Chapter 8. The Respiratory System PDF

Overview of Structures, combining forms and functions of the respiratory System Nose (nas/o): Exchanged air during inhaling and exhaling; warms, moisturizes, and filters inhaled air. Sinuses (sinus/o): produce mucus for the nasal cavities, make bones of the skull lighter, aid in sound production. P...

Overview of Structures, combining forms and functions of the respiratory System Nose (nas/o): Exchanged air during inhaling and exhaling; warms, moisturizes, and filters inhaled air. Sinuses (sinus/o): produce mucus for the nasal cavities, make bones of the skull lighter, aid in sound production. Pharynx (pharyng/o): transports air back and forth between the nose and the trachea. Larynx (laryng/o): makes speech possible. Epiglottis (epiglott/o): closes off the trachea during swallowing. Trachea (trache/o): transports air back and forth between the pharynx and the bronchi. Bronchi (bronch/o, bronchi/o): Transports air from the trachea into the lungs. Alveoli (alveol/o): air sacs that exchange gases with the pulmonary capillary blood. Lungs (pneum/o, pneumon/o, pulmon/o): Bring oxygen into the body, and remove carbon dioxide and some water waste from the body. Word Parts Ox/i, ox/o, ox/y = oxygen Phon/o = sound Pleur/o = pleura, side of the body -pnea = breathing Somn/o = sleep Spir/o = to breath Functions of the Respiratory System The functions of the respiratory system are to: Deliver air to lungs Convey oxygen from the inhaled air to the blood for delivery to the body cells Expel the waste produces (carbon dioxide and a small amount of water) returned to the lunch’s by the blood through exhalation. Produce the airflow through the larynx that makes speech possible. The respiratory system supplied the blood with oxygen for transportation to the cells in all parts of the body. Oxygen is vital to the survival and function of these cells. The respiratory system also removes carbon dioxide and some water waste from the body. Structures of the Respiratory System upper respiratory tract consist of the nose (nostrils), mouth, pharynx, epiglottis, larynx, and trachea. The lower respiratory tract consists of the bronchial tree and lungs. These structures are located within and protected by the thoracic cavity, or thorax, also known as rib cage. The upper respiratory tract and the bronchial tree of the lower respiratory tract are sometimes referred to as the airway. The Nose Air enters the body through the nose and passes through the nasal cavity, which is the interior portion of the nose. The nostrils are the external openings of the nose. The nasal septum is a wall of cartilage that divides the nose into two equal sections. A septum is a wall that separates two chambers. Cilia, the thin hairs located just inside the nostrils, filter incoming air to remove debris. Mucous membranes line the nose. These special tissues also line the digestive, reproductive, and urinary systems as well as other parts of the respiratory system. Mucus is a slippery section produced by the mucous membranes that protects and lubricates these tissues. In the nose, mucus helps moisten, warm, and filter the air as it enters. Notice that mucous and mucus have different spellings; however they share the same pronunciation. Mucous is the name of the tissue; mucus is the secretion that flows from the tissue. the olfactory receptors are nerve endings that act as the receptors for the sense of smell. They are also important to the sense of taste. These receptors are located in the mucous membrane in the upper part of the nasal cavity The Tonsils The tonsils and adenoids are part of the lymphatic system. they help protect the body from infection coming through the nose or the mouth. the adenoids, also called the palatine tonsils, are located at the back of the mouth. the adenoids, also called the nasopharyngeal tonsils, are higher up, behind the nose and roof of the mouth. The Paranasal Sinuses The paranasal sinuses, which are air-filled cavities lined with mucous membrane, are located in the bones of the skull (para- means near, nas means nose, and -al means pertaining to.) A sinus can be a sac or a cavity in any organ or tissue; however the term sinus most commonly refers to the paranasal sinuses. The functions are these sinuses are 1. To make the bones of the skull lighter, 2. To help produce sound by giving resonance to the voice, and 3. To produce mucus to provide lubrication for the tissues of the nasal cavity. the sinuses are connected to the nasal cavity via short ducts. The four pairs of paranasal sinuses are located on either side of the nose and are named for the bone in which they are located. The frontal sinuses are located in the frontal bone just above the eyebrows. An infection here can cause severe pain in this area. the sphenoid sinuses, which are located in the sphenoid bone behind the wow and under the pituitary gland, are close to the optic nerves, and an infection here can damage vision. The maxillary sinuses, which are the largest of the paranasal sinuses, are located in the maxillary bones