Respiratory PP (Patho)

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Respiratory PP (Patho)
2012-03-09 22:41:45
Respiratory System

Respiratory System Disorders
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  1. Two Divisions of the Respiratory System
    • •Air-conducting – delivers air
    • -Includes the nose, mouth,
    • trachea, bronchi, and bronchioles

    • •Gas exchange – swaps gases
    • between air and blood
    • -Includes alveoli and capillaries
  2. Respiratory System (other functions)
    • •Mucus, cilia, and immune
    • cells protect the system from harmful inhaled particles

    • •Capillaries in the nose
    • warms and humidifies the air to protect system from drying and damage from cold
  3. Gas Transportation
    •Carried by hemoglobin

    • •Once to the site,
    • hemoglobin must be able to release the gases

    • •Affected by a variety of things
    • such as pH and temperature
  4. Lung Compliance
    •Elasticity and recoil are vital

    •Surfactant – lipoprotein

    •Has a detergent quality

    •Produces alveoli surface tension to prevent collapse

    •Negative pressure system
  5. Breathing
    •Largely involuntary

    • •Controlled by the medulla oblongata
    • –Chemoreceptors
    • –Stretchreceptors

    • •Inspiration
    • – inhaling

    • •Expiration
    • – exhaling


    •Intercostal muscles
  6. Pulmonary Function Test
    •Lung volumes

    Tidal volume–amountof air moved in and out with a normal breath; ~500ml

    Minute respiratory volume–amount of air moved in and out in one minute; ~ 6L

    Inspiratory reserve volume–maximum amount of air that can be inhaled over tidal volume; 2-3L

    Expiratory reserve volume–maximum amount of air that can be exhaled over tidal volume;1-1.5L
  7. Pulmonary Function Test
    Vital capacity–sum of the tidal volumes and the reserves

    Residual volume–amount of air left in the lung after forced expiration; 1-1.5L

    Forced expiratory volume in one second is compared to the forced vital capacity to diagnose pulmonary disease
  8. Role in pH Balance
    • •Carbon dioxide is one of
    • the body’s acids

    • •Lungs alter the rate and
    • depth of breathing to regulate pH

    Increased rate of breathing expels more carbon dioxide and raises pH

    Decreased rate of breathing retains more carbon dioxide and lowers pH
  9. Infectious Rhinitis
    •Common cold

    •Usually caused by the rhinovirus

    •Highly contagious

    •May also see a secondary bacterial infection

    •Incubation period = 2-3 days

    • •Manifestations: sneezing, nasal congestion, nasal discharge, sore throat, nonproductive cough, malaise, myalgia,
    • low-grade fever, hoarseness, headache, and chills
  10. Infectious Rhinitis
    •Diagnosis: history and physical examination

    • •Treatment: antipyretics, analgesics, antihistamines, decongestants, antibiotics (if bacterial infection
    • is present), humidifiers, and vitamin C

    •Prevent transmission
  11. Sinusitis
    •Inflammation of the sinus cavities

    •Causes: virus, bacteria,and fungus

    •Exudate collects and blocks the sinus cavities

    •Manifestations: facial pain, nasal congestion, fever, and sore throat

    •Diagnosis: history,physical examination, sinus X-ray, and transillumination

    •Treatment: decongestants,analgesics, and antibiotics (if bacterial)
  12. Epiglottitis
    •Inflammation of the epiglottis


    • •Causes: Haemophilus influenza type B (Hib) (common infection in children) and throat
    • trauma

    • •Manifestations: fever, sore throat, difficulty swallowing, drooling with mouth open, inspiratory stridor,
    • respiratory distress, central cyanosis, anxiety, pallor, and assuming a sitting position
  13. Epiglottitis
    • •Diagnosis: visualization of the epiglottitis
    • through a fiber-optic camera, X-rays, cultures, arterial blood gases, and complete blood count

    • •Treatment: maintain airway
    • and respiratory status (e.g., oxygen therapy, endotracheal intubation with mechanical ventilation, and
    • tracheotomy), and antibiotics

    Prevent transmission
  14. Laryngitis
    •Inflammation of the larynx

    •Usually self-limiting

    •Causes: infection, increased upper respiratory exudate, and overuse

    • •Manifestations: hoarseness,weak voice or voice loss, tickling sensation and raw feeling in the throat,
    • sore throat, dry cough, and difficulty breathing
  15. Laryngitis
    • •Diagnosis: history,
    • physical examination, complete blood count , laryngoscopy,
    • and biopsy (rule out cancer)

    • •Treatment: warm humidity,resting the voice, increasing fluid intake, treating the underlying cause,
    • throat lozenges, gargling with salt water, and avoidance of decongestants

  16. Laryngotracheobronchitis

    •Common viral infection in children, usually parainfluenza viruses and adenoviruses

    • •Larynx and surrounding area
    • swell, leading to airway narrowing, obstruction, and respiratory failure

    •Manifestations: nasal congestion, seal-like barking cough, hoarseness, inspiratory stridor, dyspnea, anxiety, and cyanosis
  17. Laryngotracheobronchitis
    •Diagnosis: history,physical examination, X-rays, throat cultures, arterial blood gases, and complete blood gases

