Gas Exchange And Respiratory Function
LWBK330-4183G-c21 p484-516.qxd 23/07/2009 02:09 PM Page 484 Aptara5Gas Exchange andRespiratory FunctionConcepts From NANDA, NIC,Case Study Applyingand NOCA Patient With Impaired Cough ReflexMrs. Lewis, age 77 years, is admitted to the hospital for left lower lobepneumonia. Her vital signs are: Temp 100.6 F; HR 90 and regular;B/P: 142/74; Resp. 28. She has a weak cough, diminished breath soundsover the lower left lung field, and coarse rhonchi over the midtracheal area.She can expectorate some sputum, which is thick and grayish green. Shehas a history of stroke. Secondary to the stroke she has impaired gag andcough reflexes and mild weakness of her left side. She is allowed foodand fluids because she can swallow safely if she uses the chin-tuckmaneuver.Visit thePoint to view a concept map thatillustrates the relationships that exist betweenthe nursing diagnoses, interventions, andoutcomes for the patient’s clinical problems.
LWBK330-4183G-c21 p484-516.qxd 23/07/2009 02:09 PM Page 485 AptaraNursing Classifications and LanguagesNANDANURSING DIAGNOSESNICNURSING INTERVENTIONSNOCNURSING OUTCOMESINEFFECTIVE AIRWAY CLEARANCE—Inability to clear secretions or obstructions from the respiratorytract to maintain a clear airwayRESPIRATORY MONITORING—Collection and analysis of patientdata to ensure airway patencyand adequate gas exchangeReturn to functional baseline status, stabilization of, orimprovement in:RESPIRATORY STATUS: AIRWAYPATENCY—Extent to which thetracheobronchial passagesremain openIMPAIRED GAS EXCHANGE—Excessor deficit in oxygenation and/orcarbon dioxide elimination at thealveolar-capillary membraneAIRWAY MANAGEMENT—Facilitationof patency of air passagesRESPIRATORY STATUS: GASEXCHANGE—The alveolarexchange of O2 and CO2 to maintain arterial blood gas concentrationsINEFFECTIVE BREATHING PATTERN—Inspiration and/or expiration thatdoes not provide adequate ventilationCOUGH ENHANCEMENT—Promotion of deep inhalation bythe patient with subsequent generation of high intrathoracic pressures and compression of underlying lung parenchyma for theforceful expulsion of airRESPIRATORY STATUS:VENTILATION—Movement of air inand out of the lungsRISK FOR ASPIRATION—At risk forentry of gastrointestinalsecretions, oropharyngeal secretions, solids, or fluids intotracheobronchial passagesAIRWAY SUCTIONING—Removal ofairway secretions by inserting asuction catheter into the patient’soral airway and/or tracheaASPIRATION PRECAUTIONS—Prevention or minimization ofrisk factors in the patient at riskfor aspirationBulechek, G. M., Butcher, H. K., & Dochterman, J. M. (2008). Nursing interventions classification (NIC) (5th ed.). St. Louis: Mosby.Johnson, M., Bulechek, G., Butcher, H. K., et al. (2006). NANDA, NOC, and NIC linkages (2nd ed.). St. Louis: Mosby.Moorhead, S., Johnson, M., Mass, M. L., et al. (2008). Nursing outcomes classification (NOC) (4th ed.). St. Louis: Mosby.NANDA International. (2007). Nursing diagnoses: Definitions & classification 2007–2008. Philadelphia: North American NursingDiagnosis Association.485
LWBK330-4183G-c21 p484-516.qxd 23/07/2009 02:10 PM Page 486 Aptarachapter21Assessment of RespiratoryFunctionLEARNING OBJECTIVESGLOSSARYOn completion of this chapter, the learner will beable to:apnea: temporary cessation of breathingbronchophony: abnormal increase in clarity of transmittedvoice soundsbronchoscopy: direct examination of larynx, trachea, andbronchi using an endoscopecilia: short hairs that provide a constant whipping motion thatserves to propel mucus and foreign substances away fromthe lung toward the larynxcompliance: measure of the force required to expand orinflate the lungscrackles: soft, high-pitched, discontinuous popping soundsduring inspiration caused by delayed reopening of theairwaysdiffusion: exchange of gas molecules from areas of highconcentration to areas of low concentrationdyspnea: labored breathing or shortness of breathegophony: abnormal change in tone of voice that is heardwhen auscultating lungsfremitus: vibrations of speech felt as tremors of chest wallduring palpationhemoptysis: expectoration of blood from the respiratory tracthypoxemia: decrease in arterial oxygen tension in the bloodhypoxia: decrease in oxygen supply to the tissues and cellsobstructive sleep apnea: temporary absence of breathing during sleep secondary to transient upper airway obstructionorthopnea: