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INTRODUCTION
Pneumonia is an illness of the lungs and respiratory system in which the alveoli
(microscopic air-filled sacs of the lung responsible for absorbing oxygen from the
atmosphere) become inflamed and flooded with fluid. Pneumonia can result from a variety
a general term which refers to the inflammation of the lungs and Pneumonia is one of the
of the lungs. Pneumonia is a serious infection that affects the air sacs in the lungs, resulting
to significant reduction in oxygenation. Because of this, the oxygen will have difficulty
reaching the blood. If there is too little oxygen in the blood, body cells cannot work
Pneumonia is a special concern to both extremes of age – the too old and the too
young, because it is during this time the individual is most at risk, for the too old, it is for the
reason that their immune system is degenerating, while for the too young it is because their
immune system is not yet fully developed. Although these extremes of age are greatly at
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risk, Pneumonia can also affect healthy individuals, it is a common illness that affects
thousands of people in the Philippines each year. It remains as the leading cause of
Appropriate nursing care should be given to patients with Pneumonia. Health care
providers should remain vigilant with regards to dealing with this kind of disease. Nurses, in
cooperation with other members of the health care team should not only focus on the
curative aspect of the disease but to its preventive aspect as well. A patient with pneumonia
should be given appropriate care in order to hasten his/her recovery. The focus should not
only be in the patient himself but to the public as well for a person with pneumonia could
A major trial of a pneumococcal vaccine in South Africa has given children extra
The World Health Organization (WHO), which helped run the testing program, says
that pneumonia, caused by pneumococcus bacteria, is the leading cause of death in children
developed countries.
Although the lung congestion has many causes, the most common is pneumococcus.
The bacterium can also cause meningitis, ear infections and sinusitis.
The trial involved 40,000 children in Soweto, and found that the new vaccine
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In addition, the vaccine reduced the incidence of "invasive pneumococcal disease" -
where bacteria can be found in the bloodstream - by more than 80%. The invasive form of
Pneumococcal disease is one of the predatory illnesses most likely to kill HIV-
Researchers show a new type of vaccine can reduce the incidence of pneumonia in
children with and without human immunodeficiency virus (HIV). Acute respiratory
infections are a major cause of death in children under age 5. Additionally, pneumonia is
becoming increasingly resistant to antibiotics. Doctors from around the world are in search
of new methods to treat the illness. Researchers, conducted a study with nearly 40,000
children in South Africa. At 6 weeks, 10 weeks and 14 weeks of age, half of the children
received the 9-valent pneumococcal polysaccharide vaccine. All of the children received the
flu vaccine. The researchers found the pneumonia vaccine decreased the rate of the
particular strain of pneumonia in the vaccine, by 72 percent. It also reduced the rate of
decrease in these two outcomes were remarkably similar in both U.S. children and South
African children. However, in South Africa about one third of the cases of invasive disease
caused by serotypes included in the vaccine were associated with meningitis, a much higher
proportion than in the United States.” This vaccine, according to the study investigators,
may be useful in countries where HIV infection is a significant cause of pneumonia. It also
may reduce the risk of antibiotic resistance. However researchers noted an increase in
asthma in those who received the vaccine, but that reason is not yet understood.
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Another study showed particularly UT Southwestern Medical Center scientists have
help people with pneumonia recover more quickly than with antibiotics alone.
Corticosteroids are often used to treat inflammation related to infectious diseases, such as
bacterial meningitis, but they have been rendered ineffective in case of other infectious
diseases. In a new study, scientists have shown that mice with a type of severe bacterial
pneumonia, when treated with steroids and antibiotics recovered faster. The steroid treated
mice had far less inflammation in their lungs than mice treated with antibiotics alone. "Some
people might think that if you give steroids, it would counteract the effect of the antibiotic.
But it turns out you need the antibiotic to kill the bug and the steroid to make the
inflammation in the lung from the infection get better. The steroids don't kill the bugs, but
they do help restore health," said Dr. Robert Hardy, associate professor of internal medicine
and pediatrics and the study's senior author. For the study, the researchers gave a daily
to mice infected with the M pneumoniae bacterium. The animals were then evaluated after
one, three and six days of therapy. "It turns out that the group that got both the antibiotic and
the steroids did the best. The inflammation in their lungs got significantly better," said
Hardy
. While antimicrobials have been the primary therapy for M pneumoniae infection, many
physicians have tried adding steroids to the treatment regimen of patients with severe cases.
