pulmonary lecture

1. PULMONARY SYSTEM
Presenter
- Joud alsaluli (20231439)
- Nada alruwily (20231332)
- Reem abdumanam (20231389)
Instructor
Dr. LAILA

2. Outline
- Discuss the acute respiratory failure disease with
management
- Explain the cause, symptom and management of Acute
Respiratory Distress Syndrome
- Describe the Chronic Obstructive Pulmonary and Asthma
Disease the cause, symptom and management
- Outline the cause, symptom and management of Pulmonary
embolism (PE) and pneumonia disease and drwnoing disease

3. Introduction
- The pulmonary system serves as a cornerstone of health and disease
management, encompassing vital functions beyond mere gas exchange
- Its intricate anatomy and physiology intricately influence overall
physiological balance and immune response, making it a focal point in
healthcare.
- From acute respiratory distress to chronic obstructive pulmonary
disease, understanding pulmonary function is paramount for effective
diagnosis and treatment.

4. Anatomy and Physiology
- Pulmonary function evaluation encompasses a thorough assessment
utilizing various modalities, including physical examination, diagnostic
tests, and imaging studies.
- During the physical examination, healthcare providers auscultate lung
sounds to detect abnormalities, inspect for signs of respiratory distress,
and evaluate respiratory rate and effort.
- Diagnostic tests, such as spirometry and arterial blood gas analysis,
provide quantitative measures of lung function and oxygenation, aiding in
the diagnosis and monitoring of respiratory conditions.

5. Acute Respiratory Failure (ARF)

6. • Pathophysiology
• Acute respiratory failure occurs when the respiratory
system is unable to adequately exchange oxygen and
carbon dioxide, leading to dangerously low oxygen levels
or high carbon dioxide levels in the blood.
sings and Symptoms
• Acute Respiratory Failure (ARF) symptoms comprise
severe dyspnea,
• rapid and shallow breathing,
• mental confusion,
• cyanosis, increased heart rate,
• fatigue, anxiety, and difficulty speaking.
• These signs indicate a critical respiratory impairment,
requiring urgent medical intervention for oxygenation
and carbon dioxide elimination.

7. Etiology and risk factors:
smoke tobacco product drink alcohol
excessivelyhave a family history of respiratory
disease or conditions
• Lung diseases (COPD, pneumonia, ARDS),
• Trauma
• Drug overdoses,
• Neuromuscular disorders
• Systemic conditions like sepsis.
• Any disruption in lung oxygen-carbon dioxide exchange
may contribute to ARF.

8. Management Strategies of Acute Respiratory
Failure (ARF)
• Acute Respiratory Failure (ARF) management involves
addressing the root cause, utilizing strategies such as
oxygen therapy and mechanical ventilation, and
administering medications for symptom relief.
• Close monitoring, nutrition, and a multidisciplinary
approach are crucial, with ICU admission in severe
cases. Regular reassessment and collaboration ensure
effective care.
DIAGNOSING TAST:
.CHEST X-ray
.blood gas test
Pulse oximetey

9. Acute Respiratory Distress Syndrome (ARDS)
• Pathophysiology
• Acute Respiratory Distress Syndrome (ARDS) is a severe lung
condition marked by rapid onset of widespread inflammation in the
lungs, leading to impaired oxygen exchange.
Symptoms
• Sudden onset of severe shortness of breath
• Rapid and labored breathing,
• Low oxygen levels,
• Confusion, and cyanosis (bluish skin color).
• Patients may also experience extreme fatigue, rapid heart rate,
and difficulty speaking due to respiratory distress.
•

10. Acute Respiratory Distress Syndrome (ARDS)
Etiology and risk factors
• Severe lung injuries, such as pneumonia
• Sepsis
• Trauma, or inhalation of harmful substances.
• Inflammatory responses trigger widespread damage, leading to
increased permeability of lung blood vessels and air sacs, resulting in
fluid accumulation and impaired oxygenation.
• Potential complications
• lung damage, such as a collapsed lung (also called pneumothorax) due to
injury from the breathing machine needed to treat the
diseasePulmonary fibrosis (scarring of the lung)Ventilator-associated
pneumonia