under the eyes. An infection in these sinuses can cause pain in the posterior maxillary teeth. The ethmoid sinuses, which are located in the ethmoid bones between the nose and the eyes, are irregularly shaped air cells that are separated from the orbital cavity by only a thin layer of bone. The Pharynx The pharynx, which is commonly known as the throat, receives the air after it passes through the nose or mouth, as well as food. The pharynx is made up of three divisions The nasopharynx is posterior to the nasal cavity and continues downward to behind the mouth. this portion of the pharynx is used only by the respiratory system for the transport of air and opens into the oropharynx. The oropharynx is the portion that is visible when looking into the mouth. The oropharynx is shared by the respiratory and digestive systems and transports air, food, and fluids downward to the laryngopharynx The laryngopharynx is also shared by both the respiratory and digestive systems. Air, food, and fluids continue downward to the openings of the esophagus and trachea where air enter the trachea and food and fluids flow into the esophagus. The Larynx The larynx, also known as the voice box, is a triangular chamber located between the pharynx and the trachea. The larynx is protected and supported by a series of nine separate cartilages. The thyroid cartilage is the largest, and when enlarged it projects from the front of the throat and is commonly known as the Adam’s apple. The larynx contains the vocal cords. During breathing, the cords are separated to let air pass. During speech, they close together, and sound it produced as air is expelled from the lungs, causing the cords to vibrate against each other Protective Swallowing Mechanisms The respiratory and digstive systems share part of the pharynx. During swallowing, there is the risk of a blocked airway or aspiration pneumonia caused by food or water going into the trachea and entering the lungs instead of going into the esophagus. Two protective mechanisms act automatically during swallowing to ensure that only air goes into the lungs: The soft palate, which is the muscular posterior portion of the roof of the mouth, moves up and backward during swallowing to close off the nasopharynx. This prevents food or liquid from going up into the nose. At the same time, the epiglottis, a lid-like structure located at the base of the tongue, swings downward and closes off the laryngopharynx so that food does not enter the trachea and the lungs. The Trachea The role of the trachea is to transport air to and from the lungs. This tube, which is commonly known as the windpipe, is located directly in front of the esophagus. The trachea is held open by a series of flexible C-shaped cartilage rings that make it possible for the trachea to compress so that food can pass down the esophagus. The Bronchi The bronchi are two large tubes known as primary bronchi, which branch out from the trachea and convey air into the two lungs. Because of the silimarity of these structures to an inverted tree, this is referred to as the bronchial tree. Wishing the lung, each primary bronchus divides and subdivides into increasingly smaller bronchioles, which are the smallest branches of the bronchi. The Alveoli Alveoli, also known as air sacs, are very small, grapelike clusters found at the end of each bronchiole. The alveoli are where the exchange of oxygen and carbon dioxide takes place. Each lung contains millions of alveoli. During respiration, the alveoli are filled with air from the bronchioles. A network of microscopic pulmonary capillaries surrounds the alveoli. Pulmonary means relating to or affecting the lungs. The exchange of oxygen and carbon dioxide between the air inside the alveoli and the blood in the pulmonary capillaries occurs through the thin, elastic walls of the alveoli. The alveoli produce a detergent-like substance known as surfactant, which reduces the surface tension of the fluid in the lungs. This makes the alveoli more stable so they do not collapse when an individual exhales. Premature babies often lack adequate surfactant. The Lungs The lungs, which are the essential organs of respiration, are divided into lobes. A lobe is a subdivision or part of an organ. The right lung is larger and has three lobes: the upper, middle, and lower. The left lung has only two lobes, the upper and lower, due to space restrictions because the heart is located on that side of the body. The Mediastinum The mediastinum is the middle section of the chest cavity and is located between the lungs. This cavity contains connective tissue and organs, including the heart and its veins and arteries, the esophagus, trachea, bronchi, thymus gland, and lymph nodes. The Pleura The pleura is a thin, moist, and slippery membrane that covers the outer surface of the lungs and lines the inner surface of the thoracic cavity. The parietal pleura is the outer layer of the pleura. It lines the walls of the thoracic cavity, covers the diaphragm, and forms the sac containing each lung. The parietal pleura is attached to the chest wall. Parietal means relating to the walls of a cavity. The visceral pleura, which in the inner layer of pleura that covers each lung, is attached directly to the lungs. The Pleural cavity, is the thin, fluid-filled space between the parietal and visceral pleural membranes. The fluid acts as a lubricant, allowing the membranes to slide easily over each other during respiration. The Diaphragm The diaphragm is a dome shaped sheet of muscle that separates the thoracic cavity from the abdomen. It is the contraction and relaxation of this muscle that makes breathing possible.  