Chapter 10 The Respiratory System - Pulmonology

Introduction to Respiratory System Respiratory System: ❖ Inhalation: Bringing air into the lungs ❖ Exhalation: Breathing air out the lungs ❖ Throat (pharynx) ❖ Voice Box (larynx ❖ Windpipe (Trachea) ❖ Breathing Tubes (Bronchi) Breathing: WR: Spir/o ❖ Spir/o (WR) ❖ InExpiration: Exhalation: Remove CO2 ❖ Spir/o (WR) ❖ Ex❖ Ventilator (Helps patients breathe) or Respirator (Helps filter air particles) Incentive Spirometer: ❖ Meter: measure ❖ Spiro (WR) ❖ Post Op: Expand lungs to prevent pneumonia Oxygen: WR: Ox/o S: -oxia: ❖ Hypoxemia (hypoxia) ➢ Low oxygen levels ❖ Oximeter ➢ Measures the oxygen levels Carbon Dioxide: WR: Capn/o S: -Capnia ❖ Hypocapnia: Low levels of carbon dioxide ➢ Etiology: tachypnea ❖ Hypercapnia ➢ Etiology: Bradypnea *Arterial Blood Gases (ABG): ❖ Most reliable way to measure O2 & CO2 in the blood ❖ Done by registered respiratory therapist (RRT) Auscultation: ❖ Listen with a stethoscope “funny” sounds may indicate what is wrong ➢ Ex: Rales (Crackles), stridor, rhonchi, and wheezing ❖ Percussion ➢ Tap on surface of chest to listen to sound density (dull or hollow) Breath Sounds: Auscultation ❖ Normal ❖ Rales (Crackles): Hear some bubbling ❖ Rhonchi: Rattling sound because of mucus in the larger airways/bronchus ❖ Stridor: Harsh, high pitched sounds on inspiration ❖ Abnormal (Grunting) Assessing Breathing ❖ -pnea (s) ❖ Look at: ➢ Rate ➢ Depth ➢ Ease Assess Rate Of Breathing: ❖ Eupnea ❖ Tachypnea ❖ Bradypnea ❖ Apnea: Not breathing ➢ Sleep apnea: Airway is blocked and air does not move through ■ Tongue falls in the back of the throat which stops their breathing Assess Depth of Breathing: ❖ Hypopnea ❖ Hyperpnea ❖ Cheyne-strokes: Pt. dying. Periods of hypopnea, hyperpnea, apnea Assess Ease of Breathing: ❖ Dyspnea: Bad or painful breathing ➢ Still breathing, but difficult ❖ Orthopnea ➢ Sit upright for breathing or breath better when standing Larynx: Voice Box: WR: Laryng/o ❖ Laryngitis: Inflammation of the voice box → cannot speak ❖ Laryngeal Polyps: Polyp is an abnormal growth on a mucus membrane ❖ Laryngectomy Word Building: Laryng/o ❖ Laryngoscopy/Laryngoscope Trachea (Windpipe) WR: Trache/o ❖ Tracheotomy ❖ Endotracheal Trachea ❖ Tracheostomy ❖ Tracheotomy ❖ Tracheoectomy Word Building: Bronch/o ❖ Bronchogenic Carcinoma ❖ Hemoptysis: ➢ -ptysis (S) spitting ➢ hem/o (WR) Asthma: ❖ Affects bronchioles. Etiology: infection, allergens, exercise induced, exposure to cold air, stress. ❖ S/S ➢ Frequent cough ➢ Copious amounts clear sputum ➢ Wheezing ➢ Dyspnea ❖ Tx: Corticosteroids, bronchodilators, Metered dose inhaler (MDI), aerosol tx Word Building: Pulmon/o ❖ Pulmonary Embolism (PE): ➢ Embolism: Traveling clot (blood or fatty plaque) ➢ Dx: ventilation-perfusion (V/Q) Scan ■ Small amount of radioactive gas is inhaled. Distribution pattern picked up by a machine Pulmonary Diseases: ❖ Cystic Fibrosis (CF): ➢ Hereditary condition resulting in thick, mucous secretions that do not drain normally ➢ Exocrine (Ducts) glands affected: sweat, lungs, pancreas, intestines. ❖ S/S: steatorrhea, malnutrition, small for age, clubbed fingers ❖ Dx: sweat test ❖ Tx: pancreatic enzymes, salt tablets, vitamins, increased calorie diet, respiratory therapy measures Pulmonary Diseases: ❖ Emphysema: (COPD) Chronic Obstructive Pulmonary Disease ❖ S/S: Barrel-chest, club-shaped (spoon shaped) fingers, dyspnea, orthopnea ❖ Tuberculosis (TB): ➢ Highly communicable disease ➢ Droplet transmission ➢ S/S hemoptysis, cough, weight loss, night sweats, chest pain ❖ Dx: ➢ Mantoux Skin Test (Tuberculin Skin Test or PPD: Purified Protein Derivative) ➢ Chest X-ray (CXR) ➢ Sputum Specimen: Acid Fast Bacilli (AFB) ➢ Bronchoscopy Dx Pulmonary Diseases: ❖ Pulmonary Function Tests (PFTs): ➢ Information about airflow, lung volumes and capacity ➢ Identify chronic respiratory diseases ➢ Periodic assessment of lung condition Pleural Conditions: ❖ Pneumothorax: Basically a collapsed lung ➢ -thorax (s) chest or pleural cavity ➢ pneum/o (CF) air, gas or lung ❖ Hemothorax: Blood within the chest cavity Chest Disorders: ❖ THoracostomy (Chest Tube) Word Building: Pneumon/o ❖ Pneumonectomy: Complete removal of an entire lung ❖ Removal of a Lobe: Lobectomy ➢ Lob/o (WR) Lobe Chest 3 WRs: Pector/o, Thorac/o, Steth/o ❖ Thoracotomy ❖ Thoracentesis (Thoracentesis) Chest: ❖ Thoracentesis (Thoracentesis): Surgical Puncture to remove fluid, usually through the posterior side nose nas/o (Latin for nose), rhin/o (Greek for nose) roots: examples nasogastric tube, nasendoscope, rhinorrhea, rhinoplasty : notes: Rhinoceros is the combination of rhino and ceros (horn), which means horn nose. A poet named Publius Ovidius Naso (43 BC–17 AD) lived in ancient Rome. Perhaps you know him by the much shorter name Ovid. Apparently, he or one of his ancestors had quite a prominent nose—hence the root naso . The entry point for air into the body is primarily through the nose, with some air entering through the mouth. The nose serves to warm, clean, and moisten the air. The nose consists of two nostrils (nares ) , a septum (septum) , and tube-shaped cartilage inside the nose (turbinates) . The nose is very vascular, which means that it contains many blood vessels, which is why the nose bleeds easily. The blood in these vessels warms the air as it enters the rest of the respiratory tract. In addition, multiple hairs line the nose and filter out dust and other particles. Finally, the nose produces mucus, which helps clean and moisten the air. The air passes through the nose or mouth and proceeds into the throat (pharynx) . There are three parts to the pharynx: the nasopharynx, the oropharynx, and the laryngopharynx. The laryngopharynx contains the vocal cords (larynx) . When air passes across these cords upon exhalation, the cords vibrate at certain speeds—just like a harmonica or saxophone. These vibrations make sounds, which we use to form speech. The air continues down the windpipe (trachea ) . The trachea is surrounded by bumpy rings of cartilage that prevent it from caving in. air or lungs roots: examples pneum/o, pneumat/o, pneumon/o pneumomelanosis, pneumatology, pneumonia : notes: These roots can mean either lung  or air. Context and familiarity will help in determining which to use. For instance, it makes more sense to translate pneumothorax  as air in the chest rather than lung in the chest. T  he term pneumatic can also be found in the construction world. It refers to any tool that moves by forcing air into it (i.e., a pneumatic drill), as opposed to hydraulic tools, which involve the use of water instead of air (i.e., a hydraulic lift). lungs root: examples : pulmon/o pulmonologist, pulmonary notes: Pulmon/ o is listed by itself instead of with the various forms of pneum / ob ecause while pulmon/ o means only lung, pneum/ o  can mean both lung (as in pneumonia) and air (as in pneumothorax) . lobe root: examples lob/o lobectomy, lobotomy : notes: A lobe is a well-defined portion of any organ. The main organs that have lobes are the lungs, brain, and liver. What is the difference between a lobectomy and a lobotomy? bronchus roots: examples bronch/o, bronchi/o bronchoscope, bronchiostenosis : notes: The main branches from the trachea into each lung. rib root: examples cost/o costectomy, costophrenic : notes: Ribs are sometimes grouped into three categories: true, false, and floating. The top seven ribs are called “true” ribs because they attach to both the spine and the sternum. The next three ribs are called “false” ribs