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70 year-old female moves to Colorado and experiences difficulty breathing,…

- - - - Trachea: tube that connects larynx to two main bronchi branches
        
        Bronchial Tree: system of air-conducting passages
        
        Bronchioles: smaller bronchi that extend from segmental bronchi to lungs
        
        Alveolar Ducts: collect air from bronchioles and dispurses it to alveoli
        
        Alveoli: found inside alveolar sacs; exchange O2 & CO2 in the lungs
        
        Simple Squamous Epithelium
        
        Epithelium Lining of Respiratory Tract
        
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        Millions in lungs
        
        Alveolar Pores: openings btwn alveoli that allow for collateral ventilation
        
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        Alveolar Type I Cells: 95% of alveolar surface; primary cells that form alveolar epithelium
        
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        Alveolar Macrophage/Dust Cell: engulf microbes and can leave the lungs by lymph vessels or coughed up in sputum
        
        Simple Squamous Epithelium: gas exchange/diffusion, osmosis, and filtration
        
        Simple Ciliated Cuboidal Epithelium: secretion and absorption (some protection)
        
        Terminal Bronchioles: last portion of conducting pathway; lead to respiratory bronchioles (1st segment of resp. zone)
        
        Contain no cartilage, instead have a thicker layer of smooth muscle
        
        Respiratory Bronchioles: simple cuboidal epithelium; facilitates gas diffusion
        
        Simple Ciliated Columnar Epithelium: secrete and aid in the production and movement of mucus
        
        Primary Bronchi: enter lung on medial surface; right bronchus is shorter and wider than left bronchus
        
        Lobar Bronchi: extend to each lobe of the lung from primary bronchi
        
        Right Lung: 3 lobar bronchi
        
        Left Lung: 2 lobar bronchi
        
        Segmental Bronchi: branching from lobar branches, serve as divisions of lungs (bronchopulmonary segments)
        
        Right Lung: 10 segmental bronchi
        
        Left Lung: 8-10 segmental bronchi
        
        Lungs
        
        Hilum: indention where blood vessels, nerves, and lymph vessels enter and leave the lungs
        
        Horizontal Fissure: separates superior lobe from middle lobe
        
        Oblique Fissure: separates middle lobe from inferior lobe
        
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        Pseudostratified Ciliated Columnar Epithelium: mucous secretions that aid in collection of foreign materials for expulsion
        
        Tracheal Wall
        
        Mucosa w/ goblet cells and lamina propria
        
        Lamina Propria: holds epithelial cells together for passage of nutrients and blood vessels
        
        Submucosa: aerolar connective tissue w/ larger blood vessels, nerves, serous/mucus glands, lymphatic tissue
        
        Tracheal Cartilage: support trachea and allow for movement during breathing
        
        Cilia propels mucus that contains dust, microbes, and other particles towards larynx to be expelled
      - Nonkeratinized Stratified Squamous Epithelium: withstand abrasion
      - Passageway for air; prevents ingested materials from entering resp. tract; produces sound for speech; increases pressure in abdomen; cough and sneeze reflex
  - - - Anatomic Dead Space: space where there is no exchange of respiratory gases; volume of 150 mL
        
        Volume is less than pulmonary ventilation due to volume of air in anatomic dead space is subtracted from total air inhaled per breath
        
        Deeper breaths = more efficient due to not having to overcome dead air space more than once
        
        Decreased # of alveoli = physiological dead space (normal anatomic dead space plus loss of alveoli)
        
        Steps of Alveolar & Systemic Gas Exchange
        
        Exchange of gas occurs as resp. gases are exchanged btwn alveoli and pulmonary capillaries across resp. mem.
        
        O2 diffuses from alveoli into blood of pulmonary capillaries
        
        CO2 simultaneously diffuses in the reverse direction (from pulmonary capillaries into the alveoli)
        
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  - - - If pressure gradients exist btwn 2 regions, air moves from high to low pressure until pressure of 2 regions become equal
      - Air does not move if pressure is equal btwn 2 areas; gradients established by changes in volumes
      - Atmospheric Pressure: pressure gases in air exert in environment
      - Intrapleural Pressure:pressure exerted within pleural cavity; always lower than intrapulmonary pressure so lungs stay inflated
      - Intrapulmonary Pressure: equal to atmospheric pressure; pressure inside the lung
      - Dalton's Law: total pressure in mixture of gases is equal to sum of all individual partial pressures
        
        Partial Pressure: pressure exerted by gas in a mixture of gases, measured in mm Hg
        
        Partial Pressure Gradient: exists when partial pressure for specific gas is higher in one region than in another; gas moves from high to low partial pressure until they become equal
        
