1. Respiratory system Anatomy and Physiologi

RESPIRATORY SYSTEM

Yunus Elon, MSNYunus Elon, MSNFaculty of NursingFaculty of Nursing

Universitas Advent IndonesiaUniversitas Advent Indonesia

Hi I am O2 ,you can call me oxygen, and I will be your guide today.

I advise you keep all feet and hands inside the ride at all times.

08/21/16 YunelDocRespiratory 1

Value Integration: Mazmur 139:14

Aku bersyukur kepada-Mu oleh Aku bersyukur kepada-Mu oleh karena kejadianku dahsyat dan ajaib; karena kejadianku dahsyat dan ajaib; ajaib apa yang Kaubuat, dan jiwaku ajaib apa yang Kaubuat, dan jiwaku

benar-benar menyadarinya.benar-benar menyadarinya.

And I praise You because of the wonderful way You created me. Everything You do is marvelous!

Of this I have no doubt(ACEV)

Human Respiratory SystemHuman Respiratory System

Functions:Functions: Works closely with circulatory system, Works closely with circulatory system,

exchanging gases between air and blood:exchanging gases between air and blood:Takes up oxygen from air and supplies it to Takes up oxygen from air and supplies it to

blood (for cellular respiration).blood (for cellular respiration).Removal and disposal of carbon dioxide Removal and disposal of carbon dioxide

from blood (waste product from cellular from blood (waste product from cellular respiration).respiration).

Homeostatic Role:Homeostatic Role:

Regulates blood pH.Regulates blood pH. Regulates blood oxygen and carbon dioxide Regulates blood oxygen and carbon dioxide

levels.levels.08/21/16 YunelDocRespiratory 3

Blood Transports Gases Between Lungs and Tissues


Human Respiratory SystemHuman Respiratory SystemComponentsComponents: :

Nasal cavity, throat (pharynx), larynx (voice box), Nasal cavity, throat (pharynx), larynx (voice box), trachea, bronchi, alveoli, and lungs.trachea, bronchi, alveoli, and lungs.

Pathway of Inhaled Air: Pathway of Inhaled Air: � Nasal cavityNasal cavity� Pharynx Pharynx (Throat)(Throat)� Larynx Larynx (Voice Box)(Voice Box)� Trachea Trachea (Windpipe)(Windpipe)

� BronchiBronchi� BronchiolesBronchioles� Alveoli Alveoli ((Site of gas exchangeSite of gas exchange))

Exhaled air follows reverse pathway.Exhaled air follows reverse pathway.08/21/16 YunelDocRespiratory 5




Human Respiratory SystemHuman Respiratory System1. Nasal cavity: 1. Nasal cavity: Air enters nostrils, is filtered by hairs, Air enters nostrils, is filtered by hairs,

warmed, humidified, and sampled for odors as it flows warmed, humidified, and sampled for odors as it flows through a maze of spaces. through a maze of spaces.

2. Pharynx (Throat):2. Pharynx (Throat): Intersection where pathway for air Intersection where pathway for air and food cross. Most of the time, the pathway for air is and food cross. Most of the time, the pathway for air is open, except when we swallow.open, except when we swallow.

3. Larynx (Voice Box):3. Larynx (Voice Box): Reinforced with cartilage. Contains Reinforced with cartilage. Contains vocal cordsvocal cords, which allow us to make sounds by , which allow us to make sounds by voluntarily tensing muscles.voluntarily tensing muscles. High pitched sounds:High pitched sounds: Vocal cords are tense, vibrate Vocal cords are tense, vibrate

fast.fast. Low pitched sounds:Low pitched sounds: Vocal cords are relaxed, Vocal cords are relaxed,

vibrate slowly.vibrate slowly. More prominent in males (More prominent in males (Adam’s appleAdam’s apple).).




Human Respiratory SystemHuman Respiratory System4. Trachea (Windpipe): 4. Trachea (Windpipe): Rings of cartilage maintain shape Rings of cartilage maintain shape

of trachea, to prevent it from closing. Forks into two of trachea, to prevent it from closing. Forks into two bronchi.bronchi.

5. Bronchi5. Bronchi (Sing. Bronchus):(Sing. Bronchus): Each bronchus leads into a Each bronchus leads into a lung and branches into smaller and smaller lung and branches into smaller and smaller bronchiolesbronchioles, , resembling an inverted tree. resembling an inverted tree.

