Respiration

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Respiration

• BS
• Chapter 18

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Respiration

• Not just breathing in and out
• Or inhaling and exhaling
• Respiration is the process by which oxygen is
  obtained from the environment and delivered to
  cells and carbon dioxide is transported to the
  outside in a reverse pathway

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Respiration includes 3 phases

• 1. Pulmonary ventilation
• 2. Diffusion
• 3. Transport of gases

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Pulmonary ventilation

• This is the exchange of air between the
  atmosphere and the air sacs of the lung
• Pulmonary ventilation is usually accomplished by
  the inspiration and expiration of breathing

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The Diffusion of Gases

• This includes the passage of oxygen from the air
  sacs into the blood and the passage of carbon
  dioxide out of the blood

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Transport of gases

• Into the circulating blood. O2 is carried to the
  cells and carbon dioxide is transported from the
  cells to the lungs

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Cellular respiration

• This is at the cell level
• O2 is taken into the cell and used in the
  breakdown of nutrients with the release of energy
• CO2 is the waste product of cellular respiration

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The Respiratory System

• Air travels into the nostrils at 21 room air
• Soof the 100 of the air in the room, we need
  21 oxygen at minimum, to breathe and be 95-100
• The atmosphere we are in right now only has 21
  O2 in it and this is fine for normal, breathing
  humans

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The Respiratory System

• Air travels into the nasal cavity
• Moves to the pharynx (3 parts)
• To the larynx
• Over the Adams Apple (voice box)
• Into the trachea
• To the carina
• To each left and right bronchi
• To the bronchioles
• To the alveoli

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• Air enters the nasal cavity which is divided by a
  septum
• The septum and the walls of the nasal cavity are
  lined with mucous membrane
• There are many blood vessels here. These vessels
  provide heat and moisture to the inhaled air
• Cilia act as filters to dust and other debris

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Mucous Membrane

• The cells of this membrane secrete a large amount
  of fluid, up to 1 quart a day, this helps keep
  the nasal cavity moist
• If the mucosal membrane is dry, small microscopic
  cracks form and this is an easy entrance for
  microorganisms

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Conchae (konk-ke)

• On the side walls of each nasal cavity are three
  projections called conchae
• The shell-like conchae greatly increase the
  surface area over which air must travel on its
  way through the nasal cavities

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Pharynx throat

• There are 3 parts
• Nasopharynx
• Oropharynx
• Laryngeal pharynx
• All parts are made of muscle and help to carry
  food and liquids into the digestive tract

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Nasopharynx

• This is the top part of the pharynx, it is behind
  the nasal cavity

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Oropharynx

• This is the middle section of the pharynx and is
  located behind the mouth
• This is the throat as we know it

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Laryngeal Pharynx

• This is the lowest portion of the pharynx
• This last section opens into the larynx toward
  the front and into the esophagus towards the back

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Larynx

• A.K.A. voice box
• This is located
• between the pharynx
• and the trachea
• It is made of cartilage
• (partly thyroid cartilage),
• that protrudes in the front
• of the neck

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Adams Apple

• The projection formed by the thyroid cartilage is
  popularly called the Adams Apple because it is
  bigger in the male than it is in the female

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On both sides of the larynx

• There are folds of mucous membrane used in
  producing speech
• These are the vocal folds or vocal cords
• They are set into vibration by the flow of air
  from the lungs

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Deep Voice

• A difference in the size of the larynx is what
  accounts for the difference between male and
  female voices
• Men have a lower pitch than women
• The nasal cavities, sinuses, and pharynx all
  serve as resonating chambers for speech

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Glottis Epiglottis

• The space between the vocal cords is called the
  glottis
• The little leaf shaped cartilage that covers the
  larynx during swallowing is the epiglottis, this
  protects us from aspiration

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Swallowing

• As the larynx moves upward and forward during
  swallowing
• The epiglottis moves downward covering the
  opening of the larynx
• The glottis assists by closing during swallowing
• Gently place your fingers over your larynx as you
  swallow, you will feel the movement

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Trachea

• Also called the windpipe
• Purpose of this structure is to conduct air
  between the larynx and the lungs
• The trachea has a framework or ringed cartilage
  to help keep it open, the rings are C shaped
  and are found along the entire length of the
  trachea

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Carina

• At the bottom of the
• trachea is the split to
• where the Right
• Left bronchi are
• This is the point to which
• you push the suction catheter down to, if you
  go any further down, your catheter will enter the
  Right or Left main bronchithis is not
  comfortable for the pt

