Lesson 8-B Respiratory

I.
Respiratory Anatomy & Physiology
A.
General Respiratory Anatomy and Physiology
1.
The respiratory system is comprised of the upper airway and lower airway
structures
2.
The upper respiratory system filters, moistens and warms air during
inspiration
3.
The lower respiratory system is the site of gas exchange, regulating the
body's oxygen (PaO2) and carbon dioxide (PaCO2) levels and acid-base (pH)
balance
4.
Gas-exchange in the respiratory system occurs in the alveoli and pulmonary
capillaries
B.
1.
a.
b.

Physiology of Breathing
Inspiration: an active process
contraction of the intercostal muscles and diaphragm expands the chest
intrathoracic pressure decreases, drawing oxygenated air through the upper
airway into the lungs

2.
a.
b.

Expiration: a passive process

relaxation of the intercostal muscles increases intrathoracic pressure
carbon dioxide, a waste product of metabolism, is exhaled from the lungs
through the upper airway

3.

Gas exchange of oxygen and carbon dioxide occurs through diffusion across
the alveolar-capillary membrane

4.
a.
b.
c.

Neural control of breathing

occurs through chemoreceptors in the medulla
stimulated by the concentration of hydrogen ions in the blood
increased hydrogen levels (acidosis) stimulate increased respiratory rate and
volume - "blows off" acid (CO2)

5.
a.
b.

Chemical control of breathing

occurs through chemoreceptors in the carotid arteries and aortic arch
decreased blood pH and oxygen levels and increased carbon dioxide levels
stimulate the respiratory center in the medulla

6.
a.

Acid-base balance - serum pH of 7.4 is necessary for optimal health

respiratory system - maintains pH balance through the regulation of CO2 (an
acid) by adjusting ventilation rate and depth and this results in rapid
restoration of pH balance
correction of respiratory acid-base imbalance

 compensation in metabolic causes of acid-base imbalance

b.
the renal system also maintains a normal pH through the regulation of
bicarbonate or HCO3 (a base) ion excretion and this results in a slower
correction of pH imbalance
i.
correction of metabolic causes of acid-base imbalance
ii.
compensation for respiratory causes of acid-base imbalance.
c.
lab normals
i.
pH (partial pressure of hydrogen in blood) = 7.35 - 7.45
ii.
PaCO2 (partial pressure of carbon dioxide in arterial blood) = 35 - 45
mm Hg
iii.
HCO3 (bicarbonate level) = 22 - 26 mEq/L
d.
steps used to interpret arterial blood gases
i.
first - determine if it's compensated (within normal limits of pH) or
uncompensated
ii.
next - determine if it's acid or alkaline (based on pH)
iii.
finally - look at CO2 and HCO3 to determine the cause (respiratory or
metabolic)
e.
acid-base lab interpretation
pH
HCO3
PaCO2
respiratory acidosis (< 7.35) (> 26)
(> 45)
respiratory alkalosis
(> 7.45) (< 22)
(< 35)
metabolic acidosis (< 7.35) (< 22)
(< 35)
metabolic alkalosis (> 7.45) (> 26)
(> 45)
Remember Acid-Base lab interpretation using - R.O.M.E.
R=Respiratory
O=Opposite
M=Metabolic
E=Equal
C.
1.

Upper respiratory structures

Nose and sinuses

a.
b.
c.
d.

filters, warms and humidifies air

first defense against foreign particles
inhalation for deep breathing usually occurs through the nose
exhalation usually occurs through the mouth

2.
a.
b.

Pharynx
behind oral and nasal cavities
nasopharynx
i.
behind nose
ii.
soft palate, adenoids and eustachian tube
oropharynx
i.
from soft palate to base of tongue
ii.
palatine tonsils
laryngopharynx
i.
base of tongue to esophagus
ii.
where food and fluids are separated from air
iii.
bifurcation of larynx and esophagus

c.

d.

3.
a.
b.
c.
d.
e.
f.
g.

Larynx
between trachea and pharynx
commonly called the voice box
vocal cords - responsible for voice, airway protection and control of airflow
through trachea
glottis - opening between vocal cords
epiglottis - covers airway during swallowing, protecting against aspiration
thyroid cartilage - Adam's apple
cricoid cartilage

i.
ii.

D.
1.
a.
b.

contains vocal cords

the only complete ring in the airway

Lower respiratory and other structures

Trachea
anterior neck in front of esophagus
carries air to lungs

2.
Mainstem bronchi
a.
right and left
b.
older adults - right middle lobe is most likely to receive aspirate in people
with swallowing difficulty
3.
a.

Conducting airways
lobar bronchi
i.
surrounded by blood vessels, lymphatics, and nerves lined with
ciliated, columnar epithelial cells

b.

ii.
cilia move mucus or foreign substances up to larger airways
bronchioles
i.
no cartilage; collapse more easily
ii.
no cilia
iii.
do not participate in gas exchange

4.

Alveolar ducts and alveoli

a.
b.

lungs contain approximately 300 million alveoli

alveoli surrounded by capillary network

c.
gas exchange happens at alveolar-capillary membrane (blood takes in O2,
gives off CO2)
d.
alveoli are held open by surfactant which decreases surface tension to
minimize alveolar collapse
5.
Accessory muscles of respiration - use indicates additional effort needed to
breathe
a.
scalene muscles - elevate first two ribs
b.
sternocleidomastoid - raises sternum
c.
trapezius and pectoralis - stabilize shoulders
d.
abdominal muscles - puts power into cough and used most often with chronic
respiratory problems and acute severe respiratory distress
e.
In infants - nasal flaring, sternal or intercostal retractions, grunting
f.
older adults - respiratory changes with age include
stiffening and reduced function of respiratory structures
reduced capacity of respiratory defense mechanisms
less effective respiratory control