The respiratory system performs its functions through pulmonary ventilation, respiration, & perfusion.

Normal functioning depends on 3 factors:

1. The integrity of the airway system to transport air to & from the lungs.
2. A properly functioning alveolar system in the lungs to oxygenate venous blood & to remove CO2 from the blood.
3. A properly functioning cardiovascular & hematologic system to carry nutrients & wastes to and from body cells.

Upper airway

lower airway

• Composed of the nose, pharynx, larynx, & epiglottis.
• Function: to warm, filter, & humidify inspired air.

• known as the "tracheobronchial tree"
• Composed of the trachea, right and left main stem bronchi, segmental bronchi, & terminal bronchioles
• Function: Conduction of air, mucociliary clearance, & production of pulmonary surfactant.

The airways are lined w/ mucus, which traps cells, particles, & infectious debris. This mucus covering also helps to protect the underlying tissues from irritation & infection.

Cilia:

• Microscopic hair-like projections, propel trapped material & accompanying mucus toward the upper airway so they can be removed by coughing.

• Main organs of respirations
• located w/in the thoracic cavity on the right & left sides.
• extend from the base at the level of the diaphragm to the apex (top), which is above the first rib. 
• The heart lies b/t the left & right lung.
• Each lung is divided into lobes. The right lung has 3 & the left lung has 2.
• Composed of elastic tissue that can stretch & recoil. (alveoli, surfactant, pleura)

Lung's elastic tissue

Alveoli:

• located at the end of the terminal bronchioles. (small air sacs)
• Site of gas exchange.
• Wall of each alveolus is made up of a single cell layer of squamous epithelium.
• This wall allows for exchange of gases w/ the capillaries covering the alveoli.
• Average adult has more than 300 million alveoli.

Lung's elastic tissue

• A detergent-like phospholipid, reduces the surface tension b/t the moist membranes of the alveoli, preventing their collapse. 
• When surfactant productin is reduced, the lungs becomes stiff & the alveoli collapse.

Lung's elastic tissue

• A serous membrane that lines the lungs & thoracic cavity.
• Visceral pleura: covers the lungs./ Parietal pleura: lines the thoracic cavity.
• Pleural space lies b/t the 2 layers. 
• Pleaural fluid b/t the membranes acts as a lubricant & as an adhesive agent to hold the lungs in an expanded position. 
• A few ml of fluid b/t the pleural surfaces allows the lungs to move easily along the chest wall as they expand & contract. W/out this fluid, filling & emptying of the lungs is difficult.

Negative pressure: Pleura

Function:

Pulmonary Ventilation:

(Breathing)

Refers to the mvmt of air into & out of the lungs.

(Intake of O2 and the release of CO2)

Inspiration (Inhalation)

Expiration (Exhalation)

• Active phase of ventilation
• Involves movement of muscles and thorax to bring air into the lungs

• Passive phase of ventilation
• Movement of air out of the lungs

Process of Ventilation

(Involving inspiration)

• During inspiration, the diaphragm contracts & descends, lengthening the thoracic cavity
• The external intercostal muscles contract, lifting the ribs upward & outward. The sternum is pushed forward, enlarging the chest from front to back
• Increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lungs) to lesser pressure (inside lungs).

Process of Ventilation

(Involving expiration)

• The relaxation of these structures results in expiration.
• The diaphragm relaxes & moves up, the ribs move down, & the sternum drops back into position.
• This causes a decreased volume in the lungs and an increase in intrapulmonic pressure.
• As a result, air in the lungs moves from an area of greater pressure to one of lesser pressure and is expired.

Respiration (gas exchange) occurs at the terminal alveolar capillary system.

Diffusion:

• The mvmnt of gas or particles from areas of higher presure or concentraion to areas of lower pressure or concentration.
• In respiration, diffusion refers to the mvmt of O2 and CO2 b/t the air (in the alveoli) and the blood (in the capillaries).

1. Change in surface area available (Ex. removal of a lung or the presence of a disease that destroys lung tissue can decrease the surface area available, ultimately affecting gas exchange/ Incomplete lung expansion or the collapse of alveoli-Atelectasis)
2. Thickening of alveolar-capillary membrane (pneumonia, pulmonary edema)
3. Partial pressure, or pressure resulting from any gas in a mixture depending on its concentration.
4. Solubility and molecular weight of the gas

Perfusion

Hypoxia:

• May occur if a problem exists in ventilation, respiration, or perfusion.
• A condition in which an inadequate amt of O2 is available to cells.
• Symtoms of Hypoxia: Dyspnea-Difficulty breathing./ an elevated bp w/ a small pulse pressure./ increase resp & pulse rates./ pallor/ cyanosis. Anxiety, restlessness, confusion, & drowsiness.

