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