Introduction to the Respiratory Care Profession

UNIT © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC I NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction to the Respiratory Care Profession © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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84379_CH01_001_021.pdf 2 8/25/10 8:09 AM CHAPTER © Jones &Cardiopulmonary Bartlett Learning, LLC and ©Central Jones & Bartlett Learning, LLC 1 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Nervous System Structures and Functions © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OUTLINE OBJECTIVES Introduction Upon completion of this chapter, the reader should be Organs of the Cardiovascular System able to do the following: The Heart 1. Name the structures that compose the © Jones & BartlettThe Heart Learning, Chambers LLC © Jones cardiovascular& Bartlett Learning, system. LLC NOT FOR SALEThe OR Heart DISTRIBUTION Valves NOT 2.FOR Distinguish SALE OR among DISTRIBUTION the various coverings of the The Heart Wall heart and the layers that compose the heart Blood Supply to the Heart wall. The Conduction System of the Heart 3. Discuss the cardiac cycle and blood pressure. Electrocardiogram 4. Compare the structures and functions of the Blood Vessels © Jones & Bartlett Learning, LLC major types of blood vessels.© Jones & Bartlett Learning, LLC The Cardiac Cycle NOT FOR SALE OR DISTRIBUTION5. Identify the general functionsNOT FORof the SALErespiratory OR DISTRIBUTION Blood Pressure system. Pulmonary and Systemic Circuits 6. Describe the locations of the organs of the Organs of the Respiratory System respiratory system. Nose and Nasal Cavity 7. Describe the functions of each organ of the © JonesPharynx & Bartlett Learning, LLC respiratory© Jones system. & Bartlett Learning, LLC NOTLarynx FOR SALE OR DISTRIBUTION 8. ExplainNOT the mechanismsFOR SALE of ORinspiration DISTRIBUTION and Trachea expiration. Bronchial Tree 9. Describe the four main parts of the brain and Lungs their functions. Breathing Mechanism 10. Explain the effect of the sympathetic and © Jones & BartlettRespiratory Learning, Air Volumes LLC and Capacities © Jones parasympathetic& Bartlett Learning, nervous systems LLC upon the NOT FOR SALEControl OR of DISTRIBUTION Breathing NOT FORcardiopulmonary SALE OR DISTRIBUTION system. Factors That Affect Breathing Alveolar Gas Exchanges KEY TERMS Gas Transport Aerobic Depolarization Overview of the Nervous System Aerobic metabolism Diaphragm Central Nervous© System Jones & Bartlett Learning, LLCAorta ©Diastole Jones & Bartlett Learning, LLC Brain NOT FOR SALE OR DISTRIBUTIONAortic valve NOTECG FOR SALE OR DISTRIBUTION Spinal Cord Atria EKG Peripheral Nervous System Brainstem Electrocardiogram Cranial Nerves Bronchial tree Endocardium Spinal Nerves Carbaminohemoglobin Epicardium ©Autonomic Jones & Nervous Bartlett System Learning, LLC Carbonic anhydrase© Jones & BartlettEpiglottis Learning, LLC NOTParasympathetic FOR SALE OR Division DISTRIBUTION Cardiac cycleNOT FOR SALEEsophagus OR DISTRIBUTION Sympathetic Division Cardiac veins Expiration Autonomic Neurotransmitters Coronary arteries External respiration Patient Education Coronary sinus Hemoglobin (Hb) Summary Cricoid cartilage Inspiration © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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KEY TERMS (cont’d) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Internal Parietal pleura NOT FOR SALE OR DISTRIBUTION NOT FOR SALE respiration OR DISTRIBUTIONPons Mediastinum Pulmonary valve Carotid arteries Medulla oblongata Respiration Jugular veins Midbrain Septum Superior vena cava Ascending aorta Mitral valve Systole Pulmonary veins Pulmonary arteries © Jones & Bartlett Learning, LLC © Jones & BartlettCoronary arteries Learning, LLC Myocardium Thyroid cartilage Brachial artery NOT FOR SALE OR DISTRIBUTIONRenal vein NOT FOR SALE OR DISTRIBUTION Nasal septum Tricuspid valve Neurons Visceral pleura INTRODUCTION Renal artery Abdominal aorta The cardiovascular system circulates blood to all Inferior vena cava © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,Capillary LLC beds partsNOT of the FOR body. SALE The pumping OR DISTRIBUTION of the heart provides NOT FOR SALE OR DISTRIBUTION oxygen to the body’s cells as well as nutritive ele- ments. It also removes waste materials and carbon Femoral artery dioxide. The heart is a muscular pump that is the central organ of the cardiovascular system, which also © Jones & includesBartlett the Learning, arteries, veins, LLC and capillaries. © Jones & Bartlett Learning, LLC NOT FOR SALEThe pulmonaryOR DISTRIBUTION system consists of the nose, NOT FOR SALE OR DISTRIBUTION pharynx, larynx, trachea, bronchi, and lungs. It fur- Femoral vein nishes oxygen for individual tissue cells and takes away their gaseous waste products. This process is accomplished through the act of respiration, which consists of external ©and Jones internal & processes. Bartlett ExternalLearning, LLC © Jones & Bartlett Learning, LLC respiration is the methodNOT inFOR which SALE the lungs OR are DISTRIBUTION venti- NOT FOR SALE OR DISTRIBUTION lated, and oxygen and carbon dioxide are exchanged between the alveoli of the lungs and the blood in the pulmonary capillaries. Internal respiration occurs when oxygen and carbon dioxide are exchanged between© Jones the blood & Bartlett in systemic Learning, capillaries LLCand the © Jones & Bartlett Learning, LLC body’sNOT tissues FOR and SALE cells OR(see FiguresDISTRIBUTION 1–1 and 1–2). NOT FOR SALE OR DISTRIBUTION The various organs, components, and functions of the cardiopulmonary system are described in this chapter. The brain and autonomic nervous system control FIGURE 1–1 The cardiovascular system. Note its many similarities the operation of the cardiovascular and respiratory to a river. © Jones & system.Bartlett Therefore, Learning, this chapterLLC will include a discus- © Jones & Bartlett Learning, LLC NOT FOR SALEsion of theOR brain’s DISTRIBUTION four major regions: cerebrum, NOT FOR SALE OR DISTRIBUTION diencephalon, brainstem, and cerebellum. It will also discuss the sympathetic and parasympathetic divisions of the autonomic nervous system. Pharynx Nasal cavity © Jones & Bartlett Learning, LLC (throat) © Jones & Bartlett Learning, LLC Organs of the Cardiovascular Oral System NOT FOR SALE OR DISTRIBUTION NOT FOR SALEcavity OR DISTRIBUTION Esophagus The heart never rests; it beats approximately 100,000 Epiglottis Trachea Larynx times each day, pumping nearly 8000 liters of blood. The (windpipe) heart is a small organ that is nearly the size of an adult’s closed fist. Primary © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,bronchi LLC NOT FOR SALE OR DISTRIBUTION Lungs NOT FOR SALE OR DISTRIBUTIONSecondary The Heart bronchi

The heart is a hollow organ that is somewhat cone Alveoli shaped. It is found within the thoracic cavity, resting Diaphragm upon the diaphragm. The heart contains four muscular © Jones & chambers:Bartlett theLearning, left and right LLC atria, and the left and right© Jones & Bartlett Learning, LLC NOT FOR SALEventricles. OR The DISTRIBUTION heart itself weighs about 300 grams (in anNOT FORFIGURE SALE 1–2 The OR respiratory DISTRIBUTION system.

