ana physiology of respi.docx
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ANATOMY & PHSIOLOGY OF RESPIRATORY SYSTEM -------- COMMON HEALTH PROBLEMSAir conductionFunction of upper respiratory system
Gas exchangeFunction of lower respiratory system
NoseFor airway, warming, moistening the air, filters air
PharynxBoth for digestion and respiration
LarynxVoicebox (composed of hyoid, thyroid & cricoid cartilage)
GlottisOpening of the laryx
GlottisPrevents aspiration of fluid & food of respiratory tract
Trachea10-14cm, 4-5 in, 1.5-2.5 cm in dm
16-20# of C-shaped cartilages of trachea
Bronchi1 ml in dm
BronchiolesCollection of terminal branches
AlveoliSac
Right & leftParts of hylum in the lungs:
9,10Number of segments of hylum in the lungs: Left:_ Right:_
Terminal bronchiolesDivides respiratory bronchioles
PleuraThin translucent elastic tissue that covers the lungs
Parietal & visceral pleuraParts that covers the lungs
EffusionAbnormal accumulation of fluid in the blood
BLOOD SUPPLY:1. Comes from the pulmonary artery & receives blood from the RIGHT VENTRICLE(deoxygenated)2. Comes from the bronchial ateries & receives blood from the AORTA (oxygenated)3. Coming from the aorta per se and this supplies blood to the bronchial artery, bronchial arterioles & bronchial capillaries
PULMONARY CIRCULATION
Pulmonary veinLeft arterioles
CiliaCovers surface of tracheobronchial epithelium
CiliaEndowed w/ rhythmic movement to expel secretions w/c are undesirable
Neutrophils, macrophages, IgA, IgG4 phagocytic cells that protects the lungs
SurfactantPrevents collapse
Intrapulmonic pressure/intraalveolar pressureMaintained before & after respiration
Intrathoracic pressurePressure maintained after deep inspiration & expiration
Lung vol and capacityAmount of O2 retained and expelled
Tidal volumeFraction of lungs not inhaled/exhaled w/ each normal breath (500-600cc)
IRVAdtl vol of air that can be inhaled at the end of normal respiration
ERVAmount of air that is forcefully exhaled/released after the normal respiration
RVAmnt of air that cant be expelled after forceful exhalation (1200-1300ml/cc)
CapacityCombination of /more volumes
Inspiratory capacityTV(500)+IRV(3000)=3500 cc
Functional residual capacityERV(1500)+RV(1500)=3000 cc
Vital capacityTV+IRV+ERV= 5000-6000cc
Vital capacityMaximal amnt to be inhaled after maximal expiration
Total lung capacityVC+RV= 6500-7000cc
Minute ventilationTV x RR/min
External respirationExchanging of O2 & CO2 between atmosphere and blood
Ventilation, alveolar diffusionTypes of external respiration
Internal respirationTransporting O2 from blood to cells 7 removal of CO2 of cells to the blood
External & internalTypes of respiration
Steps of respiration1. Transport of O2 & CO2 via hemoglobin & plasma2. Cellular diffusion3. Oxidation reduction-reaction
MyocardiumMuscle of the heart
MyocardiumSupplies the left ventricle
Left ventricle Has the strongest contraction
KidneysTolerate 6-8 hrs of O2 lack
Acute renal failureMore than 6-8 hrs results to:
VENTILATION-PERFUSION PATCHES
VentilationFlow of gas in & out of the lungs
PerfusionDistribution of blood all throughout the body
low-ventilation perfusion ratio, high-ventilation perfusion ratio, silent units3 VENTILATION-PERFUSION PATCHES:
1. Low-ventilation perfusion ratioLow perfusion compared to ventilation
Low-ventilation perfusion ratioLack of O2 to supply the lung tissue
Physiologic shuntIll effect of low-ventilation perfusion ratio
2. High-ventilation perfusion ratioMore air than fluid distribution
High-ventilation perfusion ratioLung tissue becomes physiologic dead space
