Universidad de Manila College of Nursing

In partial Fulfillment of Requirements in Related Learning Experience

I/F Pneumonia with Hyperactive Airway disease

Submitted by: Pidal, John Nikko D. Romero, Ivy Kristine T. Santos, Amanda Nikki C. Tabora, Liezel M. Vengano, Alleobert P. Porlares, Charlyn L. Sacatani, Glory-Ann D. Santos, Analyn B. Torres, Mark Wilson E. Ventura, Cyril G.

Villaraza, Saleen Vane D.

Group 5 (NR 22) January 26, 2012

CHAPTER I INTRODUCTION

ACKNOWLEDGEMENT

The Group would like to extend their warmers gratitude to all the people who made the success of this undertaking a reality. First and foremost, to the Almighty Father, for his unceasing love and blessing; for giving as enough power and fortitude to face all the hardships in the making of this work. To him be all glory and praise. To our Clinical instructor Jann Carlo Luigi R. Naz, RN, MAN, CCRN together with all other Clinical Instructors, for their invaluable time, knowledge and effort rendered to us. To the staff and personnel of Gat.Andres Bonifacio Memorial Medical Center especially in the Pediatric ward for giving us the opportunity to complete endeavor. To the Pidal Family, for their very warm hospitality while we were making this paper at their house. To our dear families and friends, for their never ending support and understanding for always being there to guide us and care for us after the long days of duties. To our patient who marked a part of hearts, for challenging us to do more and for pushing us beyond our limits. To our classmates, friends, mentors, and colleagues, for giving us the inspiration to finish this seemingly attainable task. Lastly, to the group, we would like to recognize each other for our own radical efforts in order to complete this case study; for sticking together through thick and thin and for simply being there.

ABSTRACT

Pneumonia is an inflammatory illness of the lung. Frequently, it is described as lung parenchyma/alveolar inflammation and alveolar filling with fluid (consolidation and exudation). The alveoli are microscopic air-filled sacs in the lungs responsible for absorbing oxygen. Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. It may also be officially described as idiopathic that is, unknown when infectious causes have excluded. Typical symptoms associated with pneumonia included cough, chest pain, fever, and difficulty in breathing. Diagnostic tools include x-rays and examination of the sputum. Treatment depends on the cause of pneumonia; bacterial pneumonia is treated with antibiotics. Pneumonia is a common illness which occurs in all age groups, and is a leading cause of death among elderly and people who are chronically and terminally ill. Additionally, it is the leading cause of death in children under five years of worldwide. Vaccines to prevent certain types of pneumonia is available. The prognosis depends on the type of pneumonia, the appropriate treatment, any complications, and the persons underlying health.

BACKGROUND OF THE CASE STUDY

During our stay at Gat Andres Bonifacio Memorial Medical Center Pediatric Ward, we encountered a patient with I/F Pneumonia with HAAD. The Child was admitted with a chief complaint of difficulty in breathing on January 17, 2012 at Out Patient Department. Pneumonia, inflammation of the lungs specially affecting the air sacs associated with fever. Typical symptoms include cough, chest pain, fever and difficulty in

breathing. Usually when a patient has an infectious pneumonia, it is often accompanied with productive cough, fever, shortness of breath and increased in respiratory rate. During auscultation, crackling sounds may be heard over the affected area. Pleural effusion occurs when excess fluid is present between the two pleural layers. Too much amount of these fluids can impair breathing by limiting the expansion of the lungs during ventilation thus causes the patient to have Hyperactive Airway Disease (HAAD). The group chose pneumonia as our case to be studied due to curiosity. Since its our first time to encounter this kind of case, our group was interested in it. We are willing to do this case to challenge our mind in analyzing the problem and to enhance our knowledge, and also to gain new experiences which could bring new skills for each of the group member.

OBJECTIVE OF THE CASE STUDY

General Objective: This case study aims to identify and determine general health problems and needs of the patient with an admitting diagnose of Pneumonia with hyperactive airway disease this also tends patient to promote health and medical understanding of such condition through the application of nursing skills.

Specific objective Determine the causes of the disease. Determine the risk factors affecting the disease. Know the different and symptoms or clinical manifestations of the disease Identify the medical and nursing management of patient diagnosed with pneumonia severe with hyperactive airway disease Find out the relevance and rationale of the study. Enhance our skills in caring a patient with nephritic Syndrome. Recognized appropriate nursing care and management Help the patient realized her role in maintaining and improving health.

