Ch. 7 - Respiratory System

Function: organs of the respiratory system are responsible for bringing fresh air into the lungs, exchanging oxygen for carbon dioxide between the air sacs of the lungs and the bloodstream, and exhaling the stale air. Organs: nasal cavity, pharynx, larynx, trachea, bronchial tubes, lungs Word parts: aer/o: air alveol/o: alveolus angi/o: vessel anthrac/o: coal arteri/o: artery atel/o: incomplete bronch/o: bronchus bronchi/o: bronchus bronchiol/o: bronchiole coni/o: dust cortic/o: outer layer cyan/o: blue cyst/o: sac diaphragmat/o: diaphragm embol/o: plus epiglott/o: epiglottis hal/o: to breathe laryng/o: larynx lob/o: lobe Suffixes: -algia: pain -capnia: carbon dioxide -centesis: puncture to withdraw fluid -dynia: pain -ectasis: dilation -ectomy: surgical removal -emia: blood condition -genic: produced by -ia: condition -ism: state of -lytic: destruction -meter: instrument to measure -metry: process of measuring -osmia: smell -ostomy: surgically create an opening muc/o: mucus myc/o: fungus nas/o: nose orth/o: straight ox/o, ox/i: oxygen pharyng/o: pharynx pleur/o: pleura pneum/o: lung, air pneumon/o: lung, air pulmon/o: lung py/o: pus rhin/o: nose sept/o: wall sinus/o: sinus somn/o: sleep spir/o: breathing trache/o: trachea tuss/o: cough -phonia: voice -phylaxis: protection -plegia: paralysis -pnea: breathing -ptysis: spitting -rrhagia: abnormal flow condition -rrhea: discharge -spasm: involuntary muscle contraction -stenosis: narrowing -thorax: chest Prefixes: Brady- slow Dys- difficult, abnormal Endo- within Eu- normal tachy- fast Anatomy and Physiology of the Respiratory System ❖ Process of respiration can be subdivided into 3 parts: ➢ Ventilation: flow of air between the outside environment and lungs ➢ External respiration: exchange of oxygen and carbon dioxide that takes place in the lungs ➢ Internal respiration: process of oxygen and carbon dioxide exchange at the cellular level when oxygen leaves the bloodstream and delivered to the tissues ❖ Inhalation: flow of air into the lungs ➢ Brings fresh oxygen into air sacs ❖ Exhalation: flow of air out of the lungs ➢ Removes carbon dioxide from body ❖ Nasal cavity ➢ Air enters through two external openings - nares ➢ Nasal cavity is divided down missile by nasal septum ➢ Plate - roof of the mouth separates the nasal cavity above from the mouth below ➢ Walls of the nasal cavity and nasal septum are made of flexible cartilage covered with mucous membrane ➢ Paranasal sinuses: air-filled cavities ❖ Pharynx ➢ A.k.a. “Throat” ➢ Air enters trachea; liquids shunted into the esophagus ➢ Roughly a 5 inch long tube consisting of 3 parts: ■ Upper nasopharynx ● Behind the nose ● Contains adenoids or pharyngeal tonsils ● Also where the opening of the eustachian or auditory tube is found ■ Middle oropharynx ● Behind the mouth ● Palatine tonsils and the lingual tonsils ■ Lower laryngopharynx ➢ Tonsils strategically placed to keep pathogens from entering the body through either the air breathed or food and liquid swallowed ❖ Larynx ➢ “Voice box” ➢ Contains the vocal cords ■ ❖ ❖ ❖ ❖ ❖ Folds of membranous tissue that produce sounds by vibrating as air passes through the glottis - opening between two vocal cords ➢ Epiglottis - flap of cartilaginous tissue - sits above the glottis and provides protection against food and liquid being inhaled into the lungs ■ Covers the larynx and trachea during swallowing and shunts food and liquid from the pharynx into the esophagus ➢ Thyroid cartilage: forms the Adam’s apple Trachea ➢ Windpipe ➢ Passage for air that extends from the pharynx and larynx down to the main bronchi Bronchial tubes ➢ Distal end divides to form the left and right main bronchi ➢ Each bronchus enters one of the lungs and branches repeatedly to form secondary and tertiary bronchi ➢ Each branch narrows until narrowest branches (bronchioles) are formed ■ Each bronchiole terminated in a small group of air sacs (alveoli) ➢ Network of pulmonary capillaries from the pulmonary blood vessels tightly encases each alveolus ➢ Respiratory membrane: walls of alveoli and capillaries are tightly associated with each other and are referred to as a single