Respiratory

• Respiratory system


  The organs in your body that help you to breathe and are involved in the intake and exchange of oxygen and carbon dioxide between an organism and the environment
• Parts of the respiratory system

  • Upper respiratory tract
  • Nasal cavity
  • Pharynx
  • Larynx
  • Lower respiratory tract
  • Trachea
  • Primary bronchi
  • Lungs
• Nasal cavity


  • Large air filled space above and behind the nose in the middle of the face
  • Divided into a right and left passageway
  • Contains blood vessels that warm the air
  • Contains cells that add moisture to the air
  • Contains cilia and mucus that trap and remove dust and germs
• Pharynx


  Passageway leading from the mouth and nose to the esophagus and larynx
• Larynx


  Organ in the neck involved in breathing, sound production, and protecting the trachea against food aspiration
• Lungs


  • Main organs of the respiratory system
  • Where oxygen is taken into the body and carbon dioxide is breathed out
  • Red blood cells pick up oxygen and carry it to body cells, then pick up carbon dioxide and transport it back to the lungs
• Trachea


  Filters the air we breathe and branches into the bronchi
• Bronchi


  Two air tubes that branch off of the trachea and carry air directly into the lungs
• Alveoli


  • Small balloon-like structures where oxygen exchange takes place
  • Inflate and deflate with inhalation and exhalation
  • Functional unit of the lungs
• Diaphragm


  Major muscle of respiration that contracts and relaxes to create the vacuum that pulls air in and forces air out
• Pleura


  • Protective linings of the lungs that maintain negative pressure and aid in mechanics of breathing
  • Parietal pleura lines thoracic wall and superior portion of diaphragm
  • Visceral pleura is extension of parietal pleura that covers lung
• Functions of the respiratory system

  • Exchange of oxygen and carbon dioxide through respiration
  • Maintaining acid-base balance
• Physiology of respiration


  1. Mechanical process of pulmonary ventilation (inspiration and expiration)

  2. Physiological process of external respiration (exchange of gases between alveoli and blood), internal respiration (exchange of gases between capillaries and tissues), and cellular respiration (exchange of gases within the cell)
• Acid-base balance


  Respiratory system responds to changes in blood acidity by adjusting rate and depth of respiration
• Metabolic acidosis


  Respiratory system increases rate and depth of respiration to blow off excess carbon dioxide
• Metabolic alkalosis


  Respiratory system decreases rate and depth of respiration to conserve carbon dioxide
• Infants


  • Obligatory nose breathers
  • Respirations are primarily abdominal with irregular rhythm and brief periods of apnea
  • Chest shape is more round than oval
• Pregnant women


  • Have a 20% increase in oxygen consumption
  • Diaphragm rises and costal angle widens to accommodate enlarging uterus
• Older adults


  • Alveoli become fibrotic, reducing surface area for gas exchange
  • Breathing and lung capacity decrease due to muscle weakness and decreased elasticity
  • Increased dead space, trapped air, and decreased vital capacity
  • Musculoskeletal changes can cause barrel chest appearance
• Respiratory disease makes people tire easily because most of their energy is expended on breathing
• Biographical data


  Review of patient's age, residence, and occupation to identify actual or potential respiratory problems
• Major respiratory symptoms


  • Dyspnea
  • Cough
  • Chest pain
• Cough


  Protective, reflexive mechanism that helps maintain a patent airway
• Dyspnea


  Subjective sensation of breathing difficulty, may signal underlying cardiopulmonary or neuromuscular problem
• Chest pain


  May have cardiac, pulmonary, gastrointestinal, or musculoskeletal origin
• Other respiratory symptoms


  • Edema (from right-side congestive heart failure)
  • Hypoxia (increased energy expended for breathing, associated cardiac involvement)
• It may be normal with overexertion or anxiety, but may also signal underlying cardiopulmonary or neuromuscular problem
• Chest pain


  May have a cardiac, pulmonary, gastrointestinal, or musculoskeletal origin
• Chest pain of respiratory origin

  Is associated with the parietal pleura, chest wall, and mediastinal structures because the lungs and visceral pleura do not have pain fibers
• Edema


  • Results from right-side congestive heart failure, a common complication of COPD
  • Usually located in lower extremities or abdomen
• Hypoxia


  • Increased energy expended for breathing, and associated cardiac involvement accompany long-standing lung disease and contribute to the development of fatigue
  • Lower activity level, more difficulty performing ADLs
  • Changes in rest and sleep patterns may also be seen
• COPD


  • Chronic, progressive disease characterized by airway obstruction and diminished lung function
  • Includes emphysema and chronic bronchitis
  • Increasing dyspnea may correlate with the progression of the disease
• CHF


  • Causes the heart to pump ineffectively, resulting in volume overload
  • The right side, left side, or both sides of the heart can fail
  • Right heart failure (cor pulmonale) is frequently associated with lung disease
• Cor Pulmonale


  • Right heart hypertrophy or failure resulting from disorders of the lungs or pulmonary vessels
  • Common causes include COPDs and living at high altitudes for extended periods
• Past Health History


  • The purpose is to compare it with the patient's present respiratory status or uncover risk factors that might predispose him or her to respiratory disorders
  • Be sure to follow up on any unclear or vague answers
  • Rewording the question may help the patient find a relevant response
• Family History


  • The purpose is to identify any predisposing or causative factors of respiratory origin
  • If possible, help patients draw a family tree to help them remember more relevant information about family members
• Review of Systems


  • Identifies changes in other systems that result from changes in the respiratory system
  • Allows you to catch anything that you might have missed so far, and it gives meaning to the symptom by relating it to the affected symptom
• Psychosocial Profile


  • Reveals the lifestyle patterns that may affect the respiratory system and place the patient at risk for respiratory disorders
  • The patient's lifestyle may be affected by respiratory disease, especially when it is chronic
• Thoracic landmarks


  • Anteriorly, apices of lungs extend about 2cm above the inner aspect of the clavicles and continue downward to the 6th intercostal space at the MCI
  • Laterally, the lower border of the lung is at the 8th rib at the midaxillary line
  • Posteriorly, the apices of the lungs start at T1 and extend to T10 and T12 on deep inspiration
  • The right lung may be slightly higher because of the liver
• Sitting position


  • The best position for examination
  • For posterior approach, ask the patient to lean forward and cross his or her arms over the chest to spread the scapula and provide the greatest access to the lung surface
  • Perform all assessment techniques at each approach before changing the patient's position