SIGNIFICANCE OF THE STUDY

This case study will helped the group in understanding the disease process of the patient. This would also help the group in identifying the primary needs of the patient with pneumonia. By identifying such needs and health problems arise that the group can now formulate an individualize care plan for the patient that would address these needs and problems effectively. Effective management of the problems identified will help the patient to recover faster and maintain a holistic sense of wellness even while in the hospital. This case study would also equip the group with knowledge, skills and attitude on how to manage future patients with the same or similar disease.

Scope and Limitation

The study covers necessary information about I/F Pneumonia with hyperactive airway disease understanding about the disease. The concentration of the study is during the hospitalization of the patient in Gat. Andres Bonifacio Memorial Medical Center I/F Pneumonia with hyperactive airway disease since this is the case of the patient The study will not cover other information not related to the condition of the patient.

CHAPTER II NURSING SUMMARY

NURSING HEALTH HISTORY Name: Baby X Ag: 1 year old Sex: Female Address: Area B Gate 8 Parola St. Tondo Manila. Birthday: April 25, 2012 Birthplace: Manila Date Admitted: January 17, 2012

A. Personal Data: Patient is baby X, a 1 years old from Area B Gate 8 Parola St. Tondo Manila. B. Chief Complaint The patient was admitted at Gat Andres Bonifacio Memorial Medical Center last January 17, 2012, due to the complaint of difficulty of breathing (DOB). She was admitted in Emergency Room and had taken clinical history, physical assessment and administered IV. She was transferred at Pediatric ward particularly in the Room of special cases for further evaluation of the complaint. She was attended by the physician on duty. C. History of Present illness The patient was admitted with the diagnosis of I/F Pneumonia with Hyperactive Airway disease D. Past Medical History The patient is known with primary complex. E. Family History Mother side = (+) asthma Father side= (unknown)

B. GORDONS FUNCTIONAL HEALTH PATTERN

Before Hospitalization Health Perception/ Management NutritionalMetabolic Pattern Elimination Pattern Activity Pattern Sleep-Rest Pattern CognitivePerceptual Pattern Self Perception/ Concept RoleRelationship Pattern SexuallyReproductive Pattern Coping-Stress Tolerance Value-Belief Pattern Sometimes she visits her Doctor together with her mother for the treatment of her primary complex She usually breastfeed, sometimes she eat fruit and but not vegetable. She is frequently urinating and she defecate at least once a day She always plays with her sister and she is very lively. She always sleeps at afternoon and at night. She is active and talkative she is always shouting. She draws a different kind of line. She looks comfortable and blooming. She always bond with her family, she play with her sister and mother . NOT APPLICABLE NOT APPLICABLE After Hospitalization Her primary complex cured but another lung problem occurred. Her appetite was decreased, her oral fluid intake was restricted due to her present illness She urinates twice a day and defecates every other day. She always want to sleep She sleep time to time She does not respond when someone wants to play her She looks tired and irritable. She is always crying. There not time to bond with the family

NOT APPLICABLE NOT APPLICABLE

Sometimes she go to church with She is not going to church her family

PHYSICAL ASSESSMENT
Physical appearance/ Posture/ Body movements/ Hygiene/ Nutritional Status

Patient was seen in a well appearance and a good posture. He has limited body movements because of his condition. He wasnt able to achieve overall hygiene but still managed to maintained cleanliness. He was maintained on strict aspiration precaution.
Level of consciousness/ Facial expression/ Mood and affect/ Speech/ Gait

Patient was conscious and coherent, able to follow simple instructions and to demonstrate the appropriate reaction at the same time. Mood of the patient was affected because of the acute pain that he is recently experiencing.

BODYPART

Normal findings

E.R FINDINGS

Interpretation

Medicine ward findings

Interpretation

HEAD Skull

>Generally round, with prominences in frontal and occipital area

Skull is round in shape symmetrical. No masses noted. Facial movement is (Normocephalic) symmetrical Hair color is black with >No tenderness minimal noted upon streaks of palpation white

NORMAL

Skull is round in shape symmetrical. No masses noted. Facial movement is symmetrical. Hair color is black with minimal steaks of white

