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Respiratory Disorders Chapter 19 Pgs 310-360
Homework Assignment <ul><li>Due Tuesday Oct 18  </li></ul><ul><li>It does NOT have to be typed! </li></ul><ul><li>You may ...
Overview <ul><li>Diagnostic Tests </li></ul><ul><li>General Manifestations of Respiratory Disease </li></ul><ul><li>Infect...
Diagnostic Tests <ul><li>Spirometry </li></ul><ul><li>Arterial blood gas determination </li></ul><ul><li>Oximeters </li></...
General Manifestations of Respiratory Disease <ul><li>Sneezing </li></ul><ul><li>Coughing </li></ul><ul><ul><li>Irritation...
Manifestations <ul><li>Breathing patterns and characteristics </li></ul><ul><ul><li>Kussmaul respiration </li></ul></ul><u...
Manifestations <ul><li>Dyspnea </li></ul><ul><ul><li>Severe </li></ul></ul><ul><ul><li>Orthopnea </li></ul></ul><ul><ul><l...
Causes of Hypoxia <ul><li>Low RBC, Hb </li></ul><ul><li>Circulation impairment </li></ul><ul><li>Excessive release of oxyg...
Upper Respiratory Tract Infections:  Common Cold (Infectious Rhinitis) <ul><li>Viral (rhinovirus) </li></ul><ul><li>Spread...
Common Cold <ul><li>Infection, inflammation can spread </li></ul><ul><ul><li>Laryngitis </li></ul></ul><ul><ul><li>Bronchi...
Secondary Bacterial Infections
Sinusitis <ul><li>Secondary bacterial infection </li></ul><ul><li>Obstruct drainage in 1 or more paranasal sinuses </li></...
 
Lower Respiratory Tract Infections:  Bronchiolitis (RSV Infection) <ul><li>2-12 month </li></ul><ul><li>Caused by syncytia...
Pneumonia <ul><li>Primary acute or secondary </li></ul><ul><li>Risk following aspiration, inflammation in lung </li></ul><...
Classification of the Pneumonias <ul><li>Causative agent </li></ul><ul><ul><li>Virus, bacteria, fungus </li></ul></ul><ul>...
 
 
Lobar Pneumonia <ul><li>Streptococcal pneumoniae, pneumococcal </li></ul><ul><li>Infection localized in 1 or more lobes </...
Stages of Pneumonia <ul><li>Congestion </li></ul><ul><ul><li>Inflammation and vascular congestion in alveolar wall </li></...
Consolidation
Pneumonia <ul><li>Pleurae typically involved </li></ul><ul><ul><li>Infection in pleural cavity </li></ul></ul><ul><ul><ul>...
Pneumonia <ul><li>Treatment </li></ul><ul><ul><li>Antibacterials (Penicillin) </li></ul></ul><ul><ul><li>Supportive measur...
Obstructive Lung Disease:  Lung Cancer <ul><li>Primary or secondary; benign rare </li></ul><ul><ul><li>Primary is major ca...
Normal Lung vs. Cancerous Lung
Types of Lung Cancer <ul><li>Bronchogenic carcinoma </li></ul><ul><ul><li>Most common </li></ul></ul><ul><ul><li>Arise fro...
Bronchogenic Carcinoma
Lung Cancer—Pathophysiology  <ul><li>First change </li></ul><ul><ul><li>Metaplasia, change in epithelial tissue </li></ul>...
 
Lung Cancer—Effects of Tumors <ul><li>Obstruction of air flow </li></ul><ul><li>Inflammation </li></ul><ul><li>Pleural eff...
Lung Cancer—Etiology  <ul><li>General stats </li></ul><ul><ul><li>173,330 new cases each year </li></ul></ul><ul><ul><li>1...
Lung Cancer—Signs and Symptoms <ul><li>Insidious onset </li></ul><ul><li>Normally metastized before diagnosis </li></ul><u...
Lung Cancer—Early Signs (#1) <ul><li>Persistent, productive cough, dyspnea, wheezing </li></ul><ul><li>Detection on chest ...
Lung Cancer (#2-4) <ul><li>Systemic signs </li></ul><ul><ul><li>Wt. loss, anemia, fatigue </li></ul></ul><ul><li>Paraneopl...
Lung Cancer—Diagnostic Tests  <ul><li>Chest X-rays </li></ul><ul><li>Bronchoscopy </li></ul><ul><li>Pulmonary function tes...
 