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average adult male) and lies slightly AORTA © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC to the left of the body’s midline. It SUPERIOR VENA CAVA NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONPulmonary contains three layers of muscle tis- trunk sue, which will be discussed later in this chapter. Left pulmonary arteries Aortic semilunar valve Pulmonary semilunar The Heart Chambers© Jones & Bartlettvalve Learning, LLC © Jones & Bartlett Learning, LLC The heart consists NOTof four FOR hollow SALE OR DISTRIBUTION NOT FORPulmonary SALE veins OR DISTRIBUTION chambers: two on the left, and two LEFT ATRIUM Pulmonary veins on the right. The upper chambers RIGHT ATRIUM are called atria and have thin walls. Left atrioventricular (bicuspid valve) The lower chambers are called ven- Right atrioventricular (tricuspid valve) tricles;© Jones they receive & Bartlett blood from Learning, the LLC © Jones & Bartlett Learning, LLC Chordae tendineae LEFT VENTRICLE atria and contract to force blood out NOT FOR SALE OR DISTRIBUTIONRIGHT VENTRICLE NOT FOR SALE OR DISTRIBUTION of the heart and into the arteries. AORTA The left atrium collects blood Papillary muscles from the pulmonary veins. It then INFERIOR VENA CAVA moves this blood into the left ven- © Jones & tricle,Bartlett which Learning, pumps it into LLC the sys- © Jones & Bartlett Learning, LLC NOT FOR SALEtemic circuit OR DISTRIBUTION (via the aorta). The NOT FOR SALE OR DISTRIBUTION right atrium collects blood from the systemic circuit (via the inferior and superior vena cava) as well as the coronary sinus and conducts it into the right ventricle.© Jones This ven- & Bartlett Learning, LLC © JonesLeft coronary & Bartlett artery Learning, LLC tricle pumps the bloodNOT intoFOR the SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Circumflex branch pulmonary artery, which separates Right coronary artery into the left and right pulmonary branches. The left and right atria, as Anterior interventricular branch well as the left and right ventricles, Anterior cardiac vein Great cardiac vein are© separated Jones from& Bartlett one another Learning, by Marginal LLC branch © Jones & Bartlett Learning, LLC wall-likeNOT structures,FOR SALE each OR of which DISTRIBUTION Small cardiac vein NOT FOR SALE OR DISTRIBUTION is known as a septum. Because of the septums, blood from each side of the heart never mixes with blood FIGURE 1–3 Anatomy of the heart. from the other side (see Figure 1–3). © Jones & BartlettWhen the Learning, heart beats, LLC the atria © Jones & Bartlett Learning, LLC NOT FOR SALEcontract OR first, DISTRIBUTION followed by the ven- NOT FOR SALE OR DISTRIBUTION tricles. The ventricles contract at the same time, ejecting equal amounts of blood into the pulmonary and systemic ■ TABLE 1–1 Heart Valves circuits. Valve Location Function The Heart Valves© Jones & Bartlett Learning, LLCMitral Opens between © JonesPrevents the & blood Bartlett from moving Learning, LLC (bicuspid) the left atrium from the left ventricle into the left An atrioventricularNOT valve FOR(A-V valve),SALE includingOR DISTRIBUTION the valve and left ventricle NOTatrium FOR when theSALE ventricle OR contracts DISTRIBUTION tricuspid valve on the right and the mitral valve on the left, makes the blood flow one way between the atria and Aortic valve At the entrance Prevents the blood from moving ventricles. The pulmonary valve allows blood to flow to the aorta from the aorta into the left ventricle when the ventricle relaxes from the right ventricle while preventing backflow into the© ventricle. Jones As& Bartlettthe left ventricle Learning, contracts, LLC the mitral Tricuspid © JonesOpens between & Bartlett Prevents Learning, the blood from LLC moving valveNOT closes, FOR and SALE blood ORcan onlyDISTRIBUTION exit through a large valve NOTthe FORright atrium SALE from OR the DISTRIBUTION right ventricle into the right artery known as the aorta. The aortic valve, located at and right atrium when the ventricle contracts ventricle the base of the aorta, opens to allow blood to leave the left ventricle when it contracts. Both the pulmonary and Pulmonary At the entrance Prevents the blood from moving aortic valves are called semilunar valves because their valve to the pulmonary from the pulmonary trunk into the © Jones & cuspsBartlett are shaped Learning, like half-moons. LLC Table 1–1 explains the© Jones & Bartletttrunk Learning,right LLC ventricle when the ventricle relaxes NOT FOR SALElocations OR and DISTRIBUTION functions of the heart valves. NOT FOR SALE OR DISTRIBUTION

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The Heart Wall © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR TheDISTRIBUTION heart wall is made up of three distinct layers: the inner endocar- Heart dium, the middle myocardium, and the outer epicardium. Figure 1–4 shows these three heart layers. © Jones & Bartlett Learning, LLC The ©heart’s Jones inner & Bartlett surfaces Learning, LLC NOT FOR SALE OR DISTRIBUTION (includingNOT the heartFOR valves) SALE are OR cov- DISTRIBUTION ered by the endocardium. The myocardium (the muscular heart wall) forms both the atria and ventricles. Diaphragm It contains cardiac muscle tissue, epi- (A)(a) © Jones & Bartlett Learning, LLC © Jonesnerves, & Bartlett and blood Learning, vessels. The LLC cardium is the layer that covers the NOT FOR SALE OR DISTRIBUTIONParietal NOT FOR SALE OR DISTRIBUTION pericardium heart’s outer surface. Pericardial space Blood Supply to the Heart The right and left coronary arter- Heart © JonesVisceral & Bartlett Learning, LLC © JonesEpicardium & Bartlett Learning,ies are the firstLLC two branches of pericardium (visceral NOT FOR SALE OR DISTRIBUTION NOTpericardium) FOR SALE OR theDISTRIBUTION aorta. They supply blood to the Parietal Heart heart’s tissues. Cardiac muscle cells pericardium Myocardium wall require steady supplies of oxygen Pericardial (B)(b) space Endocardium and nutrients because the heart works continuously. Branches of © Jones & Bartlett Learning, LLC the cardiac© Jones veins drain & Bartlett blood from Learning, LLC NOT(C)(c) FOR SALE OR DISTRIBUTION the myocardialNOT FOR capillaries SALE into OR the DISTRIBUTION coronary sinus, emptying into the right atrium. FIGURE 1–4 The heart is located in the mediastinum (A). It is surrounded by the pericardium, which contains the pericardial space (B). There are three layers to the heart wall (C). The Conduction System © Jones & Bartlett Learning, LLC © Jonesof &the Bartlett Heart Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION R The heart requires electrical impulses to maintain a heartbeat. A network of highly spe- cialized muscle tissue transmits © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,these impulses LLC originating from T the sinoatrial (SA) and atrioven- NOT FOR SALE OR DISTRIBUTION P NOT FOR SALE OR tricularDISTRIBUTION (AV) nodes. This network includes the conducting fibers QS between the nodes, the bundle of His (AV bundle), the left and right © Jones & Bartlett Learning,Atrioventricular LLC bundle branches,© Jones and & theBartlett Purkinje Learning, LLC bundle fibers (see Figure 1–5). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION SINOATRIAL (SA) Purkinje NODE (pacemaker) fibers Electrocardiogram

Interventricular An electrocardiogram graphi- septum cally depicts, onto a moving strip ATRIOVENTRICULAR (AV) NODE© Jones & Bartlett Learning, LLC © Jonesof &paper, Bartlett a representation Learning, of LLC the electrical impulses of the heart as NOT FOR SALE OR DISTRIBUTIONRight and left NOT FOR SALE OR DISTRIBUTION Conduction myofibers branches it beats. The paper can be printed (Purkinje fibers) of AV bundle or the graph can be viewed on a FIGURE 1–5 The impulse generation and conduction system of your heart. The fibrotendinous ring is variety of monitoring devices. An shown in blue. Also shown is the tracking of an EKG. The p wave corresponds to atrail depolarization, the electrocardiogram is abbreviated © JonesQRS complex& Bartlett to ventricular Learning, depolarization, LLC and the T wave to ventricular repolarization.© Jones & Bartlett Learning,as both ECG LLC and EKG. Every time NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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the heart beats, a wave of depolarization moves through ■ The P–R interval extends from the beginning © Jones &the Bartlett atria, reaches Learning, the AV LLC nodes, and moves down the© Jones of& atrialBartlett depolarization Learning, to LLCthe start of the QRS NOT FOR SALEintraventricular OR DISTRIBUTION septum to the apex. This wave thenNOT FORcomplex. SALE OR DISTRIBUTION turns and spreads through the ventricular myocardium ■ The Q–T interval indicates the time needed for the toward its base. ventricles to depolarize and repolarize one time. An ECG collects its electric information from elec- This is usually measured from the end of the P–R trodes at different places© Jones on the &surface Bartlett of the Learning, body. An LLC interval. © Jones & Bartlett Learning, LLC ECG can reveal normal and abnormal patterns of heart Refer back to Figure 1–5 once more to examine the conduction, such asNOT when FOR part ofSALE the heart OR hasDISTRIBUTION been appearance of the electrical phasesNOT ofFOR the heart. SALE OR DISTRIBUTION damaged by a heart attack. The following are the components of an ECG: Blood Vessels ■ A small P wave accompanies the atrial The blood vessels form a closed circuit of tubes that © depolarization.Jones & Bartlett Learning, LLC carry blood© from Jones the heart & Bartlett to the cells Learning, of the body LLC and ■ The QRS complex appears during ventricular back again. Blood leaves the heart via the pulmonary NOTdepolarization. FOR SALE The OR ventricles DISTRIBUTION begin to contract trunk (whichNOT originates FOR atSALE the right OR ventricle) DISTRIBUTION and the briefly after the peak of the R wave. aorta (which originates at the left ventricle). The pulmo- ■ A smaller T wave indicates ventricular repolariza- nary arteries branch from the pulmonary trunk, carrying tion. Note: The QRS complex helps to mask any blood to the lungs. Systemic arteries branch from the © Jones & Bartlettindication Learning, of atrial LLC repolarization, which occurs© Jonesaorta, &distributing Bartlett bloodLearning, to all other LLC body organs (see while the ventricles are depolarizing. Figures 1–6 and 1–7). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Capillary beds of ✈ lungs © Jones & Bartlett Learning, LLC Main Street© Jones & Bartlett Learning, LLC East Street West Street