Embolism, pulmonary infarction, thrombosisExamples:
3. Silent unitsComplete absence of perfusion & ventilation exs: pneumothorax, ARDS
peripheral chemoreceptorsAt the aortic arc/carotid
When is the peripheral chemoreceptors activated:1. When theres decreased partial O2/ increased in partial O22. When theres increased partial CO2/ decreased in partial CO23. When there are PH changes in the blood
Hering Breuer reflexActive to prevent overdistention
ProprioceptorsIn muscles & joints and is active during exercise
Phrenic nervePrimary nerve involved in quiet breathing, C4
Intercostal nerveInnervates intercostal muscles, from thoracic nerves 1-11
FACTORS OF _:
1. Atmospheric factorIncreased altitude, decreased atmospheric pressure
Atmospheric factorDecreased PaO2 , decreased atmospheric pressure
Atmospheric factorDecreased altitude, increased diffusion of nitrogen in the blood
2. Pulmonary/lung factorPatent airway, patent gas exchange
3. Circulatory factorComposition of blood
4-7MNormal lvl of RBC
5-8LNormal blood vol in adults
150,000-450,000Normal # of platelets
4. Normal pumping capacity of the heart
60-90 bpmNormal HR in adults
5. Cellular factorNormal utilization of O2 by the cells
6. Aging process
Middle age (40 y.o)Theres decreased SA for exchange of O2 and CO2
50 up (age)The alveoli loses elasticity
AgedIf theres decreased lung recoil, theres decreased lung capacity. If theres increased lung vol, theres increased chest wall stiffness.
History takingIncludes the treatment modalities the patient employs
*Medication history*previous respi problems*diet & fluid intake*precipitating activitiesWhat to ask for history taking:
precipitating activitiesIncreased more of occurrence of conditions
1. sudden dyspnea2. orthopnea3. respiratory wheezing4.sterterus breathing5. expiratory and inspiratory wheezing6. severe grade of dyspneas/sx of clients w/ aeration problems:
LaryngeochacitisHi pitched cough
Viral infectionDry cough
BronchiocarcinomaBrassy cough
Severe changing coughBrought by pleural/chest wall involvement
Nocturnal coughOnset of asthma/CHF
BronchitisMorning cough
Post nasal dripCoughing in supine position
AspirationCoughing after food intake
Bacterial infectionSputum is perfused(purulent) yellow/green color
PneumoniaRusty colored sputum, metallic taste
Viral infectionThin and mucoid sputum
Chronic bronchitis, bronchiectasisSputum increased overtime
Lung tumorPink tinged mucoid sputum
Pulmonary edemaProfusely pinkish, fruity
Lung abscess, bronchiectasisMalodorous sputum
Pneumonia, pulmonary embolism, lung infarctionChest pain
Bronchogenic carcinomaPain at last, invasion of chest wall, mediastinum & spine
Pruritic chest painStabbing of knife, pleuritic irritation
Nail clubbingLast structure that receives O2
HemoptysisCoughing out of blood
HemoptysisFrothy, bright red, pinkish (rupture inside the lungs)
CyanosisBluish discoloration of skin and mucus membranes
CyanosisPoor tissue perfusion
CyanosisDecreased perfusion, increased ventilation
CyanosisThere are signs of hypoxia
Central cyanosisHemoglobin below 5 gms
Peripheral cyanosisHemoglobin less than 9 gms
Peripheral cyanosisDue to decreased blood flow to certain areas of the body
RR, HR, BP, TEMPVital signs
1. Inspection2. Auscultation3. Percussion4. Palpation4 modalities of physical exam:
HypoxiaInadequate cellular oxygenation
*insufficient O2 intake*insufficient perfusion of O2 in pulmonary system(decreased intravascular vol)Causes of hypoxia
HypoventilationInsufficient ventilation to meet bodys metabolic needs; leads to metabolic acidosis
HyperventilationVentilation that exceeds bodys metabolic needs; leads to respiratory alkalosis
