4TH TUTORIAL

PLENARY DISCUSSION PAPER

4th TUTORIAL :

Kiara Rindang Sinoel (20130310020)

Tommy Akroma (20130310021)

Aldi Effando (20130310022)

Anggita Ratna D. (20130310023)

Yullytia Franika M (20130310024)

Fajar Rifki Prasetya (20130310025)

Syeifira Salsabilla (20130310026)

Fernanda Arifta Hutama (20130310028)

Irawati Hidayah (20130310029)

Ade Ayuningsih Utami (20130310030)

Syukurina Isnaini (20130310032)

Nurun Alan Nur (20130310033)

Ami Puspitasari (20130310034)

MEDICAL FACULTY

MUHAMMADIYAH YOGYAKARTA UNIVERSITY

2013

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PREFACE

All praise be to Allah SWT who has been giving us the mercy and blessing, so we always in
Allah guidance. Shalawat with salam we send to our big prophet, Muhammad SAW and his
relatives, so we can do our duties and responsibilities for make our paper to complete our
task of plenary discussion. Without Him, we will have no chance to complete this paper.

This task is one of the task given to us to complete this block. Then, we are very thankful to
dr. Ratna Indriawati, M. Kes. as our responsible lecture in our block.

Finally, the writer realizes that this paper is still far from being perfect.. Hence, the writer
looking forward to the constructive criticism and suggestions from the reader for the
perfection of our paper.

Yogyakarta, December 2013

The Writer

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INTRODUCTION

A. Skenario
Sixty minutes before the race, Jim was sitting quietly on the bank of the
Schuylkill River. He was visualizing the race he was about to row. Two thousand
meters of intense physical activity, pushing his body to the very limits of its
capabilities. But sitting there, he was calm and relaxed, mentally willing his heart rate
and respiratory rate down. He had done his stretching and warm-up excercise, but his
heart rate was now just 65 beats per minute and he was breathing 12 breaths per
minute. His body temperature was 37o C (98.6o F). He was well hydrated. His weight
was 180 pounds.
That was an hour ago. Now, he was sitting in the bow seat of the Mens
Varsity Eight. In lane four on the starting line, he could see two boats to his left and
three boats to his right. The rowers all looked bigger than him and his crew, but then
they always did. The starter on the shore was saying something over the loudspeaker
but Jim wasnt playing attention. He was concentrating on being ready and was
listening to his coxswain. These last few seconds before the race were the most
stressful you could feel the tension in the air. He knew that all 48 rowers and even the
six coxswains on that starting line were feeling the same as he was. He was sweating
although the air was cool. His heart rate was now 85 beats per minute and he was
breathing 18 breaths per minute. He felt a nervous excitement. His mouth was dry.
Three short strokes to get the 60-foot-long shell moving. And then 20 strokes
at maximum power. His crew was rowing 39 strokes per minute and water was flying
everywhere. It seemed like he could hear everythingcoxswain yelling, rowers
grunting, oars and rigors banging. Mostly he heard himself breathing. He was putting
all of his strenght into each stroke, knowing that after those first 20, the pace and the
power would come down some. At the end of that first minute, Jim heart rate was 201
beats per minute. He was taking two breaths per stroke, fast and forced. Their stroke
rate was now 34 strokes per minute. He was sweating more now. His body
temperature was 37.5oC (99.5oF) His muscles hurttheir felt like they were burning.
Two minutes later, they had traveled just over 1000 meters. They were still
rowing at 34 strokes per minute. Jim tried to put himself into a trance, shutting out the
pain and the external distraction, concentrating on keeping the power up. He was

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giving each stroke about 80% of his maximum power. His heart rate was 180. His
respiratory rate was also down slightly. His body temperature was 38oC. With 250
meters to go to the finish line, Jim was sitting even with the bowman of the boat in the
lane three. They were trading the lead with every alternate stroke. His cox was talking
to the team, keeping them focused, getting ready for the sprint. The crew next to them
started to movethey were up on seat! He heard his coxswain call for what he was
dreadingfive strokes to bring it up for the sprint. He focused on a spot between the
shoulder blades of his number two man and forced his muscle to respond. Thirty-
seven strokes per minute, then 38 strokes. Bow ball to bow ball, the winner of this
race was going to be whichever crew got in the last stroke. As Jim crossed the finish
line, six minutes and 58 seconds after starting and one-tenth of a second behind the
triumphant crew in lane three, his heart rate was 208 beats per minute. He stopped
rowing and slumped over the oar, breathing nearly 80 times per minute but still not
feeling like he could get enough air. It felt like his arms and legs were on fire. Sweat
was pouring out of every pore of his body. He felt light-headed. His body temperature
was 102oF .
Ten minutes later after a dejected row back to the docks, Jims heart rate and
respiratory rate were almost back to normal. His body temperature was still half a
degree above normal. He felt drained of energy. He was still very thirsty. He had
allowed himself only small sips of water on the row back. He weighed 176 pounds.

B. Unfamiliar terms
1. Heart rate : the frequency with which the heart beats, calculated by counting the
number of QRS complexes or ventricular bearts per minute. (Mosby's Dictionary
of Complementary and Alternative Medicine. (c) 2005, Elsevier.)
2. Respiratory rate : The rate of breathing. It is typically from 40 to 50 breaths per
minute for newborns, 20 to 25 breaths per minute for older children, and 12 to 20
breaths per minute for teenagers and adults. An adult rate per minute may be
regarded as accelerated, whereas a rate less than 12 breaths per minute is
abnormally low. The rate may be more rapid in fever, acute pulmonary infection,
diffuse pulmonary fibrosis, gas gangrene, left ventricular failure, thyrotoxicosis,
and states of tension. Slower breathing rates may result from head injury, coma, or
narcotic overdose. (Mosby's Dictionary of Complementary and Alternative
Medicine. (c) 2005, Elsevier.)

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3. Sweating : the secretion of sweat, especially the profuse secretion associated with
an elevated body temperature, physical exertion, exposure to heat, and mental or
emotional stress. Sweating is centrally controlled by the sympathetic nervous
system and is primarily a thermoregulatory mechanism. However, the sweat
glands on the palms and soles respond to emotional stimuli and do not always
participate in thermal sweating. The rate of sweating is generally not affected by
water deficiency, but it may be reduced by severe dehydration; it also diminishes
when salt intake exceeds salt loss. (Mosby's Medical Dictionary, 8th edition.
2009, Elsevier.)
4. Stretching: mechanical lengthening of myofascial fibers. Muscles and fascia
lengthen longitudinally and cross-directionally. (Mosby's Dictionary of
Complementary and Alternative Medicine. (c) 2005, Elsevier.)
5. Temperature: the degree of sensible heat or cold, expressed in terms of a specific
scale. See Table of Temperature Equivalents in the Appendices. Body temperature
is measured by a clinical thermometer and represents a balance between the heat
produced by the body and the heat it loses. Though heat production and heat loss
vary with circumstances, the body regulates them, keeping a remarkably constant
temperature. (Mosby's Dental Dictionary, 2nd edition. 2008 Elsevier, Inc. All
rights reserved)
6. Hydrated: Combined with water, forming a hydrate. (Dorland's Medical
Dictionary for Health Consumers. 2007 by Saunders, an imprint of Elsevier,
Inc. All rights reserved.)
7. Thirsty: a sensation, often referred to the mouth and throat, associated with a
craving for drink; ordinarily interpreted as a desire for water. (Dorland's Medical
Dictionary for Health Consumers. 2007 by Saunders, an imprint of Elsevier,
Inc. All rights reserved)

C. Problem Definition
1. What is the anatomy of the human respiration?
2. How is the mechanism of the human respiration?
3. What is the factor that influence respiratory rate and heart rate?
4. How can we count respiratory rate and heart rate?
5. What is the relation between respiratory rate and heart rate with heavy activities?
6. What is the factor that influence the body temperature?

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7. What is the factor that influence amount of sweat?

8. How is the mechanism of sweating?
9. What is the anatomy of the integumen system?
10. How is the reflex of thirst feeling?