 
Lung Cancer—Treatment  <ul><li>Surgery on localized lesions </li></ul><ul><li>Chemotherapy and radiation </li></ul><ul><li...
Asthma <ul><li>Periodic episodes of severe but reversible bronchial obstruction </li></ul><ul><li>Frequency may lead to ir...
 
Asthma—Pathophysiology:  Acute Attack <ul><li>Both types </li></ul><ul><li>Bronchi and bronchioles respond to stimulus wit...
 
Asthma—Pathophysiology:  Extrinsic Asthma <ul><li>1 st  stage </li></ul><ul><ul><li>Allergen reacts with IgE on previously...
Asthma—Pathophysiology:  Partial Obstruction <ul><li>Small bronchi, bronchioles </li></ul><ul><li>Air trapping with hyperi...
Asthma—Pathophysiology:   Total Obstruction <ul><li>Mucus plugs completely block </li></ul><ul><li>Air in distal section d...
Asthma—Etiology  <ul><li>Family history of hay fever, asthma, eczema </li></ul><ul><li>Significant rise due to: </li></ul>...
Asthma—Signs and Symptoms <ul><li>Cough, dyspnea, tight feeling in chest </li></ul><ul><li>Wheezing </li></ul><ul><li>Rapi...
Asthma—Treatment  <ul><li>General measures </li></ul><ul><ul><li>Determine allergies </li></ul></ul><ul><ul><li>Avoid trig...
Chronic Obstructive Pulmonary Disease (COPD) <ul><li>Progressive tissue damage and obstruction of airways </li></ul><ul><l...
Emphysema—Pathophysiology  <ul><li>Significant change is destruction of alveolar walls and spaces </li></ul><ul><ul><li>Le...
 
 
Emphysema—Pathophysiology:  Contributing Factors <ul><li>Genetic </li></ul><ul><ul><li>Low alpha1-antitrypsin </li></ul></...
Emphysema—Pathophysiology:  Effects of Tissue Changes on Lung Function <ul><li>Break down of alveolar wall </li></ul><ul><...
 
Severe Emphysema <ul><li>Adjacent damaged alveoli  </li></ul><ul><li>Lung appears full of holes </li></ul><ul><li>Frequent...
Emphysema—Etiology  <ul><li>Cigarette smokers </li></ul><ul><li>Genetic </li></ul><ul><li>Exposure to air pollutants </li>...
Emphysema—Signs and Symptoms <ul><li>Onset insidious </li></ul><ul><li>Dyspnea occurs 1 st  on exertion </li></ul><ul><li>...
Emphysema—Diagonstic Tests  <ul><li>Chest X-rays </li></ul><ul><li>Pulmonary function tests </li></ul><ul><ul><li>Indicate...
Emphysema—Treatment  <ul><li>Avoid resp infections, irritants </li></ul><ul><li>Stop smoking </li></ul><ul><li>Pulmonary r...
Chronic Bronchitis—Pathophysiology  <ul><li>Significant changes in bronchi </li></ul><ul><ul><li>Irreversible and progress...
 
Chronic Bronchitis—Etiology  <ul><li>Smoking </li></ul><ul><ul><li>Crap!  Not again! </li></ul></ul><ul><li>Living in urba...
Chronic Bronchitis—Signs and Symptoms <ul><li>Constant productive cough </li></ul><ul><li>Tachypnea, shortness of breath <...
Chronic Bronchitis—Treatment  <ul><li>Decrease exposure to irritants </li></ul><ul><li>Expectorants, bronchodilators, ches...
 
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Transcript of "Respiratory Disorders"

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