Pulmonary conditions


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Pulmonary conditions

  1. 1. A Report by: Kenneth Pierre M.Lopez
  2. 2. • Nose or Mouth: entry point into the respiratory system. The nose filters, humidifies and warms air.• Pharynx: common area used for both respiratory and digestive systems.• Larynx: connects the pharynx to the trachea, including the epiglottis and vocal
  3. 3. • The conducting airways, trachea to terminal bronchioles, only transport air. No gas exchange occurs.• The respiratory unit: respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli. Diffusion of gas occurs through all these structures.
  4. 4. • Parietal pleura covers the inner surface of the thoracic cage, diaphragm, and mediastinal border of the lung• Visceral pleura wraps the outer surface of the lung including fissure lines• Intrapleural space is the potential space between the two pleurae that maintains the approximation of the rib cage and lungs, allowing forces to be transmitted from one structure to another.
  5. 5. Primary Secondary• Produces a normal resting • Used when a more rapid tidal volume or deeper inhalation is• Diaphragm required• External Intercostals • Scalenes and SCM • Levator Costarum and Serratus • Expiration • Quadratus Lumborum • Internal intercostals • Abdominals
  6. 6. • Expiratory Reserve • Inspiratory Capacity: The Volume: Maximal volume amount of air that can be expired after Normal inspired after a normal Respiration; 1000mL exhalation 3500mL• Forced Expiratory Volume: • Inspiratory Reserve the amount of air exhaled Volume: Maximal volume in 1st-3rd second of forced inspired after normal vital capacity test inspiration 3000mL• Forced Vital Capacity: the • Residual Volume: Lung amount of air forcefully volume remaining in the expired after a maximal lungs 1200mL inspiration • Tidal Volume: Total volume• Functional Residual inspired and expired per Capacity: Volume in the breath; 500mL lungs after normal • Total Lung Capacity: Lung exhalation 2300mL Volume measured at the end of maximal inspiration 5800mL • Vital Capacity: Maximal
  7. 7. • Total Lung Capacity = IRV + TV + ERV + RV• Vital Capacity = IRV + TV + ERV• Inspiratory Capacity = TV + IRV• Functional Residual Capacity = ERV + RV
  8. 8. - A disease characterized by airflow limitation that is notfully reversible. Limitation is usually both progressiveand associated with an abnormal inflammatory responseof the lungs to noxious particles or gasses.
  9. 9. • Increased reactivity of the trachea and bronchi to various stimuli (allergens, exercise, cold) and manifests by widespread narrowing of the airways due to inflammation, smooth muscle constriction, and increased secretions that is reversible in nature.• 15 million are affected in all age groups and gender in the USA; women are affected more than men, hormones are thought to be the possible cause• Lungs become hyperactive, responding to irritants in an exaggerated way. Muscles around the airways constrict and inflammation causes air passages to swell and produce excess mucus impairing
  10. 10. Signs and Symptoms Contributing Factors• Wheezing, possible • Respiratory infections, crackles, decreased breath colds sounds • Cigarette Smoke• Increased mucus • Allergic Reactions to pollen, secretions mold, animal dander,• Dyspnea feather, dust, food, insects• Increased accessory • Air pollutants muscle use • Physical exertion• Anxiety • Exposure to sudden• Tachycardia, Tachypnea, temperature change (cold) Hypoxemia • Excitement or strong• Cyanosis emotion, psychological or emotional stress
  11. 11. Listen For Look For• Wheezing, however light • Skin retraction (clavicles,• Irregular breathing with ribs, sternum) prolonged expiration • Hunched-over body posture; inability to stand,• Noisy, difficult breathing sit straight or relax• Clearing the throat • Pursed-lip breathing• Cough with or without • Nostrils Flaring sputum production, • Unusual pallor or especially in the absence of unexplained sweating a cold and/or occurring 5 – • Spirometry will show 10 minutes after exercise impaired flow rates • CXR shows hyperlucency and flattened diaphragms during exacerbation