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CONTENT
Analyzing the Problem

A. Respiration
1. Anatomy of Human Respiration
a. Nose and Nasal Cavity
Position and structure
The nasal cavity is the first of the respiratory organs and consists of a
large irregular cavity divided into two equal passages by a septum. The
posterior bony part of the septum is formed by the perpendicular plate
of the ethmoid bone and the vomer. Anteriorly it consists of hyaline
cartilage. The roof is formed by the cribriform plate of the ethmoid
bone, and the sphenoid bone, frontal bone, and nasal bones.
The floor is formed by the roof of the mouth and consists of the hard
palate in front and the soft palate behind. The hard palate is composed
of the maxilla and palatine bones and the soft palate consists of
involuntary muscle. The medial wall is formed by septum. The lateral
walls are formed by the maxilla, the ethmoid bone and the inferior
conchae. The posterior wall is formed by posterior wall of the pharynx.
Respiratory function of the nose
The nose is the first of respiratory passages through which the inspired
air passes. The function of the nose is to begin the process by which
the air is warmed, moistened, and filtered.
Warming. This is due to immense vascularity of the mucosa. This
explains the large blood loss when a nose bleed (epistaxis) occurs.
Filtering and cleaning of air. This occurs as hairs at the anterior nares
trap larger particles. Smaller particles such as dust and microbes settle
and adhere to the mucus. Mucus protect the underlying epithelium
from irritation and prevents drying.
Humidification. This occurs as air travels over the moist mucosa and
becomes saturated with water vapour. Irritation of the nasal mucosa
results in sneezing, a reflex action that forcibly expels an irritant.

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b. Pharynx
Position
The pharynx is a tube 12 to 14 cm long that extends from the base of
the skull to the level of the 6th cervicaal vertebrae. It lies behind the
nose, mouth, and larynx and is wider at its upper end.

Parts of pharynx
o Nasopharynx
The nasal part of pharynx lies behind nose above the level of
the soft palate. On its lateral walls are the two openings of the
auditory tubes, one leading to eaach middle ear. On the
posterior wall there are the pharyngeal tonsils (adenoids),
consisting of lymphoid tissue.
o Oropharynx
The oral part of the pharynx lies behind the mouth, extending
from below the level of the soft palate to the level of the upper
part of the body of the third cervical vertebrae.
o Laryngopharynx
The laryngeal part of pharynx extends from the oropharynx
above and continues as the oesophagus below.
Structure

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The pharynx is composed of three layers of tissue :

o Mucous membrane lining
The mucosa varies slightly in the different parts. In the
nasopharynx, it is continous with the lining of the nose and
consists of ciliated columnar epithelium, in the oropharynx and
laryngopharynx, it is formed by tougher stratified squamous
epithelium which is continous with the lining of the mouth and
oesophagus.
o Fibrous tissue
It is thicker in the nasopharynx, where there is little muscle,
and become thinner towards the lower end, where the muscle
layer is thicker.
o Muscle tissue
This consists of several involuntary constrictor muscles that
play an important part in the mechanism of swallowing which,
in the pharynx, is not under voluntary control.
Blood and nerve supply
Blood is supplied to the pharynx by several branches of the facial
artery. The venous return is into the facial and internal jugular veins.
The nerve supply is from pharyngeal plexus, formed by
parasympathetic and sympathetic nervous. Parasympathetic supply is
by the vagus and glossopharyngeal nerves. Sympathetic supply is by
nerves from the superior cervical ganglia.
Function
o Passageway for air and food
o Warming and humidifying
o Taste
o Hearing
o Protection
o Speech
c. Larynx
Position

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The larynx or voice box extends from the root of the tongue and the
hyoid bone to the trachea. It lies in front of the laryngopharynx at the
level of 3rd, 4th, 5th, and 6th cervical vertebrae.

Structure
o Cartilages
The main cartilages are:
1 thyroid cartilage
2 cricoid cartilage hyaline cartilage
2 arytenoid cartilage
3 1 epiglottis - elastic fibrocartilage
o The epiglottis

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The epiglottis acts as the lid; it closes of the larynx during

swallowing, protecting the lungs from accidental inhalation of
foreign objects.

Blood and nerve supply

Blood is supply to the larynx by the superior and inferior laryngeal and
recurrent laryngeal nerves, which are branches of the vagus nerves, and
the sympathetic nerves are from the superior cervical ganglia, one on
each side. These provide the motor nerve supply to the uscles of the
larynx and sensory fibres to the lining membrane.
Function
o Production of sound
o Protection of the lower respiratory tract
o Passageway for air
o Humidifying, filtering, and warming
d. Trachea
Position
It is approximately 10 to 11 cm long and lies mainly in the median
plane in front of oesophagus.

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Structure
Three layes of tissue which clothe the ccartilage of the trachea:
o The outer layer: consists of fibrous and elastic tissue and
encloses the cartilage.
o The middle layer: consists of cartilage and bands of smooth
muscle that wind round the trache in a helical arrangement.
There is some areolar tissue containing blood and lymph
vessels and autonomic nerves.
o The inner lining: consists of ciliated columnar epithelium,
containing mucus-secreting globet cells.
Blood and nerve supply, lymph drainage
o The arterial blood supply
This is mainly by the inferior thyroid and bronchial arteries and
the venous return is by the inferior thyroid veins into the
brachiocephalic veins.
o Nerve supply
Parasympathetic supply is by the recurrent laryngeal nerves and
other branches of the vagi. Sympathetic supply is by nerves
from the sympathetic ganglia.
o Lymph
Lymph from the respiratory passages passes through lymph
nodes situated around the trachea and in the carina, the area
where it divides into two bronchi.
Functions
o Support and patency
o Mucociliary escalator
o Cough reflex
o Warming, humidifying, and filtering of air
e. Two bronchi
The right bronchus
This is wider, shorter, and more vertical than the left bronchus and is
therefore the more likely of the two to become obstructed by an
inhaled foreign body. It is approximately 2,5 cm long. After entering

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the right lung at the hilum it divides into three branches, one to each
lobe. Each branch then subdivides into numerous smaller branches.
The left bronchus
This is about 5 cm long ad is narrower than the right. After entering the
lung at the hilum it divides into two branches, one to each lobe. Each
branch then subdivides into progressively smaller tubes within the lung
substances.
f. Bronchioles
Structure
The bronchi progressively subdivide into bronchioles, terminal
bronchioles, repiratory bronchioles, alveolar ducts, and finally, alveoli.
Blood and nerve supply, lymph drainage
o The arterial blood supply
The supply to the walls of the bronchi and smaller air passage
is through branches of the right and left bronchial arteries and
the venous return is mainly through the bronchial veins. On the
right side they empty into the azygos vein and on the left into
the superior intercostal vein.
o The nerve supply
This is by parasympathetic and sympathetic nerves. The vagus
nerves stimulates contraction of smooth muscles in the
bronchial tree, causing bronchoconstriction, and sympathetic
stimulation causes bronchodilatation.
o the lymphatic vessels and lymph nodeslymph is drained from
the walls of air passage in a network of lymph vessels. It passes
through lymph nodes situated around the trachea and bronchial
tree then into the thoracic duct on the left side and right
lyphatic duct on the other.
Function
o Control of air entry
o Warming and humidifying
o Support and patency
o Removal of particular matter

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o Cough reflex
g. Respiratory bronchioles and alveoli
Structures
Lobules are the blind ends of the respiratory tract distal to the terminal
bronchioles, consisting of: respiratory bronchioles, alveolar ducts, and
alveoli.
Functions
o External respiration
o Defence against microbes
o Warming and humidifying
h. Two lungs and their coverings, the pleuraa
Pleura
The pleura are double-layered serous membranes that surround each
lung. Attached to the wall of the thoracic cavity, the parietal pleura
forms the outer layer of the membrane. The visceral pleura forms the
inner layer of the membrane covering the outside surface of the lungs.
Between the parietal and visceral pleura is the pleural cavity, which
creates a hollow space for the lungs to expand into during inhalation.
Serous fluid secreted by the pleural membranes lubricates the inside of
the pleural cavity to prevent irritation to the lungs during breathing.
External Anatomy
Occupying most of the space within the thoracic cavity, the lungs
extend laterally from the heart to the ribs on both sides of the chest and
continue posteriorly toward the spine. Each soft, spongy lung is
roughly cone-shaped with the superior end of the lung forming the
point of the cone and the inferior end forming the base. The superior
end of the lungs narrows to a rounded tip known as the apex. The
inferior end of the lungs, known as the base, rests on the dome-shaped
diaphragm. The base of the lungs is concave to follow the contour of
the diaphragm.
The left lung is slightly smaller than the right lung because 2/3 of the
heart is located on the left side of the body. The left lung contains the

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cardiac notch, an indentation in the lung that surrounds the apex of the
heart.
Each lung consists of several distinct lobes. The right lung (the larger
of the two) has 3 lobes the superior, middle, and inferior lobes. The
horizontal fissure separates the superior lobe from the middle lobe,
while the right oblique fissure separates the middle and inferior lobes.
The smaller left lung only has 2 lobes superior and inferior
separated by the left oblique fissure.
Arteries, Veins and Innervation of the Lungs
o Arterial Supply of the Lungs
- These arise from the pulmonary trunk and distribute
deoxygenated blood.
- The right and left pulmonary arteries pass to the
corresponding root of the lung and give off a branch to the
superior lobe before entering the hilum.
- There is a branch of this artery to each lobe,
bronchopulmonary segment, and lobule of the lung.
o The Bronchial Arteries
- These supply blood to the connective tissue of the bronchial
tree.
- The two left bronchial arteries arise from the superior part
of the thoracic aorta.
- The single right bronchial artery often arises as a common
trunk with the 3rd (or 5th) posterior intercostal artery, or
from the superior left bronchial artery.
Venous Drainage of the Lungs
The Pulmonary Veins
o These carry oxygenated blood back to the left atrium of the
heart.
o A main vein drains each bronchopulmonary segment, usually
on the anterior surface of each corresponding bronchus.