The phrenic nerves stimulate the diaphragm and cause it to contract Respiration Respiration, or breathing, is the exchange of oxygen fro carbon dioxide that is essential to life. A single respiration, or breath, consists of one inhalation and one exhalation. Ventilation is another word for moving air into and out of the lungs. Inhalation and Exhalation Inhalation is the act of taking in air as the diaphragm contracts and pulls downward. This action causes the thoracic cavity to expand. This creates negative pressure within the thoracic cavity that draws air into the lungs. Exhalation is the act of breathing out. As the diaphragm relaxes, it moves upwards, causing the thoracic cavity to become narrower. this action creates positive pressure, forcing air out of the lungs. External Respiration External respiration is the act of bringing air into and out of the lungs from the outside environment and, in the process, exchanging oxygen for carbon dioxide. As air is inhaled into the alveoli, oxygen immediately passes into the surrounding capillaries and is carried by the erythrocytes to all body cells. At the same time, the waste product carbon dioxide that has passed into the blood stream is transported into the air spaces of the lungs to be exhaled. Internal Respiration Internal respiration, also known as cellular respiration, is the exchange of gases within the cells of the blood and tissues. In this process, oxygen passes from the blood stream into the cells The cells give off the waste product carbon dioxide, which passes into the bloodstream. The bloodstream transports the carbon dioxide to the lungs, where it is expelled during exhalation. Medical Specialties Related to the Respiratory System An otolaryngologist (ENT) is a physician with specialized training in the diagnosis and treatment of diseases and disorders of the head and neck. A pulmonologist is a physician who specialized in diagnosing and treating diseases and disorders of the respiratory system. A respiratory therapy (RT) is a licensed medical professional who speializes in treating patients who are having difficulty breathing, both in hospital and outpatient settings. A thoracic surgeon performs operations on the organs inside the thorax, or chest, including the heart, lungs and esophagus. Pathology of the Respiratory System Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease (COPD) is a group of lung disease in which the bronchial airflow is obstructed, making it difficult to breathe out. COPD, which is most often caused by long- term smoking, is generally permanent and progressive. Most people with COPD suffer from two related conditions: chronic bronchitis and emphysema. Chronic Bronchitis Chronic Bronchitis is a disease in which the airways have become inflamed due to recurrent exposure to an inhaled irritant, usually cigarette smoke. An increase in the number and size of mucus-producing cells results in excessive mucus production and thickening of the walls of the air passages. This causes chronic coughing, difficulty getting air into and out of the lungs, and increased risk of bacterial lung infections. Emphysema Emphysema is the progressive, long-term loss of lung function, usually do to smoking. Emphysema is characterized by a decrease in the total number of alveoli, the enlargement of the remaining alveoli, and the progressive destruction of the walls of these remaining alveoli. As the alveoli are destroyed, breathing becomes increasingly rapid, shallow, and difficult. In an effort to compensate for the loss of capacity, the lungs chronically overinflate, and the rip cage stays partially expanded all the time, resulting in a slightly rounded shape called a barrel chest. Asthma Asthma is a chronic inflammatory disease of the bronchial tubes, often triggered by an allergic reaction, An asthma attack is characterized by episodes of severe breathing difficulty, coughing, and wheezing. Wheezing is breath sound caused by a partially obstructed airway. The frequency and severity of asthma attacks are influenced by a variety of factor, including allergens, environmental agents, exercise, and infection Airway inflammation is the swelling and clogging of the bronchial tubes with mucus. This usually occurs after the airway has been exposed to inhaled allergens. A bronchospasm is a contraction of the smooth muscle in the walls of the bronchi and bronchioles, tightening and squeezing the airway shut. Exercise-induced bronchoconstriction is the narrowing of the airways