectasis :- Partial & Complete collapse of Lungs.

Pleurisy :- Pleura क� Visceral एवं Parietal Membrane म� Inflammation को Pleurisy कहते ह�,

इसम� जब भी Patient, Deep Breathing एवं Coughing करता ह� तब उसम� Knife like Painदेखने को �मलता ह� ।

Pleura ( Covering Layer of Lungs )

● Severe Acute Respiratory Syndrome ( SARS ) is caused by Corona Virus.

Influenza :-

Avian Influenza Caused by H5 N1 Virus.

Swine flue caused by H1N1 Virus.

Full Form Of H & N ( H = Hemagglutinin , N = Neuraminidase ).

Cor Pulmonale :- ( Pulmonary Heart Disease )

Hypertrophy of Right Ventricle of Heart.

Chest Trauma :-

1. Blunt Chest Trauma :- Sudden compression to the chest wall eg. Sternal & Ribfracture , Flail Chest

2. Penetrating Chest Trauma :- when Foreign Object Penetrates the Chest wall.eg. Gunshot and Stab Wound.

Epiglotitis :- inflammation of Epiglottis.

o Caused by - Hemophilus Influenza or Streptococcus Pneumoniae.

o Assessment - Sore throat, Dyspnea

Histoplasmosis :- यह एक Pulmonary Fungle Infection ह� जो Histoplasma Capsulatum के कारण होताह� ।

Anil Kantiwal ( OM Nursing Academy )

Other Important Points :-

Legionnaires diseases Caused by Legionella Pneumophilia.

Sputum Specimen obtain on early morning sterile specimen by suctioning orExpectoration.

Breathing Retaining - Use to Promote CO2 Elimination and Decrease Use ofAccessory muscles.

Pursed Lip Breathing - COPD & Asthma.

Diaphragmatic Breathing / Belly Breathing :-

Ventilator से जड़ुा मु�य infection - Ventilator Associated Pneumonia

अगर कोई Patient Mechanical Ventilator पर ह� तब �कसी भी Stressful Situation म� पहलेPatient को Access कर�गे उसके बाद Ventilator को ।

ABG ( Arterial Blood Gas ) Analysis यह Gas Exchange Analysis के �लए GoldStanderd method ह� ।

Capnometer :- Device that measure CO2

Normal Pulse Oximetry Value is 96% - 100%.

Pulse Oximetry अगर 91% से कम �दखे तो HCP को सू�चत कर� ।

Pulse Oximetry 70% से कम होना Life threatening situation ह� ।

Suction Catheter को Sterile water या Water Soluble Jelly से Lubricate करना चा�हएAIIMS

Anil Kantiwal ( OM Nursing Academy )

Charcoal layden crystal are seen in Bronchial Asthma.

Common Cause of Pulmonary Embolism is - Venous Thrombi.

Complications due of DVT is Pulmonary Embolism. Aiims & RRB

Thoracentesis :-

Position

o Sitting Upright , arms & Shoulder supported by a table at the Bedside.

o अगर Patient बठै नह� सकता तब - Lying in Bed toward the Unaffected side withhead of the Bed elevated.

Tracheostomy :-

Position - Rose Position ( Supine with Hyper extension of Neck ).

Site - 2-3rd Ring Incised

Suctioning - Suctioning कभी भी 5-10 सेकंड से �यादा ना कर�, �य��क �यादा ल�बे समय तकSuctioning करने से Patient म� Hypoxia तथा इसके प�रणाम�व�प Cardiac Arrest हो सकता ह�

Decannulation :- The Process of Removal of Tracheostomy Tube.

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