Respiratory Chapt.

Respiratory Chapt.
The chest is a cage of bone, cartilage, muscles capable of movement for lung expansion. Consists of the sternum, manubrium, xiphoid process, and costal cartilages, lateral of the 12 pairs of ribs, posterior of the 12 thoracic vertebrae.
Diaphragm and intercostal muscles are primary muscles of respiration, dominate muscles move downward
External intercostal muscles increaseAP chest diameter during respiration
Interior chest divided in 3 spaces: right and left pleural cavities, and the mediastinum
Mediastinum is between lungs, contains thoracic viscera except lungs
Pleural cavities are lined up with parietal and visceral pleurae , a serous membrane
Each lung lobe contains blood vessels, lymphatics, nerves, and an alveolar duct connecting with alveoli as many as300 million in an adult
Tracheobronchial tree is a tubular system for airflow pathways in which air if filtered, humidified, and warmed
Right Bronchus is wider, shorter and more vertically placed, its more susceptible to infection
3 bronchi branches on the right, two branches on the left
Bronchi transports air and some filtering of foreign bodies
Bronchial arties branch from anterior aortaand intercostal arteries supplying blood to lungs and stroma
Chemoreceptors in medulla oblongata react to changes in hydrogen ion concentration in blood and spinal fluid
Pons regulate respiratory muscles, high levels of CO2 stimulate respiration
Infants and Children: 4 weeks of gestation lungs are a groove on the wall of gut
Fetal gas exchange is mediated by the placenta
Newborn chests areround equal to that of the head until about 2 years old
Chest wall is thin in infants
Pregnant Women: lower ribs flare up increasing diameter about 2cm and an increase in the circumference of 5cm or 7cm. Subcostal angle progressively increases to about 68.5 degrees to 103.5 degrees later in pregnancy, minute ventilation increases 30% to 50% corresponding 50-70% increase in alveolar ventilation.Respiratory rate remains unchanged.
Older Adults: Barrel Chest is loss of muscle strength in the thorax and diaphragm, loss of lung resiliency, ademas skeletal changes and dorsal curve of spine. Alveoli become less elastic and more fibrous, loss of tensile strength , results in underventilation of the alveoli. Aging mucous membranes tend to become drier makes older people more susceptible toinfections
Dyspnea – when older people exceed their customary light or moderate exertional demands
Inspection: sit patient upright without support naked to waist. Stethoscope should be warm, have bright tangential. Detect pulsations or retractions, presence of deformity. If patient is in bed, access both sides higher or lower bed as needed
Barrel Chest – results from compromised repirations,ex. Chronic asthma, emphysema, or cystic fibrosis, trachea may be posteriorly displaced
Pigeon chest or pectus carinatum – prominent sternal protrusion
Funnel chest or pectus excavatum – indentation of lower sternum above the xiphoid process
Inspect skin, nails, lips, and nipples noting signs of cyanosis or pallor, clues to respiratory or cardiac disorder.
Smell breath to detect intrathoracicinfection
Supernumerary nipples are clues to congenital abnormalities
Superficial venous patterns over chest are signs of heart disorder or vascular obstruction or disease
Respiratory rates 12-20 …..1:4 heartbeat ratio . Note rhythm, rate, depth
Dyspnea difficulty or labored breathing w shortness of breathing. A sedentary lifestyle or obesity can cause it
Orthopea – Shortness of breath thatbegins or increased when patient lies down
Paroxysmal nocturnal dyspnea – sudden onset of shortness of breath after a period of sleep
Platypnea- dyspnea increase in upright posture
Tachypnea – 25 resp. per minute
Shallow breaths symptoms of protective splinting from pain by broken rib or pleurisy, massive liver enlargement, or abnormal ascites.
Bradypnea – slower than 12 breaths /min...