Anatomy and Physiology

Respiratory System
The Respiratory System provides Oxygen to the body cells while removing Carbon Dioxide, a
waste product that can be lethal if allowed to accumulate. The respiratory system involves processes
such as ventilation (breathing), the exchange of Oxygen and Carbon Dioxide between the air in the
Lungs and Blood, the transport of Oxygen and Carbon Dioxide in the blood, and the exchange of
oxygen and carbon dioxide between the blood and tissues.

The respiratory system is divided into the upper respiratory system and lower respiratory system.
The upper respiratory system includes the nose, nasal cavity, and the pharynx; while the lower
respiratory system includes the larynx, trachea, bronchi, and the lungs. There are primary muscles for
respiration like the diaphragm, the internal and external intercostals. The upper respiratory tract
humidifies inhaled air, and also provides taste, smell, and chewing and swallowing food. In the upper
respiratory tract, involuntary defense mechanisms like sneezing, coughing, gagging, and spasms that
help protect the respiratory system from infection, and to prevent foreign body inhalation.

Air enters the body through the nostrils, where small hairs filter out dust and large foreign
particles. Air then passes into the 2 nasal passages, which are separated by the septum. Cartilage forms
the anterior walls of the nasal passages; bony structures (conchae or turbinates) form the posterior
walls. The conchae cleanse, warm, and humidify air before it passes into the nasopharynx. Their mucus
layer also traps finer foreign particles, which the cilia carry to the pharynx to be swallowed.

The pharynx is the common passageway for both the respiratory and digestive systems. Air from
the nasal cavity and air, food, and water from the mouth pass through the pharynx. The pharynx can be
divided into 3 regions: the nasopharynx, oropharynx, and laryngopharynx. The nasopharynx is the
superior part of the pharynx. The oropharynx extends from the uvula to the epiglottis, and the oral
cavity opens into the oropharynx. Thus, foods, drinks, and air all pass to the oropharynx. The
oropharynx is lined with stratified squamous epithelium, which protects against abrasion. The
laryngopharynx passes posterior to the larynx and extends from the tip of the epiglottis to the
esophagus.

The larynx, which contains the vocal cords, connects the pharynx with the trachea. The trachea, or
windpipe, is a membranous tube attached to the larynx. C-shaped cartilage rings reinforce and protect
the trachea, preventing its collapse and maintain an open passageway for air. The Trachea divides into
the left and right main bronchi, or primary bronchi. The primary bronchi deliver air to the left and right
lungs. The primary bronchi divide into five lobar bronchi and these enter the pleural cavities and the
lungs. Each lobar bronchus enters a lobe in each lung, within its lobe, each of the lobar bronchi
branches into segmental bronchi. The segments continue to branch into smaller and smaller bronchi,
finally branching into bronchioles.

Each bronchiole branches into a lobule. The lobule includes terminal bronchioles and the acinus-
the chief respiratory unit for gas exchange. Within the acinus, the terminal bronchioles branches into
respiratory bronchioles which feed directly into the alveoli, which are small air sacs. Gas exchange
takes place throughout the thin-walled respiratory bronchioles and the alveoli.
 The lungs are the principal organs for respiration. The respiratory membrane of the lungs is where
gas exchange between the air and blood takes place. The respiratory system has layers to facilitate the
diffusion of gases.

Once the inspired air reaches the smallest part of the lungs, the alveoli, gaseous exchange can take
place. This refers to the process of Oxygen and Carbon Dioxide moving between the lungs and blood.

Diffusion occurs when molecules move from an area of high concentration (of that molecule) to an area
of low concentration. This occurs during gaseous exchange as the blood in the capillaries surrounding
the alveoli has a lower oxygen concentration of Oxygen than the air in the alveoli which has just been
inhaled. Both alveoli and capillaries have walls which are only one cell thick and allow gases to diffuse
across them. The same happens with Carbon Dioxide (CO2). The blood in the surrounding capillaries
has a higher concentration of CO2 than the inspired air due to it being a waste product of energy
production. Therefore CO2 diffuses the other way, from the capillaries, into the alveoli where it can
then be exhaled. When Oxygen diffuses into the blood it attaches to hemoglobin in red blood cells to be
transported via the circulatory system.