        Relevant Partial Pressures
        
        PO2 & PCO2
        
        Alveoli in the Lungs:O2 lower in alveoli than in atmosphere; PCO2 higher in alveoli than in atmosphere
        
        PO2: 104 vs 159 mm Hg
        
        PCO2: 40 vs .3 mm Hg
        
        Systemic Cells: directly reflects activities of cellular respiration; use O2 in cellular resp. & produce CO2 as waste product
        
        Resting Conditions PP: Po2 = 40 mm Hg; Pco2 = 45 mm Hg
        
        Circulating Blood: not set values due to continuous circulation
        
        Henry's Law/ Gas Solubility: at a given temp., solubility of a gas in a liquid is dependent on PP of gas in air & solubility coefficient in gas of liquid
        
        PP of gas = driving force of moving it into a liquid
        
        Solubility Coefficient: volume of gas that dissolves in specified volume of liquid @ given temp & press.
        
        Coefficient depends on interactions of molecules of gas and liquid
        
        More molecular interactions = greater amount of gas that dissolves to liquid
        
        Most to Least Soluble: CO2>O2>N2
        
        Low Solubility Coefficients = larger press. gradient to PUSH gas into liquid
    - - Partial Pressure: pressure exerted by each gas within a mixture of gases and is measured in mm HG
        
        Atmospheric Pressure: total pressure of gases (N2, O2, CO2); sea lvl pressure = 760 mm Hg
        
        Total Pressure * % of gas = Partial Pressure of that Gas
        
        PP for each gas can be calculated from atmosphere from total pressure
        
        78.6% = Nitrogen
        
        20.9%= O2
        
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        597 mm Hg
        
        Increase in Elevation = Decrease in Atmospheric Pressure
        
        Decrease in Atmospheric Pressure = Decrease in each Partial Pressure of Gases
        
        Decrease in Partial Pressure = Increase in force exerted on gas to liquify in the lungs
        
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      - Effects of Inflammation on Respiratory System
        
        Bronchiole Diameter: decreases as inflammation increases which causes increased resistance of air to flow through resp. system
        
        Cause body to continue to drop off epinephrine from adrenal medulla to bronchodilate
        
        Can also cause accumulation of mucus from inflammation, leading to bronchioles or airway being obstructed in some way
        
        Alveolar Damage: increase pressure within the lungs due to inflammation can cause alveoli to overwork and become scarred/damaged
        
        Decrease in alveoli = increase in physiological dead space = decrease in amount of tissue that can diffuse/partake in gas exchange
        
        Cause lower oxygen levels, higher respiration count due to low oxygen levels; bronchial dilation; strain on heart to keep up with lack of oxygen to tissues and organs
        
        Pleurisy: pleural sacs become inflamed
        
        Collection of pus in pleural space due to infection
        
        Friction between serous membrane layers; damage to lungs
- - - - In attempt to defend against the virus, mucous membranes secrete sputum that traps other bacteria and viral cells
        
        Decreased PP causes decrease in production of transforming gas to liquid, therefore allows for a wheezing sounding breath due to increased pressure in the lungs from inability to move gas to liquid
        
        Inability to expire certain mucous and fluid in the lungs, directly causes pneumonia
  - - - Constricted arterioles in the lungs also causes the lack of blood to flow to other tissues, causing lymphatic system to not process the lymph in the lungs which may have contributed to the infection of pneumonia
- - - - Sepsis and septic shock
  - - - Bursts into pleural space
        
        Empyema
  - - - Increased fluid build-up in the lungs
        
        Pleural effusion
        
        Fluid becomes infected
        
        Empyema
  - - - Possible acidosis if unable to expire
      - Respiratory failure from lack of O2
- - - - Immune system can be overloaded trying to fight the viral infection that another opportunistic infection can occur in conjunction to pneumonia causing an increased chance of complications/death
  - - - Decreased plasma being filtered = Infection can continue to metastasize in the bloodstream since the lymphatic system is unable to process the majority of blood from the high internal lung pressures & decreased PP
  - - - Unable to transport sufficient amount of O2 for organs and different tissues to utilize for metabolism, cellular processes, etc.
        
        Organ damage
        
        Pulmonary hypertension, fatigue, increased heart rate
      - Increased amounts of CO2 due to alternate pathways for cellular respiration for energy/ oxygen supply for the lungs
        
        Increased pH of the blood = acidosis
  - - - With arterial constriction, the heart has to increase the force it exerts on the blood vessels to be able to pump blood throughout the body at an efficient rate
        
        This directly causes an increase in blood pressure that will continue to exacerbate and exhaust the heart