Now let's look at the respiratory system.
Now our goal here is to maintain adequate
oxygenation for tissue perfusion.
So you need the heart to
transport it around,
but you need the respiratory system to
make sure you have adequate oxygen
in that blood supply.
So, remember, you're going to listen to
lung sounds posterior and anteriorly.
That's going to tell us about the lungs,
and remember in the cardiovascular,
we talked about you're listening
closely for signs of crackles,
or fluid volume overload.
Monitor and assess the patient's oxygenation.
You might do this with a simple
or you can just watch for signs
where the patient
might be getting restless or agitated.
You want to do a pulse ox to check on that.
So if we need to, provide some
supplemental O2 as required.
Remember, Mr. Johnson was
on nasal cannula at 2 liters.
And encourage the patient to
move and deep breathe.
People are usually resistant to
this, right, because they're
a little fearful, they're a little overwhelmed,
and they're just flat tired.
So you're going to have to be very positive
and not take "no" for an answer easily.
Encourage the patient to get up
and to move and to be active
because we want those -- deep breaths,
and if we move them around,
they are more likely to breathe, too.
But you can also do deep breathing with
them while they're right in bed.
So you want to watch them for any
signs of respiratory complications
because what we're trying to avoid
with the deep breaths is atelectasis.
That means lungs are kind of collapsed,
and collapsed lungs do not
exchange CO2 and O2.
So that's why we want all patients to
cough and deep breathe, right?
So, we want them to -- take a really
deep breath and we can encourage
coughing because that helps
to open up those airways.
Now, the health care provider might
even order an incentive spirometer.
That's just a little tool that
you'll use a mouthpiece
and the patient will breathe so that
you can see how much volume
they're actually able to pull.
So, we're looking for atelectasis.
We want these lungs all fully functioning.
We're also watching him closely
for aspiration pneumonia.
Now, we worked with the
speech therapist, right,
to make sure he could swallow safely,
and they made recommendation as to the
type of diet that he would be eating.
So, we know if he can take thin liquids or
needs those yucky thickening
put into his normally thin liquids,
we know what he needs, but we still
want to watch him closely
for any signs of choking or
The only protection you have is your
epiglottis, and that's a little flap
that protects either your airway
when you're trying to eat food. So that's
that slaps, it's a little leaf flap shape,
it will close over your airway when
you're swallowing food,
so it doesn't go down the wrong pipe, like
your grandmother probably used to call it.
So patients with a stroke sometimes
had difficulty with chewing
and with swallowing, and they're at an
increased risk for aspirating something.
Now, that means they'll either take food
or liquids down into their lungs.
They weren't protected. It went straight
down into their lungs
and it can develop an infection,
which is what aspiration pneumonia is.
We're also watching for pulmonary edema.
You already hit that, right?
You know that you listen to
the front and the back,
and we expect we'll hear it
first in the bases.
So, let's wrap this 1 part up.
The respiratory complications
I'm taking a look at,
I'm watching for is atelectasis,
collapsed areas of the lungs where the
lung sounds will be very diminished.
Aspiration pneumonia where they're
going to sound real junkie,
or pulmonary edema, which will be crackles.
So, let's practice with Mr. Johnson.
I want you to think through in your mind,
as you're going through an assessment,
a long assessment of Mr. Johnson,
what are the sounds that would let you
know that he's in trouble?
Don't look at your notes. Just pause the
video and think through
what are the worst case scenarios
you're on the alert for
with Mr. Johnson because he's had a stroke?