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70 year old patient with breathing problems, and a developed infection in…

- - - - higher altitude
        
        moved to Denver CO
        
        much higher elevation than Fort Worth
        
        pulmonary and cerebral edema may occur
        
        atmospheric pressure and Po2 are lower
        
        acute mountain sickness
        
        symptoms
        
        headaches
        
        shortness of breath
        
        nausea
        
        dizziness
        
        lower than normal hemoglobin saturation
        
        less O2 is available to be loaded
      - fluid in lungs
        
        pneumonia
        
        infection that inflames the air sacs in the lungs
        
        lungs get fill with fluid or pus
        
        symptoms
        
        chest pain
        
        chills
        
        sweating
        
        fever
        
        muscle pain
        
        exhaustion
        
        cough
        
        shortness of breath
        
        causes
        
        bacteria and viruses
        
        in the air
        
        bacteria
        
        Streptococcus Pneumoniae
        
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        bacteria-like organisms
        
        mycoplasma pneumoniae
        
        Fungi
        
        common in people with chronic health problems
        
        viruses
        
        common in children younger than 5 years
        
        germs overpower immune system
        
        complications
        
        Pleurisy
        
        inflammation of the pleurae
        
        friction and stabbing pain with each breath
        
        fibrosis
        
        nonelastic scar tissue
        
        decreases production of surfactant
      - other symptoms
        
        fast, shallow breathing
        
        tachypnea
        
        abnormally rapid breathing
        
        wet, wheezy cough
        
        caused
        
        fluid in the airways causing cough reflexes
        
        causes
        
        respiratory infection
        
        common cold
        
        bronchitis
        
        pneumonia
        
        chronic lung conditions
        
        heart condition
    - - age
        
        70 year old
        
        weakened or suppressed immune system
        
        vulnerable to infetions
        
        changes in lung tissue
        
        decline in lung capacity
        
        alveoli can lose their shape
        
        diaphragm can weaken
        
        decrease ability to inhale and exhale
        
        ribcage bones
        
        become thinner and change shape
        
        nerves in airways
        
        become less sensitive
      - other lung conditions
        
        asthma
        
        inflammation and narrowing of the airways
        
        cause
        
        shortness of breath
        
        wheezing
        
        chest tightness
        
        coughing
        
        Chronic obstructive pulmonary disease (COPD)
        
        disease that lead to poor lung function
        
        symptoms
        
        wheezing
        
        constant cough
        
        increase mucus production
        
        low oxygen levels
        
        chest tightness
      - lack of exercise
        
        weak muscles
        
        weak diaphram
        
        weak intracoastal muscles
- - - - supply the body with oxygen and dispose of carbon dioxide
        
        for cellular respiration
    - - pulmonary ventilation
        
        inspiration
        
        air into the lungs
        
        expiration
        
        air out of the lungs
      - external respiration
        
        O2 diffuse from lungs to blood
        
        CO2 diffuse from blood to the lungs
      - Transport of respiratory gases
        
        blood transport gases
        
        O2 from lungs to tissue cells
        
        CO2 from tissue cells to lungs
      - Internal Respiration
        
        O2 diffuses from blood to tissue cells
        
        CO2 diffuses from tissue cells to blood
  - - - Nose and Paranal Sinuses
        
        nose
        
        moistens and warms entering air
        
        filters and cleans inspired air
        
        serves as a resonating chambers for speech
        
        houses olfactory receptors
        
        external nose
        
        nostrils( nares)
        
