ANATOMY AND PHYSIOLOGY OF

RESPIRATORY SYSTEM
A. Primary functions of the respiratory system
1. Provides oxygen for metabolism in the tissues
2. Removes carbon dioxide, the waste product of
metabolism
B. Secondary functions of the respiratory system
1. Facilitates sense of smell
2. Produces speech
3. Maintains acid–base balance
4. Maintains body water levels
5. Maintains heat balance
 UPPER RESPIRATORY AIRWAY
1. Nose Humidifies, warms, and filters inspired air
2. Sinuses: 1. Air-filled cavities within the hollow bones that
surround the nasal passages and provide
2. resonance during speech
3. Pharynx
a. Passageway for the respiratory and digestive tracts
b. located behind the oral and nasal cavities
b. Divided into the nasopharynx, oropharynx, and laryngopharynx
4. Larynx
a. Located just below the pharynx at the root of the tongue;
commonly called the voice box
b. Contains 2 pairs of vocal cords, the false and true cords
c. The opening between the true vocal cords is the glottis. The
glottis plays an important role in coughing, which is the most
fundamental defense mechanism of the lungs.
Epiglottis
a. Leaf-shaped elastic flap structure at the top of the larynx
b. Prevents food from entering the tracheobronchial tree by closing over the glottis
during swallowing
 LOWER RESPIRATORY AIRWAY
1. Trachea: Located in front of the esophagus; branches into the right
and left mainstem bronchi at the carina
2. Mainstem bronchi --- Begin at the carina
3. Bronchioles
a. Branch from the secondary bronchi and subdivide into the small
terminal and respiratory bronchioles
4. Alveolar ducts and alveoli a. Acinus (plural, acini) is a term used to
indicate all structures distal to the terminal bronchiole.
5. Lungs-- a. Located in the pleural cavity in the thorax
b. Extend from just above the clavicles to the diaphragm, the major
muscle of inspiration
c. The right lung, which is larger than the left, is divided into 3 lobes:
the upper, middle, and lower lobes.
d. The left lung, which is narrower than the right lung to
accommodate the heart, is divided into 2 lobes.
e. The respiratory structures are innervated by the phrenic nerve, the
vagus nerve, and the thoracic nerves.
 RISK FACTORS FOR RESPIRATORY
DISORDERS
▪ Environmental allergies
▪ Chest injury
▪ Crowded living conditions
▪ Exposure to chemicals and environmental pollutants
▪ Family history of infectious disease
▪ Frequent respiratory illnesses
▪ Geographical residence and travel to foreign countries
▪ Smoking
▪ Surgery
▪ Use of chewing tobacco
▪ Viral syndromes
 DIAGNOSTIC TESTS
Chest x-ray film (radiograph)
Description: Provides information regarding the anatomical location and appearance
of the lungs
Sputum specimen
Description: Specimen obtained by expectoration or tracheal suctioning to assist in
the identification of organisms or abnormal cells
Laryngoscopy and bronchoscopy
Description: Direct visual examination of the larynx, trachea, and bronchi with a
fiberoptic bronchoscope
Endobronchial ultrasound (EBUS)
Tissue samples are obtained from central lung masses and lymph nodes, using a
bronchoscope with the help of ultrasound guidance.
Pulmonary angiography
Description: a. A fluoroscopic procedure in which a catheter is inserted through the
antecubital or femoral vein into the pulmonary artery or 1 of its branches
G. Thoracentesis
Description: Removal of fluid or air from the pleural space via transthoracic aspiration
Pulmonary function tests
1. Description: Tests used to evaluate lung mechanics, gas exchange,
and acid–base disturbance through spirometric measurements, lung
volumes, and arterial blood gas levels.
Lung biopsy
1. Description
a. A transbronchial biopsy and a transbronchial needle aspiration may
be performed to obtain tissue for analysis by culture or cytological
examination.
B. An open lung biopsy is performed in the operating room.
Spiral (helical) computed tomography (CT) scan
1. Frequently used test to diagnose pulmonary embolism
2. IV injection of contrast medium is used; if the client cannot have
contrast medium, a ventilation-perfusion (V/Q) scan will be done.
V/Q lung scan
The perfusion scan evaluates blood flow to the lungs.
The ventilation scan determines the patency of the pulmonary
airways and detects abnormalities in ventilation.
Computed tomography pulmonary angiography
The scan visualizes the pulmonary arteries and blood flow.
Its main use is to diagnose pulmonary embolism and is the preferred
method.
M. Skin tests: A skin test uses an intradermal injection to help
diagnose various infectious diseases .(Mountex test TB)
Assess the reaction at the injection site 24 to 72 hours after
administration of the test antigen.
Assess the test site for the amount of induration (hard swelling) in
millimeters and for the presence of erythema and vesiculation
N. Arterial blood gases (ABGs)
1. Description: Measurement of the dissolved oxygen and carbon
dioxide in the arterial blood helps indicate the acid–base state and
how well oxygen is being carried to the body.
Avoid suctioning the client before drawing an ABG sample, because
the suctioning procedure will deplete the client’s oxygen, resulting in
inaccurate ABG results

