ANATOMY AND PHYSIOLOGY

UPPER RESPIRATORY TRACT Respiration is defined in two ways. In common usage, respiration refers to the act of breathing, or inhaling and exhaling. Biologically speaking, respiration strictly means the uptake of oxygen by an organism, its use in the tissues, and the release of carbon dioxide. By either definition, respiration has two main functions: to supply the cells of the body with the oxygen needed for metabolism and to remove carbon dioxide formed as a waste product from metabolism. This lesson describes the components of the upper respiratory tract. The upper respiratory tract conducts air from outside the body to the lower respiratory tract and helps protect the body from irritating substances. The upper respiratory tract consists of the following structures: The nasal cavity, the mouth, the pharynx, the epiglottis, the larynx, and the upper trachea. The esophagus leads to the digestive tract. One of the features of both the upper and lower respiratory tracts is the mucociliary apparatus that protects the airways from irritating substances, and is composed of the ciliated cells and mucus-producing glands in the nasal epithelium. The glands produce a layer of mucus that traps unwanted particles as they are inhaled. These are swept toward the posterior pharynx, from where they are swallowed, spat out, sneezed, or blown out. Air passes through each of the structures of the upper respiratory tract on its way to the lower respiratory tract. When a person at rest inhales, air enters via the nose and mouth. The nasal cavity filters, warms, and humidifies air. The pharynx or throat is a tube like structure that connects the back of the nasal cavity and mouth to the larynx, a passageway for air, and the esophagus, a passageway for food. The pharynx serves as a common hallway for the respiratory and digestive tracts, allowing both air and food to pass through before entering the appropriate passageways. The pharynx contains a specialized flap-like structure called the epiglottis that lowers over the larynx to prevent the inhalation of food and liquid into the lower respiratory tract. The larynx, or voice box, is a unique structure that contains the vocal cords, which are essential for human speech. Small and triangular in shape, the larynx extends from the epiglottis to the trachea. The larynx helps control movement of the epiglottis. In addition, the larynx has specialized muscular folds that close it off and also prevent food, foreign objects, and secretions such as saliva from entering the lower respiratory tract.

LOWER RESPIRATORY TRACT The lower respiratory tract begins with the trachea, which is just below the larynx. The trachea, or windpipe, is a hollow, flexible, but sturdy air tube that contains C-shaped cartilage in its walls. The inner portion of the trachea is called the lumen. The first branching point of the respiratory tree occurs at the lower end of the trachea, which divides into two larger airways of the lower respiratory tract called the right bronchus and left bronchus. The wall of each bronchus contains substantial amounts of cartilage that help keep the airway open. Each bronchus enters a lung at a site called the hilum. The bronchi branch sequentially into secondary bronchi and tertiary bronchi. The tertiary bronchi branch into the bronchioles. The bronchioles branch several times until they arrive at the terminal bronchioles, each of which subsequently branches into two or more respiratory bronchioles. The respiratory bronchiole leads into alveolar ducts and alveoli. The alveoli are bubble-like, elastic, thin-walled structures that are responsible for the lungs most vital function: the exchange of oxygen and carbon dioxide. Each structure of the lower respiratory tract, beginning with the trachea, divides into smaller branches. This branching pattern occurs multiple times, creating multiple branches. In this way, the lower respiratory tract resembles an upside-down tree that begins with one trachea trunk and ends with more than 250 million alveoli leaves. Because of this resemblance, the lower respiratory tract is often referred to as the respiratory tree. In descending order, these generations of branches include:

trachea right bronchus and left bronchus secondary bronchi tertiary bronchi bronchioles terminal bronchioles respiratory bronchioles alveoli

