week 6 - disorders of the respiratory system Flashcards
What are the 3 functions of the respiratory system?
- Breathing
- exchange of O2 and CO2
- Speech production
What is external respiration>?
exchange of gases across membrane of the lungs
Gas exchange at pulmonary capillaries
Ventilation occurs
what is ventilation?
exchange of air between lungs and atmosphere
What is internal respiration?
exchange of gases from blood into organs and tissues
gas exchange at cellular level
as all cells need oxygen for metabolism and need to remove carbon dioxide
What areas are part of the upper respiratory tract?
Nose and naval cavity - air in, smell
Pharynx - carries food and air to oesophagus
Larynx - breathing, prevents against breathing in food
What is the function of the upper respiratory tract?
moistens/warms incoming air
filters incoming air
passageway fir respiration
What areas are part of the lower respiratory tract?
Larynx - maintains open airway, routes food and air
Trachea - transports air to and from the lungs
Broinchi - branch into the lungs
Lungs - transport air to the alveoli for gas exchange
Describe the bronchi in more detail?
Consist of cartilage rings and smooth muscle
They divide into bronchioles
They stop at the alveoli
What is pleura?
The pleura covers the lung:
Parietal pleura - inner
Pleural cavity - middle
Visceral pleura - outer
The pleura lubricarte fluid
What is the diaphragm?
It is a muscle which separates the chest and the abdomen
Innervated (supplied with nerves) by phrenic nerve
Describe the alveoli/
They are air sacs in the lungs.
Their membranes are one cell thick and are surrounded by capillaries for efficient gaseous exchange
What are properties of the alveoli for efficient gas exchange?
Large surface area
Good blood supply
Short diffusion. pathway
Moist surfaces - the liquid on the surface of alveoli dissolves gases and facilitates diffusion
Describe gas exchange in brief?
Oxygen moves from lungs to the bloodstream while carbon dioxide passes from the bloodstream top the lungs
What is the partial pressure gradient?
Where a gas diffuses from a higher pressure to a lower pressure down the gradient
What are the 2 phases of the respiratory cycle?
Inspiration
Expiration
Describe the process of inspiration (breathing in)?
external intercostal muscles contract - so ribs move up and out
Diaphragm contracts and flattens
Chest cavity/wall and lungs expand as ribs expand
Lung volume increases - causing air pressure to fall so air can flow in
Describe the process of expiration (breathing out)?
external intercostal muscles relax - so ribs return back to normal
the diaphragm relaxes
chest cavity and lungs contract as ribs return back to normal
Lung volume decreases - causing air pressure to rise so air can flow out
How is breathing regulated via the central nervous system/
- Respiratory centre in MO establishes basic breathing pattern
- Chemoreceptors - monitor CO2, O2, H+ levels
- Medulla - sensitive to H+ in CSF resulting from co2 in blood
- Carotid/aortic bodies sensitive to co2, Ph, o2
- Conscious control in the brain
What is physiologic dead space (Vd) - a type of breathing measurement?
volume of air in respiratory zone that does not take part in gas exchange
What is tidal volume (Vt) - a type of breathing measurement?
The amount of air in and out of the lungs with each respiratory cycle (1 breath, expiration and inspiration)
What is respiratory rate (f) - type of breathing measurement?
Amount of breathes per minute
How can you calculate minute volume (Ve) (L/min) - a type of breathing measurement?
(Vt x f)
What is alveolar ventilation (Va) - a type of breathing measurement?
And how do you calculate it?
it is the amount of air that reaches the alveoli
Calculate it by (Vt-Vd) x f
What does Vd/Vt calculate/
the portion of Vt that does not exchange
What are the 3 ways to measure lung function?
Pulmonary function tests
Lung volumes and vital capacity
Gas transfer test
What is tidal volume (Vt) - a measurement of lung function?
Amount of air inhaled/exhaled during normal breathing
What is minute volume (MV) - a measurement of lung function?
The total air exhaled per minute
What is vital capacity (VC) - a measurement of lung function?
The total volume of air exhaled after max inhaling
What is functional residual capacity (FRC) - a measurement of lung function?
The amount of air left in the lungs after exhaling normally
What is residual volume - a measurement of lung function?
The amount of air left in the lungs after exhaling max
What is forced vital capacity (FVC) - a measurement of lung function?
