Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 Adult Health Nursing R.S: part 1. second years student Nursing Collage Iman Al Shaweesh Sept. 2008 Al Najah Univesity.

Similar presentations


Presentation on theme: "1 Adult Health Nursing R.S: part 1. second years student Nursing Collage Iman Al Shaweesh Sept. 2008 Al Najah Univesity."— Presentation transcript:

1 1 Adult Health Nursing R.S: part 1. second years student Nursing Collage Iman Al Shaweesh Sept Al Najah Univesity

2 2 Anatomy & physiology overview Upper & lower respiratory responsible for ventilation (movement of air in and out of the airways). Upper & lower respiratory responsible for ventilation (movement of air in and out of the airways). Upper tract, upper airway, warms & filtrates inspired air so lower (lungs). Can accomplish gas exchange. Upper tract, upper airway, warms & filtrates inspired air so lower (lungs). Can accomplish gas exchange. Upper respiratory tract: consist of nose, sinuses, nasal passage, pharynx, tonsils adenoid, larynx, trachea. Upper respiratory tract: consist of nose, sinuses, nasal passage, pharynx, tonsils adenoid, larynx, trachea.

3 3

4 4 1-Nose Composed of external & eternal portion serves as a passageway for airway to pass to and from the lungs. (filter & humidifiers). Composed of external & eternal portion serves as a passageway for airway to pass to and from the lungs. (filter & humidifiers). Responsible for olfaction. Because olfactory receptor are located in the nasal mucosa. Responsible for olfaction. Because olfactory receptor are located in the nasal mucosa. 2-Paranasal sinuses: four pairs of bony cavity, names by their location. Frontal, ethmoidal, sphenoidal & maxillary. 2-Paranasal sinuses: four pairs of bony cavity, names by their location. Frontal, ethmoidal, sphenoidal & maxillary. Common site for infection Common site for infection

5 5 P rominent function to serve as resonating chamber in speech.

6 6 3-Pharynx, tonsils & adenoids Tube like structure that connect the nasal & oral cavities to the larynx Tube like structure that connect the nasal & oral cavities to the larynx They are located in the roof of nasopharynx. They are located in the roof of nasopharynx. They are important links in the chain of the lymphodes guarding the body from invasion by organism. They are important links in the chain of the lymphodes guarding the body from invasion by organism.

7 7 4- larynx Is avice organ, connect the pharynx & trachea. Is avice organ, connect the pharynx & trachea. Major function vocalization. Major function vocalization. Protect the airway from foreign substance & facilitate coughing. Protect the airway from foreign substance & facilitate coughing. Voice box consist of (epiglottis, glottis, thyroid, cartilage, vocal cord, cricoid areytenoid cartilage). Voice box consist of (epiglottis, glottis, thyroid, cartilage, vocal cord, cricoid areytenoid cartilage).

8 8 5- trachea or windpipe Composed of smooth muscle with C shaped, ring of cartilage at regular interval. Composed of smooth muscle with C shaped, ring of cartilage at regular interval. Cartilaginous ring are incomplete on posterior & give firmness to wall of trachea. Cartilaginous ring are incomplete on posterior & give firmness to wall of trachea. Prevent from collapse. Prevent from collapse.

9 9 Anatomy of lower respiratory tract (lungs). Are paired elastic structure. Ventilation requires movement of the walls of the thoracic cage & of its floor, increase capacity of chest increased air enters through trachea. Inspiratory phase require energy. It occur during 1st third of the respiratory cycle, expiratory during the latter two thirds. Are paired elastic structure. Ventilation requires movement of the walls of the thoracic cage & of its floor, increase capacity of chest increased air enters through trachea. Inspiratory phase require energy. It occur during 1st third of the respiratory cycle, expiratory during the latter two thirds.