NORMAL

Scalp/ Hair

>Lighter in color than the complexion

Scalp is clear from dandruff and lice. No scars and wounds noted. >Can be moist or Hair is short black evenly oily. distributed and >No scars noted covers the > Free from lice, whole scalp nits and dandruff >No lesions should be noted >No tenderness or masses on palpation. HAIR >can be black, brown or burgundy depending on the race. >Evenly distributed covers the whole scalp >Maybe think or thin, coarse or

NORMAL

Scalp is clear NORMAL from dandruff and lice. No scars and wounds noted Hair is short and color black, evenly distributed and covers the whole scalp

smooth. >Neither brittle nor dry. The clients head has a round smooth skull contour. The hair is thick black and fine which is evenly distributed. The scalp is smooth and firm. No lesions noted. FACE Oblong shaped symmetrical smooth and no involuntary muscle movements Oblong shaped symmetrical smooth and no involuntary muscle movements
NORMAL

Oblong shaped symmetrical smooth and no involuntary muscle movements Has symmetrical eyebrows movement shape and hair distribution. Eyebrows color is

NORMAL

Eyes/ Eyebrows/ Vision

Eyes/ Eyebrows >symmetrical and line with each other. >Maybe black brown or blond depending on race.

Pinkish palpebral conjunctiva, Puffy eyelids. Eyelashes are evenly distributed and curled outward. He is able to rotate

NORMAL

NORMAL

>Evenly eyes and has distributed. Eyes coordinated eye >Evenly spaced movements. and in line with each other. >Nonprotruding. >Equal palpebral fissure. EYELASHES >Color dependent on race. >Evenly distributed. >Turned outward. His eyes are symmetrical black in color, almond shape. Pupils constrict when diverted to light and dilated when he gazes afar, conjunctivas are pink. Eyelashes are equally

black. Eyelashes are evenly distributed and curled outward. Eyelids have no discharges and bilaterally blink Upper lid covers the small portion of the iris and cornea. Lacrimal duct openings are evident at nasal ends of upper and lower lid with no tenderness noted. Palpebral conjunctiva are pinkish in color

distributed and skin around the eyes is intact. The eyes involuntarily blink

while the pupils constricted to light (2mm), round in shape shows uniform convergence . He is able to rotate eyes and has coordinated eye movements Auricle has same color as with the skin, has symmetrical shape and located a little bit higher than the eye.
NORMAL

Ears/ Hearing

The ears lobes are bean shaped, parallel, and symmetrical.

>The upper connection of the ear lobe is parallel with the outer canthus of Cerumen was present but the eye. not impacted >Skin is same or excessive in color as the amount. Upon complexion. palpation, auricles were >No lesions

Auricle has same color as with the skin, has symmetrical shape and located a little bit higher than the eye. Cerumen was present but not impacted or excessive in amount.

NORMAL

noted on inspection.

firm, and not tender as evidenced by >The auricles are the auricle has a firm being pulled cartilage on upward, palpation. downward and backward >The Pinna without recoils when resistance, and folded. the pinna >There is no being folded pain or forward tenderness on without the palpation of resistance and the Auricles and recoiling after mastoid process. folding. He can >The ears canal hear on both ears. has normally some cerumen of inspection. >No discharges or lesions noted at the ear canal. Color Ears are symmetrical with no discharge. The Clients auricles have the same color as the

Upon palpation, auricles were firm, and not tender as evidenced by the auricle being pulled upward, downward and backward without resistance, and the pinna being folded forward without resistance and recoiling after folding. He can hear on both ears.

facial skin. Client can hear with ease when spoken softly. NOSE Nose has ABNORMAL, uniform color >symmetric and and straight symmetrical in >No discharge or shape. Nasal hairs are very flaring evident when >Uniform color light is flashed >Not tender and through the nasal no lesions passageways; >patient nares its color is >Mucosa is pink black. Nasal flaring is noted >Clear, watery upon discharge respiration. No tenderness of >nasal septum sinuses, intact and in midline. presence of Nose
mucous secretion.

Nose has ABNORMAL uniform color and symmetrical in shape. Nasal hairs are very evident when light is flashed through the nasal passageways ; its color is black. Nasal flaring is noted upon respiration. O2 inhalation is at bedside and can be used if needed no tenderness of sinuses noted.