Grade 1 dyspneaMild exertion
Grade 2SOB while walking
Grade 3 SOB of daily living
Grade 4SOB at rest
Grade 5SOB at supine position
TB DIAGNOSTIC TESTS:*Tuberculin test*Mantoux test*PPD*Xray*Sputum study*Psytologic exam*Sputum culture*Lung scan*Bronchosopy-visualization of brochi, laynx, trachea & alveoli
Purposes of bronchoscopy:*Identify obstructions*Remove foreign body*Idnetify surgical preparation
BrochographyXray of the chest
ThoracentesisAspiration of sample/ fluid from particular cavity (pleural space)
ParacentesisRemoval/aspiration of fluid from parital pleura
PFT(Pulmonary function test)Measures lung capacity and vol
TREATMENT MODALITIES
1. Transtracheal aspirationAspiration of trachea by inspiratory needle
Transtracheal aspirationEmployed to promote coughing w/ patient w/ absent cough reflex
2. Thoracostomy tube
3. O2 Administration
O2 therapyFor clients w/ hypoxia/hypoxemia
O2 therapyDry, tasteless, odorless
ColonDirtiest part of the body
1. Positioning2.Oropharyngeal suctioning3. Nasopharyngeal suctioning4. Tracheostomy suctioning5. Endotracheal suctioning6. Incentive spirometryHow to maintain a patent airway:
Mechanical device for patients to achieve maximum inspiration, preventing lung collapse
*Decreased partial O2*Continuous of PaCO2*Persistent acidosisIndications of mechanical ventilation:
4 CLASSES OF DISORDERS:
1. Restrictive diseasesLimit lung expansion & restrict chest wall movement throughout respiratory cycle
Restrictive diseasesDecrease lung volume, pulmonary compliance
Atelectasis, pneumothorax, pleural effusion, pneumonia, neuromuscular alteration, neuromuscular disordersExamples of restrictive diseases
*kyphosis*fractured ribs*muscular dystrophy*myasthenia gravis*Guillen barre syndrome*abdominal distention*pain/tight application of bondageExamples of neuromuscular disorders
*occupational hazards*Trauma to chest(rib fracture)*past & present history of musculoskeletal disordersRisk factors of restrictive diseases:
2. Obstructive diseasesSomething in tracheobronchial tat impedes the airflow
Acute/chronicObstructive diseases can be :
CHRONIC OBSTRUCTIVE DISEASES:
*AsthmaConstriction of tracheobronchial tree
*Bronchitis Inflammation of bronchi/bronchioles
*EmphysemaEnlarged alveoli
*Edema
*Mucus ciliary transport caused by chemical damage
. Respiratory Tract infection Exs: TB & pneumonia
*exposure to infected person*stressRisk factors of respiratory tract infection
. Pulmonary related cardiac diseaseDisorders of pulmonary system, exs: corpulmonary and pulmonary embolism
5 CARDINAL SIGNS OF INFLAMMATION:
1. Transient vasoconstrictionNeural reflex
32. VasodilationRedness at site of injury(rubor)
VasodilationSudden gush of blood at the site of injury
3. Warm(pallor)
4. Exudation
5. Pain-loss of function
RhinitisCaused by allergic/ non-allergic agents/ infections
SinusitisCan be acute/chronic
PharyngitisCan be acute/chronic
*Rhinorrhea*Nasal congestion*Nasal itchiness*sneezing*headacheManifestations of rhinitis:
*facial pain*tenderness of paranasal sinuses*purulent nasal discharge*ear pain*dental pain*Decreased sense of smellManifestations of sinusitis:
*fiery red pharyngeal membrane*white purple flexed exudates*enlarged lymph nodes*fever*malaise*sore throat*diff of swallowing*cough may be absentManifestations of pharyngitis:
Interventions of rhinitis, sinusitis, pharyngitis:1. Maintain patent airway2. Administer medications to relieve nasal congestions3. Increase oral fluids4. Vaporizer5. Promote comfort
5 SAAC- ESCALANTE
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