Hypoxia is caused by:

Hypoventilation

• Hypoventilatoin: Decreased rate or depth of air mvmt into the lungs.

**Hypoxia can be chronic. Effects of chronic hypoxia can be detected in all body systems & are manifested as altered thought processes, headaches, chest pain, enlarged heart, clubbing, anorexia, constipation, decreased urinary output, muscle pain, & weakness of extremity muscles.

The respiratory center is located in the medulla in the brainstem, immediately above the spinal cord.

Medulla:

• Stimulation of the medulla increases the rate and depth of ventilation (both inspriation & expiration) to blow of CO2 and H and increase O2 levels (the pt is breathing faster & more deeply). The medulla sends an impulse down the spinal cord to the resp muscles to stimulate a contraction leading to inhalation. If a condition causes a chronic change in the O2 & CO2 levels, these chemoreceptors may become desensitized & not regulate ventilation adequately.

• Oxygen is carried in the body via plasma and red blood cells
• Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin
• Hemoglobin also carries carbon dioxide in form of carboxyhemoglobin
• Internal respiration between the circulating blood and tissue cells must occur

• The Cardiovascular system is composed of heart & blood vessels.(Vital for exchange of gases)
• Deoxygenated blood (low in O2, high in CO2) is carried to & from the right side of the heart to the lungs, where O2 is picked up & CO2 is released, then returned to the left side of the heart. This oxygenated blood (high in O2, low in CO2) is pumped out to all other parts of the body and back again.

1. Levels of health
2. Developmental considerations
3. Medications
4. Lifestyle
5. Environment 
6. Psychological health

Factors affecting resp functioning

Level of Health

• Acute & chronic illnesses can affect a person's respiratory function dramatically
• Ex: Ppl w/ renal or cardiac disorders often have compromised respiratory functioning because of fluid overload & impaired tissue perfusion. Ppl w/ chronic illnesses often have muscle wasting & poor muscle tone-affect muscles of resp system.

Factors affecting resp functioning

• Lungs are transformed from fluid filled structures to air filled organs.
• Chest is small, airways are short, & aspiration is a potential problem. 
• Resp rate is more rapid than any other age.
• As the alveoli increase in # & size, adequate oxygenation is accomplished at lower respiratory rates.
• Respiratory activity is primarliy abdominal in infants.
• Synthetic surfactant can be given to infants to help reopen the alveoli.

Respiratory Variations in the Life Cycle

• Respiratory Rate: 30-60 breaths/min
• Respiratory Pattern: Abdominal breathing, irregular in rate & depth.
• Chest wall: Thin, little muscle, ribs, & sternum easily seen.
• Breath Sounds: Loud, harsh crackles at end of deep inspiration.
• Shape of thorax: Round

Factors affecting resp functioning

• Preschooler's eustachian tubes, bronchi, & bronchioles are elongated & less angular. Thus, the average # of routine colds & infections decreases until the child enters daycare/school & is exposed more freq to pathogens.
• Young children that aren't placed in school haven't had the opportunity to develop antibodies for viruses & bacteria that they may encounter in the future.
• End of late childhood & during adulthood= immune system is prepared to protect the person from most infections.

Respiratory Variations in the Life Cycle

Early Childhood

(1-5yrs)

• Respiratory Rate: 20-40 breaths/min
• Respiratory Pattern: Abdominal breathing, irregular
• chest wall: same as infant's but w/ more subcutaneous fat
• Breath sounds: loud, harsh expiration longer than inspiration.
• Shape of thorax: Elliptical

Respiratory Variations in the Life Cycle

Late Childhood

(6-12yrs)

• Respiratory Rate: 15-25 breaths/min
• Respiratory Pattern: thoracic breathing, regular
• Chest wall: further subcutaneous fat deposited, structures less prominent
• Breath Sounds: Clear inspiration is longer than expiration
• Shape of thorax: elliptical