Mouth/Lips

- Smooth, white, shiny tooth enamel - Pink gums (bluish or dark patches in dark skinned clients) - Moist, firm texture to gums - Smooth, intact dentures Tongue/Floor of the Mouth - Central position - Pink color ( some brown on borders for dark skinned clients); Moist; slightly rough; thin whitish coating - Moves freely ; no tenderness - No prominent veins and

Lips are a little pale in color, dry and have cracks. Tongue is in midline pinkish in color with thin whitish coating on top. Able to move tongue freely (up & down, side to side). Soft palate is light pink in color while hard palate is lighter in color. Gums are slightly blackish in color. Her teeth are yellow in color with plaques.

NORMAL

Lips are a little brownish in color, dry and have cracks. Tongue is in midline pinkish in color with thin whitish coating on top. Able to move tongue freely (up & down, side to side). Soft palate is light pink in color while hard palate is lighter in color. Gums are slightly blackish in color. Her teeth are yellow in color with plaques.

NORMAL

palpable nodules Uvula - Pink and smooth posterior wall - No discharge She has a complete set of teeth. Oral mucosa and gingival are pink in color, moist, and there were no lesions or inflammation noted. Tongue is pinkish with thin whitish coating and free if swelling and lesions. Neck 1. The neck is straight. 2. No visible mass or lumps. 3. Symmetrical 4. No jugular Trachea is in midline. No tenderness of thyroid noted. No enlargement of the neck noted. She is able to flex and NORMAL Trachea is in midline. No tenderness of thyroid noted. No enlargement. NORMAL

Venous distension (suggestive of cardiac congestion) 5. The trachea is palpable. It is positioned in the line and straight. Thorax and Lungs

extend neck and move literally (left & right)

Thorax and Lungs Patient is Posterior Thorax - -Chest symmetric - - Spine vertically aligned - - Skin intact; uniform temperature - - Chest wall intact; no tenderness; no masses - - Full and symmetric chest expansion (3-5cm gap) - - Bilateral symmetry of vocal fremitus experiencing difficulty in breathing. She has a high respiratory rate.

Abnormal. Patient experiencing difficulty of breathing because there is insufficient oxygen supply in the lungs, and the abnormal rate shows that the patient is tachypnic.

She is still experiencing difficulty of breathing but now she is prescribed to have nebulizer inhalation every 2 hours.

Abnormal. Patient is still tachypnic but the use of oxygen is prescribed and he can use it of needed.

- Anterior Thorax - - Quiet, rhythmic, and effortless respirations - - Full symmetric excursion - -Bronchial and tubular breath sounds upon auscultation on trachea. She has a regular rhythm with a 12-20 breaths per minute. Breath sounds are clear on both lungs upon auscultation. Abdomen/Bl adder Abdomen Inspection - Unblemished skin - Uniform color - Flat, rounded (convex), or scaphoid (concave) - Symmetric Unblemished skin, her abdomens color is some with the rest of the part of her body. Her umbilicus is coated with blackish dirt. Its rounded and has a symmetric NORMAL Her abdomens color is same with the rest of the part of his body. Her umbilicus is coated with blackish dirt. Its rounded and has a symmetric NORMAL

contour - Symmetric movements caused by respiration - No visible vascular pattern Auscultation Palpation - No tenderness; relaxed abdomen with smooth, consistent tension. The abdomen is uniform in color; its rounded and has a symmetric contour. No tenderness was palpated. Upper/Lower Extremities Upper Extremities - No edema - Skin texture resilient and moist

contour.

contour. No tenderness was palpated. Audible bowel sounds heard over auscultation.

Edema is noted on both arms, capillary refill is above normal (4-5 sec)

Abnormal edema is a sign of having excess fluid volume in the body. Prolonged

Absence of edema on both arms.

NORMAL

- Capillary refill test: immediate return of color (23 sec) - Limbs not tender - Symmetric in size. The client has a brownish complexion. Dry skin is noted. A capillary refill of 3 seconds was noted. No lesions and scars noted. Able to extend arms in front or push them out to the side.

capillary refill, sign decreased oxygen on the body.

Lower Extremities - No edema - Skin texture Edema is noted on both legs of Abnormal. Edema is a sign of having excess fluid volume in the body. NORMAL

resilient and moist the patient. Cant move - Capillary refill easily because test: immediate of pain return of color (2-

3 sec) - Symmetric in size of the feet is undefined with lines on the sole, some scars and no lesions noted. Can move easily, with no pain

DIAGNOSTIC and LABORATORY Procedures Complete Blood Count Diagnostic Laboratory Procedures Date Ordered Date Results Results Normal Values Analysis and Interpretation of Results

Platelet Count

D.O / D.R 01-17-12

611 x 10 9/l

150-450 x 10 9/1

The result is above normal level, it occurs in such disorders in which the bone marrow produces too many platelets; high platelet levels (thrombocytosis) may indicate either a benign reaction to an infection, surgery, or certain medication.