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Bronchi

• Right Bronchus larger in diameter than the left
• Extends downward in a more vertical direction
• If a foreign body does get inhales in, it is
  likely to go to this right side first d/t the
  angle and gravity
• Each bronchus enters the lung at a notch or
  depression called the hilus

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Hilus

• This is the place where
• blood vessels and nerves
• connect with the lung in
• this region
• Hilus is on either right or left bronchus

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Lining of the bronchus

• These are lined with a special type of epithelium
  cells called
• Simple columnar epithelium
• The cells are arranged in these columns that make
  it look stratified like stripes
• The epithelial cells contain cilia to dust out
  the impurities and to create movement of fluids
  within the conducting tubes

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Cilia in the bronchi

• Help to sweep impurities toward the throat where
  they can be eliminated by coughing, sneezing or
  blowing of the nose

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The Lungs

• This is the organ in which the diffusion of gases
  takes place through extremely thin and delicate
  lung tissues
• The bronchi split into right and left lobes of
  the lung
• Right has 3 lobes
• Left has 2 lobes

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Bronchial tree

• The bronchi further subdivide into tiny
  structures that resemble trees therefore, they
  are called bronchial tree

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Bronchioles

• As the bronchi get smaller, they branch into
  bronchioles
• The bronchi contain small bits of cartilage to
  help keep them open, there are smaller amt of
  cartilage the deeper you go into the bronchi.
• In the bronchioles, there is NO cartilage, it now
  becomes smoothe muscle which is under the control
  of the ANS involuntary

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The alveoli

• There are millions of alveoli at the end of the
  terminal bronchioles. They are the smallest
  division of the bronchiole tree, there are
  clusters or sacs which hold air, known as alveoli
• The alveoli are thin walled and single celled and
  they provide easy passage for gasses entering and
  leaving the blood as the blood circulates through
  the millions of tiny capillaries that cover the
  alveoli

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Surfactant

• Certain cells in the alveolar wall produce this
  substance that reduces surface tension or the
  pull of fluids that line the alveoli.the
  substance is called surfactant
• The surfactant prevents collapse of the alveoli
  and eases expansion of the lungs

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How does blood travel to the alveoli

• The pulmonary circuit brings blood to and from
  the lungs (pulmonary artery takes blood through
  the lung from the heart then sends it back to the
  left atrium via the pulmonary veins) and as blood
  passes through the alveoli, gas exchange takes
  place

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Diaphragm

• The lungs take up a great deal of space in the
  thoracic cavity
• It is a large dome-shaped muscle that is attached
  to the body wall around the base of the rib cage
• The lungs are separated from the abdominal cavity
  by the muscular partition known as the diaphragm
• The diaphragm moves downward in the thoracic
  cavity when we inhale, this allows for more room
  to allow the lungs to expand

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What covers the lungs

• A continuous double sac known as the pleura
  covers each lung, the pleural sac is made of
  serous membrane
• The different areas that the pleura covers are
  called different things such as
• Parietal pleura is the portion of the pleura that
  is attached to the chest wall
• Visceral pleura is the portion that is attached
  to the surface of the lung

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Pleural Space

• Between the parietal and visceral layers of the
  pleura is called the pleural space
• This space hold the serous fluid that lubricates
  the 2 membranes to avoid friction when the lung
  expands, this allows the lungs to open bigger
  effortlessly

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Pleural Space
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Mediastinum

• This is the region between the lungs, it contains
  the heart, great vessels, esophagus, trachea
• and lymph nodes

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Intercostal Muscles

• The diaphragm is very important in enlarging the
  size of the thoracic cavity to allow the lungs to
  inflate
• The intercostal muscles also help. They contract
  and lift the rib cage upward and outward
• (Costochondritis)

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What happens when we breathe

• Inhalation is considered to be the active
  phase, air rushes in expanding the lungs and
  moving the thoracic cavity making the pressure in
  the pleural space drop causing air to be drawn
  into the lungs as by suction
• Exhalation is considered to be passive. The
  muscles of respiration relax and the lungs recoil
  and we breathe out carbon dioxide

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When O2 enters the bronchi.

