RESPIRATORY SYSTEM

REVIEW OF ANATOMY AND

PHYSIOLOGY
1. Airway and Lungs – divided into the upper
and lower airway

A. UPPER AIRWAY
- Includes the nasopharynx (nose), oropharynx
(mouth), laryngopharynx, and larynx
Purpose:
 Warm, filter, and humidify inhaled air
 Helps to make sound and send air to the

lower airway
B. Lower Airway

- Begins with the trachea

- Divides into the right and left mainstem
bronchi
- Lobar bronchi which is lined with mucus
producing ciliated epithelium (one of the
lungs’ major defense sytems
- Alveoli
 Lungs of typical adult contain about 300
million alveoli
 Right Lung – has 3 lobes (upper, middle,
lower or superior, middle, and inferior)
 Left Lung – has only 2 lobes (upper, lower)
2. Thorax
Includes:
 Clavicles
 Sternum
 Scapula
 12 sets of ribs (made of bone and cartilage

and allow chest to expand and contract

during each breath)
 12 thoracic vertebrae
3. RESPIRATORY MUSCLES
 Primary: Diaphragm and Intercostal Muscles
 Function: Contract when patient inhales and

relax when patient exhales

 Otheraccessory muscles:
Trapezius
Sternocleidomastoid
Scalenes
Functions:
1. VENTILATION – act of moving air in and out
of the lungs
2. RESPIRATION – gas exchange
- transport of oxygen and carbon dioxide
- Diffusion of oxygen and carbon dioxide
2 Types of Respiration
 EXTERNAL RESPIRATION – between alveoli and
capillaries

 INTERNAL RESPIRATION – between capillaries

and tissues / cells
3. LUNG VOLUMES AND CAPACITIES
 Lung function, which reflects the mechanics

of ventilation, is viewed in terms of lung

volumes and lung capacities
• TIDAL VOLUME – the volume of air inhaled
and exhaled with each breath

Abbreviation: VT or TV
Normal Value: 500 ml
• INSPIRATORY RESERVE VOLUME – the
maximum volume of air that can be inhaled
after a normal inhalation

Abbreviation: IRV
Normal Value: 3000 ml
• EXPIRATORY RESERVE VOLUME – the
maximum volume of air that can be exhaled
forcibly after a normal exhalation

Abbreviation: ERV
Normal Value: 1100 ml
• RESIDUAL VOLUME – the volume of air
remaining in the lungs after a maximum
exhalation

Abbreviation: RV
Normal Value: 1200 ml
LUNG CAPACITIES
• VITAL CAPACITY – the maximum volume of
air exhaled from the point of maximum
inspiration

Abbreviation: VC
Normal Value: 4600 ml

VC = TV+IRV+ERV
• INSPIRATORY CAPACITY – the maximum
volume of air inhaled after normal
expiration

Abbreviation: IC
Normal Value: 3500 ml

IC = TV+IRV
• FUNCTIONAL RESIDUAL CAPACITY – the
volume of air remaining in the lungs after a
normal expiration

Abbreviation: FRC
Normal Value: 2300 ml

FRC = ERV+IRV
• TOTAL LUNG CAPACITY – the volume of air
in the lungs after a maximum inspiration

Abbreviation: TLC
Normal Value: 5800 ml

TLC = TV+IRV+ERV+RV
Want to know your lung capacity? TRY
THIS EXPERIMENT AT HOME!

YOUTUBE VIDEO: How To Measure Your

Lung Capacity
Significant Terms
 PULMONARY PERFUSION – actual blood flow
through the pulmonary vasculature

Blood is pumped into the lungs by the Right

Ventricle through the pulmonary artery
 PULMONARY DIFFUSION – process by which
oxygen and carbon dioxide are exchanged
from areas of high concentration to areas of
low concentration at the air-blood interface
VENTILATION-PERFUSION RATIO
NORMAL – A given amount of blood that
passes an alveolus should be matched with an
equal amount of gas (1:1)
V/Q Imbalances
1. Low Ventilation-Perfusion
 SHUNTS
 Perfusion exceeds ventilation (Q>V)
 Blood bypasses alveoli without gas exchange
occurring
SEEN IN PATIENTS WITH:

 Pneumonia
 Atelectasis
 Tumor
 Mucus Plug
2. High Ventilation-Perfusion
 DEAD SPACE
 Ventilation exceeds perfusion (V>Q)
 There is inadequate blood supply for gas

exchange
SEEN IN PATIENTS WITH:

 Pulmonary emboli
 Pulmonary infarction
 Cardiogenic shock
3. Silent Unit
 Absence of both ventilation and perfusion or

with limited Ventilation and Perfusion

SEEN IN PATIENTS WITH:

 Pneumothrorax
 Severe ARDS
HEALTH ASSESSMENT
HEALTH HISTORY – initially focuses on the
patient’s presenting problem and associated
symptoms, with close attention to how all
aspects of the patient’s life are impacted

Includes:
 Activities of daily living
 Quality of life
CHIEF COMPLAINT
- onset, location, duration, character,
aggravating and alleviating factors, radiation (if
relevant), and timing of presenting problem
and associated symptoms
PAST HEALTH, SOCIAL, AND FAMILY
HISTORY
 Childhood illnesses
 Immunization (Including most recent
influenza and pneumonia vaccinations)
 Medical conditions
 Injuries
 Hospitalizations
 Surgeries
 Allergies
 Current medications (OTC, Prescribed, Herbal)
 Diet
 Exercise
 Sleep
 Recreational Habits
 Religion
RISK FACTORS
Smoking (the single most important
contributor to lung disease)

History should include exposure to second

hand smoke expressed in pack years
Computation:
# of cigarette # of years the
MULTIPLIED
packs smoked BY: patients has
per day smoked
RISK FACTORS:
 Personal or family history of lung disease
 Genetic make-up
 Exposure to allergens and environmental
pollutants
 Exposure to certain recreational and
occupational hazards
 Vitamin D deficiency
 Obesity
 Excessive exposure to acetaminophen
prenatally and in the first 2 years of life
PHYSICAL ASSESSMENT / EXAM
 Inspection
 Palpation
 Percussion
 Auscultation
A. INSPECTION
Inspect for:
 Masses, Scars – Indicate trauma or surgery
 Chest Wall Symmetry - Sides of the
chest should be equal at rest and
expand equally as patient inhales
 Front to Back chest diameter should be
about half the width of the chest
Costal angle – angle between ribs and sternum
at the immediately above the xiphoid process

Costal angle should be less than 90 degrees in

adults
 Use of accessory muscles when breathing
THORACIC DEFORMITIES
 BARREL CHEST
Increased front to back
(anterioposterior) chest
diameter
PIGEON CHEST
Anteriorly displaced sternum
FUNNEL CHEST
Depressed lower sternum
 THORACIC KYPHOSCOLIOSIS
Raised shoulder and scapula, thoracic
convexity, and flared interspaces
 Note the Respiratory Pattern
 Normal Respiratory Rate: 10-20

breaths/minute
 Should be even, coordinated, and regular

with occasional sighs

 Count for 1 full minute
RESPIRATION PATTERNS
 EUPNEA – normal breathing rate and pattern

 TACHYPNEA – increased rate (more than 20

breaths/minute) and shallow

 BRADYPNEA – decreased rate (less than 10

breaths/minute) and regular
 Hyperventilation – increased rate and
increased depth of breathing

 Hypoventilation – decreased rate, decreased

depth, and irregular pattern
 Cheyne-Stokes Respiration – regular pattern
characterized by alternating periods of deep,
rapid breathing followed by periods of apnea

 Biot’s Respiration – Irregular pattern

characterized by varying depth and rate of
respirations followed by periods of apnea
 APNEA – absence of breathing
B. PALPATING THE CHEST
 Use both light and deep palpation
 Chest wall should feel smooth, warm, and dry
 There should be no detectable tender spots

or bulges in the chest

 Palpate for TACTILE FREMITUS – normal
palpable vibrations caused by the
transmission of air through the
bronchopulmonary system
Checking for Tactile Fremitus
1. Ask patient to fold arms across his chest
2. Lightly place your open palms on both sides
of the back without touching the back of
fingers
3. Ask the patient to repeat the phrase
“ninety-nine” loud enough
4. Palpate the front of the chest using the
same hand positions after
C. PERCUSSING THE CHEST
Purposes:
 To find the boundaries of the lungs
 To determine whether the lungs are filled

with air, fluid, or solid material

 Resonant sound over normal lung tissue
 Dull sound is present when fluid or solid

tissue replaces air in the lung or occupies the

pleural space
 Hyperresonance is elicited in cases of trapped

air such as in emphysema or pneumothorax

POSTERIOR THORAX
D. AUSCULTATING THE CHEST
 Auscultation sites are the same as
percussion sites
 Listen to a full inspiration and expiration at

each site, using the diaphragm of the

stethoscope
 Ask the patient to breathe through his

mouth
 Press the stethoscope firmly against the

skin
NORMAL BREATH SOUNDS
 There are four types of breath sounds over
normal lungs
Breath Sound Quality Location

TRACHEAL Harsh, High-Pitched Over trachea

BRONCHIAL Loud, High-Pitched Next to trachea

BRONCHOVESICULAR Medium in loudness Next to sternum,

and pitch between scapula
VESICULAR Soft, Low-Pitched Remainder of lungs
ABNORMAL BREATH SOUNDS
 Adventitious (abnormal) breath sounds may
be heard in the presence of respiratory
symptoms