Nursing Anatomy & Physiology Module 19 PDF

Anatomy & Physiology – Lecture (Nursing) Module #19 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________...

Anatomy & Physiology – Lecture (Nursing) Module #19 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Lesson title: RESPIRATORY SYSTEM (Part 2) Learning Targets: At the end of the module, students will be able to: 1. Define the anatomical dead space; Materials: Book, pen and notebook 2. Describe the process of gas exchange and its transport in blood; 3. Identify the significance of rhythmic breathing, its nervous & References: chemical control; VanPutte, C., Regan, J., & Russo, A. 4. List the effects of exercise on breathing; 5. Identify the different diseases & disorders associated with (2019). Seeley’s essentials of anatomy & respiratory system with its description; and, physiology (10th ed.). New York, NY: 6. Enumerate the effects of aging on the respiratory system. McGraw-Hill Education. A. LESSON PREVIEW / REVIEW To refresh your knowledge regarding the previous lesson, answer the question presented based on your own analysis. Do this without looking at your notes and check it right after. Enjoy! Illustrate the passage of air through the organs of the respiratory system. ____________________________________________________________________________________ ____________________________________________________________________________________ B. MAIN LESSON You must read & study the concepts and refer to figures/tables in Chapter 15 of the book. Anatomical Dead Space – area in respiratory passageways where gas exchange between air & blood does not occur. Factors that Affect Gas Exchange: 1. Increased thickness of the respiratory membrane may result in decreased rate of gas exchange. 2. A decrease in surface area of the respiratory membrane to 1/3 or ¼ of normal resting conditions can result in significantly restricted gas exchange. 3. The pressure exerted by specific gas in a mixture of gases is known as partial pressure. The molecules diffuse down their pressure gradient: from areas of higher partial pressure to areas of lower partial pressure. Gas Exchange: (See Process figure 15.13) O2 diffuses into pulmonary capillaries & CO2 diffuses into alveoli ↓ Due to diffusion at pulmonary capillaries, the PO2 & PCO2 in blood & alveoli equalized (CO2 diffuses from a higher partial pressure in pulmonary capillaries to a lower partial pressure in alveoli) ↓ Deoxygenated blood mixes in pulmonary veins (less PO2) ↓ O2 diffuses out of capillaries & CO2 diffuses out of tissues ↓ Due to diffusion at tissue capillaries, the PO2 & PCO2 in blood & tissue equalized (CO2 diffuses from a higher partial pressure in tissues to a lower partial pressure in the tissue capillaries) This document is the property of PHINMA EDUCATION 1 of 6  Anatomy & Physiology – Lecture (Nursing) Module #19 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Gas Transport in the Blood: Oxygen (See Process figure 15.14) ▪ At high PO2, hemoglobin binds to O2; at low PO2, hemoglobin releases O2. ▪ At rest, approximately 23% of O2 picked up by hemoglobin in lungs is released to tissues. ▪ Increased amounts of O2 are released from oxyhemoglobin by low PO2, high PCO2, low pH, & high temperature. Gas Transport in the Blood: Carbon Dioxide & Blood pH (See Process figure 15.14) CO2 enters blood ↓ Dissolved in plasma (7%); Bound to hemoglobin (23%); Transported as bicarbonate ions (70%) ↓ Reacts with H2O, forming carbonic acid (H2CO3) (Rate increased by carbonic anhydrase) ↓ Dissociates to form H+ & bicarbonate ions (HCO3-) ▪ In lung capillaries, process is reversed: H+ + HCO3- = H2CO3 (forming H2O & CO2) ▪ As the CO2 increases, the blood pH decreases and vice versa. Rhythmic Breathing ✔ 12-20 bpm – normal rate of breathing in adults ✔ 20-40 bpm – normal rate of breathing in children ✔ Respiratory areas are controlled within the medullary respiratory centers, consisting of: ▪ two dorsal respiratory groups – stimulate contractions of diaphragm ▪ two ventral respiratory groups – stimulate the intercostal & abdominal muscles o Pre-BÖtzinger Complex – known to establish the basic rhythm of breathing. ▪ pontine respiratory group – collection of neurons in pons & play a role in switching between inspiration & expiration. Generation of Rhythmic Breathing: (See figure 15.15) Stimulus activates medullary respiratory center & inputs reach a threshold level ↓ Somatic nervous system neurons stimulate respiratory muscles via action potentials ↓ Inspiration starts; more neurons activated (lasting approximately for 2 seconds) ↓ Inputs from pontine respiratory neurons, stretch receptors, & other sources exceed threshold ↓ Stimulate respiratory muscles to be inhibited and be relaxed ↓ Expiration lasting for approximately 3 seconds Nervous Control of Breathing: (See figure 15.16) ▪ Breathing can be voluntarily controlled. However, as soon as conscious control of respiration is lost, automatic control resumes & the person starts to breathe again. ▪ Hering-Breuer Reflex – supports rhythmic respiratory movements by limiting the extent of inspiration. ▪ Touch, thermal, & pain receptors in skin stimulate the respiratory center. This document is the property of PHINMA EDUCATION 2 of 6  Anatomy & Physiology – Lecture (Nursing) Module #19 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Chemical Control of Breathing: (See figure 15.16) ▪ The level of CO2 in blood is the major driving force regulating breathing. o Hypercapnia – increase in CO2 level o Hypoxia – low level of O2 in tissues Effect of Exercise on Breathing: 1. Initial increase can be as much as 50% of total increase that will occur abruptly. 