inability to breathe easily except in an uprightpositionoxygen saturation: percentage of hemoglobin that is boundto oxygenphysiologic dead space: portion of the tracheobronchial treethat does not participate in gas exchangepulmonary perfusion: blood flow through the pulmonaryvasculaturerespiration: gas exchange between atmospheric air and theblood and between the blood and cells of the bodyrhonchi: low-pitched wheezing or snoring sound associatedwith partial airway obstruction, heard on chest auscultationstridor: harsh high-pitched sound heard on inspiration, usuallywithout need of stethoscope, secondary to upper airwayobstructiontachypnea: abnormally rapid respirationstidal volume: volume of air inspired and expired with eachbreath during normal breathingventilation: movement of air in and out of airwayswheezes: continuous musical sounds associated with airwaynarrowing or partial obstruction1 Describe the structures and functions of the upper andlower respiratory tracts.2 Describe ventilation, perfusion, diffusion, shunting, andthe relationship of pulmonary circulation to theseprocesses.3 Discriminate between normal and abnormal breathsounds.4 Use assessment parameters appropriate for determiningthe characteristics and severity of the major symptomsof respiratory dysfunction.5 Identify the nursing implications of procedures used fordiagnostic evaluation of respiratory function.486
LWBK330-4183G-c21 p484-516.qxd 23/07/2009 02:10 PM Page 487 AptaraChapter 21Disorders of the respiratory system are common and are encountered by nurses in every setting from the community tothe intensive care unit. Expert assessment skills must be developed and used to provide the best care for patients withacute and chronic respiratory problems. In order to differentiate between normal and abnormal assessment findings,an understanding of respiratory function and the significance of abnormal diagnostic test results is essential.Anatomic and Physiologic OverviewThe respiratory system is composed of the upper and lowerrespiratory tracts. Together, the two tracts are responsible forventilation (movement of air in and out of the airways). Theupper respiratory tract, known as the upper airway, warmsand filters inspired air so that the lower respiratory tract (thelungs) can accomplish gas exchange. Gas exchange involvesdelivering oxygen to the tissues through the bloodstreamand expelling waste gases, such as carbon dioxide, during expiration. The respiratory system works in concert with thecardiovascular system; the respiratory system is responsiblefor ventilation and diffusion, and the cardiovascular systemis responsible for perfusion (Farquhar & Fantasia, 2005).Assessment of Respiratory FunctionCribriform plateof ethmoidFrontalsinusUpper airway structures consist of the nose, sinuses andnasal passages, pharynx, tonsils and adenoids, larynx, andtrachea.NoseThe nose serves as a passageway for air to pass to and fromthe lungs. It filters impurities and humidifies and warms theair as it is inhaled. The nose is composed of an external andan internal portion. The external portion protrudes from theface and is supported by the nasal bones and cartilage. Theanterior nares (nostrils) are the external openings of the nasalcavities.The internal portion of the nose is a hollow cavity separated into the right and left nasal cavities by a narrow verticaldivider, the septum. Each nasal cavity is divided into threepassageways by the projection of the turbinates from the lateral walls. The turbinate bones are also called conchae (thename suggested by their shell-like appearance). Because oftheir curves, these bones increase the mucous membrane surface of the nasal passages and slightly obstruct the air flowingthrough them (Fig. 21-1).Air entering the nostrils is deflected upward to the roofof the nose, and it follows a circuitous route before itreaches the nasopharynx. It comes into contact with a largesurface of moist, warm, highly vascular, ciliated mucousmembrane (called nasal mucosa) that traps practically allthe dust and organisms in the inhaled air. The air is moistened, warmed to body temperature, and brought into contact with sensitive nerves. Some of these nerves detectodors; others provoke sneezing to expel irritating dust. Mucus, secreted continuously by goblet cells, covers the surfaceof the nasal mucosa and is moved back to the nasopharynxby the action of the