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An elderly, 70-year-old, female patient recently retired from her job in…

- - - - upper respiratory
        
        paranasal sinuses
        
        functions
        
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        mucosa-lined , air-filled cavities in cranial bones surrounding nasal cavity
        
        pharynx
        
        3 subdivisions
        
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        run from base of skull to vertebrae C6
        
        muscular tube connecting nasal cavity to larynx and oral cavity to esophagus
        
        functions
        
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        nose and nasal cavity
        
        nose
        
        2 regions
        
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        nasal conchae
        
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        functions
        
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        lower respiratory
        
        bronchi and branches
        
        23 orders of branching
        
        bronchial tree
        
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        trachea divides to form
        
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        from tips of bronchial tree
        
        conducting zone give rise to respiratory zone
        
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        lungs
        
        gross anatomy of lungs
        
        right lung
        
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        left lung
        
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        hilium
        
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        pleurae
        
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        trachea:part of conducting zone
        
        windpipe
        
        mucosa lined with
        
        ciliated pseudo stratified epithelium
        
        goblet cells
        
        submucosa
        
        connective tissue
        
        supported by 16-20 C-shaped cartilage rings
        
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        ≈4 inches long
        
        3/4 inches in diameter, very flexible
        
        extends from larynx into mediatstinum
        
        divide into 2 bronchi
        
        functions
        
        air passageway
        
        cleans, warms, moistens incoming air
        
        larynx:part of conducting zone
        
        voice box
        
        functions
        
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        vestibular folds
        
        false vocal cords
        
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        opens into laryngopharynx
        
        continuous with trachea
        
        consists of 9 cartilage
        
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        sphincter functions of larynx
        
        example of Valsalva’s maneuver
        
        glottis closes to prevent exhalation
        
        intra-abdominal pressure rises
        
        helps to empty rectum or stabilizes trunk during heavy lifting
        
        abdominal muscles contract
        
        act as sphincter to prevent air passage
  - - - gas exchange
        
        Effects of high altitude
        
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        both processes subject to
        
        basic properties of gases
        
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        composition of alveolar gas
        
        gaseous makeup of atmosphere different from that in alveoli
        
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        internal respiration
        
        diffusion of gases between blood and tissues
        
        external respiration
        
        diffusion of gases between blood and lungs
      - closely coupled with circulatory system
        
        4 proceses involved
        
        circulatory system
        
        transport of O2 and CO2 in blood
        
        internal respiration
        
        exchange of O2 and CO2 between systemic blood vessels and tissues
        
        respiratory system
        
        pulmonary ventilation
        
        movement of air in and out of lungs
        
        breathing
        
        2 phases
        
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        external respiration
        
        exchange of O2 and CO2 between lungs and blood
      - Mechanics of breathing
        
        nonrespiratory air movements
        
        examples
        
        coughing
        
        sneezing
        
        crying, laughing
        
        hiccups, yawns
        
        most result from reflex action
        
        may modify normal respiratory rhythm
        
        processes moving air into / out of lungs besides breathing
        
        some are voluntary
        
        pulmonary ventilation
        
        Boyle’s Law
        
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        consists of
        
        inspiration
        
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        expiration
        
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        mechanical process depending on volume change in thoracic cavity
        
        volume changes lead to pressure changes
        
        pressure changes lead to flow of gases to equalize pressure
        
        3 physical factors influencing pulmonary ventilation
        
        influence ease of air passage and amount of energy required for ventilation
        
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        pressure relationship in thoracic cavity
        
        atmospheric pressure Patm
        
        pressure exerted by air surrounding body
        
        respiratory pressures
        
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        760 mm Hg at sea level= 1 atmosphere
        
        intrapulmonary pressure Ppul
        
        fluctuates with breathing
        
        always eventually equalizes with Patm
        
        pressure in alveoli
        
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        intrapleural pressure Pip
        
        always negative pressure
        
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        usually - 4 mm Hg
        
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        pressure in pleural cavity
        
        kept free from excess fluid
        
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        chest is vacuum
        
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      - functions
        
        dispose of CO2 waste of cellular respiration
        
        olfaction: smell
        
        supply body with O2 for cellular respiration
        
        speech
      - assessing ventilation
        
        respiratory volumes
        
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        tidal volume
        
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        respiratory capacities
        
        combination of 2 or more respiratory volumes
        
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        pulmonary function tests
        
        spirometry can distinguish between
        
        obstructive pulmonary disease
        
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        restrictive pulmonary disease
        
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        spirometer
        
        clinical tool to measure respiratory volumes
        
        respiratory volumes combine to calculate respiratory capacities
        
        give information on respiratory status
        
        abnormal in people with pulmonary disorders
      - gas transport
        
        oxygen transport
        
        1.5 % dissolved in plasma
        
        98.5% lovely bound to each Fe of hemoglobin in RBC
        
        carbon dioxide transport
        
        chemically bound to hemoglobin
        
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        bicarbonate ion HCO3- in plasma
        
        formation involves
        
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        70%
        
        dissolved in plasma as PCO2
        
        7-10%
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- - - - previously in Fort Worth
  - - - 70 years old
      - weak immune system
- - - - causes fluid to enter the lungs
      - occurs in persons normally living at low altitude who travel to an altitude above 8,200 ft
  - - - wet, wheezy cough
      - fast , shallow breathing
    - - inflammation of lung affecting alveoli
      - alveoli fill with fluid or pus
    - - pleural effusion
        
        collection of fluid in pleural cavity
      - empyema
        
        collection of pus when fluid become infected
  - - - asthma
        
        active infllammation of airways
        
        followed by bronchospasms
        
        immune response leading to inflammation
        
        airways thickened with inflammatory exudate
        
        magnify effect of bronchospasms
        
        spasm of sooth muscle in bronchioles
        
        characterized by
        
        coughing, dyspnea, wheezing, chest tightness
        
        Pneumonitis
        
        occurs when an irritating substance cause alveoli to become inflamed
        
        difficult for oxygen to pass through the alveoli into the bloodstream
        
        chronic obstructive pulmonary disease
        
        emphysema
        
        3 consequences
        
        accessory muscles
        
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        trapped air causes
        
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        damaged pulmonary capillaries
        
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        permanent enlargement of alveoli
        
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        destruction of alveolar walls
        
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        hereditary factors include
        
        alpha-1 antitrypsin deficiency
        
        chronic bronchitis
        
        mucosal of lower respiratory passageways
        
        become inflamed and fibrosed
        
        results in
        
        obstructed airways
        
        that impair lung ventilation and gas exchange
        
        inhaled irritants cause
        
        chronic excessive mucus
        
        symptoms
        
        frequent pulmonary infections