• It travels down through the bronchiole tree to
  the bronchioles and down to the alveoli
• Here, the incoming air mixes with the existing
  air thats already in the alveoli so that the
  gasses soon are evenly distributed
• New O2 comes in and CO2 moves out in both blood
  and out of mouth into the air

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Looking a bit closer at gas exchange in the lungs

• After O2 reaches the alveoli, the O2 must make
  its transfer with CO2, it does this through the
  capillaries that surround the alveoli
• The alveoli have a thin membrane around them that
  is moist. On the other side of this membrane are
  the alveolar capillaries that are microscopic

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• The membrane around the alveoli is moist and aids
  in the transfer of O2 and CO2
• The O2 and CO2 must go into solution before they
  can diffuse across the membrane

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In the lungs

• Oxygen enters the blood and carbon dioxide trades
  places with the O2 and the CO2 leaves

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In tissues

• O2 leaves the blood to go to organs and tissues
  and carbon dioxide enters the blood to be
  eventually taken to the lungs to be blown off

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Hemoglobin

• When O2 enters the lungs and diffuses over to
  capillaries, it attaches to hemoglobin and is
  carried away in the blood stream
• The richly supplied blood, travels to all parts
  of the body to deliver nutrients and O2 to organs
  and tissues
• Hgb 12 HCT - 36

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Remember

• A RBC carries 4 O2 seats and also some CO2
• CO2 hold on tighter than O2 and can cause O2 to
  be bumped off as in CO poisoning
• CO2 is continuously produced in the tissues as a
  bi-product of metabolism, it diffuses from the
  cells into the blood to be transported to the
  lungs to be blown off

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Pons Medulla of the brain

• Normal ventilation and regulation of acidity is
  controlled in part by the
• Medulla and pons of the brain stem
• Main part of the control center in the medulla
  sets the basic pattern of respiration
• The pons medulla regulate rate, depth and
  rhythm of breathing

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Chemoreceptors in the body

• These receptors detect changes in gas composition
  of the blood and are found in the
• Carotid and aorta
• They are also called carotid and aortic bodies,
  these bodies contain many small blood vessels and
  sensory neurons that are able to respond to the
  increases in CO2 and acidity and then decrease O2
  supplies

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Phrenic Nerve

• From the respiratory center in the medulla, motor
  nerve fibers extend into the spinal cord
• From the cervical or neck part of the cord,
  these nerve fibers continue through the phrenic
  nerve to the diaphragm and can control
  respirations

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Phrenic Nerve
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When we retain CO2

• Our medulla and pons and phrenic nerve all react
  and they tell us to breath faster
• Breathe, breathe, breathe and hopefully, we will
  blow off the retained CO2
• If this does not work, we end up having CO2 and
  H2O combine in our body and an H ion is released
  which increases acidity and lowers our ph making
  us acidic or lt7.35 and we then have another
  system to try and help

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Kidney

• The kidney releases bicarb in our time of need to
  try and balance out the acidity

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Respiratory Problems

• Hyperventilation an increased amount of air
  enters the alveoli resulting in deep, rapid
  respirations. These commonly occur in anxiety
  attacks
• This causes an increase level of O2 and a
  decrease on CO2
• The loss of CO2 too quickly, causes alkalosis
  dizziness, tingling of the body

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• In hyperventilation or alkalosis, breathing may
  stop because the resp. center is not
  stimulatedit gets stimulated by holding in too
  much CO2remember, too much CO2 tells out brain
  to breathe and fix the problem

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Hypoventilation

• When an insufficient amount of air enters the
  alveoli can be d/t
• Resp. obstruction
• Lung disease
• Injury to resp. center of the brain
• Depression of resp. center by drugs
• Remember, hypoventilation means you are not
  breathing in O2 a build up of CO2 acidosis
  and decrease ph

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Normal R.R.

• Normal adults 12-20

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Types of altered breathing

• Hyperpnea increase in depth and rate of
  breathing
• Tachypnea excessive rate of breathing,
  breathing fast
• Apnea temporary cessation of breathing
• Dyspnea difficulty in breathing
• Orthopnea difficulty relieved by upright
  position
• Cheyne-Stokes irregular resps found in
  terminally or critically ill
• Kussmaul resps seen in diabetic pts, fruity
  breath

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Possible Results of altered breathing

• Cyanosis blue skin color
• Hypoxia an O2 deficiency, pt gets agitated
• Hypoxemia lower than normal concentration of O2
  in arterial blood
• Suffocation the state of being choked by
  obstruction

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Disorders of the Respiratory System

• Sinusitis inflammation and sometimes infection
  of the sinuses
• Deviated septum when the septum, part that
  divides the nasal cavities, moves d/t broken nose
  or injury making one side of the nasal cavity
  smaller. Breathing probs occur
• Epistaxis (epi-STAK-sis) common nosebleed
• URI caused by the common cold, pharyngitis or
  sore throat or laryngitis or bronchitis

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The common cold

• Is the most widespread of all resp. diseases
• All viral
• Probably over 200 different strands