NOT FOR SALE OR DISTRIBUTION 132NOT FOR SALE OR DISTRIBUTION 65

81 Clark Street Pulmonary circuit Morales Avenue

Pulmonary Pulmonary Bruno Street arteries© Jones & Bartlett Learning, LLCveins (4) © Jones & Bartlett Learning, LLC

NOT FOR SALE OR DISTRIBUTION Pulmonary circuit NOT FOR SALE OR DISTRIBUTION Superior and Aorta and inferior branches vena cavae Metarteriole © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Right Left ventricle ventricle Systemic circuit Venule © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Capillaries NOT FOR SALE OR DISTRIBUTION Systemic circuit Arterioles Arteriole

Capillary beds of © Jones & Bartlett Learning,all body LLC tissues © Jones & Bartlett Learning, LLC Venules NOT FOR SALE OR DISTRIBUTION PrecapillaryNOT FOR SALE OR DISTRIBUTION Oxygen-poor, Oxygen-rich, sphincters CO2-rich blood CO2-poor blood

FIGURE 1–6 The blood pathway includes two circuits. The right ventricle supplies the pulmonary circuit, and the left ventricle supplies FIGURE 1–7 Just as we travel on different types of roads, our © Jones & theBartlett systemic circuit.Learning, LLC © Jonesvasculature & Bartlett consists of several Learning, different types LLC of vessels. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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The blood vessels include arteries, arterioles, capillar- blood between the gas exchange surfaces of the lungs) © Jones &ies, Bartlett venules, Learning, and veins. They LLC are defined as follows: © Jonesand a &systemic Bartlett circuit Learning, (which transports LLC blood to and NOT FOR SALE■ An OR artery DISTRIBUTION is a blood vessel that carries blood awayNOT from FOR the SALE remainder OR DISTRIBUTIONof the body). Each circuit begins from the heart and toward peripheral capillaries. and ends at the heart. Oxygenated blood is sent from ■ An arteriole is a smaller blood vessel that works the left ventricle to the aorta and then circulated with the arteries to carry blood to the capillaries. through the body (the systemic circuit). Therefore, once ■ A capillary is the© Jones smallest &type Bartlett of blood Learning, vessel in LLCdeoxygenated, the blood returns© Jones to the &right Bartlett atrium. Learning,It LLC the cardiovascular system. Capillaries allow the moves into the right ventricle and is then sent into the blood to distributeNOT oxygen FOR andSALE nutrients OR DISTRIBUTION to indi- pulmonary trunk. Through NOTpulmonary FOR circulation, SALE OR the DISTRIBUTION vidual cells while picking up carbon dioxide and exchange of oxygen and carbon dioxide occurs, and waste products from these cells. Blood is passed the blood returns to the left atrium. The process then from the arterioles to the capillaries, eventually begins again. © movingJones on & to Bartlett the venules. Learning, LLC All body© cells Jones need energy& Bartlett for maintenance, Learning, growth, LLC ■ A venule is a small blood vessel that passes blood defense, and division. Energy is obtained mostly through NOTfrom FOR the capillaries SALE toOR the DISTRIBUTION veins. Venules are smaller aerobic mechanismsNOT FOR that SALE require OR oxygen DISTRIBUTION and produce in size than veins and perform the reverse function carbon dioxide. Circulating blood contains oxygen, car- of the arterioles. rying it from the lungs to the peripheral tissues. This ■ A vein is a blood vessel that carries blood back to blood also transports carbon dioxide generated by the © Jones & Bartlettthe heart. Learning, Except for LLC the pulmonary vein, all veins© Jonesperipheral & Bartlett tissues to Learning, the lungs so LLCthat it can be exhaled. carry blood that is oxygen depleted and darker Deoxygenated blood is reoxygenated by the lungs. NOT FOR SALEin ORcolor DISTRIBUTION than that of oxygenated arterial blood.NOT FOR SALE OR DISTRIBUTION Veins are more numerous than arteries and hold Organs of the Respiratory System a greater volume of blood. They contain valves The organs of the respiratory system can be divided into that prevent blood from flowing backward. Vein two tracts: the upper respiratory tract (nose, nasal cavity, walls are thinner than the walls of corresponding © Jones & Bartlett Learning, LLCparanasal sinuses, and pharynx)© Jones and the & lower Bartlett respira- Learning, LLC arteries because the blood pressure in the veins is tory tract (larynx, trachea, bronchial tree, and lungs). lower than the NOTblood pressureFOR SALE in the arteries.OR DISTRIBUTION Large NOT FOR SALE OR DISTRIBUTION The bronchial trees terminate into grapelike clusters veins include the superior and inferior venae cavae, (alveoli) in the lungs. which carry less-oxygenated blood into the right atrium. Nose and Nasal Cavity © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The Cardiac Cycle The nose is the main passage that allows air to enter the NOT FOR SALE OR DISTRIBUTION respiratory NOTsystem. FOR Air moves SALE through OR DISTRIBUTION the two external The cardiac cycle is the period between the start of nares (nostrils), which open into the nasal cavity. The one heartbeat and the start of the next heartbeat. Atrial nasal septum divides the nasal cavity into a right and contraction regulates the heart chambers in an action a left portion, and the anterior portion of the septum known as atrial systole. During this action, the ventricles consists of hyaline cartilage. The nasal cavity’s lateral © Jones & relaxBartlett (called Learning, ventricular LLC diastole). Next, the ventri-© Jonesand superior & Bartlett walls areLearning, formed by LLC the maxillary, nasal, NOT FOR SALEcles contract OR DISTRIBUTION (ventricular systole) while the atria relaxNOT frontal, FOR SALEethmoid, OR and DISTRIBUTION sphenoid bones of the skull (see (atrial diastole). Finally, both the atria and ventricles Figure 1–8). relax for a brief interval. The superior, middle, and inferior nasal conchae project toward the nasal septum from the nasal cavity’s Blood Pressure lateral walls. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Blood pressure is defined as the force that the blood exerts against the wallsNOT of theFOR blood SALE vessels. OR It DISTRIBUTIONis influ- Pharynx NOT FOR SALE OR DISTRIBUTION enced by the amount of blood that the heart pumps, how The pharynx is a hollow chamber that is also part of much blood volume is in the circulatory system, and the the respiratory and digestive systems. It is divided into squeezing force of the smooth muscle in the blood vessel the nasopharynx, oropharynx, and laryngopharynx (see walls.© Jones Normal &blood Bartlett pressure Learning, (in adults) LLCis considered Figure 1–9).© Jones & Bartlett Learning, LLC to be less than 120/80 millimeters of mercury (mm Hg). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Larynx POINT TO REMEMBER Pulmonary and Systemic Circuits The larynx (voice The most sensitive areas of the Blood flows through the blood vessel network between box) is a cham- air passages are in the larynx, the heart and peripheral tissues. This network can be ber surrounded as well as in regions near the © Jones & subdividedBartlett Learning, into a pulmonary LLC circuit (which carries© Jonesby cartilage & Bartlett that Learning,branches LLC of the major bronchi. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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primarily functions to keep food and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,liquids out LLC of the airway. It also con- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONtains the vocal cords (see Figure 1–10). There are three types of cartilage that form the larynx: ■ Thyroid cartilage: The thyroid cartilage © Jones & Bartlett Learning, LLC © Jones &is Bartlettthe largest Learning, of the LLC three; it forms most of the ante- Nasal cavity NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Middle nasal concha rior and lateral laryngeal walls. ■ Cricoid cartilage: The cricoid Maxillary sinus cartilage is inferior to the thy- Inferior nasal concha roid cartilage; it also helps to Hard palate © Jones & Bartlett Learning, LLC © Jones & Bartlettprotect Learning,the glottis and LLC entrance to the trachea. Nasal septum Air movement NOT FOR SALE OR DISTRIBUTION NOT FOR SALE■ Epiglottis: OR DISTRIBUTION Shaped like a shoe- FIGURE 1–8 The nasal concha causes air to swirl as it passes through this cavity. horn, the epiglottis is cartilage that forms a lid over the glottis. During swallowing, the larynx is ele- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,vated, with LLC the epiglottis folding back over the glottis to prevent the entry NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONof either liquids or solid food into the respiratory tract.