that develops after 5 to 15 minutes of physical exertion, usually triggered by the inhalation of cold, dry air. Upper Respiratory Diseases Upper respiratory infections (URI) and acute nasopharyngitis are amount the terms used to describe the common cold. An upper respiratory infection can be caused by any one of 200 different viruses, the most common of which is the human rhinovirus. Allergic rhinitis, commonly referred to as an allergy, is an allergic reaction to airborne allergens that causes an increased flow of mucus. Nonallergic rhinitis is an inflammation of the lining of the nose caused by something other than an allergen, such as col air, spicy food, or medication. Croup is an acute respiratory infection in children and infants characterized by obstruction of the larynx, hoarseness, and swelling around the vocal cords resulting in a barking cough and stridor. Stridor is a harsh, high-pitched sound caused by a blockage present when breathing in. Epistaxis, also known as a nosebleed, is bleeding from the nose that may be caused by dry air,  injury, medication to prevent blood clotting, or high blood pressure. Influenza also known as the flue, is an acute, highly contagious viral infection characterized by respiratory inflammation, fever, chills and muscle pain. Influenza is spread by respiratory droplets and occurs most commonly in epidemics during the colder months. There are many strains of the influenza virus. Some strains can be prevented by annual immunization. Pertussis, also known as whooping cough, is a contagious bacterial infection of the upper respiratory tract that is characterized by recurrent bouts of a paroxysmal cough, followed by breathlessness and a noisy inspiration. Paroxysmal means sudden or spasm-like. Childhood immunizations against diphtheria, tetanus, and acellular pertussis are given together. Respiratory syncytial virus (RSV) is a common, highly contagious viral infection spread by respiratory droplets. Most infections are mild and similar to the common cold. However, RSV can cause bronchiolitis is younger children and infants, which may require hospitalization. Bronchiolitis is inflammation of the bronchioles. Rhinorrhea, aka runny nose, is the watery flow of mucus from the nose. Sinusitis is an inflammation of the sinuses. Pharynx and Larynx Pharyngitis aka sore throat, is an inflammation of the pharynx. It is often a symptom of a cold, flu, or sinus infection. Pharyngitis caused by the bacteria Streptococcus is commonly referred to as strep throat. A laryngospasm is the sudden spasmodic closure of the larynx. It is sometimes associated with gastroesohageal reflux disease (GERD). Voice Disorders Aphonia is the loss of the ability of the larynx to produce normal speech sounds. patients with aphonia are only able to whisper. Dysphonia is difficulty in speaking, which may include any impairment in vocal quality, including hoarseness, weakness, or the cracking of a boy’s voice during puberty. Laryngitis is an inflammation of the larynx. This term is also commonly used to describe voice loss that is caused by thi inflammation. Trachea and Bronchi Acute bronchitis, also known as a chest cold, is inflammation of the bronchi usually caused by a viral infection. It is characterized by a productive cough, shortness of breath, and often wheezing and a low-grade fever. A productive cough is a cough that brings up mucus or phlegm. Bronchiectasis (bronch/i means bronchus, and -ectasis means stretching or enlargement) is the permanent thickening of the walls of the bronchi, caused by chronic infection and inflammation. Bronchorrhea is an excessive discharge of watery mucus from the bronchi. This is often caused by chronic bronchitis or asthma. Pleural Cavity Pleurisy aka pleuritis, is an inflammation of the pleura, the membranes that cover the lung and line the pleural cavity. Pleurisy, which causes pleurodynia, may result from trauma, tuberculosis, connective tissue disease, or an infection. Pleurodynia is a sharp chest pain that occurs when the inflamed pleural membranes rub against each other with inhalation.  Pleural effusion is the excess accumulation of fluid in the pleural space. This produces a feeling of breathlessness because it prevents the lung from fully expanding. Effusion is the escape of fluid from blood or lymphatic vessels into the tissues or into a body cavity. Pyothorax aka pleural empyema, is the presence of pus in the pleural cavity between the layers of the pleural membrane resulting from a bacterial infection. Empyema refers to a collection of pus in any body cavity. Hemothorax is a collection of blood in the pleural cavity. This condition often results from chest trauma, such as a stab wound, or it can be caused by disease or surgery. A Pneumothorax is the accumulation of air in the pleural space resulting in a pressure imbalance that cause the lung to fully or partially collapse. This an have an external cause, such as a stab wound through the chest wall, or it can occur when there is a lung-disease-related rupture in the pleura that allows air to leak into