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Pulmonary Disease. NFSC 470 McCafferty. Components of the Respiratory System. Drive Mechanism Pumping Mechanism Gas Exchange Organs. Drive Mechanism Controls breathing patterns Sensitive to hypoxia and hypercarbia Modulated by the CNS Brainstem governs automatic respiration

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pulmonary disease

Pulmonary Disease

NFSC 470


components of the respiratory system
Components of the Respiratory System
  • Drive Mechanism
  • Pumping Mechanism
  • Gas Exchange Organs
Drive Mechanism
    • Controls breathing patterns
    • Sensitive to hypoxia and hypercarbia
    • Modulated by the CNS
      • Brainstem governs automatic respiration
      • Cerebral cortex controls voluntary breathing
Pumping Mechanism
    • Air flows in/out as volume of thoracic cavity changes
    • Regulated by 3 groups of muscles:
      • Diaphragm: major muscle for inspiratory respiration. Moves up or down to lengthen or shorten cavity. (Inspiration: diaphragm contracts to increase volume of thoracic cage).
      • Intercostal muscles: internal & external muscles connecting ribs. Contract to pull ribs up and out to increase thoracic diameter
        • Major role in transition from inspiration to expiration
        • Provide major muscular work when demands for ventilation increase
Accessory muscles: elevate and stabilize chest wall at its largest diameter (once already “open”). Increases efficiency of diaphragm. Active during heavy breathing.


  • Chest wall assist with inspiration
  • Abdominals: used in active exhalation, ie. Exercise. Also role in inspiration

Inspiration is usually active – major role in pumping mechanism.

Expiration is usually passive.

Gas Exchange Organs
    • Upper airway (nose, mouth, pharynx) conducts air and keeps out large particles
    • Lower airway (larynx, trachea, bronchi, bronchioles, alveolar ducts, and alveoli)
      • O2 thru alveolar membrane  capillary membrane  Hgb  tissues
      • CO2 thru capillary membrane  alveolar membrane  through bronchial membrane exhaled
      • Alveolar membrane produces surfactant (PL): decreases surface tension and tendancy of collapse.
functions of the respiratory system
Functions of the Respiratory System
  • Gas exchange
  • Speech
  • Cardiovascular
  • Metabolic Functions
Gas Exchange
    • Normal: 15x/min, 500 ml air, therefore ventilate ~ 11000L air/day
    • ~6000 L blood moves through per day
    • ~600 L O2 in and 460 L CO2 removed
  • Speech

Thoracic cage supplies exhaled air to voice apparatus (larynx)

  • Cardiovascular

Nature of lung inflation affects pressure in thoracic cage; can affect heart i.e. pulmonary edema

Metabolic Functions
    • Surfactant production
    • Formation of angiotensin-converting enzyme (ACE)
    • Endothelial cells: produce SOD enzymes

I. Partial Pressure: used to indicate the amount of any gas in the atmosphere, alveoli, or plasma

  • PCO2 Partial Pressure of carbon dioxide
    • Normal arterial blood values = 35-45 mm Hg
    • Normal venous blood values = 41-51 mm Hg
  • PO2 Partial Pressure of oxygen
    • Normal arterial blood values = 80-100 mm Hg
    • Normal venous blood values = 35-40 mm Hg
  • Arterial blood preferred: oxygenated, coming from the heart
    • Gives idea of how things are throughout the body
    • Gives idea of how well lungs have oxygenated the blood
Note: PCO2 measures respiratory status

↑ PCO2 means poor respiratory function

↓ PCO2 means hyperventilation

II. Respiratory Failure

A. Obstructive

B. Restrictive

effects of respiratory ds on nutritional status
Effects of Respiratory Ds. On Nutritional Status
  • intake (see previous slide)
  • Medications

Steroids (anti-inflammatory) cause protein catabolism, gluconeogenesis, muscle wasting and neg. N balance.

  • Constipation/diarrhea

Choice of low fiber foods (2’ dyspnea); poor peristalsis 2’  O2 to GI tract.

respiratory complications malnutrition
Respiratory Complications: Malnutrition
  • Established:
    •  respiratory muscle structure and fx.
    •  ventilatory drive
    •  pulmonary host immune defenses ( susceptibility to infections)
  • Proposed:

A.  surfactant production

copd chronic obstructive pulmonary disease
COPD: Chronic Obstructive Pulmonary Disease
  • Chronic Obstructive Pulmonary Disease
    • Slow, progressive obstruction of airways
  • Maj. Causes: tobacco smoke, environmental pollution, genetic susceptibility
Emphysema: lung ds. characterized by
  • Pts present older, thin, mild hypoxemia but NL HCT values. Cor pulmonale develops later
Cron. Bronchitis:
  • pts NL wt to ovrwt, hypoxemia and  HCT
  • Cor pulmonale develops early.
  • Cor Pulmonale:
  • Assessment: %IBW alone not sufficient; ongoing assessment of LBM
Kcals: replete but don’t overfeed!
  • Indirect calorimetry if possible: Kcal needs have been observed to range from 94% to 146% of predicted
respiratory quotient
Respiratory Quotient
  • Amount of CO2 produced/amount of O2 consumed…
  • For glucose:
  • For fat:
  • For protein:
  • RQ for conversion of glucose to fat
  • Preserve lung, muscle, and immune fx
  • To preserve appropriate RQ:
  • Prot:
  • Fat:
  • CHO:
  • Smokers :
  • Mg and Ca imp in muscle contraction/relax, Mg and Phos monitored
  • Poss vit D&K
Respiratory rehab: exercise, fluids, easily chewed diet w/adequate fiber  GI motility
  • If experiencing bloating, decrease gaseous foods.
To  intake
    • Prevent aspiration:
    • TF to  kcals in some pts (aspiration issues)
      • Issues of O2 use at nighttime (overnight feedings). O2 consumption decreases by 15%-25% during sleep.
respiratory failure
Respiratory Failure
  • Causes:
  • MODS
  • ARDS
respiratory failure cont
Respiratory Failure, cont.
  • Pts. require O2 by nasal cannula or by mechanical ventilator.
  • Weaning from vent:
  • MNT: varies
  • Body comp. fluctuation –