6. Bronchioles:6. Bronchioles: Fine tubes that allow passage of air. Muscle Fine tubes that allow passage of air. Muscle layer constricts bronchioles. Epithelium of bronchioles layer constricts bronchioles. Epithelium of bronchioles is covered with cilia and mucus.is covered with cilia and mucus. Mucus traps dust and other particles.Mucus traps dust and other particles. Ciliary EscalatorCiliary Escalator: Cilia beat upwards and remove : Cilia beat upwards and remove

trapped particles from lower respiratory airways. trapped particles from lower respiratory airways. Rate about 1 to 3 cm per hour.Rate about 1 to 3 cm per hour.



Pulmonary Function Tests

Assessed by spirometry.Assessed by spirometry. Subject breathes into a closed system in Subject breathes into a closed system in

which air is trapped within a bell floating which air is trapped within a bell floating in Hin H220.0.

The bell moves up when the subject The bell moves up when the subject exhales and down when the subject inhales.exhales and down when the subject inhales.


Spirogram

Tidal volume: Tidal volume: Amount of air expired with each breath.Amount of air expired with each breath. Vital capacity:Vital capacity: The maximum amount of air that can be forcefully exhaled after maximum The maximum amount of air that can be forcefully exhaled after maximum

inhalation.inhalation.


Table 16.3 Terms Used to Describe Lung Volumes and Capacities

Term Definit ionLung Volumes The four nonoverlapping components of the total lung

capacity

Tidal volume The volume of gas inspired or expired in an unforced respiratory cycle

Inspiratory reserve volume The maximum volume of gas that can be inspired during forced breathing in addition to tidal volume

Expiratory reserve volume The maximum volume of gas that can be expired during forced breathing in addition to tidal volume

Residual volume The volume of gas remaining in the lungs after a maximum expiration

Lung Capacities Measurements that are the sum of two or more lung volumes

Total lung capacity The total amount of gas in the lungs after a maximum inspiration

Vital capacity The maximum amount of gas that can be expired after a maximum inspiration

Inspiratory capacity The maximum amount of gas that can be inspired after a normal tidal expiration

Functional residual capacity The amount of gas remaining in the lungs after a normal tidal expiration08/21/16 YunelDocRespiratory 16


Anatomical Dead Space Not all of the inspired air reached the alveoli.Not all of the inspired air reached the alveoli. As fresh air is inhaled it is mixed with anatomical As fresh air is inhaled it is mixed with anatomical

dead space.dead space. Conducting zone and alveoli where 0Conducting zone and alveoli where 022

concentration is lower than normal and C0concentration is lower than normal and C022 concentration is higher than normal.concentration is higher than normal.

Alveolar ventilation: f x (TV- DS)Alveolar ventilation: f x (TV- DS) F = frequency (breaths/min.).F = frequency (breaths/min.). TV = tidal volume.TV = tidal volume. DS = dead space.DS = dead space.


Restrictive and Obstructive Disorders

Restrictive Restrictive disorder:disorder: Vital capacity Vital capacity

is reduced. is reduced. FVC is normal.FVC is normal.

Obstructive Obstructive disorder:disorder: VC is normal.VC is normal. FEVFEV11 is is

reduced.reduced.08/21/16 YunelDocRespiratory 19


Breathing Ventilates the LungsBreathing Ventilates the LungsBreathing:Breathing: Alternation of inhalation and exhalation. Alternation of inhalation and exhalation.

Supplies our lungs with oxygen rich air, and expels excess Supplies our lungs with oxygen rich air, and expels excess carbon dioxide.carbon dioxide.

� Inhalation:Inhalation: Diaphragm contracts, moving downward and Diaphragm contracts, moving downward and causing rib cage, chest cavity, and lungs to expand. Air causing rib cage, chest cavity, and lungs to expand. Air rushes in, due to decrease in internal lung pressure as rushes in, due to decrease in internal lung pressure as lungs expand.lungs expand.

� Exhalation:Exhalation: Diaphragm relaxes, moving upwards and Diaphragm relaxes, moving upwards and causing rib cage, chest cavity, and lungs to contract. Air causing rib cage, chest cavity, and lungs to contract. Air rushes out, due to the increase in internal lung pressure as rushes out, due to the increase in internal lung pressure as lungs contract.lungs contract.

Breathing is controlled by centers in the nervous system to Breathing is controlled by centers in the nervous system to keep up with body’s demands.keep up with body’s demands.