11. Acute Respiratory Distress Syndrome (ARDS)
Management strategies and tretment
• In the management of Acute Respiratory Distress Syndrome (ARDS),
supportive care is employed to optimize oxygenation and address the
underlying cause.
• Treatment involves the use of mechanical ventilation with low tidal
volumes, positive end-expiratory pressure (PEEP), and sometimes prone
positioning.
• Crucial elements for patient recovery include supportive measures
such as fluid management, sedation, and addressing complications.
• DIAGNOSING TAST:
• Sputum cultures and analysisTests for possible infections

12. Pulmonary embolism (PE)
• Pathophysiology :
- Pulmonary embolism (PE) is a life-threatening
condition characterized by the sudden blockage of
one or more pulmonary arteries in the lungs, usually
by blood clots that travel from the legs or other
parts of the body.

13. Pulmonary embolism (PE)
Pathophysiology:
Pulmonary embolism (PE), an obstruction of the pulmonary artery by an embolus, affects lung tissue, the
pulmonary circulation, and the function of the right and left sides of the heart.
Most emboli (>90%) arise from deep venous thromboses (DVTs) .
Distribution of emboli is related to the size of emboli and blood flow.
Very large emboli have an effect in a large artery; however, the thrombus may break up and block
several smaller vessels
Effects of acute pulmonary artery obstruction:
Over perfusion of the uninvolved lung.
Development of post embolic pulmonary edema

14. Pulmonary embolism (PE)
Etiology and risk factors:
- Surgery or prolonged immobilization
- Heart failure, acute myocardial infarction
- Diabetes mellitus
- Estrogen administration and Pregnancy
- Trauma
- Burns
- Obesity

15. Pulmonary embolism (PE)
Signs and Symptoms
- Sudden onset of chest pain (usually pleuritic)
- cough, and hemoptysis
- Dyspnea, and tachypnea
- increased work of breathing
- Tachycardia, diffuse chest discomfort, reduced blood pressure
- Anxiety, restlessness, apprehension, agitation, syncope

16. Diagnostic study findings of
Pulmonary embolism (PE)
Laboratory:
ABG levels may indicate respiratory alkalosis
D-dimer, which may be nonspecific, but if normal makes the diagnosis of PE less likely
Cardiac enzymes Frequently leads to misdiagnosis of congestive heart failure.
Pulmonary angiography:
Most definitive test CT-angio or CT-PA very sensitive and done more often than pulmonary angiography.
Electrocardiogram (ECG):
In massive PE may reveal “P pulmonale,” right-axis deviation, or incomplete or new righty bundle branch block.
Chest radiograph:Nonspecific Useful to detect other things causing similar symptoms.
Lower-extremity Doppler ultrasonography:
Negative findings on serial ultrasonographic scans reduce the likelihood of PE.

17. Pulmonary embolism (PE)
* Management and treatment :
- O2 administration, as needed
- Early ambulation, turning, promotion of coughing and deep breathing
- Use of elastic stockings, pneumatic compression stockings (if not contraindicated)
- Adequate fluid intake to avoid dehydration
- Anticoagulant therapy, heparin or low-molecular-weight heparin, Warfarin
- Placement of filter device in inferior vena cava
• Potential complications:
- Bleeding

18. Pathophysiology:
Etiology and risk factors
Signs
Pathophysiology:
Etiology and risk factors
Signs and symptoms:
chronic cough and sputum
production.
Wheezing
Chest expansion may be
normal
Various forms of tobacco
inhalation which include
cigarette smoking—the
most important factor and
the major toxic stimulus,
cigars and vaping
Environmental pollution,
occupational exposure
the presence of chronic
cough
with sputum production on
a daily basis for a minimum
of 3 months a year
for not less than 2
successive years
Chronic bronchitis:
dyspnea on exertion and
eventually dyspnea at rest.
Skin color often pinkish
because the patient is well
oxygenated
Weight loss, inability to
perform ADLs
Barrel chest and Pursed-lip
breathing
Anatomic alteration of the
lung characterized by an
abnormal enlargement of
the air spaces distal to the
terminal, nonrespiratory
bronchioles, accompanied
by destructive changes in
the alveolar walls.
Emphysema:
Chronic obstructive pulmonary disease (COPD)

