Respiratory System Lecture Note

Ch. 17: Respiratory System: ● Physiology of Lower Respiratory Tract: ○ Trachea ○ Bronchi ○ Lungs ○ Pleural Membranes ○ Mediastinum ● Respiratory Process: ○ Muscles of Respiration ■ Muscles in thoracic cage (internal and external intercostal, diaphragm assist in breathing process) ■ The accessory muscles in the neck: ● Play a major role in respiratory cycle during distress and pathology ● Trapezius ● Scalene ● Sternocleidomastoid ● Abdomen (rectus) ● Chest (pectorals) ○ Thoracic Cage ■ Consists of bone, cartilage, and muscles of thorax ■ The sternum is located in the anterior midline of the thorax ■ There are 12 pairs of ribs ● 8, 9, 10 articulates with cartilage of rib 7 ● 11, 12 are free floating and do not articulate anteriorly ■ This cage helps protect many vital organs of the pleura and mediastinum, supports shoulders and upper extremities, and helps support many muscles in upper part of body ○ Respiratory Cycle ■ Inspiration ■ Expiration ● Landmarks ● Healthy People 2020 ○ Table 17.1 ● Lines of thorax ○ Anterior Thorax ■ Pg. 378 ○ Posterior Thorax ■ Pg. 379 ○ Lateral Thorax ■ Pg. 379 ● Lobes of the lungs: ○ Posterior View ■ Pg. 380 ○ Anterior View ■ Pg. 381 ○ Lateral View of Left Lobe ■ Pg. 381 ○ Lateral View of Right Lobe ■ Pg. 382 ● Infants and Children: ○ Compared to adults, children have much smaller, more compliant airways until early adolescence ○ Until that time, children are more prone to airway collapse and blockage ○ Oxygen needs are higher in small children because their increased metabolic rates result in higher oxygen consumption ○ Risk of respiratory failure is greatest in infants, toddlers, and preschoolers, but children of all ages experience respiratory failure much more quickly than adults ■ Choanal atresia ● A congenital defect that results in a thin membrane that obstructs nasal passages ■ Laryngomalacia/ Tracheomalacia ● Congenital defects of the cartilage in the larynx and trachea ● Pregnant Female: ○ Shortness of breath and dyspnea ■ Very common as maternal and fetal demand for oxygen increase ○ Total oxygen consumption can increase by 20% and the maternal respiratory rate increases ~2 breaths/ min ● The Older Adult ○ Lungs lose their elasticity ● ● ● ● ○ Skeletal muscles begin to weaken ○ Bones lose density ○ Rate of respirations in the older adult is slightly higher than in middle-aged adult ○ More shallow respiratory cycle ○ Use more accessory muscles; use of more energy Psychosocial Considerations ○ Stress ○ Anxiety ○ Pain ○ Fatigue Cultural and Environmental Considerations ○ Prevalence of asthma is highest among individuals who are: ■ Puerto Ricans ■ American Indians ■ Alaskan Natives ■ Non-Hispanic Blacks ■ Filipino ■ Non-Hispanic Whites ○ Lowest prevalence of asthma: ■ Asian Indian descent ■ Chinese ■ Mexican Focused Interview ○ Pg. 385-392 Techniques of Exam ○ Initial Survey ■ Inspect overall appearance, posture, and positions of the pt. ■ Note: color, and respiratory effort ■ Observe for signs and anxiety or distress ○ Inspection of Anterior and Lateral Thorax ○ Inspection of Posterior Thorax ○ Palpation of the Posterior Thorax ■ Figure 17.14 - Pattern for palpating posterior thorax ■ Figure 17. 15 - Palpation for respiratory expansion ■ Figure 17. 16 - Palpation for tactile fremitus ○ Percussion of Posterior Thorax ■ Figure 17. 17 - Pattern for percussion: Posterior thorax ■ Figure 17. 18 A/B - diaphragmatic movement, measurement ○ Auscultation of the Posterior Thorax ■ Sounds change as the airway size changes or with the presence of fluid or mucus ○ ○ ○ ○ ○ ■ Pattern for auscultation of respiratory system is same as that for percussion ● Figure 17.19 ● Table 17.3 Normal Breath Sounds ● Table 17.4 Adventitious Breath Sounds Assessment of Voice Sounds Palpation of the Anterior and Lateral Thorax Percussion of the Anterior and Lateral Thorax Auscultation of the Anterior and Lateral Thorax ■ Box 17.1 Normal and Abnormal Resp. Rates and Patterns (pg. 410-411) ■ Normal and Abnormal Chest Configurations ● Box 17. 2, 17.3 ● Pg. 412-413 Abnormal Findings ■ Asthma ■ Atelectasis ■ Chronic Bronchitis ■ Emphysema ■ Lobar Pneumonia ■ Pleural Effusion ■ Pneumothorax ■ Left Heart Failure ■ Valley Fever