Respiratory

Anatomy & physiology

Nasal Cavity

• Location– Btw mouth & cranium

• Function– Remove foreign bodies– Warm – Moisten – Olfactory

Nasal Cavity

• Nasal Septum• Separates• Cartilage

• Nostrils (nares)• Entrance• Mucous membrane

• Turbinates (Conchae)– surface area

Nasal Cavity

• Cilia– Hair-like – Wave-like movement– Moves towards

pharynx– with age

• Sensitive nerve endings:– Olfactory – Instigate sneeze

Para-Nasal Sinuses

• Description– 4 pairs– Facial area– Continuous w/ nasal

cavity

• Function:– Resonating chamber – Speech

Para-Nasal Sinuses

• Frontal– Forehead

• Ethmoid– Behind nasal bone

• Sphenoid– Behind ethmoid

• Maxillary– Sides of nose

Which is the largest sinus and the most likely to get infected?

A. FrontalB. EthmoidC. SphenoidD. Maxillary

Pharynx (throat)

• Passageway– Food & liquids

• Digestive tract

– Air • Respiratory tract

Pharynx (throat)

• Divided into 3 regions– Nasopharynx

• Upper portion• Behind nasal cavity• Adenoids

– Lymph system

• Eustachian tubes– Middle ear

Pharynx (throat)

• Oropharynx– Middle– Behind mouth– Tonsils

• Lymph chain

• Laryngeal pharynx– Lowest portion– Opens into 2 space

Larynx (voice box)

• Location– Btw pharynx & trachea

• Function– Vocalization– Protect Lower RT– Facilitates

cough/sneeze

Larynx (voice box)

• Glottis• Epiglottis– Epi = upon– Gateway / trap door– Flap of elastic cartilage

• Thyroid cartilage– Adam’s apple– Male

Larynx (voice box)

• Vocal cords– Cord like – Vibration– Controlled by muscles

Trachea (Windpipe):

• Location– Btw larynx & bronchi

• Description– 4-5 inches long– Palpate– Above sternal notch– Normal = midline

Trachea (Windpipe):

• Function– Conduct air– C-shaped rings of

cartilage– Carina

• Bifurcation• Very sensitive• When stim cough &

bronchospasm

Bronchi (pl)/Bronchus (sngl)

• Location– Below trachea– Center of chest– Behind the heart– Branches into 2 tubes

• Rt – diameter– More vertical– Shorter in length

Question?

Mr. Henderson had a CVA 5 days ago and is having some difficulty swallowing. There is some question that he may have aspirated some food and developed pneumonia. What side pneumonia would you except him to have?

A. Right sidedB. Left sided

Lungs

• Location– Thoracic cage– Airtight – Mult. Air sacs

• Description– Rt

• 3 lobes• Upper, middle, lower

– Lf• 2 lobes• Upper• Lower

Lungs

• Hilum (sngl)/ Hilus (pl)– URT– LRT

• Bronchi – Bronchial tree

• Bronchioles– No cartilage– Patency d/t

• elastic recoil of the smooth muscles

• alveolar pressure

Lungs

• Cilia• Alveolar ducts– Smallest tubes

• Alveoli– Functional unit– Air sacs– Gas exchange– Surrounded by pulm.

Capillaries

Lungs

• Alveoli– Thin membrane– Tendency to collapse

• Alveolar Pressure

– Secreted surfactant

Lungs

• Surfactant– Soft– Open– surface tension – Prevents collapse– Allows exchange– Stretch/sigh

• surfactant– Stiff & Collapse– Atelectasis

Pleural membrane

• Location– Surrounds surface of

lung & interior wall of thorax

• Function– Protects– Neg. pressure– Allows movement (

friction)

Pleural membrane

• Parietal pleura– Line chest cavity

• Visceral pleura– Covers lungs

• Pleural space/cavity– Btw– Contains fluid– fluid = pleural

effusion

Mediastinum

• Location– Space btw lungs

• Contains– Heart– Large blood vessels– Esophagus– Trachea– Bronchi

Diaphragm

• Location– Muscle btw lungs & abd.

Cavity• Aids in resp• CNS

– C-3 - C-5 • size of cavity

– pressure• Air flows from area of

higher pressure to lower pressure

• Inspiration– Contracts– Lowers– Pressure

•

• Expiration– Relax– Raises– Pressure

•

Skeletal System

• Ribs– 12 pairs– Thoracic cage

• Sternum– Manubruim– Body– Xiphoid process

Pulmonary circulation

• Main function of resp. system is to deviler O2 to the blood & remove CO2 from it.

• Pulm. Art. – CO2 / deoxygenated

• Pulm vein– O2 / oxygenated

Blood flow: heart and lungs

• Inf/sup vena cave• Rt atrium

– Tricuspid • Rt ventricle

– Pulm • Pulm art• Pulm cap• Pulm vein• Lt atrium

– Bicuspid / mitral• Left venticle• Aorta

Small Group Questions

• Name the structures that air flows past on its way to the lungs

• What is the primary function of the sinuses• How is speech produced?• What is the function of the epiglottis?• What are the supporting structures of the

trachea?

