Anatomy and Physiology of the Respiratory System

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24 Οκτ 2013 (πριν από 4 χρόνια και 2 μήνες)

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Anatomy and
Physiology of the
Respiratory System

and

Nursing Diagnosis of
Chronic Broncitis

Function of Respiratory System

1.
Gas Exchange



a. External respiration



b. Internal respiration



c. Cellular respiration

2.
Ventilation

3.
Blood Reservoir

4.
Systemic Blood Filter

5.
Fluid Exchange

6.
Metabolic Functions of the Lungs



Upper Airway

1.
Nose

2.
Paranasal sinuses

3.
Oral cavity

4.
Pharynx


1.
Nose


The nose humidifies and warms air to body temperature
and filters inspired air by trapping particles >6
μ
m in
diameter.

2.
Paranasal sinuses


Posterior sphenoid sinuses that provide temperature
insulation and voice resonance enhancement.

3.
Oral cavity


I
nvolved in digestion, speech, and respiration.

4.
Pharynx


It separates inspired air from food and water.


a. Nasopharynx


b. Oropharynx


c. Laryngopharynx


d. Pharyngeal musculature



Lower Airway


1.
Larynx

2.
Trachea

3.
Bronchi

4.
Lungs

1
. Larynx


Lies between the upper and lower airway at the
level of C4
-
6
.

2
. Trachea


a flexibel, slightly rigid tubular organ.

3.
Bronchi


Enter the lungs at the hilus


Right bronchus: wider, shorter and straighter than
left


Bronchi subdivide into smaller tubes.

4.
Lungs


Left lung


Two lobes


Right lung


three lobes


Mechanics of Breathing

A.
Inspiration


The active process of contracting the diaphragm downward
to create a negative pressure within the thoracic cavity
that draws gas into the lungs.



a. Diaphragm


b. External intercostal muscles


c. Abdominal muscles


d. Neck muscles (scalene and sternocleidomastoid)

B. Expiration


The passive act of relaxing the respiratory
muscles allowing a decrease in thoracic size
and the elastic recoil of the lungs to deflate
the lungs.



a. Intercostal and accessory muscles


b. Abdominal muscles

PHATOPHYSIOLOGY

1.
Mucus
hypersecretion

:
incresed

size and number of
submucous

glands in the large bronchi. The increase of mucous
leads to airway narrowing and airway obstruction

2.
In smaller airway, chronic inflammation leads to repeated
cycles of injury and repair of airways and
therefor

scar tissue
formation and narrowing airways.

3.
Reduction of alveolar ventilation due to increased secretions.

4.
Expiratory airflow limitation

5.
Breathlessness due to airway narrowing and
bronchoconstriction



TOKSIK

INFLAMASI

INCREASE BRONCHIAL
SECRETION

INCREASE
BRONKOMOTOR TONE

HIPERSEKRESI

DISFUNGTION
SILIA

REFLEKS VAGAL

INFEKSI

CHRONICAL
BRONCITIS

CLASIFICATION and TYPE

1.
Simple Chronic
B
ronchitis
, characterized
by
coughing and other minor
complaints.

2.
C
hronic

bronchitis
Mucopurulen
,

characterized by thick phlegm cough,
purulent (yellowish
).

3.
Chronic
bronchitis with airway
constriction,
characterized by coughing up phlegm that is
accompanied by severe shortness of breath
and wheezing sound.

1.
Cigarette


Smoking


hiperpaplasia

of
mukus

brochi

gland

and metaplasia of

silia

activity inhibition, alveolar

makrofag
,
surfaktan



depreciation of force

expiration volume

2.
Infection


Virus
infection


secondary bacteria infection

(
Haemophilus

influenzae

dan

Streptococus



pneumonia
)


infection on upper
respiratory



infection
on
lower
respiratory

3.
Polution


Industrial
polution

(fiber, gas, cement) but it have not

big influence


4.
Breed


Deficiencies of alpha
-
1 anti
tripsin



abnormal

preolitik

enzyme



tissue damage

5.
Social
-
Economy Factor


Low environment and economy

6.
Old age


Increasing age


decreasing
imunity



susceptible

disease





Symptoms of Chronic Bronchitis may include :


Much phlegm or voluminous cough


Sometimes making
purulen

sputum or blood
cough


Dispnea


A moment
dispnea

on sleep


disp
n
ea

on
cold air and misty


progresif

on activity or
rest. Sometimes espoused tired right heart.


Listened wheezing



Describing bronchi stricture


Listened gargling on inspiration


Describing phlegm


Breast pain


Fever


Headache

A.
History



Exposure to risk factor



Past medical history (ex: asma)



Family history of COPD



Chronic Cough: lenght of time



Smoking history



Respiratory illness






B.
Potensial Abnormal Physical Exam


A
ssesment of severity based on level of
symptoms


Severity of spirometric abnormalities


Characteristic of respiratory pattern


Breath sounds


Shortness of breath with speech


Sputum producing color





C. Laboratorium Diagnostic


Chest X
-
ray


Postbronchodilator


Pulmonary function test


Arterial blood gasses


Oxygen saturation


Nursing Diagnosis


Ineffective airway clearance related to bronchospasm,
increased
production
of
secret
.

S
D
:


-

The client complained of cough with shortness
of

breath

OD
:
-

The client looks coughing up
phlegm


Pain disorder a sense of comfort with respect to the presence
of pleural inflammation, characterized
by:

SD
:
C
lient

complains of chest pain
center

OD
:
Client winced in
pain


Disruption
of intolerance
activity with
respect to the physical
weakness, characterized
by:

SD
:
clients say easily tired, lethargic body when many
brgerak

OD
:
Clients seem weak, so that helped a client's activities such
as sitting, eating and to the
bathroom



Disorders of bed rest with respect to the presence of
cough

DS

:
C
lients

complain
:

insomnia

DO: sclera appear red, the frequency of sleep
±

5 hours / day




Nursing Intervention


Vital sign observation

Rasional: to checked vital sign’s changes


T
each
a client

for effective coughing
exercises

Rasional:
effective coughing
exercises

can help the client remove
secretion


A
ssess

the level of pain with a pain
scale

Rasional:
t
o
determine the quality of perceived pain
intensity


H
elp

clients meet the daily
needs

Rasional:
By helping clients to mobilize bit by bit, the client can
perform activities independently without the help
of
.



The Therapy


Airway clearance techniques: Controlled
cough and deep breathing, flutter valve,
Thairpy vest, PEP theraphy


Glucocorticosteroids: regular treatment does
not modify long term decline of FEV1 but they
are apropiate for symtomatic COPD patient
with FEV1<50%


Hydration: to keep secretions thin and
minimal 6
-
8 glasses of water/ day


Nutrition: maintain physical condition with increased
fats and decreased carbohydrat in order to decrease
CO2 production.


Antibiotics: used when secretions become infected.


Patient teaching:
R
elaxation techniques, cough
control, and pursed lip breathing.


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