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Upper respiratory tract
Nose, sinus, pharynx, larynx, epiglottis
- ⁃ A. passageway for the respiratory and digestive tracts located behind the oral and nasal cavities.
- B. Divided into the nasopharynx, oropharynx, and laryngopharynx
- A. Located above the trachea just below the pharynx at the root of the tongue, commonly called the voice box
- - B. Contains two pairs of vocal cords, the false and true cords
- - C. The opening between the true vocal cords, is the glottis
- - D. glottis plays a huge role in coughing, most fundamental defense mechanism of the lungs.
- - A. Leaf shaped elastic structure attached along one end to the top of the larynx.
- - prevents food from entering the tracheobronchial tree by closing over the glottis during swallowing
Lower respiratory tract
Trachea, main stream bronchi, bronchioles, alveolar ducts and alveoli, lungs
Located in front of the esophagus; branches into the right and left mainstrem bronchi at the carina
- A. Begin at the carina
- - B. The right bronchus is slightly wider, shorter, and more vertical than the left bronchus.
- - C. Mainstream bronchi divide into secondary or lobar bronchi that enter each of the five lobes of the lung.
- - D. Bronchi are lined with cilia, which propel mucus up and away from the lower airway to the tracha, where it can be expectorated or swallowed.
- - A. Branch from secondary bronchi and subdivide into the small terminal and respiratory bronchioles
- - B. The bronchioles contain no cartilage and depend on the elastic recoil of the lung for patency.
- - C. The terminal bronchioles contain no cilia and do not participate in gas exchange.
Alveolar ducts and alveoli:
- A. Acinus (plural acini) term is used to indicate all structures distal to the terminal bronchiole.
- - B. Alveolar ducts branch from the respiratory bronchioles
- - C. Alveolar sacs, which arise from the ducts, contain cluster of alveoli, which are the basic units of gas exchange.
- - D. Type 2 alveolar cells in the walls of the alveoli secrete surfactant, a phospholipid protein that reduces the surface tension in the alveoli; w/o surfactant, the alveoli would collapse.
- - A. located in the pleural cavity of 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 three lobes: the upper, middle, and lower lobes.
- - D. Left lung is narrower than the right lung to accomodate the heart, divided into two lobes.
- - E. Respiratory structures innervated by the PHRENIC NERVE, VAGUS NERVE, AND THORACIC NERVE.
- - F. Parietal pleura lines the inside of the thoracic cavity, includes the upper surface of the diaphram.
- - G. Visceral pleura covers the pulmonary surfaces
- - H. A thin fluid layer, produced by the cells lining the pleura lubricates the visceral pleura and the parietal pleura, allowing them to glide smoothly and painlessly during respiration.
- - I. Blood flows through the lungs via the PULMONARY system and the BRONCHIAL system.
Accessory muscles of respiration
Scalene muscles, which elevate the first two ribs, the sternocleidomastoid muscles, which raise the sternum, and the trapezius and pectoralis muscles, which fix the shoulders.
- A. Diaghram descends into the abdominal cavity during INSPIRATION, causing NEGATIVE pressure in the lungs.
- B. Negative pressure draws air from the area of greater pressure, the atmosphere, into the area of lesser pressure, the lungs.
- C. In the lungs, air passes through the terminal bronchioles into the alveoli to oxygenate the body tissues.
- D. At the end of inspiration, the diaphram and intercostal muscles relax and lungs recoil.
- E. As the lungs recoil, pressure w/in the lungs becomes higher than atmospheric pressure, causing the air, which now contains the cellular waste products of co2 and water, to move from the alveoli in the lungs to the atmosphere.
- F. Effective gas exchange depends on distribution of gas (ventilation) and blood (perfusion) in all portions of the lungs.
Primary functions of respiratory system:
- ⁃ 1. provide oxygen for metabolism in the tissues
- 2. Remove carbon dioxide, the waste product of metabolism.
- - Secondary functions:
- - 1. facilitate sense of smell
- - 2. maintain acid base balance
- - 3. maintain body water levels
- - 4. produces speech
- - 5. maintains heat balance.
Interaction of respiratory system with Circulatory System
⁃ The lungs are where the body is able to engage in gas exchange between the blood and the air. The circulatory system sends deoxygenated blood to the lungs, where it is again oxygenated and returned to the heart, so it can be pumped to tissues and organs throughout body.
Interaction of the respiratory system with the Nervous System
Various sensors and receptors in the lungs are sensitive to inflation, deflation, and chemical stimulation, and can activate the nervous system. Afferent signals sent from the respiratory system can initiate neurally-controlled responses such as a cough reflex or changes in the breathing pattern.
Interaction of the respiratory system with the Lymphatic
The lymph system helps to maintain the fluid balance in the lungs and plays an important role in the specific defenses of the immune system. Injury or disease to lung tissues activate this system into removing excess fluid and providing a route of transportation for immune cells.
Interaction of respiratory system with Immune
Foreign particles and cells in the respiratory system stimulate the immune system to release macrophages and lymphocytes as protection. Asthma is a complex inflammatory disease resulting from a mistaken immune response.