        apex of nose
        
        point of nose
        
        ala of nose
        
        side of nose
        
        dorsum nasi
        
        anterior margin
        
        root and bridge
        
        between eyebrows
        
        provides airways for respiration
        
        nasal cavity
        
        posterior to external nose
        
        parts
        
        posterior nasal aperture
        
        back of nasal cavity
        
        olfactory epithelium
        
        nasal conchae
        
        superior, middle, inferior
        
        increase mucosal surface
        
        minimize amount of moisture and heat lost
        
        nasal meatuses
        
        nasal vestibule
        
        sweat glands hair follicles
        
        uvula
        
        soft palate
        
        Hard palate
        
        membranes
        
        olfactory mucosa
        
        lines superior region of nasal cavity
        
        smell receptors
        
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        respiratory mucosa
        
        lines most of nasal cavity
        
        pseoodostratified ciliated columnar epithelium
        
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        ciliated cells
        
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        paranasal Sinuses
        
        located
        
        frontal, sphenoid, ethmoid, maxillary
      - Pharynx
        
        connects the nasal cavity and the mouth to the larynx and esophafus
        
        regions
        
        nasopharynx
        
        posterior to nasal cavity, inferior to spenoid bone
        
        air passageway
        
        pharyngeal tonsil
        
        trap and destroy pathogens
        
        oropharynx
        
        posterior to the oral cavity
        
        isthmus of the fauces
        
        swallow
        
        food
        
        inhale
        
        air
        
        palatine tonsil
        
        posterior to oral cavity
        
        lingual tonsil
        
        posterior surface of tongue
        
        laryngopharynx
        
        passageway for food and air
    - - zones
        
        respiratory zone
        
        actual site of gas exchange
        
        bronchioles, alveolar ducts and alveoli
        
        conduction zone
        
        respiratory passageways from nose to bronchioles
        
        cleanse, humidify, warm incoming air
      - Larynx-voice box
        
        funciton
        
        provides airway
        
        switching mechanism to route air and food
        
        voice production
        
        parts
        
        thyroid cartilage
        
        shild shape
        
        laryngeal prominence
        
        midline of thyroid cartilage
        
        cricoid cartilage
        
        inferior to thyroid cartilage, ring shape
        
        cartilages
        
        arytenoid
        
        cuneiform
        
        corniculate
      - Epiglottis
        
        spoon shape, elastic cartilage, covered with tast bud mucosa
        
        guardian of the airways
        
        cough reflex to expel substances
      - Vocal Folds
        
        glottis
        
        opening
        
        folds
        
        vestibular
        
        vocal
        
        elastic fibers
        
        vibrate
        
        produce sounds
      - Trachea
        
        windpipe
        
        neck and into mediastinum
        
        into 2 main bronchi
        
        layers
        
        mucosa
        
        pseudo stratified epithelium with goblet cells
        
        lamina propria
        
        connective tissue
        
        submucosa
        
        connective tissue layer
        
        produces mucus
        
        adventitia
        
        connective tissue
        
        outermost layer
      - Bronchial tree
        
        right/ left main (primary) bronchi
        
        lobar (secondary) bronchi
        
        segmental (tertiary) bronchi
        
        terminal bronchioles
        
        respiratory bronchioles
        
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      - Alveoli
        
        main site of gas exchange
        
        types of cells
        
        Type I alveolar cells
        
        squamous epithelial cells
        
        alveolar walls
        
        Type II alveolar cells
        
        cuboidal epithelial cells
        
        secrete surfactant
        
        Alveolar macrophages
        
        consume bacteria, dust, debris
    - - pulmunary arteries
        
        take blood from heart to lungs
        
        to oxygenate blood
      - pulmoary veins
        
        take blood from lungs to heart
        
        oxygenated blood
      - blood pressure circulation
  - - - pressure relationships
        
        atomosphereric pressure (Patm) = 760mm Hg
        
        negative pressure
        
        lower than atmospheric pressure
        
        positive pressure
        
        higher than atmospheric pressure
        
        zero pressure
        
        equal to atmospheric pressure
      - Intrapulmonary Pressure (Ppul)
        
        presssure in the alveoli
        
        0mm Hg
        
        pressure rises and falls but always equalizes Patm
      - intrapleural pressure (Pip)
        
        pressure in pleural cavity
        
        -4mm Hg
        
        always 4mm Hg less that Ppul
      - transpulmonary Pressure
        
        difference between Ppul- Pip
        
        keeps lungs from collapsing
    - - mechanical process
        
        volume changes in thoracic cavity
      - volume changes
        
        leads to pressure changes
      - pressure changes
        
        leads to flow of gases
      - Boyle's law
        
        P1V1=P2V2
      - changes in thoracic volume
        
        inspiration
        
        diaphragm descends, rib cage rises
        
        thoracic cavity volume increases
        
        lungs are stretch; intrapulmonary volume increases
        
        intrapulmonary pressure drops to -1mm Hg
        
        air goes into lungs, down its pressure gradient.( Ppul equals 0)
        
        expiration
        
        diaphragn rises, rib cage descends
        
        thoracic cavity volume decreases
        
        lungs recoil, intrapulmonary volume decreases
        
        intrapulmonary pressure rises to +1 mm Hg
        
        Air flows out of the lungs, until intrapulmonary pressure is 0.
        
        nonrespiratory Air Movements
        
        cough
        
        sneeze
        
        cry
        
        laugh
        
        hiccup
        
        yawn
      - factors that influence Pulmonary Ventilation
        
        Airway Resistance
        
        F(flow)=pressure(P)/ resistance (R)
        