because they connect to the spine and to the lowest true rib instead of the sternum. The lowest two ribs are called “floating” ribs because they attach only to the spine. chest roots: examples thorac/o, pector/o (also pectus), steth/o thoracic, pectoralgia, pectus excavatum, stethoscope : notes: The root pector/ o can also stand as a word by itself. When it does, however, the ending changes slightly, from pectoro  to pectus. Hence, pectus excavatum. The term stethoscope literally means an instrument for looking at the chest,  but of course, you do not look with a stethoscope—you listen. pleura root: examples pleur/o pleuritis, pleurectomy : notes: The pleura is a membrane surrounding the lungs. diaphragm root: examples phren/o phrenospasm, phrenoplegia : notes: In addition to the diaphragm, phren/ o can also refer to the brain (as in the term schizophrenia) . The rationale comes from the ancient Greek view of the mind. The Greeks believed that the chest was the seat of emotion and reason. As that view changed and the location of the mind moved from the chest to the brain, the word for mind became applied to both regions of the body. carbon dioxide roots: examples capn/o (Greek for smoke), carb/o (Latin for coal) hypercapnia, hypocarbia : notes: One of the treatments for hyperventilation is to have the person breathe into a paper bag. A person who is hyperventilating has hypocarbia  and thus needs to increase the carbon dioxide in his or her respiratory system. breathing processes Term Word Analysis apnea a / pnea AP-nee-ah not / breathing Definition cessation of breathing eupnea eu / pnea YOOP-nee-ah good / breathing Definition good/normal breathing tachypnea tachy / pnea ta-KIP-nee-ah fast / breathing Definition rapid breathing bradypnea brady / pnea brad-ip-NEE-ah slow / breathing Definition slow breathing hypopnea hypo / pnea hai-POP-nee-ah under / breathing Definition shallow breathing hyperpnea hyper / pnea hai-perp-NEE-ah over / breathing Definition heavy breathing dyspnea dys / pnea disp-NEE-ah bad / breathing Definition difficulty breathing orthopnea ortho / pnea or-thop-NEE-ah straight / breathing Definition able to breathe only in an upright position hyperventilation hyper / ventil / ation hai-per-ven-ti-LAY-s over / breathing / hun process Definition overbreathing; the condition of having too much air flowing into and out of the lungs; leads to hypocapnia hypoventilation hypo / ventil / ation hai-po-ven-ti-LAY-s under / breathing / hun process Definition underbreathing; the condition of having too little air flowing into and out of the lungs; leads to hypercapnia upper respiratory Term Word Analysis dysphonia dys / phonia dis-FON-ia bad / sound / voice Definition bad voice condition (also known as hoarseness) epistaxis from the Greek ep-ee-STAKS wordepistazo, m  eaning -is to drip out or upon Definition a nosebleed epistaxis rhinorrhagia rhino / rrhagia rai-no-RAY-j nose / excessive bleeding ah Definition excessive blood flow from the nose (another term for a nosebleed) rhinorrhea rhino / rrhea rai-no-REE-y nose / discharge ah Definition runny nose lower respiratory Term Word Analysis bronchospasm broncho / spasm BRON-ko-spaz- bronchus / involuntary um contraction Definition involuntary contraction of the bronchus phrenospasm phreno / spasm fre-no-SPAZ-um diaphragm / involuntary contraction Definition involuntary contraction of the diaphragm (also known as the hiccups) pleuralgia pleur / algia plur-AL-jah pleura / pain Definition pain in the pleura pleurodynia pleuro / dynia plur-oh-DIH-nee pleura / pain -ah Definition pain in the pleura thoracalgia thorac / algia thor-a-KAL-jah chest / pain Definition chest pain discharges and secretions Term Word Analysis bronchorrhea broncho / rrhea