ANATOMY AND

PHYSIOLOGY OF
RESPIRATORY SYSTEM
Functions of the Respiratory System:

 Ventilation (distribution of air)

 Diffusion and Perfusion (movement of
oxygen and carbon dioxide across the
alveolar-capillary membrane to the blood
in the pulmonary capillaries)
 Blood flow( transportation of respiratory
gases)
 The Control of breathing
Upper Respiratory Tract

1. Nose
a. passageway for
the incoming and
outgoing air, filtering,
warming, moistening.
b. Organ of smell
c. Aids in
phonation
2. Pharynx

 Serve as
passageway and
entrance to the
respiratory and
digestive tracts
 Aids in phonation
3. Larynx

 Voice production: during

expiration, air passing
through the larynx causes
the vocal cords to vibrate;
short, tense cords produce
a high pitch and long,
relaxed cords, a low pitch
 Serve as part of the
passageway for air and as
the entrance to the lower
respiratory tract
LOWER RESPIRATORY TRACT
 Trachea-
furnishes an
open
passageway for
air going to and
from the lungs
Lungs
 Main organs of respiration, lie
within the thoracic cavity on
either side of the heart.
 Each lung is divided into
lobes, three in the right, two in
the left.
 Pleura: serous membrane
covering the lungs;
continuous with the parietal
pleura that lines the chest
wall.
 Associated structures of the
lungs are protected by the
chest wall.
Lower respiratory tract
1. Bronchi, bronchioles, alveolar
duct; the lower part of the airway
through which air moves into out of
alveoli.
2. Alveoli: microscopic sacs in
which gases are exchanged rapidly
between the air and blood; the
membranous walls of the millions of
alveoli provide a surface area large
and thin enough to make rapid gas
exchange.
3. Alveolar surfaces are coated
with group of substances called
surfactant; the effect is to lower the
alveolar surface tension so as to
facilitate breathing, since sacs have
fewer tendencies to collapse as their
walls adhere to one another.
CHEST WALL

 Includes the rib cage, intercostals muscles, and

diaphragm
 Parietal pleura lines the chest wall and secretes small
amounts of lubricating fluid into the intrapleural space
space between the visceral and parietal pleura. This
fluid holds the lung and chest wall together as single
unit.
 The chest wall is shaped and supported by 12 pairs of
ribs and costal cartilages
 The diaphragm is the major muscle of ventilation.( the
exchange air of air between the atmosphere and the
alveoli.)
Physiology of Respiration

A. Mechanism of Inspiration
1. The respiratory muscles
contract
2. The thorax increases in size
3. The intrathoracic pressure
decreases
4. The lungs increase in size
5. The intrapulmonic pressure
decreases
6. Air rushes from the
atmosphere, which has positive
pressure, to the alveoli, which
has a negative pressure
7. The inspiration is completed
Mechanism of Expiration

1. The respiratory muscles relax

2. The thorax decreases in size
3. The intrathoracic pressures
increases
4. The lungs decrease in size
5. The intrapulmonic pressure
increases
6. Air is expelled from the lung,
which has a higher pressure to
the atmosphere, which has a
lower pressure
7. The expiration is completed
Chemical Control

1. Blood ph: a decrease in ph stimulates respiration through

the direct stimulation of the neurons of the respiratory
center and indirectly, through the stimulation of the
carotid and aortic chemoreceptor
2. Blood PCO2: an increase in the arterial results in a
decrease in pH and mimics the effects in no 1
3. Blood PO2: a decrease in the arterial P02 produces
effects similar to decreased blood ph.
4. The stimulation of the respiratory center neurons or
chemoreceptors results in hyperventilation;
hypoventilation occurs when the arterial ph rises or when
the arterial PC02 falls
ASSESSMENT

