Respiratory Disorders
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    Respiratory Disorders Respiratory Disorders Presentation Transcript

    • Respiratory Disorders Chapter 19 Pgs 310-360
    • Homework Assignment
      • Due Tuesday Oct 18
      • It does NOT have to be typed!
      • You may work in groups
      • Answers MUST be in your own words
      • Case Study A
        • a, b,c, d, f, g, h, o
      • Case Study B
        • a, c, g, h, i, j
      • Case Study C
        • a, b, g, h, i
    • Overview
      • Diagnostic Tests
      • General Manifestations of Respiratory Disease
      • Infectious Diseases
        • Upper respiratory tract infections
          • Common cold
          • Sinusitis
        • Lower respiratory tract infections
          • RSV
          • Pneumonia
      • Obstructive Lung Diseases
        • Lung Cancer
        • Asthma
      • Chronic Obstructive Pulmonary Disease (COPD)
        • Emphysema
        • Chronic Bronchitis
    • Diagnostic Tests
      • Spirometry
      • Arterial blood gas determination
      • Oximeters
      • Exercise tolerance
      • Radiography
      • Bronchoscopy
      • Culture, sensitivity tests
    • General Manifestations of Respiratory Disease
      • Sneezing
      • Coughing
        • Irritation
        • Controlled by medulla
        • Constant, dry unproductive vs. productive cough
      • Sputum
        • Mucus discharge
        • Yellowish-green
        • Rusty, dark-colored
        • Thick, sticky
        • Hemoptysis
    • Manifestations
      • Breathing patterns and characteristics
        • Kussmaul respiration
        • Labored respiration, prolonged inspiration/expiration times
        • Wheezing
        • Stridors
      • Breath sounds
        • Rales
        • Rhonchi
        • Absence
    • Manifestations
      • Dyspnea
        • Severe
        • Orthopnea
        • Paroxysmal nocturnal dyspnea
      • Cyanosis
      • Pleural pain
      • Friction rub
      • Clubbed fingers
      • Changes in ABG (arterial blood gases
        • Hypoxemia  inadequate oxygen in blood
        • Hypoxia  inadequate oxygen supply to cells
    • Causes of Hypoxia
      • Low RBC, Hb
      • Circulation impairment
      • Excessive release of oxygen from RBC
      • Impaired respiratory function
      • CO poisoning
    • Upper Respiratory Tract Infections: Common Cold (Infectious Rhinitis)
      • Viral (rhinovirus)
      • Spread thru respiratory droplets
      • Highly contagious
      • Initially mucous membranes of nose, pharynx swollen, increased secretions
      • Signs
        • Nasal congestion and watery discharge
        • Mouth breathing
        • Change in tone of voice
        • Sore throat, headache, slight fever
        • Cough
    • Common Cold
      • Infection, inflammation can spread
        • Laryngitis
        • Bronchitis
      • Treatment is symptomatic
        • Acetaminophen
        • Decongestant
        • Antihistamine
        • Humidifiers
        • Are antibiotics prescribed?
