NCM 112 – A.

PARTS OF URT
LECTURE NOTES a. Nose – is a passageway for air and
is also a sensory organ. It warms
I. RESPIRATORY SYSTEM and moistens the air, and hair-like
processes (cilia) filter the air
• The human respiratory system is a before it reaches the lungs.
series of organs responsible for taking b. Pharynx – or “throat” is a funnel-
oxygen and expelling carbon dioxide. shaped tube acting as a
passageway for air and food. The
➢ LUNGS – the primary organ of the lowest portion of the pharynx
respiratory system and which carries joins the esophagus (food tube).
out the exchange of gases we breathe.
PARTS OF PHARYNX:
➢ OXYGEN (O2) and CARBON
DIOXIDE (CO2) – are
chemoreceptors that stimulate
breathing.

TWO PARTS OF THE RESPIRATORY

SYSTEM

I. UPPER RESPIRATORY
TRACT

• Nasopharynx – the top part of the

throat that connects to the nasal
cavities (nose) and lets air pass
through. (between the nose and the
pharynx).
• Oropharynx – the middle part of the
throat that connects to the oral cavity
or the mouth. (between the mouth and
pharynx).
1. Filters the air – the cilia or the
• Laryngopharynx – the bottom part
tiny hairs inside our nose filter out
of the throat is near the larynx (voice
dust and other particles.
box). (between the larynx and
2. Warming and Moistening – this is
pharynx).
to prevent and protect from
▪ Larynx – (voice box)
constriction of the bronchioles
is responsible for
and promotes bronchodilation.
phonation and cough
(when breathing hot or cold air, it
reflex.
can cause bronchoconstriction as
▪ Glottis – serves as a
a result of obstruction of
protection from
airways).
aspiration of foods.
3. Humidification
II. LOWER RESPIRATORY RESPIRATORY SYSTEM AND
TRACT CAPACITIES

1. The main function of the LRT is A. RESPIRATORY VOLUME – is a

the gas exchange or respiration. term used for various volumes of air
Respiration is moved through the lungs at a given
the process of point in the respiratory cycle.
exchange of ➢ Tidal Volume – the amount
oxygen and of air that normally enters the
carbon dioxide lungs,
between blood ➢ Expiratory Reserve Volume
vessels and (ERV) – forcefully exhale
alveoli sacs. past a normal tidal expiration.
➢ Inspiratory Reserve Volume
(IRV) –is the amount of gas
A. PARTS OF LRT being produced by deep
breathing.
a. Trachea - or “windpipe”, is a site ➢ Residual Volume – air left in
of the permanent or artificial the lungs if you exhale as
airway. Tracheostomy is the term much air as possible. It is not
for the surgery of the trachea. measured directly. It prevents
Carina is at the bottom of the the alveolar sacs from
trachea and is the point at which collapsing.
the trachea divides into the left
and right main bronchus. Process and tools used to measure TV,
b. Bronchus – bronchi is the plural ERV, IRV, and RV:
form of the bronchus. It is a main
passageway into the lungs. a. Spirometry – a process used to
c. Lungs - the primary organ of the measure respiratory volume
respiratory system and which b. Spirometer – a tool or equipment
carries out the exchange of gases used to measure the respiratory
we breathe. volume
RIGHT (3 Lobes) is equal to 10
segments (upper, middle, and B. RESPIRATORY CAPACITY – a
lower) computation or a sum of two volumes
LEFT (2 lobes) is equal to 8 of respiration that is greater than the
segments (upper and lower) volume.
d. Alveoli – acinar cells which are ➢ Inspiratory Capacity – the
responsible for respiration and amount of gas that an
ventilation (inhalation and individual can inhale starting
exhalation). at tidal inspiration. (IRV +
TV)
➢ Vital Lung Capacity – it is
the amount of gas that can be
exhaled after maximal
 inspiration. (IRV + TV +
ERV)
➢ Functional Residual
Capacity – the amount of gas
in the lungs after tidal
inspiration. Cannot be
measured, it requires a
chemical reaction to measure
it. (ERV + RV)
➢ Total Lung Capacity –the
amount of gas in the lungs
after maximum inspiration.
(IRV + TV + ERV + RV)