cilia (fine eInferiorturbinateHardpalateSoftpalateOrifice of auditory(eustachian) tubeAnatomy of the Respiratory SystemUpper Respiratory TractSphenoidalsinus487Figure 21-1 Cross-section of nasal cavity.Paranasal SinusesThe paranasal sinuses include four pairs of bony cavitiesthat are lined with nasal mucosa and ciliated pseudostratified columnar epithelium. These air spaces are connected bya series of ducts that drain into the nasal cavity. The sinusesare named by their location: frontal, ethmoidal, sphenoidal,and maxillary (Fig. 21-2). A prominent function of the sinuses is to serve as a resonating chamber in speech. The sinuses are a common site of infection.Pharynx, Tonsils, and AdenoidsThe pharynx, or throat, is a tubelike structure that connectsthe nasal and oral cavities to the larynx. It is divided intothree regions: nasal, oral, and laryngeal. The nasopharynx islocated posterior to the nose and above the soft palate. Theoropharynx houses the faucial, or palatine, tonsils. Thelaryngopharynx extends from the hyoid bone to the cricoidcartilage. The epiglottis forms the entrance to the larynx.FrontalEthmoidSphenoidMaxillaryFigure 21-2 The paranasal sinuses.
LWBK330-4183G-c21 p484-516.qxd 23/07/2009 02:10 PM Page 488 Aptara488Unit 5Gas Exchange and Respiratory FunctionThe adenoids, or pharyngeal tonsils, are located in theroof of the nasopharynx. The tonsils, the adenoids, andother lymphoid tissue encircle the throat. These structuresare important links in the chain of lymph nodes guardingthe body from invasion by organisms entering the nose andthe throat. The pharynx functions as a passageway for therespiratory and digestive tracts.TracheaThe trachea, or windpipe, is composed of smooth musclewith C-shaped rings of cartilage at regular intervals. Thecartilaginous rings are incomplete on the posterior surfaceand give firmness to the wall of the trachea, preventing itfrom collapsing. The trachea serves as the passage betweenthe larynx and the bronchi.LarynxLower Respiratory TractThe larynx, or voice organ, is a cartilaginous epitheliumlined structure that connects the pharynx and the trachea.The major function of the larynx is vocalization. It also protects the lower airway from foreign substances and facilitates coughing. It is frequently referred to as the voice boxand consists of the following: Epiglottis: a valve flap of cartilage that covers theopening to the larynx during swallowing Glottis: the opening between the vocal cords in thelarynx Thyroid cartilage: the largest of the cartilage structures; part of it forms the Adam’s apple Cricoid cartilage: the only complete cartilaginous ringin the larynx (located below the thyroid cartilage) Arytenoid cartilages: used in vocal cord movementwith the thyroid cartilage Vocal cords: ligaments controlled by muscular movements that produce sounds; located in the lumen ofthe larynxThe lower respiratory tract consists of the lungs, which containthe bronchial and alveolar structures needed for gas exchange.LungsThe lungs are paired elastic structures enclosed in the thoraciccage, which is an airtight chamber with distensible walls(Fig. 21-3). Ventilation requires movement of the walls of thethoracic cage and of its floor, the diaphragm. The effect ofthese movements is alternately to increase and decrease the capacity of the chest. When the capacity of the chest is increased, air enters through the trachea (inspiration) because ofthe lowered pressure within and inflates the lungs. When thechest wall and diaphragm return to their previous positions (expiration), the lungs recoil and force the air out through thebronchi and trachea. Inspiration occurs during the first third ofthe respiratory cycle, expiration during the later two thirds. Theinspiratory phase of respiration normally requires energy; theexpiratory phase is normally passive, requiring very little energy.From pulmonaryarteryAlveolarductFrontal sinusNasal cavityEpiglottisRight LungRightbronchusSphenoidal sinusNasopharynxOropharynxLaryngeal pharynxAlveoliPharynxLarynx and vocal cordsEsophagusCapillariesBTracheaMediastinumRight LungTerminalbronchioleTopulmonaryveinLeft lungDiaphragmThoracicvertabraLeft LungParietalpleuraWall ofthoraxPleuralspaceVisceralpleuraACSternumFigure 21-3 The respiratory system; A, upper respiratory structures and the structures of the thorax; B, alveoli, C, and a horizontalcross-section of the lungs.