    • Secondary Bacterial Infections
    • Sinusitis
      • Secondary bacterial infection
      • Obstruct drainage in 1 or more paranasal sinuses
      • Common causative organisms
        • Pneumococci
        • Streptococci
        • Haemophilus influenzae
      • Exudate accumulates
      • Signs
        • Nasal congestion, fever, sore throat
      • Diagnosis confirmed by radiograph, transillumination
      • Decongestants, analgesics
      • Antibiotics
    •  
    • Lower Respiratory Tract Infections: Bronchiolitis (RSV Infection)
      • 2-12 month
      • Caused by syncytial virus
      • Transmitted by oral droplet
      • Predisposing factors (asthma, smoking)
      • Causes necrosis and inflammation of small bronchi and bronchioles
      • Signs
        • Wheezing and dyspnea
        • Rapid, shallow respirations
        • Cough
        • Rales
        • Chest retractions
        • Fever
      • Treatment
        • Supportive and symptomatic
    • Pneumonia
      • Primary acute or secondary
      • Risk following aspiration, inflammation in lung
      • Transmission
        • Inhaling virus
        • Resident bacteria spreading along mucosa
        • Aspiration in secretions
    • Classification of the Pneumonias
      • Causative agent
        • Virus, bacteria, fungus
        • Lobar is typically bacterial
          • Pneumococcus
      • Anatomical distribution of lesion
        • Both lungs or lobar
      • Pathophysiologic changes
        • Viral  changes in interstitial tissue or alveolar septae
        • Pneumococcal  alveoli inflamed and fluid filled
          • Exudate
      • Epidemiologic categories
        • Nosocomial
        • Community acquired
    •  
    •  
    • Lobar Pneumonia
      • Streptococcal pneumoniae, pneumococcal
      • Infection localized in 1 or more lobes
    • Stages of Pneumonia
      • Congestion
        • Inflammation and vascular congestion in alveolar wall
          • Exudate forms in alveoli
            • Interferes with oxygen diffusion
      • Consolidation
        • Neutrophils, RBCs, fibrin accum in exudate
          • Form solid mass
      • RBCs break down, infection resolves
        • Macrophages break down exudate
          • Expectorated or resorbed
    • Consolidation
    • Pneumonia
      • Pleurae typically involved
        • Infection in pleural cavity
          • Emphysema
            • Adhesions between membranes
      • Manifestations
        • Sudden onset
        • Systemic signs: high fever, chills, fatigue
        • Dyspnea, tachycardia
        • Pleuritic pain
        • Rales
        • Productive cough
    • Pneumonia
      • Treatment
        • Antibacterials (Penicillin)
        • Supportive measures
        • Pneumococcal vaccine
    • Obstructive Lung Disease: Lung Cancer
      • Primary or secondary; benign rare
        • Primary is major cause of death
      • Linked with cigarette smoking
      • Metastases develop freq in lung b/c:
        • Venous return and lymph vessels bring tumor cells from distant site in body  heart  lung
      • Poor prognosis
    • Normal Lung vs. Cancerous Lung
    • Types of Lung Cancer
      • Bronchogenic carcinoma
        • Most common
        • Arise from bronchial epithelium
      • Squamous cell carcinoma
        • Develop from epithelial lining in bronchus
        • Project into airway
      • Adenocarcinomas and bronchoalveolar cell carcinoma
        • Found on lung periphery
        • Less symptomatic, more difficult to treat
      • Small cell carcinoma
        • Rapidly growing; located near major bronchus
        • Invasive and metastize early in dev
      • Large cell carcinoma
        • Found in periphery
        • Consist of large, undifferentiated cells
        • Rapid growth rate, metastize early
    • Bronchogenic Carcinoma
    • Lung Cancer—Pathophysiology
      • First change
        • Metaplasia, change in epithelial tissue
          • Smoking, chronic irritation
          • Reversible if irritation removed
        • Loss of ciliated pseudostratified epithelium
          • More vulnerable to irritants
      • Next
        • Dysplasia, carcinoma develop
        • Hard to detect
    •  
    • Lung Cancer—Effects of Tumors
      • Obstruction of air flow
      • Inflammation
      • Pleural effusion, hemothorax, pneumothorax
      • Paraneoplastic syndrome
    • Lung Cancer—Etiology
      • General stats
        • 173,330 new cases each year
        • 160,440 deaths per year
      • Smoking (primary and secondary)
        • 87% of lung cancers related to smoking
