NurseReview.Org - Lymphatics and respiratory system

The Lymphatic System

The Lymphatic SystemIncludes the lymph, lymphatic vessels, lymph nodes, lymphoid organs (tonsils, spleen and thymus)

Primary Functions:1. Maintains fluid homeostasis2. Absorbs lipids from the GIT3. Filters blood (spleen)4. Contains lymphocytes participating in immunity

The LymphFluid similar to composition as plasmaWithout RBC and less proteinsSpecial Lymph from the GIT is loaded with fats and is called CHYLE

Fig. 14.2

The Lymph vesselsCarry fluid away from tissues into the venous circulationThese are NOT present in the central nervous system, Bone marrow, epidermis and cartilageThey resemble vein because they have valves

3 mechanisms of edema formation

1. Decrease oncotic pressure cirrhosis and kwashiorkor2. Increased hydrostatic pressure CHF and prolonged standing3. Lymphatic obstruction or destruction filiariasis, lymph node dissection

Lymphatic duct1. Right lymphatic duct- drains the right side of the head and the upper right side of the thorax and the right extremities2. Thoracic duct- drains the rest of the body

The Lymphatic organs1. Tonsils

A. palatineB. pharyngealC. lingualD. tubal

The lymphatic organs2. Lymph nodes

Small round structures of lymphoid tissueMajor lymph nodes are the axillary,

inguinal and cervicalFilters lymphActivates the immune systemRemoves microorganisms from the blood

The lymphoid organs3. The spleen

Reddish, flat organ lying next to the 9th and 10th rib in the left upper quadrantFunctions:

Repository of old RBCActivates the immune systemStorage of BloodSequesters bacteriaMOST COMMONLY INJURED

in BLUNT abdominal trauma

The lymphoid organs4. Thymus

Bilobed organ in the superior mediastinumLymphocytes from the bone marrow mature and grow as T-lymphocytesPositive selection= T-cells that react to foreign antigen are selectedNegative selection= T-cells that do not react to the self-antigen are selected

IMMUNITYInnate or Non-specific

1. Mechanical- skin, mucus, saliva, urine2. Chemical- enzymes, lysozymes3. Vascular Blood cells- Neutrophils and macrophages4. Inflammation

Specific Immunity1. Cellular Immunity- T-cell system2. Humoral Immunity- B-cell system

Non-specific ImmunityInflammatory responseReaction of the vacularized living tissues to injury

Classic signs:1. Rubor- redness2. Calor- heat3. Tumor- swelling4. Dolor- pain5. Functio laesa- loss of function

InflammationInitial reaction Vasoconstriction!VC VD VP (due to HISTAMINE)VD Redness and HeatVP SwellingBradykinin, Prostaglandin, compression of tissues pain

Specific Immunity: T cellT-cells originate in the bone marrow and mature in the thymus

4 types of T-cells1. Cytotoxic T cells- kill infected cells, cancer cells and transplanted cells2. Helper T cells- help the humoral immunity3. Suppressor T cells- suppress that actions of cytotoxic and Helper cells4. Memory T cells- for recall and specificity

Specific Immunity: B cellsB cells are produced and mature in the bone marrowB cells helped by Helper cells turn into Plasma cells secrete ANTIBODIES

ANTIBODIESAre proteins that can combine with antigens and function for:1. Opsonization2. Neutralization3. Activation of complement system

ANTIBODIES typesFive classes

1. Ig M- priMary response, pentaMer2. Ig G- secondary response, most abundant, can cross placenta3. Ig A- secreted by the body (sIgA)4. Ig D- receptor for B cells5. Ig E- allergic and parasitic reactions

TYPES OF IMMUNITY1. Natural Immunity

Active naturalPassive natural

2. Artificial ImmunityActive artificialPassive artificial

Fig. 14.18

End of Immune System

THE RESPIRATORY SYSTEM

The Respiratory SystemComposed of the air conducting system and the respiratory unit (lungs)Major function is RESPIRATIONCommonly divided into UPPER RESPIRATORY tract and LOWER RESPIRATORY tract

Ventilation and Respiration

VENTILATION- movement of air from the atmosphere into the lungs and out of the lungsEXTERNAL RESPIRATION- exchange of gases between the alveoli and the bloodINTERNAL RESPIRATION- exchange of gases between the blood and the tissues

