Review of anatomy and physiology of respiratory system

By
Mr.A.Sanjaikumar M.Sc
Nursing, PhD Fellow
Medical Surgical Nursing
Critical Care Department
Associate Professor
School of Health Sciences
Madda Walabu University
Bale Goba.
3/4/2019 BY: sanjaikumar

 Review of anatomy and physiology of respiratory system
 Assessment of patient with respiratory disorder
 Upper respiratory disorders
Tonsillitis
Pharyngitis and adenoiditis
Laryngitis
 Lower respiratory tract disorders and interventions for
clients with LRT disorders
Bronchitis (acute)
Pneumonia
COPD
Chronic Bronchitis

 Bronchiectasis
 Emphysema
 Asthma
 Lung abscess
 Pneumothorax
 TB
 Atelectasis
 Cor pulmonale
 Pulmonary embolism
 Pulmonary oedema
 Pluerisy
 Applying postural drainage
 Care of the pt with water-sealed drainage
 Care of the pt with tracheostomy
 Care of pt with Thoracentesis

 Learning objectives
 Anatomic & physiologic overview of RS

 At the end this presentation you will be able to:
 Identify the anatomy of RS structures
 Describe anatomical landmarks useful for
respiratory system assessment

Function of the Respiratory System
 Major Functions of the Respiratory System
 Supply O2 for energy production
 Remove CO2 , waste product of energy reactions
 Homeostasis, acid-base balance of arterial blood
 Heat exchange

The respiratory system is composed of:
Upper respiratory tract
warms and filters inspired air
Lower respiratory tracts.
gas exchange.
3/4/2019
BY: sanjaikumar

Consist of the nose, sinuses and nasal passages,
pharynx, tonsils and adenoids, larynx, and trachea.
Nose
 Passageway for air to pass to and from the lungs.
 Filters impurities and humidifies and warms the air
as it is inhaled.
 Is composed of an external and an internal portion.

External portion of nose:
 protrudes from the face
and is supported by the
nasal bones and
cartilage.
 The anterior nares
(nostrils) are the
external openings of the
nasal cavities.
Internal portion of the nose
o Hollow cavity separated into the
right and left nasal cavities by nasal
septum.
o Each nasal cavity is divided into
three passageways by the
projection of the turbinates from
the lateral walls.
o The turbinate bones are also called
conchae (the name suggested by
their shell-like appearance).

 Paranasal Sinuses
 Four pairs of bony cavities
These air spaces are connected by a series of ducts that
drain into the nasal cavity.
Named by their location: frontal, ethmoidal,
sphenoidal, and maxillary .
A prominent function of the sinuses is to serve as a
resonating chamber in speech.
The sinuses are a common site of infection.

Pharynx, tonsils, and adenoids
 Pharynx (throat):
 Is a tubelike structure that connects the nasal and oral
cavities to the larynx.
 Has three regions: nasal, oral, and laryngeal.
Nasopharynx: is located posterior to the nose and
above the soft palate.
Oropharynx: houses the faucial, or palatine, tonsils.
Laryngopharynx: extends from the hyoid bone to
the cricoid cartilage.
The epiglottis forms the entrance to the

 Adenoids(pharyngeal tonsils)
 Are located in the roof of the nasopharynx.
The tonsils, the adenoids, and other lymphoid tissue
encircle the throat.
These structures are important links in the chain of
lymph nodes guarding the body from invasion by
organisms entering the nose and the throat.
The pharynx functions as a passageway for the
respiratory and digestive tracts.

Larynx
 Is a cartilaginous epithelium lined
structure that connects the pharynx
and the trachea.
 Its major function is vocalization.
 It also protects the lower airway
from foreign substances and
facilitates coughing.
 It is frequently referred to as the
voice box.

Trachea (windpipe)
Is composed of smooth muscle with C-shaped rings
of cartilage at regular intervals.
Trachea bifurcates into its main stem bronchi at the
levels of the sternal angle anteriorly and the T4
spinous process posteriorly.
The trachea serves as the passage between the larynx
and the bronchi.

B. LOWER RESPIRATORY TRACT
• Consists of the lungs, which contain the bronchial and
alveolar structures

Lungs
 Paired elastic structures enclosed in the thoracic cage
 When the capacity of the chest is increased, air enters
through the trachea (inspiration) because of the
lowered pressure within and inflates the lungs.
 When the chest wall and diaphragm return to their
previous positions (expiration), the lungs recoil and
force the air out through the bronchi and trachea.

Pleura:
A serous membrane that lines the lungs and wall of
the thorax
Visceral pleura: covers the lungs
 Parietal pleura : lines the thorax.
Small amount of pleural fluid between these two
membranes

 Mediastinum.
• Middle of the thorax, between the pleural sacs that
contain the two lungs.
• Extends from the sternum to the vertebral column
and contains all the thoracic tissue outside the lungs
(heart, thymus, certain large blood vessels [ie, aorta,
vena cava], and esophagus).

