Chapter 26: Structure & Function of the Pulmonary System

Bronchial Circulation

- Part of systemic circulation - Moistens inspired air. - Supplies nutrients to conducting airways, large pulmonary vessels, & membranes.

Pores of Kohn

- Pressure Equalizers - Promote collateral ventilation & even distribution of air among alveoli.

Mucous Blanket

- Protects trachea & bronchi from injury - Trap bacteria that reach lower airways

Chest Wall

- Skin, ribs, & intercostal muscles. - Protect lungs from injury.

What is the function of the tissue of the bronchi?

- Support - Prevent distortion or collapse of bronchi during ventilation.

Perfusion

- The movement of blood into and out of the capillary beds of the lungs to body organs & tissues. - Performed by CV system.

Alveoli

- The primary gas-exchange units of the lung, where oxygen enters & CO2 is removed. - Thin walled.

Alveolocapillary Membrane

- This is the respiratory membrane where gas exchange occurs. - If this membrane thickens, gas exchange is impaired.

Cor Pulmonale

- a.k.a. Right Heart Failure - Caused by permanent pulmonary artery hypertension

Visceral Pleura

Membrane coving the lungs.

What are the structures of the Pulmonary System?

1.) 2 Lungs 2.) Upper/Lower Airways 3.) Blood Vessels 4.) Diaphragm 5.) Chest Wall

What are the effects of pulmonary circulation?

1.) Facilitate gas exchange 2.) Deliver nutrients to lung tissue 3.) Serve as a reservoir for L ventricle 4.) Filter clots, air, & debris from circulation

Endolarynx

1.) Supraglottis (false vocal cords) 2.) True vocal cords

How does gas exchange occur?

1.) Ventilation 2.) Diffusion 3.) Perfusion

At sea level, the partial pressure of oxygen is approximately ___% (round to the nearest whole number).

21%

How many lobes does the L lung have?

2: - Upper - Lower

How many lobes does the R lung have?

3: - Upper - Middle - Lower

Surfactant

A lipoprotein produced by type II alveolar cells. It coats the inner surface of the alveolus & lowers alveolar surface tension at end-expiration = Prevents lung collapse.

Bronchi

A set of conducting airways that deliver air to each section of the lung.

An 80-year-old develops pneumonia in the hospital. An assessment identifies that the patient is cyanotic and tachycardic and has developed a fever and a cough. Chest x-ray reveals pus in the pleural space. This symptomology supports which medical diagnosis? Select one: a. Empyema b. Emphysema c. Pleurisy d. Chyle

ANS: A

As a result of a severe head injury, a patient is now experiencing respiratory abnormalities characterized by alternating periods of deep and shallow breathing with periods of apnea. What term should the nurse use when charting this condition? Select one: a. Cheyne-Stokes b. Apnea c. Frank-Starling d. Orthopnea

ANS: A

Which of the following patients is at highest risk for developing pulmonary embolism (PE)? Select one: a. 72-year-old male who is recovering from hip replacement surgery in the hospital b. 28-year-old woman who had a baby 6 months earlier c. 21-year-old male with a hemophilia bleeding disorder d. 36-year-old woman with a history of alcohol abuse who is recovering from a gastric ulcer

ANS: A

Which assessment finding would be expected in pulmonary embolism (PE)? (select all that apply) Select one or more: a. fever b. tachypnea c. hemoptysis d. tachycardia e. chest pain

ANS: A, B, C, D, E

A 50-year-old presents with hypotension, hypoxemia, and tracheal deviation to the left. Tests reveal that the air pressure in the pleural cavity exceeds barometric pressure in the atmosphere. Based upon these assessment findings, what does the nurse suspect the patient is experiencing? Select one: a. Pleural effusion b. Tension pneumothorax c. Open pneumothorax d. Transudative pneumothorax

ANS: B

Diffusion of respiratory gases takes place at the: Select one: a. visceral pleurae b. alveolo capillary membrane c. parietal pleurae d. respiratory center

ANS: B

The most common cause of pulmonary edema is: Select one: a. asthma b. left heart failure c. right heart failure d. lung cancer

ANS: B

A 20-year-old presents reporting difficulty breathing when lying down. What term should the nurse use to document this condition? Select one: a. tachypnea b. apnea c. orthopnea d. dyspnea

ANS: C

A 50-year-old is diagnosed with lung cancer. The health history includes a 30-year history of smoking, exposure to air pollution, asbestos, and radiation. What had the greatest impact on the development of his cancer? Select one: a. Air pollution b. Radiation c. Cigarette smoke d. Asbestos

