ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM

RESPIRATORY SYSTEM performs the following functions:

1. Gas exchange allows oxygen from the air to enter the blood and carbon dioxide to leave
the blood and enter the air
2. Regulation of blood pH can alter blood pH by changing blood carbon dioxide levels
3. Voice production air movements past the vocal cords makes sound and speech possible
4. Olfaction - -sensation of smells occurs when airborne molecules are drawn into the nasal
cavity
5. Innate immunity - protects us by preventing and removing microorganism from
respiratory surfaces
Structure: The Respiratory System is comprised of:
nose
paranasal sinuses
pharynx, tonsils, and adenoids
larynx
trachea
lungs
UPPER RESPIRATORY TRACTS

NOSE
consists of the external nose
and the nasal cavity
external nose is the visible
structure that forms a
prominent feature of the face,
most of it is composed of
hyaline cartilage although the
bridge of the external nose
consists of bone
nares or nostrils are the external openings of the nose, and choanae are the openings of
the pharynx
concerned with filtering and providing a passage for air on its way to the lungs

NASAL CAVITY and PARANASAL

SINUSES
it is the inside of your nose
nasal cavity extends from nares to the
choanae
nasal septum is a partition dividing
the nasal cavity into right and left
parts
hard palate forms the floor of the
nasal cavity which separates the nasal
cavity form the oral cavity
lined with mucous membrane that
helps keep your nose moist by
making mucus to prevent nosebleeds
from dry noise
conchae are present on the lateral walls on each side of the nasal cavity which increase
the surface area of the nasal cavity to cause air to churn, to be cleansed, humidified and
warmed
paranasal sinuses are air-filled spaces within bone, it include the maxillary, frontal,
ethmoidal, and sphenoidal sinuses

PHARYNX, TONSILS and ADENOIDS

is is the common passageway for both the
respiratory and the digestive system
inferiorly, it leads to the rest of the respiratory
system through the opening into the larynx and
to the digestive system through the esophagus
can be divided into three regions, the
nasopharynx, the oropharynx and the
laryngopharynx
nasopharynx is the posterior part of the pharynx,
it is lined with pseudostratified ciliated columnar
epithelium that is continuous with the nasal cavity
oropharynx extends from uvula to the epiglottis, and the oral cavity opens into the
oropharynx, it is lined with stratified squamous epithelium, which protects against
abrasion

laryngopharynx passes posterior to the larynx and

extends from the tip of the epiglottis to the esophagus,
it is lined with stratified squamous epithelium and
ciliated columnar epithelium
adenoids or pharyngeal tonsils, are located in the roof
of the nasopharynx
tonsils, adenoids and other lymphoid tissue encircle the
throat

LARYNX
larynx or voice organ is a
cartilaginous epithelium lined
structure, it connects the
pharynx and the trachea
its major function is vocalization
but it also protects the lower
airway from foreign substances
and facilitates coughing
frequently referred as the voice box and consists of the following
o epiglottis valve flap of cartilage, covers the opening to the larynx during
swallowing
o glottis opening between the vocal cords in the larynx
o thyroid cartilage largest of the cartilage structures; part of it forms the Adams
apple
o cricoid cartilage the only complete cartilaginous ring in the larynx
o arytenoid cartilages used in vocal cord movement with the thyroid cartilage
o vocal cords ligaments controlled by muscular movements that produce sounds;
located in the lumen of the larynx
TRACHEA
trachea or windpipe, is a membranous tube
attached to the larynx
it is composed of smooth muscle with C-shaped
rings of cartilage at regular intervals
the cartilages protect the trachea and maintain an
open passageway for air
it serves as the passage between the larynx and the
bronchi

LOWER RESPIRATORY TRACT

Lungs
lungs are the principal organs of
respiration, it contain the
bronchial and alveolar structures
needed for gas exchange
lungs are paired elastic structures
enclosed in the thoracic cage,
which is an airtight chamber with
distensible walls
each lung is cone-shaped, with its
base resting on the diaphragm and its apex extending superiorly to a point about 2.5cm
above the clavicle
the right lungs has three lobes, called the superior, middle and inferior lobes while the left
lung has two lobes, called the inferior and inferior lobes
o Pleura the lungs and the wall of the thorax are lined with a serous membrane
called the pleura. the visceral pleura covers the lungs while the parietal pleura
lines the thorax, the visceral and parietal with the small amount of pleural fluid
serve to lubricate the thorax and the lungs and permit smooth motion of the lungs
o Mediastinum it is in the middle of the thorax, between the pleural sacs that
contain the two lungs
o Lobes each lung is divided into lobes, the right lungs has upper, middle and
lower lobes whereas the left lung consists of upper and lower lobes. Each lobes is
further subdivided into two to five segments separated by fissures, which are
extension of the pleura
o Bronchi there are several divisions of the bronchi within each lobe of the lung.
Lobar bronchi three in the right lung and two in the left. It divide into
segmental bronchi (10 on the right and 8 on the left), which are the
structures identified when choosing the most effective postural draining.
Segmental bronchi divide into subsegmental bronchi which are
surrounded by connective tissue that contains arteries, lymphatics and
nerves.
Subsegmental bronchi branch into bronchioles which have no cartilage
in their walls and their patency depends entirely on the elastic recoil of the
surrounding smooth muscle and on the alveolar pressure
o Bronchioles it contain submucosal glands, which produce mucus that covers the
inside lining of the airways. Bronchioles branch into terminal bronchioles and it
becomes respiratory bronchioles which are considered to be the transitional
passageways between the conducting airways and the gas exchange airways
o Alveoli the lung is made up of about 300 million alveoli arranged into clusters
of 15 and 20. There are three types of alveolar cells
Type I alveolar cells epithelial cells that form the alveolar walls