Nasal cavity Trachea Middle nasal concha © Jones & Bartlett Learning, LLC The ©laryngeal Jones epithelium & Bartlett is continu-Learning, LLC Nasopharynx Inferior nasal concha NOT FOR SALE OR DISTRIBUTION ous withNOT the FOR trachea SALE (windpipe), OR DISTRIBUTION which Pharynx Oropharynx Hard palate is a tough, flexible tube about 1 inch in Laryngopharynx Tongue diameter. It contains 15 to 20 tracheal Epiglottis cartilages (see Figure 1–11). These Vocal cords serve to make the tracheal walls stiff, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Esophagus Larynx protecting the airway and preventing NOT FOR SALE OR DISTRIBUTION NOT FORit SALE from collapsing OR DISTRIBUTION or expanding too Trachea greatly when pressures change in the respiratory system. The tracheal cartilages are all C shaped, with the open part of the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,C facing posteriorlyLLC toward the esoph- NOT FOR SALEFIGURE 1–9OR The DISTRIBUTION upper respiratory tract. NOT FOR SALE OR DISTRIBUTIONagus. Because they are not continuous cartilages, the posterior wall of the Epiglottis trachea can distort easily when swal- Hyoid Epiglottis lowing, allowing large pieces of food to bone pass through the esophagus. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Ventricular fold NOT FORCuneiform SALE OR DISTRIBUTION(false vocal cord) NOT FOR SALE OR DISTRIBUTION cartilage Bronchial Tree Thyroid Thyroid cartilage cartilage Arytenoid The primary bronchi, along with their cartilage Vocal cord branches, form the bronchial tree. Cricoid Cricoid The left and right primary bronchi are cartilage© Jones & Bartlett Learning, LLC cartilage© Jones &located Bartlett outside Learning, the lungs, LLCso they are TrachealNOT FOR SALE OR DISTRIBUTION NOT FOR calledSALE extrapulmonary OR DISTRIBUTION bronchi. As the cartilages Tracheal cartilages primary bronchi enter into the lungs, they divide into smaller passageways Larynx Larynx known as secondary bronchi. In each (anterior view) (sagittal view) lung, one of the secondary bronchi © Jones & FIGUREBartlett 1–10 Learning, The larynx. LLC © Jones & Bartlett Learning,connects LLCto each lobe. It is important NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Trachea © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTAlveoli FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Primary bronchi Capillary Secondary network bronchi © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Terminal bronchiole FIGURE 1–11 The trachea conveys air from the larynx to the bronchi, which distribute air throughout the lungs. The bronchioles lead to the alveoli. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

to ©remember Jones that& Bartlett the right Learning, lung has three LLC secondary involved in© exchanging Jones & Bartlettoxygen and Learning, carbon dioxide LLC bronchi,NOT andFOR the SALEleft lung OR has onlyDISTRIBUTION two. between theNOT lungs FOR and SALE the external OR DISTRIBUTION environment. Because the epithelium is continuous from the nares Lungs to the alveoli, the lungs are actually considered part of The lungs are located in the thoracic cavity and have a the external environment. External respiration occurs soft, spongy structure in a cone-shaped form. The right between the alveoli of the lungs and the pulmonary capillaries. Internal respiration is the absorption of © Jones & andBartlett left lungs Learning, are separated LLC medially by the mediasti-© Jones & Bartlett Learning, LLC oxygen and the release of carbon dioxide by the cells of NOT FOR SALEnum, and OR they DISTRIBUTION are enclosed by the thoracic cage andNOT FOR SALE OR DISTRIBUTION the respiratory system. It occurs between the systemic diaphragm (see Figure 1–12). Each lung fills most of the thoracic space where capillaries and body tissues and cells. it is located. The lungs are suspended by a bronchus Breathing (ventilation), is the physical movement of and some large blood vessels, with a layer of serous air from the outside of the body into and out of the bronchial tree and alveoli. This air movement is provided by membrane (the visceral© Jones pleura &) Bartlett attached Learning,firmly to LLC © Jones & Bartlett Learning, LLC inspiration the surface of eachNOT lung. FOR This SALE pleura OR folds DISTRIBUTION back, actions collectively called NOT FOR (inhalation) SALE OR and DISTRIBUTION expiration (exhalation). becoming the parietal pleura, which also forms part of the mediastinum and lines the inner thoracic cavity walls. Respiratory Air Volumes and Capacities © Jones & Bartlett Learning, LLC There are four© Jones differ- & Bartlett Learning, LLC Breathing Mechanism NOT FOR SALE OR DISTRIBUTION ent respiratoryNOT vol-FOR SALEPOINT OR TO DISTRIBUTION REMEMBER The general term respi- umes as measured by POINT TO REMEMBER A person should never ration refers to the pro- using spirometry (see hyperventilate to help hold Sometimes a person who cesses of external and Figure 1–13). A respi- the breath while swimming is emotionally upset may internal respiration. ratory cycle consists because it is possible to lose © Jones hyperventilate,& Bartlett becomeLearning, dizzy, LLCExternal respiration© Jonesof one & Bartlettinspiration Learning, consciousness LLC under water and lose consciousness. and drown. NOT FOR SALE OR DISTRIBUTIONincludes the processesNOT and FOR its SALE subsequent OR DISTRIBUTION

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Nasal air passage Upper Pharynx airway © JonesMouth & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Oropharynx Larynx Epiglottis Trachea Apex of the lung Alveoli Lower airway © Jones & Bartlett Learning, LLC © Jones & BartlettBronchioles Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Carina Main bronchi

Base of the lung © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Diaphragm NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

LUNG VOLUME IN LITERS (L) VOLUME LUNG 1 e 0 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

a total lung capacity e expiratory reserve volume

b functional residual capacity f inspiratory reserve volume © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC c vital capacity g total volume NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION d residual volume h inspiratory capacity

FIGURE 1–13 Respiratory air volumes and capacities. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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expiration. The amount of air entering and leaving dur- and fear or pain usually increases the breathing rate. © Jones &ing Bartlett one respiratory Learning, cycle isLLC called the tidal volume. This© JonesBecause & theBartlett respiratory Learning, muscles are LLC voluntary, conscious NOT FOR SALEconsists ORof approximately DISTRIBUTION 500 mL of air. Nearly the sameNOT control FOR ofSALE breathing OR is DISTRIBUTIONalso possible. amount of air leaves during a normal, resting expiration and is known as resting tidal volume. Alveolar Gas Exchanges Air that is in addition to the resting tidal volume is Pulmonary ventilation ensures that the alveoli have known as inspiratory reserve volume (complemental © Jones & Bartlett Learning, LLCadequate oxygen supply. It also© Jonesremoves &carbon Bartlett dioxide Learning, LLC air) and totals about 3000 mL. The lungs can also expel from the bloodstream, and the gas exchanges occur about 1100 mL beyondNOT the FOR resting SALE tidal volume, OR DISTRIBUTION known NOT FOR SALE OR DISTRIBUTION between the blood and alveolar air across the respiratory as expiratory reserve volume (supplemental air). Even membranes (see Figure 1–15). after forceful expiration, about 1200 mL of air remains in the lungs, known as residual volume. When fresh air is inhaled© Jones into the & lungs, Bartlett it mixes Learning, with the air LLC already pres- © Jones & Bartlett Learning, LLC ent and prevents wide fluctuations between oxygen and Hypothalamus carbonNOT dioxide FOR concentrations. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The four respiratory capacities are as follows: Cerebrum ■ Vital capacity (4600 mL): a combination of the inspiratory reserve volume, the tidal volume, and © Jones & Bartlettthe expiratory Learning, reserve LLC volume © Jones & Bartlett Learning, LLC ■ Inspiratory capacity (3500 mL): a combination NOT FOR SALEof ORthe tidalDISTRIBUTION volume plus the inspiratory reserveNOT FOR SALE OR DISTRIBUTION

volume Cerebellum ■ Functional residual capacity (2300 mL): a combination of the expiratory reserve volume and the residual volume© Jones & Bartlett Learning, LLC Midbrain © Jones & Bartlett Learning, LLC ■ Total lung capacity (5800 mL): a combination of the Brain Pons NOT FOR SALE OR DISTRIBUTIONstem NOT FOR SALE OR DISTRIBUTION vital capacity plus the residual volume (total lung Medulla oblongata capacity varies with age, body size, and gender) Spinal cord

FIGURE 1–14 Cross-section of the brain. Control of Breathing The© brainstem Jones & regulates Bartlett the Learning, involuntary andLLC rhythmic © Jones & Bartlett Learning, LLC deliveryNOT andFOR removal SALE of OR oxygen DISTRIBUTION and carbon dioxide. NOT FOR SALE OR DISTRIBUTION Control of the respiratory centers comes from the medulla oblongata and the pons (see Figure © Jones & 1–14Bartlett). Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Factors That Affect Breathing Alveoli Factors that affect breath- of lung ing and the depth of ventilation include certain© body Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC chemicals, level of physicalNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION activity, emotional states, Alveoli of lung and the stretchability of O2 O2 the lung tissues. As car- Hemoglobin H H H bon dioxide accumulates H H © Jones & Bartlett Learning,H LLC H © JonesH & Bartlett Learning, LLC in the blood, it stimulates H H H H H H H breathingNOT FOR depth SALEand rate. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Capillary O Low blood oxygen has 2 O2 O O2 only small direct effects O2 2 Typical oxygen consumption on central chemoreceptors in systemic tissues Hypotic tissue in the respiratory system. (exercising muscle) © Jones & NormalBartlett breathing Learning, can be LLC © Jones & Bartlett Learning, LLC NOT FOR SALEaltered byOR emotional DISTRIBUTION upset, FIGURE 1–15 The relationshipNOT between FOR the partial SALE pressure OR of oxygenDISTRIBUTION and hemoglobin.