10 10

11 11 1- Pleura Lung & wall of thorax are lined with serous membrane called pluera. Lung & wall of thorax are lined with serous membrane called pluera. Visceral pluera cover the lung. Visceral pluera cover the lung. Parietal pleura lines thorax, they serve to lubricate the thorax, lungs and permit smooth motion of the lungs within thoracic cavity with each breath. Parietal pleura lines thorax, they serve to lubricate the thorax, lungs and permit smooth motion of the lungs within thoracic cavity with each breath.

12 12 2- lobes Lt lung (upper & lower lob). Lt lung (upper & lower lob). Rt lung (upper, middle, lower lob). Rt lung (upper, middle, lower lob). Each lob subdivided into two or five segments separated by fissures. Each lob subdivided into two or five segments separated by fissures. 3- bronchi & bronchioles 3- bronchi & bronchioles  Lobar bronchi (3 in Rt., 2 IN Lt).  Lobar bronchi divided into segmental bronchi(10 in Rt, 8in Lt).

13 13  Then segmented divided to sub segmental surrounded by connective tissue that contains arteries, lymphatic, nerves.  Bronchioles contain submucosal glands which produce mucus that cover the inside lining of the airways.  Conducting airway contain about 150 ml of air in tracheobroncheal tree that doesn’t participate in gas exchange, this known as (physiologic dead space) (physiologic dead space)

14 14 Respiratory bronchi then lead to into alveolar ducts, alveolar sacs & alveali.O2&CO2 exchange takes place in the alveoli. Respiratory bronchi then lead to into alveolar ducts, alveolar sacs & alveali.O2&CO2 exchange takes place in the alveoli. 4-Alveoli 4-Alveoli 300 million alveoli, arrange in clusters of Their surface 70 m2 300 million alveoli, arrange in clusters of Their surface 70 m2 3 type of alveoli: 3 type of alveoli:

15 15 1- I alveolar cell are epithelial cells that form alveolar wall. 1- I alveolar cell are epithelial cells that form alveolar wall. 2- II alveoli, metabolically active that secrete surfactant that prevent collapse 2- II alveoli, metabolically active that secrete surfactant that prevent collapse 3- III alveolar cell macrophages are large phagocytic cells that ingest foreign matter. 3- III alveolar cell macrophages are large phagocytic cells that ingest foreign matter.

16 16

17 17

18 18 Function of respiratory system Certain vital tissues as those of brain &heart cant survive for long without containing supply O2. Certain vital tissues as those of brain &heart cant survive for long without containing supply O2. Cell of body derive energy they need from oxidation of CHO, fats, protein, for process require O2. Cell of body derive energy they need from oxidation of CHO, fats, protein, for process require O2. Respiratory system performs this function by facilitating life sustaining process as O2 transplant, respiration & ventilation, gas exchange. Respiratory system performs this function by facilitating life sustaining process as O2 transplant, respiration & ventilation, gas exchange.

19 19 O2 Transplant O2 supplied & CO2 is removed from cells by way of circulating blood. O2 supplied & CO2 is removed from cells by way of circulating blood. Cell are in close contact with capillaries whose thin wall permit easy exchange of o2&co2. Cell are in close contact with capillaries whose thin wall permit easy exchange of o2&co2. O2 diffuses from capillary wall to interstitial fluid, at this point it diffuses through the membrane of tissue cells O2 diffuses from capillary wall to interstitial fluid, at this point it diffuses through the membrane of tissue cells The movement of CO2 occurs by diffusion in the opposite direction, from cell to blood. The movement of CO2 occurs by diffusion in the opposite direction, from cell to blood.

20 20 2- respiration After tissue capillary exchange, blood enters the systemic vein & travel to pulmonary circulation. After tissue capillary exchange, blood enters the systemic vein & travel to pulmonary circulation. Co2 in lower in low than lungs air sacs. (alveoli). Because of that o2 diffuse from alveoli to blood & co2 from blood to alveoli. \(higher to lower concentration). Co2 in lower in low than lungs air sacs. (alveoli). Because of that o2 diffuse from alveoli to blood & co2 from blood to alveoli. \(higher to lower concentration). The whole process of gas exchange between atmospheric air & blood, blood & cell of body is called respiration. The whole process of gas exchange between atmospheric air & blood, blood & cell of body is called respiration.

