RESPIRATORY SYSTEM

THE RESPIRATORY SYSTEM

Paranasal Sinuses
Organs of the Respiratory system  Cavities within bones surrounding the nasal
 Nose cavity
o Frontal bone
 Pharynx
o Sphenoid bone
 Larynx
o Ethmoid bone
 Trachea
o Maxillary bone
 Bronchi
 Lungs – alveoli
 Function of the sinuses
o Lighten the skull
o Act as resonance chambers for speech
Function of the Respiratory System o Produce mucus that drains into the nasal
 Oversees gas exchanges between the blood and cavity Produce mucus that drains into
external environment the nasal cavity
 Exchange of gasses takes place within the
alveoli Pharynx (Throat)
 Passageways to the lungs purify, warm, and  Muscular passage from nasal cavity to
humidify the incoming air larynx
 Three regions of the pharynx
The NOSE o Nasopharynx – superior region
 The only externally visible part of the behind nasal cavity
respiratory system o Oropharynx – middle region behind
 Air enters the nose through the external nares mouth
(nostrils) o Laryngopharynx – inferior region
 The interior of the nose consists of a nasal attached to larynx
cavity divided by a nasal septum  The oropharynx and laryngopharynx are common
passageways for air and food
Structures of the Pharynx
UPPER RESPIRATORY TRACT  Auditory tubes enter the nasopharynx •
Tonsils of the pharynx
o Pharyngeal tonsil (adenoids) in the
nasopharynx
o Palatine tonsils in the oropharynx
o Lingual tonsils at the base of the
tongue

Larynx (Voice Box)

Anatomy of the Nasal Cavity
 Routes air and food into proper channels
 Olfactory receptors are located in the mucosa
 Plays a role in speech
on the superior surface
 Made of eight rigid hyaline cartilages and a
 The rest of the cavity is lined with respiratory
spoon-shaped flap of elastic cartilage
mucosa
(epiglottis)
o Moistens air
 Vocal cords - vibrate with expelled air to create
o Traps incoming foreign particles
sound (speech)
Structures of the Larynx
 Lateral walls have projections called conchae  Thyroid cartilage
o Increases surface area o Largest hyaline cartilage
o Increases air turbulence within the nasal o Protrudes anteriorly (Adam’s apple)
cavity  Epiglottis
 The nasal cavity is separated from the oral o Superior opening of the larynx
cavity by the palate o Routes food to the larynx and air
o Anterior hard palate (bone) toward the trachea
o Posterior soft palate (muscle)  Glottis – opening between vocal cords

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 RESPIRATORY SYSTEM
o Alveolar duct
Trachea (Windpipe) o Alveoli
 Connects larynx with bronchi  Site of gas exchange
 Lined with ciliated mucosa
o Beat continuously in the opposite Alveoli
direction of incoming air  Structure of alveoli
o Expel mucus loaded with dust and o Alveolar duct
other debris away from lungs o Alveolar sac
 Walls are reinforced with C-shaped o Alveolus
hyaline cartilage  Gas exchange takes place within the alveoli
in the respiratory membrane
Primary Bronchi  Squamous epithelial lining alveolar walls
 Formed by division of the trachea  Covered with pulmonary capillaries on
 Enters the lung at the hilus external surfaces
(medial depression)
 Right bronchus is wider, shorter, and Respiratory Membrane (AirBlood Barrier)
straighter than left
 Bronchi subdivide into smaller and
smaller branches