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o The right superior and left superior pulmonary veins drain the
superior and middle and superior lobes of their respective
lungs.
o The right and left inferior pulmonary veins each drain the
inferior lobe of their respective lungs.
The Bronchial Veins
o These only drain the part of the blood delivered by the
bronchial arteries to the bronchial tree.
o The right bronchial vein drains into the azygos vein.
o The left bronchial vein drains into the accessory hemiazygos
vein or into the left superior intercostal vein.
Innervation of the Lungs and Pleura
o The lungs and pleura are innervated by the anterior and
posterior pulmonary plexuses.
o These are located anterior and posterior to the root of the lung.
o They are mixed plexuses containing vagal (parasympathetic)
and sympathetic fibres.

2. Physiology of Human Respiration

a. Breathing and Lung Mechanics
Ventilation is the exchange of air between the external environment and the
alveoli. Air moves by bulk flow from an area of high pressure to low pressure.
All pressures in the respiratory system are relative to atmospheric pressure
(760mmHg at sea level). Air will move in or out of the lungs depending on the
pressure in the alveoli. The body changes the pressure in the alveoli by
changing the volume of the lungs. As volume increases pressure decreases and
as volume decreases pressure increases. There are two phases of ventilation;
inspiration and expiration. During each phase the body changes the lung
dimensions to produce a flow of air either in or out of the lungs.
The body is able to stay at the dimensions of the lungs because of the
relationship of the lungs to the thoracic wall. Each lung is completely enclosed
in a sac called the pleural sac. Two structures contribute to the formation of
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this sac. The parietal pleura is attached to the thoracic wall where as the
visceral pleura is attached to the lung itself. In-between these two membranes
is a thin layer of intrapleural fluid. The intrapleural fluid completely surrounds
the lungs and lubricates the two surfaces so that they can slide across each
other. Changing the pressure of this fluid also allows the lungs and the
thoracic wall to move together during normal breathing. Much the way two
glass slides with water in-between them are difficult to pull apart, such is the
relationship of the lungs to the thoracic wall.
The rhythm of ventilation is also controlled by the "Respiratory Center" which
is located largely in the medulla oblongata of the brain stem. This is part of the
autonomic system and as such is not controlled voluntarily (one can increase
or decrease breathing rate voluntarily, but that involves a different part of the
brain). While resting, the respiratory center sends out action potentials that
travel along the phrenic nerves into the diaphragm and the external intercostal
muscles of the rib cage, causing inhalation. Relaxed exhalation occurs
between impulses when the muscles relax. Normal adults have a breathing rate
of 12-20 respirations per minute.
The Pathway of Air
When one breathes air in at sea level, the inhalation is composed of
different gases. These gases and their quantities are Oxygen which
makes up 21%, Nitrogen which is 78%, Carbon Dioxide with 0.04%
and others with significantly smaller portions.
In the process of breathing, air enters into the nasal cavity through the
nostrils and is filtered by coarse hairs (vibrissae) and mucous that are
found there. The vibrissae filter macroparticles, which are particles of
large size. Dust, pollen, smoke, and fine particles are trapped in the
mucous that lines the nasal cavities (hollow spaces within the bones of
the skull that warm, moisten, and filter the air). There are three bony
projections inside the nasal cavity. The superior, middle, and inferior
nasal conchae. Air passes between these conchae via the nasal
meatuses.
Air then travels past the nasopharynx, oropharynx, and
laryngopharynx, which are the three portions that make up the
pharynx. The pharynx is a funnel-shaped tube that connects our nasal
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and oral cavities to the larynx. The tonsils which are part of the
lymphatic system, form a ring at the connection of the oral cavity and
the pharynx. Here, they protect against foreign invasion of antigens.
Therefore the respiratory tract aids the immune system through this
protection. Then the air travels through the larynx. The larynx closes at
the epiglottis to prevent the passage of food or drink as a protection to
our trachea and lungs. The larynx is also our voicebox; it contains
vocal cords, in which it produces sound. Sound is produced from the
vibration of the vocal cords when air passes through them.
The trachea, which is also known as our windpipe, has ciliated cells
and mucous secreting cells lining it, and is held open by C-shaped
cartilage rings. One of its functions is similar to the larynx and nasal
cavity, by way of protection from dust and other particles. The dust
will adhere to the sticky mucous and the cilia helps propel it back up
the trachea, to where it is either swallowed or coughed up. The
mucociliary escalator extends from the top of the trachea all the way
down to the bronchioles, which we will discuss later. Through the
trachea, the air is now able to pass into the bronchi.
Inspiration
Inspiration is initiated by contraction of the diaphragm and in some
cases the intercostals muscles when they receive nervous impulses.
During normal quiet breathing, the phrenic nerves stimulate the
diaphragm to contract and move downward into the abdomen. This
downward movement of the diaphragm enlarges the thorax. When
necessary, the intercostal muscles also increase the thorax by
contacting and drawing the ribs upward and outward.

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As the diaphragm contracts inferiorly and thoracic muscles pull the

chest wall outwardly, the volume of the thoracic cavity increases. The
lungs are held to the thoracic wall by negative pressure in the pleural
cavity, a very thin space filled with a few milliliters of lubricating
pleural fluid. The negative pressure in the pleural cavity is enough to
hold the lungs open in spite of the inherent elasticity of the tissue.
Hence, as the thoracic cavity increases in volume the lungs are pulled
from all sides to expand, causing a drop in the pressure (a partial
vacuum) within the lung itself (but note that this negative pressure is
still not as great as the negative pressure within the pleural cavity--
otherwise the lungs would pull away from the chest wall). Assuming
the airway is open, air from the external environment then follows its
pressure gradient down and expands the alveoli of the lungs, where gas
exchange with the blood takes place. As long as pressure within the
alveoli is lower than atmospheric pressure air will continue to move
inwardly, but as soon as the pressure is stabilized air movement stops.
Expiration
During quiet breathing, expiration is normally a passive process and
does not require muscles to work (rather it is the result of the muscles
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relaxing). When the lungs are stretched and expanded, stretch receptors
within the alveoli send inhibitory nerve impulses to the medulla
oblongata, causing it to stop sending signals to the rib cage and
diaphragm to contract. The muscles of respiration and the lungs
themselves are elastic, so when the diaphragm and intercostal muscles
relax there is an elastic recoil, which creates a positive pressure
(pressure in the lungs becomes greater than atmospheric pressure), and
air moves out of the lungs by flowing down its pressure gradient.

