the pulmonary system
TRANSCRIPT
THE PULMONARY THE PULMONARY SYSTEMSYSTEM
EMRITA C. MENDOZA, R.N., EMRITA C. MENDOZA, R.N., M.D.M.D.
FUNCTIONS OF THE FUNCTIONS OF THE PULMONARY SYSTEMPULMONARY SYSTEM
Inhalation and Inhalation and exhalation of air exhalation of air through airways through airways to and from the to and from the lungslungs
(Ventilation)(Ventilation) To exchange To exchange
gases between gases between alveoli and alveoli and capillaries capillaries (Perfusion)(Perfusion)
FLOW OF AIR FLOW OF AIR THROUGH THE AIRWAYSTHROUGH THE AIRWAYS
Nostrils Nostrils Nasal passages and Nasal passages and
sinuses sinuses Pharynx Pharynx EpiglottisEpiglottis Larynx Larynx Trachea (windpipe)Trachea (windpipe) Main Bronchi (R & L)Main Bronchi (R & L) Secondary Lobar Secondary Lobar
BronchiBronchi Tertiary Lobular Tertiary Lobular
BronchiBronchi Terminal BronchiolesTerminal Bronchioles
ANATOMY OF ANATOMY OF THE AIRWAYSTHE AIRWAYS Larynx:Larynx:
muscular cords muscular cords protected by protected by circular circular cartilagescartilages
Trachea:Trachea: continues as continues as hyaline hyaline cartilages with cartilages with inner ciliated inner ciliated lininglining
ANATOMY OF THE ANATOMY OF THE AIRWAYSAIRWAYS Right main bronchus Right main bronchus
is shorter & wider is shorter & wider than the left.than the left.
Trachea divides into Trachea divides into the R & L primary the R & L primary bronchi at the bronchi at the carina.carina.
BRONCHUSBRONCHUS secondary bronchisecondary bronchi tertiary or segmental tertiary or segmental bronchibronchi respiratory respiratory bronchiolesbronchioles
LOCATION OF THE LOCATION OF THE LUNGSLUNGS
Two large, Two large, spongy organs spongy organs occupying the occupying the thoracic cavity thoracic cavity on either side of on either side of the heartthe heart
Composed of Composed of elastic elastic connective tissue connective tissue whose linings are whose linings are coated with coated with surfactantsurfactant
PLEURAL MEMBRANESPLEURAL MEMBRANES
Each lung is lined Each lung is lined with with visceral pleuravisceral pleura
Continuous with the Continuous with the parietal pleuraparietal pleura of of the thoracic cavitythe thoracic cavity
Space in between is Space in between is the the pleural cavitypleural cavity or or sac, which is sac, which is lubricated for easier lubricated for easier gliding of the lungsgliding of the lungs
RELATIONS OF THE LUNGSRELATIONS OF THE LUNGS
Lungs lie within the Lungs lie within the borders of the borders of the thoracic cagethoracic cage
Floor is the Floor is the diaphragm, which diaphragm, which is higher on the is higher on the rightright
Heart lies in Heart lies in between and between and anterior, occupying anterior, occupying the (L) cardiac the (L) cardiac notchnotch
Rib Levels of the LungsRib Levels of the Lungs
Apex or Apical Apex or Apical region = neck region = neck of the of the
first ribfirst rib Hilar region is Hilar region is
where a where a bronchus bronchus entersenters
Basilar region Basilar region lies along the lies along the basebase
Pleural CavitiesPleural Cavities
Costodiaphragmatic Costodiaphragmatic recessesrecesses
: Spaces in the : Spaces in the pleural cavities pleural cavities below each lung, below each lung, superior to the superior to the diaphragm.diaphragm.
Lobes of the LungsLobes of the Lungs
(R) lung(R) lung = 3 lobes = 3 lobes - upper, middle, - upper, middle,
lower lower fissures:fissures:
horizontal, horizontal, obliqueoblique
(L) lung(L) lung = 2 lobes = 2 lobes - upper with - upper with
lingula, lingula, lower lower fissure:fissure: oblique oblique
Bronchopulmonary Bronchopulmonary SegmentsSegments
The anatomical, The anatomical, functional, and functional, and surgical lung unit surgical lung unit
Composed of:Composed of:
A. tertiary bronchiA. tertiary bronchi
B. branch of B. branch of pulmonary pulmonary
arteryartery
C. lung parenchymaC. lung parenchyma
Histology of the AirwaysHistology of the Airways Conductive Conductive
portion of the portion of the respiratory tree:respiratory tree:
A. hyaline A. hyaline cartilage cartilage
B. smooth muscle B. smooth muscle C. inner elastic C. inner elastic layer: lined with layer: lined with ciliated epithelium ciliated epithelium with mucus-with mucus-secreting goblet secreting goblet cellscells
Conductive Conductive bronchioles:bronchioles: do not do not contain cartilage but contain cartilage but Clara cells which Clara cells which secrete cytochrome secrete cytochrome P-450 to attack P-450 to attack airborne toxinsairborne toxins
Histology of Respiratory Histology of Respiratory ParenchymaParenchyma
Respiratory Respiratory bronchioles are bronchioles are unciliated.unciliated.