The amount of air exhaled forcefully and quickly after inhaling max
What is forced expiratory volume (FEV) - a measurement of lung function?
The amount of air expired during the 1st 2nd and 3rd seconds of the FVC test
What is spirometry? - a measurement of lung function
Spirometry measures the amount an/or speed of air that can be inhaled and exhaled
Revise the spirometry graph
Describe the process of the gas transfer test - measurement of lung function
Go over it
What are the 4 respiratory processes?
Pulmonary ventilation
External respiration
Internal respiration
Cellular respiration
What is pulmonary ventilation./
breathing
What is external respiration?
The gas exchange between air in alveoli and the blood in capillaries
What is internal inspiration?
The gas exchange between blood and cells/tissues of body
What is cellular respiration?
The production of energy - ATP
What are some disorders of the respiratory system ?
Asthma, emphysema, bronchitis
Infections like pneumonia, TB, botulism
Lung cancer
Congestive heart failure - CHF
Cystic fibrosis
Lung capacity in disease slide
What happens in a respiratory assessment/
Determine the adequacy of gas exchange routinely on the patient
If there is early recognition of respiratory disease, response is early
What should a respiratory assessment include?
HIPPAA
History
Inspection/observation
Palpation
Percussion
Auscultation
Adjuncts - blood gas analysis, chest x ray, spirometry etc
History
What are some history considerations in a respiratory assessment?
medical history
Sputum presence
employment history
exercise tolerance
reason for admission
What is sputum?
It is a thick mucus produced in the lungs coughed up from the lower airways
What are the types of sputum and what do they show?
Green, thick, foul - infection
Blood stained - TB, pleural effusion, lung cancer
White, thick - COPD, asthma
Pink and frothy - pulmonary oedema, HF
Brown/brick coloured - TB, infection
Inspection/Observation
What measures should be inspected during a respiratory assessment on the patient?
Breathing rate
Quality of breathing
Breathing rhythm
Degree of effort to breathe
Cough
Mental status
Skin colour
Deformities
What are some other breathing terms?
Tachypnoea - fast breathing rate
Bradypnoea - slow breathing rate
Orthopnoea - sensation of breathlessness
Dyspnoea - shortness of breath
Palpitation?
Assess the bilateral movements of the chest
Percussion
The chest should have a resonant/hollow percussion
Disease - hyper-resonant/flat notes
Pneumothorax/emphysema - high percussion note
Pleural effusion - low percussion note
Asthma - drum like sound
Auscultation
This is where you listen to the chest with stethoscope to check for normal breathing sounds
Detect air entry throughout
Learn the adventitious breath sounds
What are some respiratory assessment tools
Pulse oximetry
Spirometry
Arterial blood gas analysis
Chest x-ray
Describe pulse oximetry?
It is where you assess o2 saturation
What are the potential problems with pulse oximetry?
Dark skin pigmentation, nail varnish etc can affect light emission
Thick skin can inhibit conduction
The monitor becomes unreliable if o2 saturation is below 85%
etc etc
Important points on pulse oximetry?
Does not record co2
Does not indicate adequate ventilation
The position of the probe must be changed frequently to prevent pressure damage
How does a chest x-ray assess any respiratory issues?
It identifies and diagnoses problems with the lungs
What is arterial blood gas (ABG) sampling?
It is where blood is obtained from the patient when they are deemed acutely ill/at risk by direct arterial puncture/insertion of arterial line
Blood gas measured in kPa, 1 kPa = 7.5mmHg
What does ABG help with?
Gives indication of respiratory function
Gives view of metabolic environment in patients body
Gives indication of bodies ability to maintain homeostasis
What is a limitation of blood gases?
It must be examined alongside medical history, clinical symptoms/examonation
Learn ABG analysis values?
What conditions can be tested for via ABG?
hypoxia
Severe sepsis
Diabetic ketoacidosis - acidic blood
Renal tubular acidosis - kidneys do not remove acid
What is Chronic Obstructive Pulmonary Disease? (COPD)
It is when there is a recurrent obstruction to airflow
Consists of a group of disorders like emphysema/bronchitis
Incurable
What are the features of asthma? COPD
Bronchospasms, productive cough,
What are the features of chronic bronchitis? COPD
Mucosal swelling, chest pain, cough
What are the features of emphysema? COPD
Barrel chest, Dyspnoea, Orthopnoea