*Types of Breathing:

TIDAL BREATHING VOLUME – normal

or quiet breathing
DIAGPHRAGMATIC BREATHING –
deep breathing
RESPIRATORY DISEASES viral and fungal infections can
also cause it.
I. PNEUMONIA – inflammation ➢ Atypical Pneumonia - the
of the lung parenchyma leading to infection is caused by
pulmonary consolidation as different bacteria than the
alveoli are filled with exudates. more common ones that cause
- Either external or internal pneumonia. Atypical
of the lungs pneumonia also tends to have
- High Risk: Elderly and milder symptoms than typical
children between 5 y/o pneumonia.
(they don’t have the ➢ Lobular Pneumonia - a
capacity to cough) serious infection in which the
air sacs fill with pus and other
liquid. Lobar pneumonia
affects one or more sections
(lobes) of the lungs.

A. CLASSIFICATION OF
PNEUMONIA
1. Community-Acquired
Pneumonia – pneumonia
acquired outside of the hospital STAGES OF LOBULAR PNEUMONIA
2. Hospital Acquired Pneumonia –
also called “nosocomial 1. Congestion:
pneumonia” - Day 1-2
3. Aspiration Pneumonia – occurs - Clogged because of mucus
when food or liquid is breathed 2. Red Hepatization:
into the airways or lungs, instead - Days 3-4
of being swallowed. - Came from RBCs
4. Ventilator Assisted Pneumonia - Lungs appear like a liver
- a lung infection that develops in 3. Gray Hepatization:
a person who is on a ventilator. - Days 5-7
- When the RBCs are
B. CHARACTERISTICS OF hardened, it will turn gray
PNEUMONIA 4. Resolution:
➢ Bronchopneumonia - a type - Days 8-3 weeks
of pneumonia that affects the - It means you are getting
bronchi in the lungs. This better
condition commonly results -
from a bacterial infection, but
C. PREDISPOSING FACTORS 10. Diet; increase CHO or CHON and
Vit. C
• Smoking
• Air pollution G. MEDICATIONS
• Immuno-compromised; • Broad Spectrum antibiotics
AIDS, Bronchogenic • Antipyretics
• Prolonged Immobility – CVA • Mucolytics or Expectorants
ex. Stroke
• Over fatigue
• Age II. PULMONARY
• Gender TUBERCULOSIS