bron-koh-REE-ah bronchus / discharge Definition discharge from the bronchi expectoration ex / pector / ation eks-pec-tor-A-shun out / chest / process Definition coughing or spitting material out of the lungs hemoptysis hemo / ptysis heem-op-TIS-is blood / cough Definition coughing up blood Latin for spit sputum SPYOO-tum Definition mucus discharged from the lungs by coughing physical findings and examination methods Term Word Analysis auscultation from the Latin ah-skul-TAY-  eaning tolisten wordausculto,m shun Definition a health care professional using a stethoscope cyanosis cyan / osis sai-an-O-sis blue / condition Definition a bluish color in the skin caused by insufficient oxygen pectoriloquy pectori / loquy pek-tor-IH-lo chest / speak w-kwee Definition speaking from the chest; used as a means of finding masses in the lung. A health professional listening to a patient's chest asks the patient to whisper a word. The word will be audible in areas where fluid or a mass is present. Hence the chest “speaks” in those places. pectus carinatum laboratory data Term Word Analysis hypercapnia hyper / capn / ia hai-per-CAP-nee- over / carbon dioxide / yah condition Definition excessive carbon dioxide hypercarbia hyper / carb / ia hai-per-CAR-bee- over / carbon dioxide / yah condition Definition excessive carbon dioxide hypocapnia hypo / capn / ia hai-po-CAP-nee-y under / carbon dioxide / ah condition Definition insufficient carbon dioxide hypocarbia hypo / carb / ia hai-po-CAR-bee-y under / carbon dioxide / ah condition Definition insufficient carbon dioxide hypoxemia hypo / ox / emia hai-poks-EEM-ee- under / oxygen / blood yah condition Definition insufficient oxygen in the blood hypoxia hypo / ox / ia hai-POKS-ee-yah under / oxygen / condition Definition insufficient oxygen pleuritis pleur / itis plur-AI-tis pleura / inflammation Definition inflammation of the pleura pleurisy pleur / isy PLUR-ih-see pleura / inflammation Definition another word for pleuritis pneumonectomy pneumon / ectomy new-mon-EK-toe-mee lung / removal Definition removal of a lung drugs Term Word Analysis antitussive anti / tuss / ive an-tee-TUSS-iv against / cough / agent Definition a drug that prevents coughing antitussive bronchodilator broncho / dilator bron-koh-DAI-la bronchus / expander y-tor Definition a drug that expands the walls of the bronchi expectorant ex / pector / ant eks-PEK-tor-ant out / chest / agent Definition a drug that encourages the expulsion of material from the lungs mucolytic muco / lytic myoo-koh-LIT-i mucus / breakdown agent k Definition a drug that aids in the breakdown of mucus nebulizer nebulizer from the Latin neh-byoo-LAI-zi wordnebula, meaningcloud r Definition a machine that administers respiratory medication by creating a “cloud” or mist that is inhaled by the patient abbreviations Abbreviation ABG Definition arterial blood gas analysis of the gases in the blood; used to determine the effectiveness of the lungs in exchanging gases Bx biopsy COPD chronic obstructive pulmonary disease CPAP continuous positive airway pressure a treatment for apnea involving keeping a patient's airways open Bx (biopsy) using air pressure delivered via a face mask CPR cardiopulmonary resuscitation CT computed tomography CTA clear to auscultation when an examination reveals nothing abnormal about a patient's lung CXR chest x-ray ET endotracheal IRDS infant respiratory distress syndrome LTB laryngotracheobronchitis MRI magnetic resonance imaging OSA obstructive sleep apnea PE pulmonary embolism PET positron emission tomography PFT pulmonary function test PSG polysomnography SOB shortness of breath T&A tonsillectomy and adenoidectomy TB tuberculosis URI upper respiratory infection V/Q ventilation–perfusion scan CXR (chest x-ray)