Factors affecting resp functioning

• Tissue & airways of the respiratory tract (including the alveoli) becomes less elastic.
• The power of the respiratory & abdominal muscles is reduced, & therefore the diaphragm moves less efficiently. 
• The chest is unable to stretch as much, resulting in a decline in maximum inspiration & expiration.
• Airways collapse more easily.
• Increased risk for pneumonia and other chest infections

Respiratory Variations in the Life Cycle

Aged Adult

65+ years

• Respiratory Rate: 16-20 breaths/min
• Respiratory Pattern: Thoracic, regular
• Chest wall: Thin, structures prominent
• Breath Sounds: Clear
• Shape of Thorax: Barrel shaped or elliptical

Factors affecting resp functioning

Medications:

• Pts receiving drugs that affect the CNS need to be monitored carefully for respiratory complications
• Ex: opioids are chemical agents that depress the medullary respiratory center. As a result, the rate & depth of respirations decrease.
• Be alert for the possibility of respiratory depression or arrest when administering any narcotic or sedative.

Factors affecting resp functioning

• Activity levels & habits can dramatically affect a person's respiratory status.
• People who exercise 3-6times/wk can better respond to stressors to resp health. Sedentary activity patterns don't encourage the expansion of alveoli & the development of pulmonary exercise patterns (deep breathing).
• Cigarette smoking (active or passive) is a major contributor to lung disease & respiratory distress. Its the most important risk factor for chronic COPD.

Factors affecting resp functioning

• A high correlation b/t air pollution & cancer & lung diseases.
• Ex. radiation, coal dust, asbestos, silica, environmental pollution

Factors affecting resp functioning

• Individuals responding to stress may sigh excessively or exhibit hyperventilation (increase rate & depth of ventilation, above the body's normal metabolic requirements).Hyperventilation can lead to a lowered level of arterial CO2. 
• Anxiety can cause bronchospasm to produce an episode of bronchial asthma.
• Some pts w/ resp problems develop some anxiety as a result of hypoxia caused by the resp problem.

Guidelines for Obtaining a Nursing History

Assessing:

• Determine why the patient needs nursing care 
• Determine what kind of care is needed to maintain a sufficient intake of air
• Identify current or potential health deviations
• Identify actions performed by the patient for meeting respiratory needs 
• Make use of aids to improve intake of air and effects on patient’s lifestyle and relationship with others

Guidelines for Obtaining a Physcial Assessment

• Inspect chest contour & shape.
• Note contour of intercostal spaces, which should be flat or depressed, & the mvmt of the chest, which should be symmetrical.
• Inspect skin over thorax for temp & color. Should be warm & dry & even in color.
• Note any flaring of nostrils, muscular retractions, tachypnea (rapid breathing), or bradypnea (slow breathing).

Guidelines for Obtaining a Physcial Assessment

• Resonance—loud, hollow low-pitched sound heard over normal lungs
• Hyperresonance—loud, low booming sound heard over emphysematous lungs
• Flatness—detected over bone or heavy muscle
• Dullness—with medium pitch and intensity heard over the liver
• Tympany—high-pitched, loud, drum-like sound produced over the stomach

Guidelines for Obtaining a Physcial Assessment

• Vesicular—low-pitched, soft sounds heard over peripheral lung fields.
• Bronchial—loud, high-pitched and longer, heard primarily over trachea & larynx.
• Bronchovesicular—medium pitch and sound during expiration, heard over upper anterior chest and intercostal area

Guidelines for Obtaining a Physcial Assessment

• Crackles: intermittent sounds occurring when air moves through airways that contain fluid. Occur due to inflammation or congestion. Associated w/ pneumonia, COPD. Classified as fine (brief sounds), medium, or coarse (louder, moist, bubbly sounds)
• Wheezes: continuous sounds heard as air passes through airways constricted by swelling, secretions, or tumors. Classified as sibilant or sonorous wheezes. Heard in pts w/ asthma, tumors, buildup secretions.
• Pleural friction rub: Continous, dry grating sound. Caused by inflammation of pleural surfaces & loss of lubricating plerual fluid.

• Pulmonary function studies
• Peak expiratory flow rate
• Pulse oximetry
• Thoracentesis

• Provides an evaluation of lung dysfunction, diagnose disease, assess disease severity, assist in management of disease, & evlauate respiratory interventions.
• Administered by resp therapists, techs, nurses w/ specialized training, or physicians.
• Specialized tests: exercise training helps evaluate dyspnea during exertion, max resp pressures help evaluate neuromuscular causes of resp dysfuntion, or inert gas dilution, N washout, & body.

