Respiratory system Flashcards
Name 2 products of Oxidation
- Water
- Carbon Dioxide
What are the 4 principle functions of the respiratory system?
- Extract o2 from atmosphere and transfer it to the bloodstream and the lungs
- Excrete water vapour and co2
- Maintain the normal acid base status of the blood
- Ventilate lungs
What are the 5 components of Inspired air?
- 79% Nitrogen
- 20% o2
- 0.04% co2
- 1% inert Gases
- Water vapour (variable)
What are the 5 components of expired air?
- 79% Nitrogen
- 16% o2
- 4% co2
- 1% Inert gases
- Water vapour increased amount to saturation
Is expired air resuscitation effective? If so why?
-Yes, because expired air still contains 16% o2
What are the 8 components of the respiratory tract?
- Nose
- Pharynx
- Larynx
- Trachea
- Bronchi
- Bronchioles
- Alveolar ducts
- Alveoli
What is the top of the larynx protected by?
-The epiglottis
What is the function of the epiglottis?
2
- Opens for breathing
- Shuts when food/fluid being swallowed by upward movement of the larynx
When does the protective mechanism of the epiglottis not operate?
-When PTs are unconscious
Which part of the respiratory tract divides into the Bronchi?
-The trachea
Which Bronchus is shorter?
The right is shorter than the left
What do the bronchi branch into?
-Bronchioles (smaller tubes)
What do the Bronchioles lead to?
-Alveolar ducts which end in air sacs (Alveoli)
What surrounds the Alveoli?
A fine network of capillaries
What happens in the network of capillaries that surround the alveoli?
An exchange of gases takes place across the endothelium (capillary wall)
What are the lungs comprised of?
2
Alveoli
Connective tissue
How many lobes does each lung have?
Left has 2
Right has 3
What is the outer surface of the lung called?
The pleura
What is the pleura continuous with?
The membrane lining of the inner surfaces of chest wall
What moves over each other as the lung expands and relaxes?
The pleura and inner membrane lining of chest wall
Where does external respiration take place?
In the lungs
Where does internal respiration take place?
In the tissues
Where does diffusion take place?
Internal and external respiration
What is the process of diffusion?
Dissolved substances cross a semi permeable membrane from high to low concentration.
If two gases of different composition come into contact intermingling of gases takes place until composition is both the same.
What are the 2 things that happen in external respiration?
- o2 from inhaled air is absorbed into the blood via capillaries of the lung
- co2 is released from the blood into lungs & exhaled
What 2 things happen on internal respiration?
- blood and circulatory system carries o2 to body cells
- O2 is given off for use by cells. Co2 is absorbed by the blood which is carried to lungs
How would you describe the process of normal quiet breathing?
Active, process involving muscle activity
How would you describe expiration?
Passive, relies on elastic recoil of lungs
What happens to the chest cavity when inspiration takes place?
It is enlarged
What happens when the chest cavity is enlarged by process of inspiration?
The pressure within it causes air to enter lungs via airways.
What change causes air to be drawn in?
The change of pressure in the chest cavity
What are the 2 main factors that enlarge the chest cavity?
- flattening downward movement of the diaphragm
- upward and outward movement of ribs, caused by action of intercostal muscles
Where is voluntary control of respiration controlled?
Cerebral cortex
When would an example of voluntary respiration control take place?
(2)
Speaking and singing
What is voluntary control of respiration overriden by?
2
Chemical and nervous activity
What is involuntary respiration controlled by?
3
- Nerve cells in brain stem
- Respiratory centre in the Medulla oblongata
- Pneumotaxic centre in pons varolii
The cells in the respiratory centre are covered with what?
Inspiration
What is concerned with the inhibition of inspiration?
The cells of the pneumotaxic centre
With regards to nerves how does inspiration take place?
Nerve impulses originating In respiratory centre pass via phrenic nerves to diaphragm via intercostal nerves to intercostal muscles resulting in contraction
How does expiration happen?
Nerve endings in the lungs sensitive to stretch are stimulated when lungs are inflated, impulses are passed to pneumotaxic centre
Where are chemoreceptors situated?
Walls of aorta
Carotid bodies
What are chemoreceptors sensitive to?
Partial pressure of co2 in blood
Partial pressure of o2 in blood
Chemoreceptors and respiratory centre are stimulated by what?
An increase in partial pressure of co2 in blood
In chemoreceptors, what does an increase in partial pressure of co2 in blood result in
Increased ventilation
What does a small reduction in the partial pressure of o2 do?
