Anatomy and physiology of the respiratory system

It consists of the following parts of the breathing apparatus:

Nose: located at the entrance of the respiratory system and is divided into internal and external.
Pharynx (throat): tube of approximately 13 cm, which begins in the internal nares up to the cricoid
cartilage and is divided into 3: nasopharynx, oropharynx and laryngopharynx.
Larynx or sounding box: short tube that connects the laryngopharynx with the trachea. It is located in
the midline of the neck in front of the esophagus and between C4-C6.
Trachea: tube that measures approximately 12 cm and 2.5 cm, is located in front of the esophagus
and extends from the larynx to the upper border of T5 and divides the left and right bronchi.
Layers: mucosa, subucosa, cartilage, hyaline and adventitia.
Right main bronchus: it is more vertical, shorter and wider than the left.
Main, secondary (lobar), segmental (tertiary) bronchi, bronchioles and terminal bronchioles. The
lungs are a pair of spongy-textured organs located in the chest cavity. The right lung is larger than the
left and is composed of 3 lobes (superior, middle and inferior), which are divided by two fissures: the
oblique fissure and the horizontal fissure. The left lung has only two lobes (upper and lower), divided
by an oblique fissure. Each lung has 3 surfaces, an apex and a base. The surfaces of the lungs are:
costal, medial or mediastinal, and diaphragmatic surface; which receive their name according to the
anatomical structure adjacent to them. The mediastinal surface connects the lung to the mediastinum
by means of its hilum. The apex of the lung is the site where the mediastinal and costal surfaces
converge. The apex is the uppermost portion of the lung, extending even to the place where the neck
originates. The base has a concave appearance and is the lowest part of the lung where it lies on the
diaphragm.Each pulmonary hilum contains the following structures: main bronchus, pulmonary artery,
two pulmonary veins, bronchial vessels, pulmonary autonomic plexus, and lymph nodes and vessels.
The pulmonary alveolus is a sac approximately 0.2 to 0.5 mm in diameter. These alveoli are located
at the end of the pulmonary airways. Sometimes the structure of the alveoli is compared to that of a
raspberry or a bunch of grapes. In an average adult, each lung has approximately 480 million alveoli
(range 274-790 million, coefficient of variation: 37%, also the number varies according to the total
lung volume of each individual), with a combined internal surface area of approximately 75 square
meters, more or less the dimensions of a tennis court. Each alveolus is in turn surrounded by a
network of blood capillaries from small branches of the pulmonary artery.

The breathing
Pulmonary ventilation: breathing, which produces the exchange of air from the atmosphere between
the alveoli
External (pulmonary) respiration: exchange of gases between the blood of the systemic and
pulmonary capillaries, through the respiratory membrane Obtaining O2 and losing CO2
Internal (tissue) respiration: gas exchange between blood in systemic capillaries and tissue cells. The
blood loses O2 and acquires CO2

Respiratory pathophysiology
A type of disease that affects the lungs and other parts of the respiratory system. Respiratory
diseases are caused by infections, tobacco use or inhalation of secondhand smoke, and exposure to
radon, asbestos, or other forms of air pollution. Respiratory diseases include asthma, chronic
obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumonia, and lung cancer. Also called
lung disease and lung disorder.
 Respiratory insufficiency
Respiratory failure is a condition in which your blood does not have enough oxygen or has too much
carbon dioxide. Illnesses that affect your breathing can cause respiratory failure. These can affect the
muscles, nerves, bones, or tissues that have to do with breathing. Or they can directly affect the
lungs. These conditions include: diseases that affect the lungs, such as chronic obstructive
pulmonary disease (COPD), cystic fibrosis, pneumonia, pulmonary embolism, and COVID-19,
conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral
sclerosis, muscular dystrophy, spinal cord injury and stroke, problems with the spine, such as
scoliosis (a curvature of the spine). They can affect the bones and muscles used for breathing,
damage the tissues and ribs around the lungs. An injury to the chest can cause this problem, drug or
alcohol overdose, and inhalation injuries, such as inhalation of smoke (from fires) or noxious gases.

