Respiratory System & Pharyngitis

• Provides information about assessment of respiratory function, upper, chest, lower respiratory disorders

Key Words

• Hypoxemia refers to low oxygen levels in the blood.
• Hypoxia refers to low oxygen levels in tissues and cells.
• Physiologic dead space refers to the portion of the tracheobronchial tree without gas exchange participation.

Respiratory System Function

• Ventilation is how air is moved in and out.
• Gas exchange occurs when oxygen enters and carbon dioxide exits.
• Air filtration occurs via the nose and cilia, which trap air particles.
• Immune defense is a function of tonsils, adenoids, and alveolar macrophages.
• Speech production involves the sinuses and larynx.
• Works with the cardiovascular system to establish perfusion (blood flow to the lungs).

Anatomy of the Respiratory System

Upper Respiratory Tract

• Includes the nose, paranasal sinuses, pharynx, tonsils, adenoids, larynx, and trachea.
• The nose filters, humidifies, and warms air.
• Paranasal sinuses provide resonance in speech and are a common site of infection.
• There are four pairs of sinuses: frontal, ethmoid, sphenoid, and maxillary.
• The pharynx (throat) is a passageway for air and food that connects to the larynx.
• Tonsils and adenoids (pharyngeal tonsils) are part of the immune system, protecting against infections.
• The larynx (voice box) connects the pharynx to the trachea, protects the airway, and produces sound.
• The epiglottis prevents food entry into the airway.
• Vocal cords produce sound.
• Thyroid cartilage is the largest and forms the Adam's apple.
• Cricoid cartilage is the only complete cartilage ring in the larynx.
• The trachea (windpipe) connects the larynx to the bronchi.
• It has smooth muscle and C-shaped cartilage rings, which prevent collapse.

Lower Respiratory Tract

• Composed of the lungs, bronchi, bronchioles, and alveoli.

Lungs

• The right lung has three lobes, while the left has two.
• The lungs are surrounded by pleura (visceral and parietal) to reduce friction.
• The mediastinum is the space between the lungs, containing the heart, thymus, major blood vessels, and esophagus.

Bronchi & Bronchioles

• Bronchi are the major airways branching from the trachea into the lungs.
• Bronchioles are smaller airways without cartilage, leading to alveoli.
• Cilia are tiny hairlike structures that move mucus and foreign particles out of the lungs.

Alveoli

• There are 300 million tiny air sacs in the lungs for gas exchange.
• Type I alveolar cells cover 95% of alveolar surface area to act as a barrier between air and blood.
• Type II alveolar cells produce type I cells and surfactant to reduce lung surface tension.
• Macrophages are defense cells which remove foreign particles.
• Oxygen (O2) moves from the blood to tissue fluid cells, then to cells, where it is used by mitochondria. CO2 goes in the opposite direction.

Respiration (Gas Exchange Process)

• Oxygen moves from the alveoli into the blood because O2 levels are higher in the alveoli.
• Carbon dioxide moves from the blood into the alveoli, where levels are lower, and is exhaled.

Ventilation (Breathing)

• Inhalation is when air moves into the lungs as the chest expands.
• Exhalation is when air leaves the lungs as the chest relaxes.
• Inhalation requires energy, while exhalation is mostly passive.

Mechanics of Ventilation

• Air pressure variances
• Resistance to airflow
• Lung compliance.

Air Pressure Variations

• Air moves from high to low pressure.
• Inhalation: Chest expands which decreases pressure inside (lower than atm), so air flows in.
• Exhalation: Chest contracts, which increases pressure inside and lets air flow out.

Airway Resistance

• Airway size affects airflow; smaller airways increase resistance, making breathing harder.
• Causes of increased resistance:
• Asthma (muscle contraction)
• Chronic bronchitis (thicker airway walls)
• Blockages (mucus, tumors, foreign objects)
• Emphysema (loss of lung elasticity).

Lung Compliance

Normal refers to elasticity and expendability, where the lungs and thorax easily stretch when pressure is applied.