Hemoglobin

D.O / D.R 01-17-12

110 gm/l

120-180 gm/l

The result is below normal level, thus indicating renal malfunction and thereby causing anemia.

Hematocrit

D.O / D.R 01-17-12

0.331

0.370-0.540

The result is below normal level, showing anemia and renal disease.

Leukocyte Count

D.O / D.R 01-17-12

18 x10 9/l

4.6-10.0 x 10 9/l

The result is above normal level, it shows presence of inflammation and infection.

Lymphocytes

D.O / D.R 01-17-12

.72

0.60-0.70

The result is above normal level, is may shows viral infections, and connective tissue diseases.

Monocyte

D.O / D.R 01-17-12

.28

0.20-0.40

Normal.

CHAPTER III

DEFINITION OF THE DISEASE

Pneumonia is a swelling of the inner parts of the lungs. The swelling is usually caused by an infection from a bacteria or virus but can also be caused by irritation from chemicals or other agents. People with pneumonia may have difficulty breathing, a cough and a fever. There is a vaccine available to prevent specific types of pneumonia and is recommended for certain age groups. Pneumonia is the leading cause of death in the US from vaccine preventable disease. Description of the Disease Pneumonia is an inflammation of the lung, usually caused by a bacterial, viral, or fungal infection. It also may be caused by accidentally inhaling a liquid or chemical. Young children, the elderly, and those with chronic health problems are most at risk. The symptoms of pneumonia include difficulty breathing, cough, and fever. Antibiotics may be needed to treat bacterial pneumonia. Viral pneumonia is more potentially dangerous, but may respond to rest and extra fluids. Preventing pneumonia is always better than treating it. The best preventive measures include washing your hands frequently, not smoking, and wearing a mask when cleaning dusty or moldy areas. There is a vaccine for pneumococcal pneumonia, a bacterial infection which accounts for up to a quarter of all pneumonias.

ANATOMY AND PHYSIOLOGY

The Respiratory system consists of the external nose, the nasal cavity, the pharynx, the larynx, the trachea, the bronchi and the lungs. Although air frequently passes through the oral cavity, it is considered to be part of the digestive system instead of the respiratory system. The upper respiratory tract refers to the external nose, nasal cavity, pharynx, and associated structures; and the lower respiratory tract includes the larynx, trachea, bronchi, and lungs.

Nose

The nose consists of the external nose and the nasal cavity. The external nose is the visible structure that forms a prominent feature of the face. Most of the external nose is composed of hyaline cartilage, although the bridge of the external nose consists of bone. The bone and cartilage are covered by connective tissue and skin.

The nasal cavity extends from the nares to the choane. The nares or nostrils, are the external openings of the nose and the choane are the openings into the pharynx. The nasal septum is a partition dividing the nasal cavity into left and right parts. A deviated nasal septum occurs when the septum bulges to one side or the other. The hard palate forms the floor of the nasal cavity, separating the nasal cavity from the oral cavity. Air can flow through the nasal cavity when the mouth is closed or when the oral cavity is full of food. Three prominent bony ridges called conchae are present on the lateral walls on each side of the nasal cavity. The conchae increase the surface of the nasal cavity. Paranasal sinuses are air-filled spaces within bone. The maxillary, frontal, ethmoidal and sphenoidal sinuses are named after the bones in which they are located. The paranasal sinuses open into the nasal cavity and are lined with a mucous membrane. They reduce the weight of the skull, produce mucus, and influence the quality of thevoice by acting as resonating chambers. The nasolacrimal ducts, which carry tears from the eyes, also open into the nasal cavity. Sensory receptors for the sense of smell are found in the superior part of the nasal cavity. Air enters the nasal cavity through the nares. Just inside the nares the epithelial lining is composed of stratified squamousepithelium containing coarse hairs. The hairs trap some of the large particles of dust suspended in the air. The rest of the nasal cavity is lined with pseudostratified columnar epithelial cells containing cilia and many mucus-producing goblet cells. Mucus produced by the goblet cells also traps debris in the air. The cilia sweep the mucus posteriorly to the pharynx, where it is swallowed. As air flows through the nasal cavities, it is humidified by moisture from the mucous epithelium and is warmed by blood flowing through the superficial capillary networks underlying the mucous epithelium. Pharynx