  12. 12. • An inflammation of the trachea and bronchi that is self-limiting and of short duration with few pulmonary signs. This condition may result from chemical irritation or may occur with viral infections such as influenza, measles, chickenpox or whooping cough.• Signs and Symptoms • Mild fever (1-3 days) • Malaise • Back and Muscle Pain • Sore Throat • Cough with sputum production, followed by wheezing • Possible Laryngitis
  13. 13. • A condition associated with prolonged exposure to nonspecific bronchial irritants and is accompanied by mucus hypersecretion and structural changes in the bronchi, anyone who coughs for at least 3 months per year for 2 consecutive years without having had a precipitating disease• Results from exposure to cigarette smoke, long- term inhalation of dust or air pollution and causes hypertrophy of mucus-producing cells in the bronchi• Partial or complete blockage of the airways from mucus secretions causes insufficient oxygenation in the alveoli• Common in older clients and with chronic lung or
  14. 14. Signs and Symptoms Tests• Persistent cough with • Sputum analysis production of sputum • Spirometry• Reduced chest expansion• Wheezing• Fever• Dyspnea• Cyanosis• Decreased exercise tolerance
  15. 15. • May develop in a person after a long history of chronic bronchitis in which alveolar walls are destroyed, leading to permanent over-distention of the air spaces and loss of normal elastic tension in the lung tissue.• Air passages are obstructed as a result of these changes. Difficult expiration in emphysema is due to the destruction of the walls between the alveoli, partial airway collapse and loss of elastic recoil.• The work of breathing is increased because there is less functional lung tissue to exchange oxygen and CO2. Capillaries are also destroyed further reducing perfusion and ventilation
  16. 16. Centriacinar Emphysema• Centrilobular Emphysema • Most common type, destroys bronchioles, usually in upper lung regions• Panlobular Emphysema • Destroys the more distal alveolar walls, most commonly involving the lower lung. May occur secondary to infection or to irritantsParaseptal (panacinar) Emphysema • Destroys the alveoli in the lower lobes of the lungs, resulting in isolated blebs along the lung periphery
  17. 17. Signs and Symptoms Tests• Shortness of Breath • Spirometry• Dyspnea on Exertion • ABG (low arterial oxygen• Orthopnea levels)• Chronic Cough• Barrel Chest• Weight Loss• Malaise• Use of accessory muscles of respiration• Prolonged expiratory period• Wheezing• Pursed lip breathing• Increased respiratory rate• Peripheral Cyanosis
  18. 18. • An inherited disease of the exocrine glands primarily affecting the digestive and respiratory systems.• Most common genetic disease in the US, inherited as a recessive trait: both parents must be carriers, each having a defective copy of the CF gene. Each time two carriers conceive a child there is a 25% chance the child will have it, 50% chance the child will be a carrier, 25% of the child not having it.• 12 million people, carry a single copy of the gene 5% of the total population
  19. 19. • In healthy people a protein called cystic fibrosis transmembrane conductance regulator provides a channel by which chloride can pass in and out of cells.• Persons with CF have a defective copy of the gene causing accumulation of salts in the cells lining the lungs and digestive tissues, making the surrounding mucus abnormally thick and sticky. This obstructs the ducts of the pancreas, liver and lungs and causes abnormal sweat and salivary secretions.• Diagnosis is made postnatally by a blood test showing the presence of trypsinogen or later by a positive sweat electrolyte test
  20. 20. Signs and Symptoms Other Tests• Onset of symptoms usually in • Abnormal PFT’s showing early childhood• Dyspnea an obstructive pattern,• Productive cough restrictive pattern or both• Hypoxemia, hypercapnea • CXR shows increased• Cyanosis markings and findings of• Clubbing bronchiectasis and/or• Use of accessory muscles in pneumonitis breathing – Barrel Chest• Tachypnea• Crackles, wheezes and/or decreased breath sounds• Recurrent pneumonia• Poor weight gain• Salty skin/sweat• Bulky foul smelling stools