unit Lungs ➢ Pleura: double membrane that protects the lung ➢ Parietal pleura: pleura’s outer membrane; lines the wall of the chest cavity ➢ Visceral pleura: inner membrane; adheres to the surface of the lungs ➢ Pleural cavity: sac formed around each lung ➢ Serous fluid: watery fluid between two layers of pleura that reduces friction ➢ Lobes: divides lungs ■ 3 lobes in larger right lung (right upper, right middle, and right lower lobes) ■ 2 in the left lung (left upper and left lower lobes) ➢ Hilum: medial border ➢ Mediastinum: area between the right and left lung ■ Contains heart, aorta, esophagus, thymus gland, and trachea Lung Volumes and Capacities ➢ Lung volumes measures by respiratory therapists ■ Aid in determining the functional level of the respiratory system ■ Pulmonary function tests Respiratory Muscles ➢ Diaphragm: muscle separating the abdomen from the thoracic cavity ➢ Lung Volumes and Capacities ■ Tidal volume (TV): amount of air that enters lungs in a single inhalation or leaves lungs in a single exhalation of quiet breathing; in adults this is normally 500 mL Inspiratory reserve volume (IRV): amount of air that can be forcibly inhaled after normal inspirational complemental air, generally measures around 3000 mL ■ Expiratory reserve volume (ERV): amount of air that can be forcibly exhaled after normal, quiet exhalation; supplemental air, approximately 1000 mL ■ Residual Volume (RV): air remaining in lungs after forced exhalation; about 1500 mL in an adult ■ Inspiratory capacity (IC): Volume of air inhaled after normal exhale ■ Functional residual capacity (FRC): air that remains in lungs after normal exhalation has taken place ■ Vital Capacity (VC): total volume of air that can be exhaled after maximum inhalation; amount will be equal to sum of TV, IRV, and ERV ■ Total lung capacity (TLC): volume of air in lungs after maximal inhalation ➢ Intercostal muscles: between ribs assist in inhalation by raising the rib cage to further enlarge the thoracic cavity ❖ Respiratory Rate ➢ One of body’s vital signs ➢ Rates for different age groups: ■ Newborn: 30-60 ■ 1 y.o. : 18-39 ■ 16 y.o: 16-20 ■ Adult: 12-20 ❖ Adjective forms of Anatomical terms ➢ Alveolar: pertaining to alveoli ➢ Bronchial: pertaining to a bronchus ➢ Bronchiolar: pertaining to a bronchiole ➢ Diaphragmatic: pertaining to diaphragm ➢ Epiglottic: pertaining to epiglottis ➢ Laryngeal: pertaining to larynx ➢ Lobar: pertaining to a lobe (of the lung) ➢ Mucous: pertaining to mucus ➢ Nasal: pertaining to nose or nasal cavity ➢ Nasopharyngeal: pertaining to nose and pharynx ➢ Paranasal: pertaining to beside the nose ➢ Pharyngeal: pertaining to pharynx ➢ Pleural: pertaining to lung ➢ Pulmonary: pertaining to lung ➢ Septal: pertaining to wall ➢ Thoracic: pertaining to chest ➢ Tracheal: pertaining to trachea ■ Pathology ❖ Medical specialties ➢ Internal medicine: branch of medicine involving diagnosis and treatment of diseases and conditions of internal organs such as respiratory system ➢ Otorhinolaryngology: branch of medicine involving diagnosis and treatment of conditions and diseases of the ears, nose, and throat region. ➢ Pulmonology: branch of medicine involved in diagnosis and treatment of diseases and disorders of respiratory system ➢ Respiratory therapy: Allied health specialty that assists patients with respiratory and cardiopulmonary disorders ➢ Thoracic surgery: branch of medicine involving diagnosis and treatment of conditions and diseases of respiratory system by surgical means ❖ Signs and symptoms ➢ Anosmia: lack of sense of smell ➢ Anoxia: condition of receiving almost no oxygen from inhaled air ➢ Aphonia: condition of being unable to produce sounds ➢ Apnea: not breathing ➢ Asphyxia: lack of oxygen that can lead to unconsciousness and death if not corrected immediately ➢ Aspiration: refers to withdrawing fluid from body cavity using suction ➢ Bradypnea: breathing too slowly ➢ Bronchiectasis: dilated bronchus ➢ Bronchospasm: involuntary muscle spasm of smooth muscle in the wall of bronchus ➢ Cheyne-Stokes respiration: abnormal breathing pattern in which there are long periods of apnea followed by depper, more rapid breathing ➢ Clubbing: abnormal widening and thickening of ends of fingers and toes associated with chronic oxygen deficiency ➢ Crackles: abnormal crackling or bubbling sound made during inspiration ➢ Cyanosis: refers to bluish tint of skin that is receiving insufficient amount of oxygen or circulation ➢ Dysphonia: condition of having difficulty producing sounds or producing abnormal sounds ➢ Dyspnea: term describing difficult or labored breathing ➢ Epistaxis: nosebleed ➢ Eupnea: normal breathing and respiratory rate ➢ Hemoptysis: to cough up blood or blood-stained sputum ➢ Hemothorax: presence of blood in chest cavity ➢ Hypercapnia: condition of having excessive carbon dioxide in body ➢ Hyperpnea: taking deep breaths ➢ Hyperventilation: breathing both too fast and too deep ➢ Hypocapnia: insufficient level of carbon dioxide in body ➢ Hypopnea: taking shallow breaths ➢ Hypoventilation: breathing both too slow and too shallow Hypoxemia: condition of having insufficient amount of oxygen in bloodstream Hypoxia: condition of receiving insufficient amount of oxygen from inhaled air Laryngoplegia: paralysis of muscles controlling larynx Orthopnea: term describing dyspnea worsened by lying flat Pansinusitis: inflammation of all paranasal sinuses Patent: open or unblocked, such as patent airway Phlegm: thick mucus secreted by membranes lining respiratory tract Pleural rub: grating sound made when two layers of pleura rub together during respiration ➢ Pleurodynia: pleural pain ➢ Pyothorax: presence of pus in chest cavity ➢ Rhinitis: inflammation of nasal cavity ➢ Rhinorrhagia: rapid flow of blood from nose ➢ Rhinorrhea: discharge from nose ➢ Rhonchi: somewhat musical sound during expiration, often found in asthma or infection ➢ Shortness of breath (SOB): term used to indicate a patient is having some difficulty breathing ➢ Sputum: mucus or phlegm coughed up from lining of respiratory tract ➢ Stridor: harsh, high-pitched, noisy breathing sound made when there is obstruction of bronchus or larynx ➢ Tachypnea: breathing fast ➢ Thoracalgia: chest pain ➢ Tracheostenosis: narrowing of trachea ❖ Upper respiratory system ➢ Croup: acute respiratory condition found in infants and children characterized by barking type of cough or stridor ➢ Diphtheria: bacterial upper respiratory infection characterized by formation of thick membranous film across throat and high mortality rate ➢ Laryngitis: inflammation of larynx ➢ Nasopharyngitis: inflammation of nasal cavity and pharynx ➢ Pertussis: infectious bacterial diseases of upper respiratory system that children receive immunization against as part of their DPT shots ➢ Pharyngitis: inflammation of pharynx ➢ Rhinomycosis: fungal infection of nasal cavity ❖ Bronchial Tubes ➢ Asthma: disease caused by various conditions, like allergens, and resulting in constriction of bronchial airways, dyspnea, coughing, and wheezing ➢ Bronchiectasis: abnormal enlargement of bronchi ➢ Bronchitis: inflammation of bronchus ➢ Bronchogenic carcinoma: malignant tumor originating in bronchi ❖ Lungs ➢ Acute respiratory distress syndrome (ARDS): acute respiratory failure in adults characterized by tachypnea, dyspnea, cyanosis, tachycardia, and hypoxia ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ Anthracosis: type of pneumoconiosis that develops from collection of coal dust in lung ➢ Asbestosis: type of pneumoconiosis that develops from collection of asbestos fibers in lungs ➢ Atelectasis: condition in which alveoli in a portion of the lung collapse, preventing respiratory exchange of oxygen and carbon dioxide ➢ Chronic obstructive pulmonary disease: progressive, chronic, and usually irreversible group of conditions in which lungs have diminished capacity for inhalation and exhalation ➢ Cystic fibrosis: hereditary condition causing exocrine glands to malfunction ➢ Emphysema: pulmonary condition characterized by destruction of walls of alveoli, resulting in fewer overexpanded air sacs ➢ Histoplasmosis: pulmonary infection caused by fungus Histoplasma capsulatum found in dust and in droppings of pigeons and chickens ➢ Infant respiratory distress syndrome (IRDS): lung condition most commonly found in premature