NURS 123 Final (Pumonary System)

jasmine's version from 2016-02-15 06:02

Section 1

Question Answer
Pulmonary System Primary function of the pulmonary system is the exchange of gases between the environmental air and the blood; Consists of upper and lower airways, two lungs, the chest wall (thoracic cage), pulmonary circulation, diaphragm and the blood vessels that serve the system; Normally functions efficiently under a variety of conditions and with little energy expenditure
3 steps of the primary function of the pulmonary system Ventilation (pulmonary system), Diffusion (pulmonary system), and Perfusion (cardiovascular system)
Ventilation The movement of air into and out of the lungs by the pulmonary system
Diffusion The movement of gases between air spaces in the lungs and the bloodstream by the pulmonary system
Perfusion The movement of blood into and out of the capillary beds of the lungs to body organs and tissues by the cardiovascular system
Right lung Contains 3 lobes with each lobe divided into segments and lobules
Left lung Contains 2 lobes with each lobe divided into segments and lobules
Mediastinum Space between the lungs that contains the heart, great vessels, and esophagus
Bronchi A set of conducting airways that deliver air to each section of the lung; The lung tissue that surrounds the airways supports this, preventing their distortion or collapse as gas moves in and out during ventilation
Diaphragm Dome-shaped muscle that separates the thoracic and abdominal cavities and is involved in ventilation
Pulmonary Defense Mechanisms (exogenous contaminants) 1) Upper respiratory tract mucosa, 2) Nasal hairs and turbinates, 3) Mucous blanket, 4) cilia, 5) Alveolar macrophages, 6) Surfactant, 7) Irritant receptors in nares, 8) Irritant receptors in trachea and large airways
Upper Respiratory Tract Mucosa Maintains constant temperature and humidification of gas entering the lungs; traps and removes foreign particles, some bacteria, and noxious gases from inspired air
Nasal Hairs and Turbinates Trap and remove foreign particles, some bacteria, and noxious gases from inspired air
Mucous Blanket Protects trachea and bronchi from injury; traps most foreign particles and bacteria that reach the lower airways
Cilia Propel mucous blanket and entrapped particles toward the oropharynx, where they can be swallowed or expectorated
Alveolar Macrophages Ingest and remove bacteria and other foreign material from alveoli by phagocytosis
Surfactant A lipoprotein that coats the inner surface of the alveolus and facilitates its expansion during inspiration, lowers alveolar surface tension at end-expiration, and thereby, prevents lung collapse; It also enhances phagocytosis of pathogens and allergens in alveoli; down-regulate inflammatory responses
Irritant Receptors in Nares (nostrils)Stimulation by chemical or mechanical irritants triggers sneeze reflex, which results in rapid removal of irritants from nasal passages
Irritant Receptors in Trachea and Large Airways Stimulation by chemical or mechanical irritants triggers cough reflex, which results in removal of irritants from the trachea and large airways
Upper Airway Called the nasopharynx, oropharynx, and related structures
Nasopharynx, Oropharynx, and related structures Lined with a ciliated mucosa with a very rich vascular supply
Mucosal Lining Warms and humidifies inspired air to 100 percent, and removes foreign particles from it as it passes into the lungs
Quiet Breathing Gas usually flows through the nose, nasopharynx, and oropharynx to the lower airways
Mouth and Oropharynx Filtering and humidifying are not as efficient with mouth breathing; Provide for ventilation when the nose is obstructed or when increased flow is required, such as during exercise
Larynx Connects the upper and lower airways; Consists of the endolarynx, and its surrounding triangular-shaped bony and cartilaginous structures
Endolarynx Formed by two pairs of folds that form the false vocal cords (supraglottis) and the true vocal cords
Glottis The slit-shaped space between the true cords
Vestibule The space above the false vocal cords
Laryngeal Box Formed by three large cartilages: epiglottis, thyroid, and cricoid; and three smaller cartilages: arytenoid, corniculate, and cuneiform that are connected by ligaments; The supporting carilages prevent the collapse of the larynx during inspiration and swallowing
Internal Laryngeal MusclesControl vocal cord length and tension; Contract during swallowing to prevent aspiration into the trachea and contributes to voice pitch
External Laryngeal Muscles Move the larynx as a whole
Internal and External Laryngeal Muscles Important to swallowing, respiration, and vocalization
Trachea Supported by U-shaped cartilage, connects the larynx to the bronchi, the conducting airways of the lungs; This divides into the two main airways, or bronchi, at the carina; When stimulated, this area can cause coughing and airway narrowing due to sensitivity
Left main stem bronchus Branches from the trachea at about a 45 degree angle
Right main stem bronchus Slightly larger than the other, and more vertical than the other by branches at about a 20 to 30 degree angle form the trachea; **Aspirated fluids or foreign particles thus tend to enter the right lung rather than the left
Right and left main bronchi Enter the lungs at the hila, or roots, of the lungs, along with the pulmonary blood and lymphatic vessels
Hila Lung roots that are relatively complicated structures that consist mainly of the major bronchi the pulmonary arteries and veins
From the hila The main bronchi branch into lobar bronchi, then to segmental and sub-segmental bronchi, and finally end at the 16th division in the smallest of the conducting airways, the terminal bronchioles; **With these multiple divisions, the cross-sectional area of the airways increases to 20 times that of the trachea
What is the result of the cross-sectional area of the airways increasing to 20 times that of the trachea? Decreased velocity of airflow into the gas-exchange portion of the lung and allows for optimal gas diffusion
3 layers of the bronchial walls Epithelial lining, smooth muscle layer, and connective tissue layer
Large Bronchi (to approximately the 10th division) The connective tissue layer contains cartilage

