CHAPTER 19
Functions of the respiratory system:
(1) supplying oxygen to the body for energy production;
(2) removing carbon dioxide as a waste product of energy reactions;
(3) maintaining homeostasis (acid-base balance) of arterial blood;
(4) maintaining heat exchange (less important in humans).
Terms
Hypoventilation
slow, shallow breathing) causes carbon dioxide to build up in the blood, and
Hyperventilation
rapid, deep breathing) causes carbon dioxide to be blown off.
Hypercapnia
The normal stimulus to breathe for most of us is an increase of carbon dioxide in
the blood
Hypoxemia
A decrease of oxygen in the blood also increases respirations but is less effective
than hypercapnia.
Vertical Diameter
lengthens or shortens, which is accomplished by downward or upward movement
of the diaphragm
Anteroposterior (AP) Diameter
increases or decreases, which is accomplished by elevation or depression of the
ribs. The anteroposterior (AP) diameter should be less than the transverse
diameter. The ratio of AP to transverse diameter is about 0.70 to 0.75 in adults,
and it increases with age. 2:1 ratio.
Orthopnea
is difficulty breathing when supine. State number of pillows needed to achieve
comfort (e.g., “two-pillow orthopnea”).
Paroxysmal nocturnal dyspnea
is awakening from sleep with SOB and needing to be upright to achieve comfort.
The Aging Adult
- The costal cartilages become calcified; thus the thorax is less mobile.
- Respiratory muscle strength declines after age 50 years and continues to decrease into the
70s.
- Lungs become less elastic- lessening their tendency to collapse and recoil.
- The aging lung rigid structure that is harder to inflate.
- Causes decreased vital capacity (the maximum amount of air that a person can expel
from the lungs after first filling the lungs to maximum)
- BUT increases residual volume (the amount of air remaining in the lungs even after the
most forceful expiration).
- Gradual loss of intra-alveolar septa and a decreased number of alveoli (causes less
surface area is available for gas exchange)
, - This increases the older person's risk for dyspnea with exertion beyond his or her usual
workload.
- At Risk for postoperative atelectasis and infection from a decreased ability to cough, a
loss of protective airway reflexes, and increased secretions.
SMOKING ASSESSMENT
-Ask about his or her tobacco use status at every visit and record the person's response.
Advise Give clear, nonjudgmental, and personalized suggestions for quitting. “I
- understand that quitting is difficult and challenging, but it is the most important thing
- you can do for your own health and for your family.”
Assess each person's readiness for and interest in quitting. The response will affect the
next
- step. If he or she is willing to quit, you'll offer resources and assistance. If not, you'll help
- the person determine the barriers to cessation.
Assist each person with a specific cessation plan that includes medications, behavioral
- modification, exercise programs, or referrals. Encourage to pick a quit date and give
- support and feedback.
Arrange follow-up visits. If relapse occurs, state that you are there to help start over
again.
- Remind that quitting takes practice and often does not happen in the first attempt.
Note: Some older adults feel pleuritic pain less intensely than younger adults.
Precisely localized sharp pain (points to it with one finger)—consider fractured rib or muscle
injury.
Lung Sounds
Crackles are discontinuous popping sounds heard over inspiration; wheezes are continuous
musical sounds heard mainly over expiration.
atelectatic crackles, is not pathologic. Atelectatic crackles are short, popping, crackling sounds
that last only a few breaths. When sections of alveoli are not fully aerated (as in sleepers or in
older adults), they deflate slightly and accumulate secretions. Crackles are heard when these
sections are expanded by a few deep breaths. Atelectatic crackles are heard only in the periphery,
usually in dependent portions of the lungs, and disappear after the first few breaths or after a
cough.
forced expiratory time is the number of seconds it takes for the person to exhale from total lung
capacity to residual volume. 6 seconds or more = obstruction.
Persistent fine crackles that are scattered over the chest occur with pneumonia, bronchiolitis, or
atelectasis. Crackles only in upper lung fields occur with cystic fibrosis; crackles only in lower
lung fields occur with heart failure.
, Expiratory wheezing occurs with lower airway obstruction (e.g., asthma or bronchiolitis). When
unilateral, it may be foreign body aspiration. Persistent peristaltic sounds with diminished breath
sounds on the same side may indicate diaphragmatic hernia.