21 21 3- ventilation Mechanism of ventilation, is physical factors that govern air flow in & out of the lungs, include: Mechanism of ventilation, is physical factors that govern air flow in & out of the lungs, include: A. Air pressure variances: during respiration movement of diaphragm & muscle of respiration enlarges the thoracic cavity & lower pressure inside the thorax to level below of atmospheric pressure. During expiration diaphragm relax, lung recoil result in decrease thoracic cavity.

22 22 Alveolar pressure the exceeds atmospheric pressure & air slows from lungs into the atmosphere. Alveolar pressure the exceeds atmospheric pressure & air slows from lungs into the atmosphere. B. Air resistance: is determine chiefly by the size of the airway through which the air is flowing any process that changes the bronchial diameter or width effect airway resistance. C. Compliance: is a measure of the elasticity, expandability & dispensability of the lungs & thoracic structures.

23 23  Factors that determine lungs & thoracic structure Surface tension of alveoli (normally low), connective tissue (collagen & elastin). Surface tension of alveoli (normally low), connective tissue (collagen & elastin).  Compliance determined by examining volume pressure relationship in lungs& thorax, normal 1L/cmHo2.  Increase compliance occur when lung loss elasticity, thorax over distended e.g. emphysema.  Decrease compliance, lung & thorax stiff (e.g. hemothorax, pneumothorax, atelactasis, pulmonary edema, RDS)

24 24 Lung volume & capacities  Lung function reflect mechanism of ventilation is viewed as lung volume &capacities.  Categorizes as: tidal volume, respiratory reserve volume, residual volume, expiratory reserve volume.  Capacity is evaluated in terms of: vital capacity, respiratory capacity, functional residual capacity, total lung capacities.  Diffusion: is the process by which O2 & CO2 are exchange at the air-blood interfere.

25 25  Pulmonary effusion: is the actual blood flow through the pulmonary circulation. (filling of pulmonary capillaries with blood).  Blood pump into the lungs by Rt ventricle, pulmonary artery, divided Rt, Lt branches to supply both lung, divided further to supply all parts of lungs.  Normally 2% of blood pumped by Rt ventricle doesn’t perfuse the alveolar capillaries, this shunted blood drain to Lt side of the heart.

26 26  Pulmonary circulation is considered low pressure systemic, systolic pressure in pulmonary 20-30mmHg, diastolic  When person lying down turns to one side more blood flow & pass to dependent lung.  If person up right, upper part of lung of poor supply blood, lower with maximal blood supply.  Perfusion influence by alveolar pressure.

27 27 Ventilation & Perfusion balance. V/P. Ventilation: flow of gas in & out of the lung. Ventilation: flow of gas in & out of the lung. Perfusion: filling of pulmonary capillaries with blood. Perfusion: filling of pulmonary capillaries with blood. Imbalance occur from inadequate V/P or both, this cause shunting of blood resulting in hypoxemia (low cellular O2 level). Imbalance occur from inadequate V/P or both, this cause shunting of blood resulting in hypoxemia (low cellular O2 level).  Gas exchange: Breath 78.62% nitrogen, 20.84% O2,.04% CO2, WATER VAPOR.05%, helium, argon, atmospheric pressure 760mmHg. Breath 78.62% nitrogen, 20.84% O2,.04% CO2, WATER VAPOR.05%, helium, argon, atmospheric pressure 760mmHg.

28 28  Arterial pressure of gases: O2 21% of 760=160mmHG.  Once air enters the trachea, become fully saturated with water vapor, which displace some of the gases so air pressure within lung remain equal, the air pressure out side 760mmHg.

