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SYSTEM C
Results
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Learning Objectives
• Nasopharynx
• Oropharynx
• Ciliated mucosa
• Warms, filters, and humidifies the air
• Connected to the lower airways by
the larynx
Lower Airways
• The trachea connects the larynx to the bronchi
• Divides at the carina into two bronchi
• Right
• Larger and more vertical
• Left
• Smaller
Lower Airways
• The bronchi connect to the lungs
via the hila
• The bronchi divide into terminal
bronchioles and end in the
respiratory bronchioles
• These end in alveolar ducts, and
then alveolar sacs
• The bronchioles and alveoli are
responsible for gas exchange
Lungs
• Lungs
• Right
• Lobes
• Upper
• Middle
• Lower
• Left
• Lobes
• Upper
• Lower
• When you are upright, gravity pulls the lungs down
Blood Vessels
• Blood vessels
• Responsible for gas exchange
• What controls the pulmonary
circulation?
• Hint: It also controls the systemic
circulation
• The autonomic nervous system
• The entire amount of blood from the right
ventricle enters the pulmonary artery
• The alveolocapillary membrane is where
gas exchange occurs
• Thin with a large surface area
• The pulmonary capillaries drain into the
pulmonary veins which then enter the left
atrium
Alveoli
• Alveoli
• Primary area for gas-exchange
• Oxygen enters the blood
• CO2 is removed from the blood
• Adults have 480 million alveoli
• Surfactant
• Causes expansion during inspiration, lowers surface
tension at the end of expiration, and prevents lung
collapse
Thoracic Cage
• Thoracic cage
• Also called the chest wall
• Protects the lungs and performs the work of breathing
• The pleura is a serous membrane that adheres to the lungs
(visceral pleura) and to the chest wall (parietal pleura)
• The area between these two pleura is called the pleural space
• It is normal to have a thin layer of fluid in the pleural space to
allow for the two to slide over each other
• Has a negative pressure
Diaphragm
• Diaphragm
• Performs the work of breathing
• Inhale: diaphragm contracts and flattens
• Exhale: diaphragm relaxes
Mediastinum
• Mediastinum
• Space between the lungs that contain the
heart, great vessels, and esophagus
FUNCTIONS OF THE
PULMONARY SYSTEM
C
Ventilation
• Ventilation
• The movement of gas or air into and out of the
lungs
• Involuntary process by the respiratory center/ANS
• Often misnamed respiration (which is actually
the exchange of O2 and CO2)
• Cellular metabolism creates CO2
• CO2 must be eliminated to maintain a normal
PaCO2 (40 mmHg) and a normal acid-base
balance
• How can you determine adequate ventilation?
• Hint: not by respiration rate
• Arterial blood glass analysis
Muscles of Breathing
• Inspiration
• Major muscles
• Diaphragm
• When it contracts, it flattens downward,
which increases the volume of the
thoracic cavity and creates a negative
pressure, which draws gas into the lungs
• External intercostal muscles
• When they contract, this elevates the
anterior portion of the ribs, which
increases the volume of the thoracic
cavity Accessory muscles
• Sternocleidomastoid
• Scalene
• Used with an increased work of breathing
Muscles of Breathing
• Expiration
• Normally is a passive process, no muscles used
• Elastic recoil
• The lungs return to normal state after inspiration
• Compliance
• Measure of the lung and chest wall’s stretch ability
• Increased = loss of elastic recoil
• Decreased = stiff and difficult to inflate lungs
Alveolar Surface Tension
• Alveolar Surface Tension
• Surface tension makes expansion more difficult
• Surfactant lowers the surface tension of the alveoli
• Lines the alveolar side of the alveolocapillary membrane
• Prevents alveolar collapse
Airway Resistance
• Airway resistance
• Normally low
• Increases as the diameter of the airway decreases
• Increased with bronchoconstriction or edema
• Decreased with bronchodilation
Gas Transport: Steps
• Gas Transport
• Delivers O2 to the cells
• 1. Ventilation of the lungs
• 2. Diffusion of O2 from the alveoli into the
capillary blood
• 3. Perfusion of the systemic capillaries with
oxygenated blood
• 4. Diffusion of oxygen from systemic
capillaries into the cells
• 1 L of O2 is delivered to the cells every minute
Gas Transport: Steps
ALTERATIONS
Dyspnea
