Download the respiratory system

THE RESPIRATORY SYSTEM
Pages 103-105 and 146 - 150
1
When the respiratory system is mentioned,
people generally think of breathing, but
breathing is only one of the activities of the
respiratory system. The body cells need a
continuous supply of oxygen for the metabolic
processes that are necessary to maintain life.
The respiratory system works with the
circulatory system to provide this oxygen and to
remove the waste products of metabolism. It
also helps to regulate pH of the blood.
2
Respiration is the sequence of events that results in
the exchange of oxygen and carbon dioxide between
the atmosphere and the body cells. Every 3 to 5 seconds,
nerve impulses stimulate the breathing process, or
ventilation, which moves air through a series of passages
into and out of the lungs. After this, there is an exchange
of gases between the lungs and the blood. This is called
external respiration. The blood transports the gases to
and from the tissue cells. The exchange of gases
between the blood and tissue cells is internal respiration.
Finally, the cells utilize the oxygen for their specific
activities. This is cellular metabolism, or cellular
respiration. Together these activities constitute
respiration.
3
Ventilation, or breathing, is the movement of air
through the conducting passages between the
atmosphere and the lungs. The air moves
through the passages because of pressure
gradients that are produced by contraction of
the diaphragm and thoracic muscles.
4
Pulmonary Ventilation
Pulmonary ventilation is commonly referred to as
breathing. It is the process of air flowing into the lungs
during inspiration (inhalation) and out of the lungs during
expiration (exhalation). Air flows because of pressure
differences between the atmosphere and the gases
inside the lungs. Air, like other gases, flows from a
region with higher pressure to a region with lower
pressure. Muscular breathing movements and recoil of
elastic tissues create the changes in pressure that result
in ventilation.
5
Atmospheric Pressure
Pulmonary ventilation involves three different
pressures:
Intraalveolar (intrapulmonary) pressure
2. Intrapleural pressure
3. Atmospheric pressure is the pressure of the air
outside the body.
Intraalveolar pressure is the pressure inside the
alveoli of the lungs. Intrapleural pressure is the
pressure within the pleural cavity. These three
pressures are responsible for pulmonary ventilation.
1.
6
Inspiration
Inspiration (inhalation) is the process of taking air into
the lungs. It is the active phase of ventilation because
it is the result of muscle contraction. During
inspiration, the diaphragm contracts and the thoracic
cavity increases in volume. This decreases the
Intraalveolar pressure so that air flows into the lungs.
Inspiration draws air into the lungs.
7
Expiration
Expiration (exhalation) is the process of letting air out
of the lungs during the breathing cycle. During
expiration, the relaxation of the diaphragm and
elastic recoil of tissue decreases the thoracic volume
and increases the intraalveolar pressure. Expiration
pushes air out of the lungs.
8
Under normal conditions, the average adult takes 12
to 15 breaths a minute. A breath is one complete
respiratory cycle that consists of one inspiration and
one expiration.
An instrument called a spirometer is used to measure
the volume of air that moves into and out of the
lungs, and the process of taking the measurements is
called spirometry. Respiratory (pulmonary) volumes
are an important aspect of pulmonary function testing
because they can provide information about the
physical condition of the lungs.
9
10
11
Respiratory capacity (pulmonary capacity) is the sum
of two or more volumes.
Factors such as age, sex, body build, and physical
conditioning have an influence on lung volumes and
capacities. Lungs usually reach their maximum in
capacity in early adulthood and decline with age after
that.
12
The respiratory conducting passages are divided
into the upper respiratory tract and the lower
respiratory tract. The upper respiratory tract
includes the nose, pharynx, and larynx. The
lower respiratory tract consists of the trachea,
bronchial tree, and lungs. These tracts open to
the outside and are lined with mucous
membranes. In some regions, the membrane has
hairs that help filter the air. Other regions may
have cilia to propel mucus.
13
UPPER RESPIRATORY TRACT
14
LOWER RESPIRATORY TRACT
15

