NCM 112 LEC | MEDICAL – SURGICAL NURSING by: tinyya~

Anatomy and Physiology

Functions of the Respiratory System:

1. Gas Exchange
2. pH homeostasis – regulation of the blood pH by changing blood CO2 levels
3. Voice production/Vocalization (air movement pass the vocal cords & make sounds possible)
4. Olfaction (sensation of smells)
5. Innate immunity
Processes of Respirations:
1. Ventilation (breathing) – movement of air in & out of the lungs
2. Exchange of O2 & CO2 between the air in the lungs & blood
3. Transport of O2 & CO2 in the blood
4. Exchange of O2 & CO2 between the blood & tissues

Anatomy & Physiology of the Respiratory System

Upper Respiratory Tract Lower Respiratory Tract
 Nasal cavity, Pharynx, Larynx  Trachea, Primary Bronchi , Lungs

1. Nose
- Functions: humidifies, warms, filters inspired air, voice resonance chamber, &
houses olfactory receptors
- Nasal vibrissae (hairs) coated w/ mucus → traps large particles (e.g. dust,
pollen)
- Consists of the external nose & the nasal cavity

1.1. External nose

- Visible structure that forms a prominent feature of the face

1.2. Nasal cavity

- Extends from the nares to the choanae
- Nasal cavity division:
 Midline nasal septum: composed of septal cartilage, anteriorly; partition dividing the nasal cavity
into right & left part.
 Vomer bone: posteriorly

Vocabulary:
Goblet cells – arise from pluripotent stem cells & derive their name from their goblet, cup-like appearance & its function
is to secrete mucin & create a protective mucus layer.
Defensins – are small (29–35 amino acids) proteins produced by circulating wbcs & tissue cells; capable of killing
bacteria or inhibiting bacterial growth.
Mucociliary escalator – mucus traps particles → ciliated columnar cells beat rhythmically → moves mucus;
trapped particles towards pharynx → spit out/swallowed.
Tidal volume – it is the amount of air that moves in or out of the lungs w/ each respiratory cycle.
NCM 112 LEC | MEDICAL – SURGICAL NURSING by: tinyya~

- 4 Paranasal sinuses (air-filled spaces inside bones)

 Ethmoid, frontal, sphenoid, maxillary
 Functions: warms, moistens inspired air, amplifies voice, & lightens the weight of the skull
- Nasolacrimal ducts (also called the tear duct) carry tears from the lacrimal sac of the eye into the nasal
cavity.
- Sensory receptors from the sense of smell are in the superior part of the nasal cavity
- 2 types of mucous membrane
 Olfactory Mucosa: olfactory epithelium containing smell receptors
 Respiratory Mucosa: Pseudo stratified ciliated columnar epithelium containing goblet cells;
secretes mucus containing lysozyme, defensins
- Nasal Conchae
 3 mucosa-covered projections (superior, middle, inferior nasal conchae) of nasal cavity’s lateral
wall
 Meatus: groove inferior to each conchae (superior, middle, inferior meatus)
 Functions: turbulence inside cavity to filter, humidify inspired air; reabsorb heat, moisture during
nasal expiration

1. Stratified Squamous Epithelium – just inside the nares containing coarse hairs
2. Pseudo stratified Columnar Epithelial cells – the rest of the nasal cavity containing cilia & mucus
producing goblet cells.

1.3. Palate
- Separates nasal cavity from oral cavity
- Hard palate: anterior portion supported by palatine bones
- Soft palate: posterior portion, not supported by bones
- Soft palate & uvula move together → forms valve that closes nasopharynx when swallowing (prevents
food from entering nasopharynx)

2. Pharynx
- A.k.a. throat
- Common passageway for both the respiratory
& digestive systems
- Passageway connecting nasal cavity, oral cavity,
larynx, esophagus
- Divided into 3 regions: Nasopharynx,
Oropharynx, & Laryngopharynx

2.1. Nasopharynx
- Region connecting nasal cavity to pharynx
- Posterior to nasal cavity, inferior to sphenoid bone, superior to soft palate

Vocabulary:
Goblet cells – arise from pluripotent stem cells & derive their name from their goblet, cup-like appearance & its function
is to secrete mucin & create a protective mucus layer.
Defensins – are small (29–35 amino acids) proteins produced by circulating wbcs & tissue cells; capable of killing
bacteria or inhibiting bacterial growth.
Mucociliary escalator – mucus traps particles → ciliated columnar cells beat rhythmically → moves mucus;
trapped particles towards pharynx → spit out/swallowed.
Tidal volume – it is the amount of air that moves in or out of the lungs w/ each respiratory cycle.
NCM 112 LEC | MEDICAL – SURGICAL NURSING by: tinyya~

- Air-only passageway
- Pharyngeal tonsils (adenoids): located on posterior wall, traps & kills pathogens
- Pseudo stratified ciliated epithelium (part of mucociliary escalator)

2.2. Oropharynx
- Region connecting pharynx to oral cavity
- Posterior to oral cavity, continuous w/ isthmus of fauces
- Soft palate superior, epiglottis inferior
- Food, air passageway
- Pseudo stratified columnar epithelium of nasopharynx stratified → squamous epithelium
- Palatine tonsils located on lateral walls
- Lingual tonsils cover posterior tongue