Lungs
 Ocupy most of the thoracic cavity
o Apex is near the clavicle (superior
portion)
o Each lung is divided into lobes by
fissures
 Left lung – two lobes Gas Exchange
 Right lung – three lobes  Gas crosses the respiratory membrane
L by diffusion
Coverings of the Lungs o Oxygen enters the blood
 Pulmonary (visceral) pleura covers the o Carbon dioxide enters the alveoli
lung surface  Macrophages add protection
 Parietal pleura lines the walls of the  Surfactant coats gas-exposed alveolar
thoracic cavity surfaces
 Pleural fluid fills the area between layers
of pleura to allow gliding Events of Respiration
 Pulmonary ventilation – moving air in
Respiratory Tree Divisions and out of the lungs
 Primary bronchi  External respiration – gas exchange
 Secondary bronchi between pulmonary blood and alveoli
 Tertiary bronchi  Respiratory gas transport – transport of
 Bronchioli oxygen and carbon dioxide via the
 Terminal bronchioli bloodstream
 Internal respiration – gas exchange
Bronchioles between blood and tissue cells in
Smallest branches of the systemic capillaries
bronchi
 All but the smallest
branches have
reinforcing
cartilage
 Terminal bronchioles
end in alveoli Mechanics of Breathing (Pulmonary Ventilation)
Respiratory  Mechanical process
Zone  Depends on volume changes in the
 Structures thoracic cavity
o Respiratory bronchioli

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 RESPIRATORY SYSTEM
 Volume changes lead to pressure o Amount of air that can be forcibly exhaled
changes, which lead to equalize pressure o Approximately 1200 ml
of flow of gases  Residual volume
 2 phases o Air remaining in lung after expiration
o Inspiration – flow of air into lung o About 1200 ml
o Expiration – air leaving lung  Functional volume
o Air that actually reaches the respiratory
Inspiration zone
 Diaphragm and o Usually about 350 ml
intercostal muscles  Respiratory capacities
contract are measured with a
 The size of the spirometer
thoracic cavity
increases
 External air is pulled into the lungs due Respiratory Sounds
to an increase in intrapulmonary volume  Sounds are monitored with a stethoscope
 Bronchial sounds – produced by air rushing
Expiration through trachea and bronchi
 Passive process dependent up on natural  Vesicular breathing sounds – soft sounds of
lung elasticity air filling alveoli
 As muscles relax, air is pushed out of the
lungs External Respiration
 Forced expiration can occur mostly by  Oxygen movement into the blood
contracting internal intercostal muscles to o The alveoli always has more oxygen
depress the rib cage than the blood
o Oxygen moves by diffusion towards the
Pressure Differences in the Thoracic Cavity area of lower concentration
 Normal pressure within the pleural space is o Pulmonary capillary blood gains oxygen
always negative (intrapleural pressure)
 Carbon dioxide movement out of the blood
 Differences in lung and pleural space
o Blood returning from tissues has higher
pressures keep lungs from collapsing
concentrations of carbon dioxide than air
in the alveoli
Non-respiratory Air Movements
o Pulmonary capillary blood gives up carbon
 Caused by reflexes or voluntary actions
dioxide
 Examples
 Blood leaving the lungs is oxygen-rich and
o Cough and sneeze – clears lungs of
carbon dioxide-poor
debris
o Laughing
Gas Transport in the Blood
o Crying  Oxygen transport in the blood
o Yawn o Inside red blood cells attached to
o Hiccup hemoglobin (oxyhemoglobin [HbO2])
o A small amount is
Respiratory Volumes and Capacities carried dissolved in
 Normal breathing moves about 500 ml of air with the plasma
each breath - tidal volume (TV)  Carbon dioxide
 Many factors that affect respiratory capacity transport in the blood
o A person’s size o Most is transported in
o Sex the plasma as
o Age bicarbonate ion
o Physical condition (HCO3–)
 Residual volume of air – after exhalation, o A small amount is carried inside red blood
about 1200 ml of air remains in the lungs cells on hemoglobin, but at different
 Inspiratory reserve volume (IRV) binding sites than those of oxygen
o Amount of air that can be taken in forcibly
over the tidal volume Internal Respiration
o Usually between 2100 and 3200 ml
 Expiratory reserve volume (ERV)
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 RESPIRATORY SYSTEM
 (COPD)
 Exemplified by chronic bronchitis and
emphysema
 Major causes of death and disability in the
United States
 Features of these diseases
o Patients have a history of smoking
Ex o Labored breathing (dyspnea)
change of gases between blood and body o Coughing and frequent pulmonary
cells infections
 An opposite reaction to what occurs in the o Most victims retain carbon dioxide
lungs o Have hypoxic and respiratory acidosis
o Carbon dioxide diffuses out of tissue to o Those infected will ultimately develop
blood respiratory failure
o Oxygen diffuses from blood into tissue
Emphysema
Neural Regulation of Respiration  Alveoli enlarge as adjacent chambers
 Activity of respiratory muscles is break through
transmitted to the brain by the phrenic and  Chronic inflammation promotes lung
intercostal nerves fibrosis
 Neural centers that control rate & depth are  Airways collapse during expiration
located in the medulla  Patients use a large amount of energy to
 The pons appears to smooth out respiratory exhale
rate  Over-inflation of the lungs leads to a
 Normal respiratory rate (eupnea) is 12–15 barrel chest
min.  Cyanosis appears late in the disease
 Hypernia is increased respiratory rate often
due to extra oxygen needs Chronic Bronchitis
 Inflammation of the mucosa of the lower
Factors Influencing Respiratory Rate and Depth respiratory passages
 Physical factors  Mucus production increases
o Increased body temperature  Pooled mucus impairs ventilation & gas
o Exercise exchange
o Talking  Risk of lung infection increases
o Coughing  Pneumonia is common
 Volition (conscious control)  Hypoxia and cyanosis occur early
 Emotional factors
 Chemical factors Lung Cancer
o Carbon dioxide levels  Accounts for 1/3 of all cancer deaths in the
 Level of carbon dioxide in the United States
blood is the main regulatory  Increased incidence associated with
chemical for respiration smoking
 Increased carbon dioxide increases  Three common types
respiration o Squamous cell carcinoma
 Changes in carbon dioxide act o Adenocarcinoma
directly on the medulla oblongata o Small cell carcinoma
o Oxygen levels
 Changes in oxygen concentration Sudden Infant Death syndrome (SIDS)
in the blood are detected by  Healthy infant stops breathing and dies
chemoreceptors in the aorta and during sleep
carotid artery  Some cases are thought to be a problem of
 Information is sent to the medulla the neural respiratory control center
oblongata  1/3 of cases appear to be due to heart
rhythm abnormalities
Respiratory Disorders:

Chronic Obstructive Pulmonary Disease

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 RESPIRATORY SYSTEM
 Spontaneous – air enters the pleural space
Asthma when air-filled blebs (blisters) on the lung
 Chronic inflammation if surface rupture.
the bronchiole passages
 Response to irritants with Etiology
dyspnea, coughing, and  Tension pneumothorax - unknown causes
wheezing  Secondary pneumothorax – injury to the
chest wall from trauma
 Spontaneous – ruptured bleb (common to
smokers).
Developmental Aspects of Pathophysiologic Processes and Manifestations
the Respiratory System
 Severity of symptoms depends on the size of
 Lungs are filled with fluid in the fetus
injury and the amount of tissue left intact.
 Lungs are not fully inflated with air until
two weeks after birth
 Surfactant that lowers alveolar surface Symptoms can include:
tension is not present until late in fetal  Pleuritic pain (sharp pain occurring during
development and may not be present in inhalation) 2. Increased RR
premature babies  Dyspnea
 Important birth defects  Asymmetry of chest wall (from rib fractures)
– Cystic fibrosis – over-secretion  In tension pneumothorax, onset is sudden and
of thick mucus clogs the painful.
respiratory system  Decreased breath sounds over the area of
– Cleft palate pneumothorax
 Trachea deviating to the injury site
Aging Effects  Shifting of mediastinal structures to unaffected
 Elasticity of lungs decreases side of unaffected chest
 Vital capacity decreases  Signs of shock (due to large pneumothorax)
 Blood oxygen levels decrease
 Stimulating effects of carbon Overview of Nursing Interventions:
dioxide decreases  Monitor V/S, signs of shock
 More risks of respiratory tract  Observe respirations; changing pattern may
infection indicate worsening situation
 Semi-Fowler’s position
 Administer oxygen if necessary
Respiratory Rate Changes  Analgesics as ordered
Throughout Life
Respiration rate:
• Chest tube:
 Newborns – 40 to 80 min.
 Maintain sterile dressing at chest tube
 Infants – 30 min.
insertion site
 Age 5 – 25 min.
 Adults – 12 to 18 min  Maintain patency and integrity of closed chest
 Rate often increases with old age drainage system
 Evaluate amount of fluid and breath sounds.

