Download 1 US ARMY MEDICAL DEPT. CENTER AND SCHOOL

U.S. ARMY MEDICAL DEPT. CENTER AND SCHOOL
CORRESPONDENCE PHASE
91B BNCOC TECHNICAL TRAINING
C2000104
1195
Anatomy and Physiology of the Respiratory System
I. REFERENCES.
Hafen, Brent Q., and Karren, Keith J., (1989). Prehospital
Emergency Care and Crisis Intervention. (3rd ed.) Englewood
Cliff, N.J.: Prentice-Hall.
Memmler, R. L., & Wood, D.L., (1992). The Human Body in
Health and Disease. (7th Ed). Phil, Penn: J.B.
Lippincott.
Tortora, Gerand J., and Anagnostakos, Nicholas P. (1984).
Principles of Anatomy and Physiology. (4th ed.) New York:
Harper and Row.
II. OBJECTIVES.
A.
Terminal Learning Objective.
Given a list, select the description of the anatomy and
physiology of the respiratory system and the normal
physiology of respiration which takes place in the
human body IAW cited references.
B.
Enabling Learning Objectives.
1.
Given the name of an anatomical part of the
respiratory system and a statement about the
structure or function of the part, match the
name of the part to its structure or function
IAW cited references.
2.
Given a list of statements about the physiology of
inhalation and exhalation, select the correct
statements IAW cited references.
3.
Given a list of statements about the regulation
of ventilation, select the correct statement IAW
cited references.
4.
Given a list of respiratory rates and a list of
age groups, choose the correct normal respiratory
1
C2000104
1195
rate for the age group IAW cited references.
5.
Given a list of modified forms of respirations and
a list of descriptions of forms of respira-tions,
match the form to the description IAW cited
references.
III. EXPLANATION.
Objective 1.
A.
NOTE:
Given the name of an anatomical part of the
respiratory system and a statement about the
structure or function of the part, match the name
of the part to its structure or function IAW cited
references.
Function of the Respiratory System.
1.
Supply oxygen to the individual tissue cells.
2.
Remove their gaseous waste product i.e., carbon
dioxide.
Respiration has two components. The first, called
external respiration, takes place only in the lungs
where oxygen from the outside air enters the blood and
carbon dioxide leaves the blood to be breathed into the
outside air. In the second, called internal
respiration, gas exchanges take place between the blood
and the body cells, with oxygen leaving the blood and
entering the cells at the same time that carbon dioxide
leaves the cells and enters the blood.
B.
The Respiratory System.
1.
The nasal cavities.
a.
Structure.
(1) Nostrils (NARES)--openings in the nose
where air initially enters the body.
(2)
Nasal cavities--two spaces located
between the roof of the mouth and the
cranium.
(a)
Bone covered with mucous membranes.
2
C2000014
1195
b.
2.
(b)
Contains many blood vessels.
(c)
Secretes large amount of fluid (1
qt day).
(3)
Nasal septum--a partition that separates
the nasal cavities.
(4)
Sinuses--small cavities lined with
mucous membrane in the bones of the
skull.
(a)
Closely connected to nasal
cavities.
(b)
Highly susceptible to infection.
Function of nasal cavities.
(1)
Foreign bodies, such as dust particles
and pathogens, are filtered out by the
hairs of the nostrils or caught in the
surface mucus.
(2)
Air is warmed by the blood in the
vascular membrane.
(3)
Air is moistened by the liquid
secretion.
The pharynx.
a.
b.
Structure (divided into three parts).
(1) Nasopharynx--upper portion located
immediately behind the nasal cavity.
(2)
Oropharynx--middle section located
behind the mouth.
(3)
Laryngeal pharynx--lowest portion opens
into the larynx toward the front and to
the esophagus toward the back.
Function of the pharynx.
3
C2000104
1195
3.
NOTE:
Carries air into the respiratory system.
(2)
Carries food and liquid into the
digestive system.
The larynx.
a.
NOTE:
(1)
Structure--consists of nine cartilages bound
together by an elastic membrane and moved by
muscles--lined with mucous membrane.
(1)
Located between the pharynx and the
trachea.
(2)
Larger in male than female.
(3)
Vocal cords are located at upper end.
Vocal cords are set into motion by air flow from the
lungs, difference in size of larynx makes voice high or
low.