D-dimer
1. A blood test that measures clot formation and lysis that results
from the degradation of fibrin
2. Helps diagnose (a positive test result) the presence of thrombus in
conditions such as deep vein thrombosis, pulmonary embolism, or
stroke; it is also used to diagnose disseminated intravascular
coagulation (DIC) and to monitor the effectiveness of treatment.
3. The normal D-dimer level is less than 50 ng/mL (less than 3.0
mmol/L); normal fibrinogen is 60 to 100 mg/dL (2.0 to 5.0 g/L).
 CHEST INJURIES
RIB FRACTURE
Signs and symptoms
Causes :  Pain with
 Blunt trauma movement , cough
 Falls  Shallow breathing
 # note on X-ray
 Accidents

Management :
 Place follower's position
 Analgesics eg. NASAID
 Monitor for increased respiratory distress
 Open reduction and internal fixations
 Self splinting
 Prepare the client for an intercostal nerve block as prescribed if the pain is
severe.
FLAIL CHEST
 PULMONARY CONTUSION
Characterized by interstitial haemorrhage associated with intra-alveolar haemorrhage, resulting in decreased pulmonary compliance

Causes : Signs and symptoms

a. Dyspnea
 Blunt trauma
b. Restlessness
 Falls c. Increased bronchial
 Accidents secretions
d. Hypoxemia
e. Hemoptysis
f. Decreased breath
sounds
g. Crackles and wheezes
Management :
 Place Fowler’s position
 Maintain a patent airway
 Administer oxygen
 Monitor for increased respiratory distress
 Maintain bed rest and limit activity to reduce oxygen demands.
 PNEUMOTHORAX
 Accumulation of atmospheric air in the pleural space, which results in a rise in intra-thoracic pressure and reduced vital capacity, or
the greatest amount of air expired from the lungs after taking a deep breath.
 The loss of negative intra-pleural pressure results in collapse of the lung.