the pleural space Lungs Acute respiratory distress syndrome (ARDS) is a lung condition usually caused by trauma, pneumonia, smoke, or fumes, inhaled vomit, or sepsis. ARDS is a life-threatening condition in which inflammation in the lungs and fluid is the alveoli lead to low levels of oxygen in the blood. Atelectasis (atel means incomplete, and -ectasis means stretching or enlargement) or collapsed lung, is the incomplete expansion of part or all of a lung due to a blockage of the air passages or pneumothorax. ◦Granuloma is a general term used to describe a localized area of inflammation, usually in the lungs. Granulomas are most commonly caused by infections such as tuberculosis Pulmonary edema is an accumulation of fluid in lung tissues, especially the alveoli. Edema means swelling. Pulmonary edema is often a symptom of heart failure. ◦Pulmonary embolism is the sudden blockage of a pulmonary artery by foreign matter or by an embolus that has formed in the leg or pelvic region. Tuberculosis Tuberculosis (TB), which is an infectious disease caused by Mycobacterium tuberculosis, usually attacks the lungs; however, it can also affect other parts of the body. Pleurisy and hemoptysis (coughing up blood) can be symptoms of TB in the lungs. TB occurs most commonly in individuals whose immune systems are weakened by another condition such as AIDS. A healthy individual can carry latent TB without showing symptoms of the disease. Latent means present but not active. Drug-resistant tuberculosis is a dangerous form of the disease that can occur when the prescribed drug regimen is not strictly followed, rendering the treatment insufficient to destroy all the bacteria Pneumonia Named for the Affected Lung Tissue pneumonia (PNA) is a serious inflammation of the lungs in which the alveoli and air passages fill with pus and other fluids. Pneumonia is most commonly caused by an infection and often follows a cold, flu, chronic illness, or other condition, especially in the elderly, that weakens the immune system an its ability to stave off infection. There are two types of bacterial pneumonia named for the parts of the lungs affected. These are: Bronchopneumonia is a localization form of pneumonia that often affects the bronchioles. Bronchopneumonia often leads to lobar pneumonia Lobar pneumonia affects larger areas of the lungs, often including one or more sections, or lobes, of a lung. Double pneumonia is lobar pneumonia involving both lungs and is usually a form of bacterial pneumonia. Pneumonia Named for the Causative Agent As many as 30 causes of pneumonia have been identified; however, the most common causative agents are air pollution, bacteria, fungi, wires es, and inhaled liquid or chemicals Aspiration pneumonia Community-acquired pneumonia Bacterial Pneumonia Hospital-acquired pneumonia Mycoplasma pneumonia Pneumocystis pneumonia Viral pneumonia Interstitial Lung Disease Interstitial lung disease refers to a group of almost 200 disorders that cause inflammation and scarring of the aleveoli and their supporting structures. In these lung conditions the tissue around the alveoli becomes scarred of stiff, leading to a reduction of oxygen being transferred to the blood. Pulmonary fibrosis is the progressive formation of scar tissue in the lung, resulting in decreased lung capacity and increased difficulty in breathing. Environmental and Occupational Interstital Lung Disease Pneumoconiosis is any fibrosis of the lung tissues caused by mineral dust in the lungs after prolonged environmental or occupational contact. ◦Asbestosis ◦Silicosis Cystic Fibrosis Cystic fibrosis (CF) is a life-threatening genetic disorder in which the lungs and pancreas are clogged with large quantities of abnormally thick mucus. This results in damage to the lungs, poor growth, and nutritional deficiencies. Common symptoms of cystic fibrosis include wheezing and a persistent cough. Lung Cancer Lung cancer, which is the leading cause of cancer death in the United States, is a condition in which cancer cells form in the tissues of the lung. Important risk factors for lung cancer are smoking and inhaling secondhand smoke. Breathing Disorders Eupnea is easy normal breathing  Apnea is the temporary absence of spontaneous respiration. Bradypnea is an abnormally slow rate of respiration, usually less than 10 breaths per minute. Cheyne-Stokes respiration is an irregular pattern of breathing of alternating rapid or shallow respiration followed by slower respiration of apnea. tachypnea is an abnormally rapid rate of respiration, usually of more than 20 breaths per minute. Dyspnea shortness of breath (SOB) is difficult or labored breathing Hyperpnea is breathing that is deeper and more rapid than is normal at rest Hypopnea is shallow of slow respiration Hyperventilation is an abnormally rapid rate of deep respiration that is usually associated with anxiety. Sleep-Related Breathing disorders Sleep apnea is a potentially serious disorder in which breathing repeatedly stops and starts during sleep for periods long enough to cause a measurable decrease in blood