Respiratory System

gas exchange (in alveoli)

True

eliminated

1. conducting system

2. respiratory tissues

air passes between atmosphere & lungs

where gas exchange takes place

• ventilation

• perfusion

• diffusion

movement of gases into & out of lungs

movement of blood through the lungs

diffusion of gases between lungs & blood

true

• nose

• pharynx

• larynx

• trachea

• bronchi

• bronchioles

• alveolar duct

• alveoli

gas exchange!

• internal, external, cellular respiration

inflammation of parenchymal structures of the lung in the lower respiratory tract

• 6th leading cause of death in the U.S

• infectious: S. Pneumonia, Pseudomonas, Staph (bacterial)

• Non-Infectious: inhalation of irritating fumes, aspiration of gastric contents (inflammation response)

• according to setting: community or hospital acquired (Nosocomial)

  • ex: “I was in the hospital for appendectomy but I also got pneumonia from the pt next door”

• according to type of agent causing the infection (typical or atypical)

• according to distribution of infection (lobar, bronchopneumonia)

• typical pneumonia → in alveoli

• atypical pneumonia → in tissues that surround the alveoli

Immunocompromised Pt:

• bone marrow/organ transplant

• cancers

• pts on corticosteroids

Acute Bacterial Pneumonia:

• based on etiologic agent

  • pneumococcal

  • legionella

→ assess for loss of cough reflex, damage to ciliary endothelium, diabetes, chronic bronchitis, smoking

signifies a patchy consolidation involving more than one lobe

consolidation of a part or all of a lung lobe

disease of the lung tissue itself

• leading cause of cancer death

True

• smokers can benefit at any age from smoking cessation (part of discharging a pt, to encourage a pt to not smoke anymore)

asbestos

epithelial

bronchial mucosa

necrosis

small cell or non-small cell

produce paraneoplastic syndromes

25-40% occurence

20-40% occurence

20-25% occurence

10-15% occurence

• weight loss

• anorexia

• chronic cough

• SOB

• wheezing

• hemoptysis

• pain

• chest x-ray

• history/physical

• bronchoscopy

• cytological studies

• CT scan/MRI

• PET (CAT Scan with contrast)

reduction in arterial blood O2 levels = PaO2 < 95mmHg (not enough O2)

• inadequate O2

• dysfunction of neurologic system

• alterations in circulatory function

~if PO2 pf the tissues falls below a critical level, aerobic metabolism stops → anaerobic metabolism takes over → lactic acid is released

• increased heart rate

• diaphoresis (cold, clammy, sweaty)

• mental status changes

  • restlessness

  • confusion

  • combative/agitated

  • stuper/coma

• hyperventilation

• cyanosis

• arterial blood gas (PaO2)

• pulse ox (good idea if someone is hypoxemia

increase in CO2 of arterial blood (PaCO2=too much CO2)

• pt not breathing enough

• alterations in CO2 production

• disturbance in gas exchange in lungs

• abnormalities in function of chest wall & respiratory muscles

• changes in neural control of respiration

• respiratory acidosis (decreased pH, elevated CO2)

• vasodilation of blood vessels

• CNS depression

arterial blood gas (PaCO2)

chronic disorder of airway

• episodic airway obstruction

• bronchial hyperresponsiveness

• airway inflammation

• in some → airway remodeling (repeated inflammation)

• genetic disposition for development of IgE to common allergies

• family history

• antenatal exposure to tobacco smoke

• tobacco smoke

• dust mites

• GERD

• hormones

• cold

• emotions

• excerise

• airway inflammation manifested by inflammatory cells (eosinophils, most cells) → damage to bronchial epithelium

• mediators associated with asthma

  • cytokines: tumor necrosis, interlukins 1,4,5

  • histamine

  • leukotrienes

• episodes are reversible either spontaneously or with tx

• airways narrow due to bronchospasm

• edema of bronchial mucosa

• FEV1 → decreased ( can’t get air out of alveoli)

• accessory muscle use

• increased work of breathing

• ineffective cough

• hypoxemia/hypercapnia

• decreased breath sounds

• wheezing

• chest tightness

• fatigue

• diaphoresis

• severe dyspnea

• acute resp. failure (inaudible breath sounds, no wheezing)

characterized by chronic & recurrent obstruction of airflow

• obstruction is progressive & accompanied by inflammatory responses

→ leading cause of death/hospitalization

• smoking

• antitrypsin (hereditary)

• asthma

• airway hyperresponsiveness

• inflammation

• fibrosis of bronchial wall

• hypertrophy of submucosal glands

• hypersecretion of mucus

• loss of elastic lung fibers & alveolar tissue

• destruction of alveolar tissue decreases surface area for gas exchange

• loss of elastic fibers impair expiration → oncrease air trapping airway collapse

1. emphysema

2. bronchitis

destruction of area surface of the alveoli

• enlargement of airspaces & destruction of lung tissue

→ loss of lung elasticity

→ abnormal enlargement of airspaces - air trapping

→ destruction of alveolar walls/capillary beds

→ breakdown of elastin by enzymes (protease)

• smoking

• antitrypsin deficiency

“pink puffer”

• lack of cyanosis

• use of accessory muscles

• pursed lips breathing “puffer breathing”

• airways collapse during expiration → airway trapping in alveoli & lungs = barrel chest

destruction of major/small airways

• increased mucus production

• chronic productive cough (last for 3 months → 2 years)

• hypersecretion of mucus in large airways

• plugging of airway lumen, inflammation

• increase in goblet cells

• cigarette smoking

• dust/toxic gases

“blue bloaters”

• cyanosis

• fluid retention with right sided heart failure (causes fluid to build up)