Type II alveolar cells metabolically active, secrete surfactant, a

phospholipid that lines the inner surface which prevents alveolar collapse
Type II alveolar cells large phagocytic cells that ingest foreign matter
and act as an important defense mechanism

ANATOMY AND PHYSIOLOGY OF THE LIVER

Liver
the liver weighs about 1.36
kilograms and is located in the
right upper quadrant of the
abdomen, tucked against the
inferior surface of the diaphragm
it is divided into two major lobes,
the right lobe and left lobe which
are separated by the falciform
ligament, a connective tissue
septum
porta is the gate through which
blood vessels, ducts and nerves
enter or exit the liver
the liver receives blood from two
sources, the hepatic artery which
takes oxygen-rich blood to the liver and supplies liver cells with oxygen and the hepatic
portal vein which carries blood that is oxygen-poor but rich in absorbed nutrients and
other substances from the digestive tract to the liver
the gallbladder is a small sac on the inferior surface of the liver that stores and
concentrates bile

SURGERIES FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE

CHEST TUBE
INSERTION helps
drain air, blood, or
infection from the
pleural place. A specially
designed tube is inserted
through the side of your
body, between the ribs,
and into the pleural
space.
PREPROCEDURE
Ensure a signed
informed consent
for chest tube
insertion. This
invasive
procedure
requires informed
consent.
Provide
additional

information as indicated.
Prepare all the materials and supplies needed.
Position the patient as indicated for the procedure.
Assist with chest tube insertion as needed. The procedure may be performed in a
procedure room, in the surgical suite, or at the bedside.

INTRAOPERATIVE

The doctor will prep a large area on the side of your chest, from your armpit down to
your abdomen and across to your nipple. This will involve sterilizing the area using Betadine and
potentially shaving any hair from the site, if necessary.
An intravenous and/or local anesthetic may be used to make you more comfortable
during the chest tube insertion, which can be painful.
Using a scalpel, he or she will then make a small ( inch to 1 inch) incision between
the ribs near the upper part of your chest (the specific location will depend on the reason for the
chest tube).
The doctor will gently open a space into your chest cavity using a finger and clamps, and
guide in the chest tube. (Chest tubes come in various sizes for different conditions.)
A small suture keeps the tube in place, and a sterile bandage is applied. The tube is then
attached to a special one-way drainage system that only allows air or fluid to flow out. This
prevents drainage back into the lung.
POSTOPERATIVE
Assess the respiratory status at least every 4 hours. It is necessary to monitor respiratory
status and the effect of chest tube.
Maintained a closed system. Tape all connections, and secure the chest tube to the chest
wall. These measures are important to inadvertent tube removal or disruption of the
system integrity.
Keep the collection apparatus below the level of the chest. Pleural fluid drains into the
collection apparatus by gravity flow.
Check tubes frequently for kinks or loops. These could interfere with drainage.
Check the water seal frequently. The water level should fluctuate with respiratory effort.
If it does not, the system may not be patent or intact. Periodic air bubbles in the waterseal chamber are normal and indicate that trapped air is being removed from the chest. It
is important to ensure appropriate functioning.
Measure drainage every 8 hours or as needed, marking the level on the drainage chamber.
Report drainage that is cloudy, or red, warm and free flowing. It may indicate infection.
Periodically assess water level in the suction control chamber, adding water as necessary.
Assist with frequent position changes and sitting and ambulation as needed.
When the chest tube is removed, immediately apply a sterile occlusive petroleum jelly
dressing.

BULLECTOMY is a
procedure where doctors
remove one or more of the
very large bullae from the
lungs.
COPD weakens the
structure of the lung and
may also damage the tiny
air sacs in the lung. When
these air sacs break down,
larger airspaces known as
bullae are formed.
Bullae are large air sacs that
form from hundreds of
destroyed alveoli. These air
spaces can become so large
that they interfere with
breathing.
LUNG
VOLUME
REDUCTION
SURGERY
(LVRS) it is
the removal of
one or both
lungs, making
room for the
rest of the lung
to work better.
In chronic obstructive pulmonary disease (COPD), this phenomenon is exaggerated as the
connective tissue in the lung parenchyma is destructed in addition to the airway narrowing.
Therefore, the residual volume increases further resulting in a barrel shaped chest. This rise in
residual volume also decreases the vital capacity and to compensate the tidal volume becomes
deeper and the respiratory rate becomes slower.

LUNG TRANSPLANT
replacing a sick lung with a
healthy lung
Some COPD patients with
very severe symptoms may
have a hard time breathing all
the time. In some of these
cases, doctors may suggest
lung surgery to improve
breathing. Not everyone is a
candidate for lung surgery.
Some people with COPD
have improved lung function
from surgery, but others will
not benefit. Some of the
considerations for surgery candidates include:

You must be strong enough to have the surgery.

You must participate in a pulmonary rehabilitation program.
You cannot be a current smoker.