2.3. Laryngopharynx
- Passes posterior to the larynx & extends to the tip of the epiglottis to the esophagus
- Part of pharynx continuous w/ larynx
- Food, air passageway
- Stratified squamous eithelium
- Epiglottis anterior, esophagus posterior

3. Larynx
- A.k.a. voice box
- Located in the anterior throat & extends from the base of the
tongue to the trachea
- Cartilage, connective tissue framework
- Connects pharynx to trachea, houses vocal cords, epiglottis
(cartilage flap at the top of larynx that seals airway off when
swallowing– prevents food from entering lungs/windpipe)
- Location: 3rd to 6th cervical vertebra; Superior: hyoid bone & Inferior: trachea
- 3 Main Functions:
 Maintains an open airway
 Protects the airway during swallowing
 Produces voice
- Contains cartilages:
 Thyroid cartilage (Adam’s apple): large, shield-shaped midline cartilage, produces laryngeal
prominence; attached superiorly to the hyoid bone
 Cricoid cartilage: ring-shaped cartilage inferior to thyroid cartilage, superior to trachea; forms
the base of the larynx on w/c the other cartilages rest

Vocabulary:
Goblet cells – arise from pluripotent stem cells & derive their name from their goblet, cup-like appearance & its function
is to secrete mucin & create a protective mucus layer.
Defensins – are small (29–35 amino acids) proteins produced by circulating wbcs & tissue cells; capable of killing
bacteria or inhibiting bacterial growth.
Mucociliary escalator – mucus traps particles → ciliated columnar cells beat rhythmically → moves mucus;
trapped particles towards pharynx → spit out/swallowed.
Tidal volume – it is the amount of air that moves in or out of the lungs w/ each respiratory cycle.
NCM 112 LEC | MEDICAL – SURGICAL NURSING by: tinyya~

 Function of thyroid & cricoid cartilages is to maintain an open passageway for their
movement.
 Epiglottis: spoon-shaped cartilage is pulled superiorly to cover laryngeal inlet during swallowing;
consists an elastic cartilage rather than hyaline cartilage.
 Function of epiglottis is to protect the airway during swallowing
 Arytenoid, Cuneiform, Corniculate cartilages: form posterior, lateral larynx walls (arytenoid
cartilages anchor vocal cords)
- Vocal folds/ligaments:
 Attach arytenoid cartilages to thyroid cartilage
 True vocal cords: its function is sound production, composed of elastic fibers, core of mucosal
folds, appears white (avascularity)
 False vocal cords: superior to true vocal cords, doesn’t participate in sound production, function
is that it closes the epiglottis during swallowing

1. Trachea
- A.k.a. windpipe
- Allows air to flow into the lungs
- It’s a membranous tube attached to the
larynx
- It consists of connective tissue & smooth
muscle
- Contraction of this smooth muscle can
narrow the diameter of the trachea, w/c
aids in cough reflex
- Main stem bronchi, airways
- C-shaped cartilage provides support &
maintains open passage for air
- Connected by trachealis muscle
- Layers (superficial to deep)
 Mucosa: pseudo stratified epithelium w/ goblet cells , mucociliary escalator
 Submucosa: connective tissue layer (supported by 16-20 C-shaped cartilage rings)
 Adventitia: connective tissue layer encasing cartilage rings

2. Bronchi
- The trachea divides into left & right main bronchi/primary bronchi; each of w/c connects to a lung.
- Right main stem bronchus
 Wider, more vertical
 Something accidentally inhaled → goes into right lung (more likely)

Vocabulary:
Goblet cells – arise from pluripotent stem cells & derive their name from their goblet, cup-like appearance & its function
is to secrete mucin & create a protective mucus layer.
Defensins – are small (29–35 amino acids) proteins produced by circulating wbcs & tissue cells; capable of killing
bacteria or inhibiting bacterial growth.
Mucociliary escalator – mucus traps particles → ciliated columnar cells beat rhythmically → moves mucus;
trapped particles towards pharynx → spit out/swallowed.
Tidal volume – it is the amount of air that moves in or out of the lungs w/ each respiratory cycle.
NCM 112 LEC | MEDICAL – SURGICAL NURSING by: tinyya~

- Inside lungs
 Main bronchus subdivides into lobar bronchi → segmental bronchi → terminal bronchioles
- Trachea & first 3 bronchial generations were wide & supported by cartilage rings
- Large airways lined by ciliated columnar cells, goblet cells (secrete mucus)

2.1. Bronchioles
- Narrow airways after first 3 bronchial generations
- Terminal bronchioles: last part of terminal bronchioles , end
of conducting zone
- Respiratory bronchioles: distal to terminal bronchioles, first
part of respiratory zone
- Terminal bronchiole → respiratory bronchiole → alveolar
ducts → alveolar sac → alveoli

Relaxation & Contraction of the smooth muscle within the bronchi & bronchioles can change the diameter of
the air passageway. (Example: during exercise, the diameter ↑, thus ↑ the volume of air move & during asthma
attack.

