RESPIRATORY SYSTEM &
JANET J. NELSON RN,CMA
o 1. Identify and label structures of respiratory
o Describe functions of respiratory organs
o Explain physiology of respirations
o Define four respiratory events
o Define respiratory capacity terms
o Distinguish between respiratory disorders
Do you know??
o What is snoring?
o Why do we yawn?
o What is a hiccup?
o Can you breath and swallow at
the same time?
Larynx & Epiglottis
o Glottis is the space between the vocal cords
o Laryngeal muscles control length and size of
opening by moving cartilages
o Sound is produced by the vibration of vocal
cords as air is exhaled
of Respiratory Disease
Sputum: Yellowish-green, cloudy - bacterial
Rusty or dark-colored – pneumococcal pneumonia
Large amounts purulent with foul odor – bronchiectasis
Thick, tenacious mucous - asthma or cystic fibosis
Blood tinged – chronic cough, tumor or TB
Hemoptysis with frothy sputum – pulmonary edema
General Manifestations cont.
Breathing patterns may be altered in
respiratory diseases. Normal 12-20/min
Breath sounds: Rales, Rhonchi,
Absence of breath sounds
The R.A.L.E. Repository
Green box on left---repository—normal—rales--wheeze
Tobacco Related Diseases
Destruction of respiratory cilia
Carcinogenic (Lung and oral cancer)
Peripheral Artery Disease
Duodenal and gastric ulcers
Low birth weigh infants for a smoking mom
Health Effects of Smoking
More than 4,000 individual compounds have been
identified in tobacco and tobacco smoke. Among
these are more than 60 compounds that are known
carcinogens (cancer-causing agents).
There are hundreds of substances added by
manufacturers to cigarettes to enhance the flavor or
to make the smoking experience more pleasant.
Some of the compounds found in tobacco smoke
include ammonia, tar, and carbon monoxide. Exactly
what effects these substances have on the cigarette
consumer’s health is unknown.
Health Effects of Smoking
About half of all Americans who continue to
smoke will die because of the habit. Each
year, about 438,000 people die in the US from
tobacco use. Nearly 1 of every 5 deaths is
related to smoking.
Cigarettes kill more Americans
than alcohol, car accidents,
suicide, AIDS, homicide, and
illegal drugs combined.
Health Effects of Smoking
Cigarette smoking accounts for at least 30% of all
cancer deaths. It is a major cause of cancers of the
lung, larynx (voice box), oral cavity, pharynx (throat),
and esophagus, and is a contributing cause in the
development of cancers of the bladder, pancreas,
cervix, kidney, stomach, and some leukemias.
About 87% of lung cancer deaths are caused by
smoking. Lung cancer is the leading cause of cancer
death among both men and women, and is one of the
most difficult cancers to treat. Fortunately, lung
cancer is largely a preventable disease.
Other risks of smoking
Higher incidence of SIDS & mothers
Children's asthma attacks and severity
are worsened in home with smoker.
Increase risk for hypertension
Stained teeth and halitosis
Chronic Obstructive Pulmonary Disease is a group of
common chronic respiratory disorders that are
characterized by progressive tissue degeneration and
obstruction in the airways of the lung.
These disorders are emphysema, chronic bronchitis
Fifth leading cause of death and disability in the U.S.
Features in common:
Dyspnea with progression in severity
Cough with frequent pulmonary infections
Hypoxia with retained Carbon dioxide
A serious, chronic lung condition where the
alveoli enlarge, losing elasticity and
capillaries around alveoli are destroyed.
(Permanently inflated alveolar air spaces).
Patient loses the ability to exhale CO2 and
must use incredible amount of energy to
Etiology: cigarette smoking, environment
S&S: Onset is insidious…dyspnea,
hyperventilation, barrel chest, pursed lips with
exhalation, anorexia with weight loss.
DX: Chest X-ray, PFT.
TX: Avoid irritants, stop smoking, pulmonary
rehab programs, bronchodilators, O2,
antibiotics with infection, maintain nutrition.