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Gas Transport transported as carbonic © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,POINT LLC TO REMEMBER Oxygen (O ) and carbon dioxide (CO ) are not read- acid molecules. Carbon NOT FOR SALE OR2 DISTRIBUTION 2 NOTdioxide FOR SALE is converted OR DISTRIBUTION to Exposure to high oxygen ily soluble in blood plasma. This situation of limited concentration for a prolonged solubility is a problem because peripheral tissues need carbonic acid through time may damage lung tissue, more oxygen than plasma can absorb and transport. The carbonic anhydrase particularly capillary walls. peripheral tissues also generate more carbon dioxide enzyme activity in the red than the plasma can ©absorb Jones and transport.& Bartlett Gases Learning, that are LLCblood cells. Carbonic acid molecules© Jones dissociate & Bartlett immedi- Learning, LLC dissolved are bound to hemoglobin (Hb) molecules. This ately into hydrogen and bicarbonate ions. This reaction NOT FOR SALE OR DISTRIBUTIONcan be summarized as follows:NOT FOR SALE OR DISTRIBUTION action forms oxyhemoglobin (HbO2). This reversible reaction is summarized as follows: – CO2 H2O H HCO3 Hb O2 HbO2 Approximately 23% of the carbon dioxide in the blood Aerobic© Jones metabolism & Bartlett generates Learning, carbon dioxide LLC in body is bound to© the Jones protein & Bartlettof the Hb Learning,molecules inside LLC tissues. When a CO molecule enters the bloodstream, the red blood cells. This compound is then called NOT FOR SALE2 OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION it is either converted to a carbonic acid molecule, bound carbaminohemoglobin. to the protein in hemoglobin molecules inside red blood Plasma becomes saturated with carbon dioxide. This cells, or dissolved in the blood plasma. These three reac- process is rapid. Approximately 7% of the carbon dioxide tions can be completed in reverse order. is absorbed by the peripheral capillaries and transported © Jones & BartlettMost of Learning,the carbon dioxide LLC that is absorbed in the© Jonesas dissolved & Bartlett molecules Learning, of gas. The LLCremainder is absorbed blood, which is almost 70% of the total amount, is by the red blood cells, where it is converted (via carbonic NOT FOR SALE OR DISTRIBUTION NOTanhydrase) FOR SALE or stored OR asDISTRIBUTION carbaminohemoglobin.

Overview of the Nervous System The nervous system is made up of the central nervous © Jones & Bartlett Learning, LLCsystem, which contains the brain© Jones and the spinal& Bartlett cord. The Learning, LLC NOT FOR SALE OR DISTRIBUTIONperipheral nervous system is NOTcomposed FOR of theSALE peripheral OR DISTRIBUTION nerves, which connect the central nervous system to the rest of the body. It also contains the autonomic nervous system, which utilizes autonomic neurotransmitters to function. See Figure 1–16 for a depiction of the central © Jones & Bartlett Learning, LLC and peripheral© Jones nervous systems,& Bartlett and also Learning, see Figure LLC1–17 NOT FOR SALE OR DISTRIBUTION for the majorNOT subdivisions FOR SALE of the nervous OR DISTRIBUTION system.

Nervous system

Somatic Autonomic nervous system nervous system (skeletal muscle effectors) (smooth muscle, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,cardiac muscle, LLC Central nervous and gland effectors) NOTsystem FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Peripheral nervous system Sympathetic Parasympathetic (fight or flight) (rest and digest) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC FIGURE 1–16 The nervous system can be divided into the central NOT FOR SALEnervous system OR DISTRIBUTIONand peripheral nervous system. NOTFIGURE FOR 1–17SALE Major OR subdivisions DISTRIBUTION of the nervous system.

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Central Nervous System covered with elevated ridges (gyri) separated by grooves © Jones & Bartlett Learning, LLC © Jonescalled &sulci Bartlett and fissures. Learning, The cerebrum LLC contains many NOT FOR SALEThe central OR nervousDISTRIBUTION system (CNS) is made up of theNOT FOR SALE OR DISTRIBUTION brain and the spinal cord. It functions by utilizing sen- neurons required for analytical functions. Each cerebral sory receptors that detect changes both inside and out- hemisphere is divided into five lobes. side the body. These receptors transmit impulses over The cerebrum is categorized into three functional areas: peripheral nerves to the CNS. Nervous tissue consists of motor, sensory, and association. The motor areas are masses of nerve cells© (neurons), Jones &which Bartlett are the Learning,structural LLClocated within the frontal ©lobes. Jones The &sensory Bartlett areas Learning, LLC are located within the parietal, temporal, and occipi- and functional unitsNOT of the FORnervous SALE system. OR They DISTRIBUTION trans- NOT FOR SALE OR DISTRIBUTION mit information as nerve impulses to other neurons and tal lobes. The association areas are located throughout also to cells that are outside of the nervous system. various lobes. Nerves are bundles of axons. An axon is an extension Diencephalon from a neuron’s cell body that sends out nerve impulses. The diencephalon is located between the inferior regions Another© Jones type of& extension,Bartlett theLearning, dendrite, receivesLLC elec- of the two cer©ebral Jones hemispheres. & Bartlett It contains Learning, the epithala- LLC trochemicalNOT FOR messages. SALE The OR junction DISTRIBUTION between any two mus, thalamus,NOT and FOR hypothalamus. SALE OR TheDISTRIBUTION epithalamus neurons is called a synapse. Synaptic transmission is contains the pineal gland, which is important for the accomplished by biochemicals known as neurotransmit- regulation of the body’s day and night cycles. The thala- ters, which may be either excitatory (increasing the chance mus is the main point of processing sensory information. that a nerve impulse will occur) or inhibitory (decreasing The hypothalamus is attached to the pituitary gland by © Jones & theBartlett chance thatLearning, a nerve impulse LLC will occur). Nerves that© Jonesa thin & funnel-like Bartlett stalkLearning, called the LLC infundibulum. The NOT FOR SALEconduct OR impulses DISTRIBUTION to the brain or spinal cord are calledNOT hypothalamus FOR SALE controls OR DISTRIBUTION the autonomic nervous system, sensory nerves, and those that carry impulses to muscles endocrine system, body temperature, emotions, eating, or glands are called motor nerves. Most nerves have both drinking, and sleeping. types of fibers and are called mixed nerves. Brainstem The brainstem Brain © Jones & Bartlett Learning, LLC POINT© Jones TO REMEMBER & Bartlett Learning, LLC helps to connect The brain receives andNOT processes FOR largeSALE amounts OR DISTRIBUTIONof infor- the cerebellum InjuriesNOT to theFOR respiratory SALE center OR DISTRIBUTION mation. The 100 billion neurons of the brain control to the spinal cord or to spinal nerve tracts that many activities simultaneously. The brain is divided into transmit motor impulses may and is divided into paralyze the breathing muscles. four major portions: cerebrum, diencephalon, brainstem, three regions: mes- and cerebellum (see Figure 1–18). The brain can respond © Jones & Bartlett Learning, LLC encephalon,© pons, Jones and & medulla Bartlett oblongata. Learning, The brain- LLC to various stimuli in many diverse ways. stem houses the nuclei of many of the cranial nerves and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Cerebrum contains many critical autonomic and reflex centers. The The cerebrum is made up of the two large hemispheres mesencephalon is also known as the midbrain. It con- of the brain. It is the center of conscious thought, sen- tains cranial nerves, motor tracts, axons, sensory nuclei, sory perception, memory, and motor activities. Its outer and other important structures. The pons bulges out on the anterior brainstem and © Jones & layerBartlett is known Learning, as gray matter LLC (the cerebral cortex), and© Jones & Bartlett Learning, LLC its inner layer is known as white matter. Its surface is houses sensory and motor tracts connecting the brain NOT FOR SALE OR DISTRIBUTION NOTand FOR spinal SALE cord. OR The DISTRIBUTIONmedulla oblongata is continuous with the spinal cord and even resembles it. All commu- Hypothalamus nication between the brain and spinal cord flows through the medulla oblongata. The most important autonomic centers of the medulla oblongata regulate the heart, © Jones & Bartlett Learning,Cerebrum LLCblood pressure, and breathing.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Cerebellum The cerebellum is the second largest section of the brain. Similar to the cerebrum, it also consists of two hemispheres primarily composed of white matter, with a thin © Jones & Bartlett Learning, LLCCerebellum gray matter© layer Jones on its &surface. Bartlett The cerebellumLearning, controls LLC NOT FOR SALE OR DISTRIBUTION skeletal muscleNOT movements FOR SALE and contractionsOR DISTRIBUTION to control equilibrium and posture. It is important in keeping the Midbrain skeletal muscle activity fine-tuned so that the body has Brain Pons stem correct and adequate muscle tone and strength. Medulla oblongata The cerebellum interacts with the CNS via three Spinal cord © Jones & Bartlett Learning, LLC © Jonespaired & nerve Bartlett tracts calledLearning, the cerebellar LLC peduncles. It is NOT FOR SALEFIGURE 1–18OR MajorDISTRIBUTION portions of the brain. NOTbasically FOR SALE a reflex OR center DISTRIBUTION concerned with body position.