Although the respiratory system is primarily under involuntary control,

and regulated by the medulla oblongata, we have some voluntary
control over it also. This is due to the higher brain function of the
cerebral cortex.
When under physical or emotional stress, more frequent and deep
breathing is needed, and both inspiration and expiration will work as
active processes. Additional muscles in the rib cage forcefully contract
and push air quickly out of the lungs. In addition to deeper breathing,
when coughing or sneezing we exhale forcibly. Our abdominal
muscles will contract suddenly (when there is an urge to cough or
sneeze), raising the abdominal pressure. The rapid increase in pressure

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pushes the relaxed diaphragm up against the pleural cavity. This causes
air to be forced out of the lungs.
Another function of the respiratory system is to sing and to speak. By
exerting conscious control over our breathing and regulating flow of
air across the vocal cords we are able to create and modify sounds.
Lung Compliance
Lung Compliance is the magnitude of the change in lung volume
produced by a change in pulmonary pressure. Compliance can be
considered the opposite of stiffness. A low lung compliance would
mean that the lungs would need a greater than average change in
intrapleural pressure to change the volume of the lungs. A high lung
compliance would indicate that little pressure difference in intrapleural
pressure is needed to change the volume of the lungs. More energy is
required to breathe normally in a person with low lung compliance.
Persons with low lung compliance due to disease therefore tend to take
shallow breaths and breathe more frequently.
Determination of Lung Compliance Two major things determine lung
compliance. The first is the elasticity of the lung tissue. Any thickening
of lung tissues due to disease will decrease lung compliance. The
second is surface tensions at air water interfaces in the alveoli. The
surface of the alveoli cells is moist. The attractive force, between the
water cells on the alveoli, is called surface tension. Thus, energy is
required not only to expand the tissues of the lung but also to
overcome the surface tension of the water that lines the alveoli.
To overcome the forces of surface tension, certain alveoli cells (Type
II pneumocytes) secrete a protein and lipid complex called
"Surfactant, which acts like a detergent by disrupting the hydrogen
bonding of water that lines the alveoli, hence decreasing surface
tension.
b. Homeostasis and Gas Exchange
Homeostasis is maintained by the respiratory system in two ways: gas
exchange and regulation of blood pH. Gas exchange is performed by the lungs
by eliminating carbon dioxide, a waste product given off by cellular
respiration. As carbon dioxide exits the body, oxygen needed for cellular
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respiration enters the body through the lungs. ATP, produced by cellular
respiration, provides the energy for the body to perform many functions,
including nerve conduction and muscle contraction. Lack of oxygen affects
brain function, sense of judgment, and a host of other problems.
Gas Exchange
Gas exchange in the lungs and in the alveoli is between the alveolar air
and the blood in the pulmonary capillaries. This exchange is a result of
increased concentration of oxygen, and a decrease of C02. This process
of exchange is done through diffusion.
External Respiration
External respiration is the exchange of gas between the air in the
alveoli and the blood within the pulmonary capillaries. A normal rate
of respiration is 12-25 breaths per minute. In external respiration, gases
diffuse in either direction across the walls of the alveoli. Oxygen
diffuses from the air into the blood and carbon dioxide diffuses out of
the blood into the air. Most of the carbon dioxide is carried to the lungs
in plasma as bicarbonate ions (HCO3-). When blood enters the
pulmonary capillaries, the bicarbonate ions and hydrogen ions are
converted to carbonic acid (H2CO3) and then back into carbon dioxide
(CO2) and water. This chemical reaction also uses up hydrogen ions.
The removal of these ions gives the blood a more neutral pH, allowing
hemoglobin to bind up more oxygen. De-oxygenated blood "blue
blood" coming from the pulmonary arteries, generally has an oxygen
partial pressure (pp) of 40 mmHg and CO2 pp of 45 mmHg.
Oxygenated blood leaving the lungs via the pulmonary veins has a O2
pp of 100 mmHg and CO2 pp of 40 mmHg. It should be noted that
alveolar O2 pp is 105 mmHg, and not 100 mmHg. The reason why
pulmonary venous return blood has a lower than expected O2 pp can
be explained by "Ventilation Perfusion Mismatch".
Internal Respiration
The Passage Way From the Trachea to the Bronchioles
There is a point at the inferior portion of the trachea where it branches
into two directions that form the right and left primary bronchus. This

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point is called the Carina which is the keel-like cartilage plate at the
division point. We are now at the Bronchial Tree. It is named so
because it has a series of respiratory tubes that branch off into smaller
and smaller tubes as they run throughout the lung
Right and Left Lungs

The Right Primary Bronchus is the first portion we come to, it then
branches off into the Lobar (secondary) Bronchi, Segmental (tertiary)
Bronchi, then to the Bronchioles which have little cartilage and are
lined by simple cuboidal epithelium (See fig. 1). The bronchi are lined
by pseudostratified columnar epithelium. Objects will likely lodge here
at the junction of the Carina and the Right Primary Bronchus because
of the vertical structure. Items have a tendency to fall in it, where as
the Left Primary Bronchus has more of a curve to it which would make
it hard to have things lodge there.
The Left Primary Bronchus has the same setup as the right with the
lobar, segmental bronchi and the bronchioles.
The lungs are attached to the heart and trachea through structures that
are called the roots of the lungs. The roots of the lungs are the bronchi,
pulmonary vessels, bronchial vessels, lymphatic vessels, and nerves.
These structures enter and leave at the hilus of the lung which is "the
depression in the medial surface of a lung that forms the opening
through which the bronchus, blood vessels, and nerves pass"
(medlineplus.gov).
There are a number of terminal bronchioles connected to respiratory
bronchioles which then advance into the alveolar ducts that then

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become alveolar sacs. Each bronchiole terminates in an elongated

space enclosed by many air sacs called alveoli which are surrounded
by blood capillaries. Present there as well, are Alveolar Macrophages,
they ingest any microbes that reach the alveoli. The Pulmonary Alveoli
are microscopic, which means they can only be seen through a
microscope, membranous air sacs within the lungs. They are units of
respiration and the site of gas exchange between the respiratory and
circulatory systems.
Cellular Respiration
First the oxygen must diffuse from the alveolus into the capillaries. It
is able to do this because the capillaries are permeable to oxygen. After
it is in the capillary, about 5% will be dissolved in the blood plasma.
The other oxygen will bind to red blood cells. The red blood cells
contain hemoglobin that carries oxygen. Blood with hemoglobin is
able to transport 26 times more oxygen than plasma without
hemoglobin. Our bodies would have to work much harder pumping
more blood to supply our cells with oxygen without the help of
hemoglobin. Once it diffuses by osmosis it combines with the
hemoglobin to form oxyhemoglobin.
Now the blood carrying oxygen is pumped through the heart to the rest
of the body. Oxygen will travel in the blood into arteries, arterioles,
and eventually capillaries where it will be very close to body cells.
Now with different conditions in temperature and pH (warmer and
more acidic than in the lungs), and with pressure being exerted on the
cells, the hemoglobin will give up the oxygen where it will diffuse to
the cells to be used for cellular respiration, also called aerobic
respiration. Cellular respiration is the process of moving energy from
one chemical form (glucose) into another (ATP), since all cells use
ATP for all metabolic reactions.
It is in the mitochondria of the cells where oxygen is actually
consumed and carbon dioxide produced. Oxygen is produced as it
combines with hydrogen ions to form water at the end of the electron
transport chain (see chapter on cells). As cells take apart the carbon
molecules from glucose, these get released as carbon dioxide. Each
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body cell releases carbon dioxide into nearby capillaries by diffusion,

because the level of carbon dioxide is higher in the body cells than in
the blood. In the capillaries, some of the carbon dioxide is dissolved in
plasma and some is taken by the hemoglobin, but most enters the red
blood cells where it binds with water to form carbonic acid. It travels
to the capillaries surrounding the lung where a water molecule leaves,
causing it to turn back into carbon dioxide. It then enters the lungs
where it is exhaled into the atmosphere.
c. Lung Capacity
The normal volume moved in or out of the lungs during quiet breathing is
called tidal volume. When we are in a relaxed state, only a small amount of air
is brought in and out, about 500 mL. You can increase both the amount you
inhale, and the amount you exhale, by breathing deeply. Breathing in very
deeply is Inspiratory Reserve Volume and can increase lung volume by 2900
mL, which is quite a bit more than the tidal volume of 500 mL. We can also
increase expiration by contracting our thoracic and abdominal muscles. This is
called expiratory reserve volume and is about 1400 ml of air. Vital capacity is
the total of tidal, inspiratory reserve and expiratory reserve volumes; it is
called vital capacity because it is vital for life, and the more air you can move,
the better off you are. There are a number of illnesses that we will discuss later
in the chapter that decrease vital capacity. Vital Capacity can vary a little
depending on how much we can increase inspiration by expanding our chest
and lungs. Some air that we breathe never even reaches the lungs! Instead it
fills our nasal cavities, trachea, bronchi, and bronchioles. These passages
aren't used in gas exchange so they are considered to be dead air space. To
make sure that the inhaled air gets to the lungs, we need to breathe slowly and
deeply. Even when we exhale deeply some air is still in the lungs,(about 1000
ml) and is called residual volume. This air isn't useful for gas exchange. There
are certain types of diseases of the lung where residual volume builds up
because the person cannot fully empty the lungs. This means that the vital
capacity is also reduced because their lungs are filled with useless air.
d. Stimulation of Breathing