PX: Some reversal of airway obstruction with
S&S improvement can be obtained initially,
but long term the prognosis is less favorable.
DISTENTED ALVEOLI IN EMPHYSEMA.
NOTICE THE CO2 TRAPPED IN THE
ALVEOLI EVEN AFTER DEATH
The mucosa of the LR tract become severely
inflamed and produce excessive mucous.
Impaired ventilation is the result, with
increase risk of pneumonia. (Remember
smokers are missing cilia).
Etiology: HO cigarette smoking or living in
urban industrial area.
S&S: constant cough, tachypnea, SOB, thick
& purulent sputum, rhonchi & cough worse in
a.m., cyanosis, weight loss and signs of cor
DX: History, chest X-ray, PFT
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TX: Reducing exposure to irritants, prompt
treatment of infection, Use of expectorants,
bronchodilators and low flow O2.
PX: Guarded; although consistent treatment
can slow the progression.
Voluminous sero-mucinous secretion in the trachea in a
patient with chronic bronchitis.
Chronic condition of increased reactivity of the
Two types: Extrinsic-involves acute episodes
triggered by a hypersensitivitiy reaction to an
inhaled allergen. Intrinsic, with an adult onset, is
a response to other stimuli, e.g. cold, exercise,
stress, irritants like smoke.
Genetics plays a part in etiology.
Characterized by episodes of reversible airway
obstruction, due to, bronchoconstriction, mucous
production and mucosa edema.
S&S: cough, dyspnea, wheezing, possible
sternal retractions, thick and tenacious mucous,
DX: The best tool is a PFT during attack, then
chest X-ray shows hyperinflation, allergy test,
and a CBC with elevated eosinophils.
TX: Minimize attacks, use of bronchiodilators.
PX: Acute episodes can be life threatening.
Status astmaticus: is a persistent severe attack
of asthma that does not respond to therapy. It
may be fatal.
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Lung cancer is common site of both primary and
secondary lung cancer.
Primary lung cancer is 90% HO smoking. Low
cure rate-less than 7% survive over 5 years.
Secondary: Metastasis develop as cancer cells
travel in blood and lymph from heart to first small
vessels in the the lungs.
Etiology: Smoking (cilia missing and not able to
remove the carcinogens caught in mucous),
occupational exposure of chemicals e.g silica,
S&S: Insidious, because “smokers cough” masks
S&S. Early: persistent productive cough,
hemoptysis, dyspnea, + Chest X-ray. Chest pain as
the pleura and/or mediastinum involved.
DX: Chest X-ray, bronchoscopy with biopsy.
TX: Complete resection of the diseased lung, but
with rapid metastasis, often not a choice. Radiation
and chemotherapy but many tumors are not
PX: Continues to be poor, unless tumor is in very
early stages of development.
The lymphatic and circulatory system can deliver
cancer cells to the lung = secondary cancer
An infectious and inflammatory disease of the lungs,
acquired by inhaling droplets containing bacteria.
Etiology: Mycobacterium tuberculosis is causative
agent. The primary lesion is usually in lung with
bacteria surviving in dried form for months.
. The infection begins with a primary lesion
which causes necrosis, fibrosis and
calcification. The infection than goes
dormant for possible years.
S&S: Vague with anorexia, malaise, fatique, weight
loss. Later- low grade fever, night sweats,hemoptysis,
chest pain and weakness.
DX: Mantoux test, Chest X-ray, (walled off lesions
are identified), positive sputum culture.
TX: Drug therapy with multiple antituberculosis
agents. Contacts of patient must receive
prophylactic treatment for one year and receive TB
TB is considered infectious; therefore good
handwashing and respiratory precautions must be
practiced. Place patient in isolation with HCW using
N-95or HEPA respirator mask & room air is vented
for UV ray exposure.
PX: Early and complete treatment offers an
excellent prognosis. Other organs can be involved
without adequate treatment.
Respiratory Syncytical Virus
This viral, infective condition is most common in
young & elderly. RSV is one of the most
important causes of lower respiratory tract illness
and can be fatal.
