Fundamentals of Respiratory Care

The reason why patients are in need of respiratory care is because they are not able to breathe properly and efficiently on their own, resulting in harmful conditions of inadequate oxygenation. People are interested in knowing about respiratory care, especially the fundamentals of respiratory care. 

In this article, we discuss the aspects of respiratory care fundamentals such as anatomy of respiratory system, needs assessment, respiratory care provided, etc. 

Anatomy and Physiology of Respiratory System

In this part, we will understand the anatomy of respiratory system which includes the upper and lower respiratory tracts. 

Upper respiratory tract

The upper respiratory tract includes the nose, nasal cavity, mouth, pharynx, and larynx. They play an important role because these are the parts which filter, warm, and humidify the air we breathe.

Lower respiratory tract

The lower respiratory tract has such parts as the trachea, bronchi, bronchioles, and alveoli. The trachea divides into the right and left bronchi, which further branch into bronchioles and end in alveoli. The alveoli are the primary sites for gas exchange, where oxygen enters the blood, and carbon dioxide is expelled.

Mechanics of breathing

Breathing involves the coordinated action of the diaphragm and intercostal muscles. During inhalation, the diaphragm contracts and moves downward, creating negative pressure in the thoracic cavity, drawing air into the lungs. Exhalation is typically passive, with the diaphragm relaxing and air being pushed out of the lungs.

 
Anatomy of respiratory system

Respiratory Assessment to Find out Causes

To find out what is the reason behind your respiratory issues, the doctor has tools available such as asking you about your symptoms and occupational risks, performing medical examinations, and doing diagnostic tests. 

Assessment questions

After receiving patients with respiratory problems, the healthcare provider will try to find out the causes of the problem. Based on the causes they can provide effective care to improve patient health. They will ask you about respiratory symptoms, smoking history, occupational exposures, and past medical conditions in order to identify the causes. 

Physical examination

The examination techniques used by the doctor are the following: 

1) Observing the patient’s respiratory rate, effort, and symmetry

2) Palpation assesses for tenderness, masses, or subcutaneous emphysema

3) Percussion can determine lung density

4) Auscultation with a stethoscope detects abnormal breath sounds, such as wheezes or crackles.

Diagnostic tests

A. Pulmonary Function Tests (PFTs): These tests measure lung volumes, capacities, and flow rates, providing valuable information about the functional status of the lungs.

B. Arterial Blood Gases (ABGs): ABGs assess oxygenation, ventilation, and acid-base balance by measuring the levels of oxygen, carbon dioxide, and bicarbonate in the blood.

C. Imaging: Chest X-rays, CT scans, and MRI provide detailed images of the lung structures, helping to identify abnormalities such as tumors, infections, or fluid accumulation.

Provision of Healthcare to Patients with Respiratory Issues

To promote our understanding of the fundamentals of respiratory care, the following presents descriptions of healthcare interventions intended to improve patient respiratory health and well-being.

Oxygen Therapy

Oxygen therapy improves oxygenation in patients who has hypoxemia or experiences respiratory distress. In particular, oxygen therapy is provided by your healthcare provider in cases of chronic obstructive pulmonary disease (COPD), pneumonia and heart failure. During surgical procedures this therapy is also necessary. 

The devices in this therapy are:

A. Nasal Cannula delivers low to moderate concentrations of oxygen.

B. Simple Mask provides higher concentrations of oxygen than a nasal cannula.

C. Non-rebreather Mask delivers high concentrations of oxygen, typically used in severe hypoxemia.

D. Venturi Mask allows precise control of oxygen concentrations, suitable for patients requiring specific oxygen levels.

Oxygen saturation (SpO2) is monitored using pulse oximetry, a non-invasive method that provides continuous real-time data about the patient’s oxygenation status.

 
A patient being aided with oxygen therapy

Mechanical ventilation

In cases of severe respiratory failure, apnea, severe hypoxemia, and inadequate spontaneous ventilation, the healthcare provider will provide the patient with mechanical ventilation which supports patients with respiratory failure by ensuring adequate ventilation and oxygenation.

Modes of ventilation

A. Volume-Controlled Ventilation delivers a set volume of air with each breath.

B. Pressure-Controlled Ventilation delivers air until a set pressure is reached.

C. Assist-Control Ventilation provides full support with each breath, either initiated by the patient or the ventilator.

D. Synchronized Intermittent Mandatory Ventilation (SIMV) allows patients to breathe spontaneously between mandatory breaths.

Maintaining airway patency

Maintaining airway patency is crucial for adequate ventilation and oxygenation. Here we would like to share with you the following things concerning maintaining airway patency:

1) Intubation is insertion of an endotracheal tube to maintain an open airway

2) Tracheostomy refers to surgical creation of an opening in the trachea to insert a tracheostomy tube, often used for long-term ventilation

3) Oropharyngeal Airway keeps the upper airway open in unconscious patients.

4) Nasopharyngeal Airway (NPA) is used in conscious or semi-conscious patients to maintain airway patency. NPAs help keep the airway open, especially in patients with partial obstructions due to conditions like sleep apnea, severe fatigue, or sedation. It is useful in preventing the collapse of soft tissues in the upper airway, which can obstruct airflow. By keeping the airway open, NPAs help ensure adequate ventilation and oxygenation, reducing the risk of hypoxia. The following is an image of a typical nasopharyngeal airway from a specialized and experienced manufacturer (you can refer to our website for more detailed descriptions: www.bevermedical.com) 

 
Image of a typical nasopharyngeal airway

Medicines used for respiratory care 

1) Bronchodilators, such as albuterol and ipratropium, relax bronchial muscles, relieving bronchospasm and improving airflow.

2) Corticosteroids, like prednisone, reduce airway inflammation and are used in conditions such as asthma and COPD.

3) Mucolytics, such as acetylcysteine, thin mucus, making it easier to expectorate, thereby improving airway clearance.

4) Antibiotics are prescribed to treat bacterial respiratory infections, such as pneumonia and bronchitis.

Respiratory diseases

Various diseases affect your respiratory health, such as the following. Description of these diseases enriches our knowledge about respiratory care. 

a. Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities.

b. Asthma is a chronic inflammatory disorder of the airways, resulting in reversible airway obstruction and bronchospasm.

c. Pneumonia is an infection that inflames the alveoli, causing them to fill with fluid or pus, leading to cough, fever, and difficulty breathing.

d. Pulmonary embolism is a blockage in one of the pulmonary arteries, usually due to blood clots that travel to the lungs from the legs or other parts of the body.

e. Interstitial lung disease causes progressive scarring of lung tissue, leading to reduced oxygenation and respiratory function.

Kindly Reminder

Through the above descriptions we hope you know more about the fundamentals of respiratory care. If you or your loved ones experience respiratory discomfort it is important that you or they receive medical care that is available ASAP.