Signs and symptoms

 Absent or markedly
decreased breath
sounds on affected side
 Cyanosis
 Decreased chest
expansion unilaterally
 Dyspnoea
 Hypotension
Management :  Sharp chest pain
 Apply non-pours  Subcutaneous
dressing emphysema
 Fowler’s Position  Sucking sound with
 Chest tube placement open chest wound
 Monitor tube derange  Tachycardia
 Monitor subcutaneous  Tachypnea
emphysema  Tracheal deviation to
the unaffected side
 PNEUMONIA
Infection of the pulmonary tissue, including the interstitial spaces, the alveoli, and the bronchioles
TYPE & CAUSATIVE ORGANISM
a.Community-acquired pneumonia (CAP):
caused by S. pneumoniae
(pneumococcal),H. influenzae, Legionella
pneumophila, M. pneumoniae, Chlamydia
species (C. pneumoniae; C. psittaci); viruses
b. Hospital-acquired pneumonia (HAP):
caused by S. aureus, P. aeruginosa, K.
pneumoniae, Serratia marcescens, S.
pneumoniae (pneumococcal),
c. Aspiration pneumonia: occurs when
resident flora of
upper respiratory tract, gastric contents, or
chemicals are aspirated into lung
d. Pneumonias in immunocompromised
hosts: associated with Pneumocystis
pneumonia (PCP) caused by P. jiroveci and
other fungal pneumonias (e.g., aspergillosis)
and M. tuberculosis
e. Severe acute respiratory syndrome
(SARS): atypical pneumonia caused by a
coronavirus (SARS-CoV)
Risk factors: age (older adult), COPD,
alcoholism, smoking, neutropenia,
ineffective cough, immobility, HIV infection,
endotracheal intubation
4. Pneumonia commonly spread by
respiratory droplets
 THERAPEUTIC INTERVENTIONS
1. Culture and sensitivity tests on blood and sputum to determine appropriate antibiotic;
specimen must be obtained before antimicrobial therapy is started
2. Antimicrobial therapy initiated within 6 hours of arrival at hospital: antibiotics, antiviral, or
antifungal therapy; Aspergillus infection is treated with amphotericin B, azole agents such as
itraconazole (Sporanox), or newer echinocandin agents such as caspofungin (Cancidas)
3. Respiratory support including oxygen, intubation, and ventilation as needed
4. Nutritional supplementation and fluid and electrolyte replacement
5. Bronchodilators
6. Chest physiotherapy and suctioning as needed
7. For SARS: no effective vaccine or treatment identified; supportive care
8. Global surveillance plan to limit spread (e.g., influenza, SARS)

NURSING CARE
1 Encourage coughing and deep breathing after chest physiotherapy, splinting chest as
necessary
2. Collect morning sputum specimen for culture and sensitivity tests in sterile container; notify
health care provider if organism is resistant to antibiotic prescribed
3. Increase fluid intake to 3 L daily to thin secretions
4. Encourage semi-Fowler position
5. Monitor for signs of respiratory distress (e.g., labored respirations; cool, clammy skin;
cyanosis; and change in mental status)
6. Balance rest periods to conserve oxygen with activity to mobilize secretions
7. Instruct to cover nose and mouth when coughing; dispose of tissues in fluid impervious bag
EMPYEMA
The nurse reviews ABG result for client with COPD the PH is 7.2, PaCO2 is 56
mm Hg, HCO3 is 24 mEq .which acid base imbalance is this client experiencing

A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic acidosis

A 48-year-old female patient has been admitted to the emergency department with the
following arterial blood gas results shows pH 7.54,PaCO2 29 mmhg,PaO2 86 mmhg,
HCO3- 24 mEq/L
Which of the following is the best interpretation of these results?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Q1 A .Respiratory acidosis Q2. A. Metabolic acidosis
3. The physician ordered an ABG on a 41-year-old patient with
COPD. Before drawing the sample from the radial artery, which
of the following should be performed?
A. Check the patient’s oxygen saturation
B. Modified Allen test
C. Nail bed blanching
D. Blood pressure measurement
4. The physician ordered an ABG on a 41-year-old patient with
COPD. Before drawing the sample from the radial artery, which of
the following should be AVOID ?
A. Allent’s test
B. Suctioning
C. Mechanical ventilation
D. Blood pressure measurement
 3. Ans: B suctioning
3. Ans: B Modified Allen test

Avoid suctioning the client before

drawing an ABG sample, because
the suctioning procedure will
deplete the client’s oxygen,
resulting in inaccurate ABG results
 PLEURAL EFFUSION
1. Pleural effusion is the collection of fluid in the pleural space.
2. Any condition that interferes with secretion or drainage of this fluid will lead to pleural effusion.
SIGNS AND SYMPTOMS MANAGEMENT
1.Pleuritic pain that is sharp and 1. Identify and treat the underlying cause.
increases with inspiration 2. Monitor breath sounds.
2. Progressive dyspnea with decreased 3. Place the client in a Fowler’s position.
movement of the 4. Encourage coughing and deep breathing.
chest wall on the affected side 5. Prepare the client for thoracentesis.
3. Dry, nonproductive cough 6. If pleural effusion is recurrent, prepare the client for
4. Tachycardia pleurectomy or pleurodesis as prescribed.
5. Elevated temperature Pleurectomy
6. Decreased breath sounds over 1. Consists of surgically stripping the parietal pleura
affected area away from the visceral pleura
7. Chest x-ray film that shows pleural 2. This produces an intense inflammatory reaction
effusion and a mediastinal shift away that promotes adhesion formation between the 2
from the fluid if the ffusion is more layers during healing.
than 250 mL