2.2. Alveoli
- Are small air-filled chambers where air & blood come into close contact w/ each other
- Alveolar wall: composed of a single squamous epithelium layer
- Elastic fibers surround alveoli → allow lung expansion
during inspiration, recoil during expiration
- Type I pneumocytes
 Primary gas exchange site
 O2-CO2 exchange occurs between alveolar gas,
pulmonary capillary blood
 Thin walls, large alveoli surface-area maximizes gas
exchange diffusion capabilities
- Type II pneumocytes
 Secrete surfactant (↓ surface tension within alveoli → eases expansion, prevents collapsing)
- Alveolar macrophages
 Phagocytize particles inside lungs → conducting bronchioles → mucociliary escalator
- Respiratory membrane: where the gas exchange between air & blood takes place; capillary, alveolar
walls, basement membranes
- Alveolar pores connect adjacent alveoli
- Blood supply: pulmonary capillary networks

Vocabulary:
Goblet cells – arise from pluripotent stem cells & derive their name from their goblet, cup-like appearance & its function
is to secrete mucin & create a protective mucus layer.
Defensins – are small (29–35 amino acids) proteins produced by circulating wbcs & tissue cells; capable of killing
bacteria or inhibiting bacterial growth.
Mucociliary escalator – mucus traps particles → ciliated columnar cells beat rhythmically → moves mucus;
trapped particles towards pharynx → spit out/swallowed.
Tidal volume – it is the amount of air that moves in or out of the lungs w/ each respiratory cycle.
NCM 112 LEC | MEDICAL – SURGICAL NURSING by: tinyya~

3. Lungs
- The principal organs of respiration
- Right Lung: 3 lobes (superior, middle inferior)
- Left Lung: 2 lobes (superior, inferior)
- Base of lungs rest on diaphragm
- Pleura: double-layered serosa covering lungs, pleural fluid lining pleural cavity between 2 layers
 Parietal pleura: outer layer adherent to thoracic wall, superior surface of diaphragm
 Visceral pleura: inner layer adherent to external lung surface

- Each lobe in our lungs is divided into BRONCHOPULMONARY SEGMENTS that separates them from
one another and these separations are not visible as surface fissures

Vocabulary:
Goblet cells – arise from pluripotent stem cells & derive their name from their goblet, cup-like appearance & its function
is to secrete mucin & create a protective mucus layer.
Defensins – are small (29–35 amino acids) proteins produced by circulating wbcs & tissue cells; capable of killing
bacteria or inhibiting bacterial growth.
Mucociliary escalator – mucus traps particles → ciliated columnar cells beat rhythmically → moves mucus;
trapped particles towards pharynx → spit out/swallowed.
Tidal volume – it is the amount of air that moves in or out of the lungs w/ each respiratory cycle.
NCM 112 LEC | MEDICAL – SURGICAL NURSING by: tinyya~

Respiratory Control Mechanisms of the Respiratory System

RESPIRATORY CENTERS
 Medulla Oblongata
o primary respiratory control center
o Main function: send signals to the muscle that controls respirations to cause breathing to occur
o 2 regions that control respirations:
 Ventral respiratory group stimulates expiratory movements
 Dorsal respiratory group stimulates inspiratory movements
o Also controls the reflexes for non-respiratory air movements (e.g. coughing, sneezing,
swallowing, & vomiting reflexes)
 Pons
o One of the lowermost structures in the brain, located near the bottom of the skull & just
above the medulla oblongata
o Main function: to control the rate or speed of involuntary respirations
o 2 main functional regions:
 Apneustic center sends signals for inspiration got for long and deep breaths. It
controls the intensity of breathing & is inhibited by the stretch receptors of the
pulmonary muscles at max depth of inspiration, or by signals from the pnuemotaxic
center. It also ↑ tidal volume.
 Pneumotaxic center sends inhibitory impulses to the inspiratory center, terminating
inspiration, & thereby regulating inspiratory volume & RR. This center likely is
involved in the fine-tuning of breathing. It also ↓ tidal volume.

CHEMORECEPTORS
 Detects the pH level of the blood & send signals to the respiratory center of the brain to adjust the
ventilation rate to change acidity by increasing or decreasing the removal of CO2.
 Medulla (central chemoreceptors)
o detects changes in the pH of the spinal fluid
 Aortic bodies (peripheral chemoreceptors)
o Can detect changes in blood O2 & CO2 but NOT the pH
 Carotid bodies (peripheral chemoreceptors)
o Can detect the changes in pH, blood O2, & CO2

Vocabulary:
Goblet cells – arise from pluripotent stem cells & derive their name from their goblet, cup-like appearance & its function
is to secrete mucin & create a protective mucus layer.
Defensins – are small (29–35 amino acids) proteins produced by circulating wbcs & tissue cells; capable of killing
bacteria or inhibiting bacterial growth.
Mucociliary escalator – mucus traps particles → ciliated columnar cells beat rhythmically → moves mucus;
trapped particles towards pharynx → spit out/swallowed.
Tidal volume – it is the amount of air that moves in or out of the lungs w/ each respiratory cycle.