Chapter 12: Respiratory System

Figure 12-1. Organs of the respiratory system.

Figure 12-2. The larynx from a superior view.

Figure 12-3. Position of the diaphragm during inspiration (inhalation) and expiration (exhalation).

Figure 12-4. Pathway of air from the nose to the capillaries of the lungs.

Figure 12-5. Bronchioles, alveoli, and blood vessels that surround the alveoli. Exchange of gases takes place as carbon dioxide leaves the capillaries to enter the alveoli and oxygen enters the capillaries from the alveoli.

Figure 12-6. Pulmonary resections Figure 12-6. Pulmonary resections. (A) Wedge resection is the removal of a small, localized area of diseased tissue near the surface of the lung. Pulmonary function and structure are relatively unchanged after healing. (B) Segmental resection is the removal of a bronchiole and its alveoli (one or more lung segments). The remaining lung tissue expands to fill the previously occupied space. (C) Lobectomy is the removal of an entire lobe of the lung. Following lobectomy, the remaining lung increases in size to fill the space in the thoracic cavity. (D) Pneumonectomy is the removal of an entire lung. Techniques (removal of ribs and elevation of the diaphragm) are used to reduce the size of the empty thoracic space.

Figure 12-7. Pneumothorax. Air gathers in the pleural cavity Figure 12-7. Pneumothorax. Air gathers in the pleural cavity. This condition can (A) occur with lung disease or (B) follow trauma to and perforation of (a hole through) the chest wall.

Figure 12-8. Two forms of atelectasis Figure 12-8. Two forms of atelectasis. (A) An obstruction prevents air from reaching distal airways, and alveoli collapse. The most frequent cause is blockage of a bronchus by a mucous or mucopurulent (pus-filled) plug, as might occur postoperatively. (B) Accumulations of fluid, blood, or air within the pleural cavity collapse the lung. This can occur with congestive heart failure (poor circulation leads to fluid build up in the pleural cavity) or because of leakage of air caused by a pneumothorax.

Figure 12-9. This man is sleeping with a nasal CPAP (continuous positive airway pressure) mask in place. The pressure supplied by air coming from the compressor opens the oropharynx and nasopharynx. (From Lewis SM, Heitkemper MM, Dirksen SR: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 5th ed. St. Louis, Mosby, 2000, p. 590.)

Figure 12-10. Bronchogenic carcinoma Figure 12-10. Bronchogenic carcinoma. The gray-white tumor tissue is infiltrating the substance of the lung. This tumor was identified as a squamous cell carcinoma. Squamous cell carcinomas arise in major bronchi and spread to local hilar lymph nodes. (From Kumar V, Cotran RS, Robbins SL: Basic Pathology, 7th ed. Philadelphia, WB Saunders, 2003, p. 501.)

Figure 12-11. A normal chest x-ray taken from the posteroanterior (PA) view. The backwards L in the upper corner is placed on the film to indicate the left side of the patient's chest. (A) diaphragm; (B) costophrenic angle; (C) left ventricle; (D) right atrium; (E) aortic arch; (F) superior vena cava; (G) trachea; (H) right bronchus; (I) left bronchus; (J) breast shadows. (From Black JM, Hawks JH, Keene AM: Medical-Surgical Nursing: Clinical Management for Positive Outcomes, 6th ed. Philadelphia, WB Saunders, 2001, p. 1644.)

Figure 12-12. MRI of the upper chest, transverse (axial) view Figure 12-12. MRI of the upper chest, transverse (axial) view. Notice the lungs (L) fat (F) and vessels (V). A hilar tumor (arrow) is easily identified. (From Ballinger PW, Frank ED: Merrill's Atlas of Radiographic Positions and Radiologic Procedures, 10th ed. vol 3. St. Louis, Mosby, 2003, p. 388.)

Figure 12-13. (A) Fiberoptic bronchoscopy Figure 12-13. (A) Fiberoptic bronchoscopy. A bronchoscope is passed through the nose, throat, larynx, and trachea into a bronchus. (B) A bronchoscope, with brush catheter, in place in a bronchial tube.

Figure 12-14. Endotracheal intubation Figure 12-14. Endotracheal intubation. The patient is in a supine position; the head is hyperextended, the lower portion of the neck is flexed, and the mouth is opened. A laryngoscope is used to hold the airway open, to expose the vocal cords, and as a guide for placing the ET tube into the trachea.

Figure 12-15. Thoracentesis Figure 12-15. Thoracentesis. (A) The patient is sitting in the correct position for the procedure; it allows the chest wall to be pulled outward in an expanded position. (B) The needle is inserted close to the base of the effusion so the gravity can help with drainage but it is kept as far away from the diaphragm as possible.

Figure 12-16. (A) Tracheostomy with tube in place Figure 12-16. (A) Tracheostomy with tube in place. (B) Healed tracheostomy incision after laryngectomy. (B from Black JM, Hawks JH, Keene AM: Medical-Surgical Nursing: Clinical Management for Positive Outcomes, 6th ed. Philadelphia, WB Saunders, 2001, p. 1672.)