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When damaged, the results often include tremors, the spinal cord allow two-way communication between © Jones &impaired Bartlett muscle Learning, control, LLCimbalance, and reduced mus-© Jonesthe brain & Bartlett and body Learning,parts. The ascending LLC tracts of the NOT FOR SALEcle tone. OR DISTRIBUTION NOTspinal FOR cord SALE carry OR sensory DISTRIBUTION information to the brain, and the descending tracts conduct motor impulses from the Spinal Cord brain to the muscles and glands. The spinal cord occupies the vertebral canal inside the vertebral column. Between© Jones the bony& Bartlett coverings Learning, and soft LLCPeripheral Nervous System© Jones & Bartlett Learning, LLC tissues of the CNS, layeredNOT FORmembranes SALE called OR meninges DISTRIBUTION The peripheral nervous systemNOT (PNS) FOR contains SALE the OR cra- DISTRIBUTION are found. Meninges have three layers: dura mater, arach- nial and spinal nerves, which branch out from the CNS. noid mater, and pia mater. The dura mater is attached to These nerves connect to the rest of the body. The PNS the cranial cavity and continues into the vertebral canal. is divided into the somatic and autonomic nervous sys- The arachnoid mater is a weblike membrane between the tems. The somatic nervous system oversees conscious dura© andJones pia maters. & Bartlett The pia Learning, mater contains LLC nerves and activities and© Jonesactions of & the Bartlett skin and Learning, skeletal muscles. LLC bloodNOT vessels FOR that SALE are important OR DISTRIBUTION for nourishing brain and The autonomicNOT nervous FOR systemSALE oversees OR DISTRIBUTION the actions of spinal cells. Between the arachnoid and pia maters is the the heart, stomach, intestines, and other viscera. It con- subarachnoid space, which contains the clear and watery trols unconscious activities. cerebrospinal fluid (CSF). The spinal cord itself is a slender column of nerves Cranial Nerves that passes from the brain into the vertebral canal. It © Jones & Bartlett Learning, LLC © JonesThere &are Bartlett 12 pairs of Learning, cranial nerves LLC that extend from the begins where nervous tissue exits the cranial cavity, and NOT FOR SALE OR DISTRIBUTION NOTunderside FOR SALE of the OR brain, DISTRIBUTION all of which (except for the first it ends near the intervertebral disc that separates the first pair) originate in the brainstem. These nerves lead to and second lumbar vertebrae. The spinal cord has 31 seg- various areas of the head, neck, and trunk. Table 1–2 lists ments that each have a pair of spinal nerves attached. It is the 12 pairs of cranial nerves. divided by two grooves that separate the cord into right and left halves. Gray© matterJones divides & Bartlett the spinal Learning, cord’s LLC © Jones & Bartlett Learning, LLC Spinal Nerves white matter into anterior,NOT lateral,FOR SALEand posterior OR DISTRIBUTION funiculi NOT FOR SALE OR DISTRIBUTION regions, which contain bundled nerve fibers. The 31 pairs of spinal nerves are grouped by the level of The spinal cord functions primarily to conduct nerve the spinal cord from which they arise. In general, they impulses and control spinal reflexes. The axons inside are associated with their respective spinal vertebrae.

I Olfactory Sensory (smell)

II Optic Sensory (vision) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC III Oculomotor Primarily motor (eye muscles) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION IV Trochlear Primarily motor (eye muscles)

V Trigeminal Mixed (eyes, tear glands, scalp, forehead, upper eyelids, teeth, gums, (ophthalmic, maxillary, mandibular) lips, palate, face, jaw)

VIINOT Facial FOR SALE OR DISTRIBUTION Mixed (taste and tongue, expression, tearNOT glands, FORsalivary glands)SALE OR DISTRIBUTION

VIII Vestibulocochlear Sensory (equilibrium, hearing)

IX Glossopharyngeal Mixed (pharynx, tonsils, tongue, carotid arteries, swallowing, salivary glands) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC XNOT FOR SALE Vagus OR DISTRIBUTION Mixed (speech, swallowing,NOT transmissionFOR SALE of impulses OR toDISTRIBUTION heart, smooth muscles, thoracic glands, abdominal glands; also impulses from pharynx, larynx, esophagus, and viscera)

XI Accessory Primarily motor (soft palate, pharynx, larynx, neck, back) (cranial and spinal) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC XII Hypoglossal Primarily motor (muscles that move the tongue) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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There are 8 pairs of cervical nerves, 12 pairs of thoracic Sympathetic Division © Jones &nerves, Bartlett 5 pairs Learning, of lumbar nerves,LLC 5 pairs of sacral nerves,© Jones & Bartlett Learning, LLC NOTThe FOR sympathetic SALE OR division DISTRIBUTION prepares the body for emer- NOT FOR SALEand 1 pair OR of DISTRIBUTION coccygeal nerves. Except for the thoracic gencies, hence its fight-or-flight name. The pregan- region, the main portions of spinal nerves form complex glionic fibers originate from the neurons of the spinal networks (plexuses), wherein nerve fibers are sorted cord (see Figure 1–19). Increased sympathetic activity and recombined. This allows them to innervate certain causes increased alertness and metabolism. When this peripheral body parts© evenJones though & Bartlett they originate Learning, from LLCsystem causes innervation, all© of Jones its components & Bartlett become Learning, LLC different spinal nerves. NOT FOR SALE OR DISTRIBUTIONstimulated. NOT FOR SALE OR DISTRIBUTION Autonomic Nervous System Autonomic Neurotransmitters The autonomic nervous system (ANS) governs involun- The sympathetic and parasympathetic divisions tary actions and works with the somatic nervous system secrete the neurotransmitter known as acetylcholine to regulate© Jones body & organsBartlett and Learning,functions. Both LLC are part of from their ©preganglionic Jones & Bartlett fibers (cholinergic Learning, fibers). LLC theNOT central FOR as well SALE as the peripheral OR DISTRIBUTION nervous systems. The Most sympatheticNOT FOR postganglionic SALE OR neuronsDISTRIBUTION secrete ANS functions mostly unconsciously, such as the stom- norepinephrine (noradrenaline), so they are also called ach’s process of digestion or the blood vessels’ processes adrenergic fibers. Most body organs are innervated by of coordinating blood pressure. It is activated by visceral the actions of these various autonomic neurotransmit- sensory neurons. The ANS is subdivided into the para- ters. The sympathetic and parasympathetic nervous © Jones & sympatheticBartlett Learning, and sympathetic LLC divisions, which focus on© Jonessystems & useBartlett these neurotransmitters Learning, LLC to achieve oppos- NOT FOR SALEthe control OR of DISTRIBUTION the body’s internal environment. NOTing FOR actions. SALE OR DISTRIBUTION Other neurotransmitters released from the brain Parasympathetic Division include dopamine, serotonin, and gamma-aminobutyric The parasympathetic division arises from the brainstem acid (GABA). However, their actions may not be directly and the sacral region of the spinal cord (see Figure 1–19). opposed to one another (antagonistic). Table 1–3 explains It conserves energy and© Jones replaces & nutrients, Bartlett so Learning,it is called LLCthe opposing actions of the sympathetic© Jones and& Bartlett parasympa- Learning, LLC the rest-and-digest division.NOT FOR It helps SALE to maintain OR DISTRIBUTION homeo- thetic nervous system neurotransmitters.NOT FOR SALE OR DISTRIBUTION stasis in the body. Its preganglionic axons are longer, and the relatively short postganglionic fibers continue from Patient Education the ganglia to specific muscles or glands within the vis- Respiratory therapists should be familiar with the cera. Only one or a few structures become innervated by structures and functions of the cardiovascular sys- this© system Jones at the& Bartlettsame time. Learning, LLC tem. They ©should Jones advise & Bartlett patients whoLearning, are suffering LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

■ TABLE 1–3 Opposing Neurotransmitter Actions

Body structure or function Sympathetic Parasympathetic © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEEye pupils OR DISTRIBUTIONDilation NOT FOR SALEConstriction OR DISTRIBUTION Tear glands No action Secretion