Increase ventilation
What does a substantial reduction of partial pressure of o2 do?
Depressive effect (decrease ventilation)
What happens to patients suffering COPD in hypoxic drive?
They become insensitive to level of co2. The brain uses hypoxia as stimulus to breathe
What is the normal adult breathing rate?
16-20
What is the normal infant/child respiratory rate?
24-40
What are the 4 examples of when breathing rates increase?
Exercise
Fever
Conditions affecting normal functions of lung (pneumonia, bronchitis)
Shock
What are the 2 occasions where respiratory rate is decreased?
Brain conditions
Head injury
CVA
Drugs (morphine, barbiturates)
What are abnormal respiratory conditions?
Dyspnoea
Apnoea
Hypoxia
Hypercarbia
How does respiratory compromise occur?
When blood contained in capillaries of both lungs stops or interrupts it’s normal process of o2 absorption
What 3 things does respiratory compromise affect?
Respiratory tract (air passage) Respiratory mechanism (ribs, muscles, diaphragm) Respiratory centre
What are the 5 causes of respiratory compromise?
Obstruction of air passages Chest or lung trauma Paralysis of respiratory nerves and muscles Non o2 atmospheres Lung disease and illness
What 8 factors can cause obstruction of air passages?
Tongue during unconsciousness
Maxillo facial injs
Blood and vomit
Inhaled foreign bodies (food, false teeth)
Suffocation
Extreme pressure to neck (hanging, suffocation)
Drowning
Internal swelling of throat tissues (burns, scalds, stings, disease)
What 2 things can chest trauma be caused by?
External compression (sand, masonry, vehicle damage, crowd pressure) Blast injuries
How may paralysis of respiratory nerves and muscles occur? 5
Electrocution Head/spinal injuries Poisons (cyanide, weed killers, toxic fumes) Drugs (barbiturates, morphine) Diseases (tetanus, poliomyelitis)
What 4 things can result from non o2 atmospheres?
Gases
Chemical fumes
Smoke
Altitude
In Lung diseases, what examples can lead to chronic respiratory failure? 5
Emphysema Pulmonary oedema Acute pneumonia Asthma/bronchitis Continuous fits
What 6 signs would you notice in respiratory compromise of an obstructive or mechanical origin?
Difficult/noisy breathing Cyanosis Dilated pupils Congestion of veins of head/neck Fits Gradual LOC Petechial haemorrhages
What 4 signs would you notice when dealing with respiratory compromise of paralytic origin?
Progressive deterioration in rate/depth of breathing (quiet unless obstructed by tongue)
Increasing cyanosis
Dilated pupils
Gradual LOC
What 5 ways would you manage respiratory compromise?
Open airway CPR if necessary High concentration o2 Recovery position of unconscious. Semi recumbent if conscious Reassurance
What 2 ways do respiratory conditions cause hypoxia?
Airway obstruction
Impaired perfusion of alveoli
What are the 2 main obstructive airway conditions!
Asthma
COPD
What happens in obstructive airway compromise caused by COPD and asthma?
Pulmonary tissue causes obstruction to free flow of air into lungs
What are the 2 types of COPD?
Chronic bronchitis
Emphysema
What is the definition of bronchitis?
Inflammatory condition affecting the airways
Describe acute bronchitis
Viral or bacterial. short lived experienced mainly by elderly and young children
Describe chronic bronchitis
Bronchial mucosal glands secrete excess mucous which PT coughs up but obstructs airways.
Least 3 things can result from chronic bronchitis?
Lung damage may result in
Right heart failure
Peripheral oedema
Cyanosis
What are the 14 possible signs of COPD
Productive cough Cyanosis (blue bloaters) Tachycardia Tachypnoea Dyspnoea Accessory muscle useage Dilated pupils and slow to react If hypoxia severe LOC reduced Oedema Normal BP or slightly raised Slow cap refill Reduced sats Rhonchi and wheezes Domicillary o2 useage
How would you manage COPD? 9
Open airway using suction if necessary Salb for acute exacerbation O2 Patient in most comfortable position (upright) Prepare to ventilate/CPR Encourage cough, collect examples of sputum Monitor condition Document treatment and measures Smooth journey to hosp
What 2 things happen in emphysema?
Distension of alveoli
Destructive changes in their membranes
Describe what happens in emphysema
Lung tissue loses their elasticity and airway loses muscular integrity and collapses. Leading to air not entering alveoli.