D. SIGNS AND SYMPTOMS

• Productive Cough:
- Greenish is bacterial
- Whitish is viral
• Dyspnea
• Fever, chills, anorexia,
general body malaise
• Weight loss
• Rales or crackles
• Cyanosis
• Abdominal distension • KOCH Disease
• Mycobacterium
E. DIAGNOSTIC EXAM Tuberculosis was
➢ Sputum Exam – could confirm discovered by Robert
the presence of TB and Koch in 1882
Pneumonia • inflammation of the lung
➢ CXR – Pulmo-consolidation tissue caused by MTB
➢ CBC – increase WBC
• Appears red in the culture
➢ ABG – PO2 decrease
test
➢ Dullness to Percuss – people
• Can be bronchial
having fluid exudates
• Can advance to vascular or
F. NURSING MANAGEMENT systemic (infection
1. Enforce complete bed rest already spread to other
2. Strict respiratory isolation organs)
3. Force fluid 2-3L per day MODE OF TRANSMISSION – droplet
4. Institute pulmonary toilet infection (1-5 mm in diameter)
5. DBE and Coughing exercise
6. Turning and Repositioning TYPES OF TUBERCULOSIS
7. Semi-fowler 1. LATENT TB
8. Nebulize and Suction - Not contagious
9. Comfortable and Humid - Asymptomatic
environment - Normal CXR
- (-) sputum test
 -(+) PPD (purified protein • Force fluid
derivative) and Blood Test • Nebulize and suction
2. ACTIVE TB • Diet
- Contagious • Increase Vit. C
- Symptomatic E. MEDICATIONS FOR TB
- Abnormal CXR *medications should be taken
- (+) sputum test religiously
- (+) PPD (purified protein 1. RIFAMPIN
derivative) and Blood Test - Stops RNA polymerase
- Birth control will be less
A. RISK FACTORS effective
• Malnutrition - Sensitive skin
• Overcrowding - Avoid alcohol
• Alcoholism consumption
• Virulence *rifampin turns body fluids into orange
• Over fatigue color
• Age 2. IZONIAZID – (INH)
• Gender - Stops bacterial growth
B. SIGNS AND SYMPTOMS - Decreases Vit. B6 levels
• Productive Cough 3. PYRAZINAMIDE
• Low fever - Bacterial effect
• Night sweats - Increases uric acid levels
- GI upset is common
• Dyspnea
4. ETHAMBUTOL
• Anorexia
- Stops RNA synthesis
• Weight loss (bacteriostatic)
• Chest and Back pain - Causes optic nerve
• Hemoptysis inflammation
C. DIAGNOSTIC TEST - Peripheral neuropathy
a. SKIN TEST – “Mantoux Test” 5. STREPTOMYCIN
(tuberculin test) - Stops protein synthesis
- DOH: 8-10 mm in - Kills bacteria
duration - Ototoxic (CNVIII)
- WHO: 10-14 mm in
duration
b. SPUTUM EXAM III. CHRONIC BRONCHITIS
c. CXR - Called “blue bloaters”, it is
d. CBC an inflammation of the
e. BLOOD TEST – IGRA bronchus due to
(Interferon Gamma Release hypertrophy or
Assay) hyperplasia of goblet
D. NURSING MANAGEMENT mucus producing cells
• CBR leading to narrowing of
• Strict Respiratory Isolation smaller airways.
• O2 Inhalation
• Semi-fowler
 A. PREDISPOSING FACTORS IV. PULMONARY EMPHYSEMA
- Smoking - Also called as “pink
- Air pollution puffer”
B. SIGNS AND SYMPTOMS - Characterized by
- Productive cough inelasticity of the alveolar
- Dyspnea or exertion wall leading to air trapping
- Prolonged expiratory and maldistribution of
grunt gases.
- Scattered rales - Body will compensate
- Cyanosis over distention of thoracic
- Pulmonary hypertension activity
leading to peripheral - Termed as “barrel chest”
edema because of the inability of
- Anorexia, general body the lungs to deflate due to
malaise inelasticity
C. COMPLICATIONS - It is pathognomonic which
- Multiple organ failure means s/sx cannot be seen
- Hepatomegaly in often diseases
- Ascites A. PREDISPOSING FACTORS
- Peripheral edema - Smoking
- Jugular vein distension - Air pollution
- Feet edema - Allergy
- Age
DIAGNOSTIC TEST FOR COPD - Hereditary
a. CXR B. SIGNS AND SYMPTOMS
b. Sputum Exam - Productive cough
c. Spirometry - Dyspnea at rest
d. ABG Analysis Test (ROME) - Bronchial wheezing
- should result in opposite - Decrease tactile fremitus
- upward or downward - - Resonance to
respiratory hyperresonance
- if equal (both upward and - Decreased or diminished
downward), metabolic breath sounds
Normal Values: - Pathognomonic
