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Professional Nursing

Properly functioning alveolar system in the lungs: Oxygenate venous blood & Remove carbon dioxide from blood
Properly functioning cardiovascular and hematological system: Carry nutrients and wastes to and from body cells.
Upper Airway: Function—warm, filter, humidify inspired air. Components: Nose, Pharynx, Larynx, Epiglottis.
Lower Airway: Functions—conduction of air, mucociliary clearance, production of pulmonary surfactant. Components: Trachea, Right and left mainstem bronchi, Segmental bronchi, Terminal bronchioles.
Anatomy of the Lungs: Main organs of respiration. Location: Thoracic cavity, Diaphragm to the apex (first rib). Composed of: elastic tissue(alveoli, surfactant, pleura): Stretch and recoil. Composed of lobes: Right – 3 lobes, Left – 2 lobes.
Visceral Pleura: covers the lungs
Parietal Pleura: covers the thoracic cavity
Intrapleural pressure: negative pressure
Pleural fluid and pressure: Keep lung expanded
Surfactant: phospholipid that makes things slippery and prevents alveoli collapse.
Pleural fluid between membranes: acts as a lubricant and as an adhesive agent to hold the lungs in an expanded position.
Inspiration: the active phase of ventilation. Involves movement of muscles and thorax to bring air into the lungs.
Expiration: the passive phase of ventilation. Movement of air out of the lungs.
Process of Ventilation: 1.The diaphragm contracts and descends, lengthening the thoracic cavity 2.The external intercostal muscles contract, lifting the ribs upward and outward 3.The sternum is pushed forward, enlarging the chest from front to back
Process of Ventilation: (cont) 4.Increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lungs) to lesser pressure (inside lungs) 5.The relaxation of these structures results in expiration
Gas Exchange: Refers to the intake of oxygen and release of carbon dioxide. Made possible by respiration and perfusion. Occurs via diffusion (movement of oxygen and carbon dioxide between the air and blood).
Four Factors Influencing Diffusion of Gases in the Lungs: 1.Change in surface area available 2.Thickening of alveolar-capillary membrane 3.Partial pressure 4.Solubility and molecular weight of the gas
Change in surface area available: Atelectasis & Lobectomy
Thickening of alveolar-capillary membrane: Pneumonia & Pulmonary Edema
Partial pressure: Toxic fumes, high altitude
Solubility and molecular weight of the gas: CO2 greater solubility than O2
Transport of Respiratory Gases: Oxygen is carried in the body via plasma and red blood cells. Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin.
Transport of Respiratory Gases: (cont) Hemoglobin also carries carbon dioxide in the form of carboxyhemoglobin. Internal respiration between the circulating blood and tissue cells must occur.
Cardiovascular System: Vital for exchange of gases. Composed of the heart and the blood vessels. The heart is a cone shaped, muscular pump, divided into four hollow chambers.
Cardiovascular System: (cont) The upper chambers, the atria (singular, atrium), receive blood from the veins (the superior and inferior vena cava and the left and right pulmonary veins)
Cardiovascular System: (cont) The lower chambers, the ventricles, force blood out of the heart through the arteries (the left and right pulmonary arteries and the aorta).
Hypoxemia: deficient oxygenation of blood. OCCURS IN THE ALVEOLI* “He is having shortness of breath so badly, it is causing hypoxemia.”
Hypoxemia: (cont) OCCURS IN THE LUNGS. Low arterial blood O2. Caused by poor O2 diffusion in the alveolar-capillary lung membrane.
Hypoxemia: (cont) Causes: Structural (fractures, spinal abnormalities), Airway inflammation or obstructions, infections, changes in consistency of lung tissue (COPD, pulmonary edema), atelectasis
Hypoxia: inadequate amount of oxygen available to the cells. OCCURS IN TISSUES. “The blood flow to the foot is so poor the tissue is becoming hypoxic.”
Hypoxia: (cont) Poor oxygenation of Tissue. May occur because of poor lung oxygenation or circulatory disorders. Must assess organ function and tissue perfusion. Poor tissue perfusion (weak or absent pulse, pale or cyanotic skin, cool skin temp).
Hypoxia: (cont) Causes can be because the amt of O2 taken in can not meet demands, poor heart pumping, decrease blood flow to an area.
Respiratory Center: Medulla in Brainstem. Stimulated by an increased in CO2 concentration and hydrogen ions. Decrease in O2 concentration on arterial blood to a lesser degree.
Stimulation of the Center: Increases RR. Increases depth of respirations.
Respiratory Functioning in the Older Adult: Bony landmarks are more prominent due to loss of subcutaneous fat. Kyphosis contributes to appearance of leaning forward. Barrel chest deformity may result in increased anteroposterior diameter.
Respiratory Functioning in the Older Adult: (cont) Tissues and airways become more rigid; diaphragm moves less efficiently. Older adults have an increased risk for disease, especially pneumonia.
Resonance: loud, hollow low-pitched sound heard over normal lungs.
Hyperresonance: loud, low booming sound heard over emphysematous lungs.
Flatness: detected over bone or heavy muscle.
Dullness: with medium pitch and intensity heard over the liver.
Tympany: high-pitched, loud, drum-like sound produced over the stomach.
Vesicular: low-pitched soft sound during expiration heard over most of lungs.
Bronchial: high-pitched and longer, heard primarily over trachea.
Bronchovesicular: medium pitch and sound during expiration, heard over upper anterior chest and intercostal area.
Crackles: intermittent sounds occurring when air moves through airways that contain fluid. Classified as fine, medium, or coarse.
Wheezes: continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors. Classified as sibilant or sonorous.
Tidal Volume (TV): amount of air inspired and expired in normal respiration (normal = 500 mL).
Inspiratory Reserve Volume (IRV): amount of air inspired beyond tidal volume (normal = 3100 mL).
Expiratory Reserve Volume (ERV): amount of air that can be exhaled beyond tidal volume (normal = 1200 mL).
Residual Volume: (RV) amount of air remaining in lungs after a maximal expiration (normal = 1200 mL).
Promoting Proper Breathing: Deep breathing, Using incentive spirometer, Pursed-lip breathing Abdominal or diaphragmatic breathing
Created by: mr209368