Section 2

Question Answer
Epithelial Lining Contains single-celled exocrine glands, mucus-secreting goblet cells, and ciliated cells
High Columnar Pseudostratified Epithelium Lines the larger airways, changing to columnar cuboidal epithelium in the bronchioles
Submucosal Glands Produce mucus, contributing to the mucous blanket the at covers the bronchial epithelium
Ciliated Epithelial Cells Rhythmically beat the mucous blanket toward the trachea and pharynx, where it can be swallowed or expectorated by coughing
Foreign particles and microorganisms not expelled by muco-ciliary clearance and coughing are... Attacked by cellular components of the inflammatory response and antibodies of the secretory immune system
Biochemical Mediators released early in inflammation Play a part in antibody-mediated hypersensitivity reactions, such as asthma, due to stimulating bronchial smooth muscles to constrict; With branching, the layer of the epithelium that line the bronchi become thinner; Ciliated cells and goblet cells become more sparse, and smooth muscle and connective tissue layers thin toward the terminal bronchioles
Goblet cells Mucus secreting
Acinus In combination, the gas exchange airways: Respiratory bronchioles, alveolar ducts, and alveolar
Type 1 alveolar cells Provide structure
Type 2 alveolar cells Secrete Surfactant
Adaptive immunity Antigen-specific
IgA Secreted by plasma cells forms an additional epithelial protective barrier, which prevents microbial adherence to the epithelial surface, and blocks certain viral infections (i.e., influenza and rotavirus) by interfering with their assembling processes; It also binds to pathogens, causing phagocytosis and antibody-dependent cell-mediated cytotoxicity
Selective IgA deficiency Manifests as atopy (a genetic disposition to develop an allergic reaction (as allergic rhinitis, asthma, or atopic dermatitis) and produce elevated levels of IgE upon exposure to an environmental antigen and especially one inhaled or ingested) and recurrent respiratory tract infections
Patients with COPD have decreased IgA levels in saliva and bronchial secretions
IgE Induces immediate type of hypersensitivity in the respiratory tract; It produces severe reactions by binding to these receptors on the surfaces of mast cells, basophils, eosinophils, and B lymphocytes
Repeat exposure to the same antigen Induces degranulation and the release of pro-inflammatory mediators, including histamine, prostaglandins, leukotrienes, and tryptase; These increase vascular permeability, bronchoconstriction, and inflammatory cell infiltration
Dendritic cells Originate in bone marrow, and reach tissues through blood circulation; In the lung, these cells reside in and below the airway epithlium, the alveolar septa, pulmonary capillaries, and airway spaces
Macrophage cells Reside in the airways, alveoli, and lung interstitium, or migrate into the lung microvasculature; These cells are essential in modulating acute and chronic inflammatory responses; however, although these cells can proliferate within the lung, their number is not adequate to fight infection; These cell’s functions are augmented by dendritic cells, and together they are capable of phagocytosing bacteria, particulates, and apoptotic cells
Macrophage cells are the main source of... Cytokines, chemokines, and other inflammatory mediators that propagate or suppress the immune response; These cells and epithelial cells secrete chemokines and cytokines, promoting neutrophil accumulation and local inflammation