oxygen levels. Obstructive sleep apnea (OSA) is caused by the muscles at the back of the throat relaxing and blocking the airway. Snoring, which can be a symptom of sleep apnea, is noisy breathing caused by vibration of the soft palate. Coughing Expectoration is the act of coughing up and spitting out saliva, mucus, or other body fluid (expector means to cough up) Hemoptysis is the expectoration of blood or blood-stained sputum derived from the lungs or bronchial tubes as the result of a pulmonary or bronchial hemorrhage (-ptysis means spitting) Lack of Oxygen Airway obstruction (choking) Anoxia is the absence of oxygen from the body’s tissues and organs even though there is an adequate flow of blood. Irreversible brain damage. Hypoxia is the condition of having deficient oxygen levels in the body’s tissues and organs; however it is less severe than anoxia. Altitude sickness Asphyxia is the loss of consciousness that occurs when the body cannot get the oxygen it needs to function. Asphyxiation is a state of asphyxia or suffocation. Carbon monoxide poisoning Cyanosis is a bluish discoloration of the skin and mucous membranes caused by a lack of adequate oxygen in the blood. Hypercapnia (CO2 retention) is the abnormal buildup of carbon dioxide in the blood Hypoxemia is the condition of having low oxygen levels in the blood, usually due to respiratory disorders or heart conditions. Respiratory failure aka respiratory acidosis, is a condition in which th level of oxygen in the blood becomes dangerously low of the level of carbon dioxide becomes dangerously high. Smoke inhalation is chemical damage and burns to the lungs caused by breathing in hot smoke containing products of combustion, including carbon monoxide. Sudden Infant Death Syndrome (SIDS) is the sudden and unexplainable death an an apparently healthy sleeping infant between the ages of 1 month and 1 year. Diagnostic Procedures of the Respiratory System Respiratory rate is a count of the number of breaths per minute Respiratory sounds such as rales, rhonchi, and stridor provide info about the condition of the lungs an pleura. bronchoscopy is the visual examination of the bronchi using a bronchoscope. A bronchoscope is a flexible, fiber-optic device that is passed through the nose or mouth and down the airways. A chest x-ray (CXR) Laryngoscopy is the visual examination of the larynx and vocal cords using a flexible or rigid laryngoscope inserted through the mouth. Indirect laryngoscopy is a simpler version A peak flow meter is an inexpensive handheld device used by asthma patients to measure air flow out of the lungs, revealing any narrowing of the airways in advance of an asthma attack. Polysomnography (sleep study) measures physiological activity during sleep and is often performed to detect nocturnal defects in breathing associated with sleep apnea. Pulmonary function tests (PFTs) are a group of tests that measure volume and flow of air by using a spirometer. these test are measured against a norm for the individual’s age, height, and sex. A spirometer is a recording device that measures the amount of air inhaled or exhaled and the length of time required for each breath. An incentive spirometer is used to help patients who have recently had surgery keep their lungs healthy during recovery. Pulse oximeter is an external monitor placed on the patient’s fingertip or earlobe to measure oxygen saturation level in the blood. Sputum cytology is a procedure in which a sample of mucus is coughed up from the lung and then examined under a microscope to detect cancer cells Sputum culture & sensitivity is a test in which a sample of mucus is coughed up from the lungs and monitored for bacterial growth. If bacteria grows, it is then tested for sensitivity or resistance to different antibiotics. Sputum is phlegm ejected through the mouth that can be examined for diagnostic purposes. Phlegm is thick mucus secreted by the tissues lining the respiratory passages. Tuberculosis Testing Two kinds of test can be used to help detect tuberculosis infection: tuberculin skin testing and blood tests. These these show whether the patient is infected with TB; however, they do not show whether the infection is latent or active. tuberculin skin testing (mantoux PPD skin test) is a screening test for tuberculosis in which a very small amount of tuberculin purified protein derivative is injected jut under the top layer of the skin of the forearm. A positive result from either skin or blood test indicated the possibility of exposure to the disease, and this response warrants further testing such as a chest x-ray and sputum cytology. Treatment Procedures of the Respiratory System Medications and Their Administration An antitussice (anti- means against, tuss means cough, -ive means performs aka cough medicine, is administered to prevent of relieve coughing. A decongestant, aka nasal decongestant, is administered orally or intranasally to relieve nasal congestion from allergies or illness. An expectorant is an oral medication that makes it easier to cough up mucus by making it thinner and less viscous. Many cold medications contain both decongestants and expectorants.  