19. Diagnostic study
findings
Management of patient
care and treatment
Potential complications:
1- Hospital-associated
infections
2- Inability to wean or
liberate from the ventilator
1- Positioning: Keep the
head of the bed elevated 30
to 45 degrees
2- Carefully administer O2
using the lowest FiO2 that
produces adequate
oxygenation;
observe for CO2 retention.
3- Observe for signs of fluid
overload; monitor intake
and output closely.
4- Monitor ABG levels;
notify the physician
immediately if PaO2 drops
below the
patient’s known baseline or
target level
5- Advocate for the
administration of influenza
and pneumococcal vaccine.
ABG analysis: Hypoxemia
and often hypercapnia
Polycythemia on complete
blood count (CBC)
Chronic bronchitis:
ABG analysis—may be
normal or abnormal,
depending on the type
and severity
Chest radiographs often
show low, flattened
diaphragms. In severe
emphysema
Emphysema:
Chronic obstructive pulmonary disease (COPD)

20. Asthma and status asthmatic
• Asthma is a chronic respiratory
condition characterized by
inflammation and narrowing of the
airways, causing recurrent episodes of
wheezing, coughing, chest tightness,
and shortness of breath.
• Status asthmaticus is a severe and life-
threatening exacerbation of asthma
that does not respond to standard
treatments.

21. Asthma and status asthmatic
Etiology and risk factors:
Respiratory infection
b. Allergic reaction to inhaled antigen (pollen, grass, perfume, smoke)
c. Poor bronchodilator use and management
d. Idiosyncratic reaction to aspirin or other nonsteroidal anti-inflammatory
medications
e. Emotional stress, exercise
f. Occupational or environmental exposure (air pollution)
g. Use of nonselective β-blocking agents
h. Mechanical stimulation (coughing, laughing, and cold air inhalation)
i. Sinusitis, reflux esophagitis j Genetic predisposition

22. Asthma and status asthmatic
Signs and symptoms:
- dyspnea, wheezing, cough, and chest tightness.
- Physical exhaustion, inability to sleep or rest, anxiety c.
- Difficulty speaking in sentences, minimal chest excursion with inspiration
- Production of thick, tenacious sputum
- Expiratory wheezes or rhonchi (as air and secretions move through
narrowed airways).

23. Asthma and status asthmatic
Diagnostic study findings:
- Evidence of infection (e.g., positive sputum culture results).
- Elevated WBC count
- ABG analysis: May initially show low normal or decreased PaCO2, increased pH, and
decreased PaO2 In severe asthmatic attacks, progression to a “normal” or
increased PaCO2 level may be a sign of impending respiratory failure.
- Chest radiograph may be normal. Used to confirm or rule out a diagnosis of
pneumonia, pneumothorax, or other condition that mimics asthma.

24. Asthma and status asthmatic
Management of patient care and treatment:
- Positioning , Keep the head of the bed elevated 30 to 45 degrees to maximize ventilation.
- Administer BiPAP, CPAP, heliox (helium and oxygen mixture).
- Intubation and mechanical ventilation become necessary.
- Administer fluids and humidification to keep airway secretions thin and easily expectorated
- Perform close objective monitoring of ABG values, acid-base status, and ventilatory
parameters

25. Pneumonia
• Pneumonia is an inflammatory lung condition often caused
by infection, including bacteria, viruses, or fungi.
• It leads to the air sacs in the lungs filling with pus or
other fluids, impairing oxygen exchange.
Symptoms
• Fever
• Cough
• Shortness of breath
• Chest pain, and sputum production.
• Patients may experience fatigue and weakness, and
the severity can range from mild to severe, with
more intense symptoms in older adults and those with
weakened immune systems.

26. Pneumonia
Etiology and risk factors
• Bacterial, viral, or fungal infections affecting the
lungs. Common bacterial culprits include
streptococcus pneumoniae.
• Viral causes often involve influenza and respiratory
syncytial virus (rsv).
• Aspiration of stomach contents, inhalation of harmful
substances, or underlying health conditions may also
contribute to pneumonia development.
• Diagnosis test
• .CHEST X-ray
• .blood gas test
• Pulse oximetey

27. Pneumonia
Management Strategies and treatment
• Pneumonia management involves prompt initiation of
antibiotics for bacterial pneumonia and antivirals for
viral cases.
• Supportive care includes pain relief, fever reducers,
and adequate hydration.
• Oxygen therapy and, in severe cases, mechanical
ventilation may be necessary.
• Regular monitoring and addressing complications
contribute to optimizing recovery.