Salivary glands Decreased secretion Increased secretion

Lung bronchioles Dilation Constriction © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Heart rate NOT FORIncreased SALE OR DISTRIBUTION Decreased NOT FOR SALE OR DISTRIBUTION Blood distribution Increased to skeletal muscles, decreased to Decreased to skeletal muscles, increased to digestive digestive organs organs

Blood glucose Increased Decreased

Intestinal© Jones wall muscles & Bartlett Learning,Peristalsis decreased LLC Peristalsis© Jones increased & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Intestinal glands Secretion decreased Secretion increased

Gallbladder muscles Relaxed Contracted

Urinary bladder muscles Relaxed Contracted © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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from congestive heart failure to restrict their intake of the atria and ventricles. It contains cardiac muscle © Jones &sodium, Bartlett lose Learning, weight, avoid LLC smoking, and see their phy-© Jones &tissue, Bartlett nerves, Learning, and blood vessels. LLC The epicardium NOT FOR SALEsician on OR a regular DISTRIBUTION basis. Respiratory therapists shouldNOT FOR isSALE the layer OR that DISTRIBUTION covers the heart’s outer surface. also instruct patients to take their medications exactly 3. The cardiac cycle is the period between the start as prescribed. of one heartbeat and the start of the next heartbeat. Atrial contraction regulates the heart cham- SUMMARY © Jones & Bartlett Learning, LLC bers in an action known© Jones as atrial &systole. Bartlett During Learning, LLC this action, the ventricles relax (called ventricular The heart pumps nearly 8000 liters of blood per day, yet NOT FOR SALE OR DISTRIBUTIONdiastole). Next, the ventriclesNOT FOR contract SALE (ventricu- OR DISTRIBUTION is only about the size of an adult’s clenched fist. It con- lar systole) while the atria relax (atrial diastole). sists of two hollow atria and two hollow ventricles. When Finally, both the atria and ventricles relax for a the heart beats, the atria contract first, followed by the brief interval. ventricles. Special valves in the heart control blood flow Blood pressure is defined as the force that the and© keep Jones it from & flowing Bartlett back Learning, into areas where LLC it should © Jones & Bartlett Learning, LLC blood exerts against the walls of the blood ves- not flow. The heart valves include the mitral (bicuspid), NOT FOR SALE OR DISTRIBUTION sels.NOT It is influenced FOR SALE by the OR amount DISTRIBUTION of blood that aortic, tricuspid, and pulmonary valves. The heart wall the heart pumps, how much blood volume is in is made up of three distinct layers: endocardium, myo- the circulatory system, and the squeezing force cardium, and epicardium. The heart requires electrical of the smooth muscle in the blood vessel walls. impulses to maintain a heartbeat. These impulses may Normal blood pressure (in adults) is considered © Jones & beBartlett charted Learning,on a graph known LLC as an electrocardiogram© Jones & Bartlett Learning, LLC to be 120/80 millimeters of mercury (mm Hg). (ECG or EKG). NOT FOR SALE OR DISTRIBUTION NOT FOR4. TheSALE blood OR vessels DISTRIBUTION include arteries, arterioles, The cardiopulmonary vessels include arteries, arte- capillaries, venules, and veins. They are defined rioles, capillaries, venules, and veins. Blood pressure is as follows: defined as the force that the blood exerts against the An artery is a blood vessel that carries blood walls of the blood vessels. The organs of the respiratory • away from the heart and toward peripheral system include the upper© Jones respiratory & Bartlett tract (nose, Learning, nasal LLC © Jones & Bartlett Learning, LLC capillaries. cavity, paranasal sinuses, and pharynx) and the lower NOT FOR SALE OR DISTRIBUTION An arteriole is aNOT smaller FOR blood SALE vessel OR that DISTRIBUTION respiratory tract (larynx, trachea, bronchial tree, and • works with the arteries to carry blood to the lungs). The pharynx is also part of the digestive system capillaries. because food and liquids pass through it. The lungs are A capillary is the smallest type of blood ves- the primary organs of respiration, and the processes of • sel in the cardiovascular system. Capillaries inspiration© Jones and & exhalation Bartlett are Learning, controlled LLCby the brain- © Jones & Bartlett Learning, LLC allow the blood to distribute oxygen and stem, primarily the medulla oblongata and pons. How- NOT FOR SALE OR DISTRIBUTION NOTnutrients FOR to SALEindividual OR cells DISTRIBUTION while picking ever, because the respiratory muscles are voluntary, up carbon dioxide and waste products from conscious control of breathing is also possible. these cells. Blood is passed from the arteri- The central nervous system (CNS) is made up of the oles to the capillaries, eventually moving on brain and spinal cord. The four major parts of the brain to the venules. are the cerebrum, diencephalon, brainstem, and cerebel- © Jones & Bartlett Learning, LLC © Jones & BartlettA venule Learning, is a small blood LLC vessel that passes lum. The spinal cord is a slender column of nerves that • NOT FOR SALE OR DISTRIBUTION NOT FOR SALEblood OR from DISTRIBUTION the capillaries to the veins. passes from the brain through the vertebral canal. The Venules are smaller than veins and perform peripheral nervous system (PNS) contains the cranial the reverse function of the arterioles. and spinal nerves. The autonomic nervous system (ANS) A vein is a blood vessel that carries blood governs involuntary actions to stimulate or inhibit the • back to the heart. Except for the pulmonary activity of the visceral organs. It consists of the sympa- © Jones & Bartlett Learning, LLC vein, all veins carry© Jones blood &that Bartlett is oxygen Learning, LLC thetic and parasympathetic nervous systems. NOT FOR SALE OR DISTRIBUTION depleted and darkerNOT in FOR color SALEthan that OR of DISTRIBUTION oxygenated arterial blood. Veins are more LEARNING GOALS numerous than arteries and hold a greater These learning goals correspond to the objectives at the volume of blood. They contain valves that beginning of the chapter, providing a clear summary of prevent blood from flowing backward. the© chapter’s Jones most & Bartlett important Learning, points. LLC ©Vein Jones walls &are Bartlett thinner Learning,than the walls LLC of NOT1. The FOR structures SALE ofOR the DISTRIBUTION cardiovascular system NOTcorresponding FOR SALE arteries OR because DISTRIBUTION the blood include the heart (including its chambers, valves, pressure in the veins is lower than the and wall) and the blood vessels. blood pressure in the arteries. Large veins 2. The heart’s inner surfaces (including the heart include the superior and inferior venae valves) are covered by the endocardium. The cavae, which carry less-oxygenated blood © Jones & Bartlettmyocardium Learning, (the muscularLLC heart wall) forms both© Jones & Bartlettinto the Learning,right atrium. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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5. The respiratory system furnishes oxygen for physical movement of air from the outside of © Jones & Bartlettindividual Learning, tissue ceLLClls and takes away their gas-© Jones &the Bartlett body into Learning, and out of theLLC bronchial tree and NOT FOR SALE eousOR wasteDISTRIBUTION products. Through the act of res-NOT FOR alveoli.SALE This OR air DISTRIBUTION movement is provided by actions piration, consisting of external and internal collectively called inspiration (inhalation) and processes, this process is accomplished. Exter- expiration (exhalation). nal respiration is the method in which the lungs 9. The four main parts of the brain and their func- are ventilated,© Jonesand oxygen & Bartlettand carbon Learning, dioxide LLC tions are as follows: © Jones & Bartlett Learning, LLC are exchanged between the air in the alveoli of • Cerebrum: The cerebrum is the center of con- the lungs andNOT the blood FOR in SALE the pulmonary OR DISTRIBUTION capil- scious thought, sensoryNOT perception,FOR SALE memory, OR DISTRIBUTION laries. Internal respiration occurs when oxygen and motor activities; it contains many neu- and carbon dioxide are exchanged between the rons required for analytical functions. There blood in systemic capillaries and the body’s tis- are three functional areas: motor, sensory, © Jonessues and & cells. Bartlett Learning, LLC ©and Jones association. & Bartlett Learning, LLC 6. The locations of the respiratory system organs • Diencephalon: The diencephalon contains NOTare FOR in the SALEupper respiratory OR DISTRIBUTION tract (nose, nasal cav- NOTthe pineal FOR gland, SALE which OR is importantDISTRIBUTION for the ity, and paranasal sinuses in the skull; and phar- regulation of the body’s day and night cycles. ynx in the neck) and the lower respiratory tract Another structure, the thalamus, is the main (larynx and trachea in the neck; and bronchial point of processing sensory information. The © Jones & Bartletttree Learning,and lungs in theLLC thoracic cavity). © Jones & Bartlettpart of the Learning, thalamus known LLC as the hypothala- 7. The nose is the main passage that allows air to mus controls the autonomic nervous system, NOT FOR SALE enterOR DISTRIBUTIONthe respiratory system. Air moves throughNOT FOR SALEendocrine OR DISTRIBUTION system, body temperature, emo- the two external nares (nostrils), which open into tions, eating, drinking, and sleeping. the nasal cavity. The pharynx is a hollow chamber • Brainstem: The brainstem is divided into that is also part of the respiratory and digestive three regions: mesencephalon (midbrain), systems. It is© divided Jones into & the Bartlett nasopharynx, Learning, oro- LLC pons, and medulla© Jones oblongata. & Bartlett It contains Learning, LLC pharynx, and laryngopharynx. The larynx (voice many critical autonomic and reflex centers. box) is a chamberNOT surroundedFOR SALE by ORcartilage DISTRIBUTION that All communicationNOT between FOR theSALE brain OR and DISTRIBUTION primarily functions to keep food and liquids out spinal cord flows through the medulla oblon- of the airway. It also contains the vocal cords. gata, and its most important autonomic During swallowing, the larynx is elevated, with centers regulate the heart, blood pressure, © Jonesthe epiglottis & Bartlett folding backLearning, over the LLCglottis to pre- ©and Jones breathing. & Bartlett Learning, LLC vent the entry of either liquids or solid food into • Cerebellum: The cerebellum controls skel- NOTthe FOR respiratory SALE tract. OR The DISTRIBUTION laryngeal epithelium is NOTetal muscle FOR movementsSALE OR andDISTRIBUTION contractions continuous with the trachea (windpipe), which is to control equilibrium and posture, and it a tough, flexible tube about 1 inch in diameter. It is important in keeping the skeletal muscle contains 15 to 20 tracheal cartilages. These serve activity fine-tuned so the body has correct to make the tracheal walls stiff and protect the and adequate muscle tone and strength. © Jones & Bartlettairway, Learning, as well as LLC preventing it from collapsing© Jones10. &The Bartlett cardiopulmonary Learning, system LLC is affected by the NOT FOR SALE orOR expanding DISTRIBUTION too greatly when pressures changeNOT FOR parasSALEympathetic OR DISTRIBUTION and sympathetic nervous sys- in the respiratory system. The primary bronchi, tems as follows: along with their branches, form the bronchial • Parasympathetic: The parasympathetic ner- tree. The right lung has three secondary bronchi, vous system conserves energy and replaces and the left lung has only two. The lungs are nutrients; therefore it is called the rest-and- located in the© thoracic Jones cavity, & Bartlett with a soft, Learning, spongy LLC digest division. It© helps Jones to main & homeostasisBartlett Learning, LLC structure in aNOT cone-shaped FOR SALE form. TheOR right DISTRIBUTION and in the body. NOT FOR SALE OR DISTRIBUTION left lungs are separated medially by the medias- • Sympathetic: The sympathetic nervous sys- tinum and are enclosed by the thoracic cage and tem prepares the body for emergencies, diaphragm. hence its fight-or-flight name. Increased 8. The general term respiration refers to the pro- sympathetic activity causes increased alert- © Jonescesses of& external Bartlett and Learning, internal respiration. LLC Exter- ©ness Jones and metabolism. & Bartlett Learning, LLC NOTnal FOR respiration SALE includes OR DISTRIBUTION the processes involved in NOT FOR SALE OR DISTRIBUTION exchanging oxygen and carbon dioxide between the lungs and the external environment. Inter- CRITICAL THINKING QUESTIONS nal respiration is the absorption of oxygen and 1. Cigarette smoke contains thousands of chemicals, the release of carbon dioxide by the cells of the including nicotine and carbon monoxide. Nicotine © Jones & Bartlettrespiratory Learning, system. LLC Breathing (ventilation) is the© Jonesconstricts & Bartlett blood Learning, vessels. Carbon LLC monoxide prevents NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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oxygen from binding to hemoglobin. How do these 5. Which of the following is not a function of the © Jones & Bartletttwo components Learning, of smoke LLC affect the cardiovascular© Jones &sympathetic Bartlett Learning,division of the LLC autonomic nervous NOT FOR SALEsystem? OR DISTRIBUTION NOT FOR system?SALE OR DISTRIBUTION 2. If a tracheostomy bypasses the upper respiratory A. It increases the heart rate and breathing rate. passages, how might the air entering the trachea B. It prepares the body for an emergency. differ from air normally passing through this tube? C. It increases digestive system motility and What problems ©might Jones this cause & Bartlett for the patient? Learning, LLC activity. © Jones & Bartlett Learning, LLC D. It dilates the pupils. WEB SITES NOT FOR SALE OR DISTRIBUTION6. Which of the followingNOT is not FOR part ofSALE the respira- OR DISTRIBUTION http://hes.ucfsd.org/gclaypo/repiratorysys.html tory system? A. larynx http://science.nationalgeographic.com/science/health- B. pharynx and-human-body/human-body/lungs-article.html C. thoracic duct http://users.rcn.com/jkimball.ma.ultranet/© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC D. bronchi BiologyPages/C/CNS.html NOT FOR SALE OR DISTRIBUTION 7. WhichNOT of theFOR following SALE is OR aDISTRIBUTION function of the http://www.americanheart.org/presenter not hypothalamus? .jhtml?identifier=4463 A. It regulates the sleep–wake cycle. http://www.cardiovascularcs.org/ B. It controls the autonomic nervous system. http://www.cvphysiology.com/Heart%20Disease/ C. It initiates voluntary skeletal muscle © Jones & BartlettHD002.htm Learning, LLC © Jones & Bartlett Learning, LLC movement. http://www.daviddarling.info/encyclopedia/B/ NOT FOR SALE OR DISTRIBUTION NOT FOR D.SALE It controls OR DISTRIBUTION the endocrine system. bronchial_tree.html 8. Which valve is located between the left atrium http://www.fi.edu/learn/heart/structure/structure.html and left ventricle? http://www.tutorvista.com/content/biology/biology-ii/ A. bicuspid valve respiration/breathing-mechanism.php © Jones & Bartlett Learning, LLC B. tricuspid valve © Jones & Bartlett Learning, LLC C. REVIEW QUESTIONS aortic valve NOT FOR SALE OR DISTRIBUTIOND. pulmonary valve NOT FOR SALE OR DISTRIBUTION Multiple Choice 9. The heart’s pacemaker is located in the Select the best response to each question. A. right ventricle 1. Breathing is regulated by the B. right atrium © JonesA. thalamus & Bartlett Learning, LLC C. ©left Jones ventricle & Bartlett Learning, LLC D. left atrium NOTB. FOR cerebellum SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION C. hypothalamus 10. Which structure contains some autonomic cen- D. pons ters involved in regulating respiration? 2. The artery that carries deoxygenated blood from A. pons the heart to the lungs is the B. cerebellum C. thalamus © Jones & BartlettA. coronaryLearning, artery LLC © Jones & Bartlett Learning, LLC B. D. cerebrum NOT FOR SALE ORrenal DISTRIBUTION artery NOT FOR SALE OR DISTRIBUTION C. pulmonary artery 11. Which part of the pleura is attached to the lung D. aorta surface? 3. Which part of the heart receives oxygenated A. parietal blood from the pulmonary veins? B. apical A. right atrium C. visceral © Jones & Bartlett Learning, LLC D. mediastinum © Jones & Bartlett Learning, LLC B. left atriumNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION C. right ventricle 12. Which of the following keeps the airways of the D. left ventricle trachea open? 4. Where in the lung does the exchange of gases A. ciliated epithelium take place? B. surfactant A. trachea C. smooth muscle © Jones & Bartlett Learning, LLC D. ©cartilage Jones & Bartlett Learning, LLC NOTB. FOR alveoli SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION C. bronchioles D. larynx