pH (7.35 – 7.45) - Pursed lip breathing
PaO2 (75-100 mmHg) - Flaring of alae nasi (nasal
PaCO2 (35-45 mmHg) flaring)
HCO3 (22-26 mmol/L)
e. Tidal Volume C. NURSING MANAGEMENT
- CBR
- Medications
- O2 administration
- Force fluids
- High Fowler’s position
- Nebulize and Suction
 V. PNEUMOTHORAX
2. Open Pneumothorax
- Partial / or complete a. Traumatic Pneumothorax - air
collapse of lungs due to in the pleural space resulting from
entry of air in pleural trauma and causing partial or
- Can be caused by a blunt complete lung collapse.
or penetrating chest injury, b. Tension Pneumothorax – a
certain medical severe condition that results when
procedures, or damage air is trapped in the pleural space
from underlying lung under positive pressure,
disease. displacing mediastinal structures,
A. CAUSES and compromising
cardiopulmonary function.
• Chest Injury
• Lung Disease C. SIGNS AND SYMPTOMS
• Ruptured air blisters - Chest Pain/Cyanosis -
• Mechanical Ventilation - Overt
Tachycardia/Tachypnea
B. RISK FACTORS - Low Blood Pressure
- Low SpO2
• Your Sex - Absent breath sounds on
• Smoking affected side
- Pushing the trachea to the
• Age
unaffected side
• Genetics
- Sucking Sound
• Lung Disease
- Expansion of chest
• Mechanical Ventilation unequal
• Previous Pneumothorax - Dyspnea
D. NURSING MANAGEMENT
TYPES OF PNEUMOTHORAX
- Monitoring Breath Sounds
1. Closed Pneumothorax - Assess rise and fall of the
a. Primary Spontaneous chest
Pneumothorax - is defined as - V/S
pneumothorax without - Administer O2 as ordered
underlying lung disease, and - HOB elevated in Fowler's
predominantly occurs in - Dressing for an open
young, thin males pressure
b. Secondary Spontaneous - Maintaining Chest Tube
Pneumothorax - usually System
occurs in older people with
underlying pulmonary
disease, such as emphysema
or asthma, acute or chronic
infections, lung cancer, and
congenital diseases including
cystic fibrosis.
 VI. BRONCHIAL ASTHMA things like molds, pollens and pet
- Asthma, also called dander.
bronchial asthma, is a ➢ Non-allergic: Outside factors
disease that affects your can cause asthma to flare up.
lungs. It’s a chronic Exercise, stress, illness and
(ongoing) condition, weather may cause a flare.
meaning it doesn’t go ➢ Exercise-induced asthma: This
away and needs ongoing type is triggered by exercise and
medical management. is also called exercise-induced
bronchospasm.
During an asthma attack, three things can ➢ Occupational asthma: This type
happen: of asthma happens primarily to
people who work around
• Bronchospasm: The muscles around irritating substances.
the airways constrict (tighten). When ➢ Asthma-COPD overlap
they tighten, it makes your airways syndrome (ACOS): This type
narrow. Air cannot flow freely happens when you have both
through constricted airways. asthma and chronic obstructive
• Inflammation: The lining of your pulmonary disease (COPD).
airways becomes swollen. Swollen
airways don’t let as much air in or B. RISK FACTORS
out of your lungs.
• Mucus production: During the -Lifestyle; vices, drugs,
attack, your body creates more foods
mucus. This thick mucus clogs the - Environment; sudden
airways. change in humidity and
air pressure
TYPES OF ASTHMA: - Air Pollution
- Physiological; physical
• Intermittent: This type of asthma and emotional stress
comes and goes so you can feel C. SIGNS AND SYMPTOMS
normal in between asthma flares. - Cough
• Persistent: Persistent asthma means - Dyspnea
you have symptoms much of the - Wheezing
time. Symptoms can be mild, - Cyanosis
moderate or severe. Healthcare - Restlessness
providers base asthma severity on - Tachycardia
how often you have symptoms. They - Palpitation
also consider how well you can do - Diaphoresis
things during an attack. D. NURSING MANAGEMENT
- CBR
A. CAUSES - Medications
➢ Allergic: Some - Force Fluid
people’s allergies can cause an - Oxygen inhalation
asthma attack. Allergens include - Nebulize and suction
- Semi-fowler’s position