Respiratory
System
AGATHA BABYET A. ALABATA, BSN- III STEM
Respiratory System
The respiratory system is the network of organs
and tissues for breathing. It includes airways,
lungs, and blood vessels. The muscles that
power the lungs are also one of the respiratory
system. These parts work together to move
oxygen throughout the body and clean out
waste gases like carbon dioxide.
Anatomy and Physiology
Anatomy and Physiology
UPPER RESPIRATORY TRACT LOWER RESPIRATORY TRACT
Nostrils Trachea
Nasal Cavity Bronchi and Bronchioles
Pharynx Lungs
Larynx Alveoli
Upper Respiratory Tract
All of the organs and other structures of the upper respiratory tract are involved in
conduction or the movement of air into and out of the body. Upper respiratory tract
organs provide a route for air to move between the outside atmosphere and the lungs.
They also clean, humidify, and warm the incoming air. However, no gas exchange
occurs in these organs.
Upper Respiratory Tract
Nasal Cavity
The nasal cavity is a large, air-filled space in the skull above and
behind the nose in the middle of the face. It is a continuation of the two
nostrils. As inhaled air flows through the nasal cavity, it is warmed and
humidified. Hairs in the nose help trap larger foreign particles in the air
before they go deeper into the respiratory tract. In addition to its
respiratory functions, the nasal cavity also contains chemoreceptors
that are needed for the sense of smell and that contribute importantly to
the sense of taste.
Pharynx
The pharynx is a tube-like structure that connects the nasal cavity and
the back of the mouth to other structures lower in the throat including
the larynx. The pharynx has dual functions: both air and food pass
through it, so it is part of both the respiratory and the digestive systems.
Air passes from the nasal cavity through the pharynx to the larynx.
Food passes from the mouth through the pharynx to the esophagus.
Upper Respiratory Tract
Larynx
The larynx, commonly called the voice box or
glottis, is the passageway for air between the
pharynx above and the trachea below. It extends
from the fourth to the sixth vertebral levels. The
larynx plays an essential role in human speech.
During sound production, the vocal cords close
together and vibrate as air expelled from the lungs
passes between them.
Lower Respiratory Tract
Trachea
The trachea, commonly called the windpipe, is the main airway
to the lungs. It divides into the right and left bronchi at the level
of the fifth thoracic vertebra, channeling air to the right or left
lung. The cartilage in the tracheal wall provides support and
keeps the trachea from collapsing. The mucous membrane that
lines the trachea is similar to that in the nasal cavity. Mucus
traps airborne particles and microorganisms, and the cilia propel
the mucus upward, where it is either swallowed or expelled.
Bronchi and Bronchioles
There are two main bronchial tubes, or bronchi (bronchus),
called the right and left bronchi. The bronchi carry air between
the trachea and lungs. Each bronchus branches into smaller,
secondary bronchi; and secondary bronchi branch into still
smaller tertiary bronchi. The smallest bronchi branch into very
small tubules called bronchioles. The tiniest bronchioles end in
alveolar ducts, which terminate in clusters of minuscule air sacs,
called alveoli (singular, alveolus), in the lungs.
Lower Respiratory Tract
Lungs
The lungs are the largest organs of the respiratory tract.
They are suspended within the pleural cavity of the thorax.
The lungs are surrounded by two thin membranes called
pleura, which secrete a fluid that allows the lungs to move
freely within the pleural cavity. This is necessary so the
lungs can expand and contract during breathing. Lung
tissue consists mainly of alveoli. Each time when a person
breathe in, the alveoli fill with air, making the lungs
expand. Oxygen in the air inside the alveoli is absorbed by
the blood in the mesh-like network of tiny capillaries that
surrounds each alveolus. The blood in these capillaries
also releases carbon dioxide into the air inside the alveoli.
Each time you breathe out, air leaves the alveoli and
rushes into the outside atmosphere, carrying waste gases
with it.
Functions of the Respiratory System
Functions of the Respiratory System
INHALATION AND EXHALATION
The respiratory system aids in breathing, also
called pulmonary ventilation. In pulmonary
ventilation, air is inhaled through the nasal
and oral cavities. It moves through the
pharynx, larynx, and trachea into the lungs.
Then air is exhaled, flowing back through the
same pathway. Changes to the volume and air
pressure in the lungs trigger pulmonary
ventilation. During normal inhalation, the
diaphragm and external intercostal muscles
contract and the ribcage elevates. As the
volume of the lungs increases, air pressure
drops and air rushes in. During normal
exhalation, the muscles relax. The lungs
become smaller, the air pressure rises, and air
is expelled.