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There are two pathways of motor neuron stimulation of the respiratory

muscles. The first is the control of voluntary breathing by the cerebral cortex.
The second is involuntary breathing controlled by the medulla oblongata.
There are chemoreceptors in the aorta, the carotid body of carotid arteries, and
in the medulla oblongata of the brainstem that are sensitive to pH. As carbon
dioxide levels increase there is a buildup of carbonic acid, which releases
hydrogen ions and lowers pH. Thus, the chemoreceptors do not respond to
changes in oxygen levels (which actually change much more slowly), but to
pH, which is dependent upon plasma carbon dioxide levels. In other words,
CO2 is the driving force for breathing. The receptors in the aorta and the
carotid sinus initiate a reflex that immediately stimulates breathing rate and
the receptors in the medulla stimulate a sustained increase in breathing until
blood pH returns to normal.
This response can be experienced by running a 100 meter dash. During this
exertion (or any other sustained exercise) your muscle cells must metabolize
ATP at a much faster rate than usual, and thus will produce much higher
quantities of CO2. The blood pH drops as CO2 levels increase, and you will
involuntarily increase breathing rate very soon after beginning the sprint. You
will continue to breathe heavily after the race, thus expelling more carbon
dioxide, until pH has returned to normal. Metabolic acidosis therefore is
acutely corrected by respiratory compensation (hyperventilation).
e. Regulation of Blood pH
Many of us are not aware of the importance of maintaining the acid/base
balance of our blood. It is vital to our survival. Normal blood pH is set at 7.4,
which is slightly alkaline or "basic". If the pH of our blood drops below 7.2 or
rises above 7.6 then very soon our brains would cease functioning normally
and we would be in big trouble. Blood pH levels below 6.9 or above 7.9 are
usually fatal if they last for more than a short time. Another wonder of our
amazing bodies is the ability to cope with every pH change large or small.
There are three factors in this process: the lungs, the kidneys and buffers.
So what exactly is pH? pH is the concentration of hydrogen ions (H+). Buffers
are molecules which take in or release ions in order to maintain the H+ ion
concentration at a certain level. When blood pH is too low and the blood
becomes too acidic (acidosis), the presence of too many H+ ions is to blame.

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Buffers help to soak up those extra H+ ions. On the other hand, the lack of H+
ions causes the blood to be too basic (alkalosis). In this situation, buffers
release H+ ions. Buffers function to maintain the pH of our blood by either
donating or grabbing H+ ions as necessary to keep the number of H+ ions
floating around the blood at just the right amount.
The most important buffer we have in our bodies is a mixture of carbon
dioxide (CO2) and bicarbonate ion (HCO3). CO2 forms carbonic acid
(H2CO3) when it dissolves in water and acts as an acid giving up hydrogen
ions (H+) when needed. HCO3 is a base and soaks up hydrogen ions (H+)
when there are too many of them. In a nutshell, blood pH is determined by a
balance between bicarbonate and carbon dioxide.
Bicarbonate Buffer System. With this important system our bodies maintain
homeostasis. (Note that H2CO3 is Carbonic Acid and HCO3 is Bicarbonate)
CO2 + H2O <---> H2CO3 <---> (H+) + HCO3
If pH is too high, carbonic acid will donate hydrogen ions (H+) and pH
will drop.
If pH is too low, bicarbonate will bond with hydrogen ions (H+) and pH
will rise.
Too much CO2 or too little HCO3 in the blood will cause acidosis. The
CO2 level is increased when hypoventilation or slow breathing occurs,
such as if you have emphysema or pneumonia. Bicarbonate will be
lowered by ketoacidosis, a condition caused by excess fat metabolism
(diabetes mellitus).
Too much HCO3 or too little CO2 in the blood will cause alkalosis. This
condition is less common than acidosis. CO2 can be lowered by
hyperventilation.
So, in summary, if you are going into respiratory acidosis the above
equation will move to the right. The body's H+ and CO2 levels will rise
and the pH will drop. To counteract this the body will breathe more and
release H+. In contrast, if you are going into respiratory alkalosis the
equation will move to the left. The body's H+ and CO2 levels will fall and
the pH will rise. So the body will try to breathe less to release HCO3. You
can think of it like a leak in a pipe: where ever there is a leak, the body
will "fill the hole".

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B. Heart Rate and Respiratory Rate

1. Heart Rate
a. Normal resting heart rate (pulse rate)
For a human aged 18 or more years, a normal resting heart rate can be
anything between 60 and 100 beats per minute. Usually the healthier or fitter
you are, the lower your rate. A competitive athlete may have a resting heart
rate as low as 40 beats per minute. Normal pulse rates in bpm (beats per
minute):
Newborns 0 - 1 month old: 70 - 190 beats per minute
Infants 1 - 11 months old: 80 - 160 beats per minute
Children 1 - 2 years old: 80 - 130 beats per minute
Children 3 - 4 years old: 80 - 120 beats per minute
Children 5 - 6 years old: 75 - 115 beats per minute
Children 7 - 9 years old: 70 - 110 beats per minute
Children 10 years and older, and adults (including seniors): 60 - 100
beats per minute
Well-trained athletes: 40 - 60 beats per minute
b. How to Check The Heart Rate
The wrist (the radial artery) - place the palm of your hand facing
upward. Place two fingers on the thumb side of your wrist gently, you
will sense your pulse beating there. Either count them for up to one
minute, or thirty seconds and then multiply by two. Counting for 15
seconds and then multiplying by four is less accurate. It is also possible
to test the pulse by touching the other side of the wrist, where the ulnar
artery is.
The neck (the carotid artery) - place the index and third fingers on the
neck, next to your windpipe. When you feel your pulse, either count
for the whole sixty seconds, or do it in a 30 or 15 second spell and
multiply by two or four.
c. The human heart rate can be measured at the following points:
The brachial artery - under the biceps or inside the elbow
Abdominal aorta - over the abdomen
Apex of the heart - by placing your hand or fingers on the chest

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Basilar artery - at the side of the head, close to the ear

Dorsalis pedis - the middle of dorsum of the foot
Superficial temporal artery - the temple
The facial artery - the lateral edge of the mandible
The femoral artery - in the groin
The posterior tibial artery - behind the medial malleoulus of the feet
d. Several Factors can be influenced
The level of physical activity at the time
Mental or emotional state - excitement, anger, fear, anxiety, and other
factors.
Air temperature, when temperatures (and the humidity) soar, the heart
pumps a little more blood, so the pulse rate may increase, but usually
no more than five to 10 beats a minute.
Body position; resting, sitting or standing, the pulse is usually the
same. Sometimes as a person stand for the first 15 to 20 seconds, the
pulse may go up a little bit, but after a couple of minutes it should
settle down. Emotions: If stressed, anxious or extraordinarily happy
or sad the emotions can raise the pulse.
Body size, body size usually doesnt usually change pulse. If the
person is very obese, he/she might see a higher resting pulse than
normal, but usually not more than 100.
Medication use, meds that block the adrenaline (beta blockers) tend to
slow pulse, while too much thyroid medication or too high of a dosage
will raise it.
e. Condition of the heart rate
Bradycardia - a medical term that refers to a heart beat that is too slow,
such as below 60 beats per minute (for a non-athlete)
Tachycardia - a medical term that refers to a resting heart beat of more
than 100 beats per minute, an excessively fast heart beat for an adult
f. The maximum heart rate
This is the maximum number of times the heart can beat per minute. It is a
useful measure for sports people, so they can gauge their training intensities.
There are two ways to find out what the maximum heart rate is:

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Have it clinically tested - usually by a cardiologist or an exercise

physiologist. People over 35 years of age who are overweight or have
not done exercise for a long time are advised to have their maximum
heart rates clinically tested by a trained health care professional. The
health care professional may use a treadmill and a electrocardiograph.
Predicted maximum heart rate - this involves using a mathematical
formula, called the age-adjusted formula.
For adult males: 220 minus your age. For a 25 year-old man it would
be 195 bpm (220 minus 25)
For adult females: 226 minus your age. For a 25 year-old woman it
would be 201 bpm (226 minus 25)
g. Utilities for testing the heart rate
Electrocardiograph, also known as an ECG or EKG is a more accurate
way of checking a patient's heartbeat. ECGs are commonly used in
critical care medicine, and many other fields of medicine.
Echocardiogram: an echocardiogram is a test that uses sound waves to
create a moving picture of the heart. The picture is much more detailed
than a plain x-ray image and involves no radiation exposure.
2. Respiratory Rate
The respiratory rate is defined as the number of breaths a person takes during a
one-minute period of time while at rest. Recent studies suggest that an accurate
recording of respiratory rate is very important in predicting serious medical
events; studies also suggest that measurements of respiratory rate are not done as
often as they should be, so it's been coined the ignored vital sign.
a. Measuring Respiratory Rate
Respiratory rate is measured by counting the number of breaths a person takes
in a one-minute period. Since many factors can affect the results,
understanding how to take an accurate measurement is very important.
The rate should be measured at rest, not after someone has been up and
walking about. Being aware that your breaths are being counted can make the
results inaccurate, as people often alter the way they breathe if they know it's
being monitored. Nurses are skilled at overcoming this problem by discretely
counting respirations, watching the number of times your chest rises and falls