Hemoglobin helps transport COHemoglobin helps transport CO22 and buffer and buffer

bloodbloodHemoglobin is found in red blood cellsHemoglobin is found in red blood cells

Functions:Functions:

Transports oxygenTransports oxygen Transport carbon dioxideTransport carbon dioxide Helps buffer bloodHelps buffer blood

As carbon dioxide is picked up from tissues it is converted As carbon dioxide is picked up from tissues it is converted into carbonic acid:into carbonic acid:

COCO22 + H + H22O <-----> HO <-----> H22COCO33 <----> H <----> H++ + HCO + HCO3 3 --

Carbon Carbon Carbonic acidCarbonic acid Carbonate Carbonate ioniondioxidedioxide

Hemoglobin picks up most H Hemoglobin picks up most H ++ ions, so they don’t acidify the ions, so they don’t acidify the blood.blood.


Hemoglobin Loading and Unloading of Oxygen


Respiratory Acid-Base Balance

Ventilation normally adjusted to keep Ventilation normally adjusted to keep pace with metabolic rate.pace with metabolic rate.

HH22COCO33 produced converted to CO produced converted to CO22, ,

and excreted by the lungs.and excreted by the lungs. HH220 + C00 + C022 H H22C0C033 H H+ + + HC0+ HC033

--


Respiratory Acidosis

Hypoventilation.Hypoventilation. Accumulation of COAccumulation of CO2 2 in the tissues.in the tissues.

pH decreases.pH decreases. Plasma HCOPlasma HCO33

-- increases. increases.

PPc02c02 increases. increases.


Respiratory Alkalosis

Hyperventilation.Hyperventilation. Excessive loss of COExcessive loss of CO22..

pH increases.pH increases. Plasma HCOPlasma HCO33

-- decreases. decreases.

PPc02c02 decreases. decreases.





Diseases of the Respiratory SystemDiseases of the Respiratory System Respiratory rate: 1Respiratory rate: 16 to 206 to 20 inhalations/minute. inhalations/minute.

In one day, an average human:In one day, an average human:

Breathes 20,000 timesBreathes 20,000 times

Inhales 35 pounds of airInhales 35 pounds of air

Most of us breathe in air that is heavily Most of us breathe in air that is heavily

contaminated with solid particles, ozone, sulfur contaminated with solid particles, ozone, sulfur

oxide, carbon monoxide, nitrogen oxides, and many oxide, carbon monoxide, nitrogen oxides, and many

other damaging chemicals.other damaging chemicals.

Breathing contaminated air can cause a number of Breathing contaminated air can cause a number of

diseases including asthma, bronchitis, emphysema, diseases including asthma, bronchitis, emphysema,

and lung cancer.and lung cancer.08/21/16 YunelDocRespiratory 37



Diseases of the Respiratory SystemDiseases of the Respiratory System Respiratory rate: 10 to 14 inhalations/minute.Respiratory rate: 10 to 14 inhalations/minute.

In one day, an average human:In one day, an average human:

Breathes 20,000 timesBreathes 20,000 times

Inhales 35 pounds of airInhales 35 pounds of air

Most of us breathe in air that is heavily Most of us breathe in air that is heavily

contaminated with solid particles, ozone, sulfur contaminated with solid particles, ozone, sulfur

oxide, carbon monoxide, nitrogen oxides, and many oxide, carbon monoxide, nitrogen oxides, and many

other damaging chemicals.other damaging chemicals.

Breathing contaminated air can cause a number of Breathing contaminated air can cause a number of

diseases including asthma, bronchitis, emphysema, diseases including asthma, bronchitis, emphysema,

and lung cancer.and lung cancer.08/21/16 YunelDocRespiratory 40

Diseases of the Respiratory SystemDiseases of the Respiratory System Cigarette smoke is one of the worse air pollutants.Cigarette smoke is one of the worse air pollutants.

Over 1 million people start smoking every year.Over 1 million people start smoking every year. Kills about 350,000 people every year in U.S.Kills about 350,000 people every year in U.S. Contains 4000 different chemicals.Contains 4000 different chemicals. Each cigarette smoked subtracts about 5 Each cigarette smoked subtracts about 5

minutes from life expectancy.minutes from life expectancy. Cigarette smoke Cigarette smoke paralyzes ciliaparalyzes cilia in airways, in airways,

preventing them from removing debris and preventing them from removing debris and from protecting delicate alveoli.from protecting delicate alveoli.

Frequent coughing is the only way airways can Frequent coughing is the only way airways can clean themselves.clean themselves.