29 29 Effects of pressure on O2 therapy  O²  carried in the blood in two form: 1- physically dissolve O2 in plasma. 1- physically dissolve O2 in plasma. 2- combination with Hg of RBC. 2- combination with Hg of RBC.  100ml of blood carries 0.3ml O2 physically & 20ml o2 combination with hemoglobin.  The higher Pao2 (partial pressure of alveolar O2) the greater amount of O2 dissolved. e.g. if Pao2 10mmHg……..0.3mlo2 dissolve in 100 ml of plasma. e.g. if Pao2 10mmHg……..0.3mlo2 dissolve in 100 ml of plasma. at Pao2 10mmHg…….10 times of this amount dissolve at Pao2 10mmHg…….10 times of this amount dissolve

30 30 Hemoglobin Dissociation Curve Show relation between Pao2 & Sao2. Show relation between Pao2 & Sao2. Sao2 can be affected by following factors: Sao2 can be affected by following factors: Co2, hydrogen ion concentration, temp,diphosphoglycenate. Co2, hydrogen ion concentration, temp,diphosphoglycenate.  these factors shifts occur to Rt so more o2 released to tissue at same Pao2.  These factors, curve to the Lt, making bond between o2 & hemoglobin stronger, so less os to tissue at same Pao2.

31 31 Oxyhemoglobin dissociation curve is marked to show 3 o2 level. 1- normal level Pao2 more 70mmHG. 1- normal level Pao2 more 70mmHG. 2- relative safe levels, 45-70mmHg. 2- relative safe levels, 45-70mmHg. 3- dangerous levels below 40mmHg. 3- dangerous levels below 40mmHg. Clinical significant: Clinical significant: Pao mg. (95-98%). Pao mg. (95-98%). Hg 15ml/dl- Pao2 40mmHG, (75%). Hg 15ml/dl- Pao2 40mmHG, (75%). Cardiac out put (5L/m), if C.O decrease amount of o2 delivered to the tissues also falls. Cardiac out put (5L/m), if C.O decrease amount of o2 delivered to the tissues also falls. Only 250ml of o2 used/mint. The rest return to the Rt side of the heart. Only 250ml of o2 used/mint. The rest return to the Rt side of the heart.

32 32 CO2 Transport O2 diffuse from blood to tissue, co2 diffuse in opposite direction. O2 diffuse from blood to tissue, co2 diffuse in opposite direction. One of major determinants of acid-base balance of the body, normally 6% of venous co2 removed. One of major determinants of acid-base balance of the body, normally 6% of venous co2 removed.

33 33 Neurological control of ventilation Rhythm of breathing is controlled by respiration centers in the brain. Medulla oblongata & pons control the rate & depth of ventilation to meet body metabolic demands. Rhythm of breathing is controlled by respiration centers in the brain. Medulla oblongata & pons control the rate & depth of ventilation to meet body metabolic demands. The apneustic center in lower pons stimulates the inspiratory medullary center to promote deep prolong inspiration. The apneustic center in lower pons stimulates the inspiratory medullary center to promote deep prolong inspiration. The pneumothax center in upper pons is thought to control pattern of respiration. The pneumothax center in upper pons is thought to control pattern of respiration.

34 34 Hering- breuner reflex is activated by stretch receptors in the alveoli, when the lung are distended, inspiration inhibited as a result lung don’t become over distended. Hering- breuner reflex is activated by stretch receptors in the alveoli, when the lung are distended, inspiration inhibited as a result lung don’t become over distended.

35 35 Gerentologic consideration: Vital capacity of lung & respiratory muscles strength peak between & decrease with 40,&  changes occur in the alveoli that decrease surface area available for exchange of O2 & CO. Vital capacity of lung & respiratory muscles strength peak between & decrease with 40,&  changes occur in the alveoli that decrease surface area available for exchange of O2 & CO.

36 36 50 years alveoli begin to lose its elasticity that decrease chest wall  restrict air flow & amount of respiration,  dead space 50 years alveoli begin to lose its elasticity that decrease chest wall  restrict air flow & amount of respiration,  dead space With age. With age.  diffusion capacity forO2 with age.  diffusion capacity forO2 with age.


Download ppt "1 Adult Health Nursing R.S: part 1. second years student Nursing Collage Iman Al Shaweesh Sept. 2008 Al Najah Univesity."

Similar presentations


Ads by Google