RESPIRATORY CONDITIONS
PLEURAL EFFUSION
PNEUMOTHORAX •Refers to an abnormal accumulation of fluid in the
• It is the accumulation of air in the pleural space, pleural cavity.
which results in partial or complete lung collapse. •May be:
• Types are:  transudate (hydrothorax)
 Tension – air enters but can’t leave pleural  exudates (empyema)
space  blood (hemothorax)
 Secondary – air enters the pleural space as a  chyle (chylothorax)
result of injury to the chest wall, respiratory
structures or esophagus Etiology
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 RESPIRATORY SYSTEM
 Hydrothorax Diagnostic tests: ABG indicate respiratory acidosis
o CHF
o RF Pathophysiology
o Nephrosis
o Liver failure
 Empyema
o Infections
o Malignancies
Symptoms include:
o SLE
 Dyspnea
 Hemothorax
 Wheezing
o chest injuries
 Chest tightness
o chest surgery complications
o Malignancies Pharmacotherapy:
o blood vessel rupture  Bronchodilators - to relieve bronchospasm
 Chylothorax o Beta-Adrenergic agents: rapid onset of
o Trauma actions when administered by aerosol
o inflammation o Theophylline: check pulse and blood
o malignant infiltration pressure
 Corticosteroids -relieve inflammation and edema
1. Other symptoms are  Antibiotics –if secondary infection
 Dyspnea  Cromolyn sodium
 Pleuritic pain o not used during acute attack
 Constant discomfort o Inhaled
2. Severity of hemothorax is determined by volume o inhibits histamine release in the lungs and
of fluid: prevents attack
 Minimal (300-500cc) - resolves in 10-14 days
 Moderate (500-1000 cc) - fills about 1/3 of Nursing Interventions
the pleural cavity u lung compression and  Place client in high-Fowler’s position
signs of hypovolemia  Administer oxygen as ordered
 Large (1000 cc or more) - fills half or more  Administer medications as ordered
of the chest and requires immediate drainage.  Provide humidification/hydration to loosen
secretions
Nursing Interventions:  Provide chest percussion and postural drainage
1. Observe patient for signs of shock when bronchodilation improves
2. Administer analgesics as required  Monitor for respiratory distress
3. For moderate to large:  Provide client teaching which includes:
a. Maintain fluid replacement as ordered. o Ways to prevent attacks, such as avoiding
b. Assist with insertion of chest tubes are ordered.
allergens
c. Maintain patency of tubes.
o Proper use of medication
d. Prepare for surgery if bleeding doesn’t stop.
o Anxiety control and breathing exercises

ASTHMA
• An airflow obstruction caused by BRONCHITIS
bronchoconstriction, which results from an allergic or • this is an inflammation of the bronchioles that
hypersensitive reaction • Can be classified to as: impairs airflow
 Extrinsic Types
 Intrinsic  Acute - occurs when the bronchus becomes
inflamed
Assessment Findings  Chronic – productive cough that persists for 3
- Family history of allergies months a year for 2 consecutive years
- Client history of eczema
Etiology
- Respiratory distress
 Exposure to pulmonary irritants
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 RESPIRATORY SYSTEM
 Infections including RTI and influenza o Age ü Heredity (low alpha1 anti-trypsin)
o Auto-Immune tendency
Mechanism:  Precipitating Fxs:
 Hyper-irritation of the MCTS o Bronchitis, chronic
Assessment: o Air Pollution
 Productive cough
o Smoking
 Dyspnea on exertion
o Asthma, chronic
 Use of accessory muscle of respiration
 Scattered rales and rhonchi
 Feeling of epigastric fullness PATHOPHYSIOLOGY:
 Slight cyanosis
 Distended neck veins