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often while pretending to take your pulse. While recording respiratory rate,
several other markers of respiratory problems may also be noted. Is your
patient or loved one uncomfortable? Do the muscles in her neck tighten as
they breathe? (Medical professionals call this the use of accessory muscles
to breathe.) Can you hear any wheezing or other abnormal breathing sounds?
b. Normal Respiratory Rate Ranges
In general, children have faster respiratory rates than adults, and women
breathe more often than men. The normal ranges for different age groups are
listed below:
Newborn: 30-60 breaths per minute
Infant (1 to 12 months): 30-60 breaths per minute
Toddler (1-2 years): 24-40 breaths per minute
Preschooler (3-5 years): 22-34 breaths per minute
School-age child (6-12 years): 18-30 breaths per minute
Adolescent (13-17 years): 12-16 breaths per minute
Adult: 12-18 breaths per minute
c. What Does Respiratory Rate Measure?
The number of breaths we take per minute is a sign of how often the brain is
telling our bodies to breathe. If the oxygen level in the blood is low, or
alternately if the carbon dioxide level in the blood is high, our body is
instructed to breathe more often. For example, having a severe infection
increases the carbon dioxide produced in the body, so even if there's a normal
level of oxygen in the blood, the brain instructs the body to breathe more often
to clear the carbon dioxide.
But there are times when this system doesnt work so well, such as when
people are treated with narcotic medications. These medications in effect dull
the response of the brain to signals from the blood, so someone may breathe
less often than needed. This may also occur with head injuries that damage the
respiratory center in the brain.
d. Abnormal Respiratory Rates
Both an increased and decreased respiratory rate can be a sign that something
is amiss in the body. An abnormal rate is fairly nonspecific, meaning there are
many causes of both a rapid and a slow rate. Its important again to note that

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the normal ranges are for people at rest. Respiratory rate normally increases
during exercise.
e. Increased Respiratory Rate
What is an elevated respiratory rate? In adults, the cut-off is usually
considered a rate over 20 breaths per minute, with a rate of over 24 breaths per
minute indicating a very serious condition.
As noted above, respiratory rate is a very important vital sign. One study
found that in unstable patients, an elevated respiratory rate was a better
determinant of who was stable vs unstable than heart rate or blood pressure.
There are many causes of an increased rate, some that are related to the lungs
and some that are not. Some of the more common causes include:
Fever
Dehydration Dehydration alone can result in a rapid rate of
breathing.
Asthma During an asthma attack, respiratory rate is often increased.
COPD Chronic obstructive pulmonary disease is a common cause of
a rapid respiratory rate, especially in people with a history of smoking.
Hyperventilation People may breathe more rapidly in response to
stress, pain, anger or during a panic attack.
Lung conditions Such as lung cancer, pulmonary embolism (blood
clots in the legs that travel to the lungs.)
Infections Common and uncommon infections such as the flu,
pneumonia, and tuberculosis can result in rapid breathing.
In newborns, common causes include transient tachypnea of the
newborn (TTN) a mild condition as well as conditions that are
more serious, such as respiratory distress syndrome.
Acidosis An increase in the acidity of the blood results in the
increased production of carbon dioxide, and hence an increased rate of
breathing. This can occur when a person has a condition resulting in
metabolic acidosis, such as with diabetes (diabetic ketoacidosis).
Overdoses Such as with an overdose of aspirin or amphetamines.

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Heart conditions An elevated respiratory rate was found in one study

to be a predictor of cardiac arrest in people hospitalized with heart
conditions.
f. Decreased Respiratory Rate
A lowered respiratory rate, defined as a rate less than 12 by some, or less than
8 respirations per minute by others, can also be a sign of concern. Some causes
of a decreased rate include:
Use of narcotics Some medications such as narcotics, whether used
for medical purposes or illegally, can suppress respiration.
Alcohol Consumption of alcoholic beverages can decrease
respiratory rate.
Metabolic Respiratory rate can decrease in order to balance the
effects of abnormal metabolic processes in the body.
Sleep apnea With sleep apnea, people often have episodes of apnea
and a decreased breathing rate mixed with episodes of an elevated
breathing rate.
Brain conditions Damage to the brain, such as strokes and head
injuries often result in a decreased respiratory rate.
g. Condition of respiratory rate
Bradypnea Bradypnea is the medical term used to define breathing
that is abnormally slow.
Tachypnea Tachypnea is the medical term used to define an elevated
respiratory rate.
Dyspnea Dyspnea refers to the sensation of shortness of breath, and
can occur with an elevated, a normal, or a decreased respiratory rate.
Hyperpnea Hyperpnea refers to breathing that is abnormally deep
and appears labored. It may occur with or without rapid breathing.
Apnea Apnea means literally no breath and refers to the absence of
breathing.
h. Some of the factors that affect the speed of the respiratory frequency is:
Age
Toddlers have a faster respiratory rate than alduts. The alduts,
respiratory intensity will decrease.Why it is ? Infants and toddlers have

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more breathing frequency than adults. That is because the volumes are
relatively small lungs and body cells are being developed that require a
lot of oxygen. Parents also have a lot more breathing frequency as the
chest and diaphragm contraction of the muscles are not as good as
when I was young, so a little more breathing air.
The body temperature
The higher body temperature (fever), the respiratory rate will be faster.
The position of the body
Body position affects the respiratory frequency. In the body of the
stand, the leg muscles will contract so that the necessary energy to
keep the body standing upright. It required a lot of O2 and CO2
produced. In the standing postures, breathing frequency increased.
In the sitting or lying position, the body weight of the load is supported
by most of the parts of the body resulting in the spread of the load.
This resulted in the amount of energy needed to support the body is not
too big so that is also low-frequency breathing.
Activities body
People who do a lot of activities require more energy than people who
do not perform activities ( relaxing / sleeping ) . Therefore , the body
needs more oxygen for biological oxidation and produce more waste
products . The body needs to increase the frequency of breathing in
order to provide more oxygen .
Respiratory motion is governed by the respiratory center in the brain
called the medulla oblongata and . In contrast , the respiratory nerves is
also driven by the level of carbon dioxide in the blood . We can hold
your breath a while, but when the carbon dioxide levels in the blood go
up then there will be a stimulus to breathe air immediately breathing
deeply. When blood through the alveoli , carbon dioxide content of the
same as in the alveoli .
The blood then reaches the medulla oblongata containing selsel very
sensitive to the concentration of carbon dioxide in the blood . If the
carbon dioxide content rises above normal , the medulla oblongata
responds by increasing the number of nerve impulses and the rate of

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nerve impulses that control the action of the respiratory muscles (

muscles of the diaphragm and intercostal muscles ) . The result is
improved air exchange in the lungs which restores the concentration of
carbon dioxide in the alveoli rapidly and then returns the blood
concentration of carbon dioxide concentrations to normal .
C. THIRSTY
Thirst is "the physiological urge to drink. In studies, it is recognised when subjects
report the conscious sensation of a desire to drink. Under normal conditions, most
water intake is due not to thirst but to social and cultural factors (eg drinking with
meals or at work breaks, water in food). Thirst offers a backup to these behavioural
factors and to the ADH response. Both the thirst and the ADH mechanisms are
regulated in the hypothalamus. Water intake can be considered to consist of two
components: a regulatory component (due to thirst) and a non-regulatory component
(all other fluid intake).
1. Stimuli to Thirst
The 4 major stimuli to thirst are:
a. Hypertonicity: Cellular dehydration acts via an osmoreceptor mechanism in
the hypothalamus
b. Hypovolaemia:Low volume is sensed via the low pressure baroreceptors in the
great veins and right atrium
c. Hypotension: The pressure baroreceptors in carotid sinus & aorta provide the
sensors for this input
d. Angiotensin II: This is produced consequent to the release of renin by the
kidney (eg in response to renal hypotension)
There is strong evidence for a role of the octapeptide angiotensin II in
physiological thirst: it is a potent dipsogen. The action is mediated via the effect
of angiotensin II on specific receptors located in the subfornical organ (SFO) and
the organum vasculosum of the lamina terminalis (OVLT). Both the SFO and the
OVLT are circumventricular organs: they lie outside the blood-brain barrier
allowing blood-borne substances (angiotensin II in this case) to affect neurones.
The neuronal pathway from the SFO to the hypothalamus uses angiotensin II as a
neurotransmitter. Ascending neural pathways arising from the low and high
pressure baroreceptors enter the same area of the hypothalamus. Hypovolaemia
and hypotension are facilitators for the development of thirst.