PLEURODESIS
1. Involves the instillation of a sclerosing substance into the pleural space via a
thoracotomy tube
2. The substance creates an inflammatory response that scleroses tissue together
 PULMONARY EMBOLISM 
A pulmonary embolism usually occurs when a blood clot in a deep vein in the leg or pelvis
breaks loose and travels through the blood to the lungs.
 ▪ Apprehension and restlessness
 ▪ Blood-tinged sputum
 ▪ Chest pain
 ▪ Cough
 ▪ Crackles and wheezes on auscultation
 ▪ Cyanosis
 ▪ Distended neck veins
 ▪ Dyspnea accompanied by anginal and
pleuritic pain, exacerbated by inspiration
 ▪ Feeling of impending doom
 ▪ Hypotension
 ▪ Petechiae over the chest and axilla
 ▪ Shallow respirations
 ▪ Tachypnea and tachycardia
MEDICAL MANAGEMENT NURSING MANAGEMENT
 Anticoagulation with IV heparin  Place in high-Fowler position, administer
(based on body weight) and oxygen
warfarin (Coumadin) until
 Auscultate breath sounds, monitor
international normalization ratio
(INR) is therapeutic; arfarin is used oxygen saturation, and
for maintenance therapy electrocardiogram (ECG)
 Thrombolytic therapy if respiratory  Monitor for signs and symptoms of
status is severely compromised; hypoxemia and right heart failure
alteplase (Activase), tissue  Administer prescribed
lasminogen activator (t-PA) thrombolytic/anticoagulants;
 Angiography; if condition is severe,  monitor for bleeding
an embolectomy may be indicated  Administer analgesics to reduce pain
 Vena cava interruption; a filter
and decrease anxiety
(Greenfield or umbrella) may be
implanted in inferior vena cava,
preventing passage of large thrombi
 Maintain calm environment
 Infusion of DOBUTamine (Dobutrex)
for hypotension  Educate regarding anticoagulants and
prevention of hrombophlebitis
ATELECTASIS
 MANAGEMENT
SIGNS AND SYMPTOMS  Monitor vital signs., pulseoximetry.
 Cough  Administer a concentration of oxygen based on ABG
 Exertional dyspnea values
 Wheezing and crackles  Instruct the client in diaphragmatic or abdominal breathing
 Sputum production techniques, tripod positioning, and pursed lip breathing
 Weight loss techniques
 Barrel chest (emphysema)  Record the color, amount, and consistency of sputum.
 Suction the client’s lungs, if necessary, to clear the airway
 Use of accessory muscles
and prevent infection.
for breathing  Monitor weight.
 Prolonged expiration  Encourage small, frequent meals to maintain nutrition and
 Orthopnea prevent dyspnea.
 Cardiac dysrhythmias  Provide a high-calorie, high-protein diet with
 Congestion and supplements.
hyperinflation seen on  Encourage fluid intake up to 3000 mL/day to keep
chest xray secretions thin.
 ABG levels that indicate  Place the client in a Fowler’s position and leaning forward
to aid in breathing.
respiratory acidosis and
 Allow activity as tolerated.
hypoxemia  Administer bronchodilators as prescribed
 Pulmonary function tests  Administer corticosteroids as prescribed for
that demonstrate  Administer mucolytics as prescribed to thin secretions.
decreased vital capacity  Administer antibiotics for infection if prescribed.
 TUBERCULOSIS
Etiology and Pathophysiology
■ Mycobacterium tuberculosis → granulomas of bacilli that become fibrous
tissue mass (Ghon tubercle) that can calcify or ulcerate and free bacilli
■ Miliary TB: Bacilli may travel to bone, kidneys, or brain