• Discomfort with breathing, shortness of
breath, chest tightness, increased work of
breathing
• More severe symptoms include nasal
flaring, accessory muscles, retraction of
intercostal spaces
• Can be at rest, on exertion
• Orthopnea = when lying flat
• Paroxysmal nocturnal dyspnea = wakes
you up at night, must sit up to relieve the
dyspnea
Cough
• Cough
• Clears the airways by forced expiration
Abnormal Sputum
• Abnormal sputum
• Observe amount, consistency, color, and odor
• Hemoptysis = coughed up blood
Abnormal Breathing Patterns
• Eupnea = normal breathing pattern (8-16 breaths per minute) with tidal volume
between 400-800 mL and 10-12 sigh breaths per hour
Kussmaul Respirations
• Kussmaul respirations = tachypnea, increased ventilatory rate, large tidal volume, and
no expiratory pause
Labored Breathing
• Hypoventilation
• Inadequate alveolar ventilation in relation to metabolic demands
• CO2 removal does not keep up with CO2 production and paCO2 increases, causing hypercapnia and
respiratory acidosis
Hyperventilation
• Hyperventilation
• Alveolar ventilation that exceeds metabolic demands
• Lungs remove CO2 faster than it is produced by cellular metabolism, causing hypocapnia and respiratory
alkalosis
Cyanosis
• Cyanosis
• Blue discoloration of the skin and mucous membrane
• Caused by increased amount of desaturated
hemoglobin
• Peripheral = fingers and toes (best seen in the nail beds)
• Central = mucous membranes and lips
• Clubbing
• Enlargement of the end of a digit from an interference in oxygenation
• Pain
• In the pleurae, airways, or chest wall
• Hypercapnia
• Increased CO2 concentration in the arterial blood
• Hypoxemia
• Reduced oxygenation of arterial blood
• Hypoxia
• Reduced oxygenation of cells in the tissues
• Acute respiratory failure
• Inadequate gas exchange
DISORDERS OF THE
CHEST WALL AND
C
PLEURA
Flail Chest
• Flail chest
• From rib fracture, causes paradoxical chest movement
• When the intrathoracic pressure is negative during inspiration, the fractured chest wall moves
inward and during expiration it moves outward, impairing gas exchange
Pneumothorax
• Pneumothorax
• Presence of air or gas in the pleural space,
causes pain, tachypnea, and absent breath
sounds on the affected side
• Different types
• Open pneumothorax: can be spontaneous or
traumatic
• Tension pneumothorax
• Air is drawn in at the through the site of the
pleural rupture, air enters on inspiration, but
cannot escape during expiration
• As more and more air is drawn in, the pressure
in the pleural space exceeds the barometric
pressure
• This pressure compresses the already recoiled
lung and the heart and great vessels
• Causes hypotension tracheal deviation away
from the affected lung
• Insertion of chest tube is needed
Pleural Effusion
• Pleural effusion
• Presence of fluid in the pleural space
• Chylothorax: chyle
• Hemothorax: blood
• Empyema: pus, infected pleural effusion
• Clinical Manifestations: Dyspnea, cough,
chest pain
• Treatment: Antibiotics, thoracentesis, or
chest tube
PULMONARY
DISORDERS
C
Restrictive Lung Disorders
• Pulmonary Fibrosis
• Excessive amount of fibrous or connective tissue in the lung
• Clinical manifestations: loss of lung compliance, decrease in
the diffusing capacity, hypoxemia, dyspnea on exertion,
inspiratory crackles
• Treatment: avoidance of the triggers, corticosteroids, cytotoxic
drugs, anti-fibrotic drugs, interferon, anticoagulation, lung
transplant
Pulmonary Edema
• Pulmonary Edema
• Excess water in the lung
• Most common cause = left-sided heart disease
• When the left ventricle fails, this causes an increase
in pulmonary capillary pressure. The fluid then
moves into the interstitial space. Normally, the
lymphatic system is able to remove this fluid, but
when the amount of fluid is too great, edema
develops
• Clinical manifestations: dyspnea, orthopnea,
hypoxemia, increased work of breathing,
inspiratory crackles, S3 gallop, pink frothy
sputum
• Treatment: correct the cause, diuretics,
vasodilators, drugs to increase contractility of
the heart, supplemental oxygen, end-
expiratory pressure ventilation
Obstructive Pulmonary Disease
Please read Chapters 40-42 in your McCance textbook as Mrs. Huffman-Frazee will
be going over musculoskeletal system at our next class on November 10.