• What are the hilus and the carina? Where are they located?

• How many lobes do the rt and lf lungs each have?• Describe the movement of the diaphragm during

inspiration and expiration.• What is the function of surfactant? What stimulates

its release?• What is the purpose of the serous fluid btw the

pleural membranes?

Processes of respirationsVentilation• Movement of air in & out of the the tracheobronchial tree.

Delivering O2 to the alveoli & removing CO2Perfusion• Blood flow in the capillary bed in the lungsDiffusion• Movement of gases (O2 & CO2) across the alveoli membrane• Flows from area of greater concentration to lesser

concentration

Ventilation: Mechanics

• Air pressure– Air moves from

pressure pressure– How to you pressure?

• size

– How do you pressure?• size

Ventilation: Mechanics

Airway resistance• SIZE• Anything that

diameter of resp. tube – resistance – ventilation

• Asthma, bronchitis, obstruction

Ventilation: Mechanics

Lung Compliance• compliance – Elasticity of lungs

• Factors– Surface tension– Connective tissue

• compliance – Over distended

Ventilation: Lung Function

Measures ventilation• Lung Volume

– Tidal Volume*• Norm I – Norm E

– IRV• Norm I – Max I

– ERV• Norm E – Max E

– Residual volume*• Left over after expiration

Ventilation: Lung Function

Measures ventilation• Lung Capacity– Vital capacity*

• Max E – Max I• TV+IRV+ERV

– IC

Ventilation: Lung Function

Measures ventilation• Lung Capacity– FC– TLC*

• All vol. together• TV+IRV+ERV+RV

Question?

Given the following values, what is the patients Vital capacity? Total lung capacity?

TV – 500 mlIRV – 2000ERV – 1000RV – 1500

Answer!

TV – 500 mlIRV – 2000ERV – 1000RV - 1500

• Vital capacity– TV + IRV + ERV – 500+2000+1000 = – 3500ml

• TLC– TV+IRV+ERV+RV– 500+2000+1000+1500– 5000ml

Perfusion

• Blood flow through the pulm circulation

• Rt vent.• Pulm art divides into rt &

lf• Shunted blood

– no ventilation– “shunted”– receives no oxygenation

Perfusion

• Low pressure system– 20-30/5-15 – Alveolar pressure

• alveolar pressure • capillaries squeezes• perfusion

Diffusion

• Process where O2 & CO2 are exchanged at the air-blood interface

Control of Respiration

• Autonomic (some voluntary control)

• Resp. control center– Brain stem– Pons

• Rhythm– Medulla oblongata*

• Rate

• Normal rate– 12-20 /min

Control of Respiration

• Center is controlled by:– CO2 tension, – O2 tension– acidity (pH) of arterial

blood

Control of Respiration

• Chemo receptors– Monitor

• CO2• O2• pH

– Normal Values• PaCO2: 35-45 torr• PaO2: 80-100 torr• pH: 7.35-7.45

pH review

• Blood concentration of Hydrogen ions

• pH – Alkaline / alkalosis– Base

• pH – Acidic / acidosis– Acid

Control of Respiration

• Primary stimulant for respiration– PaCO2 level

• PaCO2 – resp. rate

Control of Respiration

• O2 carried in the blood– Hgb / RBC

• CO2 carried in blood– CO2+ H2O = H2CO3

• Carbonic acid

• CO2 = Acid

Control of Respiration

• CO2 – Acid

•

– pH•

– Acidosis– Resp. rate

•

• CO2 – Acid

•

– pH•

– Alkalosis– Resp. rate

•

O2 /CO2 exchange:

Must have…• O2 supply• Patient airway• Functioning bellows• Alveoli & capillaries• Hgb• Circulatory system• CNS resp. center

O2 Supply

• Smoke inhalation• CO poisoning• Altitude

Patient airway

• Choking

Heimlich Hokey Pokey

You put your right fist in,You keep the thumb side inYou put your left hand on,

And you’re lifting in and up.Do the Heimlich Hokey Pokey,And you clear the airway out.

That’s what it’s all about!

If you are alone and chocking

Pregnant / Obese

Function bellows / movement

• Pneumothorax• Quadriplegia• Myasthenia gravis• Muscular dystrophy• Cerebral palsy

Function respiratory center

• Depressed respiratory center– Heroin– Morphine– Barbiturates– Alcohol

• CVA

Physiologic changes with aging• Ribs movement

– Cartilage calcification– Kyphosis

• Lungs more ridged & less elastic

• Residual volume–

• Vital capacity–

• Muscle strength –

• MORE VULNERABLE!– Resp problems