HEALTH HISTORY
A. Presenting problem:
1. Nose/nasal sinuses: symptoms may
include colds, discharge, epistaxis.
2 Throat: symptoms may include sore
throat, hoarseness, difficulty
swallowing, strep throat
3. Lung symptoms may
include:
a. Cough: note of duration; frequency,
type (dry, hacking, bubbly, barky,
hoarse, congested); sputum (productive
vs nonproductive) circumstances
related to cough (time of the day,
positions, talking, anxiety); Treatment
b. Dyspnea: note onset, severity, duration, efforts to treat,
whether associated with radiation, if accompanied by cough
or diaphoresis, time of the day when; whether precipitated
by and specific activities , whether accompanied by
cyanosis.
Examples:
1.) Paroxysmal nocturnal dyspnea is
shortness of breath that awakens the
individual in the middle of the night.
2.) Asthma attacks are triggered by specific
allergen.
3.) Orthopnea is difficulty of breathing when
the individual is lying down.
3. Chest pain with breathing
 Take note of the duration, location, and
nature pain, time started and was it
associated with injury or respiratory
infection.
 Treatment and medication.
4. Wheezing
5. Hemoptysis
Nursing health history should also focus on risk
factor for respiratory dysfunction, including:
a. Personal or family history of lung disease
b. Smoking (note type of tobacco, duration,
number per/day, number of years of smoking,
inhalation, related cough, desire to quit.
c. Occupational or avocational exposure to
allergens or environmental pollutants
d. Age-related changes in lung capacity and
respiratory function
e. History of upper respiratory infection
f. Postoperative changes resulting in
diminished respiratory excursion
g. Nutrition/diet: fluid intake per 24 hours
period;
intake of vitamins and minerals.
Past medical history

 Take note of immunizations (yearly

immunizations for colds/flu; frequency
and results of tuberculin skin testing);
allergies (foods, drugs, contact or
inhallant allergens, precipitating factors,
specific treatment, desensitization)
Physical
examination
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
A. Inspection involves
a. General appearance: body size, age, skin, quality
and color, posture
b. Configuration and movement of the thorax
during respiration
c. Characteristics of respiration: rate, rhythm, and
muscles used for breathing
d. Presence of cough, nature and character of
sputum ( clear, purulent, bloody, tenacious)
e. Clubbing of fingers: angle of nail bed greater than 160,
distal phalangeal depth greater than interphalangeal
depth softening of nail beds.
a. General appearance,
Posturing, Breathing
Effort and trachea
position
The clients general
appearance and posturing
should be relaxed. The
posturing should be
upright. Breathing should
occur with no effort and a
rate that is appropriate for
the client’s age. Inspect
the trachea for position. It
should be midline in the
neck.
Abnormal findings
 Tracheal deviation to one side or other may
indicate atelectasis, partial or complete
pneumothorax or pulmonary fibrosis
 An appearance of apprehension with
restlessness, forward leaning posture, possible
nasal flaring, supraclavicular or intercostal
retractions or bulging with expiration, or use of
accessory muscles during breathing are all
signs of respiratory compromise and distress.
b. Chest wall
configuration
 Inspect chest wall for Form of
Symmetry Muscle
Development, Anterior:
Posterior (AP) Diameter, and
Costal Angle. The thorax
should be symmetric in an
elliptical form, with ribs
sloping down at about 45
degrees relative to spine.
Muscle development should
be equal. The spinous
processes should appear in
straight line. The scapulae
should be symmetric in each
hemothorax.
Abnormal findings:

 Asymmetry or unequal muscle

development is abnormal. Skeletal
deformities such as scoliosis or kyphosis
may limit the expansion of the chest.
 In chronic lung hyperinflation conditions
such as chronic emphysema, the chest
wall may have a barrel chest
appearance
 In this situation, the
ribs are more
horizontal and the
chest looks like it is
held in constant
inspiration. The
costal angle is
greater than 90
degrees.
Other chest wall deformities include
pectus carinatum and pectus
excavatum
C. Observe and evaluate
respirations for rate and quality,
Breathing Pattern and Chest
expansions
 Note the respiratory rate. In men this is
generally more diaphragmatic or abdominal,
and in women more thoracic. Breathing should
be smooth and even. In the adult, passive
breathing should occur at a rate of 12-20
breaths per minute. The ratio of respirations to
pulse rate should be 1:4
 Evaluate the rhythm or pattern of breathing.
The chest wall should be symmetrically rise
and expand and then relax. It should appear
easy and without effort. There should be no
bulging or retractions observed.
Abnormal breathing
rates include
 Tachypnea: A persistent respiratory rate
greater than 20 breaths per minute.
 Bradypnea: A persistent respiratory rate
slower than 12 breaths per minute.
Abnormal breathing
patterns include:
 Hyperventilation: Breathing is rapid and
shallow. This may occur secondary to anxiety
or exercise or a metabolic disease.
 Kussmaul Breathing: Breathing appears very
deep, rapid and laborious. This type of
breathing may be associated with metabolic
acidosis.
 Hypoventilation: Breathing is very
shallow. This may be seen in clients with
broken ribs or pleuritic pain where
inspiration is painful.
Patterns of respiration
B. Palpation
 Palpate the trachea for
position. It should be
palpable just below the
thyroid. The trachea
should be midline and
slightly moveable. If the
trachea is not midline, It
may be indication of
some degree of lung
collapse
 Palpate chest wall for Symmetry. With the palmar
surface of your fingers, use both hands
simultaneously to compare the two sides of the
posterior chest wall.
 The skin should be smooth and warm and the spine
should be straight and nontender from C7 through
T12.
 The scapulae should be symmetric and the
surrounding musculature well developed. The
posterior ribs should be stable and nontender.
 Repeat the palpation techniques on the
anterior chest. The skin should be
smooth, and the rib cage should be
symmetric and firm. The sternum and
xiphoid should relatively inflexible.
Abnormal Findings
 Note any crepitus which feels like a crinky or
crackly sensation under your fingers. This
abnormal finding indicates air in the
subcutaneous tissue. The air has escaped
from somewhere in the respiratory tree.
 Pleura friction rub may be felt as a coarse
grating sensation during inspiration. It occurs
secondary inflammation of the pleural surface
 Note any curvature of the spine,
scoliosis or kyphosis
 Muscular development that is
asymmetric or an unstable chest wall
may indicate a thoracic disorder. Note
areas that are tender, where there are
masses, or where you note crepitus
Palpate the chest wall
for thoracic Expansion
 During respiration place
thumbs at about the tenth rib
along the spinal process.
While maintaining the thumb
position ,extend the fingers of
both hands outward over the
posterior chest wall.Instruct
the client to take a deep
breath. Observe for bilateral
outward movement of your
thumbs during the client’s
inspiration. Both thumbs
should move symmetrically. A
unilateral or unequal
movement of your thumbs
should be considered
abnormal
Abnormal findings:

 Asymmetry of expansion is abnormal.

Note if there is any lag between the
movement of your thumbs. Unequal
chest expansion can accompany
atelectasis, pneumonia, traumatic injury
such as fractured ribs or pneumothorax.
Pain is noted when there is inflammation
of the pleurae
Palpate the chest wall
for Vocal (tactile)
Fremitus
Fremitus is a palpable
vibration. Using the palmar
or ulnar surface of your
hands, sytematically
position your hands over
both sides of the right and
left lung fields and instruct
the client to recite “one,
two, three or “99” while you
systematically palpate
chest wall from apices to
bases. The fremitus should
feel bilaterally equal
Abnormal findings
 Decreased or absent fremitus occurs any time
there is an obstruction to the transmission of
vibrations. It is often occurs with emphysema,
pleural thickening or effusion, massive
pulmonary edema or bronchial obstruction.
 Increased fremitus occurs when lung tissue is
compressed or consolidated, as in lobar
pneumonia.
 Rhonchal fremitus is palpable when bronchial
secretions are thick.

 Pleural friction fremitus or palpable
friction rub occurs when there is
inflammation of either the parietal or
visceral pleurae, causing a decrease in
normal lubrication. Thus a grating feeling
may be palpated. (Although pleural
friction rub is most easily identified by
auscultation if it is severe enough, it may
be identified through palpation.
C. Percussion
1. Percuss the thorax for tone
and Respiratory Excursion
Percussion is the tapping of
an object to set the underlying
structures in motion and thus
produce sound. If performed
correctly, it will penetrate to a
depth of 5 to 7 cm into the
chest. Systematically percuss
first the posterior and then the
anterior chest wall. Start
posteriorly above the scapula
and end at the bottom of the
rib area. Percuss down the
posterior chest from side to
side, comparing two sides. Do
not percuss over bone surface
 The sound should be
resonance which is loud
in intensity, low in pitch,
long in duration and
hollow in quality. Move to
the anterior chest,
instruct the client to pull
the shoulders and repeat
the percussion
techniques
Abnormal findings