LWBK330-4183G-c21 p484-516.qxd 23/07/2009 02:10 PM Page 489 AptaraChapter 21In respiratory diseases, such as chronic obstructive pulmonarydisease (COPD), expiration requires energy.Pleura. The lungs and wall of the thorax are lined with aserous membrane called the pleura. The visceral pleura covers the lungs; the parietal pleura lines the thorax. The visceral and parietal pleura and the small amount of pleuralfluid between these two membranes serve to lubricate thethorax and lungs and permit smooth motion of the lungswithin the thoracic cavity with each breath.Mediastinum. The mediastinum is in the middle of thethorax, between the pleural sacs that contain the two lungs.It extends from the sternum to the vertebral column andcontains all the thoracic tissue outside the lungs (heart, thymus, certain large blood vessels [ie, aorta, vena cava], andesophagus).Lobes. Each lung is divided into lobes. The right lung hasupper, middle, and lower lobes, whereas the left lung consists of upper and lower lobes (Fig. 21-4). Each lobe is further subdivided into two to five segments separated by fissures, which are extensions of the pleura.Bronchi and Bronchioles. There are several divisions ofthe bronchi within each lobe of the lung. First are the lobar bronchi (three in the right lung and two in the leftlung). Lobar bronchi divide into segmental bronchi (10 onthe right and 8 on the left), which are the structures identified when choosing the most effective postural drainageposition for a given patient. Segmental bronchi then divideinto subsegmental bronchi. These bronchi are surroundedby connective tissue that contains arteries, lymphatics, andnerves.The subsegmental bronchi then branch into bronchioles,which have no cartilage in their walls. Their patency dependsentirely on the elastic recoil of the surrounding smooth muscle and on the alveolar pressure. The bronchioles containAssessment of Respiratory Function489submucosal glands, which produce mucus that covers theinside lining of the airways. The bronchi and bronchiolesare also lined with cells that have surfaces covered withcilia. These cilia create a constant whipping motion thatpropels mucus and foreign substances away from the lungstoward the larynx.The bronchioles then branch into terminal bronchioles,which do not have mucus glands or cilia. Terminal bronchioles then become respiratory bronchioles, which areconsidered to be the transitional passageways between theconducting airways and the gas exchange airways. Up tothis point, the conducting airways contain about 150 mL ofair in the tracheobronchial tree that does not participate ingas exchange; this is known as physiologic dead space. Therespiratory bronchioles then lead into alveolar ducts andalveolar sacs and then alveoli. Oxygen and carbon dioxideexchange takes place in the alveoli.Alveoli. The lung is made up of about 300 million alveoli,which are arranged in clusters of 15 to 20. These alveoli areso numerous that if their surfaces were united to form onesheet, it would cover 70 square meters—the size of a tenniscourt.There are three types of alveolar cells. Type I alveolar cellsare epithelial cells that form the alveolar walls. Type II alveolar cells are metabolically active. These cells secrete surfactant, a phospholipid that lines the inner surface and preventsalveolar collapse. Type III alveolar cell macrophages are largephagocytic cells that ingest foreign matter (eg, mucus, bacteria) and act as an important defense mechanism.Function of the Respiratory SystemThe cells of the body derive the energy they need from theoxidation of carbohydrates, fats, and proteins. As with anytype of combustion, this process requires oxygen. Certain vital tissues, such as those of the brain and the heart, cannotThyroid cartilageCricoid cartilageTracheal cartilageRight upper lobeRight bronchusLeft upper lobeLeft bronchusOblique fissureFigure 21-4 Anterior view ofthe lungs. The lungs consist offive lobes. The right lung has threelobes (upper, middle, lower); theleft has two (upper and lower).The lobes are further subdividedby fissures. The bronchial tree, another lung structure, inflates withair to fill the lobes.Horizontal fissureRight middle lobeBronchiolesOblique fissureRight lower lobeLeft lowerlobe
