Respiratory Disorders
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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
  •