        • 1 out of 10 chances of developing lung cancer
      • Maybe a genetic factor
      • Occupational exposure to carcinogens
      • Irritant that leads to chronic inflammation
        • Cause cell changes
          • Smoking: ciliated columnar  squamous
    • Lung Cancer—Signs and Symptoms
      • Insidious onset
      • Normally metastized before diagnosis
      • 4 possible categories of signs of lung cancer
        • Direct effects of tumor
        • Systemic effects of cancer
        • Paraneoplastic syndromes
        • Metastizes at other sites
    • Lung Cancer—Early Signs (#1)
      • Persistent, productive cough, dyspnea, wheezing
      • Detection on chest X-ray
      • Hemoptysis
      • Pleural involvement
      • Chest pain
      • Hoarseness
      • Facial, arm edema; headaches
      • Dysphagia
    • Lung Cancer (#2-4)
      • Systemic signs
        • Wt. loss, anemia, fatigue
      • Paraneoplastic syndrome
        • Signs of endocrine disorder
        • Depends on hormone being secreted
      • Signs of metastasis depends on site
    • Lung Cancer—Diagnostic Tests
      • Chest X-rays
      • Bronchoscopy
      • Pulmonary function tests
    •  
    •  
    • Lung Cancer—Treatment
      • Surgery on localized lesions
      • Chemotherapy and radiation
      • Poor prognosis unless tumor in early stages of development
    • Asthma
      • Periodic episodes of severe but reversible bronchial obstruction
      • Frequency may lead to irreversible damage and COPD
      • 2 types
        • Extrinsic asthma
          • Acute episodes triggered by type I hypersensitivities
          • Onset in childhood
        • Intrinsic asthma
          • Onset during adulthood
          • Stimuli target hyperresponsive tissue = acute attack
    •  
    • Asthma—Pathophysiology: Acute Attack
      • Both types
      • Bronchi and bronchioles respond to stimulus with 3 changes
        • Bronchoconstriction
        • Inflammation of mucosa with edema
        • Increased secretion of thick mucus in passageways
      • Changes may result in partial or total obstruction of airways
        • Interferes with oxygen supply, air flow
    •  
    • Asthma—Pathophysiology: Extrinsic Asthma
      • 1 st stage
        • Allergen reacts with IgE on previously sensitized mast cells in resp. mucosa
          • Release chemical mediators (histamine, prostaglandin)
        • Stimulates vagus nerve
          • Reflex bronchoconstriction
      • 2 nd stage
        • Hours later
        • Increased leukocytes release more chemical mediators
          • Prolong bronchoconst and epithelial damage
          • Increase WBC
            • Obstruction, hypoxia
    • Asthma—Pathophysiology: Partial Obstruction
      • Small bronchi, bronchioles
      • Air trapping with hyperinflation of lungs
      • Air only partially expired
      • Expiration passive
        • Now less force to move air out
        • Forced collapses bronchial wall
          • Even more difficult to expire
          • Increased residual volume
            • More difficult to inspire fresh air, cough
    • Asthma—Pathophysiology: Total Obstruction
      • Mucus plugs completely block
      • Air in distal section diffuses out
        • Cannot be replaced
          • Lung in that section collapses
      • Both (partial and total) lead to hypoxia and hypoxemia
      • Status asthmaticus
        • Persisant severe asthma attack
        • Does not respond to therapy
        • Can be fatal
      • Chronic asthma and COPD may develop
        • Irreversible damage in lungs
    • Asthma—Etiology
      • Family history of hay fever, asthma, eczema
      • Significant rise due to:
        • Sedentary lifestyles and obesity
        • Increased time indoors
        • Increased air pollution
    • Asthma—Signs and Symptoms
      • Cough, dyspnea, tight feeling in chest
      • Wheezing
      • Rapid, labored breathing
      • Thick, sticky mucus coughed up
      • Tachycardia and pulse paradoxus
        • Pulse differs on inspiration and expiration
      • Hypoxia
      • Respiratory acidosis
      • Severe respiratory distress
      • Respiratory failure
    • Asthma—Treatment
      • General measures
        • Determine allergies
        • Avoid triggers
      • Acute attacks
        • Inhalers
          • Bronchodilators (albuterol)
          • Most effective at 1 st indication of attack
        • Controlled breathing techniques and decrease anxiety
        • Glucocorticoids
      • Hospital care—status asthmaticus
      • Prophylaxis and treatment of chronic asthma