28. • Pathophysiology
• Ventilator-Associated Pneumonia (VAP) is a lung infection that occurs
in patients on mechanical ventilation.
• Ventilator-Associated Events (VAE) is a broader term encompassing
respiratory complications during mechanical ventilation, including
infections and non-infectious issues, often requiring further evaluation
and intervention.
SIGNS AND Symptoms
• Fever
• Increased respiratory rate, and changes in oxygenation.
• Ventilator-associated events (vae) may manifest similarly, indicating
potential respiratory complications in patients receiving mechanical
ventilation, often necessitating further evaluation and intervention.
•
Ventilator Associated Pneumonia (VAP) and Event (VAE)

29. Ventilator Associated Pneumonia (VAP) and Event (VAE )
• Ventilator-Associated Pneumonia (VAP) is mainly caused by bacterial
colonization of the ventilator system, facilitated by invasive
procedures and prolonged mechanical ventilation.
• Ventilator-Associated Events (VAE) can result from various factors,
including infections and non-infectious causes, contributing to
respiratory complications in ventilated patients.
Etiology and risk factors

30. Ventilator Associated Pneumonia (VAP) and Event (VAE )
Management And Treatmant
• Ventilator-Associated Pneumonia (VAP) management involves strict
adherence to infection control measures, early diagnosis, and
appropriate antibiotic treatment.
• Ventilator-Associated Events (VAE) management requires addressing
underlying causes, optimizing ventilation strategies, and monitoring
patient responses to prevent complications and improve outcomes.

31. • Drowning is the process of experiencing respiratory
impairment due to submersion or immersion in liquid,
leading to oxygen deprivation and, in severe cases,
respiratory failure.
Symptoms
• Drowning symptoms include coughing
• Gasping
• Difficulty breathing
• In severe cases, loss of consciousness.
• It may present subtly or be sudden, and victims
often struggle to stay afloat.
Drowning

32. Causes of Drowning
• Drowning occurs when the airway is submerged in
water, leading to oxygen deprivation.
• Causes include accidental submersion in pools,
rivers, or other water bodies, inability to swim,
alcohol consumption impairing judgment, and
inadequate supervision, particularly in children.
• Environmental factors, like rough waters or
currents, can also contribute to drowning incidents.
Drowning

33. Management Strategies
• Drowning management involves immediate rescue and
resuscitation efforts, including cardiopulmonary
resuscitation (CPR) to restore breathing and circulation.
• Hospitalization may be necessary for further evaluation
and monitoring.
• Prevention measures, such as water safety education,
lifeguard presence, and vigilant supervision, play a
crucial role in reducing drowning incidents.
Drowning

34. Assessment
 In evaluating patients presenting with symptoms suggestive
of viral myocarditis, it is imperative to consider a broad
range of differential diagnoses to ensure accurate diagnosis
and appropriate management.
 Conditions such as acute coronary syndrome, pericarditis,
and pulmonary embolism can manifest with chest pain and
dyspnea, mimicking the clinical presentation of myocarditis.
 Additionally, non-cardiac etiologies such as gastrointestinal
disorders, musculoskeletal pain, or anxiety-related
symptoms may also present similarly.
.

35. Assessment
 In ventilated patients, pneumonia and ventilator-associated
events (VAE) present with specific clinical features.
 Pneumonia manifests as fever, purulent sputum, and new or
progressive infiltrates on chest imaging.
 Patients with VAE exhibit signs such as worsening oxygenation,
increased ventilator settings, or new pulmonary infiltrates
without evidence of pneumonia.

36. References
MedilinePlus. (2022). Lung disease: Medlineplus medical encyclopedia.
MedlinePlus. https://medlineplus.gov/ency/article/000066.htm
Bates, D. V., & Flaschen, J. H. (2024). Occupational lung disease. Encyclopædia
Britannica. https://www.britannica.com/science/respiratory-
disease/Occupational-lung-disease
PubMed. (n.d.). Journal of Respiratory Diseases: JRD. Open Access Pub.
https://openaccesspub.org/journal/respiratory-diseases/aim-and-scope

37. THANK YOU