Anatomy and Physiology of the Respiratory Systemand Nursing Diagnosis of Chronic Broncitis

Function of Respiratory System

1. Gas Exchangea. External respirationb. Internal respirationc. Cellular respiration

2. Ventilation3. Blood Reservoir4. Systemic Blood Filter5. Fluid Exchange6. Metabolic Functions of the Lungs

Upper Airway

1. Nose2. Paranasal sinuses3. Oral cavity4. Pharynx

1. Nose

The nose humidifies and warms air to body temperature and filters inspired air by trapping particles >6μm in diameter.

2. Paranasal sinuses

Posterior sphenoid sinuses that provide temperature insulation and voice resonance enhancement.

3. Oral cavity

Involved in digestion, speech, and respiration. 4. Pharynx

It separates inspired air from food and water.a. Nasopharynxb. Oropharynxc. Laryngopharynxd. Pharyngeal musculature

Lower Airway

1. Larynx 2. Trachea3. Bronchi 4. Lungs

1. LarynxLies between the upper and lower airway at the level of C4-6.

2. Tracheaa flexibel, slightly rigid tubular organ.

3. Bronchi• Enter the lungs at the hilus• Right bronchus: wider, shorter and straighter than

left • Bronchi subdivide into smaller tubes.

4. Lungs• Left lung Two lobes• Right lung three lobes

Mechanics of BreathingA. Inspiration

The active process of contracting the diaphragm downward to create a negative pressure within the thoracic cavity that draws gas into the lungs.

a. Diaphragmb. External intercostal musclesc. Abdominal musclesd. Neck muscles (scalene and sternocleidomastoid)

B. ExpirationThe passive act of relaxing the respiratory muscles allowing a decrease in thoracic size and the elastic recoil of the lungs to deflate the lungs.

a. Intercostal and accessory musclesb. Abdominal muscles

CHRONICAL BRONCHITIS

PHATOPHYSIOLOGY1. Mucus hypersecretion : incresed size and number of

submucous glands in the large bronchi. The increase of mucous leads to airway narrowing and airway obstruction

2. In smaller airway, chronic inflammation leads to repeated cycles of injury and repair of airways and therefor scar tissue formation and narrowing airways.

3. Reduction of alveolar ventilation due to increased secretions.4. Expiratory airflow limitation5. Breathlessness due to airway narrowing and

bronchoconstriction

TOKSIK

INFLAMASI

INCREASE BRONCHIAL SECRETION

INCREASE BRONKOMOTOR TONE

HIPERSEKRESIDISFUNGTION SILIA REFLEKS VAGAL

INFEKSI

CHRONICAL BRONCITIS

CLASIFICATION and TYPE1. Simple Chronic Bronchitis, characterized by

coughing and other minor complaints.2. Chronic bronchitis Mucopurulen,

characterized by thick phlegm cough, purulent (yellowish).

3. Chronic bronchitis with airway constriction, characterized by coughing up phlegm that is accompanied by severe shortness of breath and wheezing sound.

1. CigaretteSmoking hiperpaplasia of mukus brochi gland and metaplasia of silia activity inhibition, alveolarmakrofag, surfaktan depreciation of force

expiration volume2. Infection

Virus infection secondary bacteria infection (Haemophilus influenzae dan Streptococus pneumonia) infection on upper respiratory infection on lower respiratory3. Polution

Industrial polution (fiber, gas, cement) but it have not big influence

Etiology

4. Breed

Deficiencies of alpha-1 anti tripsin abnormal

preolitik enzyme tissue damage

5. Social-Economy Factor

Low environment and economy

6. Old age

Increasing age decreasing imunity susceptible

disease 

Symptoms of Chronic Bronchitis may include :• Much phlegm or voluminous cough• Sometimes making purulen sputum or blood

cough• Dispnea• A moment dispnea on sleep dispnea on cold

air and misty progresif on activity or rest. Sometimes espoused tired right heart.

• Listened wheezing

Clinical Appreance

• Describing bronchi stricture• Listened gargling on inspiration • Describing phlegm• Breast pain• Fever• Headache

A. History• Exposure to risk factor• Past medical history (ex: asma)• Family history of COPD• Chronic Cough: lenght of time• Smoking history• Respiratory illness

DIAGNOSTIC ASSESMENT

B. Potensial Abnormal Physical Exam• Assesment of severity based on level of

symptoms• Severity of spirometric abnormalities• Characteristic of respiratory pattern• Breath sounds• Shortness of breath with speech• Sputum producing color

C. Laboratorium Diagnostic• Chest X-ray• Postbronchodilator• Pulmonary function test• Arterial blood gasses• Oxygen saturation

Nursing Diagnosis• Ineffective airway clearance related to bronchospasm,

increased production of secret.SD: - The client complained of cough with shortness of breathOD: - The client looks coughing up phlegm• Pain disorder a sense of comfort with respect to the presence

of pleural inflammation, characterized by:SD : Client complains of chest pain centerOD: Client winced in pain

• Disruption of intolerance activity with respect to the physical weakness, characterized by:

SD : clients say easily tired, lethargic body when many brgerakOD: Clients seem weak, so that helped a client's activities such as sitting, eating and to the bathroom

• Disorders of bed rest with respect to the presence of coughDS : Clients complain: insomniaDO: sclera appear red, the frequency of sleep ± 5 hours / day

Nursing Intervention• Vital sign observationRasional: to checked vital sign’s changes• Teach a client for effective coughing exercisesRasional: effective coughing exercises can help the client remove secretion• Assess the level of pain with a pain scaleRasional: to determine the quality of perceived pain intensity• Help clients meet the daily needsRasional: By helping clients to mobilize bit by bit, the client can perform activities independently without the help of.

The Therapy• Airway clearance techniques: Controlled

cough and deep breathing, flutter valve, Thairpy vest, PEP theraphy

• Glucocorticosteroids: regular treatment does not modify long term decline of FEV1 but they are apropiate for symtomatic COPD patient with FEV1<50%

• Hydration: to keep secretions thin and minimal 6-8 glasses of water/ day

• Nutrition: maintain physical condition with increased fats and decreased carbohydrat in order to decrease CO2 production.

• Antibiotics: used when secretions become infected.• Patient teaching: Relaxation techniques, cough

control, and pursed lip breathing.

THANKS FOR YOUR NICE ATTENTION

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