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It is not known whether the osmoreceptor which stimulates thirst is the same or
different from the one stimulating ADH release but they are located in the same
area of the hypothalamus. The osmotic threshold for thirst may be set higher than
that for ADH release but this is disputed. If it was, it would suggest that thirst has
a backup role for situations where alterations in plasma tonicity are not corrected
solely by ADH changes. Thirst and ADH release are interrelated in the
hypothalamus via neuronal connections between relevant areas.
2. Outcome
Thirst leads to drinking. This is a powerful defence against hyperosmolality. As
long as access to water is unrestricted and the person is able to drink, then
significant hyperosmolality will not develop. For example, elderly patients with
non-ketotic hyperglycaemia do not become significantly hyperosmolar unless
water intake becomes restricted for some reason.
Drinking stimulates mechanoreceptors in the mouth and pharynx. These
peripheral receptors provide input to the hypothalamus and the sensation of thirst
is attenuated. This occurs even before any reduction in plasma tonicity. This may
be a safeguard against over-ingestion of water as there is an inevitable delay
before the ingested water is absorbed and available to decrease plasma osmolarity.
3. Considerations
Drinking lots of water is usually healthy. But the urge to drink too much may be
the result of a physical or emotional disease. Excessive thirst may be a symptom
of high blood sugar (hyperglycemia). It can be an important clue in
detecting diabetes.
Excessive thirst is a common symptom. It is often the reaction to fluid loss during
exercise or to eating salty foods.
4. Causes
a. A recent salty or spicy meal
b. Bleeding enough to cause a large decrease in blood volume
c. Diabetes
d. Diabetes insipidus
e. Medicines such as anticholinergics, demeclocycline, diuretics,
phenothiazines
f. Loss of body fluids from the bloodstream into the tissues due to conditions
such as severe infections (sepsis) or burns, or heart, liver, or kidney failure

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g. A mental disorder called psychogenic polydipsia

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D. Body temperature
Body temperature is a measure of the body's ability to generate and get rid of heat.
The body is very good at keeping its temperature within a narrow, safe range in spite
of large variations in temperatures outside the body.
When you are too hot, the blood vessels in your skin expand (dilate) to carry the
excess heat to your skin's surface. You may begin to sweat, and as the sweat
evaporates, it helps cool your body. When you are too cold, your blood vessels
narrow (contract) so that blood flow to your skin is reduced to conserve body heat.
You may start shivering, which is an involuntary, rapid contraction of the muscles.
This extra muscle activity helps generate more heat. Under normal conditions, this
keeps your body temperature within a narrow, safe range.
1. Where is body temperature measured?
Your body temperature can be measured in many locations on your body. The
mouth, ear, armpit, and rectum are the most commonly used places. Temperature
can also be measured on your forehead.
2. What is normal body temperature?
Most people think of a "normal" body temperature as an oral temperature of 98.1F
(37C). This is an average of normal body temperatures. Your temperature may
actually be 1F (0.6C) or more above or below 98.6F (37C). Also, your normal
body temperature changes by as much as 1F (0.6C) throughout the day, depending
on how active you are and the time of day. Body temperature is very sensitive to
hormone levels and may be higher or lower when a woman is ovulatingor having
her menstrual period.
3. What factors influence my basal body temperature?
There are certain factors that can influence your basal body temperature. These
should be noted in the notes section of Fertility Friend or checked on the checklist
on the data entry page.These factors will usually not make charting and
impossible, especially if they occur only rarely, though it may be more
challenging. In most cases, even when these factors apply on an ongoing basis,
they will not skew your data so much that reading the chart is impossible. It is
important to make a note of the factors, however to help with the interpretation of
the chart. The following factors may influence your BBT:
a. Fever
b. illness and infections (even those that do not produce a fever)

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c. cold, sore throat

d. drugs and medications
e. alcohol (especially in large quantities, though all alcohol consumption should
be recorded)
f. smoking (if you smoke, you should consider quitting before you are even
pregnant)
g. emotional
h. physical stress
i. excitement
j. sleep disturbance (insomnia, night-waking, upsetting dreams, poor sleep)
k. change in waking time
l. jet lag
m. travel
n. change of climate
o. breastfeeding
E. Sweating
Sweat is a clear, odourless solution secreted by sweat glands, which are also known as
sudoriferous glands. It is hypotonic, meaning that it has a lower concentration of
electrolytes than the cells of the sweat glands. The body has millions of sweat glands
which lie within the deep layers of the skin and connect via ducts to the epidermis
(outer layer of skin) before opening out onto the skin surface.
Sweating is the primary mechanism by which the human body regulates its
temperature. It occurs during waking and sleeping. Sweat glands secrete sweat in
response to nervous stimuli, primarily heat stimuli, but also emotional and gustatory
(food) stimuli.
Sweat consists primarily of water and electrolytes. The primary electrolytes contained
in sweat are sodium and chloride. Potassium, urea, lactate, amino acids, bicarbonate
and calcium are also found. Approximately 1% of the total volume of sweat consists
of proteins, including immunoglobulins (proteins that function as antibodies) and
glycoproteins (proteins joined to carbohydrates which perform a range of functions in
the body). It is acidic, with a pH of 46.
1. Anatomy of sweat glands
Some 4 million sweat glands are distributed throughout the human dermis (skin).
They can be classified as one of two distinct types, which are anatomically

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different in terms of size and structure and the nervous stimuli to which they
respond, and which serve different functions in the sweating process:
a. Eccrine sweat glands: Constitute some 75% of all the body's sweat glands (~3
million); Eccrine sweat glands are tubular structures with long branches. They
consist of:
A tightly coiled tubular portion responsible for secreting sweat, located
deep within the skin layers. The tubular portion is 6080 m in
diameter and 25 mm in length; and
A straight duct portion that transports the sweat to the skin surface.
The duct portion fuses with the papillary layer of the dermis (the layer
underlying the skin surface) and opens onto the skin surface. The duct
portion is also 25 mm in length, but is slightly narrower in diameter
compared to the tubular portion.

The eccrine glands consist of three cell types:

Dark cells: Cover most of the surface of the cavities in the secretory or
tubular portion of the eccrine sweat gland;
Clear cells: Rest directly on the basement membrane (a thin, fibrous
layer separating the inner and outer layers of skin) or on myoepithelial
cells; and
Myoepithelial cells: Spindle-shaped cells which lie between the
secretory cells of the sweat glands and the basement membrane, close
to the junction between the tubular and secretory portion of the eccrine
sweat gland. These cells are also found in apocrine glands.

Eccrine sweat glands develop in utero (during foetal development) and are
distributed over the entire body, with the exception of the lip margins, nail
beds, nipples, the inner surface of the prepuce (foreskin), labia minora
(outer folds of skin of the vulva/vagina), glans penis (head of the penis)
and glans clitoris. The distribution of eccrine sweat glands at other body
sites is uneven. Sites at which eccrine glands are heavily concentrated
include:

Soles of the feet: 620 20 per cm2;

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Palms of the hands: 300 80 per cm2;

Armpits: 360 60 per cm2;
Forehead: 360 60 per cm2; and
Cheeks: 300 80 per cm2.
Sites which have a low concentration of eccrine glands include:
Trunk: 65 20 per cm2; and
Extremities (arms and legs): 120 30 per cm2.

b. Apocrine sweat glands: Comprise the other 25% (~1 million);