Neutrophil cells Provide second-line defense; These cells are the first cells to be recruited to sites of infection or injury, and attack fungi, protozoa, bacteria, viruses, and tumor cells
During pulmonary infection, neutrophil cells Migrate out of the pulmonary capillaries and into the air spaces; After phagocytosis, neutrophil cells kill ingested microbes with reactive oxygen species, antimicrobial proteins (bactericidal permeability-inducing protein and lactoferrin) and degradative enzymes (elastase)
Deficits in neutrophil quantity (neutropenia) and quality (chronic granulomatous disease) Predispose patients to opportunistic lung infections
Lymphocyte cells Found throughout the airway and lung parenchyma; 2 major population: thymus-dependent T cells and bone marrow-dependent B cells
T Lymphocyte cells Provide cell-mediated immunity
T helper cells 1 (TH1) Drive cellular immunity
T helper cells 1 (Th1) cytokines (interferon gamma, TNF-a) Produce the pro-inflammatory responses to fight viruses and other intracellular parasites, and to eliminate cancer cells; Excessive pro-inflammatory responses can lead to uncontrolled tissue damage
T helper cells 2 (Th2) Drive humoral immunity to up regulate antibody production to fight extracellular organisms
T helper cells 2 (Th2) cytokines (Interlul-4, IL-5, IL-9, and IL-13) Promote IgE and eosinophilic responses in atopy; Excessive Th2 responses will counteract the Th1-mediated anti-microbial actions
What is suited to the immune challenge? A balanced Th1 and Th2 response
What is a dysregulated response linked to? A variety of chronic inflammatory conditions like asthma and chronic bronchitis
Mast cells Reside near blood vessels and nerves in tissues throughout the body; In the airways, these cells have receptors for IgE.
Mast cell activation Produces histamine, leukotrienes, proteases, cytokines, chemokines, and other substances that cause immediate airway inflammation, leading to asthma symptoms; May be activated by a variety of stimuli through various receptors
How do mast cells function? In innate immunity, and host defense against parasites, tissue repair, and angiogenesis
What may contribute to chronic airway inflammation? Secreted cytokine and chemokine
Eosinophil cells The least common white blood cells, and often associated with parasite infections, allergic diseases (such as asthma), chronic lung inflammatory states, and hyper-eosinophilic syndrome; These cells are an important source of major basic proteins, lipid mediators, cytokines, and growth factors, and also secretes mast cell stem cell factor, essential for mast cell growth, activation, chemotaxis, and degranulation
B Lymphocyte cells Produce humoral immune responses by synthesizing antibodies
IgA in mucus and surfactant produced by alveolar cells assist in immunity against Pathogens and smaller particles
Resident immune cells within the lung parenchyma Await organisms that successfully penetrate the physical barriers
Parenchyma The functional tissue of an organ as distinguished from the connective and supporting tissue
Although the inflammatory cells take center stage... Epithelial, endothelial, and mesenchymal cells also participate in the inflammatory process

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