• Measures the volume of air in liters exhaled or inhaled by a pt over time. Evaluates lung function & airway obstruction through resp mechanims. 
• Can be use to measure the degree of airway obstruction & evaluates response to inhaled meds.
• The pt inhales deeply & exhales forefully into a spirometer, an instrument that measures lung volumes & airflow.

• Refers to the point of highest flow during forced expiration. 
• Reflects changes in the size of pulmonary airways & is measured using peak flow meter. 
• W/ pt standing or sitting up straight, the pt takes a deep breath & places the peak flow meter in mouth, closing lips tightly ard mouth piece. Pt foribly exhales into the meter & an indicator on the meter rises to a #. (repeat 3 times and record highest #) (Max flow rate during forced expiration)

• A noninvasive technique that measures the arterial oxyhemoglobin saturation or arterial blood. 
• Useful for monitoring pts receiving O2 therapy, titrating O2 therapy, monitoring risk for hypoxia, & moniroting postoperative pts. 
• A range of 95%-100% is considered normal SpO2: values less than or equal to 90% are abnormal, indicate that Oxygenation to the tissues is inadequate, & should be investigated for hypoxia or technical error.

• The procedure of puncturing the chest wall & aspirating pleural fluids.The pleural cavity is a potential cavity because it's normally not distended w/ fluid or air.
• Can be performed to obtain a specimen for diagnostic purposes or to remove fluid that has accumulated in the pleural cavity & is causing respiratory difficulty & discomfort.
• Carried out w/ pt sitting on chair on edge of bed w/ legs supported & arms folded & rested on pillow on bedside table. 
• Location of where need is inserted depends where the fluid is located and can be best aspirated. Inserted b/t intercostal muscles and fascia & into pleura.

• amount of air inspired and expired in normal respiration
• normal = 500 mL

• amount of air inspired beyond tidal volume 
• normal = 3100 mL

• amount of air that can be exhaled beyond tidal volume
• normal = 1200 mL

• amount of air remaining in lungs after a maximal expiration
• normal = 1200 mL

• amount of air that can be exhaled after a maximal inhalation
• normal = 4800 mL

• largest amount of air that can be inhaled after normal quiet exhalation
• normal = 3600 mL

• equal to the expiratory reserve volume plus the residual volume
• normal = 2400 mL

• the sum of the TV, IRV, ERV, and RV
• normal = 6000 mL

• Teaching about a pollution-free environment
• Promoting optimal function
• Promoting comfort
• Promoting proper breathing
• Managing chest tubes
• Promoting and controlling coughing
• Meeting respiratory needs with medications

• Positioning: allow free mvmt of diaphragm & expansion of the chest wall.
• Maintaining adequate fluid intake: keeps secretions thin.
• Providing humidified air: Inspiring dry air removes the normal moisture in the resp passage that protect against irritations & infection.
• Performing chest physiotherapy
• Maintaining good nutrition

• Deep breathing: used to overcome hypoventilation.
• Using incentive spirometry: Visual reinforement for deep breathing by the pt.
• Pursed-lip breathing: a pt who experiences dyspnea and feelings of panic can reduce these symptoms by using pursed-lip breathing.
• Abdominal or diaphragmatic breathing: teach pt w/ COPD to change this type of upper chest breathing to diaphragmatic breathing.

• Cough is a cleansing mechanism of the body. It's a means of helping to keep the airway clear of secretions & other debris. 
• Nonproductive Cough: Dry cough
• Productive Cough: A cough that produces respiratory secretions.
• Sputum: the resp secretion that's expelled by coughing or clearing the throat.
• Congestion: Excessive fluids or secretions in an organ or body tissue.
• Congested Lungs: Secretions or fluid in the lungs.

• Consists of an initial irritation; a deep inspiration; a quick, tight closure of the glottis together w/ a forceful contraction of the expiratory intercostal muscles; & an upward push of the diaphragm.
• Causes an explosive mvmt of air from the lower to the upper resp tract. 
• To be effective, a cough should have enough muscle contraction to force air to be expelled & to propel liquid or a solid on its way out of the resp tract. 
• Coughing is most effective w/ pt sitting upright w/ feet flat on floor.