The pharynx is the common passageway of both respiratory and digestive systems. It receives air from the nasal cavity and air, food, and water from the mouth. Inferiorly, the pharynx leads to the rest of the respiratory system through the opening into the larynx and to the digestive system through the opening into the larynx and to the digestive system through the esophagus. The pharynx can be divided into three regions :thenasopharynx, the oropharynx, and the laryngopharynx. The nasopharynx is the superior part of the pharynx. It is located posterior to the choaneae and superior to the soft palate,which is an incomplete muscle and connective tissue partition separating the nasopharynx from the oropharynx. The uvula is the posterior extension of the soft palate. The soft palate forms the floor of the nasopharynx. The nasopharynx is lined with pseudostratified ciliated columnar epithelium that is continuous with the nasal cavity. The auditory tubes extend form the middle ears open into the nasopharynx. The posterior part of the nasopharynx contains the pharyngealtonsil, which aids in defending the body against infection. The soft palate is elevated during swallowing, this movement results in the closure of the nasopharynx, which prevents food from passing from the oral cavity into the nasopharynx. The oropharynx extends from the uvula to the epiglottis, and the oral cavity opens into the oropharynx. Food and drink all passes in the oropharynx. The laryngopharynx passes posterior to the larynx and extends from the tip of the epiglottis to the sophagus.T he larynx (plural larynges), colloquially known as the voice box, is an organ in the neck of mammals involved in protection of the trachea and sound production. Thelarynx houses the vocal folds, and is situated just below where the tract of the pharynx splits into the trachea and the esophagus. Sound is generated in the larynx, and that is where pitch and volume are manipulated. The strength of expiration from the lungs alsocontributes to loudness. The trachea, or windpipe, is the bony tube that connects the nose and mouth to the lungs, and is an important part of the vertebrate respiratory system.When an individual breathes in, air flows into the lungs for respiration through thewindpipe. Because of its primary function, any damage incurred to the trachea is potentially life-threatening. The bony skeletal trachea is comprised of cartilage and ligaments, and is located at the front of the neck. The trachea begins at the lower part of the larynx and continues to the lungs, where it branches into the right and left bronchi. It measures 3.9 to 4.7 inches (10-12 cm) in length, and .62 to .7 inches (16-18 mm) in diameter. The trachea is composed of 16 to 20 c shaped rings of cartilage connected by ligaments, with a ciliated-lined mucus membrane. It is this structure that helps push objects out of the airway should something become lodged. Larynx The larynx is the portion of the breathing, or respiratory, tract containing the vocal cords which produce vocal sound. It is located between the pharynx and the trachea. The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck. We use the larynx when we breathe, talk, or swallow. Its outer wall of cartilage forms the area of the front of the neck referred to as the "Adams apple". The vocal cords, two bands of muscle, form a "V" inside the larynx. Each time we inhale (breathe in), air goes into our nose or mouth, then through the larynx, down the trachea, and into our lungs. When we exhale (breathe out), the air goes the other way. When we breathe, the vocal cords are relaxed, and air moves through the space between them without making any sound.

