Respiratory System and Care

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Breathing is the action of moving air in (inhalation) and out (exhalation) of the body. During breathing, oxygen in the air enters through the nose and mouth and travels to the lungs. The diaphragm moves down and the muscles around the ribs push out, expanding the chest. From the lungs, oxygen moves through the body to all organs, tissues and cells. During exhalation, the muscles relax and carbon dioxide, the waste product of breathing, is eliminated. The delivery of oxygen and elimination of carbon dioxide is vital to life.

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Lung: Main organs of breathing.
Diaphragm: Large muscle at base of the lungs.
Intercostals: Muscles located along rib cage.
Trachea (windpipe): Air passage to lungs.
Tracheotomy: Artificial opening from the neck into the trachea; helps breathing and can protect airway.
Tracheostomy tube (trach): Tube inserted into trachea for air movement.
Inner cannula: Inner, removable part of tracheostomy tube. Not present in all trachs.
Postural drainage: Using positioning to help drain secretions (mucus) from lungs.
Respiratory rate: Number of breaths per minute – normally, about 12 to 20 for adults.
Pneumonia: An infection of the lungs.
Aspiration Pneumonia: Pneumonia caused by inhalation of a foreign substance into the lungs.
Pulmonary embolism: Blood clot in the lungs.

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Respiratory problems may occur with various disabilities. Just like weakness in limbs, muscles for breathing may be weakened or not work properly. Examples of respiratory problems include:

Decreased ability to prevent substances other than air, such as saliva, food, or fluid, from entering the windpipe. Decreased ability to swallow or cough, thereby allowing foreign substances into the windpipe.

Mucus accumulation in lungs due to difficulty taking deep breaths or staying in one position for long periods.

Basic suggestions for respiratory care:

Drink at least six cups (8-oz) of fluid each day. Fluids help keep mucus thin and easier to cough up.

Take deep breaths to help keep the lungs and muscles working.

Change body position often to prevent mucus build up.

Follow any dietary guidelines provided by your physician or therapist.

Practice blowing bubbles and blowing up balloons.

If instructed, use a spirometer or other breathing exercise equipment.

NOTE: Use the information below to help avoid respiratory problems.

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Chest congestion or colds
Breathe deeply. This opens the lungs and prevents mucus build up.
Use a room humidifier.
Call the doctor if fever is more than 101.5, or if a cold does not get better.

Pneumonia
Signs of pneumonia, an infection in the lungs, include:
Change in respiratory rate – either very fast or very slow
Difficulty or shallow breathing
Chills or fever
Coughing
Chest congestion or chest pain
Confusion

Lifting the head of the bed or using extra pillows can also ease breathing

NOTE: If you experience these symptoms, contact your doctor or call 911. 

Preventing pneumonia
Take deep breaths, using as many muscles as possible.
Do breathing exercises as instructed by the doctor, nurse or therapist.
Change position at least once every two hours, even if in bed.

Aspiration pneumonia
Signs of aspiration pneumonia:
Coughing
Shortness of breath
Wheezing
Chest discomfort
Confusion
Excessive sweating, and/or fever, chills
Difficulty swallowing

NOTE: If you experience these symptoms, contact your doctor or call 911.

Preventing aspiration pneumonia
Elevate the head of the bed at least 30 degrees at all times or higher.
Do breathing exercises as instructed by the doctor, nurse or therapist.
Change position at least once every two hours, even if in bed.
Conduct oral hygiene at least 3 times a day to decrease bacteria in your mouth.

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Signs of PE:
Difficulty breathing/ shortness of breath
Rapid breathing
Chest pain
Bluish or dusky color in face area
Confusion
Increased/ racing or irregular heartbeat
Sense of doom or anxiety
Light–headedness

NOTE: This is a serious emergency. Call 911 immediately for help.

Preventing PE
Keep as active as possible.
Take all medicines as prescribed by the doctor. In some situations, blood–thinning medications are used to prevent clots.

References:
Alexander, T., Hiduke, R., & Stevens, K. (1999). Rehabilitation Nursing Procedures Manual. 2nd edition. NYC, NY: McGraw-Hill.

Quinn B, Baker DL, Cohen S, Stewart JL, Lima CA, Parise C. Basic nursing care to prevent non-ventilator hospital-acquired pneumonia. Journal of Nursing Scholarship. 2014;46(1):11-9.

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This content is for informational purposes only and may not be comprehensive. Information contained does not imply an endorsement from Shirley Ryan AbilityLab, and does not replace the advice of a qualified healthcare professional.  See here for further details. © Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago). Henry B. Betts LIFE Center – (312) 238-5433 – https://www.sralab.org/lifecenter