• When a cough doesn't occur as a result of reflex stimulation of the cough-sensitive areas, it can be induced voluntarily.
• Coughing is more effective when combine w/ deep breathing
• Remind pts to perform effective coughing throughout the day.
• Develop a coughing schedule for pt.
• If pt has neuromuscular disorder & is unable to cough physically, an assisted cough may be used.

• Often accompanies resp tract infections & irritations. Many times resp infections lead to the production of resp secretions. These secretions can trigger the cough mechanism. 
• When cough is productive it helps clear the airway. When cough is nonproductive it can cause fatigue and irritation.
• Meds can control involuntary cough.

• Cough suppressants
• Expectorants
• Lozenges

• Drug that facilitate the removal of respiratory tract secretions by reducing the viscosity of the secretions.
• Pts w/ tenacious (thick) secretions may need the secretions liquefied for their cough to be effective. That way, the nonproductive cough w/ a person w/ congestion will become productive.
• Adeqaute fluid intake & air humidification are considered effective expectorants by some authorities. 

• Drugs that depress a body function in this case, the cough reflex. 
• Codeine, which is present in many cough preparations, is generally considered the preferred cough suppressant ingredient. However, it can be addictive, & because of possible abuse, many states require a prescription for its use.
• Drowsiness (also common w/ antihistamines) is a side effect, so it may not be safe to use when the person must be alert, such as when driving a car.

• Can often relieve mild, nonproductive coughs in ppl w/out congestion. 
• Generally controls coughs by the local anesthetic effect of benzocaine. The local anesthetic acts on sensory and motor nerves, controlling the primary irritation & inhibiting afferent & efferent impulses.

Teaching about cough medications

Examples on why?

• Cough syrups w/ a high surgar or alcohol content can disturb the metabolic balance of pts w/ diabetes mellitus or can trigger a relapse for recovering alcoholics.
• Preparations containing antihistamines have an anticholinergic action, which can cause serious problems for ppl w/ glaucoma or cause urinary retention in men w/ prostate enlargement.
• If cough last more than 7 days, encourgae person to increase fluid intake if the secretions become too think to expectorate.

• Helps loosen & mobilize secretions, increasing mucous clearance. Helpful for pts w/ large amts of secretions or an ineffective cough. 
• Includes percussion, vibration, and postural drainage.

Performing Chest Physiotherapy

Percussion:

• Involves the use of a cupped palm to loosen pulmonary secretions so that they can be expectorated w/ greater ease. 
• Typically each area is percussed for 30-60secs several times a day. If the pt has tenacious secretions, the area may be percussed for up to 3-5mins several times per a day. 

Performing Chest Physiotherapy

Vibrating

• uses manual compression & tremor on the pt's chest wall to help loosen respiratory secretions.

Performing Chest Physiotherapy

Postural Drainage

• Makes use of gravity to drain secretions from the lungs. 
• Position pt that promotes the drainage of secretions from smaller pulmonary branches into larger ones, where they can be removed by coughing. 
• Vibration, percussion, or both often precede postural drainage.
• Ex. Use high fowlers position to drain apical secretions of the upper lobes of the lungs.

• For a pt who is unable to remove secretions w/ coughing, aspirate secretions w/ a suctioning device. 
• If pt is able to raise secretions from the airways but unable to clear from the mouth, suctioning of the oropharynx or nasopharynx may be indicated.
• If pt is unable to raise secretions from the airways, tracheal suctioning may be indicated. May be performed by passing a sterile catheter through the mouth (orotracheal) or through the nose (nasotracheal). May also be passed through a tracheostomy or endotracheal.

• Freq of suctioning varies w/ the amt of secretions present but should be done often enough to keep ventilation effective & as effortless as possible.
• Suctioning irritates the mucosa & removes O2 from the respiratory tract, possibly causing hypoxemia (insufficient O2 in the blood). Thus, it's important to pre-oxygenate the pt before suctioning. This is accomplished by applying or increasing supplemental O2 & having the pt take several deep breaths before inserting the catheter.

• Inhaled medications may be administered to open narrowed airways (bronchodilators), to liquefy or loosen thick secretions (mucolytic agents), or to reduce inflammation in airways (corticosteroids). 
• These medications typically are administered via nebulizer, metered-dose inhaler, or dry powder inhaler.

• Disperses fine particles of liquid medication into deeper passages of the respiratory tract where absorption occurs.
• The treatment continues until all the medication in the nebulizer cup has been inhaled.