When we talk, the vocal cords tighten up and move closer together. Air from the lungs is forced between them and makes them vibrate, producing the sound of our voice. The tongue, lips, and teeth form this sound into words. The esophagus, a tube that carries food from the mouth to the stomach, is just behind the trachea and the larynx. The openings of the esophagus and the larynx are very close together in the throat. When we swallow, a flap called the epiglottis moves down over the larynx to keep food out of the windpipe. Trachea A tube-like portion of the breathing or "respiratory" tract that connects the "voice box" (larynx) with the bronchial parts of the lungs. Each time we inhale (breathe in), air goes into our nose or mouth, then through the larynx, down the trachea, and into our lungs. When we exhale (breathe out), the air goes out the other way. The esophagus, the tube that carries food from the mouth to the stomach, is just behind the trachea and the larynx. The openings of the esophagus and the larynx are very close together in the throat. When we swallow, a flap called the epiglottis moves down over the larynx to keep food out of the windpipe. The trachea is also called the windpipe, weasand (sometimes written wesand or wezand) or wesil. "Cut his weasand with thy knife." The Tempest, Shakespeare. Bronchi The trachea divides into left and right main (primary) bronchi. Each of which connects to a lung. The left main bronchus is more horizontal than the right main bronchus because of it is displaced by the heart. Foreign objects that enter the trachea usually lodge in the right main bronchus, because it is more vertical than the left main bronchus and threfore more in direct line with the trachea. The main bronchi extend from the trachea to the lungs. Like the trachea, the main bronchi are lined with pseudostratifiedciliated columnar epithelium and are supported by C- shaped pieces of cartilage. The large air tubes leading from the trachea to the lungs that convey air to and from the lungs. The bronchi have cartilage as part of their supporting wall structure. The trachea divides to form the right and left main bronchi which, in turn, divide to form the lobar , segmental, and finally the subsegmental bronchi. Bronchi is the plural of bronchus from the Greek word bronchos, a conduit to the lungs. Lungs The lungs are the principal organs of respiration. Each lung is cone-shaped, with its base resting on the diaphragm and its apex extending superiorly to a point about 2.519cm above the clavicle. The right lung has three lobes called the superior, middle and inferior lobes. The left lung has two lobes called the superior and inferior lobes. The lobes of the lungs are separated by deep, prominent fissures on the surface of the lung. Each lobe is divided into broncho pulmonary segments separated from one another by connective tissue septa, but these separations are not visible as surface fissures. There are9 broncho pulmonary segments in the left lung and 10 in the right lung. The main bronchi branch many times to form the tracheobronchial tree. Each main bronchus divides into lobar bronchi as they enter

their respectibe lungs. The lobar (secondary) bronchi, two in the left and three in the right lung, conduct air to each lobe. The lobar bronchi in turn give rise to segmental (tertiary) bronchi, which extends to the broncho pulmonary segments of the lungs. The bronchi continue to branch many times, finally giving rise to bronchioles. The bronchioles also subdivide numerous times to give rise to terminal bronchioles, which then subdivide into respiratory bronchioles. Each respiratory bronchiole subdivides to form alveolar ducts, which are like long, branching hallways with many open doorways. The doorways open into alveoli which are small air sacs become so numerous that the alveolar duct wall is little more than a succession of alveoli. The alveolar ducts end as two or three alveolar sacs, which are chambers connected to two or more alveoli. There are about 300 million alveoli in the lungs. As the air passageways of the lungs becomes smaller, the structure of their walls changes. The amount of cartilage decreases and the amount of smooth muscle increases, until at the terminal bronchioles, the wall shave a prominent smooth muscle layer, but no cartilage. Relaxation and contraction of the smooth muscle within the bronchi and bronchioles can change the diameter of the air passageways. For example, during exercise the diameter can increase, thus increasing thevolume of air moved. During an asthma attack, however, contraction of the smooth muscle in the terminal bronchioles can result in greatly reduced air flow. In severe cases , air movement can be so restricted that death results. As the air passageways of the lungs become smaller, the lining of their walls also changes. The trachea and bronchi have pseudostratified ciliated columnar epithelium, the bronchioles have ciliated simple cuboidal epithelium. The ciliated epithelium of the air passageways functions as mucus-cilia escalator, which traps debris in the air and removes it from the respiratory system. The respiratory membrane of the lungs is where gas exchange between the air and blood takes place. It is mainly of the alveoli and surrounding capillaries but theres some contribution by the alveolar ducts and respiratory bronchioles it is very thin to facilitate the diffusion of gases. Pleural cavity Inhuman anatomy, the pleuralcavity is the body cavity that surrounds the lungs.The pleura are aserous membrane which folds back upon itself to form a two-layered,membrane structure. The thin space between the two pleural layers is known as the pleural cavity; it normally contains a small amount of pleural fluid. The outer pleura( parietal pleura) is attached to the chest wall. The inner pleura (visceral pleura) covers thelungs and adjoining structures, viz. blood vessels, bronchiandnerves.The pleural cavity, with its associated pleurae, aids optimal functioning of the lungs during respiration. The pleural cavity also contains pleural fluid, which allows the pleurae to slide effortlessly against each other during ventilation. Surface tension of theleural fluid also leads to close apposition of the lung surfaces with the chest wall. This physical relationship allows for optimal inflation of the alveoli during respiration. The pleural cavity transmits movements of the chest wall to the lungs, particularly during heavy breathing. This occurs because the closely opposed chest wall transmits pressures to the visceral pleural surface and hence to the lung itself.