Physical and functional examination of the respiratory system

A complete lung examination consists of
Inspection should focus on signs of respiratory distress and hypoxemia (eg, restlessness,
tachypnea, cyanosis, accessory muscle use), signs of possible chronic lung disease (eg, digital
clubbing, edema of the feet), chest wall deformities, abnormal respiratory patterns (eg, prolonged
expiratory time, Cheyne-Stokes respirations, Kussmaul respirations), and jugular vein distension.
Auscultation All fields of the chest, including the lateral and anterior fields, should be auscultated to
detect abnormalities associated with each lobe of the lung. Features to be auscultated are type and
volume of breath sounds, presence or absence of vocal sounds, and pleural friction rubs.
Percussion is the main physical maneuver used to detect the presence and level of pleural effusion.
Finding areas of dullness during percussion indicates underlying fluid or, less frequently,
consolidation.
Palpation includes tactile thrill (vibration of the chest wall felt when the patient speaks); it decreases
in cases of pleural effusion and pneumothorax and increases in pulmonary consolidation (eg, lobar
pneumonias). Patients with lung disease should have a complete physical examination, including
examination of the lymph nodes, skin, and musculoskeletal system.
Pulmonary function tests, also called pulmonary function tests or pulmonary function tests, are a
group of tests that assess how well the lungs are working. Tests look at: the capacity of the lungs
(how much air it can hold), how well air moves in and out of the lungs, and how well oxygen gets from
the lungs into the bloodstream. Blood cells need oxygen to grow and stay healthy. There are several
types of lung function tests, for example: Spirometry: The most common type of lung function test. It
measures how much air you can move to and from your lungs and how fast you can move it. Lung
Volume Test: Also known as body plethysmography. Measures the air capacity of the lungs and the
amount of air that remains after breathing out (exhaling) as much as possible, Gas Diffusion Test:
Measures how well oxygen and other gases pass from the lungs into the bloodstream and Exercise
Stress Test: Analyzes the effect of exercise on lung function
Pulmonary function tests are often used to: Find the cause of respiratory problems Diagnose and
monitor chronic lung diseases such as asthma, COPD, and emphysema Check if treatment for a lung
disease is working Check function lung before an operation and check whether exposure to
chemicals or other substances in the home or workplace has caused lung damage

Acute processes of the upper respiratory tract

The upper respiratory tract (upper respiratory system) includes the nasal fossa, sinuses, pharynx,
and the portion of the larynx that lies superior to the vocal cords. Through the process of breathing.
This process is possible thanks to the inhalation of air and its conduction towards the lungs, where
gas exchange occurs. During gas exchange, oxygen enters our blood and is exchanged for carbon
dioxide, which leaves our body during exhalation. The upper respiratory tract begins in the nasal
cavity, which opens anteriorly into the face through its two nostrils, and posteriorly into the
nasopharynx through its choanae. The nasal cavity is made up of several bones that contain air
spaces called "sinuses." The paranasal sinuses are named after the bones with which they are
associated: maxillary, frontal, sphenoid, and ethmoid.

COPD: chronic bronchitis

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes
obstruction of airflow from the lungs.
Chronic bronchitis is inflammation of the lining of the bronchi, which carry air to and from the air sacs
(alveoli) of the lungs. It is characterized by daily coughing and the production of mucus (sputum).
Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) in
the lungs are destroyed as a result of harmful exposure to cigarette smoke and other irritating gases
and particles.
Signs and symptoms of chronic obstructive pulmonary disease may include: shortness of breath,
especially during physical activity, wheezing, chest tightness, a chronic cough that may produce
mucus (sputum) that may be clear, white, yellow, or greenish, frequent respiratory infections, lack of
energy, unintentional weight loss (in later stages) and swelling in ankles, feet or legs. The causes are
the following exposures to tobacco by smoking or by passive exposure to other people's smoke;
occupational exposure to dust, fumes, or chemicals; events in fetal life and the first few years of life,
such as intrauterine growth retardation, prematurity, and frequent or severe respiratory infections in
childhood, which prevent the lungs from fully developing; childhood asthma, and alpha-1 antitrypsin,
a rare congenital disease that can lead to COPD at a young age
COPD is not curable, but it can get better if you don't smoke, avoid air pollution, and get vaccinated.
It can be treated with medication, oxygen, and pulmonary rehabilitation. The main treatment is
inhaled medications that dilate the airways and reduce inflammation. The most important drugs
against COPD are bronchodilator inhalers that relax the airways to keep them open, their short action
begins to work in seconds and their effect can last from 4 to 6 hours. They are usually used during
exacerbations and their long action takes longer to start working, but their effect is longer lasting.
They are taken daily and can be combined with inhaled corticosteroids.
There are other treatments as well: corticosteroid and antibiotic tablets, to treat exacerbations,
oxygen, in people who have had long-term COPD or with severe COPD, pulmonary rehabilitation
teaches techniques to improve breathing and the ability to exercise, and surgery can improve
symptoms in people with severe COPD.

