Respiratory and Urinary review notes

Billy Staggs Cahill

Nursing Student

Onondaga Community College

SPRING 2018

Notes by: Billy Staggs Cahill

 

Respiratory and Urinary (Renal) Systems

Abstract notes 

    When we think of the respiratory and urinary systems, we think of only breathing and urination. However, these systems are not so simplistic! There’s many cycles and functions, that are vital for human life. 

Let us take a deeper look beginning with the respiratory system:

The conducting portion of the respiratory system carries air to the lungs.

Gas exchange occurs in the alveoli.

O2 and CO2 are transported using different mechanisms. 

Air is inhaled actively and exhaled passively.

Breathing rate is controlled by the RESPIRATORY CENTER of the brain.

 

Assuming that you already know most of the basics of the respiratory system, let us take an extensive look into gas exchange:

alv1

alv2

 

The alveoli of the respiratory zone, is the site where gas exchange occurs.

External Respiration:

Note: The PCO2 is noted here, because the process is cyclic, as we know.

Diffusion of O2 occurs at a PO2 104 (give or take) → PO2 100, and PCO2 46 → PCO2 40. The O2 will then travel in the bloodstream via Hb (hemoglobin) / pulmonary circuit. 

Internal Respiration:

The RBC will reach the tissues, and the PO2 has equilibrated to PO2 104 and will diffuse into the tissues: PO2 104 → (PO2 40, inside tissue). Coming from cellular respiration, is the CO2, which is waste. It will have a PCO2 46 → (PCO2 40, inside RBC). 

As we know, there’s three ways CO2 is transported to the lungs / alveoli:

  1. 70% is transported buffered with water as carbonic acid.
  2. 20% CO2 bound to proteins, particularly Hb.
  3. 10% via plasma.

 

70% :

Pick up  CO2 → CO2 + H2O (H2O from RBC)  → H2CO3 (carbonic acid) → HCO3 and H+Hb (Hb in RBC)

Note: HCO3 diffuses into plasma

20% :

CO2 → CO2 + Hb (Hb in RBC) 

carbaminohemoglobin

10% :

CO2 → CO2 in plasma

Arrival at alveoli  

HCO3 diffuses back into RBC

H+Hb → H → Hb 

H → HCO3 → H2CO3 → CO2 and H2O 

 

All CO2 diffuses into alveoli at a PCO2 46 → PCO2 40

All via systemic circuit / deoxygenated blood.

Our gas exchange is complete. The cycle will continue repetitively!

 

The next concept is the pleural cavity.

Note: These notes are abstract and review, and not in particular order.

alv4

Pleura is a serous membrane, that surrounds the lung, doubled layered:

parietal and visceral

parietal pleura is attached to the chest wall, and the visceral pleura covers the surface of the lungs.

Between these layers of pleura is a potential space; a space that doesn’t exist but it could exist, if something goes wrong.

There’s a small amount of fluid in this potential space, this serous fluid acts like a lubricant.

The purpose for the pleura is to move inside the body cavity without friction, as friction would cause damage to the lungs. The pressure inside the pleura membrane is – 4 mmHg, intrapleural pressure is 756 mmHg, as we know atmospheric pressure is 760 mmHg. The pressure keeps the lungs ‘stuck’ to the chest wall so they don’t collapse. 

 

Lung Compliance:

Ease at which lungs can be stretched . . . elasticity.

More ELASTIC → greater the compliance

surface tension of lungs

Greater tension → less compliant

distensibility  of thoracic cavity: deformities of thorax, ossification of costal cartilages, paralysis of intercostal muscle – hinder thoracic expansion

Airway resistance: 

  1. chronic inflammation, infections – scar tissue – fibrosis.
  2. decrease of surfactant.

 

lung compliance

 

Spirometry Measurements :

PULMONARY FUNCTION TEST

pft

pft2

Vt  – tidal volume – normal respiratory cycle

IRV – inspiratory reserve volume – after a normal inspiration

ERV – expiratory reserve volume – after a normal expiration

RV – risidual volume – after maximal exhalation 

Why is a PFT given?

To test your lung function before surgery. To help diagnose lung conditions or diseases such as asthma, emphysema, chronic bronchitis, or pulmonary fibrosis. To check the extent of lung disease or to help explain new breathing symptoms. To find out if your breathing medicine is working.