If the circulatory system is inadequate, or there is a reduced amount of hemoglobin or red blood cells
(anemia or blood loss, for example), then the respiratory rate and effort might increase to try and
compensate.

Cardiovascular System
The cardiovascular system refers to the heart, blood vessels and the blood. Blood contains oxygen and
other nutrients which your body needs to survive. The body takes these essential nutrients from the
blood. At the same time, the body dumps waste products like carbon dioxide, back into the blood, so
they can be removed. The main function of the cardiovascular system is therefore to maintain blood
flow to all parts of the body, to allow it to survive. Veins deliver used blood from the body back to the
heart. Blood in the veins is low in oxygen (as it has been taken out by the body) and high in carbon
dioxide (as the body has unloaded it back into the blood). All the veins drain into the superior and
inferior vena cava which then drain into the right atrium. The right atrium pumps blood into the right
ventricle. Then the right ventricle pumps blood to the pulmonary trunk, through the pulmonary arteries
and into the lungs. In the lungs the blood picks up oxygen that we breathe in and gets rid of carbon
dioxide, which we breathe out. The blood is becomes rich in oxygen which the body can use. From the
lungs, blood drains into the left atrium and is then pumped into the left ventricle. The left ventricle then
pumps this oxygen-rich blood out into the aorta which then distributes it to the rest of the body through
other arteries. The main arteries which branch off the aorta and take blood to specific parts of the body
are:

Carotid arteries, which take blood to the neck and head

Coronary arteries, which provide blood supply to the heart itself
Hepatic artery, which takes blood to the liver with branches going to the stomach
Mesenteric artery, which takes blood to the intestines
Renal arteries, which takes blood to the kidneys
Femoral arteries, which take blood to the legs

The body is then able to use the oxygen in the blood to carry out its normal functions. This blood will
again return back to the heart through the veins and the cycle continues.
Structure and Function of the Heart

Function and Location of the Heart

The heart’s job is to pump blood around the body. The heart is located in between the two lungs. It lies
left of the middle of the chest.

Structure of the Heart

The heart is a muscle about the size of a fist, and is roughly cone-shaped. It is about 12cm long, 9cm
across the broadest point and about 6cm thick. The pericardium is a fibrous covering which wraps
around the whole heart. It holds the heart in place but allows it to move as it beats. The wall of the heart
itself is made up of a special type of muscle called cardiac muscle.

Chambers of the Heart

The heart has two sides, the right side and the left side. The heart has four chambers. The left and right
side each have two chambers, a top chamber and a bottom chamber. The two top chambers are known
as the left and right atria (singular: atrium). The atria receive blood from different sources. The left
atrium receives blood from the lungs and the right atrium receives blood from the rest of the body. The
bottom two chambers are known as the left and right ventricles. The ventricles pump blood out to
different parts of the body. The right ventricle pumps blood to the lungs while the left ventricle pumps
out blood to the rest of the body. The ventricles have much thicker walls than the atria which allows
them to perform more work by pumping out blood to the whole body.

Blood Vessels
Blood Vessel are tubes which carry blood. Veins are blood vessels which carry blood from the body
back to the heart. Arteries are blood vessels which carry blood from the heart to the body. There are
also microscopic blood vessels which connect arteries and veins together called capillaries. There are a
few main blood vessels which connect to different chambers of the heart. The aorta is the largest artery
in our body. The left ventricle pumps blood into the aorta which then carries it to the rest of the body
through smaller arteries. The pulmonary trunk is the large artery which the right ventricle pumps into.
It splits into pulmonary arteries which take the blood to the lungs. The pulmonary veins take blood
from the lungs to the left atrium. All the other veins in our body drain into the inferior vena cava (IVC)
or the superior vena cava (SVC). These two large veins then take the blood from the rest of the body
into the right atrium.

Valves
Valves are fibrous flaps of tissue found between the heart chambers and in the blood vessels. They are
rather like gates which prevent blood from flowing in the wrong direction. They are found in a number
of places. Valves between the atria and ventricles are known as the right and left atrioventricular valves,
otherwise known as the tricuspid and mitral valves respectively. Valves between the ventricles and the
great arteries are known as the semilunar valves. The aortic valve is found at the base of the aorta,
while the pulmonary valve is found the base of the pulmonary trunk. There are also many valves found
in veins throughout the body. However, there are no valves found in any of the other arteries besides
the aorta and pulmonary trunk.