Risk Factors
■ ↓Immune response (HIV, steroids), crowded living conditions
■ Alcoholism, malnutrition
Signs and Symptoms
■ Night sweats, ↓weight, cough, hemoptysis
■ +PPD/Mantoux of 10mm induration indicates immune response
■ +Chest x-ray, acid fast bacteria in sputum
Treatment
■ Combination of antituberculars for 6-12mo ■ Prophylactic INH for exposure
Nursing
■ Use airborne precautions during active disease
■ Teach need for long-term compliance with meds
 EMPHYSEMA
Etiology and Pathophysiology
■ Alveolar wall distention → ↑surface area for gas exchange, air trapping and
↑residual volume → ↑work to exhale, barrel chest, chronic hypercapnia; may →
right-sided heart failure (cor pulmonale)
Risk Factors
■ ↑Age, smoking, secondhand smoke, inhaled pollutants ■ Alpha antitrypsin
deficiency
Signs and Symptoms
■ Barrel chest, clubbing of fingers ■ Pursed-lip breathing, ↓forced expiratory
volume
■ Bronchodilators ineffective (unlike asthma)
Treatment
■ Smoking cessation ■ O2; meds: steroids and bronchodilators ■ Lung transplant
Nursing
■ Give O2 at ≤2L because with emphysema excessive exogenous O2 diminishes the
respiratory drive and results in ↓breathing and ↑CO2 retention (CO2 narcosis).
Normally ↑CO2 stimulates breathing. With emphysema there is chronic ↑CO2 and
as a result low O2 stimulates breathing
■ Teach diaphragmatic and pursed-lip breathing to extend exhalation and
keep alveoli open
 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
Etiology and Pathophysiology
■ Direct or indirect lung trauma → inflammation → fluid movement into alveolar
spaces and ↓surfactant → atelectasis → hypoxia and ↑dead space ■ Secondary to
trauma, aspiration, shock, infection
Signs and Symptoms
■ Early: Dyspnea, anxiety, ↓O2 sat, ↓PaO2 ■ Late: ↑CO2, cyanosis, lung infiltrate on
x-ray
Treatment
■ Treat cause; mechanical ventilation and positive end expiratory pressure (PEEP—
keeps alveoli open)
■ Steroids, interleukin-1 receptor antagonists, surfactant therapy ■ Sedatives or
neuromuscular blocks to ↓”fighting” ventilator
Nursing
■ Monitor S&S; suction airway ■ Mechanical ventilator care:
■ Assess breath sounds for equality (PEEP → ↑risk of pneumothorax, ET tube may be
in right bronchi)
■ Maintain trach or endotracheal tube cuff pressure seal to ensure full volume delivery
■ Check ventilator settings and alarms (↑pressure secondary to mucus or tubing kinks
and ↓pressure secondary to ↓cuff pressure or separation of tubing)
■ Provide alternate mode of communication
 LUNG CANCER
Etiology and Pathophysiology
■ Altered DNA → alters cellular replication; may be primary or metastatic; often
metastasizes to lymph nodes, bone, brain before diagnosis ■ Types: Adenocarcinoma,
small cell (oat cell), large cell (undifferentiated), and squamous cell carcinoma
Risk Factors
■ Smoking, heredity, ↓intake of fruits and vegetables ■ Exposure to asbestos or radon
Signs and Symptoms
■ Dry, chronic cough; hoarseness ■ ↓Weight, lymphadenopathy
■ Sputum positive for cytology ■ Chest x-ray indicates lesion and possible effusion ■
Biopsy indicates source (primary or secondary)
Treatment
■ Lobectomy, pneumonectomy ■ Chemotherapy, radiation, palliative care (↓pain)
Nursing
■ Lobectomy: Manage chest tubes
■ Pneumonectomy: Place on operative side
■ Chemotherapy: Manage side effects; hospice prn