  21. 21. - Diseases typified by difficulty expanding the lungscausing a reduction in lung volumes
  22. 22. • An inflammation of the lungs and can be caused by (1) aspiration of food, fluids or vomitus; (2) inhalation of toxic or caustic chemicals, smoke, dust or gases; or (3) a bacterial, viral, or mycoplasmal infection• It is an inflammatory pulmonary response to the offending organism or agent. It may involve one or both lungs at the level of the lobe (lobar pneumonia) or more distally beginning in the terminal bronchioles and alveoli (bronchopneumonia)• Pneumocystis carinii is a protozoan organism that rarely causes pneumonia in a healthy individual. This is the most common life-threatening opportunistic infection in persons with AIDS.• Nosocomial Pneumonia is a hospital-acquired pneumonia usually in patients who are using a respirator machine to help them breathe this type can be very severe and
  23. 23. Signs and Symptoms Tests• Sudden and sharp pleuritic • Sputum and/or blood chest pain that is aggravated by chest movement cultures• Shoulder pain • CXRAY• Hacking, productive cough pneumonitis/infiltration (rust-colored or green, purulent sputum) • WBC count• Dyspnea, Tachypnea • CBC (Pneumocytis carinii;• Cyanosis shows now sign of• Headache infection)• Fever and chills• Generalized aches and myalgia that may extend to the thighs and calves• Knees may be painful and swollen• Fatigue• Confusion in older adults
  24. 24. • Collapsed or airless alveolar unit, caused by hypoventilation secondary to pain during the ventilatory cycle (pleuritis, postoperative pain or rib fracture), internal bronchial obstruction (aspiration, mucus plugging), external bronchial compression (tumor or enlarged lymph nodes), low tidal volumes (narcotic overdose, inappropriately low ventilator settings), or neurologic insult.• Physical findings include • Decreased breath sounds • Dyspnea • Tachycardia • Increased temperature • CXR with platelike streaks
  25. 25. • Mycobacterium tuberculosis infection spread by aerosolized droplets from an untreated infected host. Incubation period is 2-10 weeks. It is characterized by the growth of nodules (tubercles) in the tissues commonly in the lungs.• May be diagnosed by Tuberculin Skin tests, Xrays and sputum cultures.• Signs and Symptoms Include • Fatigue, Malaise • Anorexia • Weight Loss • Low-grade fevers • Night sweats • Frequent productive cough • Dull Chest pain, tightness, or discomfort • Dyspnea
  26. 26. • Risk Factors • Rheumatoid arthritis • Health care workers secondary to • Older adults immunosuppresive • Overcrowded housing treatements • Incarcerated people • Diabetes mellitus/ end • Immigrants from Asia, stage renal disease Ethiopia, Mexico, Latin • People with a history of America, Eastern Europe GI diseases • Dependent on alcohol or other chemicals with resultant malnutrition • Infants and children under 5 years of age • HIV positive or Cancer positive patients
  27. 27. • An atypical respiratory illness caused by a coronavirus. It is a new type of atypical pneumonia that infects the lungs. Initial outbreak in southern mainland China with worldwide spread to other areas such as Singapore, Toronto, Vietnam and Hongkong• Physical Findings • High Temperature • Dry Cough • Decreased WBC, platelets and lymphocytes • Increased liver function tests • Abnormal CXR with borderline breath sounds and changes
  28. 28. • Bronchodilator Agents • Relieve bronchospasm, increase size of the airway, and reduce resistance and subsequent obstruction; 3 subsets include anticholinergics, beta-adrenergics, methylxanthine • Albuterol, Epinephrine, Pirbuterol acetate, Aminophylline• Inhaled Corticosteroid Agents • Controls inflammation of the airways; decrease bronchospasm and stabilize inflammatory response in the respiratory tract • Beclomethasone, Budesonide, Dexamethasone• Mucolytic Agents • Thin mucous secretions by altering the composition and consistency of mucus