• Higher compliance (lungs expand too easily) is seen in emphysema.
• Lower compliance (stiff lungs) occurs in obesity, lung fluid buildup, fibrosis, or a collapsed lung.

Lung Volumes & Capacities

• Tidal Volume (TV or VT): Normal breath in and out equates to 500 mL. It may not vary even with severe disease.
• Inspiratory Reserve Volume (IRV): Extra air inhaled equals 3000 mL.
• Expiratory Reserve Volume (ERV): Extra air exhaled is 1100 mL, and it decreases in restrictive conditions.
• Residual Volume (RV): Air left in the lungs after exhaling fully is 1200 mL, and it increases in obstructive diseases.
• Vital Capacity (VC): Maximum air exhaled after deep inhalation is 4600 mL, equaling TV + IRV + ERV, which decreases in neuromuscular disease, fatigue, pulmonary edema, COPD, and obesity.
• Inspiratory Capacity (IC:) Total air inhaled after normal exhalation is 3500 mL, being TV + IRV, which decreases in restrictive diseases and obesity.
• Functional Residual Capacity (FRC):, the air remaining in lungs after normal exhalation, is 2300 mL, equaling ERV + RV, which increases in COPD and decreases in ARDS and obesity.. Total Lung Capacity (TLC:) Total amount of air lungs can hold is 5800 mL, equaling TV + IRV + ERV + RV, decreasing in restrictive diseases like atelectasis and pneumonia but also increasing in COPD.

Pulmonary Diffusion (Gas Exchange)

• Describes the movement of O2 and CO2 between alveoli and capillaries.
• The alveolar capillary membrane is thin and has a large surface area, making gas exchange easy.

Pulmonary Perfusion (Blood Flow in Lungs)

• The right ventricle pumps blood via the pulmonary artery to the lungs.
• Blood passes through lung capillaries for gas exchange.
• Oxygenated blood returns to the left heart via the pulmonary vein.
• Not all blood participates in gas exchange. Shunted blood bypasses alveoli.
• Pulmonary circulation has low pressure, allowing blood flow adjustments.
• Being in an upright position means the pulmonary artery pressure isn't great enough to work against gravity to supply blood to the apex of lungs.
• The upper lung has less blood flow, the middle lung has moderate blood flow, and the lower lung has the most blood flow due to gravity.
• Lying on one side increases blood flow to the lung on that side.
• Pulmonary artery pressure, gravity, and alveolar pressure determine perfusion patterns.

Ventilation-Perfusion (V/Q)

• The V/Q Ratio (1:1) balances airflow (ventilation) and blood flow (perfusion) for adequate gas exchange.

Factors Affecting Balance

• Airway blockages
• Changes in lung compliance
• Gravity effects on blood flow.

V/Q Imbalance Types

• Normal V/Q indicates good ventilation and perfusion.
• Low V/Q (Shunt) indicates poor ventilation with normal blood flow; perfusion is less than ventilation.
• Can be caused by pneumonia, atelectasis, a tumor, or a mucus plug.
• The blood bypasses the lungs, causing low oxygen levels (hypoxia).
• Severe hypoxia occurs when shunting affects more than 20% of blood flow.
• High V/Q (Dead Space) is good ventilation with poor blood flow (e.g., pulmonary embolism) Ventilation is less than perfusion because alveoli don't have enough blood supply for gas exchange.
• Caused by pulmonary emboli and infarction, and cardiogenic shock.
• A silent unit means no ventilation or perfusion, occurring in severe lung disease, pneumothorax, or ARDS.
• Oxygen therapy may or may not help, based on the type of V/Q imbalance.

Gas Exchange

Partial Pressure of Gases

• Air is 78% N, 21% 0, and 1% other gases
• Each gas in the air has its own pressure.
• Atmospheric pressure at sea level equals about 760 mmHg.
• Partial pressures of key gases: Nitrogen (N2) is 596 mmHg while oxygen (02) is 152 mmHg, and carbon dioxide (CO2) exists in lower pressures but is important in gas exchange.