(4)
Space between vocal cords called
glottis.
(5)
Epiglottis--leaf-shaped cartilage that
covers the larynx during swallowing.
You can feel the epiglottis move by placing your
fingertips over your larynx as you swallow.
b.
4.
(6) Lined with ciliated mucous membrane.
Function of larynx.
(1)
Serves in the production of speech.
(2)
Cilia traps
moving them
expelled by
blowing the
The trachea.
a.
Structure.
4
dust and other particles,
upward to the larynx to be
coughing, sneezing, or
nose.
C2000014
1195
b.
5.
(1)
Tube that extends from the lower edge of
the larynx to the upper part of the
chest above the heart.
(2)
Framework C-shaped of cartilage keeps it
open.
(3)
All the open sections of the cartilages
are to the back so the esophagus can
bulge into this region when swallowing.
Function--conducts air between the larynx and
the lungs.
The bronchi and bronchioles.
a.
Structure.
(1)
Trachea branches off into two bronchi
which enter the lungs.
(2)
Right bronchus considerably larger in
diameter than left.
(3)
Right extends downward in a more
vertical direction than the left.
(4)
b.
NOTE:
The notch or depression where the
bronchus enters the lung is called the
hilus.
Function--passageways to bring air to
alveoli.
Blood vessels and nerves also connect the lung at this
area.
6.
The lungs.
a.
Structure.
(1)
Extremely thin and delicate lung
tissues.
(2)
Where external respiration takes place.
5
C2000104
1195
NOTE:
(3)
Two lungs sit side by side in thoracic
cavity.
(4)
Two cone-shaped structures with their
bases lying on the diaphragm.
(5)
"Bronchial Tree"--subdivisions of the
bronchus.
(6)
Bronchioles--smallest division of the
bronchi.
(7)
Terminal bronchioles--attached to the
alveoli.
(8)
Alveoli--cluster of air sacs, resembling
a bunch of grapes.
(9)
Surfactant--a substance that prevents
the alveoli from collapsing by reducing
the surface tension of the fluids that
line them.
Lungs contain about 3 times more lung tissue as is
necessary for life. Due to its number of air spaces,
lung is very light weight and will float in water.
b.
7.
Function of the lungs--gas exchange takes
place as blood passes through capillaries
around the alveoli.
The lung cavities.
a.
Lungs occupy considerable portion of thoracic
cavity.
b.
Separated from abdominal cavity by diaphragm.
c.
Pleura--double sac of serous membrane
enveloping each lung.
(1)
Parietal pleura--portion of pleura that
lines the thoracic cavity.
(2)
Visceral pleura--portion that encloses
6
C2000014
1195
the surface of the lung.
Objective 2.
C.
d.
Mediastinum--region between the lungs-contains the heart, great blood vessels,
esophagus, trachea, and lymph nodes.
e.
Pleural space--space between the two
membranes of the parietal and visceral
pleura.
Given a list of statements about the physiology of
inhalation and exhalation, select the correct
statements IAW cited references.
Physiology of Respiration.
1.
Accomplished through pressure changes in the
lungs--two phases.
a.
Two phases:
(1)
(2)
Inhalation--active process.
(a)
Initiated by contracting of the
respiratory system muscles.
(b)
Diaphragm flattens and drops down.
(c)
Intercostal muscles contract
causing ribs and sternum to move up
and out.
(d)
Enlargement of the thorax causes
pressure in the lungs to fall and
forces air into the lungs.
Exhalation--passive phase.
(a)
Respiratory muscles relax.
Diaphragm moves up.
(b)
Chest wall recoils.
(c)
Intrathoracic pressure rises.
7
C2000104
1195
(d)
NOTE:
Sign of respiratory distress is the use of accessory
muscles such as muscles in the neck.
2.
3.
Respiratory volumes.
a.
Total lung capacity--volume of gas contained
in the lung at the end of maximal inhalation-6000 cc.
b.
Tidal volume--volume of gas inhaled or
exhaled during each normal respiratory cycle-500 cc.
c.
Dead air space--amount of air that remains in
the upper air passages where it is
unavailable for gas exchanges--150 cc.
d.
Alveolar air--amount of air which reaches the
alveoli and participates in gas exchange with
the capillary blood--350 cc.
Gas exchange in the lungs.
a.