2. After onset of exercise, breathing increases immediately, continues gradually and levels off within 4 to 6 minutes. ▪ Anaerobic Threshold – highest level of exercise that can be performed without causing a significant change in blood pH. Respiratory Adaptations to Exercise: ▪ Vital capacity increases slightly & residual volume decreases slightly ▪ Tidal volume remains the same; but, increases during maximal exercise. ▪ Minute volume for athletes is unchanged or slightly reduced at rest. But at maximal exercise, it is greatly increased. Diseases and Disorders of Respiratory System: Condition Description Sinusitis inflammation of mucous membrane of sinus; one or more paranasal sinuses Laryngitis inflammation of mucous epithelium of vocal folds Pertussis / Whooping bacterial infection of tracheobronchial tree caused by Bordetella Pertussis; highly Cough contagious & can be prevented by vaccination Hyaline Membrane Disease known as Infant Respiratory Distress Syndrome (IRDS); caused by too little surfactant introduction of air into the pleural cavity, the space between the parietal & visceral Pneumothorax pleura that normally contains only pleural fluid characterized by abnormally increased constriction of trachea & bronchi in response Asthma to various stimuli, which decrease ventilation efficiency For the listed conditions below, refer to Table 15.2, page 432 of the book for description: ▪ Respiratory Disorders (Bronchitis, Emphysema, ARDS, Cystic Fibrosis & Lung Cancer) ▪ Thrombosis of Pulmonary Arteries ▪ Sudden Infant Death Syndrome (SIDS) ▪ Upper Respiratory Tract Infections (Strep Throat & Common Cold) ▪ Lower Respiratory Tract Infections (Tuberculosis, Pneumonia & Flu / Influenza) Effects of Aging on the Respiratory System: ▪ Vital capacity & maximum minute ventilation decrease due to weakening of respiratory muscles & stiffening of the thoracic cage. ▪ Residual volume & dead space increase because the diameter of respiratory passageways increases. ▪ An increase in resting tidal volume compensates for increased dead space, loss of alveolar walls (surface area), & thickening of alveolar walls. ▪ The ability to remove mucus from respiratory passageways decreases. This document is the property of PHINMA EDUCATION 3 of 6  Anatomy & Physiology – Lecture (Nursing) Module #19 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed. You are given 20 minutes for this activity. Multiple Choice 1. The direction of gas movement is determined by: a. temperature. b. size of the gas molecule. c. solubility of the gas in blood. d. partial pressure differences. e. pH. ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ 2. Which of the following statements about partial pressures of gases is TRUE? a. PO2 in lung is greater than PO2 in blood; PCO2 in lung is greater than PCO2 in blood b. PO2 in lung is greater than PO2 in blood; PCO2 in lung is less than PCO2 in blood c. PO2 in lung is greater than PO2 in blood; PCO2 in lung = PCO2 in blood d. PO2 in lung is less than PO2 in blood; PCO2 in lung is less than PCO2 in blood e. PO2 in lung is less than PO2 in blood; PCO2 in lung is greater than PCO2 in blood ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ 3. The maximum amount of oxygen is exchanged from blood in _________. a. arteries of the body b. capillaries surrounding the alveoli c. left auricle of the heart d. arteries of the body ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ 4. The oxygen is mainly transported in the system as ______________. a. Hemoglobin c. Oxyhemoglobin b. Hemo-oxyglobin d. Ferritin ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ This document is the property of PHINMA EDUCATION 4 of 6  Anatomy & Physiology – Lecture (Nursing) Module #19 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ ____________________________________________________________________________________ _______________________________________ 5. Which of the following binds stronger to hemoglobin? a. Carbon Disulphide b. Carbon Monoxide c. Carbon Dioxide d. Oxygen ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ 6. The factors that affect the rate of alveolar diffusion include: (Select all that apply) a. Solubility of gas b. Reactivity of gas c. Thickness of membrane d. Concentration gradient ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ 7. As humans, our urge to inhale is from __________. a. rising PCO2 c. rising O2 b. falling PCO2 d. falling PO2 ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ 8. Oxygen diffuses out of blood into tissues because __________. a. Oxygen concentration of tissue fluid is lower b. Oxygen concentration of blood is lower c. Carbon dioxide concentration of tissue fluid is lower d. Carbon dioxide concentration of tissue fluid is higher ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ 9. The ranking from highest to lowest PO2 in the area of the arterial ends of the tissue capillaries is: a. capillaries, tissue fluid, cells. b. cells, tissue fluid, capillaries. c. cells, capillaries, tissue fluid. d. tissue fluid, capillaries, cells. e. all three are equal. This document is the property of PHINMA EDUCATION 5 of 6  Anatomy & Physiology – Lecture (Nursing) Module #19 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ 10. Pepper has been assigned to the general ward. Upon reviewing the patient’s record, which of the following body’s responses is a manifestation of lack of oxygen to the brain? a. Gasping of air b. Depressed c. Sleepy d. Hyperactive ANSWER: ________ RATIO:______________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________ C. LESSON WRAP-UP AL Activity: CAT: Minute Paper This strategy provides feedback on whether or not you understand the lesson. You may use the space below in this activity sheet to answer the following questions: 1. What was the most useful or the most meaningful thing you learned this session? ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 2. What question(s) do you have as we end this session? ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ This document is the property of PHINMA EDUCATION 6 of 6