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MEDICAL and SURGICAL NURSING Respiratory System Lecturer: Mark Medical and Surgical Nursing Respiratory System Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN MEDICAL AND SURGICAL NURSING Respiratory System Lecturer: Mark Fredderick R. Abejo RN,MAN MS 1 Abejo Medical and Surgical Nursing Respiratory System Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN ANATOMY OF RESPIRATORY SYSTEM 2. Bronchi . Lobar Bronchi: 3 R and 2 L . Segmental Bronchi: 10 R and 8 L . Subsegmental Bronchi OXYGENATON: the dynamic interaction of gases in the body for 3. Bronchioles the purpose of delivering adequate oxygen essential for cellular . Terminal Bronchioles survival . Respiratory Bronchioles, considered to be the transitional passageways between the RESPIRATORY SYSTEM MAIN FUNCTION: conducting airways and the gas exchange GAS EXCHANGE 4. Alveoli - functional cellular units or gas-exchange I. Upper Respiratory Tract units of the lungs. A. Functions - O2 and CO2 exchange takes place 1. Filtering - Made up of about 300 million 2. Warming and moistening TYPE 1 - provide structure to the alveoli 3. Humidification TYPE 2 - secrete SURFACTANT, reduces surface B. Parts tension; increases alveoli stability & prevents their 1. Nose - made up of framework of cartilages; divided collapse into R and L by the nasal septum. TYPE 3 – alveolar cell macrophages, destroys 2. Paranasal Sinuses – includes four pair of bony foreign material, such as bacteria cavities that are lined with nasal mucosa and ciliated epithelium. Lecithin 3. Tubernate Bones ( Conchae ) . Sphingomyelin 4. Pharynx – muscular passageway for both food and L/S ratio indicates lung maturity air 2:1 normal . Nasopharynx 1:2 immature lungs . Oropharynx . Laryngopharynx PULMONARY CIRCULATION 5. Tonsils and Adenoids - Provides for reoxygenation of blood and release of CO2 6. Larynx – voice production, coughing reflex PULMONARY ARTERIES, carry blood from Made up of framework of: the heart to the lungs. Epiglottis – valve that covers the opening to the larynx during swallowing. PULMONARY VEINS, is a large blood vessel Glottis – opening between the vocal cords of the circulatory system that carries blood Hyoid bone – u shaped bone in neck from the lungs to the left atrium of the heart. Cricoid cartilage Thyroid cartilage, forms the Adam’s apple Arythenoid cartilage Speech production and cough reflex Vocal cords 7. Trachea - consists of cartilaginous rings . Passageway of air . Site of tracheostomy (4th-6th tracheal ring) II. Lower respiratory tract A. Function: facilitates gas exchange B. Parts 1. Lungs, are paired elastic structure enclosed in the thoracic cage, which is an airtight chamber with distensible walls. Right – 3 lobes, 10 segments . Left – 2 lobes, 8 segments Client post pneumonectomy affected side to promote expansion Post lobectomy unaffected side to promote drainage RESPIRATORY MUSCLES . Pleural cavity - PRIMARY: diaphragm and external intercostal muscles Parietal Visceral - ACCESORY: sternocleidomastoid (elevated sternum), Pleural Fluid: prevents pleural friction rub the scalene muscles (anterior, middle and posterior (as seen in pneumonia and pleural effusion) scalene) and the nasal alae MS 2 Abejo Medical and Surgical Nursing Respiratory System Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN • Exchange of gases occurs because of differences in partial pressures. PHYSIOLOGY OF RESPIRATORY SYSTEM • Oxygen diffuses from the air into the blood at the alveoli to be transported to the cells of the body. • Carbon dioxide diffuses from the blood into the air at the VENTILATION: The movement of air in and out of the airways. alveoli to be removed from the body. • The thoracic cavity is an air tight chamber. the floor of NEUROCHEMICAL CONTROL this chamber is the diaphragm. MEDULLA OBLONGATA – respiratory center • Inspiration: contraction of the diaphragm (movement of initiates each breath by sending messages to primary this chamber floor downward) and contraction of the respiratory muscles over the phrenic nerve external intercostal muscles increases the space in this - has inspiration and expiration centers chamber. lowered intrathoracic pressure causes air to enter through the airways and inflate the lungs. PONS – has 2 respiration centers that work with the • Expiration: with relaxation, the diaphragm moves up and inspiration center to produce normal rate of breathing intrathoracic pressure increases. this increased pressure 1. PNEUMOTAXIC CENTER – affects the inspiratory pushes air out of the lungs. expiration requires the elastic effort by limiting the volume of air inspired recoil of the lungs. 