Apocrine glands occur mainly in the arm pit, the areola of the nipples, and the
perineum (region separating the anus from the genitals). They can also be
found in the ear and eyelid. They are small and inactive before puberty. At
puberty they increase in size, and in adults, apocrine glands are larger than
eccrine glands.
Like the eccrine glands, they consist of secretory and ductal portions. In
apocrine glands, the secretory portion is a tube consisting of a single layer of
secretory cells arranged in a column and surrounded by myoepithelial cells.
The ductal portion is short compared to the eccrine gland, and opens into the
hair follicle, rather than to the skin surface.
c. Apoeccrine sweat glands: Mixed-type sweat glands known as apoeccrine
glands are also found in humans.
Apoeccrine glands are primarily found in the armpits and peri-anal region.
They are larger than typical eccrine glands and smaller than apocrine glands.
Like eccrine glands, the ductal portion of apoeccrine glands opens out to the
skin surface. They are thought to arise from eccrine glands during puberty.
The secretory portion of apoeccrine glands consists of an irregularly wide
section with a cell structure similar to apocrine glands and a narrower segment
similar in structure to the eccrine gland. It secretes a thin watery sweat
d. Innervation of the sweat glands
Nerve fibres which send signals to sweat glands arise in the sympathetic
nervous system (a section of the nervous system that controls involuntary
muscle movement). Nerves in different vertebrae of the thoracic (T) and

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lumbar (L) portions of the spinal cord supply sweat glands at different body
sites:
Upper limbs are supplied by nerves arising in vertebrae T28;
Lower limbs are supplied by nerves arising in vertebrae T10L2;
Face and eyelids are supplied by nerves arising in vertebrae T14;
Trunk is supplied by nerves arising in vertebrae T412.
2. Thermoregulatory sweating (body temperature control)
Sweating is primarily a thermoregulatory response to control the body
temperature. Normal thermoregulatory sweating occurs in response to external
heat stimuli which alters skin temperature. However, it is thought to be primarily
controlled by the body's internal temperature and particularly the temperature of
the central brain. Thermoregulatory sweating is regulated by signals from the
hypothalamus (a structure in the brain), and occurs diurnally (in the day) and
nocturnally (at night).
a. Eccrine sweat gland
Thermoregulatory stimuli (heat) stimulate the release of acetylcholine (the
neurotransmitter) from nerve endings in the eccrine glands and catalyse sweat
secretion. Sweat secretion plays an important role in thermoregulation. The
amount of sweat produced differs under different environmental conditions
and increases with increasing heat. Eccrine glands collectively have the
capacity to produce up to 10 litres of sweat each day. Under normal
conditions, only 5% of the glands are active at any given time and 0.51 L of
sweat is produced per day. However, humans are typically able to produce 1.4
L/hour of sweat when exposed to heat or during exercise.
Increases in sweating occur due to an increase in the number of active sweat
glands (in the initial phase of sweating) and an increase in the volume of sweat
produced by each gland (in sustained sweating). Most of the sweat glands are
activated within 8 minutes of exercise or passive exposure to heat.
Subsequently, increases in the volume of sweat produced per gland occur
gradually, until exercise or heat stress is withdrawn, or after 46 hours of
prolonged heat stress when sweating reduces regardless of stimuli. The
mechanisms that down-regulate sweating (decrease sweat production) during
prolonged heat exposure or exercise are not well understood.

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Eccrine glands consist of clear and dark cells, which have distinct functions.
The clear cells secrete water and electrolytes, the main salts found in sweat.
The dark cells secrete glycoproteins, the key proteins in sweat. Sweating is
catalysed by acetylcholine, which binds to receptors thought to be located in
the membrane of clear eccrine gland cells. When acetylcholine receptors are
activated, a series of electrolyte exchanges between the cytoplasm (a gel-like
substance that gives the cell its shape) and the fluid surrounding the cell are
triggered.
In the first of the series of electrolyte exchanges, calcium electrolytes
contained in the watery fluid secreted by a clear cell flood back into the clear
cell's cytoplasm. This in turn causes potassium chloride electrolytes to flood
out of the cytoplasm, as the cell attempts to regulate its electrolyte and water
concentration. The efflux (flooding out) of potassium chloride electrolytes in
turn catalyses an influx (flooding in) of nitrogen, potassium and chloride
electrolytes. At this point, there is an increase in the concentration of sodium
electrolytes within the clear cell's cytoplasm.
The increased concentration of sodium stimulates sodium pumps, which push
sodium electrolytes out of the cell and draw in potassium electrolytes from the
fluid surrounding the cells. At the same time, chloride ions move into the cell,
assisted by sodiumpotassiumchloride co-transporters, causing the
membrane of the cell to attract sodium electrolytes. Chloride and sodium
electrolytes then bind together to form sodium chloride, a key component of
the primary solution from which sweat is produced. The primary solution,
which is slightly acidic and isotonic (containing an equal concentration of
electrolytes as the cell), is secreted from the tubular portion of the eccrine
gland to the duct portion.
The tubular portion of the eccrine gland then reabsorbs sodium chloride in the
solution to preserve electrolyte balance. Following reabsorption of sodium
chloride from the primary solution, a hypotonic solution (sweat) remains and
is secreted to the skin via the sweat gland duct.
b. Apocrine sweat glands
Apocrine glands increase in size and begin to function after puberty, a process
that is regulated by androgens (male hormones). Following puberty, they
secrete a solution that is thicker than sweat and contains fatty acids and

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proteins. It also smells. The odour of sweat occurs due to bacterial

decomposition of sweat and the solution secreted from the apocrine glands,
which contains lipids, cholesterol and steroids.
The apocrine glands are evolutionary remnants; they have no known function
in humans, although in other mammals they function to produce odours that
attract the opposite sex. Some hypothesise that apocrine secretions play a role
in thermoregulation by emulsifying eccrine sweat and causing it to form a
sweat layer over the skin.
3. Non-thermoregulatory sweating
The cause of pathological sweating or hyperhidrosis is not well understood, bit is
thought to occur due to hyper-responsiveness of the nerve pathways involved in
sweating. These pathways involve the sympathetic nervous system, the cerebral
cortex (a structure in the brain that regulates involuntary movement) and the
hypothalamus. They are always diurnal, meaning that they only occur in the day.
a. Eccrine sweat glands
Eccrine sweat glands cover most of the body's surface and are the source of
excessive perspiration. In addition to heat stimuli, the eccrine glands also
respond to emotional and gustatory (food) stimuli which can cause non-
thermoregulatory, pathological sweating. Increased mental stress increases
sympathetic nerve activity, which leads to increased sweating. Hyper-
functioning of the hypothalamus during exercise is also thought to increase
thermoregulatory sweating.
Excessive sweating is most likely to occur at the sites where eccrine glands are
concentrated (armpits, palms, soles and face) in focal hyperhidrosis, a
condition characterised by excessive sweating at distinct anatomical sites.
b. Apoeccrine sweat glands
The function of apoeccrine sweat glands in excessive sweat production is not
well understood. However, in some focal hyperhidrosis patients, they are
highly concentrated in the armpit region where they can comprise up to 45%
of all sweat glands. This suggests they may have a role in non-
thermoregulatory sweating.

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CLOSING

A. Conclusion
Activities Heart Rate Respiratory Rate Temperature
After Exercise 65 beats per minute 12 breaths per minute 37oC
Before Competition 85 beats per minute 18 breaths per minute -
Competition 201 beats per minute 68 breaths per minute 37,5oC
Almost Finish 180 beats per minute Down slightly 38oC
Overtake by the other 208 beats per minute 80 breaths per minute 38,3oC
team
Finish Back to normal Back to normal 37,5oC

Note:
Normal condition: Heart rate : 60-80 beats per minute
Respiratory rate : 16-24 breaths per minute
Temperature : 37oC

From the data above, we can conclude that after doing strecthing and warm-up
exercises, the heart rate still normal but the respiratory rate decreased. Before the
competition, the heart rate increased a little because Jim felt nervous and tensed at
same time and also he was sweating although the air was cool. When competed, his
heart rate became much more than before and the temperature became increased a
little, because he was putting all of his strength into each stroke in competition. When
he and his friends had traveled just over 1000 meters, his heart rate and respiratory
rate was decreased slightly, he decided to rest a bit. But when they saw the crew next
to move and they were up one seat, his heart rate became higher than before. After
they crossed the finish line, his heart rate and respiratory rate were almost back to
normal and though his body temperature was still half a degree above normal.

B. Suggestions
Similarly, there are still many shortcomings and weaknessess, because we still lack in
knowledge and references. Hence, the writer looking forward to the constructive

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criticism and suggestions for the perfection of our paper. Hopefully this paper is
useful for the writers in particular and also the readers in general.

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Pulse_UCM_438850_Article.jsp#

Cretikos, M. et al. Respiratory rate: the neglected vital sign. Medical Journal of Australia. 2008.

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National Institute of Health. Medline Plus. Vital Signs. Updated 02/20/11.

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