Interstitial connective Interstitial connective tissue supports the tissue supports the ductsducts
Alveoli contain Alveoli contain macrophages and macrophages and pneumocytes:pneumocytes:
Type I Type I – simple – simple squamous epithelium squamous epithelium sensitive to sensitive to neutrophilic neutrophilic lysozymeslysozymes
Type II – secretes Type II – secretes surfactantsurfactant
Mechanics of Mechanics of VentilationVentilation
INSPIRATIONINSPIRATIONrespiratory muscles contract respiratory muscles contract
(diaphragm,intercostal (diaphragm,intercostal m.)m.)
increased thoracic increased thoracic diameter diameter
Decreased pressureDecreased pressure
Air goes inAir goes in
EXPIRATIONEXPIRATION
Respiratory muscles relaxRespiratory muscles relax
Decreased thoracic Decreased thoracic diameterdiameter
Increased pressureIncreased pressure
Air goes outAir goes out
Respiratory Rate (RR)Respiratory Rate (RR)
Inspiration-Inspiration-expiration cycle is expiration cycle is measured in cpm measured in cpm (cycles per (cycles per minute)minute)
Normal adult RR: Normal adult RR: 14-20cpm 14-20cpm
Children 20-30 Children 20-30 cpmcpm
Infants 40-60 cpmInfants 40-60 cpm
Regulation of RespirationRegulation of Respiration RESPIRATORY RESPIRATORY
CENTER in the CENTER in the BRAINSTEM.BRAINSTEM.
- activated by acidic - activated by acidic blood pH due to blood pH due to excess CO2 which excess CO2 which forms carbonic acid:forms carbonic acid:
CO2 + H20 CO2 + H20 H2CO3H2CO3
CAROTID AND AORTIC CAROTID AND AORTIC CHEMORECEPTORS CHEMORECEPTORS
- help regulate breathing- help regulate breathing
- High [CO2] or low [O2] - High [CO2] or low [O2] in the blood will make in the blood will make chemoreceptors send chemoreceptors send nervous impulses to the nervous impulses to the medulla and pons to medulla and pons to inform the phrenic nerveinform the phrenic nerve
Phrenic nerve stimulates Phrenic nerve stimulates the diaphragm tothe diaphragm to contractcontract
Breathing PatternsBreathing Patterns BIOTS: BIOTS:
breathing with breathing with irregularly irregularly alternating alternating periods of apnea periods of apnea and hyperpneaand hyperpnea
e.g.meningitis and e.g.meningitis and brain disorders brain disorders that cause that cause ICP ICP
CHEYNE-STOKESCHEYNE-STOKES:: common but common but usually abnormal usually abnormal periods of apnea periods of apnea lasting 10-60 lasting 10-60 seconds followed by seconds followed by gradual increase gradual increase then decreasethen decrease
e.g. frontal lobe e.g. frontal lobe and diencephalic and diencephalic dysfunctiondysfunction
Breathing PatternsBreathing Patterns COGWHEELCOGWHEEL
– – respiratory respiratory murmur, not murmur, not continuous but continuous but broken into broken into waves waves
e.g. bronchitis e.g. bronchitis and possible TBand possible TB
KUSSMAUL KUSSMAUL – deep, – deep, gasping gasping breathingbreathing
e.g. diabetic e.g. diabetic ketoacidosis and ketoacidosis and comacoma
Alveolar Ventilation/ Alveolar Ventilation/ PerfusionPerfusion
VENTILATION (V) VENTILATION (V) -refers to air -refers to air flowflow
PERFUSION (Q) PERFUSION (Q) - -refers to blood flowrefers to blood flow
V/Q measured V/Q measured in ml/min in ml/min
Normal V/Q: Normal V/Q: 0.8 ml/min 0.8 ml/min
V/Q mismatch V/Q mismatch occurs when occurs when diseases affect diseases affect either floweither flow
ARTERIAL BLOOD GASES ARTERIAL BLOOD GASES (ABG)(ABG)
Measurements of the amounts of gases in the Measurements of the amounts of gases in the bloodstream useful to help diagnose bloodstream useful to help diagnose conditions like acute respiratory distress conditions like acute respiratory distress syndrome (ARDS)syndrome (ARDS)
PULMONARY FUNCTION PULMONARY FUNCTION TESTS (PFT)TESTS (PFT)
•A spirometer can also be used to measure air flow.A spirometer can also be used to measure air flow.• Patient is guided to exhale forcefully into a tube Patient is guided to exhale forcefully into a tube which can measure RR and various lung volumeswhich can measure RR and various lung volumes