Interaction of respiratory system with Exocrine System
The lungs and the kidneys work together to maintain proper oxygen levels in the blood. When the kidneys sense that blood oxygen levels are low, they secrete erithropoyetin. This encourages the formation of additional red blood cells with oxygen binding hemoglobin so that more oxygen can be absorbed from the lungs.
Discuss environmental factors that alter the function of the respiratory system.
- Smoking history- smoking for 2 or more years appear to decline less rapidly than those of continued use.
- - Drug use- Both prescribed drugs and illicit drugs can affect lung function. Ask about breathing problems. System drugs can have an affect as well, cocaine, marijuana are often inhaled and can affect lung function.
- - Allergies- foods, dust, molds, pollen, bee stings, trees, grass, and animal dander and saliva can affect breathing.
- - Travel and geographic area of residence- possible exposure to certain diseases. EX: histoplasmosis- a fungal disease that can be inhaled by contaminated dust in central region of the US.
Chest x-ray film
(radiograph)Provides information about the anatomical location and appearance of the lungs.
Specimen obtained by expectoration or tracheal suctioning to assist in the identification of organisms or abnormal cells.
Laryngoscopy and bronchoscopy
Direct visual examination of the laryx, trachea, and bronchi with a fiberoptic bronchoscope.
Insertion of a flexible to tube through the chest wall above the sternum into the area of the upper chest between the lungs. Done to look for presence of tumors and obtain tissue samples for biopsy and culture.
Invasive fluoroscopic procedure in which a catheter is inserted through the antecubital or femoral vein into the pulmonary artery or one of it's branches.
removal of fluid or air from the pleural space via a transthoracic aspiration.
Pulmonary function tests-
Tests used to evaluate lung mechanics, gas exchange, and acid base disturbance through spirometric measurements, lung volumes and arterial blood gas levels.
A transbronchial biopsy and a transbronchial needle aspiration may be performed to aobtain tissue for analysis by culture or cytological examination.
Ventilation perfusion lung scan
Evaluates blood flow to the lugns, determines the patency of the pulmonary airways and dtects abnormalities in ventilation.
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.
used with other diagnostic data to identify various infectious diseases.
non-invasive test that registers the oxygen saturation of the clients hemoglobin.
PULMONARY FUNCTION TESTS- most accurate tests for asthma:
- ⁃ FVC- records the maximum amount of air that can be exhaled as quickly as possible after maximum inspiration. This gives an indication of respiratory muscle strength and ventialtory reserve. FVC is reduced in obstructive disease because of air trapping and restrictive disease. (Volume of air exhaled from full inhalation to full exhalation.)
- FEV- records maximum amount of air that can be exhaled in the first second of expiration. Effort dependent and declines with age. It is reduced in certain obstructive and restrictive disorders. (Volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation.)
- PEF- Fastest airflow rate reached at any time during exhalation.
- Critical to health and well being: inflammatory protection is immediate but short term against injury or invading organisms.
- It does not provide true immunity on repeated exposure to the same organisms.
- Inflammation is a non specific body defence to invasion or injury and can be started quickly by almost any event, regardless of where it occurs or what causes it.
- Inflammatory response cause tissue actions that cause visible an uncomfortable symptoms. Despite the discomfort, these actions are important in ridding the body of harmful organisms. Howevere, if inflammatory response is excessive tissue damage may occur.
- Three divisions of immunity are: inflammation, antibody mediated immunity and cell mediated immunity. Optimal function of all three are necessary for complete immunity.
Insufficient levels of oxygen in blood or tissue.
Insufficient oxygenation of arterial blood
blood flow through the pulmonary capillaries
is the lung volume representing the normal volume of air displaced between normal inspiration and expiration when extra effort is not applied. In a healthy, young adult, tidal volume is approximately 500 mL per inspiration or 7 mL/kg of body weight.
Inspiratory reserve volume
The maximal amount of gas that can be inhaled from the end-ispiratory position.
Expiratory reserve volume
The maximal amount of gas that can be exhaled from the resting end-expiratory level.
The amount of gas remaining in the lung at the end of maximal exhalation.
Total lung capacity
The amount of gas contained in the lung at the end of a maximal inhalation.
Changes to alveoli and age
surface area decreases, diffusion capacity decreases, elastic recoil decreases, elastic recoil decreases, bronchiole and alveolar ducts dilate, ability to cough decreases, airways close eary.
Changes to lungs with age
Residual volume decreases, vital capacity decreases, efficiency of oxygen and carbon dioxide exchange decreases, elasticity decreases.
Changes to Pharynx and larynx with age
muscles atrophy, vocal cords become slack, laryngeal muscles lose elasticity, and airways lose cartilage
Changes to Pulmonary vasculature with age
Vascular resistance to blood flow through pulmonary vascular system increases, pulmonary capillary blood volume decreases, risk for hypoxia increases.
Changes to exercisse tolerance with age
Body's response to hypoxia and hypercariba decrease
Changes to muscle strength with age
respiratory muscle strength, especially the diaphragm and the intercostals decreases.
changes to infection susceptibility and age
Effectiveness of cilia decreases, immunoglobulin A decreases, alveolar macrophages are altered.
Changes to chest wall and age
anteroposterior diameter increases, thorax becomes shorter, progressive kyphoscoliosis occurs, chest wall compliance (elasticity) decreases, mobility may decrease, osteoporosis possible.