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13. Which of the following large vessels drains low- CASE STUDY © Jones & Bartlettoxygen Learning, blood from LLC the majority of the lower body© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTIn FOR 1799, SALE a 67-year-old OR DISTRIBUTION man had flulike symptoms for into the right atrium? a few days during the winter. He began having trouble A. hepatic vein breathing and swallowing, and his voice became muf- B. inferior vena cava fled. His doctors tried a variety of therapies that were C. superior vena cava popular, including bleeding and using beetles to bite D. azygos vein© Jones & Bartlett Learning, LLChis legs to produce blisters.© One Jones of the & doctorsBartlett sug- Learning, LLC 14. Which of the following is a part of both the respi- NOT FOR SALE OR DISTRIBUTIONgested a tracheostomy so theNOT patient FOR could SALE breathe, OR DISTRIBUTION ratory and digestive systems and allows the pas- but the other doctors said it would not help. The man sage of food, drink, and air? later died with no improvement in his condition. If a A. nasopharynx tracheostomy had been performed, would it likely have B. trachea saved his life? C. © Jonesoropharynx & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC D. glottis 15.NOT In FORthe respiratory SALE ORsystem, DISTRIBUTION which of the following NOT FOR SALE OR DISTRIBUTION is the last and smallest conducting portion? A. terminal bronchiole B. respiratory bronchiole C. © Jones & Bartlett nasopharynxLearning, LLC © Jones & Bartlett Learning, LLC D. alveolus NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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