Functions of the Respiratory System
EXTERNAL RESPIRATION EXCHANGES
GASES BETWEEN THE LUNGS AND THE
BLOODSTREAM
This respiratory process takes place through
hundreds of millions of microscopic sacs
called alveoli. Oxygen from inhaled air
diffuses from the alveoli into pulmonary
capillaries surrounding them. It binds to
hemoglobin molecules in red blood cells, and
is pumped through the bloodstream.
Meanwhile, carbon dioxide from deoxygenated
blood diffuses from the capillaries into the
alveoli, and is expelled through exhalation.
Functions of the Respiratory System
INTERNAL RESPIRATION EXCHANGES
GASES BETWEEN THE BLOODSTREAM
AND BODY TISSUES
In this respiratory process, red blood cells
carry oxygen absorbed from the lungs
around the body, through the vasculature.
When oxygenated blood reaches the
narrow capillaries, the red blood cells
release the oxygen. It diffuses through the
capillary walls into body tissues.
Meanwhile, carbon dioxide diffuses from
the tissues into red blood cells and plasma.
The deoxygenated blood carries the
carbon dioxide back to the lungs for
release.
Functions of the Respiratory System
AIR VIBRATING THE VOCAL CORDS CREATES
SOUND
Phonation is the creation of sound by
structures in the upper respiratory tract of the
respiratory system. During exhalation, air
passes from the lungs through the larynx, or
“voice box.” When we speak, muscles in the
larynx move the arytenoid cartilages. The
arytenoid cartilages push the vocal cords, or
vocal folds, together. When the cords are
pushed together, air passing between them
makes them vibrate, creating sound. Greater
tension in the vocal cords creates more rapid
vibrations and higher-pitched sounds. Lesser
tension causes slower vibration and a lower
pitch.
Functions of the Respiratory System
OLFACTION/SMELLING ( CHEMICAL
SENSATION )
The process of olfaction begins with
olfactory fibers that line the nasal cavities
inside the nose. As air enters the cavities,
some chemicals in the air bind to and
activate nervous system receptors on the
cilia. This stimulus sends a signal to the
brain: neurons take the signal from the
nasal cavities through openings in the
ethmoid bone, and then to the olfactory
bulbs. The signal then travels from the
olfactory bulbs, along cranial nerve 1, to
the olfactory area of the cerebral cortex.
Health History
Health History
CHIEF COMPLAINT
Main reason that the patient came in ED in
their own words
AMPLE: Allergies, Medications, Past Medical
History, Last ate, Events leading to
Presentation
Health History
Sign and Symptoms
CHESTPAIN
DYSPNEA
Onset and duration: Sudden, gradual,
episodic or continuous PQRST:
Characteristics: Related to position, time Palliative and provoking factors
of the day, activity or miscellaneous Quality of pain
Acuity
Radiation and region of pain
Provoking factors: Anxiety, exercise,
environment Severity of pain
Palliative factors Time of onset and length
Assocated symptoms: Chestpain, cough, Associated symptoms: Diaphoresis, nausea,
diaphoresis, edema etc.
Self treatment and effectiveness Self treatment and effectiveness
Health History
Sign and Symptoms
SPUTUM PRODUCTION COUGH
Onset and duration Onset and duration
Characteristics: colour, Characteristics: Dry/moist,
consistency productive, postural influences
Associated symptoms: Vomiting, Associated symptoms
fever, DOB Self treatment and effectiveness
Self treatment and effectiveness
Health History
Sign and Symptoms
FAMILY HISTORY
OCCUPATIONAL HISTORY
Illness in parents or siblings, Type of work patient is engaged in;
pulmonary, cardiac, cancer are they exposed to air or chemical
pollutants
Exposure to exotic animals, birds;
pigeons, parrots, parakeets
Consider the part of the country they
are from; some diseases are
endogenous
Physical Assessment
Physical Assessment
Inspection
Auscultation
Palpation
Percussion
Physical Assessment
Inspection
General:
Level of consciousness
Agitation/ anxiety
Speech:
Sentences/phrases, words, unable to speak
Quality(hoarseness)
Skin Colour:
Pallor/Cyanosis
Exercise tolerance/body position
Physical Assessment
INSPECTION Thorax
Symmetry of chest wall movement
Head and Neck: Accessory muscle use, recession
Nasal Flaring Rate, rhythm, pattern of breathing
Pursed lip breathing Evidence of trauma, wounds, deformity, flail, bruising, scars
AP vs transverse diameter of chest
Mouth/nose breathing
Alignment of spine: presence of kyphosis, scoliosis
Evidence of trauma: Deformity,
bruising, wounds, swelling, burns Extremeties
Clubbing
Tracheal position
Edema
Peripheral cyanosis
Physical Assessment
Auscultation
NORMAL BREATH SOUNDS ABNORMAL BREATH SOUNDS
Vesicular: quiet low pitched, longer Crackles: Discontinous sounds, soft, high
inspiratory that expiratory phase, heard in pitched, popping sounds most common
most lung fields during inspiration
Bronchovesicular: Medium in pitch, Wheezes: Continous musical sounds and
inspiratory and expiratory phase equal in persist through respiratory cycle.