BRONCHIECTASIS
• Permanent abnormal dilation of the bronchi with
destruction of muscular and elastic structure of the
bronchial wall
Signs and Symptoms (Based on Types)
Caused by:
• CENTRILOBULAR
 bacterial infection
o Blue Bloater Stage
 recurrent lower respiratory tract infections
 congenital defects o Most bronchioles and alveoli plugged with
 lung tumors mucus Central airway dilated
 thick tenacious secretions o Danger: Cor Pulmonale
• Blue Bloater Type
Assessment: o Cyanotic
 Chronic cough o Edematous
 Production of mucopurulent sputum o W/ prod. Cough
 Hemoptysis o D.O.E.
 Exertional dyspnea o Weakness
 Wheezing o Nail Clubbing
 Anorexia
o ABG: Resp. Acidosis
 Fatigue
 Weight loss o S/S of hypoxia
o S/S of R-sided CHF
Diagnostic Tests o Barrel-shaped chest
 Bronchoscopy – reveals source and sites of •PAN-LOBULAR
secretions  Most alveoli and bronchioles dilated
 Possible elavation of WBC  Mucus expelled
 Hyperventilating (compensation to high pCO2)
• Pink Puffers
o Pinkish skin color
EMPHYSEMA o Emaciated
• Terminal stage of COPD o Non-productive cough
• Overdilated alveoli and bronchioles o Severe weakness
• Damage to alveoli and failure of alveolar diffusion o Anorexia
o Dyspnea
NSg. Dx: Imp. Gas Exchange
 ABG: o ABG: Resp. Alkalosis
o âpaO2
Common Signs and Symptoms:
o ápaCO2
 Anorexia
 Fatigue
Etiology (AHA-BASA)
 Weight loss
 Predisposing Factors:
 Feeling of breathlessness
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 RESPIRATORY SYSTEM
 Cough o HCO3 = 22- 26 meq/L
 Sputum production o paO2 = 80 – 100 mmHg
 Flaring of the nostrils
 Use of accessory muscles of respiration
 Increased rate and depth of breathing DECREASE INCREASE
 Dyspnea
Acidosis pH Alkalosis
Nursing Considerations 7.35-7.45
 Encourage the patient to avoid pulmonary: Alkalosis paCO2 Acidosis
irritants 35 – 45
 Institute respiratory therapy (RESPIRATORY)
 Provide adequate nutrition Acidosis HCO3 Alkalosis
 Administer low-flow oxygen. Remember : 22 – 26
CO2 is the drive to breath. (METABOLIC)

Improve ventilation:
 Position Naming a interpretation
 Instruct to use diaphragmatic muscle to breath
 Employ purse-lip breathing techniques (compensation) (paCO2 or CCo3) (pH)
 Uncompensated – AAN or ANA
Pharmacotherapy:  Partially Compensated – AAA
BRONCHODILATORS - used in treatment of  Fully compensated – NAA
bronchospasm
 Aminophylline Note: use of 7.4 rule ( all above 7.4 is still
 Terbutaline consider alka and all below is still
 Theophylline consider acid
 isoetharine
ANTIMICROBIALS - to treat bacterial
infections during acute exacerbations
 Tetracycline
 ampicillin
CORTICOSTEROIDS – give during acute
attack, to reduce inflammation
 prednisone

ABG INTERPRETATION
(ARTERIAL BLOOD GAS ANALYSIS)
 Checking for acid-base balance
VALUES
o pH = 7.35 – 7.45
o paCO2 = 35 - 45mmHg
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