        Alveolar Surface Tension
        
        draws liquid molecules closer
        
        reduces contact with dissimilar gas molecules
        
        resists any force that tends to incease surface area of the liquid
        
        lung compliance
        
        CL= change VL/ change (Ppul-Pip)
        
        determined factors
        
        distensibility of the lung tissue
        
        alveolar surface tension
    - - spirometer
        
        instrument utilized to measure respiratory capacities
      - respiratory volumes
        
        tidal volume (TV)
        
        normal quiet breathing
        
        500ml
        
        inspiratory reserve volume (IRV)
        
        amount of air that can be inspired forcibly
        
        2100 to 3200ml
        
        expiratory reserve volume (ERV)
        
        amount of air that can be expelled after normal tidal expiration
        
        1000 to 1200ml
        
        residual volume (RV)
        
        remaining air
        
        1200ml
      - Respiratory Capacities
        
        inspiratory capacity (IC)
        
        sum of TV and IRV
        
        Functional residual capacity (FRC)
        
        combination of RV and ERV
        
        Vital Capacity (VC)
        
        sum of TV, IRV and ERV
        
        total lung capacity (TLC)
        
        sum of lung volume
      - Dead space
        
        air fills conducting passageways and never contributes to gas exchange
    - - Daltons law
        
        total pressure X percentage= partial pressure
      - Henrys law
        
        gas will dissolve in liquid in proportion to its partial pressure
        
        factors
        
        partial pressure of gas
        
        solubility of gas in liquid
        
        temperature of liquid
      - Ventilation Perfusion Coupling
        
        ventilation less than perfusion
        
        increase of Pco2 and decrease of Po2
        
        pulmonary arterioles constrict
        
        match ventilation
        
        ventilation greater than perfusion
        
        decrease in Pco2 and increase of Po2
        
        pulmonary arterioles dilate
        
        match ventilation
    - - oxygen transport
        
        bound to hemoglobin
        
        98.5%
        
        four polypeptide chains
        
        bounded to iron
        
        oxygen binds to iron
        
        dissolvd in plasma
        
        1.5%
        
        oxyhemoglobin
        
        HbO2
        
        hemoglobin-oxygen combination
        
        deoxyhemoglobin
        
        HHb
        
        hemoglobin that has released oxygen
        
        equation
        
        HHb+O2=Hbo2+H
        
        factors that influence hemoglobin Saturation
        
        temperature
        
        blood pH
        
        BPG in blood
        
        Red Blood cells
      - Carbon Dioxide transport
        
        body produces
        
        200ml of CO2 each min
        
        dissolved in plasma
        
        7-10%
        
        chemically bounded to hemoglobin
        
        20%
        
        CO2+Hb=HbCO2
        
        carbaminohemoglobin
        
        bicarbonate ions in plasma
        
        70%
        
        convert carbon dioxide to bicarbonate ions
        
        CO2+H2O=H2CO3=H+HCO3
- - - - effects on respiration
        
        weak immune system
        
        vulnerable to infections
        
        nerves
        
        less sensative
        
        ribcage bones
        
        become thinner and change shape
        
        lung capacity
        
        alveoli shape
        
        emphysema
        
        inflammation in the lungs
        
        air sacs begin to harden and lose elasticity
        
        weaken diaphram
        
        shortness of breath
    - - bacterial infection
        
        streptococcus
        
        pneomonia
        
        trouble breathing
        
        inflammation or airspace in lungs
        
        interferes with gas exchange
        
        alveoli in the lungs film with pus and fluids
        
        makes it hard for oxygen to get in to bloodstream
        
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        capillaries/ alverolr walls
        
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        complications
        
        bacteremia
        
        bacteria from lungs get into bloodsteam
        
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        pleural effusions
        
        pneumonia near outer region of the lungs
        
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        treatment
        
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        lung abscess
        
        treatment
        
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        respiratory failure
        
        trouble breathing
        
        hospitalization
        
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        treatment
        
        humidifier
        
        keep airways moist
        
        gargle salt water
        
        help wash away some mucus in throat
        
        cough suppressant
        
        help with cough
        
        antibiotics/ antivitrals
        
        to treat infection or virus
        
        breathing treatment
        
        inhaler or nebulizer
        
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        anti inflammatory drugs
        
        for inflammation
        
        drink fluids
        
        loosen secretion
        
        bring up phlegm
      - high altitude
        
        less oxygen in the air
        
        tachypnea
        
        also called hyperventilation
        
        caused
        
        infections
        
        pneumonia
        
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        bronchitis
        
        blood clot
        
        blood clot in the lung
        
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        asthma
        
        spasms in bronchi of the lung
        
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        result
        
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        when you take more breaths than normal
        
        blood from lungs
        
        short on oxygen
        
        hypoxic
        
        fall atmospheric pressure
        
        decreases in partial pressure of inspired oxygen
        
        acute mountain sickness
        
        low amounts of oxygen
        
        body response
        
        to shortage of oxygen
        
        tightening blood vessels
        
        acclimatization
        
        body adjust to environment change
        
        body produces more red blood cells
        
        make up for the low oxygen saturation
        
        increase the delivery of oxygen through out the body
        
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