        • Leukotrine receptor antagonists (Singulair)
          • Block inflammation response
          • Taken regularly, not effective for acute attacks
        • Cromolyn sodium
          • Inhibits release of chemical mediators from sensitized mast cells
          • Not effective for acute attacks
    • Chronic Obstructive Pulmonary Disease (COPD)
      • Progressive tissue damage and obstruction of airways
      • Affect individual’s ability to work and function indep
        • Eventual resp failure
      • Leads to R CHF
      • Includes
        • Emphysema
        • Chronic bronchitis
        • Asthma
    • Emphysema—Pathophysiology
      • Significant change is destruction of alveolar walls and spaces
        • Leads to lg, inflated alveoli
      • Classified by specific location of changes
        • Ex: Distal alveoli emphysema
        • Ex: Bronchiolar emphysema
    •  
    •  
    • Emphysema—Pathophysiology: Contributing Factors
      • Genetic
        • Low alpha1-antitrypsin
          • Protein normally present in tissues
          • Inhibits action of proteases
            • Destruction of enzymes released by neutrophils during inflammation
            • Ex: Elastase
              • Breaks down elastic fibers
              • Destructive process increases in people with low alpha1-antitrypsin
      • Smoking
        • Increases # neutrophils in alveoli and release of elastase
        • Decreases effects of alpha1-antityrpsin
    • Emphysema—Pathophysiology: Effects of Tissue Changes on Lung Function
      • Break down of alveolar wall
        • Decrease SA for gas exchange
        • Loss of pulmonary capillaries
        • Loss of elastic fibers
        • Altered ventialtion-perfusion ratio
        • Decreased support for small bronchi
      • Fibrosis and thickening of bronchial wall
      • Progressive difficulty with expiration
        • Air trapping, increased residual volume
        • Overinflation of lungs
        • Fixation of ribs in inspiration position
    •  
    • Severe Emphysema
      • Adjacent damaged alveoli
      • Lung appears full of holes
      • Frequent infection
      • Lg. belbs near lung surface
        • May rupture
          • Pneumothorax
      • Pulmonary hypertension or R CHF
    • Emphysema—Etiology
      • Cigarette smokers
      • Genetic
      • Exposure to air pollutants
      • Conjunction with other chronic lung disorders
        • Cystic fibrosis
        • Chronic bronchitis
    • Emphysema—Signs and Symptoms
      • Onset insidious
      • Dyspnea occurs 1 st on exertion
      • Hyperventilation with prolonged expiration
        • Use of accessory muscles, hyperinflation
        • “barrel chest”
      • Anorexia, fatigue
      • Clubbed fingers
    • Emphysema—Diagonstic Tests
      • Chest X-rays
      • Pulmonary function tests
        • Indicate presence of increased residual volume and total lung capacity
        • Decreased forced expiration volume and vital capacity
    • Emphysema—Treatment
      • Avoid resp infections, irritants
      • Stop smoking
      • Pulmonary rehabilitation
      • Appropriate breathing techniques
      • Maintain adequate nutrition, hydration
      • Bronchodilators, antibiotics, oxygen therapy
        • As condition advances
      • Lung reduction surgery
        • Remove part of lung
    • Chronic Bronchitis—Pathophysiology
      • Significant changes in bronchi
        • Irreversible and progressive
      • Inflammation, obstruction, repeated infection, chronic coughing
      • Inflamed, swollen mucosa
      • Hypertrophy/plasia of mucus glands
        • Increased secretions (increased # goblet cells)
        • Decreased ciliated epithelia
      • Fibrosis and thickening of bronchial wall
        • Further obstruction; pooling of secretions
      • Decreased oxygen
        • Cyanosis during cough
      • Severe dyspnea and fatigue
      • Pulmonary hypertension and R CHF
    •  
    • Chronic Bronchitis—Etiology
      • Smoking
        • Crap! Not again!
      • Living in urban areas
      • Living in industrial areas
    • Chronic Bronchitis—Signs and Symptoms
      • Constant productive cough
      • Tachypnea, shortness of breath
      • Thick, purulent secretions
      • Severe cough and rhonchi
      • Airway obstruction
        • Hypoxia, cyanosis
      • R CHF, pulmonary hypertension
    • Chronic Bronchitis—Treatment
      • Decrease exposure to irritants
      • Expectorants, bronchodilators, chest therapy (postural drainage)
        • Remove excess drainage
    •