ANS: C

A 65-year-old diagnosed with emphysema presents to the ER for difficulty breathing. Physical exam reveals both bluish skin and mucous membranes. What term will the nurse use to document these observations? Select one: a. Hemoptysis b. Hematemesis c. Cyanosis d. Ischemia

ANS: C

A patient asks how oxygen is transported in the body. The nurse's best response is that most oxygen (O2) is transported: Select one: a. dissolved in blood b. in the form of carbon dioxide c. bound to hemoglobin d. as a free floating molecule

ANS: C

Airway obstruction contributing to increased airflow resistance and hypoventilation in asthma is caused by: Select one: a. collapse of the cartilaginous rings in the bronchi. b. alveolar fibrosis and pulmonary edema. c. mucous secretion, bronchoconstriction, and airway edema. d. type II alveolar cell injury and decreased surfactant. Feedback

ANS: C

Aspiration of oral secretions increases a patient's risk for which complication? Select one: a. Bronchiectasis b. Emphysema c. Pneumonia d. Pneumothorax

ANS: C

Surfactant facilitates alveolar distention and ventilation by: Select one: a. attracting water to the alveolar surface. b. increasing diffusion in alveoli. c. decreasing surface tension in alveoli. d. decreasing thoracic compliance.

ANS: C

The nurse is describing the movement of blood into and out of the capillary beds of the lungs to the body organs and tissues. What term should the nurse use to describe this process? Select one: a. Circulation b. Ventilation c. Perfusion d. Diffusion

ANS: C

When giving report, what term should the nurse use to describe the coughing up of bloody secretions? Select one: a. Rhinitis b. Cyanosis c. Hemoptysis d. Hematemesis

ANS: C

A 60-year-old with a 25-year history of smoking is diagnosed with emphysema. Assessment shows an increased anterior-posterior chest diameter. The nurse attributes this finding to: Select one: a. alveolar destruction. b. decreased inspiratory reserve volumes. c. increased flow rates. d. air trapping.

ANS: D

One of the functions of the pulmonary system is the: Select one: a. principal mechanism for cooling of the heart. b. expelling of bacteria c. movement of blood into and out of the capillaries. d. exchange of gases between the environment and blood.

ANS: D

The nasopharynx is lined with a ciliated mucosal membrane with a highly vascular blood supply. One function of this membrane is to: Select one: a. cool air b. exchange gases c. absorb air d. humidify air

ANS: D

Pleura

Adheres firmly to lungs and folds over itself and attaches firmly to the chest wall.

Conducting Airways

Allow air into & out of gas-exchange structures of the lung.

Cilia

Propel mucous blanket & entrapped particles toward oropharynx for swallowing or expectorating.

Alveolar Macrophages

Ingest & remove bacteria and other foreign material from alveoli by phagocytosis.

Pulmonary Hypertension

Elevated pulmonary artery pressure.

Ventilation

- Air moves in & out of lungs. - Performed by pulmonary system.

Pulmonary Veins

- Dispersed randomly throughout the lung. - Leave lung at hila. - Enter L atrium. - Have NO valves.

Diaphragm

- Dome-shaped muscle - Separates thoracic & abdominal cavities - Involved in ventilation

Diffusion

- Gas moves between air spaces in lungs - Performed by pulmonary system.

Irritant Receptors

- In trachea & large airways - Remove irritants from lower airways via cough reflex

What is the most important cause of pulmonary artery constriction?

- Low alveolar PO2. - Alveolar & pulmonary venous hypoxia, due to an increase in intracellular Ca2+ levels.

Upper Respiratory Tract Mucosa

- Maintain constant temp - Humidify gas entering lungs - Traps/Removes foreign particles

Upper Airway

- Nasopharynx - Oropharynx

Trachea

Connects the larynx to the bronchi.

Larynx

Connects the upper & lower airways and consists of the endolarynx & cartilaginous structures.

Thoracic Cavity

Contained by the chest wall and encases the lungs.

Ciliated Mucosa

Line the upper airway and warm/humidify inspired air & remove foreign particles from it.

Pleural Fluid

Lubricates the pleural surfaces and allows the two layers to slide over each other without separating.

What is the primary function of the pulmonary system?

The exchange of gases between the environmental air & blood.

Parietal Pleura

The lining of the thoracic cavity.

Mediastinum

The space between the lungs. It contains the heart, great vessels, & esophagus.

Nasal Hair Turbinates

Trap/Remove foreign particles