THE LUNGS

The thoracic cage, or ribs, and the diaphragm bound the thoracic cavity. There are two lungs that occupy a significant portion of this cavity. The diaphragm is a broad, dome-shaped muscle that separates the thoracic and abdominal cavities and generates most of the work of breathing. The intercostal muscles, located between the ribs, also aid in respiration. The internal intercostals muscles lie close to the lungs and are covered by the external intercostals muscles. The lungs are cone-shaped organs that are soft, spongy and normally pink. The lungs cannot expand or contract on their own, but their softness allows them to change shape in response to breathing. The lungs rely on expansion and contraction of the thoracic cavity to actually generate inhalation and exhalation. This process requires contraction of the diaphragm. To facilitate the movements associated with respiration, each lung is enclosed by the pleura, a membrane consisting of two layers, the parietal pleura and the visceral pleura. The parietal pleura comprise the outer layer and are attached to the chest wall. The visceral pleura are directly attached to the outer surface of each lung. The two pleural layers are separated by a normally tiny space called the pleural cavity. A thin film of serous or watery fluid called pleural fluid lines and lubricates the pleural cavity. This fluid prevents friction and holds the pleural surfaces together during inhalation and exhalation.

G. GROWTH AND DEVELOPMENT THEORY ERIKSONS PSYCHOSOCIAL DEVELOPMENT THEORY Psychosocial Stage 7 Generativity versus Stagnation FREUDS HUMAN DEVELOPMENT THEORY Genital Stage (Puberty and after) KOHLBERGS MORAL THEORY FOWLERS STAGES OF FAITH

STAGE

Postconventional Stage

Paradoxical-consolidative

DEFINITION

He adapted and expanded Freuds theory of development to include the entire life span, believing that people continue to develop throughout life. He envisions life as a sequence of level of achievements.

Energy is directed toward full sexual maturity and function and development of skills needed to cope with the environment

OUTCOME

POSITIVE RESOLUTION (Creative, productive, and shows concern for others)

POSITIVE RESOLUTION (achievement of independence, and decision making)

The person lives autonomously and defines moral values and principles that are distinct from personal identification with group values. He lives according to principles that are universally agreed on and that the person considers appropriate for life. Universal focus. POSITIVE RESOLUTION He obeys universal rules and regulations.

Awarenes of truth from a variety of viewpoints

POSITIVE RESOLUTION (interpersonal focus)

A. DRUGS Generic Name/ Brand Name Date ordered, take/given Date changed Route of administration, dosage, frequency General action, Classification, Mechanism of action Indications/ Purpose Client response to the medication, actual side effects CNS: headache, nervousness, sedation, confusion CV: Hypotension, orthostatic hypotension GU: urine retention, impotence, UTI GI: constipation, dry mouth, nausea and vomiting. Most common: Constipation, gastric irritation, nausea, abdominal cramps, anorexia, diarrhea, dark-colored stools

Midazolam (Midazolam hydrochloride)

January 18, 2010

-thru IV -2mg

preoperative sedation(to induce Purpose is to promotes sleepiness or calmness and sleep drowsiness and relieve apprehension)

Ferrous sulfate (Feosol)

January 22, 2010

-oral -200 mg

Standard iron preparation against which other oral iron preparations are usually measured. Corrects erythropoietic abnormalities induced by iron deficiency but not stimulate erythropoiesis. May reverse gastric, esophageal, and other tissue changes caused

to treat iron deficiency (microcytic, hypochromic) anemias. Also may be used prophylactically during periods of increased iron needs, as in infancy, childhood and pregnancy.

by lack of iron. Relieves pain by centrally acting synthetic analgesic compound not chemically related to opioids receptors and inhibit reuptake of norepinephrine and serotonin Management of moderate to moderately severe pain. The extendedrelease to moderately severe pain in adults who require aroundthe-clock pain therapy for an extended period of time. Most common: Dizziness, headache, CNS stimulation, ataxia, sedation/ somnolence, vertigo. Itching/pruritus, constipation, nausea.

Tramadol (Ultram)

January 20, 2010

-oral -25mg

Ranitidine (Zantac)

January 20, 2010

-oral -150mg

Competitively inhibits gastric acid secretion by blocking the effect of histamine on histamine H2 receptors.

Relief of heartburn associated with acid indigestion and sour stomach due to certain foods and beverages

Most common: Headache, abdominal pain, constipation, diarrhea, N&V.