Alveoli supply oxygen to and remove carbon
dioxide from the lungs.
b.
NOTE:
Air is pushed out.
Exchange is made by diffusion across the cell
wall of the alveoli and capillaries.
Diffusion is the movement of molecules from an area of
greater concentration to an area of lesser
concentration.
4.
Carbon dioxide in the blood.
a.
Acid-base balance is directly related to the
CO2 produced and CO2 eliminated.
b.
CO2 is transported from tissues to lungs in 3
ways:
(1)
10% dissolves into plasma and fluid in
RBCs.
8
C2000014
1195
c.
NOTE:
20% combines with plasma proteins and
hemoglobin protein.
(3)
70% is transported as bicarbonate ion
(HC03-) and H+ ion.
(a)
Forms slowly in plasma.
(b)
Enzyme (carbonic anhydrase) in RBCs
causes rapid change of CO2 and H20
into HC03- and H+ with RBC.
(c)
HC03-) and H+ diffuse into plasma
until blood reaches lungs; then it
re-enters RBCs and is converted
back into CO2 and H20. CO2 can then
enter alveoli and be blown off.
(4)
Increased CO2 in blood leads to
elevation of H+ ion (lower pH) and can
cause respiratory acidosis (may be seen
in patients that are hypoventilating due
to decreased rate or alveolar filling.
(5)
Decreased CO2 in blood leads to decrease
of H+ ion (higher pH) and may cause
respiratory alkalosis (as seen in
hyperventilation syndrome).
Increase in CO2 produced causes the need to
increase the CO2 eliminated as seen in
hyperventilation due to acidosis metabolic.
The larger the volume of air that moves in and out of
the lungs, the more CO2 that is eliminated.
5.
Oxygen in the blood.
a.
NOTE:
(2)
Fluid in the alveoli may prevent adequate
oxygen exchange.
Fluid accumulation on the lungs may be due to such
pulmonary problems as pulmonary edema from heart
failure; toxic inhalations; or drowning.
9
C2000104
1195
b.
Alveoli may be collapsed (Atelectasis)
therefore preventing adequate oxygenation of
blood.
NOTE:
Alveoli may collapse from either external forces such
as pneumothorax and/or a flail chest or internal causes
such as secretions plugging the airways and/or poor
cough and sigh mechanisms.
NOTE:
The amount of oxygen in the blood is directly
proportional to the amount of oxygen delivered to the
alveoli.
Objective 3.
6.
NOTE:
Given a list of statements about the regulation of
ventilation, select the correct statement IAW
cited references.
Regulation of ventilation.
a.
Respiratory function is involuntary although
we can consciously hold our breath or take
deep breaths, etc.
b.
Rate and depth of breathing is controlled
primarily in the respiratory center located
in the brain stem.
c.
Body detects an increase in acidic level of
the blood then compensates by increasing the
respirations to increase the CO2 elimination.
Patients with chronic respiratory diseases are unable
to rely on the brain stem to regulate respirations.
Their bodies are accustomed to high levels of CO2, so
rely on other control centers located in the aorta and
carotid arteries.
Objective 4.
7.
Given a list of respiratory rates and a list of
age groups, choose the correct normal respiratory
rate for the age group IAW cited references.
Respiratory rates.
a.
Adult--12-20 per minute.
10
C2000014
1195
Objective 5.
8.
b.
Children--20-40 per minute.
c.
Infants--> 40 per minute.
Given a list of modified forms of respirations and
a list of descriptions of forms of respirations,
match the form to the description IAW cited
references.
Modified forms of respiration.
a.
Coughing--forceful exhalation produced with a
greater than normal volume of breath (mouth).
b.
Sneezing--forceful exhalation produced with a
greater than normal volume of breath (nose).
c.
Hiccuping (singultus)--sudden inhalation, due
to spasmodic contraction of the diaphragm,
cut short by closure of the glottis.
d.
Sighing--slower and deeper than usual inhalation followed by a prolonged and sometimes
quite audible exhalation.
11
C2000104
1195
HANDOUT
INSTRUCTIONAL AIDS
Lung Lobule
12
C2000014
1195
HANDOUT
INSTRUCTIONAL AIDS
Respiratory System
13
C2000104
1195
HANDOUT
INSTRUCTIONAL AIDS
Respiratory Organs Review
14