Structure and Function of the Respiratory System
The respiratory system is responsible for gaseous exchange in the body. It is divided into the upper and the lower respiratory system. Components of the upper respiratory tract include the nasal passage, the pharynx and the larynx while components of the lower airway system comprise of the trachea, the bronchi and the lungs. Other components of the respiratory system include the diaphragm, the rib cage, the intercostal muscles (Barrett et al., 2015) . Air from the outside passes through the nasal passages where it is filtered, warmed and moisturized before it can be transferred to the lower airway tract for exchange. In the lower respiratory tract, gaseous exchange between the air in the lungs and the blood in the capillaries from the pulmonary artery happens whereby oxygen diffuses from the alveoli which are the functional units of the lung into the deoxygenated blood in the capillaries. At the same time, carbon dioxide from the deoxygenated blood in the capillaries diffuses from the capillaries into the alveoli after which it is exhaled. The now oxygenated blood is transported to the body organs for metabolism. During inspiration, the intercostal muscles contract making the rib cage to move upwards and outwards while at the same time the diaphragm relaxes. This increases the size of the thoracic cavity therefore creating a negative pressure which draws air into the lungs. During expiration, the reverse happens whereby the intercostal muscles relax causing the ribcage to move inwards and downwards. At the same time, the diaphragm contracts and these changes effectively reducing the thoracic cavity and this creates a positive pressure within the chest cavity and this helps to expel the carbon dioxide from the lungs. The respiratory rate is adjusted accordingly to suit the body’s metabolic demands (Barrett et al., 2015) . For example, during exercise, the respiratory rate increases so that more oxygen can be inhaled to match the body’s metabolic demands while at the same time expelling the carbon dioxide generated.
Subjective data pertaining the Respiratory System
Do you have a cough? How long have you been coughing? Is it a productive cough of not? What is the color of the sputum? What makes you cough worse and what relieves it?
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Do you have chest pains? How long have the pains been there?
Do you have shortness of breath? How long has the shortness of breath been there? What worsens the shortness of breath? What relieves the shortness of breath?
Do you have any fevers? Do you have any night sweats?
Have you lost weight?
Objective Data pertaining the Respiratory system
Objective data in the respiratory system can be divided into vital signs as well as the examination findings.
Examination findings
General exam- The patient with a respiratory disease will usually appear to be in distress. Signs of distress involving the respiratory system include tachypnea, head nodding, flaring of alar nasals and shortness of breath. In addition to being in distress, these patients will have cyanosis depending on the severity of the distress. These patients will also have a grunt, a wheeze, a stridor and a cough.
Chest exam findings- There will be use of accessory muscles, chest wall in drawing and intercostal recession and an increased respiratory rate. On percussion, findings of a diseased respiratory system would include a dull note on parts of the lung field or increased tympanicity, the tactile and vocal fremitus would be decreased or increased depending on the pathology. On auscultation, there would be a reduced air entry in some parts of the lungs depending on the pathology.
Vital Signs
Respiratory rate- the normal respiratory rate is 12-20 breaths per minute in adults. When the respiratory system is diseased, the respiratory rate tends to go higher as a compensatory mechanism.
Spo2- The saturation levels are likely to be decreased in a disease involving the respiratory system. Usual Spo2 readings in a healthy patient range between 94%-100% while in diseases affecting the respiratory system, the Spo2 could be lower depending on the severity of the disease.
Temperature- in an infectious process affecting the respiratory system, the temperature is likely to go higher. The normal temperature of the human body ranges from 36.1 degrees to 37.2 degrees.
Special Assessment for the Respiratory System
Assessment of the respiratory system begins with observation. From observation alone, the examining officer can learn a lot about the disease affecting the patient hence it is very important to be very keen during observation. During observation, the examining officer is to look out for features such as absence/presence of distress in form shortness of breath, head nodding, use of accessory muscles, increased respiratory rate, presence or absence of cyanosis, intercostal recession as well as lower chest wall indrawing (Glynn et al., 2012) . The examining officer should also observe for any deformities affecting the chest such as trauma, congenital deformities among others.
After observation, the examining officer should now proceed to palpation. During palpation, the examining officer should look out for the centrality of the trachea and also palpate for the presence of any masses and presence of any areas of tenderness. During the palpation, the examining officer should also check out for the tactile and vocal fremitus. While testing for the vocal fremitus, the examiner should place the ulnar border of their palms over different parts of the lungs while asking the patient to say some a word such as 99. The examiner will appreciate an increase or a decrease in vocal fremitus depending on the pathology. Before making a conclusion, the examining officer should make sure to compare the vocal fremitus emitted from identical parts of each lung (Glynn et al., 2012) . The examining officer should then proceed to do percussion. Percussion involves testing the nature of the sound emitted by the lungs after performing controlled striking of different parts of the lungs. The note emitted would be either dull, resonant or hyper-resonant depending on the pathology. It is also important that the examining officer compares the note emitted from identical parts of both lungs before making a conclusion.
Percussion should then be followed by auscultation of the lungs. This involves listening to the breath sounds emitted from different parts of the lungs by use of a stethoscope. In a normal lung, the examiner should hear a vesicular breath sound while in diseased lungs, additional sounds such as crackles, wheeze or crepitations. It is also important that the examining officer should compare the findings from identical parts of the lungs before coming up with a conclusion.
By using an oximeter, the Spo2 of the patient can be taken to determine the level of oxygen saturation. This determines whether the patient requires supplemental oxygen or not or whether a patient requires mechanical ventilation or not.
Adapting examination skills to different age groups
For the best outcomes, a physician needs to adopt their assessment/ examination skills to different age groups. With pediatric group, the main concern is to make sure that you allay their fears so that they can cooperate with the examiner. This can be done by making that their parents are around them when doing the assessment. The parent can hold the child on their laps or sit next to them while reassuring them at the same time. This gives the child the much needed moral support and the child will be at ease as the doctor does their examination (Glynn et al., 2012) . For the very young children, the doctor can examine the baby as they walk/ play within the office with their toys. This will make them less suspicious of what the doctor is doing to them and this way, they become more cooperative with the examination.
With pregnant mothers, it is important to examine them at their most comfortable position in order to prevent worsening their discomfort. It is also important to ask the association of the symptoms with pregnancy which can be done by way of asking the patient the existence of similar symptoms before the pregnancy. It is also important to ensure their privacy since they might feel more embarrassed to expose their bodies because of their condition.
For the older patients, it is important to make use of an informer because in most cases, the older patients might not be fully aware of what is going on with their lives especially for the very old who have dementia (Glynn et al., 2012) . Use of an informer will help the doctor to understand the issues with the patient better because the informer will have a better understanding of the issues facing the patient and how symptoms have been progressing. Better understanding of the patient’s condition will mean better treatment outcomes. Examination should also be done from a place where they feel more comfortable and it is important that the doctor explains in more explicit terms what they are doing so as to earn the trust of these patients which would increase their cooperativeness. It is also important to ensure their privacy during the examination because they might feel embarrassed exposing their bodies because of their age and if especially the doctor is younger than them.
Disease likely to affect the Respiratory system
One of the major diseases that is likely to affect the system is asthma. This disease is characterized by shortness of breath which results from narrowing of the airway (Popper, 2016) .
References
Barrett, K., Barman, S., Boitano, S., & Brooks, H. (2015). Ganong's Review of Medical Physiology 25th Edition . McGraw-Hill Medical Publishing Division.
Glynn, M., Drake, W., & Hutchison, R. (2012). Hutchison's clinical methods (23rd ed.).
Popper, H. (2016). Pathology of Lung Disease . Springer.