What are the 14 signs of emphysema
Thin Normal skin colour (pink puffer) Tachycardia Tachypnoea Dyspnoea Use of accessory muscles and difficulty exhaling Bp elevated Cyanosis in acute attack Pursed lips on expiration Confusion and anxiety due to hypoxia Wheezing and crackles mainly on inhalation Abnormal large chest Cardiac dysrhythmias develop Oedema
How would you manage emphysema? 8
Open airway Salb for acute exacerbation O2 Most comfortable position (usually upright) Prepare to ventilate/CPR Monitor condition Documenting treatment and measures Smooth drive
What is the definition of asthma
Narrowing of medium-small sized airways due to muscle spasm, oedema and blockage by inflammatory cells
What are the 4 signs of acute asthma
Unable to complete sentences
Resps >25
Pulse >110
Peak flow 33-50% of predicted best value
What are the 10 signs of life threatening asthma attack
Exhaustion Confusion Coma Silent chest Cyanosis Feeble resp effort Bradycardia Hypotension Peak flow
How would you manage asthma 13
Open airway Upright positioning O2 high concentration to relieve hypoxia. O2 given from home to amb due to cold air exposure risk. O2 94+ Salb Calming and resting Peak flow before and after Consider causes of intrinsic and extrinsic or mixed and remove cause Coach resps Monitor changes Rapid and smooth drive Complete documentation Professional handover
What is a good way of measuring airflow obstruction?
Peak flow meters
With regards to peak flow measurements, can a patient use different methods of using peak flow scale?
Yes
After how many minutes post salbutamol would you retest peak flow?
20mins
By how much % is an acceptable increase in peak flow considered post treatment?
15%
What does salbutamol/terbutaline serve to do?
Reverses bronchospasm in acute asthma attack, smoke inhalation & acute exacerbation of COPD.
How much salbutamol can you give an adult as initial dose?
5mg
How much salbutamol can you give a 6-12 year old on initial dose?
5mg
How much salbutamol can you give ages 0-6years?
2.5mg
What is there a risk of in COPD patients and being given salbutamol?
Acidosis
How many minutes do you give a neb to a COPD Patient and why?
6 mins.
Limits risk of hypercapnic respiratory failure
What conditions cause impaired perfusion of the alveoli?
4
Pneumonia
Pulmonary embolism
Pleurisy
TB
What industrial ling diseases cause impaired perfusion of alveoli?
4
Pneumoconiosis
Silicosis
Asbestosis
Byssinosis
What is pleurisy?
Acute inflammation of lungs caused by viruses or bacteria. Follows a cold especially on elderly or chronic bronchitis sufferers.
What are the signs of pneumonia?
4
Breathing increased/shallow
Cough up blood stained sputum
Coughing and attempts to breathe deeply cause distressing chest pain
Temp rises rapidly and patient flushed
What are the three methods of managing pneumonia?
Ensure open airway
O2 to relieve hypoxia
Monitor vitals
What is pleurisy?
Inflammation of pleura caused by bacterial infection. Occurs most often with pneumonia
How is pleurisy treated?
Same as pneumonia
Open airway
O2 to relieve hypoxia
Monitor vitals
What is a pulmonary embolism?
Blood clot blocking pulmonary artery depriving part of the ling of blood supply.
What is a PE a result of?
DVT
What can PE result in?
Pulmonary infarction
Who is at greatest risk of PE?
5
Elderly Bedridden After childbirth After abdo surgery Contraceptive pill
What are the 8 signs of PE?
Dyspnoea Tachypnoea Pleuritic pain Apprehension Tachycardia Cough Haemoptysis Leg pain/clinical DVT
How do you manage PE?
Ensure open airway
O2 or NOO
Prepare to perform CPR
What is TB?
Chronic lung infection which can persist for several years. Patient may not have symptoms
What are the 4 signs of TB?
Fever
Weight loss
Cough
Haemoptysis
What are HIV and homeless people susceptible to?
TB
How would you define hyperventilation syndrome?
Rate of breathing in excess of metabolic needs and higher than that needed to maintain normal co2 levels In blood.
When can hyperventilation syndrome occur?
4
PE
DIABETIC KETOACIDOSIS
ASTHMA
HYPOVOLAEMIA
What are the 6 signs of hyperventilation syndrome?
Acute anxiety Tetany (cramps) including sharp vending of wrist and ankle joints Numbness and tingling of mouth/lips Carpopedal spasm Aching chest muscles Light headed
How would you manage hyperventilation syndrome?
5
Open airway If signs of cyanosis reduced loc or reduced o2, give o2 and treat underlying cause Calm approach Coach resps DO NOT ENCOURAGE PAPER BAG
