Resperattory system

RESPIRATION
The Process Of Gaseous Exchange
Between The Individual And The
Environment

3 PROCESS OF RESPIRATION
 VENTILATION-
Movement Of Gases In And Out Of The Lungs
 INHALATION/INSPIRATION- VOLUNTARY
 EXHALATION/EXPIRATION- INVOLUNTARY
 DIFFUSION-
Exchange Of Gases From Area Of Higher Pressure
To Area Of Lower Pressure
 PERFUSION-
The Availability And Movement Of Blood For
Transport Of Gases, Nutrients And Metabolic
Waste Products

STRUCTURE OF THE RESPIRATORY
SYSTEM
I. The Airways
1. Upper Airways
a. Nasal cavity or nares
b. Pharynx
c. Larynx or voice box

SYSTEM
I. The Airways
2. Lower airways/tracheobronchial tree
a. trachea
b. right and left main stem bronchi
c. segmental bronchi
d. subsegmental bronchi
e. terminal bronchi

SYSTEM
I. The Airways
3. Function of the upper airways
a. transport gas to the lower airway
b. protection of lower airway from
foreign matter
c. warming, filtration, and
humidification of inspired air

STRUCTURE OF THE RESPIRATORY SYSTEM
I. The Airways
4. Function of lower airways
a. clearance mechanism
 Cough
 Mucociliary system
 Macrophages
 Lymphatics
b. immunologic response
 Call mediated immunity in the alveoli
c. pulmonary protection in injury
 Respiratory epithelium
 Mucociliary system

 Notes : the openings of the nose on the face are called
nostrils/nares
- Each nostril leads to the cavity called vestibule
- The hairs that line the vestibule are called the
vibrissae(filters foreign objects)
- The paranasal sinuses are open areas within the skull,
lined with mucous membrane. They help in
phonation. These are: frontal, maxillary, ethmoid,
sphenoid
- The pharynx is a funnel-shaped tube that extends from
the nose to the larynx. It is a common opening
between the digestive and respiratory system
- 3 section of the pharynx are: nasopharynx,
oropharynx, laryngopharynx

 Notes : from the middle ear, the eustachian tubes open into
the nasopharynx
 The larynx is the voice box
 The epiglottis covers the larynx(closes during
eating/swallowing, open during speaking/breathing)
 Trachea(windpipe) is 12cm(4-5inches)long. Carina is the
point where it divides
 Trachea and bronchi are lined with cilia and goblet
cells(secretes 120ml of mucous/day, entraps debris)
 Celia are microscopic hair like projections which have
rapid, coordinated, unidirectional upward motion
 Celia sweep out debris and excessive mucous membrane
from the lungs
 Right mainstem bronchus is shorter, broader, and more
vertical than the left

SYSTEM
II. The pleura
 are serous membrane that enclose the
lungs
 visceral pleura directly covers the lungs
 parietal pleura line the cavity of each
hemithorax
 the pleural space is a potential space
between the two pleurae which contains
the pleural fluid that serve as lubricant

SYSTEM
III. The Lungs
The right has 3 lobes while the left has 2.
The 2 are separated by the space called
mediastinum.
Approximately 3 hundred million alveoli
in the lungs.
The right is broader and shorter due to
the presence of the liver.

SYSTEM
III. The Lungs
Residual volume- amount of air that
remain in the lungs after a forceful
expiration. Prevents the collapse of the
lungs after expiration. (1200ml)
Tidal volume- amount of air that moves in
and out of the lungs with each normal
breath.(500ml)
Inspiratory reserve volume- extra amount
of air that can be inhaled beyond
TD.(1300)

SYSTEM
III. The Lungs
Expiratory reserve volume- extra amount
of air that can be exhaled after a normal
breath.(1100)
Total lung capacity- total of RS, TV, IRV
and ERV.
Vital capacity- the maximum amount of
air that can be exhaled after taking the
deepest breath. IRV,TV, and ERV.

SYSTEM
III. The Lungs
Inspiratory capacity- the total amount of
air that a person can inhale following a
resting expiration. IRV and TV
Functional residual capacity- the amount
of air that remain in the lung after a
normal expiration
Pneumocytes
 Type I lines the alveoli/structural
 Type II produce surfactant

SYSTEM
III. The Lungs
Anatomic dead space- area where gas
exchange does not occur.( trachea,
bronchi, bronchioles
Alveolar dead space- nonfunctional air
sacs due to poor blood flow from adjacent
alveoli
Physiologic dead space- both ADS(150ml)

SYSTEM
IV. The thorax and diaphragm
Thorax- Protect the lungs, heart and great
vessels
Made up of 12 pair of ribs bounded anteriorly
by the sternum and posteriorly by the
thoracic vertebrae
Diaphragm- main respiratory muscle for
inspiration, supplied by the phrenic nerve
Accessory muscles are sternocleidomastoid,
scalene, parasternal, trapezius and pectoralis

SYSTEM
V. Respiratory centers
Medulla Oblongata is the primary center
Pons
 Pneumotaxic center- rhythmic quality of
breathing
 Apneustic center- deep prolong inspiration

SYSTEM
V. Respiratory centers
Carotid and Aortic bodies
 Peripheral chemoreceptors- take up the function of
the central chemoreceptor in the MO when damaged
 Respond to low O2 concentration in blood
 Respond to pressure- BP, breathing/ BP, breathing
 CO2 is the blood stimulate breathing
Muscles and joints
 Pripioceptors- exercise increases respiratory
rate