But, Hardy said that the problem is that those were individual case reports. "They never had
a control group, so it was impossible to tell what impact the addition of steroids had on
recovery," he said. The new findings suggest that giving antibiotics with steroids can help
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individuals with pneumonia get better faster. Also, the research suggests a potentially more
effective therapy for someone in the midst of an asthma attack due to M pneumoniae
infection.
The student nurses chose Pneumonia for a case study because it is a very interesting
topic. It is one of the common problems in the country. It remains the leading cause of
as a common cough and cold because it manifests almost the same signs and symptoms, for
this reason, people with this respiratory problem usually take it for granted. With this, the
student-nurses decided to choose the case of Pneumonia for their case study.
OBJECTIVES
A. Student-Nurse Centered
After the completion of the case study, the researchers will be able to:
General Objective:
Gain knowledge and deeper understanding of the disease process itself, be able to
provide the best nursing care for the client, and impart health teachings regarding the client’s
Specific Objectives:
1. Interpret the current trends and statistics regarding the disease condition;
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2. Relate the present state of the client with his personal and pertinent family history;
3. Analyze and interpret the different diagnostic and laboratory procedures, its purpose
4. Identify treatment modalities and its importance like drugs, diet and exercise;
5. Identify surgical management and its purpose that is applicable with the disease
condition;
6. Formulate nursing care plans based on the prioritized health needs of the client;
8. Impart knowledge on fellow students in providing care for clients with the same
illness.
B. Patient-Centered
After the completion of the study, the patient will be able to:
General Objective:
Acquire knowledge on the risk factors that have contributed to the development of
the disease, gain understanding of the disease process and demonstrate compliance on the
Specific Objectives:
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3. Gain knowledge on the importance of compliance to treatment regimen;
Gender : Female
Nationality : Filipino
Admission Data:
Chief Complaint : Body weakness associated with Fever & Cough for 4 days
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Time of Admission : 08:50 pm
A. HEALTH HISTORY
FDA is a non smoker and a non alcoholic. She described herself as simple and
approachable. She might have a slow voice but she said she is talkative when someone used
to talk to her. During her high school and college years, she loved to be with her friends and
boyfriend. She may look strict but deep inside she is friendly especially if she first gets a
smile from anyone. She works hard especially when she became a mother and a wife. She is
a retard teacher and a loving mother. She and her husband works very hard just to let their
children finished their courses. She has a daughter who works now in California as a nurse
and her two sons are now in texas as a seaman and a nurse. Her husband died at the age of
72, due to a cardiovascular attack. After then, she focuses more on their businesses. She
usually spends her free time watching television and listening to radio. She spent her vacant
time sleeping to relax herself. She eats three times a day excluding snacks. She usually
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sleeps between 9pm-10pm. Her rising time was at 5 am. Whenever she had a problem, she
will ask for help to her sisters and husband. But now, she will come to her daughter. She
does simple exercise every morning like walking to their garden and does household chores.
She is very religious and attends masses every Sunday, sometimes every day.
ENVIRONMENTAL HISTORY
FDA and her family owned a house at Basak Pardo, Cebu City. They live in that
place for almost 52 years. On their house, she said that they are fine and comfortable with
the place since they live there for such a long time. The space of their house is just enough
for them. But now, since she and her one daughter left there, it was big for them. They have
their own comfort room, water and electrical supply. Their neighbors are good and so
Patient seek for consultation prior to her fever and unproductive cough for 4 days
Mrs. FDA, 93 years old, widowed from Basak Pardo, Cebu City was a patient at
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VCMC. He was confined last July 21, 2010 because of body weakness, unproductive cough
When he was confined in the hospital, Mrs. FDA said that he experienced body malaise and
chills whenever he has a high grade fever. His daughter said that it was her first time that he
saw her father experienced high grade, fever of 39.4 during our duty hours of 7-3 pm.