infants characterized by tachypnea and respiratory grunting ➢ Influenza: viral infection of the respiratory system characterized by chills, fever, body aches, and fatigue ➢ Legionnaires’ disease: severe, often fatal bacterial infection characterized by pneumonia and liver and kidney damage ➢ Middle East respiratory syndrome (MERS): life-threatening viral respiratory illness first reported in Saudi Arabia in September 2012 ➢ Mycoplasma pneumonia: less severe but longer-lasting form of pneumonia caused by Mycoplasma pneumoniae bacteria ➢ Pneumoconiosis: condition resulting from inhalation of environmental particles that become toxic ➢ Pneumonia: an inflammatory condition of lung that can be caused by bacteria, viruses, fungi, and aspirated substances ➢ Pulmonary edema: condition in which lung tissue retains excessive amounts of fluid, especially in alveoli ➢ Pulmonary embolism (PE): Obstruction of pulmonary artery or one of its branches by embolus ➢ Pulmonary fibrosis: formation of fibrous scar tissue in lungs that leads to decreased ability to expand lungs ➢ Severe acute respiratory syndrome(SARS): acute viral respiratory infection that begins like the flu but quickly progresses to severe dyspnea ➢ Silicosis: type of pneumoconiosis that develops from inhalation of silica dust found in quarrying, glasswork, sand-blasting, and ceramics ➢ Sleep apnea: condition in which breathing stops repeatedly during sleep long enough to cause drop in oxygen levels in blood ➢ Sudden infant death syndrome (SIDS):unexpected and unexplained death of apparently well infant under one year of age ➢ Tuberculosis (TB): infectious disease caused by bacteria Mycobacterium tuberculosis ❖ Pleural cavity ➢ Empyema: pus with pleural space usually associated with bacterial infection ➢ Pleural effusion: abnormal accumulation of fluid in pleural cavity preventing lungs from fully expanding ➢ Pleurisy: inflammation of pleural characterized by sharp chest pain with each breath ➢ Pneumothorax: collection of air or gas in pleural cavity, possibly resulting in collapse of lung Diagnostic procedures: ❖ Clinical laboratory tests ➢ Arterial blood gases: testing for gases present in blood ➢ Septum culture and sensitivity: testing sputum by placing it on culture medium and observing any bacterial growth ➢ Sputum cytology: examining sputum for malignant cells ❖ Diagnostic Imaging ➢ Bronchogram: X-ray record of bronchus produced by bronchography ➢ Bronchography: X-ray of lung after radiopaque substance inserted into trachea or bronchial tube ➢ Chest X-ray: taking radiographic picture of lungs and heart from back and sides ➢ Pulmonary angiography: injecting dye into a blood vessel for purpose of taking X-ray of arteries and veins of lungs ➢ Ventilation-perfusion scan: nuclear medicine diagnostic test especially useful in identifying pulmonary emboli ❖ Endoscopic procedures ➢ Bronchoscope: instrument used to view inside bronchus during bronchoscopy ➢ Bronchoscopy: visual examination of the inside of the bronchi ➢ Laryngoscope: instrument used to view inside larynx during laryngoscopy ➢ Laryngoscopy: examination of the interior of the larynx with a lighted instrument called laryngoscope ❖ Pulmonary Function Test ➢ Oximeter: instrument that measures the amount of oxygen in the bloodstream ➢ Oximetry: procedure to measure oxygen level in blood using divide, an oximeter, placed on patients fingertip or earlobe ➢ Pulmonary function test: group of diagnostic tests that give information regarding airflow in and out of lungs, lunch volumes, and gas exchange between lungs and bloodstream ➢ Spirometer: instrument to measure lung capacity used for spirometry ➢ Spirometry: procedure to measure lung capacity ❖ Add’n diagnostic procedure ➢ Polysomnography: monitoring patient while sleeping to identify sleep apnea ➢ Sweat test: test for cystic fibrosis ➢ Tuberculin skin test: procedure in which a tuberculin purified protein derivative is applied under the surface of skin to determine if patient has been exposed to tuberculosis Therapeutic procedures ❖ Respiratory therapy ➢ Aerosol therapy: medication suspended in mist intended for inhalation ➢ Continuous positive airway