Nose and Nasal Cavities

Pharynx

Larynx & Trachea

Bronchi, Bronchial Tree, and Lungs
16
Nose and Nasal Cavities
Hairs and cilia line the nasal cavities and filter foreign
particles and pathogens from the inhaled air.
Mucus secreted by the mucosa traps substances in
inhaled air, and the cilia move particles of mucus
towards the pharynx to be swallowed or expectorated.
Inhaled air is warmed and moistened as it passes over
the mucosa. The 3 turbinate bones in each cavity
cause air flow to become turbulent, which enhances
contact of air with the mucosa.
Sensory organ for the sense of smell (olfactory)
17
18
Paranasal Sinuses
Paranasal sinuses are air-filled cavities in the frontal,
maxillae, ethmoid, and sphenoid bones. These
sinuses, which have the same names as the bones in
which they are located, surround the nasal cavity
and open into it. They function to reduce the weight
of the skull, to produce mucus, and to influence voice
quality by acting as resonating chambers.
19
THE PHARYNX
The pharynx, commonly called the throat, is a
muscular tube about 12cm long, lying in front of the
cervical vertebrae and behind the nose, mouth and
larynx. It serves both the respiratory and digestive
systems by receiving air from the nasal cavity and air,
food, and water from the oral cavity.
The pharynx is lined with mucous membrane and has
3 sections:
 Nasopharynx
 Oropharynx
 laryngopharynx
20
21
THE LARYNX
The larynx, commonly called the voice box or glottis,
is the passageway for air between the pharynx above
and the trachea below. It is formed by nine cartilages
that are connected to each other by muscles and
ligaments.
22
The larynx plays an essential role in human speech.
During sound production, the vocal cords close
together and vibrate as air expelled from the lungs
passes between them. The false vocal cords have no
role in sound production, but help close off the larynx
when food is swallowed.
The thyroid cartilage is the Adam's apple. The
epiglottis acts like a trap door to keep food and other
particles from entering the larynx.
23
THE TRACHEA
The trachea, commonly called the windpipe, is the
main airway to the lungs. It divides into the right and
left bronchi at the level of the fifth thoracic vertebra,
channelling air to the right or left lung.
The hyaline cartilage in the tracheal wall provides
support and keeps the trachea from collapsing. The
posterior soft tissue allows for expansion of the
oesophagus, which is immediately posterior to the
trachea.
24
25
Bronchi and Bronchial Tree
In the mediastinum, at the level of the fifth thoracic
vertebra, the trachea divides into the right and left
primary bronchi. The bronchi branch into smaller and
smaller passageways until they terminate in tiny air
sacs called alveoli.
26
27
THE LUNGS
Are the 2 main organs of the respiratory system.
They are divided into lobes, the left lung has 2 lobes
and is smaller that the right lung (which has 3 lobes.
Upper, middle and lower.), as the heart and its vessel
take up more space in the left side of the chest.
Each lung is surrounded by the pleura which is a
membrane consisting of 2 layers that are lubricated
by pleural fluid.
28
29
The Alveoli
Are microscopic air sacs in the lungs that form a
surface area of about 70m² and are surrounded by a
network of capillaries arising from the pulmonary
arteries.
The function of the alveoli is the interchange of O²
and CO² between the air in the alveoli and the blood
in the capillaries.
30
31
MUSCLES OF VENTILATION
The main muscles responsible for ventilation are the
diaphragm and the internal and external intercostal
Muscles.
When we breath in the intercostal muscles move the
ribs upwards and outwards and the diaphragm
pushes downwards, this draws air into the expanded
lungs.
Breathing out is a passive process – the recoil of the
ribs and the lungs with the return of the diaphragm to
a higher position squeeze the air out.
32
33
EXTERNAL RESPIRATION
Is the absorption of O² from the air into the blood and
the excretion of CO² from the blood into the air.
This takes place in the lungs
34
INTERNAL OR TISSUE
RESPIRATOIN
The O² is transferred from the blood to the tissues of
the body which at the same time give up CO².
This exchange takes place through the walls of the
capillaries
35
Upper Respiratory Tract Infection
(URTI)
A URTI is marked by a fever, cough - dry
or productive, sore throat, nasal
congestion, ear ache, ‘runny’ nose,
streaming eyes and sneezing