On her early childhood, she had chicken pox and measles. Every time she had a fever
she will take paracetamol. She sometimes had a diarrhea and headache but she will just take
a medicine for it. At the age of 36 she had a cough which takes more than 1 week and her
daughter brought her to the hospital for a checkup and was advised to be admitted. She had a
diagnosis of dengue fever due to a very high fever. She remembers that she was so tired at
that time that she can’t even walk for a while. She received a complete immunization. She
was not able to undergone any operation and was never experienced to be injured. She does
Patient states that in his father’s side there is no genetic factor or illness inherited. In
contrary, hypertension is in the bloodline of his mother’s side. Patient belongs to a nuclear
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type of family. They were 6, two girls and two boys including her mother and father. She is
a. Nails
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Nail base Inspection Firm Firm Normal
Capillary refill Inspection/ White color of nail Returns within 2-3 Normal
Palpation bed under pressure seconds
should return to Normal
pink within 2-3
seconds
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symmetrically
Transparent with
light pink color
Transparent with
light pink color
Conjunctiva Inspection Normal
Mouth and Inspection Pink, moist Light pink, dry, Lack of fluid
Pharynx symmetric symmetric intake
Lips
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Gums Inspection Slightly pink color, Slightly pink color, Normal
moist and tightly moist and tightly
fit fit
against each tooth against each tooth
Hard and soft Inspection Hard palate- dome- Hard palate- dome- Normal
palate shaped shaped
Soft Palate- light Soft Palate- light
pink pink
Neck ROM Inspection Neck moves freely, Neck moves freely, Normal
without discomfort without discomfort
Thyroid gland Palpation Rises freely with Rises freely with Normal
swallowing swallowing
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minute
Extremities
Symmetrical
Symmetry Inspection Symmetrical Normal
Same with the
color of other parts
of the body
Skin color Inspection Same with the Normal
Evenly distributed color of other parts
of the body
Warm to touch
No lesions
unevenly
Hair distribution Inspection Moves freely distributed Normal
without discomfort
Presence of No lesions
lesion Inspection Normal
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GORDONS 11 FUNCTIONAL HEALTH PATTERN
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Role Relationship - she was able to do his - this time her role as a - due to her condition
Pattern responsibility as a mother patient is not fully met she is not aware of
performing his real
role in this field.
B. PHYSICAL EXAMINATION
• Flushed skin
• (-) Edema
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• Vital Signs:
• General appearance:
o irritable
• General appearance:
o irritable
• Vital Signs:
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o Body temperature of 37.6 OC (febrile) (Normal=36.8OC)
• Head:
• Skin:
o Fair complexion
o (-) cyanosis
o Flushed skin
o Pale skin
• Hair:
• Nails:
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o Both eyes are symmetrical
• Ears:
o No presence of discharges
o No lesions noted
• Mouth:
• Neck:
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o Absence of masses
• Abdomen:
• Extremities:
o No deformities
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• General appearance:
o irritable
• Vital Signs:
• Head:
• Skin:
o Fair complexion
o (-) cyanosis
o Flushed skin
o Pale skin
• Hair:
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o No presence of dandruff and pediculosis upon inspection
• Nails:
• Ears:
o No presence of discharges
o No lesions noted
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• Mouth:
• Neck:
o Absence of masses
• Abdomen:
• Extremities:
o No deformities
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IV. ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM
Respiratory System, in anatomy and physiology, organs that deliver oxygen to the
circulatory system for transport to all body cells. Oxygen is essential for cells, which use this
vital substance to liberate the energy needed for cellular activities. In addition to supplying
oxygen, the respiratory system aids in removing of carbon dioxide, preventing the lethal
buildup of this waste product in body tissues. Day-in and day-out, without the prompt of
conscious thought, the respiratory system carries out its life-sustaining activities. If the
respiratory system’s tasks are interrupted for more than a few minutes, serious, irreversible
damage to tissues occurs, followed by the failure of all body systems, and ultimately, death.