The Respiratory SystemCommonly divided into UPPER RESPIRATORY tract

andLOWER RESPIRATORY tract

The UPPER Respiratory tract

The nose, pharynx and larynx

The LOWER respiratory tract

Composed of The trachea down to the Lungs

The NOSEMade up of nasal bones and cartilagesThe NASAL cavity is made up of bones, cartilages and turbinates or conchaeThe nostril is the external openingThe choanae is the internal opening

Functions of the nose1. Hairs or vibrissae filter large particles2. Blood vessels warm the air3. Mucus serves to humidify the air4. Phonation

The PharynxMusculo-membranous tube from behind the nasal cavity to the level of the cricoid cartilage (C6)

The Pharynx3 component parts

1. Nasopharynx2. Oropharynx3. Laryngopharynx

The LarynxUpper expanded portion of the tracheaMade up of cartilages

3 Unpaired- Cricoid, Thyroid and Epiglottis ( cUte)6 Paired- Cuneiform, Corniculate and Arytenoid (pACC)

Function: air passageway and phonation

The vocal cords1. False vocal cords2. True vocal cords3. Glottis- the space between the true vocal cords and is the narrowest portion of the adult airway

Fig. 15.4

Lower airway: TracheaCalled windpipeMade up of 15-20 C-shaped cartilage10-11 inchesLined with pseudostratified

ciliated epithelium

BronchusRIGHT BronchusWiderShorterMore vertical

Left bronchusNarrowerLongerMore horizontal

BronchiolesPrimary bronchussecondary bronchustertiary bronchus terminal bronchioles

Respiratory bronchioles belong to the respiratory unit

Respiratory unitRespiratory bronchiolesAlveolar ductsAlveolar sacsalveolus

The PleuraSurrounds the lungs and provide protection1. Parietal pleura- in the chest wall2. Visceral pleura- intimately attached to the lungs3. Pleural space- in between the two

Diaphragm

Respiratory Physiology1. Ventilation and gas exchange2. Mechanics of breathing3. Gas transport4. Pulmonary volumes and capacities5. Respiratory control

VentilationVentilation is the movement of air into the lungsAir (oxygen) moves by the process of diffusion from the higher concentration in the alveoli to the pulmonary capillaries

Mechanics of breathing

Gas exchangeRespiratory membrane is thin which facilitates gas exchangeRate of diffusion depends on the thickness of the membrane, surface area and partial pressure of gases

Gas transport1. OXYGEN- majority is transported in the blood loosely bound to hemoglobin- oxyhemoglobin2. CARBON DIOXIDE- majority is transported in the blood in the RBC as BICARBONATE

Fig. 15.8

LUNG VOLUMES1. Tidal volume – TV2. Inspiratory Reserve Volume- IRV3. Expiratory Reserve Volume- ERV4. Residual volume- RV

LUNG CAPACITIESLung volume + another lung volume1. Inspiratory Capacity- IC2. Functional Residual Capacity- FRC3. Vital capacity- VC4. Total Lung capacity- TLC

NOT CLINICALLY measured1. Residual volume2. Functional residual volume3. Total lung capacity

Control of Respiration: Central

Respiratory center in the medullaControls the rate and depth of respirationIncreased CO2 is the most potent stimulus

Control of Respiration: Peripheral

1. Chemoreceptors in the carotid and aortic bodies

Sensitive to changes in pH and O2Decreased O2 increase respirationDecreased pH (acidosis) increase respiration

2. Herring-Breurer reflexStretch receptors in the lungs limit the inspiration

ASSESSMENTNormal Breathing pattern:

12-21 respiratory rateActive inspiration with contraction of diaphragmPassive expiration with relaxation of diaphragm Steady rhythm and regular rate and sizeI:E ratio is 1:2

Abnormal breathing pattern

1. Cheyne-Stoke’s2. Biot’s3. Kussmaul’s4. Agoral

Breathing rates1. Eupnea- 12-212. Bradypnea- 11 and below3. Tachypnea- 22 and above4. Dyspnea- difficulty of breathing

Breathing Position1. Platypnea- inability to breath in an upright position2. Orthopnea- difficulty in breathing in any position except upright

Breath sounds: Normal1. Bronchial or Tracheal- in the sternum2. Bronchovesicular- in the interscapular area3. Vesicular- lung periphery

Adventitious Breath sounds

1. Rales or crackles2. Stridor3. Wheeze4. Rhonchi5. Friction rub