Oxygen Transport

• Oxygen is carried in two ways, dissolved in plasma (small amount) and bound to hemoglobin (HgbO2) for major transport.
• Hgb sat (SaO2) indicates how much O2 Hgb is carrying.
• The oxyhemoglobin dissociation curve shows how 02 binds to Hgb and how it is released to tissues.

Curve Factors

• CO2, H+ concentration, temperature, and 2,3diphosphogulcerate levels affect % of saturation. It represents the relationship between PaO2 (O2 in the blood) and SaO2.
• At high PaO2 (like in the lungs, ~100 mmHg) hemoglobin holds onto oxygen (SaO2 ~97-100%), while at low PaO2 (like in tissues, ~40 mmHg) hemoglobin releases oxygen (SaO2 ~75%).
• Shifts right (less O2 picked up in lungs, more O2 released to tissues) upon increased CO2, acidity, temperature, or 2,3DPG.
• Shifts right (more Oz picked up in lungs, less released to tissues) upon increased CO2, acidity, temperature, or 2,3DPG.
• Key oxygen levels: PaO2 >70 mmHg is normal, PaO2 45-70 mmHg is kinda safe, and PaO2mmHg is kinda safe, and PaO2.
• A drop in PaO2 from 100 to 80 mmHg does not dramatically lower oxygen saturation levels because tissues can still get oxygen.
• If CO falls, the amount of O2 delivered falls which may mean the body isn't supported enough.

Carbon Dioxide Transport

• Carbon dioxide (CO2) moves from cells to blood to lungs and is exhaled.
• Venous CO2 mostly gets excreted.
• CO2 transport methods include plasma, RBC
• CO2 helps maintain acid-base balance in the body.

Neurologic Control of Breathing

• The brainstem (medulla and pons) controls breathing rate and depth.
• Key brain centers:
• Apneustic center (upper pons): deep, long inhalations.
• Pneumotaxic center (lower pons): controls breathing pattern.
• Receptors that adjust breathing include chemoreceptors, mechanoreceptors, proprioceptors, baroreceptors

Aging & Respiratory System

• After 40, lung function declines.
• Changes include alveoli elasticity loss.
• Chest wall becomes stiffer.
• Older adults can perform daily activities but may tire faster with exercise.

Health History

• Common Symptoms
• Dyspnea (Shortness of Breath):
• Asses sudden or gradual feeling of having difficulty breathing and severity, along with if it happens at rest or during activity
• Causes:
• Sudden dyspnea → Pneumothorax, airway blockage, heart attack, and allergic reaction.
• Immobilized patients → PE
• Dyspnea + tachypnea + hypoxemia in those who had lung injury, shock, multiple blood transfusions → ARDS.
• Orthopnea (worse when lying flat) →Heart disease, ~COPD.
• Noisy breathing + dyspnea Possible airway obstruction and a assessment of the stridor

Cough

• Reflex protecting lungs from irritants and secretion accumulation
• Causes:
• Nighttime cough: left-sided heart failure, bronchial asthma.
• Morning cough with mucus: Bronchitis.
• Cough worsens lying down: Postnasal drip (rhinosinusitis).
• After food intake: reflux, aspiration
• Dry, irritative cough: Viral infection, ACE inhibitor medications.
• Irritative, high-pitched cough: Laryngotracheitis.
• Brassy cough: Tracheal lesion.
• Severe or changing cough: lung cancer
• Effects: exhaustion, sleep disruption, syncope

Sputum Production

• Mucus and the appearance from the lungs can indicate various conditions
• Thick, yellow/green/rust-colored - Bacterial infection.
• Thin, clear, mucoid - Viral bronchitis.
• Pink-tinged = Possible lung tumor.
• Frothy pink = Pulmonary edema.
• Foul-smelling = Lung abscess, bronchiectasis, or infection

Assessment of Pain and Respiratory Conditions

• Dull, persistent pain Lung cancer and pulmonary infarction.
• Pain worsens with breathing = Likely pleuritic pain.
• Pain relieved by lying on the affected side Lung irritation (splinting).
• Wheezing refers to the high-pitched whistling sound, and it is due to airway narrowing.
• Expiratory wheezing and Inspiratory wheezing are indicative of asthma and bronchitis, respectively.
• Hemoptysis describes coughing up blood, such as from lung infection, lung cancer, or heart/blood disorders.

