Thorax and lungs

• The bronchiole is one of the smallest airways in the respiratory tract and it leads directly to the alveolar duct which houses the alveoli and the alveoli is responsible for exchanging gasses in the blood.
• Upper airway structures

  ● Nasopharynx

  ● Oropharynx

  ● Larynx

  ○ warms, filter and humidify

  ○ helps to make sound

  ○ sends air to lower airways
• Lower airway structures

  ● Trachea

  ○ divides into the right and left mainstem bronchi and continues to divide into smaller passages

  ● Bronchioles

  ○ divides into the right

  and left mainstem

  bronchi and continues to divide into smaller passages

  ● Alveoli

  ○ divides into the right and left mainstem bronchi and continues to divide into smaller passages
• How many?

  ○ 2 clavicles

  ○ 2 scapula

  ○ 1 Sternum (breast bone)

  ○ 12 pair of ribs – allow chest to contract and expand

  during each breath

  ○ 12 thoracic vertebrae
• Inspiration / Inhalation

  ▪ during inhalation the diaphragm presses the abdominal organs downward and forward
• Expiration / Exhalation

  ▪ during exhalation the diaphragm rises and recoils to the resting position
• ○ External Respiration

  ▪ the exchange of gasses (oxygen and carbon dioxide) between the alveoli and the blood through the alveolar-capillary membrane

  ○ Internal

  ▪ the exchange of gasses between the systemic capillaries and the tissue at the cellular level

  ○ Cellular

  ▪ exchange of gasses within the cell
• ▪ Ruddy, reddish color

  • associated with polycythemia
• ▪ Clubbing

  long-standing lung disease
• ▪ Peripheral edema

  frequently seen in people with chronic lung disease secondary to right-side CHF
• ▪ Cyanotic or dusky nails

  reflect peripheral cyanosis seen in vasoconstriction and slowing of peripheral blood flow

  also associated with central cyanosis
• ▪ Yellow-brown stains on nails and fingers

  • nicotine stains from long history of smoking
• ▪ Purple / dusky lower extremities

  - venous stasis, especially if PO2 is low
• Normal / Eupnea

  ○ normal breathing pattern

  ○ 16–20 breaths/min and regular
• • Tachypnea

  o may be a normal response to fever, anxiety, or exercise

  o can occur with respiratory insufficiency, alkalosis, pneumonia, or pleurisy

  o more than 24 breaths / min and shallow
• • Bradypnea

  o may be normal in well – conditioned athletes

  o can occur with medication – induced depression of the respiratory center, diabetic

  coma, neurologic damage

  o less than 10 breaths / min and regular
• Hyperventilation

  o usually occurs with extreme exercise, fear, or anxiety

  o causes of hyperventilation include

  o disorders of the central

  o nervous system

  o overdose of the drug salicylate

  o or severe anxiety

  o increased rate

  o increased depth
• Kussmaul

  o a type of hyperventilation associated with diabetic ketoacidosis

  o rapid, deep, labored
• Hypoventilation

  o Usually associated with overdose of narcotics or anesthetics

  o Decreased rate, decreased depth, irregular pattern
• Cheyne-Stokes Respiration

  o May result from severe congestive heart failure, drug overdose,

  o increased Intracranial pressure,

  o or renal failure

  o May be noted in elderly persons during sleep, not related to any disease process

  o Regular pattern characterized by alternating periods of deep, rapid breathing

  followed by periods of apnea
• • Biot’s Respiration

  o May be seen with meningitis or severe brain damage

  o Irregular pattern characterized by varying depth and rate of respirations followed by

  periods of apnea
• Ataxic

  o A more extreme expression of Biot’s respirations indicating respiratory compromise

  o Significant disorganization with irregular and varying depths of respiration
• Air Trapping

  o In chronic obstructive pulmonary disease, air is trapped in the lungs during forced

  expiration

  o Increasing difficulty in getting breath out
• Barrel Chest

  ▪ Most often associated with emphysema, asthma
• Pectus Excavatum

  ▪ Congenital chest wall deformity – ribs and sternum grows abnormally

  producing cave-in (concave) shape
• Pectus Carinatum

  ▪ Deformed human chest – projecting breastbone

  ▪ Defect in the connective tissue
• ▪ BRONCHIAL (B)

  • exhales – just above the clavicles on each side of the sternum
• BRONCHOVESICULAR (BV)

  • inhales and exhales – continous – next to the sternum between the

  scapula
• VESICULAR (V)

  • prolonged during inhalation shortened during exhalation – remainder of the lungs
• ▪ TRACHEAL

  • inhales or exhales above supraclavicular notch