Function of Respiratory System : performs 2 major tasks; internal and external respiration External Respiration : breathing, or exchanging air between the body and outside environment Internal Respiration : bringing oxygen to the cells and removing carbon dioxide from them Inspiration: breathing in or inhalation brings air from outside environment into the nose (or mouth) Expiration : expelling carbon dioxide (waste product of cellular metabolism) from lungs to outside environment Anatomy of Respiratory System external nares : nostrils; external nose supported by nasal bones and divided into 2 halves by nasal septum ; nasal septum : a strip of cartilage nasal cavity : a fter air enters nose, passes into nasal cavity and paranasal sinuses, where it is warmed by blood in the mucous membranes that line these areas cilia : hairs in the nasal cavity filter out foreign bodies pharynx : throat; passageway for air and food; divided into 3 sections nasopharynx, oropharynx, laryngopharynx : larynx (voice box) through which air passes to trachea or windpipe larynx: serves as passageway to trachea and as area where sounds of speech and singing are produced; contains vocal cords which are strips of epithelial tissue that vibrate when muscular tension is applies. Size and thickness of cords determine pitch of sound. Males thicker and longer vocal cords produce a lower pitch than shorter and thinner vocal cords of most women. Children’s voices then to be higher in pitch because of smaller size of vocal cords. Sound volume regulated by amount of air that passes over vocal cords. trachea (windpipe) : tube that connects larynx to right and left bronchi which are tubular branches into which the larynx divides. Point at which trachea divides is called the mediastinum. (contains the heart, lungs, esophagus, trachea and thymus gland) right and left bronchi : contain cartilage and mucous glands and are the passageways through which air enters right and left lungs. Air is pushed out of lungs travels up through the respiratory tract during expiration bronchioles : bronchi divides into smaller branches. Inside lungs, structures resemble tree branches with smaller parts branching off. At end of bronchiole is cluster or air sac. Alveoli : air sacs (singular alveolus; plural alveoli). 300 million in lungs. One celled, thin walled connect to capillaries in lungs. Oxygen exchanged from alveoli into capillaries of bloodstream and carbon dioxide is returned from capillaries into alveoli. Oxygen delivered to body’s cells called internal respiration. Affected by how well the cardiovascular system supplies oxygenated blood. Carbon dioxide expelled back up through respiratory tract during expiration Lungs take up most of thoracic cavity (thorax); reaches from collarbone to diaphragm. Right lung is larger; divided into three lobes; left lung smaller, divided into 2 lobes. Humans can function with one or more lobes removed or even entire lung removed (lung cancer) Lungs: parietal pleura : outer layer lining lungs visceral pleura : inter lining of lungs, makes lung movement in thoracic cavity easier by protecting lungs and providing moisture that allows movement; space between 2 linings is pleural cavity diaphragm : muscle divides thoracic and abdominal cavities; diaphragm lowers itself when it contracts, allowing more space in the thoracic cavity, intercostal muscles pull ribs upward and outward when they contract also enlarging thoracic cavity
Coughing usually means there is something in the respiratory passages that should not be there. Sibilant rhonchi = alternative term This can be caused by breathing in dust particles in the air or when a piece of food goes down the wrong way. It could also be a sign that an infection in the lungs is making the respiratory passages produce phlegm. Coughing can be provoked by: the common cold , which is a frequent cause of acute cough that usually settles in less than three weeks. sucking material into the breathing tubes from your mouth. more severe illnesses, such as pneumonia , acute heart failure or pulmonary embolism (a clot in the blood vessels of the lung smoking, which often causes chronic cough ( smoker's lung ). asthma - particularly in children who may only cough and show no wheezing. stomach acid coming back up the gullet and spilling over into the windpipe (GERD). medicines used in heart disease called angiotensin converting enzyme (ACE) inhibitors. bacterial or viral infections in the lungs, eg acute bronchitis, pneumonia, whooping cough, croup in children Coughing is more efficient when preceded by a full intake of air. For this reason, patients with weak muscles, poor coordination of airway closure and re-opening, or who have airflow obstruction (as in COPD ) will have a poor cough and be susceptible to complications including infection in the lower respiratory tract and pneumonia. Wheezing is a high-pitched whistling sound produced by air flowing through narrowed breathing tubes, especially the smaller ones deep in the lung. It is a common finding in asthma and chronic obstructive pulmonary disease (COPD). The clinical importance of wheezing is that it is an indicator of airway narrowing, and it may indicate difficulty breathing. Wheezing is most obvious when exhaling (breathing out), but may be present during either inspiration (breathing in) or exhalation. Wheezing most often comes from the small bronchial tubes (breathing tubes deep in the chest), but it may originate if larger airways are obstructed or in certain cases of vocal cord abnormalities. Common Causes of wheezing: asthma, bronchiectasis, bronchiolitis, bronchitis, GERD, viral infections, pneumonia, emphysema, smoking, Insect sting which causes an allergic reaction , Medications (many asthmatics wheeze after taking aspirin) ,Inhalation of foreign matter into the lungs , Heart failure (cardiac asthma)