Electrical Activity of the Heart

 To pump blood throughout the body, the muscles of the heart must be coordinated perfectly —
squeezing the blood in the right direction, at the right time, at the right pressure. The heart's activity is
coordinated by electrical impulses.
The electrical signal begins at the sino-atrial (or sinus, SA) node — the heart's pacemaker, positioned at
the top of the right atrium. This signal causes the atria to contract, pushing blood down into the
ventricles.

The electrical impulse travels to an area of cells at the bottom of the right atrium called the
atrioventricular (AV) node. These cells act as a gate; they slow the signal down so that the atria and
ventricles do not contract at the same time — there needs to be a slight delay.
From here, the signal is carried along special fibers called Purkinje fibers within the ventricle walls;
they pass the impulse to the heart muscle, causing the ventricles to contract.

An estimated 329,766 patients discharged from nonfederal hospitals nationwide in 1994 met study
criteria for ARF. The incidence of ARF was 137.1 hospitalizations per 100,000 US residents age > or =
5 years. Incidence increased nearly exponentially each decade until age 85 years. Overall, 35.9% of
patients with ARF did not survive to hospital discharge. At 31 days, hospital mortality was 31.4%.
According to the proportional hazards model, significant mortality hazards included age (> or = 80
years and > or = 30 years), multiorgan system failure (MOSF), HIV, chronic liver disease, and cancer.
Hospital admission for coronary artery bypass, drug overdose, or trauma other than head injury or
burns was associated with a reduced mortality hazard. Interaction was present between age and MOSF,
trauma, and cancer. A point system derived from the hazard model classified patients into seven groups
with distinct 31-day survival probabilities ranging from 24 to 99%.
CONCLUSIONS: The incidence of ARF increases markedly with age and is especially high among
persons > or = 65 years of age. Nonpulmonary hazards explain short-term (31-day) survival. Acute
respiratory failure occurs when fluid builds up in the air sacs in your lungs. When that happens, your
lungs can’t release oxygen into your blood. In turn, your organs can’t get enough oxygen-rich blood to
function. You can also develop acute respiratory failure if your lungs can’t remove carbon dioxide from
your blood. Respiratory failure happens when the capillaries, or tiny blood vessels, surrounding your
air sacs can’t properly exchange carbon dioxide for oxygen. The condition can be acute or chronic.
With acute respiratory failure, you experience immediate symptoms from not having enough oxygen in
your body. In most cases, this failure may lead to death if it’s not treated quickly. Respiratory failure is
classified according to blood gases abnormalities into type 1 and type 2.Both conditions can trigger
serious complications and the conditions often coexist. Type 1(hypoxemic) respiratory failure: in which
PaO2 < 60 mmHg with normal or subnormal PaCO2.In this type the gas exchange is impaired at the
level of aveolo-capillary membrane. Examples of type I respiratory failure is carcinogenic or non-
cardiogenic pulmonary edema and severe pneumonia.
Symptoms and signs of hypoxemia
• Dyspnea,irritability
• Confusion, somnolence, fits
• Tachycardia, arrhythmia
• Tachypnea
• Cyanosis Type 2 (hypercapnic) respiratory failure: in which PaCO2 > 50 mmHg.

Hypoxemia is common and it is due to respiratory pump failure. Also respiratory failure is classified
according to its onset, course and duration into acute, chronic and acute on top of chronic respiratory
failure.
Symptoms and signs of hypercapnia
• Headache
• Change of behavior
• Coma
• Asterixis
• Papilloedema
• Warm extremities

The symptoms of acute respiratory failure depend on its underlying cause and the levels of carbon
dioxide and oxygen in your blood. People with a high carbon dioxide level may experience:
• rapid breathing
• confusion People with low oxygen levels may experience:
• an inability to breathe
• bluish coloration in the skin, fingertips, or lips.

People with acute failure of the lungs and low oxygen levels may experience:
• restlessness
• anxiety
• sleepiness
• loss of consciousness
• rapid and shallow breathing
• racing heart
• irregular heartbeats (arrhythmias)
• profuse sweating.