pressure: machine that supplies constant and steady air pressure through mask ➢ Endotracheal intubation: placing of a tube through mouth, through glottis, and into trachea to create patent airway ➢ Intermittent positive pressure breathing: method for assisting patients in breathing using mask connected to machine that produces increases positive thoracic pressure ➢ Nasal cannula: two-pronged plastic device for delivering oxygen into nose ➢ Postural drainage: drainage of secretions from bronchi by placing patient in position that uses gravity to promote drainage ➢ Supplemental oxygen therapy: providing patients with add’n concentration of oxygen to improve oxygen levels in the bloodstream ➢ Ventilation: machine that provides artificial ventilation for patient unable to breathe on his or her own ❖ Surgical procedures ➢ Bronchoplasty: surgical repair of a bronchus ➢ Laryngectomy: surgical removal of larynx ➢ Laryngoplasty: surgical repair of larynx ➢ Lobectomy: surgical removal of a lobe of a lung ➢ Pleurectomy: surgical removal of pleura ➢ Pleurocentesis: procedure involving insertion of needle into pleural space to withdraw fluid ➢ Pneumonectomy: surgical removal of entire lung ➢ Rhinoplasty: surgical repair of nose ➢ Thoracentesis: surgical puncture of chest wall for removal of fluids ➢ Thoracostomy: insertion of tube into chest cavity for purpose of draining off fluid or air ➢ Thoracotomy: to cut into chest cavity ➢ Tracheotomy: surgical procedure often performed in an emergency that created opening directly into the trachea to allow the patient to breathe easier ❖ Add’n procedures ➢ Cardiopulmonary resuscitation: emergency treatment provided by persons trained in CPR and given to patients when their respirations and heart stop ➢ Heimlich maneuver: technique for removing foreign body from trachea or pharynx by exerting diaphragmatic pressure ➢ Percussion: use of fingertips to tap on surface to assess condition beneath Pharmacology ❖ Cumulative action: action that occurs in the body when a drug is allowed to accumulate or stay in body ❖ Prophylaxis: prevention of disease ❖ Drugs ➢ Antibiotic: kills bacteria causing respiratory infections ■ Ex. amoxicillin ➢ Antihistamine: blocks effects of histamine released by body during allergy attack ■ Ex. Benadryl ➢ Antitussive: relieves urge to cough ■ Ex. hydrocodon ➢ Bronchodialtor: relaxes muscle spasms in bronchial tubes ■ Ex. albuterol ➢ Corticosteroids: reduces inflammation and swelling in respiratory tract ■ Ex. Flonase ➢ Decongestant: reduces stuffiness and congestion throughout respiratory system ■ Ex. Afrin ➢ Expectorant: improves ability to cough up mucus from respiratory tracts ■ Ex. Robitussin ➢ Mucolytic: liquefies mucus so it is easier to cough and clear from respiratory tract ■ Ex. N-acetyl-cysteine ❖ Abbreviations ABGs arterial blood glasses MERs Middle East respiratory syndrome Ad lib as desired O2 oxygen ARDS adult (acute)respiratory distress syndrome PE pulmonary embolism Bronch bronchoscopy per with CF cystic fibrosis PFT pulmonary function test CO2 carbon dioxide po by mouth COPD chronic obstructive pulmonary disease PPD purified protein derivative CPAP continuous positive airway pressure prn as needed CPR cardiopulmonary resuscitation R respiration C&S culture and sensitivity RA room air CTA clear to auscultation RDS respiratory distress syndrome CXR Chest X-Ray RLL right lower lobe D day RML right middle lobe DOE dyspnea on exertion RRT registered respiratory therapist DPT diphtheria, pertussis, tetanus injection RUL right upper lobe ENT ear, nose, and throat RV reserve volume ERV expiratory reserve volume SARS severe acute respiratory syndrome Flu influenza SIDS sudden infant death syndrome FRC functional residual capacity SOB shortness of breath HMD hyaline membrane disease TB tuberculosis IC inspiratory capacity TLC total lung capacity IPPB intermittent positive pressure breathing TPR temperature, pulse, and respiration IRDS infant respiratory distress syndrome TV tidal volume IRV inspiratory reserve volume URI upper respiratory infection LLL left lower lobe VC vital capacity LUL left upper lobe VS vital signs MDI metered-dose inhaler