4. 3 PROCESS OF RESPIRATION
VENTILATION-
Movement Of Gases In And Out Of The Lungs
INHALATION/INSPIRATION- VOLUNTARY
EXHALATION/EXPIRATION- INVOLUNTARY
DIFFUSION-
Exchange Of Gases From Area Of Higher Pressure
To Area Of Lower Pressure
PERFUSION-
The Availability And Movement Of Blood For
Transport Of Gases, Nutrients And Metabolic
Waste Products
5. STRUCTURE OF THE RESPIRATORY
SYSTEM
I. The Airways
1. Upper Airways
a. Nasal cavity or nares
b. Pharynx
c. Larynx or voice box
6. STRUCTURE OF THE RESPIRATORY
SYSTEM
I. The Airways
2. Lower airways/tracheobronchial tree
a. trachea
b. right and left main stem bronchi
c. segmental bronchi
d. subsegmental bronchi
e. terminal bronchi
7. STRUCTURE OF THE RESPIRATORY
SYSTEM
I. The Airways
3. Function of the upper airways
a. transport gas to the lower airway
b. protection of lower airway from
foreign matter
c. warming, filtration, and
humidification of inspired air
8. STRUCTURE OF THE RESPIRATORY SYSTEM
I. The Airways
4. Function of lower airways
a. clearance mechanism
Cough
Mucociliary system
Macrophages
Lymphatics
b. immunologic response
Call mediated immunity in the alveoli
c. pulmonary protection in injury
Respiratory epithelium
Mucociliary system
9. STRUCTURE OF THE RESPIRATORY SYSTEM
Notes : the openings of the nose on the face are called
nostrils/nares
- Each nostril leads to the cavity called vestibule
- The hairs that line the vestibule are called the
vibrissae(filters foreign objects)
- The paranasal sinuses are open areas within the skull,
lined with mucous membrane. They help in
phonation. These are: frontal, maxillary, ethmoid,
sphenoid
- The pharynx is a funnel-shaped tube that extends from
the nose to the larynx. It is a common opening
between the digestive and respiratory system
- 3 section of the pharynx are: nasopharynx,
oropharynx, laryngopharynx
10. STRUCTURE OF THE RESPIRATORY SYSTEM
Notes : from the middle ear, the eustachian tubes open into
the nasopharynx
The larynx is the voice box
The epiglottis covers the larynx(closes during
eating/swallowing, open during speaking/breathing)
Trachea(windpipe) is 12cm(4-5inches)long. Carina is the
point where it divides
Trachea and bronchi are lined with cilia and goblet
cells(secretes 120ml of mucous/day, entraps debris)
Celia are microscopic hair like projections which have
rapid, coordinated, unidirectional upward motion
Celia sweep out debris and excessive mucous membrane
from the lungs
Right mainstem bronchus is shorter, broader, and more
vertical than the left
11. STRUCTURE OF THE RESPIRATORY
SYSTEM
II. The pleura
are serous membrane that enclose the
lungs
visceral pleura directly covers the lungs
parietal pleura line the cavity of each
hemithorax
the pleural space is a potential space
between the two pleurae which contains
the pleural fluid that serve as lubricant
12. STRUCTURE OF THE RESPIRATORY
SYSTEM
III. The Lungs
The right has 3 lobes while the left has 2.
The 2 are separated by the space called
mediastinum.
Approximately 3 hundred million alveoli
in the lungs.
The right is broader and shorter due to
the presence of the liver.
13. STRUCTURE OF THE RESPIRATORY
SYSTEM
III. The Lungs
Residual volume- amount of air that
remain in the lungs after a forceful
expiration. Prevents the collapse of the
lungs after expiration. (1200ml)
Tidal volume- amount of air that moves in
and out of the lungs with each normal
breath.(500ml)
Inspiratory reserve volume- extra amount
of air that can be inhaled beyond
TD.(1300)
14. STRUCTURE OF THE RESPIRATORY
SYSTEM
III. The Lungs
Expiratory reserve volume- extra amount
of air that can be exhaled after a normal
breath.(1100)
Total lung capacity- total of RS, TV, IRV
and ERV.
Vital capacity- the maximum amount of
air that can be exhaled after taking the
deepest breath. IRV,TV, and ERV.
15. STRUCTURE OF THE RESPIRATORY
SYSTEM
III. The Lungs
Inspiratory capacity- the total amount of
air that a person can inhale following a
resting expiration. IRV and TV
Functional residual capacity- the amount
of air that remain in the lung after a
normal expiration
Pneumocytes
Type I lines the alveoli/structural
Type II produce surfactant
16. STRUCTURE OF THE RESPIRATORY
SYSTEM
III. The Lungs
Anatomic dead space- area where gas
exchange does not occur.( trachea,
bronchi, bronchioles
Alveolar dead space- nonfunctional air
sacs due to poor blood flow from adjacent
alveoli
Physiologic dead space- both ADS(150ml)
17. STRUCTURE OF THE RESPIRATORY
SYSTEM
IV. The thorax and diaphragm
Thorax- Protect the lungs, heart and great
vessels
Made up of 12 pair of ribs bounded anteriorly
by the sternum and posteriorly by the
thoracic vertebrae
Diaphragm- main respiratory muscle for
inspiration, supplied by the phrenic nerve
Accessory muscles are sternocleidomastoid,
scalene, parasternal, trapezius and pectoralis
18. STRUCTURE OF THE RESPIRATORY
SYSTEM
V. Respiratory centers
Medulla Oblongata is the primary center
Pons
Pneumotaxic center- rhythmic quality of
breathing
Apneustic center- deep prolong inspiration
19. STRUCTURE OF THE RESPIRATORY
SYSTEM
V. Respiratory centers
Carotid and Aortic bodies
Peripheral chemoreceptors- take up the function of
the central chemoreceptor in the MO when damaged
Respond to low O2 concentration in blood
Respond to pressure- BP, breathing/ BP, breathing
CO2 is the blood stimulate breathing
Muscles and joints
Pripioceptors- exercise increases respiratory
rate
20. Physiologic changes with Aging
Reduce chest wall compliance that results from
increased calcification of costal cartilage and
decreased strength of intercostal and accessory
muscle and diaphragm
Reduce breathing capacity
Reduced vital capacity
Increased residual volume
Decreased cough reflex
Decreased ciliary activity
21. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
History
Biographic data
Chief complaint
Dyspnea
Cough
Sputum production
Hemoptysis
Wheezing
stridor
Chest pain
22. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
History
Post Medical History
Childhood/ infectious diseases
Respiratory immunization
Major illnesses/ Hospitalization
Medications
Allergies
Family history
23. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
History
Psychosocial history and Lifestyle
Occupational or environmental exposure
Geographic location
Personal habits
(yrs. of smoking x packs/day= pack yrs.)