Bronchi and Bronchioles.
 There are several divisions of the bronchi within
each lobe of the lung.
 First are the lobar bronchi (3 in the right lung and 2
in the left lung).
 Lobar bronchi divide into segmental bronchi (10 on
the right and 8 on the left), which are the structures
identified when choosing the most effective postural
drainage position for a given patient.

Alveoli.
 About 300 million alveoli, which are arranged in clusters
of 15 to 20.
 Three types of alveolar cells.
• Type i alveolar cells:
– Are epithelial cells - form the alveolar walls.
• Type ii alveolar cells:
– metabolically active.
– Secrete surfactant, a phospholipid
• Type III alveolar cell :
– Macrophages are large phagocytic
– Act as an important defense mechanism.

Breathing
Terms for Various Breathing Activities
• Hyperpnea- increased breathing movement
• Eupnea- normal breathing movements
• Hypopnea - decreased breathing movements
• Apnea- arrested breathing
• Bradypnea - decreased rate of breathing
• Tachypnea- increased rate of breathing
• Dyspnea- labored breathing (subjective feeling)
• Asphyxia- inability to breathe
• Orthopnea- labored breathing, except in the sitting or
upright position

Breathing.
• Automatic act & controlled in the brainstem and
mediated by the muscles of respiration.
 Dome-shaped diaphragm ( primary muscle of
inspiration.
 Contracts- descends & enlarges thoracic cavity,
compresses the abdominal contents, pushing
abdominal wall outward.
 Rib cage & neck expand thorax during inspiration

• During inspiration:
 Muscles contract
 Thorax expands
 Intrathoracic pressure
decreases, drawing air
through the
tracheobronchial tree into
the alveoli, or distal air
sacs, and expanding the
lungs.3/4/2019 BY: sanjaikumar

Expiratory phase:
• Begins after inspiratory
effort stops
• Chest wall and lungs recoil,
diaphragm relaxes and rises
passively,
Air flows outward, and
Chest and abdomen return to
their resting positions.

Cont’d...
• Normal breathing is quiet and easy—barely audible
near the open mouth as a faint whish.
• When a healthy person lies supine, the breathing
movements of the thorax are relatively slight. In
contrast, the abdominal movements are usually easy to
see.
• In the sitting position, movements of the thorax become
more prominent.

Cont’d...
• During exercise and in certain diseases, extra
work is required to breathe, and accessory
muscles join the inspiratory effort.
• The sternomastoids are the most important of
these, and the scalenes may become visible.
• Abdominal muscles assist in expiration.

Real anatomical land marks and imaginary
lines on chest wall.
Help in description of chest examination
findings.
Grouped in to two:-
I. Used to describe findings along vertical
axis.
II. Used to describe findings along the
circumference of the chest.

Anatomic & physiologic overview....
Land mark of anterior chest:
:-
- “U” shaped depression at the top of sternum, b/n clavicles.
adjacent to 2nd rib & just
below it is 2nd ICS.
- Site of tracheal bifurcation( Rt & Lt main bronchi.
- 2.5 cm below sternal notch.
- Reference to count ICS by walking down with 2 fingers.

Land mark of posterior chest
• Spinous process of C7 vertebrae.
- Prominent bone at the back of
flexed neck.
- At same level with the 1st rib .
• Inferior tip of the scapula
- Lies at the level of 7th rib/ICS.

• Vertical imaginary lines drawn on anterior & posterior chest walls.

.
• Vertebral line- overlies the spinous processes of the
vertebrae.
• Right and left Scapular lines:- drops from the inferior
angle of the scapula.

Anteriorly
Apex of lung : 2 - 4
cm above the inner
third of the clavicle.
Lower border lung:
crosses the 6th rib at
the MCL & the 8th rib
at the MAL.
Posteriorly
 Lower border: at T10
spinous process (on
inspiration, it descends
further).

 Each lung is divided roughly in half by an oblique
(major) fissure:
 Runs from T3 spinous process obliquely down to
6th rib at MCL.
Rt lung - divided by horizontal (minor) fissure
Runs close to 4th rib & meets oblique fissure in
MAL near the 5th rib.

• Right Lung
– Divided into 3 lobes, upper, middle , lower lobes.
– Shorter due to liver
• Left Lung
– Has only two lobes = Left Upper and Lower
– Narrower due to heart

Used to locate chest findings, such as:-
• Supraclavicular—above the clavicles
• Infraclavicular—below the clavicles
• Interscapular—between the scapulae
• Infrascapular—below the scapula
• Bases of the lungs —the lower most portions.
• Upper, middle, and lower lung fields

Review of anatomy and physiology of respiratory system

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