Differentiated Blood Sources

• Bright red, frothy blood from lungs → Alkaline pH (>7)
• Dark, coffee-ground blood from stomach → Acidic pH (<7). Often comes with sniffing from nose bleedings.
• Inherited Respiratory Diseases
• Asthma, COPD, cystic fibrosis, pulmonary fibrosis, and pulmonary hypertension are linked genetically.
• Look for 3 generations of respiratory issues.
• Early-onset chronic lung disease, or liver disease in infants can be linked to alpha lantitrypsin deficiency
• Check for frequent lung infections/wheezing/coughing/mucus, environmental exposures, and physical signs.

Physical Exam

• Clubbing occurs with spongy and curved nail angle loss, which indicates chronic of Lung diseases, congestion, heart issues, and inflammatory diseases.
• Cyanosis occurs when 5 + hemoglobin unoxygenates, but anemia may hide cyanosis and polycythemia may indicate non present.
• Central cyanosis and Peripheral cyanosis point to blood or environmental issues.

Upper Respiratory Assessment

• Inspect the external nose for lesions, swelling, or asymmetry.
• Inspect mucosa color, swelling, bleeding, discharge, septum deviations or perforations, and turbinates for color/growths
• Assess Pain or tenderness, and passes/no light

Mouth & Pharynx Examination

• Assess tonsils, uvula, pharynx color, swelling, pus, ulcers.
• Trachea Examination
• Check trachea position & the positioning, as midline isnnormally, a deviation may indicate neck or pressure.

Breathing Assessment

• Assessment is achieved with patient positioned in Posterior and Anterior positionings.
• Thoracic Inspection include skin color,loss of tissue,symmetry, shape, patterns/Respiratory Rates.
• Eupnea refers to normal breath and abnormal breathing happens within: Heart failure and neurological and sleep apnea. Retractions is indicative of obstruction, while bulging and the use of the Respiratory are for breathing difficulty. Asses the use of sternocleidomastoid and palpations and to measure lung expansion or measure tactile fremitus.

Percussion and Auscultation

• Resonance: normal airfilled
• Dull: if it solid or a mix of fluid
• Hyper: if it filled filled with air such as in emphysemia
• Diaphragm movement can be reduced duriing pregnancy.
• Ausculate for sounds: Vesicular, Bronchiovesciular, Bronchial (tubular), Crackles (rales), Wheezes, Rhonchi, Stridor, Pleural friction rub Use sounds to identify what's happening and where it is located.

Vocal Sounds

• Bronchophony sounds like a louder 99 over lug
• Egophony sounds like the letter E over fluid
• Pectoriloquy whispers words heard
• PFTs are used for diagnose test results
• Assess lung volume, breathing etc
• Use a spirometer to measure

PFT Test Types

• Forced vital and expiratory capacity in vital
• Ration of capacity helps decide if airway is being constructed etc

Arterial Blood Gas Studies

• ABGs assess the ability level, and radial arterial catheters are a source.

oPulse Oximetry

• Use pulse ox to determine the sat.
• Not for CO2 and hyper oxia use a finger or ear to determine the level.