Stridor is a high- pitched inspiratory crowing sound heard without the stethoscope, occurring
with upper airway obstruction (e.g., croup, foreign body aspiration, or acute epiglottitis)
CHAPTER 20
The superior and inferior vena cava return unoxygenated venous blood to the right side of the
heart. The pulmonary artery leaves the right ventricle, bifurcates, and carries the venous blood
to the lungs. The pulmonary veins return the freshly oxygenated blood to the left side of the
heart, and the aorta carries it out to the body.
The common metaphor is to think of the heart as a pump. But consider that the heart is actually
two pumps; the right side of the heart pumps blood into the lungs, and the left side
simultaneously pumps blood into the body
There are four valves in the heart (see Fig. 20.4). The two atrioventricular (AV) valves separate
the atria and the ventricles. The right AV valve is the tricuspid, and the left AV valve is the
bicuspid or mitral valve. The valves’ thin leaflets are anchored by collagenous fibers (chordae
tendineae) to papillary muscles embedded in the ventricle floor. The AV valves open during the
heart's filling phase, or diastole, to allow the ventricles to fill with blood. During the pumping
phase, or systole, the AV valves close to prevent regurgitation of blood back up into the atria.
The papillary muscles contract at this time so the valve leaflets meet and unite to form a perfect
seal without turning themselves inside out.
The semilunar (SL) valves are set between the ventricles and the arteries. Each valve has three
cusps that look like half moons. The SL valves are the pulmonic valve in the right side of the
heart and the aortic valve in the left side of the heart. They open during pumping (systole), when
blood ejects from the heart.
NOTE: There are no valves between the vena cava and the right atrium or between the
pulmonary veins and the left atrium. For this reason abnormally high pressure in the left side of
the heart gives
a person symptoms of pulmonary congestion, and abnormally high pressure in the right side of
the heart shows in the distended neck veins and abdomen.
The rhythmic movement of blood through the heart is the cardiac cycle. It has two phases,
diastole and systole. In diastole the ventricles relax and fill with blood. This takes up two-thirds
of the cardiac cycle. Heart contraction is systole. During systole blood is pumped from the
ventricles and fills the pulmonary and systemic arteries. This is one-third of the cardiac cycle.
The first heart sound (S1) occurs with closure of the AV valves and thus signals the beginning
of systole. The mitral component of the first sound (M1) slightly precedes the tricuspid
Functions of the respiratory system:
(1) supplying oxygen to the body for energy production;
(2) removing carbon dioxide as a waste product of energy reactions;
(3) maintaining homeostasis (acid-base balance) of arterial blood;
(4) maintaining heat exchange (less important in humans).
Terms
Hypoventilation
slow, shallow breathing) causes carbon dioxide to build up in the blood, and
Hyperventilation
rapid, deep breathing) causes carbon dioxide to be blown off.
Hypercapnia
The normal stimulus to breathe for most of us is an increase of carbon dioxide in
the blood
Hypoxemia
A decrease of oxygen in the blood also increases respirations but is less effective
than hypercapnia.
Vertical Diameter
lengthens or shortens, which is accomplished by downward or upward movement
of the diaphragm
Anteroposterior (AP) Diameter
increases or decreases, which is accomplished by elevation or depression of the
ribs. The anteroposterior (AP) diameter should be less than the transverse
diameter. The ratio of AP to transverse diameter is about 0.70 to 0.75 in adults,
and it increases with age. 2:1 ratio.
Orthopnea
is difficulty breathing when supine. State number of pillows needed to achieve
comfort (e.g., “two-pillow orthopnea”).
Paroxysmal nocturnal dyspnea
is awakening from sleep with SOB and needing to be upright to achieve comfort.
The Aging Adult
- The costal cartilages become calcified; thus the thorax is less mobile.
- Respiratory muscle strength declines after age 50 years and continues to decrease into the
70s.
- Lungs become less elastic- lessening their tendency to collapse and recoil.
- The aging lung rigid structure that is harder to inflate.
- Causes decreased vital capacity (the maximum amount of air that a person can expel
from the lungs after first filling the lungs to maximum)
- BUT increases residual volume (the amount of air remaining in the lungs even after the
most forceful expiration).
- Gradual loss of intra-alveolar septa and a decreased number of alveoli (causes less
surface area is available for gas exchange)
, - This increases the older person's risk for dyspnea with exertion beyond his or her usual
workload.
- At Risk for postoperative atelectasis and infection from a decreased ability to cough, a
loss of protective airway reflexes, and increased secretions.
SMOKING ASSESSMENT
-Ask about his or her tobacco use status at every visit and record the person's response.
