CHAPTER 11

1. CHAPTER 11 Respiratory System

2. In-class videos • http://www.youtube.com/watch?v=HiT621PrrO0  - Airway/lung review • http://www.youtube.com/watch?v=bDRTzmuwMnQ&feature=related   - awake intubation  • http://www.youtube.com/watch?NR=1&v=fARgIfASIH4    - esophagus • http://www.youtube.com/watch?v=Uerm1ZH4Ni4  - Rigid bronc • http://www.youtube.com/watch?v=LQDO2RAz24k&feature=related   - Empyema

3. Respiratory System Overview • Responsibilities of respiratory system • Respiration = exchange of gases between body and air • Provides oxygen to body cells for energy • Removes carbon dioxide from body cells • Production of sound • Assisting in body’s defense against foreign materials

4. Respiratory System Overview • External respiration • Oxygen is inhaled into lungs • Passes through capillaries of the lungs into the pulmonary bloodstream • Carbon dioxide passes from blood through the same capillaries into the lungs and is exhaled

5. Respiratory System Overview • Internal respiration • Inhaled oxygen circulates from pulmonary bloodstream in the lungs, back through the heart, to systemic bloodstream, to the body cells • At cellular level, oxygen passes through capillaries into tissue cells where it is used for energy • Carbon dioxide passes from tissue cells into capillaries and travels through bloodstream for removal from body via lungs

6. Question True or False: The purposes of the respiratory system are respiration, producing sound, and defending against foreign bodies.

7. Answer True. It is more than just breathing.

8. Respiratory System Structures • Nose • External portion composed of cartilage and bone covered with skin • Entrance to nose = nostrils or nares (singular: naris) • Air enters body through the nose and mouth

9. Respiratory System Structures • Nasal cavity • Divided into left and right chambers by dividing wall called the septum • As air enters through nose, it passes into the nasal cavity

10. Respiratory System Structures • Paranasal sinuses • Hollow areas or cavities within the skull that communicate with the nasal cavity • Lighten the skull and enhance the sound of the voice • Lined with mucous membranes • Help to warm and filter the air as it enters the respiratory system • Cilia (hair-like projections on mucous membranes) sweep dirt and foreign material toward throat for elimination

11. Respiratory System Structures • Pharynx • Airway that connects the mouth and nose to the larynx • Also known as the throat • Serves as a common passageway for both air and food • Epiglottis covers opening of larynx when swallowing

12. Respiratory System Structures • Pharynx • Commonly divided into three sections • Nasopharynx • Contains the adenoids • Oropharynx • Contains the tonsils (palatine tonsils) • Laryngopharynx

13. Respiratory System Structures • Larynx • Connects pharynx with trachea • Also known as the voice box • Most prominent of supporting cartilages is the thyroid cartilage at the front • Forms the Adam’s apple

14. Respiratory System Structures • Larynx • Contains structures that make vocal sounds possible – the vocal cords • Vocal cords vibrate as air passes through the space between them (glottis), producing sound

15. Respiratory System Structures • Trachea • Extends into the chest and serves as a passageway for air to the bronchi • Commonly known as the windpipe

16. Respiratory System Structures • Bronchi • Trachea branches into two tubes called the bronchi • Each bronchus leads to a separate lung • Divides and subdivides into progressively smaller tubes called bronchioles

17. Respiratory System Structures • Bronchioles • Smallest branches of bronchi • Terminal ends known as alveoli • Air sacs • Have thin walls that allow for exchange of gases between the lungs and the blood • Alveoli = pulmonary parenchyma

18. Respiratory System Structures • Lungs • Two cone-shaped, spongy organs consisting of alveoli, blood vessels, elastic tissue, and nerves • Left lung has two lobes and right lung has three lobes • Apex = uppermost part of lung • Base = lower part of lung • Hilum = portion in midline region where blood vessels, nerves, and bronchial tubes enter and exit the lungs

19. Respiratory System Structures

20. Respiratory System Structures • Pleura • Double-folded membrane that surrounds the lungs • Parietal pleura • Outer layer of the pleura which lines the thoracic cavity • Visceral pleura • Inner layer of the pleura which covers the lungs

21. Respiratory System Structures • Pleura • Pleural space • Small space between the pleural membranes • Filled with lubricating fluid that prevents friction when the two membranes slide against each other during respiration

22. Question A small but very important flap covers the larynx so that food cannot pass into the airway during swallowing. It is called the: • adenoids • palatine tonsils • oropharynx • epiglottis

23. Answer d. It means above or on top of the glottis. When food gets into our pharynx before a swallow is initiated and we choke, this is when we say “it went down the wrong pipe.”

