Anatomy & Physiology
UPPER AIRWAY
a. nose b. pharynx c. larynx
LOWER AIRWAY
a. trachea b. bronchi c. bronchus d. lungs
NOSE-externally, a framework of bone& cartilage
PHARYNX-muscular passageway "THROAT"
LARYNX-"voice box",connects upper to lower airway
Major FXN: a. protection of airway b. respiration c. phonation
TRACHEA-11-13 cm in length ,1.5-2.5 cm in diameter
BRONCHI divided into:
a.RIGHT mainstem-3 lobes; 10 segments, larger & straighter
b.LEFT mainstem-2 lobes (upper &lower),8 segments
BRONCHIOLE-transition to alveolar epithelium
*respiratory epitehelium
-ciliated pseudostratified with goblet cells
*alveolar epithelium
-simple squamous; important for gas exchange
LUNGS -main organ of respiration
a. Respiration-process where exchange happen between atmosphere & cells of the body
b. Ventilation-movement of air in and out of airways; replenishing oxygen and removing CO2
ALVEOLI-functional cellular unit of lung where alveolar gas exchange happens
CHEST WALL
Includes :a.rib cage b. intercostal muscles d.diaphragm
-EXT ICS MUSCLES-raise ribcage during inspiration to increase size of thoracic cavity
-INT ICS MUSCLES-pull rib down & play a role in forced expiration
-DIAPHRAGM-major muscle of ventilation
CONTROL OF RESPIRATION
a. Voluntary
B. Involuntary-via respiratory center a. pons b. medulla
1.CO2-mainly stimulate respiratory center to increase strength in both inspiration & expiration
-very potent ACUTE effect in controlling respiration BUT WEAK CHRONIC EFFECT
2. Decreased Oxygen-"relative hypoxemia"
-pO2"=30-60 mmHg
a.Health History-focus on chief complaint
Presenting problems:
-cough-duration, frequency, type, productive/non-productive
-dyspnea-difficuty of breathing
-chest pain a.sharp b. stabbing c.increase with movement & deep breathing
- hemoptysis-expectoration of blood
b.Lifestyle
-smoking-slows ciliary action & decreases mucus clearance from lungs
-alcohol intake-large amount of alcohol depress gag reflex-->aspiration
-occupation
- environmental exposure
c.Nutrition/Diet-intake of fluid for 24 hours & intake of vitamin supplements
d.Past Medical History-immunizations & results of tuberculin testing
PHYSICAL EXAMINATION
a.Inspection -configuration of the chest
*normal:transverse 2x AP diameter
**increase APT diameter-->COPD
-presence of cyanosis
-respiration (rate, regularity, effort)
-presence of clubbing
*long standing hypoxia such as fibrosis, lung cancer, COPD
b.Palpation -tracheal position for masses & displacement
-excursion (symmetrical)
-fremitus:transmission of vibration of air movement in chest wall
-compare intensity of vibration produced
-increase: *pneumonia *pulmonary fibrosis *tumor
-decrease *COPD *pneumothorax *pleural effusion
c.Percussion-sounds produced by tapping
-look for resonance over normal lung tissue
-hyperresonance-->COPD -dullness-->pneumonia, cancer
d.Auscultation Breath Sounds
Normal:
*Vesicular- peripheral lung fields & small bronchioles & alveoli
*Bronchial- trachea & larynx
*Bronchovesicular- major bronchi with few alveoli, posteriorly, between scapulae, anteriorly, upper sternum
Abnormal Sounds:
-wheezes-musical sound when air passes in a partially obstructed or narrowed airways during
EXPIRATION
-stridor-harsh sound when air passes in a partially obstructed or narrowed UPPER airways DURING INSPIRATION
-rales/crackles-sound produced with opening of small airways & alveoli
Laboratory/Diagnostic Test
Arterial Blood Gases-measures the following:
a. base excess & deficit b. O2 (saturation & content,PaO2) c. CO2 (total & PaCO2)
Nursing Care:-place bandage over puncture site
-maintain pressure with 2 fingers for 5 mins over radial & brachial; 10 mins over femoral sites
-rotate specimen gently in test tube to mix heparin with blood
-place in ice water till it can be analyzed
ABG ANALYSIS Values:
pH 7.35-7.45 pCO2 35-45 HCO3 22-26 paO2 80-100 mmHg
1.Assess the degree of hypoxemia-->decreased O2 in arterial blood
a.mild <80 b.moderate <60 c.severe <40
Tx: O2 therapy
2.Assess ventilatory state
-->paCO2 it evaluates efficiency of alveolar ventilation
Alveolar HYPOventilation= >50 mmHg due to CO2 retention
Alveolar HYPERventilation =<30 mmHg due to over breathing
3.Assess acid-base imbalance
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