A bronchodilator is an inhaled medication that relaxes and expands the bronchial passages into the lungs. Controller medicines, such as inhaled corticosteroids, are long acting medications taken daily to prevent asthma attacks. A metered-dose inhaler (MDI) administers a specific amount of a medication such as a bronchodilator in aerosol form. A gas propellant mixes with the medicine to push it into the lungs. A nebulizer is an electronic device that pumps air or oxygen through a liquid medicine to turn it into a mist, which is then inhaled by the patient via a face mask or mouthpiece. The Nose, Throat, and Larynx Endotracheal intubation is the passage of a tube through the mouth into the trachea to establish or maintain an open airway, especially when a patient must be placed on a ventilator. Functional endoscopic sinus surgery (FESS) is a procedure performed using an endoscope in which chronic sinusitis is treated by enlarging the opening between the nose and sinus. A laryngotomy is the surgical repair of parts of the nasal septum, usually to correct a deviated septum. The Trachea Tracheostomy is the surgical creation of a stoma into the trachea below the vocal cords to insert a temporary or permanent tube to facilitate breathing. An emergency tracheotomy is a procedure in which an incision is made into the trachea to gain access to the airway below a blockage. The Lungs, Pleura, and Thorax A pneumonectomy is the surgical removal of all or part of a lung. A lobectomy is the surgical removal of a lobe of an organ, usually the lung, brain, liver, or thyroid gland. Wedge resection is a surgery in which a small wedged-shaped piece of cancerous lung tissue is removed, along with a margin of healthy tissue around the cancer. Thoracentesis is the surgical puncture of the chest wall with a needle to obtain fluid from the pleural cavity. This procedure is performed to remove liquid from the pleural cavity. A thoracotomy is a surgical incision into the chest wall to open the pleural cavity for biopsy or treatment. A thoracotomy is used to gain access to the lungs, heart, esophagus, diaphragm and other organs. Video-assisted surgery (VATS) is the use of a thoracoscope to view the inside of the pleural cavity through very small incisions. A thoracoscope is a specialized endoscope used for treating the thorax. This procedure is used to remove small sections of cancerous tissue and to obtain biopsy specimens to diagnose certain types of pneumonia, infections, or tumor of the chest wall. It is also used to treat repeatedly collapsing lungs. Respiratory Therapy A CPAP (Continuous Positive Airway Pressue) is a noninvasive ventilation device used in the treatment of sleep apnea. A face mask is connected to a pump that creates constant air pressure in the nasal passages, holding the airway open. Although this does not cure sleep apnea, it does reduce snoring and prevent dangerous apnea disturbances. A BiPAP machine (Bilevel Positive Airway Pressure) is like a CPAP machine; however, it can be set at a higher pressure for inhaling and a lower pressure for exhaling. It is used for sleep apena in patients with neuromuscular disease or those who find the CPAP machine uncomfortable. An Ambu bag, or BVM (bag valve mask), is an emergency resuscitato used to assist ventilation. A flexible air chamber is squeezed to force air through a face mask into the lungs of the patient, a  process referred to as “bagging” A ventilator is a mechanical device for artificial respiration that is used to replace or supplement the patient’s natural breathing function. The ventilator forces air into the lungs; exhalation takes place passively as the lungs contract. Supplemental Oxygen Therapy Supplemental oxygen is administer when the patient is unable to maintain an adequate blood oxygen saturation level from breathing normal air. Oxygen is administered by using a compressor either flowing into a hood or tent or delivered directly to the patient using one of the following devices: A nasal cannula is a small tube that divides into two nasal prongs A rebreather mask allows the exhaled breath to be partially reused, delivering up to 60% oxygen. A non-rebreather mask allows higher levels of oxygen to be added to the air taken in by the patient Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a special chamber that allows air pressure to be raised up to three times higher than normal. The lungs and the bloodstream are thus able to absorb more oxygen, which is delivered throughout the body to promote healing and fight infection. This treatment is also used for carbon monoxide poisoning. Abbreviations Related to the Respiratory System ARDS= acute respiratory distress syndrome COPD= chronic obstructive pulmonary disease CF= cystic fibrosis FESS= functional endoscopic sinus surgery HBOT= hyperbaric oxygen therapy MDI= metered-dose inhaler PNA= pneumonia PFT= pulmonary function tests SIDS= sudden infant death syndrome TB= tuberculosis URI= upper respiratory infection