PFT : noninvasive tests including spirometry, lung volume measurements and diffusion capacity that involve breathing into a tube the measure the pressure exerted during ventilation. Spirometry useful in detecting COPD ABG determines the presence of acid-base imbalances (pH) in the blood Pulse ox noninvasive test that measures oxygen saturation Bronchoscopy direct visualization of bronchioles, can be used to take biopsy, take sputum samples or remove foreign objects from airway Radiograph, CT, MRI used to detect structural problems, presence of obstruction in airways and lung tissue Nuclear V/Q lung scan detects pulmonary embolism (lung blockage) and lung disease (emphysema and COPD) by using nuclear medicine camera and computer imaging to visualize the amount and distribution of minute amounts of radioactive materials inspired into the lungs (V) or injected into a vein (Q) that then flows through the lungs C & S determines presence and type of microorganisms in the blood and or sputum; can indicate use of ABO Thoracentesis determines presence of pleural effusion (excess fluid in the pleural space) by inserting a needle from the chest or back into the lung pleural space; the fluid is examined for presence of microorganisms
Bronchitis is the inflammation of the mucous membranes of the bronchial airways. It is caused by viral infections such as influenza, or pyogenic organisms such as streptococcus , pneumococcus , or staphylococcus . It is often preceded by a common cold. Acute bronchial irritation may also be caused by various physical and chemical agents such as dust and fumes. Allergic factors should be considered as well. Predisposing factors are exposure, chilling, fatigue, and malnutrition. The pathway of air to the bronchi and lungs is still capable of warming inspired cold air, but there are limits. Because of this, it is inadvisable to sleep in extreme cold or to vigorously exercise in extremely cold air without wearing a face mask, so that the heat produced from exhalation will be available to the inspired air. If you are a smoker, even one puff on a cigarette is enough to cause temporary paralysis of the cilia in your bronchial tubes. If you continue smoking, you may do sufficient damage to the cilia to prevent them from functioning properly. In some heavy smokers, the membrane stays inflamed and the cilia eventually stop functioning altogether. Clogged with mucus, the lungs are then vulnerable to viral and bacterial infections, which over time distort and permanently damage the lung’s airways.
www.thinkport.org/classroom/onlineclips Asthma is not a problem with breathing in, but with breathing out; during asthma episodes, the muscle spasms and swelling in the bronchial tissues narrow the lung’s tiny airways, which then get clogged with excess mucus. Stale air is trapped in the bottom of the lungs, forcing you to use the top part to past for air. Demonstrate patient-teaching methods, linking to project which includes examination methods, treatment modalities, community resources and patient education. Worksheet #21 and 23 for children; #3 for age 55 and older, worksheet handouts for adults.
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2-3 million cases diagnosed each year with 40-70,000 deaths; mortality about 14%. 60-80% caused by bacteria Streptococcus pneumoniae Vaccination will give 90% protection; recommended for people +65 with booster every 6 years. Chlamydia trachomatis can cause pneumonia and bronchitis; babies born to mothers with chlamydia give infection to the eye and travels to respiratory tract via nasolacrimal duct Pneumocystis carinii mixed fungal and protozoal causes acute, often fatal, respiratory infection in infants or immunocompromised patients; viral pneumonia caused by respiratory syncytial virus (RSV), measles, chicken pox, parainfluenza (croup) and influenza. Pneumonia as complication of chicken pox rarely occurs in children, but occurs in 1/5 of adults RSV patients hospitalized and accompanying high eosinophil counts had 56% chance of later developing asthma; unknown if virus damages respiratory system causing asthma or if people with asthma predisposed them to RSV October 2004 study showed that proton pump inhibitors, stomach acid drugs (Prilosec, Nexium, Prevacid) may lead to increased risk of pneumonia. These drugs suppress stomach acid, which can kill bacteria and viruses in the stomach. Walking pneumonia is an outdated term referring to pneumonia ( infection of the small air-filled sacs of the lung ) which does not cause significant disability. People who are affected by walking pneumonia do not require hospitalization and are often able to continue participating in school or work functions. Although these mild cases of pneumonia can be caused by any number of microorganisms , infection with viruses such as influenza and respiratory syncytial virus or atypical bacteria such a Mycoplasma pneumoniae , Chlamydophila pneumoniae , or Legionella pneumophila are the most common causes. Treatment, when necessary, is typically with oral antibiotics such as amoxicillin , a macrolide like azithromycin or clarithromycin , or a fluoroquinolone , e.g., levofloxacin . Prognosis is excellent with symptoms typically resolving after a week or less.