15yrs. of smoking x 2 packs/day= 30pack yrs.
24. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
History
Psychosocial history and Lifestyle
Occupational or environmental exposure
Geographic location
Personal habits
(yrs. of smoking x packs/day= pack yrs.)
15yrs. of smoking x 2 packs/day= 30pack yrs.
25. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
Physical Examination
Inspection
S/Sx of respiratory distress
I:E(inhalation:expiration) ratio (1:2)
Speech pattern
Chest wall configuration
Chest movement
Fingers and toes
27. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
Physical Examination
Percussion
Resonance
Hyperresonace
Dullness
28. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
Physical Examination
Auscultation
Normal breath sounds
bronchial(tracheal)- heard over manubrium
in the large tracheal airways- high pitched
and loud
Bronchovesicular- heard over bronchi-
moderate pitched, moderate amplitude
Vesicular- heard all over the chest and best
at the base of the lungs- low pitched and soft
29. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
Physical Examination
Auscultation
Adventitous breath sounds
Crackles/Rales(fine)- high pitched, soft,
crackling/popping sound(rolling strands of
hair between fingers)
Crackles/Rales(coarse)- loud/low pitched,
bubbling, gurgling(opening velcro fastener)
31. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
Physical Examination
Auscultation
Voice sounds
Egophony
Sy prolong “e”
Auscultated as “a” indicating consolidation
Whispered Pectoriloquy
Whisper “1,2,3”
Auscultated as muffled 1,2,3
If the words are distinct,indicate
consolidation
32. ASSESSMENT OF CLIENT WITH
RESPIRATORY DISORDER
Physical Examination
Auscultation
Voice sounds
bronchophony
Say “ninety-nine”
Consolidation results in increased
resonance and the words are heard clearly
33. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Physical Examination
Auscultation
Altered breathing patterns
Chyme-Stokes- rhythmic waxing and waning
respirations from very deep or very shallow
breathing and temporary apnea.
Kussmaul- hyperventilation- increase rate and
depth
Hypoventilation- slow, shallow respiration
Biots breathing-shallow breaths interrapted
by apnea; irregular irregularity
Apneustic- prolong, gasping inspiration
followed by a very short inefficient expiration
34. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Normal Findings
General appearance- appear relaxed; breathing is
quiet and easily without apparent effort; facial
expressions and limb are relaxed
Breathing pattern- smooth and regular; may have
occasional sighing; breathing is quiet and passive
with symmetric chest expansion; abdomen bulges
slightly with inhalation
Respiration rate- 12-20cpm
Skin- oral mucous membrane are pink, no cyanosis
or pallor present; palpation of skin and chest wall
reveals smooth skin and a stable chest wall, no
crepitation, masses or painful areas
35. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Normal Findings
Nails- angulation between the base of the nail and
finger, no thickening of distal finger width, no
clubbing
Chest wall configuration- symmetric, bilateral
muscle development; straight spinal processes;
downward and equal slope of the ribs
Tracheal position- middle and straight, directly
above the suprasternal notch
Vocal/Tactile Fremitus- sensation of sound
vibration is produced when the patient speaks and
compared bilateraly
36. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Normal Findings
Abnormal responses
Increased fremitus- due to presence of
consolidation of the lung caused by fluid-
filled or solid structures. i.e. pneumonia or
tumor of lung
Decreased fremitus- presence of more air than
normal which is blocked or trapped in the
lungs of pleural space. i.e. emphysema or
pneumothorax
37. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Normal Findings
Abnormal responses
Percussion Tunes
Resonant-heard over normal lung tissue
Intensity-loud
Pitched-low
Duration-long
Quality-low
38. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Normal Findings
Abnormal responses
Percussion Tunes
Flat- heard over airless areas
Soft
High
Short
Extremely dull
39. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Normal Findings
Abnormal responses
Percussion Tunes
Dull- occur over dense lung tissue. i.e. tumor
or consulidation
Medium
Medium-high
Medium
Thud-like
40. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Normal Findings
Abnormal responses
Percussion Tunes
Tympanic- indicates a large tension
pneumothorax
Loud
High
Medium
drumlike
41. ASSESSMENT OF CLIENT WITH RESPIRATORY
DISORDER
Normal Findings
Abnormal responses
Percussion Tunes
Hyper resonant- usually in adults due to
trapping of air such as obstructive disease
like emphysema and pneumothorax,
Very loud
Very low
Longer
Booming