length
Rhonchi: continuous breath sound, low
Bronchial: Higher pitched and louder pitched rumbling noises.
than vesicular, expiratory is longer than
inspiratory phase, heard around 2nd and 3rd Friction Rub: Crackling grating sound heard
intercostal space anteriorly more often with inspiration than expiration
Tracheal: Loud, high pitched, approx.
equal inspiratory and expiratory phase,
heard over trachea
Physical Assessment
Palpation
Neck Identify
Position of the trachea Areas of bony or soft tissue tenderness,
crepitus, depressions, bulges, pulsations,
Subcutaneous emphysema paradoxical movement and subcutaneous
Chest emphysema.
Palpate thorax systematically, Subcutaneous emphysema
comparing left from right Assess respiratory excursion(expansion)
Identify tactile fremitus
Physical Assessment
Percussion
Usual sound is resonant or hollow
Dull note: Medium in intensity and pitch, heard in atelectasis or consolidation is
present
Tympanic sound: High pitched heard if pneumothorax or asthma is present
Flat note: Large pleural effusion
PHYSICALASSESSMENT OF BREATHINGABILITYIN THEACUTELY ILLPATIENT
PHYSICAL ASSESSMENT OF BREATHING ABILITY IN
THE ACUTELY ILL PATIENT
Patients whose chest expansion is limited by external restrictions such as obesity or
abdominal distention and who cannot breathe deeply because of postoperative pain or
sedation will inhale and exhale a low volume of air (referred to as low tidal volumes).
Prolonged hypoventilation at low tidal volumes can produce alveolar collapse or
atelectasis. The amount of air remaining in the lungs after a normal expiration
(functional residual capacity) falls, the ability of the lungs to expand (compliance) is
reduced, and the patient must breathe faster to maintain the same degree of tissue
oxygenation. These events can be exaggerated in patients who have preexisting
pulmonary diseases and in elderly patients whose airways are less compliant, because
the small airways may collapse during expiration.
PHYSICAL ASSESSMENT OF BREATHING ABILITY
IN THE ACUTELY ILL PATIENT
TIDAL VOLUME MINUTE VENTILATION
The volume of each breath is referred Respiratory rates and tidal volume alone are
to as the tidal volume. A spirometer is unreliable indicators of adequate ventilation because
both can vary widely from breath to breath. Together,
an instrument that can be used at the however, the tidal volume and respiratory rate are
bedside to measure volumes. If the important because the minute ventilation, which is
patient is breathing through an useful in detecting respiratory failure, can be
endotracheal tube or tracheostomy, the determined from them. Minute ventilation is the
volume of air expired per minute. It is equal to the
spirometer is directly attached to it and product of the tidal volume and the respiratory rate or
the exhaled volume is obtained from the frequency. In practice, the minute ventilation is not
reading on the gauge. In other patients, calculated but is measured directly using a spirometer.
the spirometer is attached to a facemask Minute ventilation may be decreased by a variety of
or a mouthpiece positioned so that it is conditions that result in hypoventilation. When the
airtight, and the exhaled volume is minute ventilation falls, alveolar ventilation in the
lungs also decreases, and the PaCO2 increases.
measured.
PHYSICAL ASSESSMENT OF BREATHING ABILITY
IN THE ACUTELY ILL PATIENT
VITAL CAPACITY INSPIRATORY FORCE
Vital capacity is measured by having the patient take in Inspiratory force evaluates the effort the
a maximal breath and exhale fully through a patient is making during inspiration. It does
spirometer. The normal value depends on the patient’s
age, gender, body build, and weight. not require patient cooperation and thus is
useful in the unconscious patient. The
When the vital capacity is exhaled at a maximal flow
rate, the forced vital capacity is measured. Most
equipment needed for this measurement
patients can exhale at least 80% of their vital capacity includes a manometer that measures negative
in 1 second (forced expiratory volume in 1 second, or pressure and adapters that are connected to an
FEV1) and almost all of it in 3 seconds (FEV 3 ). A anesthesia mask or a cuffed endotracheal tube.
reduction in FEV1 suggests abnormal pulmonary air The manometer is attached and the air-way is
flow. If the patient’s FEV1 and forced vital capacity are completely occluded for 10 to 20 seconds
proportionately reduced, maximal lung expansion is
restricted in some way. If the reduction in FEV 1 greatly while the inspiratory efforts of the patient are
exceeds the reduction in forced vital capacity, the registered on the manometer.
patient may have some degree of airway obstruction.