• Delivers controlled dose of medication with each compression of the canister.
• Pt must activate the device while continuing to inhale.

• Activated by the patient’s inspiration.
• Quick deep breath activates the flow of medication, eliminating the need to coordinate activating the inhaler while inhaling the medicine at the same time.

• Avoid open flames in patient’s room
• Place no smoking signs in conspicuous places
• Check to see electrical equipment in room is in good working order
• Avoid wearing and using synthetic fabrics (builds up static electricity)
• Avoid using oils in the area (ignite spontaneously in oxygen)

• Nasal cannula
• Nasal catheter
• Transtracheal catheter
• Simple mask
• Partial rebreather mask
• Nonrebreather mask
• Venturi mask
• Tent

Nasal Cannula

(Nasal Prongs)

• The most commonly used O2 delivery device. 
• Cannula: A disposable plastic device w/ 2 protruding prongs that are inserted into the nostrils. Cannula is connected to an O2 source w/ a flow meter &, many times, a humidifier.
• Disadvantages: Can be dislodged easily & can cause dryness of the nasal mucosa.

• Infrequently used because its considered uncomfortable for the pt & may cause trauma to respiratory mucous membranes.
• Inserted into the nose through one nostril, w/ the end of the catheter resting in the oropharynx. Cath must be removed for cleaning & changed to the other nostril q 12-24hrs. 
• Gastric distention often occurs because the gas flow can be misdirected into the stomach.

• Connect to O2 tubing, a humidifier, & a flow meter, just like the nasal cannula. Mask has vents on sides that allow rm air to leak in at many places, thereby diluting the source O2. Also allows CO2 to escape.
• Used when increased delivery of O2 is needed for short periods.

• Is equipped w/ a reservoir bag for the collection of the 1st part of the pt's exhaled air. The remaining exhaled air exits through vents. The air in the reservoir is mixed w/ 100% O2 for the next inhalation.

• Delivers the highest concentration of O2 via a mask to a spontaneously breathing pt.
• 2 one-way valves prevent the pt from rebreathing exhaled air. 
• Reservoir bag is filled w/ O2 that enters the mask on inspiration. 

• Allows the mask to deliver the most precise concentrations of O2. Has a large tube w/ an O2 inlet. As the tube narrows, the pressure drops, causing air to be pulled in through side ports.

• A light, portable structure made of clear plastic & attached to a motor-driven unit. The motor helps to circulate & cool the air in the tent. 

• Pt w/ fluid (pleural effusion), blood (hemothorax), or air (pneumothorax) in the pleural space require a chest tube to drain these substances & allow the compressed lung to reexpand.
• Assist with insertion and removal of chest tube
• Monitor the patient’s respiratory status and vital signs
• Check the dressing
• Maintain the patency and integrity of the drainage system

• Oropharyngeal & Nasopharyngeal Airways
• Endotracheal Tube
• Tracheostomy

• Used to keep the tongue clear of the airway. Often used for postoperative pts until they regain consciousness.

Nasopharyngeal Airway

(Nasal Trumpet)

• Inserted through the nare & protrudes into the back of the pharynx. Allows for frequent nasotracheal suctioning w/out trauma to the nasal passageway.

• A polyvinychloride airway that is inserted through the nose or the mouth into the trachea, using a laryngoscope as a guide. Used to administer O2 by mechanical ventialtor, to suction secretions easily, or to bypass upper airway obstructions.

• Artificial opening made into the trachea, usually at the level of the 2nd or 3rd cartilaginous ring. A curved tube, called a tracheostomy tube, is inserted though the opening. 
• May be either cuffed or cuffless. The inflated cuff seals the opening ard the tube to create a tight fit in the trachea. Prevents air leakage & aspiration, & permits mechanical ventilation. If cuffed tube is used, always deflate it before oral feeding unless the pt is at high risk for aspiration.

Administering Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is the combination of mouth-to-mouth breathing, which supplies O2 to the lungs, and chest compressions, which ciruclate blood. Described in terms of the ABCDs:

1. Airway—tip the head and check for breathing
2. Breathing—if victim is not breathing spontaneously, give two breaths lasting 1.5 to 2 seconds
3. Circulation—check the pulse; if victim has no pulse, initiate chest compressions
4. Defibrillation: Apply the AED as soon as it's available.