Culturing

• Collect bacteria etc at the throat or naval area to deter infections
• Morning Sptum will help determine other illnesses.
• Imaging Study
• Determine pneumonia by x ray as well as any lung issue CT imaging, MRI, CXR Deep breath and laying still for ~30mins

End Proc

• Key words
• Bronchoscope, therapeutic or diagnostic procedure
• Fiberoptic vs rigid choice base of pulmonary injury or foreign

Thoracoscopy

• Video with sample, need to check the pt afterwards
• Diagnose fluid such as tumor staging,

Thorancentesis

• Needle aspirations
• Therapeutic to remove pleural and diagnos
• Complications are breathing and coughing, and pt coughing too much
• Upper airway: allarengeal is voice loss
• URIs
• Is the infection acute or chronic.
• Check for genetic factors from genetic infections like athsma
• Emergency symtpoms
• Treat laryng with proton pump inhibitors such as omeprazole or penicillin

Phraningitis

• Supportive care such as rest, fluids, antibiotics Most issues are prevented with vaccine, smoke avoidance

Upper Resp 2

• Inflammation in the area, can cause sinus, ear, breath
• Can affect 10-30, causes dust, allergies and triggers such as cold
• Thick musks is due to bacterial

Rhinosinusitis

• Is infla,ation, and can infect bacterial or envirhazards
• Bacteria: Staphs and Streps are commcon
• Biofilms: Protect from eradicts and cause regrowth
• Symptoms: Facial, headache from 102 fever and from the sinus drainage

ABRS and AVRS

• Have high intensity's with fever but will differ base of temp
• CRS: Has post nasal drip for congestion
• For Fungal, check to severe immune and look to see the fungus Aspergillus
• Check with sinus aspiration to do diagnostics and use swabs.

AbRS and Viral Treatment

• Antibotics (oxcillin, tetra)
• Intra nasal lava and allergies
• With AVRS
• no abx
• nasal spray etc

CRS Treatment

• Steroid and surgery if med doesn't work
• Nursing: Dx are def airway
• Teach and take a few precaution with fluids
• Check for coughing.

Pharyngitis

• Is viral, and spreads winter with throat pain
• Chronic includes adults that work in dirty env, causes alcohol excess
• There are types of cronhc

Tx

• Viral:
• With fluids and throat medication and with allergies
• Bacteria:
• Needs abx and to be completed, or it could become severe
• Check for emergency if difficut breathing.

Tonalitis

• Comes with throat, fever. It could be viral/bacteria
• Dx is RADT
• Support with fluids
• Needs to be treated or might get surgered based on swelling
• Nursing: Keep them positiones and diet with liquids

Peritonitis

• Affect soft tissue with infection. Needs to be drained or else
• Antibio can drain the throat
• Treat: Laryngitis
• Common: caused by virus but not from the flu or can't swallow
• Check for voice loss

Epistatis

• Nose bleed
• Due from trauma, dry use, etc but can be due health factors high BP
• Lean pt, with head forward
• Can be packed!

Lung Injury

• Lung injury and hypoxemic repiratory and ARDS
• PE: PE the blood flow is being impaired
• DVT formin has venous, high risk of DVT,
• Signs: Dys, pain. Taccy, hypoxia.

Dx

• CT to test. And check ofr abnormalities
• Is to put filter etc with therapy (Heps)
• Acd pro is best to get ambulation for all pt at risk.

CDOP

• lung issue by obstrunctuin. And is not fixable treat with smoke avoidance
• types: Bronchitis and wheezing
• Diagnoses with pft
• Comp: Resp fliar

Treat

• Quit smoking, medicine,
• Steroid: If inhailed severe, try oxygen Re-enable pulmo Rehab:
• If bullectomy lung can improve O2 Sat - maintain at 90% Meter - to use it right

Pneumonia

• Causes fluid or it.
• Encourage to sit up to have good mechanics Dx tests can he chest or lung issue Lifestyle: Avoid stimuli, etc
• Asthma = Hyper, over production. REsultd in a lot of things, such as constriction and edma

Causes

A strong allergies, meds, pollution,

• Dx

COPD:

Inhalation vs exhalation.

• Dx with flow or peak for airway
• Avoid bacteria.
• PEEP will keep alveoli more open Check the mucus. Can be fixed with CFTR or lung removal if all else fails 14'