Physiologic changes with Aging
 Reduce chest wall compliance that results from
increased calcification of costal cartilage and
decreased strength of intercostal and accessory
muscle and diaphragm
 Reduce breathing capacity
 Reduced vital capacity
 Increased residual volume
 Decreased cough reflex
 Decreased ciliary activity

ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
 History
 Biographic data
 Chief complaint
 Dyspnea
 Cough
 Sputum production
 Hemoptysis
 Wheezing
 stridor
 Chest pain

 History
 Post Medical History
 Childhood/ infectious diseases
 Respiratory immunization
 Major illnesses/ Hospitalization
 Medications
 Allergies
 Family history

 History
 Psychosocial history and Lifestyle
 Occupational or environmental exposure
 Geographic location
 Personal habits
 (yrs. of smoking x packs/day= pack yrs.)
15yrs. of smoking x 2 packs/day= 30pack yrs.

 Physical Examination
 Inspection
 S/Sx of respiratory distress
 I:E(inhalation:expiration) ratio (1:2)
 Speech pattern
 Chest wall configuration
 Chest movement
 Fingers and toes

 Palpation
 Trachea
 Chest wall
 Thoracic excursion
 Tactile fremitus

 Percussion
 Resonance
 Hyperresonace
 Dullness

 Auscultation
 Normal breath sounds
 bronchial(tracheal)- heard over manubrium
in the large tracheal airways- high pitched
and loud
 Bronchovesicular- heard over bronchi-
moderate pitched, moderate amplitude
 Vesicular- heard all over the chest and best
at the base of the lungs- low pitched and soft

 Auscultation
 Adventitous breath sounds
 Crackles/Rales(fine)- high pitched, soft,
crackling/popping sound(rolling strands of
hair between fingers)
 Crackles/Rales(coarse)- loud/low pitched,
bubbling, gurgling(opening velcro fastener)

 Auscultation
 Adventitous breath sounds
 Pleural friction rub- coarse, low pitched,
grating sound
 Wheeze- high pitched, squeaking sound
(sibilant ronchi)
 Wheeze- low pitched, musical snoring,
moaning sound(sonorous rhonchi)

 Auscultation
 Voice sounds
 Egophony
 Sy prolong “e”
 Auscultated as “a” indicating consolidation
 Whispered Pectoriloquy
 Whisper “1,2,3”
 Auscultated as muffled 1,2,3
 If the words are distinct,indicate
consolidation

 Auscultation
 Voice sounds
 bronchophony
 Say “ninety-nine”
 Consolidation results in increased
resonance and the words are heard clearly

ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
 Auscultation
 Altered breathing patterns
 Chyme-Stokes- rhythmic waxing and waning
respirations from very deep or very shallow
breathing and temporary apnea.
 Kussmaul- hyperventilation- increase rate and
depth
 Hypoventilation- slow, shallow respiration
 Biots breathing-shallow breaths interrapted
by apnea; irregular irregularity
 Apneustic- prolong, gasping inspiration
followed by a very short inefficient expiration

DISORDER
 Normal Findings
 General appearance- appear relaxed; breathing is
quiet and easily without apparent effort; facial
expressions and limb are relaxed
 Breathing pattern- smooth and regular; may have
occasional sighing; breathing is quiet and passive
with symmetric chest expansion; abdomen bulges
slightly with inhalation
 Respiration rate- 12-20cpm
 Skin- oral mucous membrane are pink, no cyanosis
or pallor present; palpation of skin and chest wall
reveals smooth skin and a stable chest wall, no
crepitation, masses or painful areas

DISORDER
 Normal Findings
 Nails- angulation between the base of the nail and
finger, no thickening of distal finger width, no
clubbing
 Chest wall configuration- symmetric, bilateral
muscle development; straight spinal processes;
downward and equal slope of the ribs
 Tracheal position- middle and straight, directly
above the suprasternal notch
 Vocal/Tactile Fremitus- sensation of sound
vibration is produced when the patient speaks and
compared bilateraly

DISORDER
Normal Findings
 Abnormal responses
 Increased fremitus- due to presence of
consolidation of the lung caused by fluid-
filled or solid structures. i.e. pneumonia or
tumor of lung
 Decreased fremitus- presence of more air than
normal which is blocked or trapped in the
lungs of pleural space. i.e. emphysema or
pneumothorax

DISORDER
Normal Findings
Abnormal responses
 Percussion Tunes
 Resonant-heard over normal lung tissue
 Intensity-loud
 Pitched-low
 Duration-long
 Quality-low

DISORDER
Normal Findings
 Flat- heard over airless areas
 Soft
 High
 Short
 Extremely dull

DISORDER
Normal Findings
 Dull- occur over dense lung tissue. i.e. tumor
or consulidation
 Medium
 Medium-high
 Medium
 Thud-like

DISORDER
Normal Findings
 Tympanic- indicates a large tension
pneumothorax
 Loud
 High
 Medium
 drumlike

DISORDER
Normal Findings
 Hyper resonant- usually in adults due to
trapping of air such as obstructive disease
like emphysema and pneumothorax,
 Very loud
 Very low
 Longer
 Booming

Resperattory system

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