While the intake of oxygen and removal of carbon dioxide are the primary functions
of the respiratory system, it plays other important roles in the body. The respiratory system
helps regulate the balance of acid and base in tissues, a process crucial for the normal
functioning of cells. It protects the body against disease-causing organisms and toxic
substances inhaled with air. The respiratory system also houses the cells that detect smell,
The respiratory and circulatory systems work together to deliver oxygen to cells and
remove carbon dioxide in a two-phase process called respiration. The first phase of
respiration begins with breathing in, or inhalation. Inhalation brings air from outside the
body into the lungs. Oxygen in the air moves from the lungs through blood vessels to the
heart, which pumps the oxygen-rich blood to all parts of the body. Oxygen then moves from
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the bloodstream into cells, which completes the first phase of respiration. In the cells,
produces carbon dioxide as a byproduct. The second phase of respiration begins with the
movement of carbon dioxide from the cells to the bloodstream. The bloodstream carries
carbon dioxide to the heart, which pumps the carbon dioxide-laden blood to the lungs. In the
lungs, breathing out, or exhalation, removes carbon dioxide from the body, thus completing
STRUCTURE
The organs of the respiratory system extend from the nose to the lungs and are
divided into the upper and lower respiratory tracts. The upper respiratory tract consists of the
nose and the pharynx, or throat. The lower respiratory tract includes the larynx, or voice
box; the trachea, or windpipe, which splits into two main branches called bronchi; tiny
branches of the bronchi called bronchioles; and the lungs, a pair of saclike, spongy organs.
The nose, pharynx, larynx, trachea, bronchi, and bronchioles conduct air to and from the
lungs. The lungs interact with the circulatory system to deliver oxygen and remove carbon
dioxide.
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NASAL PASSAGES
The uppermost portion of the human respiratory system, the nose is a hollow air
passage that functions in breathing and in the sense of smell. The nasal cavity moistens and
warms incoming air, while small hairs and mucus filter out harmful particles and
microorganisms.
The flow of air from outside of the body to the lungs begins with the nose, which is
divided into the left and right nasal passages. The nasal passages are lined with a membrane
composed primarily of one layer of flat, closely packed cells called epithelial cells. Each
epithelial cell is densely fringed with thousands of microscopic cilia, fingerlike extensions of
the cells. Interspersed among the epithelial cells are goblet cells, specialized cells that
produce mucus, a sticky, thick, moist fluid that coats the epithelial cells and the cilia.
Numerous tiny blood vessels called capillaries lie just under the mucous membrane, near the
surface of the nasal passages. While transporting air to the pharynx, the nasal passages play
two critical roles: they filter the air to remove potentially disease-causing particles; and they
moisten and warm the air to protect the structures in the respiratory system.
substances from entering the lungs, where they may cause infection. Filtering also
eliminates smog and dust particles, which may clog the narrow air passages in the smallest
bronchioles. Coarse hairs found just inside the nostrils of the nose trap airborne particles as
they are inhaled. The particles drop down onto the mucous membrane lining the nasal
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passages. The cilia embedded in the mucous membrane wave constantly, creating a current
of mucus that propels the particles out of the nose or downward to the pharynx. In the
pharynx, the mucus is swallowed and passed to the stomach, where the particles are
destroyed by stomach acid. If more particles are in the nasal passages than the cilia can
handle, the particles build up on the mucus and irritate the membrane beneath it. This
irritation triggers a reflex that produces a sneeze to get rid of the polluted air.
The nasal passages also moisten and warm air to prevent it from damaging the
delicate membranes of the lung. The mucous membranes of the nasal passages release water
vapor, which moistens the air as it passes over the membranes. As air moves over the
extensive capillaries in the nasal passages, it is warmed by the blood in the capillaries. If the
nose is blocked or “stuffy” due to a cold or allergies, a person is forced to breathe through
the mouth. This can be potentially harmful to the respiratory system membranes, since the
In addition to their role in the respiratory system, the nasal passages house cells
called olfactory receptors, which are involved in the sense of smell. When chemicals enter
the nasal passages, they contact the olfactory receptors. This triggers the receptors to send a
PHARYNX
Air leaves the nasal passages and flows to the pharynx, a short, funnel-shaped tube
about 13 cm (5 in) long that transports air to the larynx. Like the nasal passages, the pharynx
is lined with a protective mucous membrane and ciliated cells that remove impurities from
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the air. In addition to serving as an air passage, the pharynx houses the tonsils, lymphatic
tissues that contain white blood cells. The white blood cells attack any disease-causing
organisms that escape the hairs, cilia, and mucus of the nasal passages and pharynx. The
tonsils are strategically located to prevent these organisms from moving further into the
body. One tonsil, called the adenoids, is found high in the rear wall of the pharynx. A pair of
tonsils, the palatine tonsils, is located at the back of the pharynx on either side of the tongue.