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Influenza

• A.K.A the flu
• Characterized by an inflammatory condition of the
  upper resp. tract accompanied by general aches
  and pains
• Caused by a virus
• Can develop into pneumonia
• You can receive a vaccination for this yearly to
  try and help

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Pneumonia

• Is an inflammation of the lungs in which the air
  spaces become filled with fluid
• Can be caused by streptococci and many other
  bugs
• These bugs can be carried around for a while
  until someones immune system is depleted and
  then they cant fight it and you get pneumonia

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Tuberculosis (TB)

• Is an infectious disease caused by the Bacillus
  Mycobacterium tuberculosis
• Can cause lots of mucous that leads to
  tuberculosis pleurisy which is inflammation of
  the pleuracan also cause
• An effusion which is an accumulation of fluid in
  the pleural space

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Hay fever asthma

• Hypersensitivity to dust, pollen and molds causes
  an antigen-antibody reaction
• Inflammation of the airway and the release of
  histamine occur runny nose, watery eyes,
  itching
• Whats the treatment for histamine reaction??????
• Whats the treatment for asthma to open the
  bronchioles????? Bronchodialator called ?????

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What makes humans breathe?

• The amount of CO2 remaining in our body
  determines whether or not I should breathe fast
  to blow it off and get rid of it
• Or
• If CO2 levels in the blood are low, then I dont
  have to breathe as fast

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Therefore

• Q What makes me breathe?
• A the amount of CO2 I have in my bloodstream
• Who breathes differently than this, based on
  something else?
• COPD pts ?

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COPD chronic obstructive pulmonary disease

• This is an umbrella term used to describe 3 lung
  disorders such as
• Chronic bronchitis
• Emphysema
• Asthma

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Chronic Bronchitis

• The linings of the airways are chronically
  inflamed and excessive secretions are produced
• Inhalers and antibiotics are needed

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Emphysema

• Is characterized by dilation and finally
  destruction of the alveoli, air gets trapped, pt
  usually has a barrel chest d/t this
• O2 and bronchodilators are needed

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Asthma

• Narrowing of the resp. passageways
• Wheezing is a sign
• Albuterol, Xopenex usedepi SQ. used in
  emergency, it dilates the bronchioles stat

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COPD

• Respiratory function is impaired by obstruction
  of normal air flow
• Air gets trapped and over inflation of parts of
  the lung occurs which reduces the exchange of O2
  and CO2
• Over time, the pt becomes SOB and has dsypnea

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Atelectasis

• The incomplete expansion of a lung or portion of
  the lung, it collapses
• Symptoms include hypoxia and dyspnea

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Who Has Atelectasis?

• Pts that lay in bed post-op
• Lung cancer pts
• Pts with respiratory distress syndrome (RDS)
• Other pts with lung disease

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Lung Cancer

• Smoking is a major causative factor
• Causes huge problems, blocks bronchus causes
  pneumonias
• Usually spreads to other parts of the body

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Pleurisy

• Inflammation of the pleura
• Usually accompanies a lung infection such as
  pneumonia or tuberculosis
• This condition can be painful because the
  inflammation produces a sticky exudate that
  roughens pleura of both lungs and the chest wall,
  when the 2 surfaces rub together during
  ventilation, the roughness causes acute irritation

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Pneumothorax

• Is an accumulation of air in the pleural space
• The lung on the affected side collapses causing
  the pt to have great difficulty breathing
• Can be caused by a wound in the chest

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Pneumothorax chest tube is needed
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Hemothorax

• Blood in the pleural space usually caused by a
  penetrating wound
• The 1st priority is to stop the bleeding into the
  space

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Hemothorax- chest tube needed
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Thoracentesis

• The abnormal fluid or air in the pleural space
  calls for treatment to remove the air or fluid
• This can be done through the insertion of a
  needle between the ribs into the pleural space
  below the lung to remove fluid or air.
• A chest tube may be required to restore negative
  pressure in the pleural space to allow for
  re-expansion of the lung

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Age and the respiratory tract

• With age, tissues of the resp. tract loose their
  elasticity and become more rigid
• Arthritis sets in and causes the loss of strength
  to the chest wall and in breathing muscles
  resulting in an overall decrease in compliance
  and in lung capacity

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• Decrease in protective mechanisms like in the
  immune system cause greater risk of infection
  leading to pneumonia and possibly death

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Special equipment for respiratory treatment

• Bronchoscope - used to view the bronchi and
  lungs
• Can also be used to remove foreign objects or
  absesses
• Throat is usually anesthesized 1st, must check
  gag reflex before giving P.O.

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Other Special Equipment used

• O2
• Suction
• Tracheostomy
• Artificial respiration

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The End