1.RESPIRATORY SYSTEM

2. ANATOMY AND PHYSIOLOGY 3. RESPIRATION The Process Of Gaseous Exchange Between The Individual And The Environment 4. 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 5. STRUCTURE OF THE RESPIRATORY SYSTEM I. The Airways 1. Upper Airways a. Nasal cavity or nares b. Pharynx c. Larynx or voice box 6. STRUCTURE OF THE RESPIRATORY 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 7. STRUCTURE OF THE RESPIRATORY 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 8. 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 9. STRUCTURE OF THE RESPIRATORY 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 10. STRUCTURE OF THE RESPIRATORY SYSTEM 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 11. STRUCTURE OF THE RESPIRATORY 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 12. STRUCTURE OF THE RESPIRATORY 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. 13. STRUCTURE OF THE RESPIRATORY 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) 14. STRUCTURE OF THE RESPIRATORY 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. 15. STRUCTURE OF THE RESPIRATORY 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 16. STRUCTURE OF THE RESPIRATORY 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) 17. STRUCTURE OF THE RESPIRATORY 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 18. STRUCTURE OF THE RESPIRATORY SYSTEM V. Respiratory centers Medulla Oblongata is the primary center Pons Pneumotaxic center- rhythmic quality of breathing Apneustic center- deep prolong inspiration 19. STRUCTURE OF THE RESPIRATORY 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 20. 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 21. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER History Biographic data Chief complaint Dyspnea Cough Sputum production Hemoptysis Wheezing stridor Chest pain 22. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER History Post Medical History Childhood/ infectious diseases Respiratory immunization Major illnesses/ Hospitalization Medications Allergies Family history 23. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER 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. 24. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER 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. 25. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER 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 26. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Physical Examination Palpation Trachea Chest wall Thoracic excursion Tactile fremitus 27. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Physical Examination Percussion Resonance Hyperresonace Dullness 28. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Physical Examination 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 29. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Physical Examination 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) 30. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Physical Examination 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) 31. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Physical Examination 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 32. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Physical Examination Auscultation Voice sounds bronchophony Say ninety-nine Consolidation results in increased resonance and the words are heard clearly 33. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Physical Examination 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 34. ASSESSMENT OF CLIENT WITH RESPIRATORY 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 35. ASSESSMENT OF CLIENT WITH RESPIRATORY 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 36. ASSESSMENT OF CLIENT WITH RESPIRATORY 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 37. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Normal Findings Abnormal responses Percussion Tunes Resonant-heard over normal lung tissue Intensity-loud Pitched-low Duration-long Quality-low 38. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Normal Findings Abnormal responses Percussion Tunes Flat- heard over airless areas Soft High Short Extremely dull 39. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Normal Findings Abnormal responses Percussion Tunes Dull- occur over dense lung tissue. i.e. tumor or consulidation Medium Medium-high Medium Thud-like 40. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Normal Findings Abnormal responses Percussion Tunes Tympanic- indicates a large tension pneumothorax Loud High Medium drumlike 41. ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDER Normal Findings Abnormal responses Percussion Tunes Hyper resonant- usually in adults due to trapping of air such as obstructive disease like emphysema and pneumothorax, Very loud Very low Longer Booming