2. APNEUSTIC CENTER – prolongs inhalation • Inspiration normally is 1/3 of the respiratory cycle and expiration is 2/3. NOTE: Chemoreceptors responds to changes in ph, increased PaCO2 = increase RR DRIVING FORCE FOR AIR FLOW Airflow driven by the pressure difference between RESPIRATORY EXAMINATION AND atmosphere (barometric pressure) and inside the lungs (intrapulmonary pressure). ASSESSMENT Background information A. Abnormal patterns of breathing 1. Sleep Apnea cessation of airflow for more than 10 seconds more than 10 times a night during sleep causes: obstructive (e.g. obesity with upper narrowing, enlarged tonsils, pharyngeal soft tissue changes in acromegaly or hypothyroidism) 2. Cheyne-Stokes periods of apnoea alternating with periods of hyperpnoae pathophysiology: delay in medullary chemoreceptor response to blood gas changes causes left ventricular failure brain damage (e.g. trauma, cerebral, haemorrhage) AIRWAY RESISTANCE high altitude 3. Kussmaul's (air hunger) Resistance is determined chiefly by the radius size of the deep rapid respiration due to stimulation of respiratory airway. centre Causes of Increased Airway Resistance causes: metabolic acidosis (e.g. diabetes mellitus, 1. Contraction of bronchial mucosa chronic renal failure) 2. Thickening of bronchial mucosa 4. Hyperventilation 3. Obstruction of the airway complications: alkalosis and tetany 4. Loss of lung elasticity causes: anxiety 5. Ataxic (Biot) irregular in timing and deep RESPIRATION causes: brainstem damage • The process of gas exchange between atmospheric air 6. Apneustic and the blood at the alveoli, and between the blood cells post-inspiratory pause in breathing and the cells of the body. causes: brain (pontine) damage MS 3 Abejo Medical and Surgical Nursing Respiratory System Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN - asthma 7. Paradoxical - carcinoma of bronchus the abdomen sucks with respiration (normally, it - left ventricular failure pouches uotward due to diaphragmatic descent) - interstitial lung disease causes: diaphragmatic paralysis - ACE inhibitors Sputum B. Cyanosis volume 1. Refers to blue discoloration of skin and mucous type (purulent, mucoid, mucopurulent) membranes , is due to presence of deoxygenated presence or absence of blood? haemoglobin in superficial blood vessels Stridor 2. Central cyanosis = abnromal amout of deoxygenated croaking noise loudest on inspiration haemoglobin in arteries and that blue discoloration is is a sign that requires urgent attention present in parts of body with good circulation such as causes: (obstruction of larynx, trachea or large tongue broncus) 3. Peripheral cyanosis = occurs when blood supply to a - acute onset (minutes) certain part of body is reduced, and the tissue extracts . inhaled foreign body more oxygen from normal from the circulating blood, e.g. acute epiglottitis lips in cold weather are often blue, but lips are spared . anaphylaxis 4. Causes of cyanosis . toxic gas inhalation Central cyanosis - gradual onset (days, weeks) decreased arterial saturation . laryngeal and pharyngeal tumours . decreased concentration of inspired oxygen: . crico-arytenoid rheumatoid arthritis high altitude . bilateral vocal cord palsy . lung disease: COPD with cor pulmoale, . tracheal carcinoma massive pulmonary embolism . paratracheal compression by lymph nodes . right to left cardiac shunt (cyanotic congenital . post-tracheostomy or intubation heart disease) granulomata polycythaemia Hoarseness haemoglobin abnromalities (rare): causes include: methaemoglobinaemia, sulphaemoglobinaemia - laryngitis Peripheral cyanosis - laryngeal nerve palsy associated with all causes of central cyanosis cause peripheral carcinoma of lung cyanosis - laryngeal carcinoma exposure to cold reduced cardiac output: left ventricular failure or The Hands shock Clubbing arterial or venous obstruction commonly cause by respiratory disease (but NOT Position: patient sitting over edge of bed emphysema or chronic bronchitis) occasionally, clubbing is associated with hypertrophic General appearance pulmonary osteoarthropathy (HPO) look for the following characterised by periosteal inflammation at distal ends Dyspnea of long bones, wrists, ankles, metacarpals and normal respiratory rate < 14 each minute metatarsals tachypnoea = rapid respiratory rate sweelling and tenderness over wrists and other are accessory muscles being used (sternomastoids, involved areas platysma, strap muscles of neck) - characteristically, the accessory muscles cause elevation of shoulders with inspiration and aid respiration by increasing chest expansion Cyanosis Character of cough ask patient to cough several times Staining lack of usual explosive beginning may indicate staining of fingers - sign of cigarette smoking (caused by vocal cord paralysis (bovine cough) tar, not nicotine) muffled, wheezy ineffective cough suggests airflow Wasting and weakness limitation Pulse rate very loose productive
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