Another pair, the lingual tonsils, is found deep in the pharynx at the base of the tongue. In
their battles with disease-causing organisms, the tonsils sometimes become swollen with
infection. When the adenoids are swollen, they block the flow of air from the nasal passages
LARYNX
Air moves from the pharynx to the larynx, a structure about 5 cm (2 in) long located
approximately in the middle of the neck. Several layers of cartilage, a tough and flexible
tissue, comprise most of the larynx. A protrusion in the cartilage called the Adam’s apple
sometimes enlarges in males during puberty, creating a prominent bulge visible on the neck.
While the primary role of the larynx is to transport air to the trachea, it also serves
other functions. It plays a primary role in producing sound; it prevents food and fluid from
entering the air passage to cause choking; and its mucous membranes and cilia-bearing cells
help filter air. The cilia in the larynx waft airborne particles up toward the pharynx to be
swallowed.
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Food and fluids from the pharynx usually are prevented from entering the larynx by
the epiglottis, a thin, leaflike tissue. The “stem” of the leaf attaches to the front and top of
the larynx. When a person is breathing, the epiglottis is held in a vertical position, like an
open trap door. When a person swallows, however, a reflex causes the larynx and the
epiglottis to move toward each other, forming a protective seal, and food and fluids are
routed to the esophagus. If a person is eating or drinking too rapidly, or laughs while
swallowing, the swallowing reflex may not work, and food or fluid can enter the larynx.
Food, fluid, or other substances in the larynx initiate a cough reflex as the body attempts to
clear the larynx of the obstruction. If the cough reflex does not work, a person can choke, a
larynx (see First Aid). A surgical procedure called a tracheotomy is used to bypass the
Air passes from the larynx into the trachea, a tube about 12 to 15 cm (about 5 to 6 in)
long located just below the larynx. The trachea is formed of 15 to 20 C-shaped rings of
cartilage. The sturdy cartilage rings hold the trachea open, enabling air to pass freely at all
times. The open part of the C-shaped cartilage lies at the back of the trachea, and the ends of
The base of the trachea is located a little below where the neck meets the trunk of the
body. Here the trachea branches into two tubes, the left and right bronchi, which deliver air
to the left and right lungs, respectively. Within the lungs, the bronchi branch into smaller
tubes called bronchioles. The trachea, bronchi, and the first few bronchioles contribute to the
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cleansing function of the respiratory system, for they, too, are lined with mucous membranes
Human Lungs
In humans the lungs occupy a large portion of the chest cavity from the collarbone
down to the diaphragm. The right lung is divided into three sections, or lobes. The left lung,
with a cleft to accommodate the heart, has only two lobes. The two branches of the trachea,
called bronchi, subdivide within the lobes into smaller and smaller air vessels known as
bronchioles. Bronchioles terminate in alveoli, tiny air sacs surrounded by capillaries. When
the alveoli inflate with inhaled air, oxygen diffuses into the blood in the capillaries to be
pumped by the heart to the tissues of the body. At the same time carbon dioxide diffuses out
The bronchioles divide many more times in the lungs to create an impressive tree
with smaller and smaller branches, some no larger than 0.5 mm (0.02 in) in diameter. These
branches dead-end into tiny air sacs called alveoli. The alveoli deliver oxygen to the
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circulatory system and remove carbon dioxide. Interspersed among the alveoli are numerous
macrophages, large white blood cells that patrol the alveoli and remove foreign substances
that have not been filtered out earlier. The macrophages are the last line of defense of the
respiratory system; their presence helps ensure that the alveoli are protected from infection
Alveoli
A scanning electron micrograph reveals the tiny sacs known as alveoli within a
section of human lung tissue. Human beings have a thin layer of about 700 million alveoli
within their lungs. This layer is crucial in the process called respiration, exchanging oxygen
The alveoli number about 150 million per lung and comprise most of the lung tissue.