24. Breathing Process • Inhalation = Inspiration • Diaphragm is stimulated by phrenic nerve • Diaphragm contracts and flattens (descends) • Chest cavity enlarges • Decrease in pressure within the thorax • Air is drawn into the lungs

25. Breathing Process • Exhalation = Expiration • Diaphragm relaxes and rises back into thoracic cavity • Chest cavity decreases in size • Increase in pressure with the thorax • Air is forced out of lungs

26. Animation Click Here to Play Respiration Animation

27. Physical Exam Techniques • Inspection • Visual examination of the external surface of the body as well as of its movements and posture • Palpation • Process of examining, by application of the hands or fingers to the external surface of the body, to detect evidence of disease or abnormalities in the various organs

28. Physical Exam Techniques • Auscultation • Process of listening for sounds within the body, usually to sounds of thoracic or abdominal viscera, to detect some abnormal condition, or to detect fetal heart sounds • Performed with a stethoscope

29. Physical Exam Techniques • Percussion • Use of the fingertips to tap the body lightly but sharply to determine position, size, and consistency of an underlying structure and the presence of fluid or pus in a cavity • Tapping over solid organ = dull, flat sound • Tapping over air-filled structure = clear, hollow sound

30. Question True or False: When the doctor listens to our lungs in the office, he is performing percussion.

31. Answer False. Auscultation is the correct term.

32. Common Signs and Symptoms • Apnea • Temporary cessation of breathing • “Without breathing” • Bradypnea • Abnormally slow breathing • Evidenced by respiratory rate slower than 12 respirations per minute

33. Common Signs and Symptoms • Cough • Forceful and sometimes violent expiratory effort preceded by a preliminary inspiration • Glottis is partially closed, accessory muscles of expiration brought into action, air is noisily expelled • Due to irritation of the airways or infection • Irritants = dust, smoke, mucus

34. Common Signs and Symptoms • Cough • Nonproductive = unproductive • Not effective in bringing up sputum • “Dry cough” • Productive • Effective in bringing up sputum • “Wet cough”

35. Common Signs and Symptoms • Cyanosis • Slightly bluish, grayish, slate-like, or dark purple discoloration of the skin due to presence of abnormal amounts of reduced hemoglobin in the blood • Dysphonia • Difficulty in speaking • Hoarseness

36. Common Signs and Symptoms • Dyspnea • Air hunger resulting in labored or difficult breathing, sometimes accompanied by pain • Epistaxis • Hemorrhage from the nose; nosebleed

37. Question The medical term element for breathing is _________. • –pneum • glottis • –pnea • –capnia

38. Answer c. The element -pneum/on means lung or air, and -capnia refers to carbon dioxide in the blood.

39. Common Signs and Symptoms • Expectoration • Act of spitting out saliva or coughing up materials from the air passageways leading to the lungs • Hemoptysis • Expectoration of blood arising from the oral cavity, larynx, trachea, bronchi, or lungs

40. Common Signs and Symptoms • Hypercapnia • Increased amount of carbon dioxide in the blood • Hypoxemia • Insufficient oxygenation of the blood • Hypoxia • Deficiency of oxygen

41. Common Signs and Symptoms • Kussmaul respirations • Very deep, gasping type of respiration associated with severe diabetic acidosis • Orthopnea • Respiratory condition in which there is discomfort in breathing in any but erect, sitting, or standing position

42. Common Signs and Symptoms • Pleural rub • Friction rub caused by inflammation of the pleural space • Rales • Abnormal sound heard on auscultation of the chest, produced by passage of air through bronchi that contain secretion or exudate or that are constricted by spasm or a thickening of their walls

43. Common Signs and Symptoms • Rhinorrhea • Thin, watery discharge from the nose • Rhonchi • Rales or rattlings in the throat, especially when it resembles snoring

44. Common Signs and Symptoms • Sneeze • To expel air forcibly through the nose and mouth by spasmodic contraction of muscles of expiration due to irritation of nasal mucosa • Stridor • Harsh sound during respiration • High pitched and resembling the blowing of wind, due to obstruction of air passages

45. Common Signs and Symptoms • Tachypnea • Abnormal rapidity of breathing • Wheeze • Whistling sound or sighing sound resulting from narrowing of the lumen of a respiratory passageway

46. Question True or False: Hypoxemia usually causes hypoxia.

47. Answer True. The insufficiency of oxygenated blood means oxygen cannot get to the tissues.

48. PATHOLOGICAL CONDITIONS Upper Respiratory System

49. Coryza • Pronounced • (kor-RYE-zuh) • Defined • Inflammation of the respiratory mucous membranes, known as the common cold • “Common cold” usually refers to symptoms of an upper respiratory tract infection

50. Croup • Pronounced • (KROOP) • Defined • Childhood disease characterized by a barking cough, suffocative and difficult breathing, stridor, and laryngeal spasm