  29. 29. • Expectorant Agents • Increase removal of mucus through transport from the lungs • Guaifenesin, Iodinated glycerol, Terpin hydrate• Antiasthmatic Agents • Stabilize mast cells; inhibit the release of inflammatory substances • Cromolyn sodium, Nedocromil sodium
  30. 30. • Breathing exercises• Coughing techniques• Postural Drainage, Chest PT• Endurance/ Exercise training• Relaxation techniques• Mobility Training
  31. 31. • Patients who have acute or chronic respiratory problems• The inability to expel pulmonary secretions• An ineffective cough• Patients with increased secretions• Patients with pneumonia• Patients with atelectasis• Patients with neurological impairments that cause swallowing difficulties
  32. 32. Postural Drainage Percussion• Congestive heart failure • Over a fracture site• Significant pulmonary • Over a spinal fusion site edema • Over osteoporotic bone• Significant pleural effusion • Unstable angina• Pneumothorax • Low platelet count• Cardiac arrhythmia • Anticoagulation therapy• History of recent • Pulmonary embolism myocardial infarction• Unstable angina• Pulmonary embolism
  33. 33. • Percussion • A force rhythmically applied with the therapist’s cupped hands to the specific area of the chest wall that corresponds to the involved lung segment. Percussion is used to increase the amount of secretions cleared form the tracheobronchial tree. It is usually used in conjunction with postural drainage.• Shaking (Vibration) • Following a deep inhalation, shaking is a bouncing maneuver applied to the rib cage throughout exhalation. Shaking hastens the removal of secretions from the tracheobronchial tree. Commonly used following percussion in the appropriate postural drainage position. Modification of this technique may be necessary for patient tolerance.
  34. 34. Treatment Protocol Goals for Retraining• Teach proper use of • Improve overall ventilation inspiratory muscles and respiration• 2-4 sessions of 30 to 50 • Decrease accumulation of minutes of deep breathing with proper diaphragmatic secretions and prevent breathing complications• Use sniffing to increase • Decrease the work of awareness regarding the breathing proper use of the diaphragm • Improve the efficiency of when breathing coughing• Strength training through • Strengthening respiratory resisted inhalation for patients muscles that have TV > 500ml• Strength training through • Improve chest wall mobility active breathing exercises for
  35. 35. • Diaphragmatic Breathing • Attempts to enhance movement of the diaphragm upon inspiration and expiration and diminish accessory muscle use. Used with patient’s with obstructive or restrictive pulmonary ailments• Low Frequency Breathing • Low-frequency breathing is slow deep breathing designed to improve alveolar ventilation and oxygenation. Used with patients who have pleuritic, incisional or posttrauma pain that is causing decreased movement in a portion of the thorax and are risk for developing atelectasis• Pursed Lip Breathing • Attempts to improve ventilation by decreasing the respiratory rate and increasing the tidal volume. This technique assists with shortness of breath that is commonly encountered in patients with COPD who experience dyspnea at rest or with
  36. 36. • Cough • The patient should be asked to cough in the upright sitting position, if possible, after each area of lung has been treated. Coughing is effective in clearing secretions from the major central airways.• Huff • Huffing is more effective in patients with collapsible airways, such as patients with chronic obstructive diseases; it prevents the high intrathoracic pressure which causes premature airway closure• Assisted Cough • The therapist’s hand or fist becomes the force behind the patient’s exhaled air. Assisted cough is used when the patients abdominal muscles cannot generate effective cough. The amount of force by the therapist is dependent upon patient tolerance and abdominal sensation• Tracheal Stimulation • Used with patients who are unable to cough on command, such as infants, patients following brain injury or stroke