TB Sheets It spreads through the air like a cold virus, but it usually takes multiple exposures for a person to catch tuberculosis. Some people harbor the bacterium harmlessly for years before contracting active TB, which destroys the lungs and slowly eats away at the body Health care and correctional facility workers have long been at risk of contracting Tuberculosis (TB). Cases in health care workers constituted 3 percent of all TB cases. TB is a potentially severe contagious disease that is spread from person to person through the air. The TB germs may spray into the air if a person with TB disease of the lungs or throat coughs, speaks, or sneezes. Anyone nearby can breathe TB germs into their lungs. People with TB infection do not feel sick and do not have any symptoms. However, they may develop TB disease at some time in the future. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. The Mantoux tuberculin skin test is the standard method of identifying persons infected with M. tuberculosis. Tuberculin skin testing is both safe and reliable throughout the course of pregnancy. The Mantoux tuberculin test is performed by placing an intradermal injection of 0.1 ml of purified protein derivative (PPD) tuberculin containing 5 tuberculin units (TU) into the inner surface of the forearm. The injection should be made with a tuberculin syringe, just beneath the surface of the skin, with the needle bevel facing upward. This should produce a discrete, pale elevation of the skin (a wheal) 6 mm to 10 mm in diameter. All tests should be read between 48 and 72 hours. If more than 72 hours has elapsed and there is not an easily palpable positive reaction, repeat the test on the other arm and read at 48 to 72 hours after the second administration. Measure the induration - not erythema. Measure and report results in millimeters of induration. 15 or more millimeters induration is always considered positive. 10 or more millimeters induration is considered positive for high risk groups
I wish I had a dollar for everyone that died within that year. Got ‘em hot by the collar, plenty an old maid shed a tear. Now within my heart, it sure put on a squeeze. Oh, Legionnaire’s Disease. Granddad fought in a revolutionary war, father in the War of 1812, Uncle fought in Vietnam and then he fought a war all by himself. Whatever it was, it came out of the trees. Oh, that Legionnaire’s disease. The convention of the Independent Order of Oddfellows was held in September in Philadelphia at the Bellevue Stratford Hotel. Eleven cases of severe pneumonia occurred among the participants, some of whom died. This occurred in September of 1974. In July of 1976, the American Legion held their 58 th state convention in the same hotel. 221 people became sick shortly after leaving the 3-day convention, 34 of those dies. At the time, the disease was a mystery to the medical community. Since it had no name or face, it took on the identity of those it affect4d, thus becoming known as Legionnaire’s disease. Some Legionnaire’s were upset about the name: it cast a cloud over the American Legion. “I was losing my voice because nobody would come near me” said Janet Marberti, who attended the convention. She was forced to shout at people because they wouldn’t come close enough for her to talk. Many Legionnaire’s were ostracized in this manner. What we don’t know, we are afraid of. What was the mood in Seattle when the National Convention of the American Legion was held in August, just one month later? Most of the deaths had occurred already. In January of the following year, the CDC identified the bacterium responsible for the outbreak.
121 Week 7 Chapter 11 Respiratory
Objectives <ul><li>Identify anatomy and physiology of the respiratory system </li></ul><ul><li>Recognize common symptoms of the respiratory system </li></ul><ul><li>Recognize common laboratory and diagnostic tests for diseases of the respiratory system </li></ul><ul><li>Differentiate various diseases of the respiratory system </li></ul><ul><li>Specific diseases covered in class Chronic Bronchitis Asthma Pneumonia Tuberculosis Legionnaire’s disease </li></ul>
Objective #3 Common Lab and Diagnostic Tests <ul><li>Pulmonary function tests Arterial blood gases </li></ul><ul><li>Pulse oximetry Radiograph, CT, MRI </li></ul><ul><li>Bronchoscopy Thoracentesis </li></ul><ul><li>Nuclear (V/Q) lung scan Culture & Sensitivity tests </li></ul>
Chronic Bronchitis <ul><li>Inflammation of the bronchial mucous membrane </li></ul><ul><li>Caused by cigarette smoking, exposure to dust </li></ul><ul><li>Chronic productive cough, edema, cyanosis, tachypnea </li></ul><ul><li>Productive cough that exists 3 months a year for 2 years </li></ul><ul><li>Symptomatic treatment </li></ul><ul><li>May lead to COPD </li></ul>
Asthma <ul><li>Recurrent attacks of labored breathing with wheezing and bronchiole spasms </li></ul><ul><li>Pt. displays dyspnea, tachypnea </li></ul><ul><li>Diagnosed by PE, Hx, PFT </li></ul><ul><li>Treatment: with medications </li></ul>
Pneumonia <ul><li>Acute inflammation of respiratory bronchioles, alveolar, ducts & sacs (inflammation of lungs themselves) </li></ul><ul><li>6 th leading cause of death </li></ul><ul><li>Caused by variety of microorganisms </li></ul><ul><li>Pt. displays cough, sputum production, pleuritic chest pain, fever </li></ul><ul><li>Diagnosed by chest x-ray, sputum, blood cultures </li></ul><ul><li>Treatment depends on etiology </li></ul>
Legionnaire’s Disease <ul><li>“ Some say it was radiation. Some say there was acid on the microphone. Some say a combination that turned their hearts to stone. But whatever it was, it drove them to their knees. Oh, Legionnaire’s disease.” </li></ul><ul><li>Bob Dylan 1981 </li></ul>