Etiology: RSV is the causative agent. The
greatest occurrence is during the winter months.
Premature infants are at greatest risks. Most
people have experienced several RSV infections
in their life. Most are self limiting. RSV is spread
by contact with infective secretions.
S&S: Cold-like symptoms with nasal congestion,
otitis media, cough and URI. As the virus
progresses downward to the lower respiratory
tract, the patient experiences fever, malaise,
lethargy, cough and dyspnea.
DX: The clinical picture and thorough PE are key.
If necessary a nasal lavage with viral culture can
TX: Palliative. Hospitalization may be necessary
to ensure adequate respiration.
CF is a chronic dysfunction of the exocrine
glands affecting multiple body systems; it
is the most common fatal genetic disease.
Etiology: It is an inherited disorder and is
transmitted as an autosomal recessive
Each of us inherits two CFTR genes, one from each parent.
Children who inherit an abnormal CFTR gene from each parent will have
•Children who inherit an abnormal CFTR gene from one parent and a
normal CFTR gene from the other parent will not have CF. They will
be CF carriers.
S&S:May be apparent soon after birth or develop
in childhood.Primarily attacks the lungs and
digestive tract with production of copious thick
and sticky mucous that accumulates and blocks
Salty sweat (Mom notices with kiss, positive sweat test)
Signs of malabsorption (steatorrhea,& abd.distention)
Chronic cough and respiratory infections
Failure to meet normal growth milestones
DX: Sweat test, check stools for fat content and
trypsin (pancreatic enzyme) PFT, Chest X-ray,
TX: CF is considered a fatal disease. However,
with early diagnosis and treatment, the life
expectancy has improved greatly during the past
few decades. High calorie, high NaCl diet,
postural drainage, pancreatic enzyme
supplementation, O2 prn. Lung transplants are a
Include: coryza, sinusitis, laryngotracheo-
bronchitis, epiglottitis, & influenza.
Viral etiology for cold, croup and influenza.
Bacterial for sinusitis and epiglottitis.
Secondary bacterial infection may follow viral.
S&S: Cold and flu-red, swollen mucous
membranes of nose & pharynx with increase
secretions, rhinorrhea, maybe sore throat and
fever. The infection advancing to larynx
causes hoarseness and cough (bronchi).
S&S: Colds are usually 7 days in duration while
the flu is sudden with fever, fatique lasting for
weeks. Croup-barking cough,(due to edema and
mucous with possible obstruction) with hoarse
voice and inspiratory stridor. Epiglottitis-”red ball
obstruction”, severe sore throat, refuse to
swallow, anxious breathing and inspiratory
DX: History and exam.
TX: Viral-palliative, Prevention of influenza with
immunization. Bacterial-antibiotics, supportive
PX: Good with treatment. Secondary infections
Include: bronchiolitis (RSV), acute bronchitis,
Etiology: Acute bronchitis may be bacterial
secondary infection following URI, or result of
irritative inhalants. Pneumonia may be
primary or secondary, bacterial or viral. May
follow aspiration when fluids pool or cilia are
Classifications of pneumonia:
The causative agent
S&S: Acute bronchitis is often preceded by URI.
Cough is initially dry and nonproductive and then
changes to viscid and later abundant and mucoid
or mucopurulent. Pneumonia S&S vary: cough,
fever, SOB while at rest, chills, chest pain,
cyanosis and hemoptysis.
DX: History, exam, chest X-ray, sputum C&S.
TX: antibiotics, expectorants, broncholdilators.
PX” Bronchitis can lead to pneumonia.
Pneumonia can range from mild to life
threatening, being the 5th
leading cause of death
in the US.
Pneumonia fills the lung's alveoli with fluid, keeping oxygen
from reaching the bloodstream. The alveolus on the left is
normal, while the alveolus on the right is full of fluid from
Pneumonia as seen on chest x-ray. A: Normal chest x-ray. B:
Abnormal chest x-ray with shadowing from pneumonia in the right
lung (left side of image).
Upper Respiratory #1
Bronchial Tree #2
Respiratory Review Sheet
The Incredible Journey
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