Bronchial asthma
It is a respiratory disease, characterized by chronic inflammation of the airways (bronchial tubes),
which causes recurrent episodes of shortness of breath (dyspnea), wheezing in the chest (wheezing),
coughing, and a feeling of tightness in the chest.Signs and symptoms of asthma include: shortness of
breath, chest pain or tightness, wheezing, which is a common sign of asthma in children, sleep
problems caused by shortness of breath, coughing or wheezing, and coughing or wheezing that is
made worse by a respiratory virus, such as a cold or flu.
Nursing care is as follows to check the frequency, rhythm and depth of respirations. Observe if there
are possible allergies, interactions and contraindications regarding the medications, administer the
medication with the appropriate technique and routes and observe the therapeutic effects of the
medication in the patient.
Treatment consists of self-care and bronchodilators. Asthma is usually treated with rescue inhalers to
attack symptoms and controller inhalers (steroids) that prevent symptoms. More severe cases may
require long-acting inhalers.

Atelectasis
Atelectasis is a complete or partial collapse of the entire lung or part (lobe) of the lung. It occurs when
the small air sacs (alveoli) that make up the lungs deflate or possibly fill with fluid. There are two
different causes
Obstructive when the airways are blocked, either by mucus, foreign bodies or the presence of a
tumor and non-obstructive when the lung is subjected to greater pressure, caused by trauma,
pneumonia, tumors, pleural effusions, pneumothorax and other conditions pulmonary.
Nursing care is the following bed rest in high decubitus; maintain a clean and airy environment;
promote oral and body hygiene; exchange client and bed linen whenever necessary; offer
hypercaloric and liquid-rich diet.
Treatments include one or more of the following: patting (percussion) the chest to loosen mucus
plugs in the airway. Perform deep breathing exercises (with the aid of incentive spirometry devices),
remove or relieve any obstruction in the airway by bronchoscopy, tilt the person so that the head is
lower than the chest (called postural drainage). This allows mucus to drain more easily, treat a tumor
or other condition, turn the person over so they are lying on the healthy side, allowing the collapsed
area of the lung to expand again, use inhaled medications to open the airway, use other devices that
help increase positive airway pressure and remove fluid and, if possible, be physically active.

Bronchiectasis
Bronchiectasis is a disease that occurs when the tubes that carry air in and out of the lungs are
damaged, causing them to become wide and loose and scarred. Bronchiectasis can be caused by a
previous lung disease (pneumonia, tuberculosis, radiotherapy), be associated with chronic respiratory
diseases (COPD, asthma, bronchial stenosis) or even general diseases such as cystic fibrosis,
immunodeficiencies or inflammatory bowel disease. It is usually treated with medication, hydration,
and chest physiotherapy (CPT). Your doctor may recommend surgery if the bronchiectasis is isolated
to one section of the lung or if there is a lot of bleeding.
Nursing care is as follows: An important objective of the nurse is to promote drainage and elimination
of bronchial mucus. Teaching the patient to practice effective deep breathing and coughing exercises,
respiratory physiotherapy with postural drainage of the affected parts is recommended. Some
patients require elevation of the foot of the bed by 10-12 cm to facilitate drainage. The pillows are
used in the hospital and at home to help the patient adopt the appropriate drainage postures, the use
of mucus clearance devices, such as the flutter: it is a manual device that vibrates the airway during
the phase expiratory breathing and positive expiratory pressure (PEP) therapy consists of a
respiratory maneuver that is carried out against expiratory resistance and is often used in conjunction
with nebulized medication.