 Hyperesonance is heard when there is

overinflation of the lungs. It has a very
loud resonance of low pitch that lasts
longer than normal and seems “booming”
This may be found in individuals with
emphysema. Dull tones may be heard in
clients with pneumonia, pleural effusion,
or atelectasis.
D. Auscultation
1. Auscultate breath sounds
for location. Evaluate the
client’s breath sounds
over the posterior,
anterior, and lateral
chest walls. Instruct the
client to sit upright and
breath deeply and slowly
through the mouth.
Using diaphragm of the
stethoscope , start
posteriorly and more
laterally to auscultate the
chest from apex to base.
 Auscultation involves listening to air movement in lungs to
detect normal or adventitious breath sounds,
including:
a. Vesicular sounds: low-pitched rustling sound
heard over most of lung field, most prominently
on inspiration; indicative of normal, clear lungs
b. Bronchial sounds: high-pitched tubular sound
with slight pause between inspiration and
expiration; normal over large airways
c. Brochovesicular sound: combination of vesicular and
bronchial sound, normally heard anteriorly to the right
or left of the sternum and posteriorly between the
scapulae; inspiration and expiration equal
d. Adventitious breath sounds: crackles (fine to coarse),
wheezes (sibilant, sonorous), pleural friction rub
Characteristics of
breath sounds
6. During assessment, the nurse should be alert for
cardinal signs and symptoms of respiratory dysfunction,
including:
a. Dyspnea
b. Orthopnea
c. Cough; may be hacking, brassy, wheezing,
productive or nonproductive
d. Increased sputum production; purulent (yellow
or green), rusty, bloody or mucoid sputum
e. Chest pain
f. Wheezing
g. Clubbing of fingers
h. Hemoptysis
i. cyanosis
B. Laboratory studies and
diagnostic tests
1. Radiographic and scanning studies, done to
visualize respiratory system structures,
include:
a. Chest radiograph
b. Chest tomography
c. Lung Scan
d. Computed tomography (CT) scan
e. Positron-emission tomography scan
f . Fluoroscopy
g. Barium swallow
2. Endoscopy studies, invasive technique
performed to visualize pulmonary structures
and obtain tissue specimens, include:
a. Bronchoscopy
b. Esophogoscopy
c. Mediastinoscopy
3. Thoracentesis involves needle aspiration of
pleural fluid for diagnostic and therapeutic
purposes
4. Needle biopsy is an invasive technique
involving entering the lung or pleura to obtain
tissue for analysis
5. Spirometry (pulmonary function test) is a
noninvasive technique used to determine lung
volumes, ventilatory function, airway
resistance, and distribution of gases.
6. Sputum culture determines the presence of
pathogenic organisms.
7. Arterial blood gas (ABG) studies determine O2
and C02 content and evaluate the body’s acid-
base balance
Respiratory Diseases

 Chronic Bronchitis is an inflammation of

bronchi caused by irritantants (cigarette
smoke, air polutants) It can be acute or
chronic and is characterized by
obstruction of airflow.
 Chronic bronchitis is defined as the
presence of productive cough that last 3
months a year for 2 consecutive years.
Clinical Manifestation

 Chronic, productive cough

 Dyspnea
 Body weakness
Diagnostic test

 Chest x-ray may show hyperinflation and

increased bronchovascular markings
 Pulmonary function demonstrate
increased residual volume, decreased
vital capacity and forced expiratory flow,
and normal static compliance and
diffusing capacity.
Nur sing Car e
Plan
Nursing Diagnosis and
Plan of care
1.Ineffective airway clearance related to
increased tracheobronchial secretions as
manifested by : productive cough,
purulent sputum and dyspnea.
Plan: The Client will be able to
expectorate phlegm effectively. The
breath sounds clear and respirations
noiseless.
Interventions
 Identify causative /precipitating factor
 Suction naso/tracheal/oral prn to clear airway.
 Elevate head of the bed/change position every 2 hours
and prn to take advantage of gravity pulling organs
away from diaphragm.
 Encourage deep breathing and coughing exercise
 Give expectorants/bronchodilator as ordered.
 Instruct client to increase fluid intake at least 6 to 8
glasses per day.
 Provide opportunities for rest; limit activities to level of
need
Evaluation

 The client was able to expectorate

moderate amount of sputum.
 Respiratory rate of 22 f
2. Emphysema

 Is an abnormal permanent enlargement

of gas exhange airway. Accompanied by
destruction of alveolar wall. Obstruction
results from changes in the lung tissue,
rather than mucus production and
inflammation as in chronic bronchitis.
The major mechanism of airflow
limitation is loss of elastic recoil.
Clinical Manifestation

 Dyspnea
 Wheezes
 Tachypnea
 Anorexia
 Weight loss
Diagnostic Test

 Chest x-ray reveals hyperflation, a

flattened diaphragm
 Pulmonary function test reveals
increased total lung capacity, residual
volume.
 ABGs may reveal mild hypoxia with
hypercapnea
Nursing Care Plan

1. Impaired gas exchange related to

destruction of alveoli as manifested by:
dyspnea, presence of wheezes on right
lung field.
Plan of Care:
The clients respiratory rate, color and
ABG’s value will be within normal limits.
Nursing Intervention

 Administer oxygen at least 1-2 liter per

minute as ordered by physician.
 Encourage deep breathing exercise.
 Maintain restful environment.
 Elevate the client’s head of the bed 30 to
45 degrees and encourage the client to
change positions frequently.
Evaluation

Respiratory rate is 22 breaths per minute,

ABGs results are normal.
T hank you