 

Bonus: 

Diffusion capacity/DLCO tests

This test determines how well the oxygen in your lungs is able to move to the bloodstream.  You will be asked to keep a tight seal on a mouthpiece with a clip on your nose and breathe normally.  After several breaths, you will take in as deep a breath as possible and blow it out slowly.  You will keep blowing out until you are told to take a deep breath in and hold it for 10 to 15 seconds.  Then, you will blow out again through the mouthpiece.

Taken from UPMC, life changing medicine. 

Lung Capacities: 

4200 female capacity

6000 male capacity

Acidosis and Alkalosis

Acidosis – abnormal physiological state characterized by a plasma PH below 7.35.

Alkalosis – A condition of a plasma PH above 7.45; deficiency oh hydrogen ions or an excess of bicarbonate ions.

Respiratory response to acidosis –

Increased respiratory rate lowers PCO2 effectively converting carbonic acid molecules to water.

H2CO3 → H2O

Respiratory response to alkalosis –

Decreased respiratory rate elevates PCO2 effectively converting CO2 molecules to carbonic acid.

CO2 → H2CO3

 

Renal response to acidosis –

Kidney tubules respond by secreting H ions, removing CO2, Reabsorbing HCO3 to help replenish bicarbonate reserves.

Renal response to alkalosis –

Kidney tubules respond by conserving H ions and secreting HCO3.

 

Capsule cells:

pcyte1

Factors Controlling Glomerular Filtration:

pcyte2

55 mm Hg  –  (30+15)

55 mm Hg – 45 mm Hg

= 10 mm Hg

If at ZERO = No Filtration

Nephron:

 

nephron

 

 

 

 

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Respiratory System Notes / exam prep

 

Notes By Billy Staggs Cahill

Fall / 2017

Onondaga Community College

Anatomy & Physiology / Nursing

 

 

 

resp1

resp2

resp3

resp4

resp5

resp6

resp7

resp8

resp9

resp10

resp11

resp12

resp13

resp14

resp15

resp16

Exhalation:

  • forceful  exhalation:  active  process
  • muscles  of  exhalation  contract

+  rectus  abdominis

+  internal  intercostals

Factors  influencing  pulmonary  ventilation

  • factors  effecting  rate  of  airflow  and  ease  of  pulmonary  ventilation:
  1. surface   tension
  2.  compliance  of  lungs
  3.  airway  resistance

+  surface  tension

  • must  be  overcome  for  inhalation
  • SURFACTANT :  mix  of  phospholipids  and  lipoproteins  prevents  total  alveolar  deflation  during  exhalation
  • respiratory  distress  syndrome

Factors  influencing  pulmonary  ventilation

+  compliance

  • how  much  effort  needed  to  stretch  lungs  and  chest  wall
  • high  compliance:  chest  wall  expands  easily

INFLUENCED  BY:

  • surface  tension:  surfactant  increase  compliance
  • elasticity:  increase  compliance
  • pulmonary  fibrosis,  scoliosis,  emphysema  

+ airway  resistance  

  • some  resistance  normal
  • narrowing  of  airway  or  obstruction  ↑  resistance  and  more  pressure  needed  for  airflow:  asthma 

LUNG VOLUME AND CAPACITIES 

Samples:

lung v1

 

lung v2

lung v3

lung v4

  • At  rest

+  average  respiratory  rate:  12  breaths  /  minute

+ adapts  to  O2  needs

+  adults  (rest):  12  –  18  br  /  min

(exercise):  40

+  child  (rest):  18  –  20  br  /  min

(exercise):  60

Tidal  volume  (Vt):  volume  of  one  breath:  500  ml  /  breath

Respiratory  minute  volume:  total  volume  of  air  moved  in  /  out  each  minute

(resp  rate  (BPM))  x  (Vt)

=  600  ml  /  min  or  6  L  / min

ALVEOLAR  VENTILATION

alve1

alve2

alve3

alve lec

Visual Notes:

visual1

visual2

visual3

visual4

visual5

visual6

Integument II / nurse notes

Notes and writing by Billy Staggs Cahill 

Nursing – RN 

Fall 2017

Anatomy and Physiology

Instructor: Dr. Vera Mcilvain

 

Why it’s important for a nurse to know the Integumentary System.

By: Billy Staggs Cahill (Nursing Student)

     Like most anatomy, the epidermis and dermis is very complex and has physiological cycle to it. It’s important for a nurse to know about about skincare, vitamins, nutrients, and learning about the subcutaneous layer — the hypodermis is important, since hypodermic syringes are part of nursing. It’s all relative and accumulative knowledge; the more a nurse knows, the better she / he is on the career front.