Pneumonias
It is inflammation of the lungs caused by bacteria, viruses, or chemical irritants. It is a serious
infection or inflammation in which the air sacs fill with pus and other fluids.
types of pneumonia
Pneumonia lobular It affects one or more sections (lobes) of the lungs.
Bronchial pneumonia (or bronchopneumonia). It affects areas of both lungs.
Bacterial pneumonia. Caused by different bacteria. Streptococcus pneumoniae is the bacterium that
most frequently causes bacterial pneumonia. Some symptoms are a productive cough (with mucus),
chest pain, vomiting or diarrhea, decreased appetite, fatigue and fever.
viral pneumonia. Caused by different viruses, including: respiratory syncytial virus (most common in
children under 5 years of age), parainfluenza virus, influenza (flu) virus, and adenovirus.
Mycoplasma pneumonia. It has somewhat different symptoms and physical signs than the other
types of pneumonia. They usually cause mild, generalized pneumonia that affects people of all ages,
but more cases occur in children older than 5 years.
They usually don't start out like a cold, and symptoms can include: fever and cough at first, persistent
cough, which can last three to four weeks, and severe cough that can produce phlegm.
Nursing care must be provided as follows: administration of medication, fluids, control of vital signs,
adequate diet, respiratory therapy and supplemental oxygen support.
Treatment consists of antibiotics that can treat various types of pneumonia and some can be
prevented by vaccinations.

Tuberculosis pleuropulmonary
It is considered the most common form of extrapulmonary tuberculosis and affects approximately
20% of patients diagnosed with tuberculosis. It can appear as an isolated manifestation or associated
with pulmonary tuberculosis, generally affecting a hemithorax. It can provoke empyema, i.e.
accumulation of purulent discharge in the pleural cavity. The diagnosis is suspected by the symptoms
and imaging tests such as X-ray and magnetic resonance imaging of the chest, the diagnosis of
certainty requires making an incision in the chest (thoracentesis) and obtaining a sample of the
pleural fluid in which a compound exudate can be seen. mainly lymphocytes with low glucose levels,
later a culture is performed to check the growth of Mycobacterium tuberculosis, the causative agent
of the disease. The symptoms initially may not be very striking and consist of pain similar to a
sensation of pricking in the chest that can radiate to the lumbar region and persists for days or weeks
with periods of exacerbation. When massive pleural effusion occurs, the sensation of shortness of
breath (dyspnea) appears, which increases with physical activity. There may be a dry cough, fever,
malaise, weight loss, and anorexia.

Diseases due to exposure to organic dust

• Byssinosis: Inhalation of cotton dust (production of cotton or other textile fibers). Symptoms may
include any of the following: chest tightness, coughing, wheezing, and shortness of breath.
Symptoms are worse at the beginning of the work week and improve later in the week. The
symptoms are also less severe when the person is away from the workplace.
The most important treatment is to stop exposure to dust. Reducing dust levels within the factory (by
improving machinery or ventilation) will help prevent byssinosis. Some people may need to change
jobs to avoid future exposures. Medications used for asthma, such as bronchodilators, usually
improve symptoms. In the most severe cases, corticosteroids may be prescribed. It is very important
that people with this condition stop smoking. Respiratory treatments, including nebulizers, may be
prescribed if the condition becomes prolonged. Home oxygen therapy may be necessary if blood
oxygen levels are low. Exercise programs, breathing exercises, and patient education programs are
often helpful for people who have had lung disease due to long time (chronic).
• BAGASSOSIS: Inhalation of dust residue from sugar cane. People with bagasse disease may
develop flu-like symptoms after periods of exposure to bagasse. These symptoms include: slight
fever, shortness of breath, wheezing, rhinitis, eye irritation, asthma, dry cough, and chills.
Treatment to avoid bagasse disease is to avoid being in contact with sugarcane bagasse since the
symptoms usually disappear after a few days if exposure to it is avoided. In some cases,
corticosteroids can be administered to alleviate the symptoms. If working in an industrial environment
with bagasse, it is advisable to: wear a protective mask, adequate ventilation of the work area, apply
antifungal products (propionic acid) to the bagasse and avoid exposing the bagasse to heat and
humidity.
• HYPERSENSITIVITY PNEUMONITIS (allergy): Inhalation of fungal spores Symptoms after acute
exposure may include: chills, cough, fever, malaise (feeling sick), shortness of breath. Symptoms of
chronic hypersensitivity pneumonitis may include: respiratory failure, especially with activity, cough,
often dry, loss of appetite, and involuntary weight loss.
• OCCUPATIONAL ASTHMA: Inhalation of irritating products (dust, gases, fumes, vapors). The
symptoms usually occur shortly after being exposed to the substance. Symptoms often improve or go
away when you leave work. Some people may not have symptoms for 12 or more hours after being
exposed to the trigger. Symptoms include: cough, shortness of breath, tightness in the chest, and
wheezing.

