CHAPTER 1

PROLOGUE
1.1 Background

The respiratory system is formed by several structures. The entire structure

is involved in the process of external respiration is the process of oxygen
exchange between the atmosphere and the blood and carbon dioxide
exchange between the blood and the atmosphere.

External respiration is the process of gas exchange between blood and

atmosphere while internal respiration is the process of gas exchange between
blood circulation and tissue cells. Internal respiration (cellular respiration)
takes place in all body systems

Structures that make up the respiratory system can be divided into the
primary structure and structural appendages. Which includes the structure of
the respiratory system is the major respiratory airways, consisting of airway
and respiratory tract, and lungs. Which is referred to as the airway is nose,
pharynx, larynx. While the airway is the trachea, bronchi and bronchioles.

1.2 Purpose

1) General Contructional Purpose

After this learning process of Englih in Nursing, students are expected
to understand about the nursing process of respiratory tract.
2) Specific Contructional Purpose
After this learning process of Englih in Nursing, students are expected
to apply their knowledge in society.
1.3 Benefit
1) Advancing knowledge and experience in nursing process.

2) Understanding about the structure of respiratory tract.

3) Adding more vocabularies and grammar.

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 CHAPTER 2
FUNDAMENTAL THEORIS

2.1 Anatomy and physiology of respiratary system

The respiratory system is situated in the thorax, and responsible for
gaseous exchange beetwen the circulatory system and the outside world.
Air is taken in via the upper airways (the nasal cavity, pharynx, and
larynx) through the lower airways (trachea, primary bronchi, and bronchial
tree) and into the small bronchioles and alveoli within tissues.
The lungs aare divided into lobes. The left lungs is composed of the
upper lobe, thelower lobe, and the lingula (a small remnant next to the
apex of the heart). The right lung is composed of the upper, the middle,
and the lower lobes.
o Bronchi : the two main air passages into the lungs
o Diaphragm : the main muscle used for breathing ; separates the
chest cavity from the abdominal cavity
o Epiglotis : a flap of cartilage thet prevent foodfrom entering
the tracea
o Esophagus : the tube through which food passes from the
mouth down into the stomach
o Heart : the muscular organ that pumps blood throughout
the body.
o Incostal muscle : thin sheets of muscle between each rib that
expand (when air is inhaled) and contract (when air is exhaled).
o Larynx : voice box
o Lungs : the two organs that extract oxygen from inhaled air
and expel carbon dioxide in exhaled air
o Muscles attached to the diaphragm : these muscles help move the
diaphragm up and own for breathing
o Nasal caviry : interior area of the nose ; lined with a sticky
mucous membrane and contains tiny suefaces hairs called cilia

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o Nose hairs : located at the entance of the nose, these hairs trap
large participles that are inhaled
o Paranasal sinuses : air space within the skull
o Pharynx : the throat
o Pleural membrane: covering the lung and lining the chest cavity, this
membrane has 1 thin layers
o Pulmonary vessels: pulmonary arteries carry deoxygenated blood
from the hearth and lungs; pulmonary veins carry oxygenated blood
back to the heart
o Respiratory center : barea of the brain that control breathing
o Ribs : bone attached to the spine and central portion of
the breastbone, which support the chest wall and protect the heart,
lungs, and other organs in the chest.
o Trachea : tube through which air passes from the nose to the
lungs (also known as the windpipe)

Mechanics of breathing
To take a breath in, the external intercostal muscles contract, moving the
ribcage up and out. The diaphragm moves down at the same time, creating
negative pressure within the thorax. The lungs are held to the thoracic wall
by the pleural membranes, and so expand outwards as well. This creates
negative pressure within the lungs, and so air rushes in through the upper
and lower airways. Expiration is mainly due to the natural elasticity of the
lungs, which tend to collapse if they are not held against the toracic wall.

Respiratory system

Respiration has two meaning in biology. At the cellular level, it

refers to the O2 requiring chemical reactins that take place in the
mitochondria and are the chief source of energy in the eukaryotic cells. At
the level of the whole organism, it designates the process of taking in O2
from the environment and returning CO2 to it.

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 Oxygen consumption is directly related to energy expenditure. Energy
requirements are usually calculated by measuring O2 intake or CO2 release.
Energy expenditure at rest is known as basal metabolism.

Diffusion and Air Pressure

In every organism, from amoeba to elephant, gas exchange-the exchange

of O2 and CO2 between cells and the surrounding environment-takes place
by diffusion. Diffusion is the net movement of particles from a region of
higher concentration to a region of lower concentration as a result of their
random movement.

In describing gases, scientists speak of the pressure of a gas rather than its
concentration. At sea level, air exert a pressure of one (1) atm (15 lb/in2).
This pressure is enough to support a column of mercury 760 mm high.

2.2 Types And Classification

Based on the organs involved in the events of inspiration and expiration.