     There are many nursing and pre – nursing students who look at anatomy and physiology as a mountain to climb on their way to success. In all that is sacred of science and useful in the medical field — anatomy and physiology should be a main focus at the time it’s studied by the student. It’s very important for a good nurse to know and study anatomy and physiology thoroughly. 

“A fine perceptive of the human anatomy is clinically significant to members of the health care team, including nurses. It is important to know the human body and how it functions in its healthy state. By knowing such, it will be easier to learn about pathophysiology, clinical assessment and many other nursing procedures. Those are exact reasons why we, nurses, have this subject as a prerequisite for other nursing subjects.” Nursing Crib — Why You Should Know Your Anatomy is a good online article and source that sums up why it’s important for all the health team should know anatomy, including nurses! Of course — this is relating to your own medical knowledge.

In what ways is it good for a nurse to know about the Integumentary System?

Why should we know about the skin? 

Diet?

Vitamins and oils?

How about nutrition, and what our skin needs?

 It’s good for nurses to take care of themselves, maintaining a healthy lifestyle and diet. Let’s get one thing straight! There’s no such thing as perfect! However, there is theory and practice. What works best for each individual’s skin may not be for everyone. This doesn’t mean go out and spend all your money on some secret anti – aging cream or drops. It simply means to know the Integumentary System is to know how our skin works — what’s best for our skin and good hygiene. 

Let’s focus on skincare:

skin care1

 People are always looking at ways to help their skin, and sometimes they may ask a nurse. Most likely not, but as nurses ( female or male), we should focus on ways helping ourselves and maintaining a good example of health. It doesn’t take a “skin genius” Dermatologist to maintain good skin. 

According to WebMD, the following are the vitamins and antioxidants to maintain skin health:

  • Vitamin A, also known as retinol, is important for helping to keep skin healthy
  • Vitamin C, also known as ascorbic acid, helps protect cells and tissue and aids wound healing.
  • Vitamin E helps to maintain cell structures and protect cell membranes.
  • Selenium is a mineral that helps prevent damage to cells and tissues.
  • Vitamins C and E, and selenium are antioxidants that may help protect skin from sun damage.

There are numerous products that can be used for different types of skin. Everyone varies when it comes to using skin products. We may use a new lotion or soap that has hit the market, while our mothers’ use Oil of Olay. Some people invent their own skin products by fruits, herbs, lotions and all kinds of x, y, z potions. Whatever you find works best for your integument is what’s best for you — it’s really that simplex. Personally, I find a combination of Vit. E & A to work wonders. Also many different lotions seem to work best for skin. It doesn’t have to be a specific, expensive lotion from Eden. It can be as simplex as baby lotions, coconut oils or Argon. There’s so many different names and varieties, it’s all sample, test and game. 

     Many people, including nurses have a bad habit of biting their nails. There’s ways of stopping and breaking this bad habit! It’s called a clear coat of nail hardener, even men can use this technique to stop biting their nails. It makes you think twice about biting your nails with a chemical layered on top of it. Who wants a nurse with nails like Dr. Jekyl? I certainly wouldn’t! 

     Good hygiene and skincare IMO is a big PLUS for nurses, doctors and anyone who desires to be a good example of health. This is ONLY one reason it’s good to know the Integumentary System and all anatomy of our bodies. It’s not only critical for a health team, but also good measure in taking care of ourselves! 

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Side notes (compilation) to the Integumentary System:

Langer’s Lines:

Important for surgeons to know, not so much nurses.

langer's lines

  • In certain areas of the body
  • Collagen fibers in reticular region orient more in one direction than in others
  • Knowledge of lines important for surgeons, however on Integ. Exams for all medical students.

 

HAIR

  • Functions:
  • Protects and insulates
  • Guards openings (nose, ears) against particles and insects
  • Is sensitive to very light touch
  • Hair follicle: produce hair
  • Invagination of epidermis into dermis
  • Wrapped with dense Connective Tissue
  • Surrounded by root hair plexus
  • Arrector pili – smooth muscle cells. “goosebumps”
  • Hair color (melanocytes) grey hair: melanocytes produce less melanin

 

Microscope slides / Melanocytes and other / Epidermis & Dermis

ms1

ms2

ms3

ms4

ms5

ms6

ms7

ms8

 

Burns:

burns

Hypodermic syringes:

hypodermic needle2

hypo1

hypo2

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integ

integ2