(Anderson et a. 1996).
36
Implications for Nursing Assistants

Assist residents as symptoms arise and
observe for any deterioration in condition.
37
CHRONIC AIRWAYS LIMITATION
CAL is also know as:
 Chronic Obstructive Pulmonary Disease – COPD

Chronic Obstructive Airways Disease – COAD
and is a term used to describe several similar
respiratory disorders that result in persistent
obstruction of the bronchial airflow.
38
ASTHMA
39
ASTHMA
40
ASTHMA

Chronic Asthma is a condition, which
manifests itself by intermittent episodes
of wheezing and dyspnoea. It is generally
associated with a hypersensitive state of
the bronchi, which may be attributable to
an allergic response.
(Miller et al. 1990).
41
Presenting Problems:






Cough, or tightness in chest.
Wheezing, shortness of breath.
Dyspnoea.
Anxiety, restlessness.
Fatigue.
Sputum- foamy, clear white too more
thick and/or purulent.
(Miller et al. 1990)
42
BRONCHITIS
43
BRONCHITIS

Chronic Bronchitis is a hyper secretion of
mucous and subsequent obstruction of
airflow.
(Miller et al 1990)
44
Presenting Problems




Shortness of breath.
Cough.
Expectoration.
Infection, necrosis and fibrosis of the
respiratory tract.
(Miller et al. 1990)
45
Implications for Nursing Assistants





Never turn on oxygen or increase oxygen on
a resident with breathing problems.
Focus your care on conserving the minimal
energy these residents possess.
Assist with activities of daily living.
Reassure the resident as problems with
breathing lead to anxiety.
Position resident to facilitate breathing orthopnoeic position or sitting with arms
crossed in front on table supported by pillow.
46




Maintain hydration and good nutrition.
Assist with deep breathing and coughing
exercises and postural drainage.
Encourage resident to assess the impact
of lifestyle choices, which affect their
condition e.g. smoking.
Sputum collection as required for culture
in the event of infection.
(Anderson 1996).
47
EMPHYSEMA
48
EMPHYSEMA

Emphysema is a lung disease
characterised by loss of lung elasticity due
to destruction of the alveoli. It can occur
as a result of chronic asthma and
bronchitis
(Miller et al. 1990).
49
Presenting Problems

Severe shortness of breath.

Cough, wheeze.

Barrel chest, clubbing of fingers.

Cardiac problems.
(Miller et al. 1990)
50
LUNG CANCER
51
Lung Cancer

Malignancy may arise in the bronchus as a
primary tumour and is a common site for
metastases
(Miller et al. 1990)
52
Presenting Problems






Cough.
Haemoptysis.
Discomfort, pain in chest.
Wheeze.
Repeated infections.
General symptoms: anorexia, weight
loss, fatigue.
(Miller et al. 1990)
53
Implications for Nursing Assistants




Emotional support of resident and
significant others.
Individual requirements for nutrition
and fluids.
Respond to symptoms as the need
arises: cough and shortness of breath.
Assist with activities of daily living.
(Anderson et al 1996)
54
PNEUMONIA
55
Pneumonia

Pneumonia is an inflammation of the lung
with consolidation and exudation. It can
be caused by bacteria or by viruses or by
inhalation or by immobility.
(Miller et al. 1990)
56
Presenting Problems





Cough.
High fever.
Night sweats.
Blood-streaked sputum.
Increase in pulse and respiratory rate.
(Miller et al. 1990)
57
PULMONARY TUBERCULOSIS
58
PULMONARY TUBERCULOSIS

T.B is an infectious (tubercle bacillus),
inflammatory, chronic lung disease
(Miller et al. 1990).
59
Presenting Problems









Malaise.
Anorexia.
Loss of weight.
Fever.
Cough.
Night sweats.
Purulent sputum.
Haemoptysis.
Pleurisy.
(Miller et al. 1990)
60
Implications for Nursing
Assistants






Assist with hygiene: resident may feel uncomfortable
after diaphoresis.
Encourage resident to maintain fluid intake and good
nutrition.
Position for comfort - lay on affected side; splint chest.
Assist resident to a position that facilitates breathing.
Encourage ambulation or assist with passive exercises.
Ensure standard precautions practiced when
appropriate especially when disposing of sputum.
(Anderson et al. 1996 & Luckman et al. 1990)
61