Pulmonary embolism
A pulmonary embolism is caused by a blood clot that blocks and stops the flow of blood to an artery
in the lungs. In most cases, the blood clot starts in a deep vein in the leg and travels to the lung.
Common symptoms include the following: Shortness of breath, chest pain, fainting, cough possibly
accompanied by bloody or blood-streaked mucus, fast or irregular heartbeat, feeling light-headed or
dizzy, hyperhidrosis, fever, pain or swelling in the leg, or both, usually behind the lower leg and moist
or discolored skin (cyanosis).

Pulmonary infarction
It occurs when there is an abrupt cessation of blood flow, due to the obstruction of an artery that
supplies the lung parenchyma. The obstruction causes ischemic-like necrosis of the tissue. The lung,
being a tissue with extensive vascularization, is infrequently infarcted in normal people. In general,
pulmonary infarction is preceded by pulmonary thromboembolism, although there are other causes
such as: post-surgical patients (mainly those who suffered a fracture of hip), heart disease patients,
respiratory disease patients, cancer patients, long-term bedridden patients, and infections.
There are no specific symptoms for pulmonary infarction. There are symptoms that point to the
diagnosis: dyspnea, which is usually abrupt and sudden onset, which generally does not improve
unless supplemental oxygen is applied, pleuritic pain, the patient reports that he cannot take a deep
breath, hemoptysis and febrile syndrome, which, associated with dyspnea and pleuritic pain, could be
confused with pneumonia. Symptoms can develop in a matter of hours and even days, depending on
the extent of the infarct.

Diseases of the pleura

The pleura is the membrane that lines the thoracic (chest) cavity and covers the lungs. It is like a
large sheet of tissue that wraps around the outside of the lungs and lines the inside of the chest
cavity. There are several types of pleural diseases, including: pleurisy – an infection of the pleural
cavity, symptoms of pleurisy can include: shortness of breath, cough, fever and chills, rapid and
shallow breathing, unexplained weight loss and sore throat followed by inflammation and pain in the
joints. Pleural effusion: Collection of pleural fluid in the pleural cavity, usually pleural effusion does not
cause symptoms. Pneumothorax - presence of air or gas in the pleural cavity, symptoms of
pneumothorax include: sudden sharp pain that worsens with deep breathing, shortness of breath,
tightness in the chest, fatigue, rapid heart rate, and bluish skin color (called cyanosis), hemothorax:
presence of blood in the pleural cavity, symptoms of hemothorax may include: chest pain, shortness
of breath, respiratory failure, rapid heart rate, anxiety and restlessness; pleural tumors, symptoms of
pleural tumors may include: shortness of breath, chest pain, malaise, cough, and unexplained weight
loss.
Causes of pleurisy include: viral, bacterial, and fungal infections, lung cancer, other lung diseases,
such as sarcoidosis, asbestosis, lymphangioleiomyomatosis, and mesothelioma, pulmonary
embolism, familial Mediterranean fever, parasites, heart surgery, chest injury (trauma) and reaction to
certain medications. Causes of pleural effusion include: congestive heart failure, lung cancer,
pneumonia, tuberculosis, asbestosis, sarcoidosis, and drug reactions, bulla, which is a large
distended air space, lung diseases such as chronic obstructive pulmonary disease, tuberculosis,
surgery, trauma, chest trauma, lung and pleural cancer, and chest or heart surgery. Causes of
hemothorax include: For some pleural tumors, the cause is unknown. Known causes of pleural
tumors may include cancer that has spread to the pleural space.