Respiratory there are two types, namely chest breathing and abdominal
breathing. Actually, chest breathing and abdominal breathing occur
simultaneously. For more details see the following description.

a. Breathing Chest
Occurs due to respiratory chest muscles to contract so that the ribs between
bones ribs raised, consequently the volume of the chest cavity enlarges.
Enlargement of the chest cavity to make the pressure in the chest cavity
smaller and inflate the lungs. The air pressure outside is greater than in the
peru-lung, consequently incoming air. In contrast, when muscle relaxation
ribs between bones, ribs down. As a result, the volume of the chest cavity
smaller so that the pressure inside goes up. In these circumstances, the
lungs deflated so that air out.

b. Abdominal breathing
Abdominal breathing occurs due to the movement of the diaphragm. If the
diaphragm muscle to contract, enlarge the chest cavity and the lungs

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 inflate. As a result, the air goes into the lungs. When the diaphragm muscle
relaxation, diaphragm back to its original state. At that time, narrowed
chest cavity, pushing the lungs to deflate. Furthermore, the air from the
lungs will get out.

Respiration can be divided into two types, namely:

1. Respiration Beyond that is between O2 and CO2 exchange between

blood and air.

2. Respiration in which an exchange of O2 and CO2 from the bloodstream

into the body's cells.

2.3 Etiology

a. Asthma

Asthma is a disease known as tight-breath that caused by a constriction of

respiratory tract because of an over activity of the body. Asthma can cause
both of inflammation and constriction in blood vessel and oxygen flow to the
lungs. In general situation, someone who has asthma suffering tight-breath
can be recovered by some medicines or without any medicines.

b. Etiology

The causes of asthma still can not be understood completely in all

researchers. But the mechanism of immunology is the thing that can not be
doubted in etiology of asthma. The increasing of sensitivity in respiratory
tract can be caused by known antigen. For example are household-dust, fur,
or pollen. The non-specific trigger factors are cold, excercise, and medicines
like β-blocker and aspirin or some certain unknown factors. In general, the
patient can be divided into two, the patient with extrinsic asthma (atopic) and
the patient with intrinsic (non-atopic). In extrinsic asthma, alergen can be
identified by skin-test or provocation-test and family history. In intrinsic
asthma, the trigger factors can not be found by those method.

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2.4 Clinic appearence

Asthma is not a specific disease but a syndrome produced by multiple

mechanisms and produce complex clinical symptoms include reversible
airway obstruction. The most important characteristics of this disease are
dyspnea, wheezing, difficulty breathing, and reversible airway obstruction of
bronchodilator, hyperresponsiveness to specific or non-specific stimuli, and
imflammation in respiratory tract. Usually, it will get worse in the night. And
for the kids, the main symptom will come up when they cough.

Asthma attack is characterized by cough, wheezing, and difficulty

breathing. Symptoms are often obvious is the use of additional breathing
muscle, the onset of pulsus paradoxus and Kussmaul's sign. Patients will find
a comfortable position. That is sitting upright with his hands holding on to
something in order to keep the shoulder stable, usually clinging to the arm of
the chair. Thus, additional respiratory muscles may work better. Tachycardia
will occur at the beginning of the attack, followed by central cyanosis.

Symptoms of asthma can be distinguished by symptoms of airway

obstruction, such as chronic bronchitis, emphysema, and cytic fibrosis.
Asthma occurs in young patients with non-smoker, while in the acute
axacerbation, the functional residual capacity values are normal, and
endurance during exercise in patients with asthma spirometrik parameters do
not change much compared to patients with chronic bronchitis and
emphysema patients.

As a simple measure, it can be said if the peak flow <120 liters or FEV <1
liter, a condition called severe airway obstruction.

To determine whether hospitalization or not, used the index-degree

assessment of asthma attack.

 Heart rate > 120/minute

 Tachypnea with a frequency of > 30/minute
 Pulsus paradoxus ≥ 18 mmHg

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 PEF ≥ 120L/minute

If these four things are found in patients, as estimated 95% will relapse and
need hospitalization. However, the thing that can be used as a appropriate
indication is a success of initial treatment. Photo rongent is only useful to get
rid of the possibility of pneumonia or pneumoyhorax, not to assess the degree
of asthma although lungs hyperinflaton can indicate possiblity of acute
asthma attack.

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 CHAPTER 3
CLOSING

3.1 Conclusion
The respiratory system is formed by several structures. The entire structure
is involved in the process of external respiration is the process of oxygen
exchange between the atmosphere and the blood and carbon dioxide
exchange between the blood and the atmosphere.

Based on the organs involved in the events of inspiration and expiration.

Respiratory there are two types, namely chest breathing and abdominal
breathing.

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 REFERENCES

Djojodibroto, darmanto. 2009. Respirologi (respiratory medicine). Jakarta : EGC.

Muttaqin, Arif.___. Asuhan Keperawatan Klien dengan Gngguan sistem
pernapasan. Jakarta : salemba medika
Nursalam. 2010. English for Nursing - Midwifery science and technology. Jakarta
: salemba medika.