Alveoli resemble tiny, collapsed balloons with thin elastic walls that expand as air flows into
them and collapse when the air is exhaled. Alveoli are arranged in grapelike clusters, and
each cluster is surrounded by a dense hairnet of tiny, thin-walled capillaries. The alveoli and
capillaries are arranged in such a way that air in the wall of the alveoli is only about 0.1 to
0.2 microns from the blood in the capillary. Since the concentration of oxygen is much
higher in the alveoli than in the capillaries, the oxygen diffuses from the alveoli to the
capillaries. The oxygen flows through the capillaries to larger vessels, which carry the
oxygenated blood to the heart, where it is pumped to the rest of the body.
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Carbon dioxide that has been dumped into the bloodstream as a waste product from
cells throughout the body flows through the bloodstream to the heart, and then to the
alveolar capillaries. The concentration of carbon dioxide in the capillaries is much higher
than in the alveoli, causing carbon dioxide to diffuse into the alveoli. Exhalation forces the
carbon dioxide back through the respiratory passages and then to the outside of the body.
As the diaphragm contracts and moves downward, the pectoralis minor and
intercostal muscles pull the rib cage outward. The chest cavity expands, and air rushes into
the lungs through the trachea to fill the resulting vacuum. When the diaphragm relaxes to its
The flow of air in and out of the lungs is controlled by the nervous system, which
ensures that humans breathe in a regular pattern and at a regular rate. Breathing is carried
out day and night by an unconscious process. It begins with a cluster of nerve cells in the
brain stem called the respiratory center. These cells send simultaneous signals to the
diaphragm and rib muscles, the muscles involved in inhalation. The diaphragm is a large,
dome-shaped muscle that lies just under the lungs. When the diaphragm is stimulated by a
nervous impulse, it flattens. The downward movement of the diaphragm expands the volume
of the cavity that contains the lungs, the thoracic cavity. When the rib muscles are
stimulated, they also contract, pulling the rib cage up and out like the handle of a pail. This
movement also expands the thoracic cavity. The increased volume of the thoracic cavity
causes air to rush into the lungs. The nervous stimulation is brief, and when it ceases, the
diaphragm and rib muscles relax and exhalation occurs. Under normal conditions, the
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respiratory center emits signals 12 to 20 times a minute, causing a person to take 12 to 20
The rhythm set by the respiratory center can be altered by conscious control. The
breathing pattern changes when a person sings or whistles, for example. A person also can
alter the breathing pattern by holding the breath. The cerebral cortex, the part of the brain
involved in thinking, can send signals to the diaphragm and rib muscles that temporarily
override the signals from the respiratory center. The ability to hold one’s breath has survival
value. If a person encounters noxious fumes, for example, it is possible to avoid inhaling the
fumes.
A person cannot hold the breath indefinitely, however. If exhalation does not occur,
carbon dioxide accumulates in the blood, which, in turn, causes the blood to become more
acidic. Increased acidity interferes with the action of enzymes, the specialized proteins that
participate in virtually all biochemical reaction in the body. To prevent the blood from
becoming too acidic, the blood is monitored by special receptors called chemoreceptors,
located in the brainstem and in the blood vessels of the neck. If acid builds up in the blood,
the chemoreceptors send nervous signals to the respiratory center, which overrides the
signals from the cerebral cortex and causes a person to exhale and then resume breathing.
These exhalations expel the carbon dioxide and bring the blood acid level back to normal.
A person can exert some degree of control over the amount of air inhaled, with some
limitations. To prevent the lungs from bursting from overinflation, specialized cells in the
lungs called stretch receptors measure the volume of air in the lungs. When the volume
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reaches an unsafe threshold, the stretch receptors send signals to the respiratory center,
which shuts down the muscles of inhalation and halts the intake of air.
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