LWBK330-4183G-c21 p484-516.qxd 23/07/2009 02:10 PM Page 490 Aptara490Unit 5Gas Exchange and Respiratory Functionsurvive for long without a continuous supply of oxygen.However, as a result of oxidation in the body tissues, carbondioxide is produced and must be removed from the cells toprevent the buildup of acid waste products. The respiratorysystem performs this function by facilitating life-sustainingprocesses such as oxygen transport, respiration and ventilation, and gas exchange.Oxygen TransportChart 21-1 Causes of Increased AirwayResistanceCommon phenomena that may alter bronchial diameter,which affects airway resistance, include the following: Contraction of bronchial smooth muscle—as in asthma Thickening of bronchial mucosa—as in chronic bronchitis Obstruction of the airway—by mucus, a tumor, or aforeign body Loss of lung elasticity—as in emphysema, which ischaracterized by connective tissue encircling the airways,thereby keeping them open during both inspiration andexpirationOxygen is supplied to, and carbon dioxide is removed from,cells by way of the circulating blood. Cells are in close contact with capillaries, the thin walls of which permit easypassage or exchange of oxygen and carbon dioxide. Oxygendiffuses from the capillary through the capillary wall to theinterstitial fluid. At this point, it diffuses through the membrane of tissue cells, where it is used by mitochondria forcellular respiration. The movement of carbon dioxide occurs by diffusion in the opposite direction—from cell toblood.sistance and alters the rate of air flow for a given pressuregradient during respiration (Chart 21-1). With increasedresistance, greater-than-normal respiratory effort is requiredto achieve normal levels of ventilation.RespirationComplianceAfter these tissue capillary exchanges, blood enters the systemic veins (where it is called venous blood) and travels tothe pulmonary circulation. The oxygen concentration inblood within the capillaries of the lungs is lower than in thelungs’ air sacs (alveoli). Because of this concentration gradient, oxygen diffuses from the alveoli to the blood. Carbondioxide, which has a higher concentration in the bloodthan in the alveoli, diffuses from the blood into the alveoli.Movement of air in and out of the airways (ventilation)continually replenishes the oxygen and removes the carbondioxide from the airways and lungs. This whole process ofgas exchange between the atmospheric air an
The respiratory system is composed of the upper and lower respiratory tracts. Together, the two tracts are responsible for ventilation (movement of air in and out of the airways). The upper respiratory tract, known as the upper airway, warms and filters inspired air so that the lower respirator
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Notes on Respiratory System by Qasim Page 1 RESPIRATORY SYSTEM BASICS Types of Respiration External Respiration: Exchange of respiratory gases between lungs and blood Internal Respiration: Exchange of respiratory gases between blood and tissues Phases of Respiration Inspiration: During which the air enter the lungs from the atmosphere Expiration: During which the air leaves the .
Essentials of Anatomy & Physiology,4th Edition Martini/Bartholomew . Respiratory Physiology An Overview of Respiration and Respiratory Processes Respiration: Gas Exchange Figure 15-12 PLAY. Respiratory Physiology. Respiratory Physiology
PSI 11 Postoperative Respiratory Failure Rate www.qualityindicators.ahrq.gov J95821 Acute postprocedural respiratory failure J9620 Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia J95822 Acute and chronic postprocedural respiratory failure J9621 Acute and chronic respiratory failure with hypoxia
respiratory problems such as a cold Upper respiratory tract-Nose-Pharynx-Larynx Nose Pharynx Larynx Lower respiratory tract in the thorax - trachea, bronchial tree & lungs Respiratory Tract Nose, pharynx, larynx, trachea, bronchi & bronchioles are hollow tubes - Form air passageways - Constitute conducting portion of respiratory system
HASPI Medical Anatomy & Physiology 14a Lab Activity The Respiratory System A healthy respiratory system is crucial to an individual’s overall health, and respiratory distress is often one of the first indicators of a life-threatening illness. The function of the respiratory system is to exchange gases between the external air and the body.
The respiratory system begins with the nostrils through which air is taken in, continues with canal structures called respiratory tracts and ends with structures where gas exchange takes place (Aughey and Frye, 2001). In addition, the respiratory system
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