Cigarette smoke also causes fetal damage, which Cigarette smoke also causes fetal damage, which can result in miscarriage, premature birth, low can result in miscarriage, premature birth, low birth weight, and poor development.birth weight, and poor development.08/21/16 YunelDocRespiratory 41

Diseases of the Respiratory SystemDiseases of the Respiratory System Asthma:Asthma: Condition in which breathing is Condition in which breathing is

impaired by constriction of bronchi and impaired by constriction of bronchi and bronchioles, cough, and thick mucus bronchioles, cough, and thick mucus secretions. The severity and incidence of secretions. The severity and incidence of asthma has risen dramatically in recent years, asthma has risen dramatically in recent years, especially in children. May be fatal if not especially in children. May be fatal if not treated.treated.Causes:Causes: Attacks may be precipitated by Attacks may be precipitated by inhalation of allergens (e.g.: pollen, cats, and inhalation of allergens (e.g.: pollen, cats, and cockroach proteins), pollutants, infection, or cockroach proteins), pollutants, infection, or emotional stress.emotional stress.Treatment:Treatment: Alleviates symptoms (e.g.: Alleviates symptoms (e.g.: immuno-suppressors, bronchodilators), but is immuno-suppressors, bronchodilators), but is not a cure.not a cure.08/21/16 YunelDocRespiratory 42

Diseases of the Respiratory SystemDiseases of the Respiratory System Bronchitis:Bronchitis: Inflammation of the mucous Inflammation of the mucous

membranes of the bronchi. May present with membranes of the bronchi. May present with cough, fever, chest or back pain, and fatigue.cough, fever, chest or back pain, and fatigue.Causes:Causes: Associated with smoking, pollution, Associated with smoking, pollution, and bacterial or viral infections.and bacterial or viral infections.

Pneumonia:Pneumonia: Acute inflammation of the lungs. Acute inflammation of the lungs. Symptoms include high fever, chills, headache, Symptoms include high fever, chills, headache, cough, and chest pain. cough, and chest pain. Causes: Causes: Bacterial, fungal, or viral infections.Bacterial, fungal, or viral infections.Treatment:Treatment: Antibiotics or other antimicrobials. Antibiotics or other antimicrobials.


Diseases of the Respiratory SystemDiseases of the Respiratory System Emphysema:Emphysema: Permanent and irreversible Permanent and irreversible

destruction of alveolar walls, resulting in loss of destruction of alveolar walls, resulting in loss of lung elasticity and gas exchange surface. lung elasticity and gas exchange surface. Symptoms include shortness of breath, Symptoms include shortness of breath, difficulty exhaling, cough, weakness, anxiety, difficulty exhaling, cough, weakness, anxiety, confusion, heart failure, lung edema (swelling), confusion, heart failure, lung edema (swelling), and respiratory failure.and respiratory failure.Causes:Causes: SmokingSmoking, pollution, old age, and , pollution, old age, and infections.infections.Treatment:Treatment: Oxygen to help breathing. No Oxygen to help breathing. No cure.cure.


Diseases of the Respiratory SystemDiseases of the Respiratory System Lung Cancer:Lung Cancer: Cancerous growth that invades Cancerous growth that invades

and destroys lung tissue. Very high fatality and destroys lung tissue. Very high fatality rate. rate. Symptoms include bloody sputum, persistent Symptoms include bloody sputum, persistent cough, difficulty breathing, chest pain, and cough, difficulty breathing, chest pain, and repeated attacks of bronchitis or pneumonia.repeated attacks of bronchitis or pneumonia.Causes:Causes: Smoking Smoking (50% of all cases) and (50% of all cases) and pollution (radon, asbestos). Smokers are 10 pollution (radon, asbestos). Smokers are 10 times more likely to develop lung cancer than times more likely to develop lung cancer than nonsmokers.nonsmokers.Treatment:Treatment: Surgery is most effective, but only Surgery is most effective, but only 50% of all lung cancers are operable by time of 50% of all lung cancers are operable by time of detection. Other treatments include radiation detection. Other treatments include radiation and chemotherapy.and chemotherapy.08/21/16 YunelDocRespiratory 45


Human Fetus Exchanges Gases with Mother’s Blood through the Placenta




References

Porth, C. M., (2011). Essential of Pathofisiology. 3Porth, C. M., (2011). Essential of Pathofisiology. 3 rdrd Edition. Edition. Lippincott Williams & Wilkins

Saladin, K. S., (2008). Human Anatomy. 2nd Edition. New York McGraw-Hill Companies.

Osborn, K. S., Wraa, C. E., Watson, A. B., and Holleran, R., (2014). Medical Surgical Nursing. Preparation For Practice. 2nd edition., Pearson Education, Inc: NewJersey


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