Advise Give clear, nonjudgmental, and personalized suggestions for quitting. “I
- understand that quitting is difficult and challenging, but it is the most important thing
- you can do for your own health and for your family.”
Assess each person's readiness for and interest in quitting. The response will affect the
next
- step. If he or she is willing to quit, you'll offer resources and assistance. If not, you'll help
- the person determine the barriers to cessation.
Assist each person with a specific cessation plan that includes medications, behavioral
- modification, exercise programs, or referrals. Encourage to pick a quit date and give
- support and feedback.
Arrange follow-up visits. If relapse occurs, state that you are there to help start over
again.
- Remind that quitting takes practice and often does not happen in the first attempt.
Note: Some older adults feel pleuritic pain less intensely than younger adults.
Precisely localized sharp pain (points to it with one finger)—consider fractured rib or muscle
injury.
Lung Sounds
Crackles are discontinuous popping sounds heard over inspiration; wheezes are continuous
musical sounds heard mainly over expiration.
atelectatic crackles, is not pathologic. Atelectatic crackles are short, popping, crackling sounds
that last only a few breaths. When sections of alveoli are not fully aerated (as in sleepers or in
older adults), they deflate slightly and accumulate secretions. Crackles are heard when these
sections are expanded by a few deep breaths. Atelectatic crackles are heard only in the periphery,
usually in dependent portions of the lungs, and disappear after the first few breaths or after a
cough.
forced expiratory time is the number of seconds it takes for the person to exhale from total lung
capacity to residual volume. 6 seconds or more = obstruction.
Persistent fine crackles that are scattered over the chest occur with pneumonia, bronchiolitis, or
atelectasis. Crackles only in upper lung fields occur with cystic fibrosis; crackles only in lower
lung fields occur with heart failure.
, Expiratory wheezing occurs with lower airway obstruction (e.g., asthma or bronchiolitis). When
unilateral, it may be foreign body aspiration. Persistent peristaltic sounds with diminished breath
sounds on the same side may indicate diaphragmatic hernia.
Stridor is a high- pitched inspiratory crowing sound heard without the stethoscope, occurring
with upper airway obstruction (e.g., croup, foreign body aspiration, or acute epiglottitis)
CHAPTER 20
The superior and inferior vena cava return unoxygenated venous blood to the right side of the
heart. The pulmonary artery leaves the right ventricle, bifurcates, and carries the venous blood
to the lungs. The pulmonary veins return the freshly oxygenated blood to the left side of the
heart, and the aorta carries it out to the body.
The common metaphor is to think of the heart as a pump. But consider that the heart is actually
two pumps; the right side of the heart pumps blood into the lungs, and the left side
simultaneously pumps blood into the body
There are four valves in the heart (see Fig. 20.4). The two atrioventricular (AV) valves separate
the atria and the ventricles. The right AV valve is the tricuspid, and the left AV valve is the
bicuspid or mitral valve. The valves’ thin leaflets are anchored by collagenous fibers (chordae
tendineae) to papillary muscles embedded in the ventricle floor. The AV valves open during the
heart's filling phase, or diastole, to allow the ventricles to fill with blood. During the pumping
phase, or systole, the AV valves close to prevent regurgitation of blood back up into the atria.
The papillary muscles contract at this time so the valve leaflets meet and unite to form a perfect
seal without turning themselves inside out.
The semilunar (SL) valves are set between the ventricles and the arteries. Each valve has three
cusps that look like half moons. The SL valves are the pulmonic valve in the right side of the
heart and the aortic valve in the left side of the heart. They open during pumping (systole), when
blood ejects from the heart.
NOTE: There are no valves between the vena cava and the right atrium or between the
pulmonary veins and the left atrium. For this reason abnormally high pressure in the left side of
the heart gives
a person symptoms of pulmonary congestion, and abnormally high pressure in the right side of
the heart shows in the distended neck veins and abdomen.
The rhythmic movement of blood through the heart is the cardiac cycle. It has two phases,
diastole and systole. In diastole the ventricles relax and fill with blood. This takes up two-thirds
of the cardiac cycle. Heart contraction is systole. During systole blood is pumped from the
ventricles and fills the pulmonary and systemic arteries. This is one-third of the cardiac cycle.
The first heart sound (S1) occurs with closure of the AV valves and thus signals the beginning
of systole. The mitral component of the first sound (M1) slightly precedes the tricuspid