Acute respiratory failure has several different causes: Obstruction When something lodges in your
throat, you may have trouble getting enough oxygen into your lungs. Obstruction can also occur in
people with chronic obstructive pulmonary disease (COPD) or asthma when an exacerbation causes the
airways to become narrow. Injury An injury that impairs or compromises your respiratory system can
adversely affect the amount of oxygen in your blood. For instance, an injury to the spinal cord or brain
can immediately affect your breathing. The brain tells the lungs to breathe. If the brain can’t relay
messages due to injury or damage, the lungs can’t continue to function properly. An injury to the ribs or
chest can also hamper the breathing process. These injuries can impair your ability to inhale enough
oxygen into your lungs. Acute respiratory distress syndrome Acute respiratory distress syndrome
(ARDS) is a serious condition characterized by low oxygen in the blood. ARDS affects you if you
already have an underlying health problem such as:
• pneumonia
• pancreatitis (inflammation of the pancreas)
• severe trauma
• sepsis
• severe brain injuries
• lung injuries caused by inhalation of smoke or chemical products.

It can occur while you’re in the hospital being treated for your underlying condition. Drug or alcohol
abuse If you overdose on drugs or drink too much alcohol, you can impair brain function and hinder
your ability to breathe in or exhale. Chemical inhalation Inhaling toxic chemicals, smoke,

Chemical inhalation
Inhaling toxic chemicals, smoke, or fumes can also cause acute respiratory failure. These chemicals
may injure or damage the tissues of your lungs, including the air sacs and capillaries.

Stroke
A stroke occurs when your brain experiences tissue death or damage on one or both sides of the brain.
Often, it affects only one side. Although stroke does present some warning signs, such as slurred
speech or confusion, it typically occurs quickly. If you have a stroke, you may lose your ability to
breathe properly.

Infection
Infections are a common cause of respiratory distress. Pneumonia in particular, may cause respiratory
failure, even in the absence of ARDS. According to the Mayo Clinic, in some cases pneumonia affects
all five lobes of the lungs.

You may be at risk for acute respiratory failure if you:

• smoke tobacco products
• drink alcohol excessively
• have a family history of respiratory disease or conditions
• sustain an injury to the spine, brain, or chest
• have a compromised immune system
• have chronic (long-term) respiratory problems, such as cancer of the lungs, chronic obstructive
pulmonary disease (COPD), or asthma

Diagnosing acute respiratory failure

Acute respiratory failure requires immediate medical attention. You may receive oxygen to help you
breathe and to prevent tissue death in your organs and brain.
After your doctor stabilizes you, he or she will take certain steps to diagnose your condition, such as:
• perform a physical exam
• ask you questions about your family or personal health history
• check your body’s oxygen and carbon dioxide levels level with a pulse oximetry device and an
arterial blood gas test
• order a chest X-ray to look for abnormalities in your lungs

Treating acute respiratory failure

Treatment usually addresses any underlying conditions you may have. Your doctor will then treat your
respiratory failure with a variety of options.
• Your doctor may prescribe pain medications or other medicines to help you breathe better.
• If you can breathe adequately on your own and your hypoxemia is mild, you may receive oxygen
from an oxygen tank to help you breathe better. Portable air tanks are available if your condition
requires one.
• If you can’t breathe adequately on your own, your doctor may insert a breathing tube into your mouth
or nose, and connect the tube to a ventilator to help you breathe.
• If you require prolonged ventilator support, an operation that creates an artificial airway in the
windpipe called a tracheostomy may be necessary.
• You may receive oxygen via an oxygen tank or ventilator to help you breathe better.

Nursing management
-Patients with acute respiratory failure should be closely observed for potential deterioration.
-Respiratory assessment should occur on a frequent/continual basis.
-Monitoring may involve intermittent/continual pulse oximetry and regular peak expiratory flow rate
measurement but should always include basic respiratory rate monitoring and general assessment.
-Physiological track and trigger warning systems are widely used to identify patients on general wards
at risk of clinical deterioration (NICE, 2007).These systems provide a framework to access higher
levels of care.
-Patients at risk of developing acute respiratory failure are an ideal group for these systems and their
use should be encouraged.
-Any changes in physiological signs should be reported promptly to the senior practitioner.

https://www.ncbi.nlm.nih.gov/m/pubmed/11035684/
https://www.healthline.com/health/acute-respiratory-failure#treatment
https://www.nursingtimes.net/clinical-archive/respiratory/acute-respiratory-failure-2-nursing-
management/1852446.article