    • •Treatment:
    • •Usually self-limiting but can be life threatening

    • •Include cool humidity,
    • corticosteroids, and bronchodilators

  18. Acute Bronchitis
    •Inflammation of the tracheobronchial tree or large bronchi

    •Causes: viruses, bacterial, irritant inhalation, and allergic reactions

    • •Manifestations: productive and nonproductive cough, dyspnea, wheezing, low-grade fever, pharyngitis,
    • malaise, and chest discomfort
  19. Acute Bronchitis
    •Diagnosis: history, physical examination, and X-ray

    • •Treatment: antipyretics,analgesics, antihistamines, decongestants, cough suppressants, bronchodilators,
    • increasing fluid intake, avoiding smoke, and humidifying air
  20. Influenza

    •Viral infection that may affect the upper and lower respiratory tract

    •Highly-adaptive virus

    • •Types
    • -Type A – most severe and most
    • common in US
    • -Type B – less severe
    • -Type C– usually causes small outbreaks
  21. Influenza
    •US flu season between November and March

    • •Incubation period of 1–4
    • days

    •Can cause significant problems with children, elderly, and those who are immune compromised

    • •Manifestations: fever,headache, chills, dry cough, body aches, nasal congestion, sore throat,
    • sweating, and malaise
  22. Influenza
    •Diagnosis: history, physical examinations, rapid flu screen, and flu culture

    •Treatment: antiviral agents, increasing fluids, rest, antipyretics, and analgesics

    •Prevention of transmission: handwashing, avoiding crowds, and vaccination
  23. Bronchiolitis
    •Common viral infection of the bronchioles, usually respiratory syncytial virus

    •More frequent in children under 1 year and during the winter months

    •Can lead to atelectasis and respiratory failure

    •Manifestations: nasal drainage, nasal congestion, cough, wheezing, rapid and shallow respirations,chest retractions, dyspnea, fever, tachycardia, and malaise
  24. Bronchiolitis
    • •Diagnosis: history, physical examination, chest X-ray,
    • mucous swab, complete blood counts, and arterial blood gases

    • •Treatment: oxygen therapy, intubation, cool humidity,
    • increased fluids, keeping the child calm, bronchodilators, and corticosteroids
  25. Pneumonia
    •Causes: infectious agents,injurious agents or events, and pulmonary secretion stasis

    • •Viral
    • -Usually mild
    • -Can lead to secondary bacterialpneumonia

    • •Bacterial
    • -More common than viral
    • -Most often Streptococcus pneumoniae
  26. Pneumonia
    • •Aspiration pneumonia
    • -Causes: impaired gag reflex, improper lower esophageal sphincter closure, inappropriate tube-feeding
    • placement

    • •Lobular pneumonia
    • -Confined to a single lobe

    • •Bronchopneumonia
    • -Most frequent type
    • -A patchy pneumonia throughout several lobes
  27. Pneumonia
    • •Interstitial pneumonia or atypical
    • -Occurs in the areas between the alveoli
    • -Routinely caused by viruses or by uncommon bacteria

    • •Nosocomial pneumonia
    • -Develops more than 48 hours after a hospital admission

    • •Community-acquired pneumonia
    • -Acquired outside the hospital or
    • healthcare setting
  28. Legionnaires’ Disease
    •Pneumonia caused by Legionella pneumophila

    • •Thrives in warm, moist environments, particularly air conditioning systems and spas
    • -Not contagious – spread through aerosoled droplets
    • -Higher risk in the immune compromised
    • -Can be life-threatening

    •Diagnosis: urine test for Legionella antigens
  29. Pneumocystic Carinii Pneumonia
    • •Caused by yeastlike fungus, Pneumocystosis jiroveci
    • -Opportunistic infection
    • -Can be life-threatening

    •Diagnosis: sputum culture
  30. Pneumonia
    •Complications: septicemia, pulmonary edema, lung abscess, and acute respiratory distress syndrome

    •Manifestations: productive or non-productive cough, fatigue, pleuritic pain, dyspnea, fever, chills, crackles or rales, pleural rub, tachypnea, and mental status changes (especially in the elderly)
  31. Pneumonia
    • •Diagnosis: history,physical examination, chest X-ray, sputum cultures, complete blood count,
    • arterial blood gases, and bronchoscopy

    • •Treatment: intubation with ventilator support, oxygen therapy, antibiotics (if bacterial),
    • bronchodilators, corticosteroids, antipyretics, analgesics, chest physiotherapy, increased fluids, rest, and swallowing studies (if aspiration)

    • •Prevention: hand washing,avoiding crowds, vaccinations, turning, coughing, deep breathing), and smoking
    • cessation
  32. Tuberculosis
    •Caused by the bacillus, Mycobacterium tuberculosis

    •Fairly controlled until recently

    •Resistant strains have developed in those immune compromised

    •Most frequently occurs in the lungs, but can spread to other organs

    Carried by airborne droplets
  33. Tuberculosis
    • •Primary infection
    • -When bacillus first enters the body
    • -Macrophages engulf the microbe causing a local inflammatory response
    • -Some bacilli travel to the lymph nodes, activating the type IV hypersensitivity reaction
    • -Granuloma and tubercle forms
    • -Caseous necrosis and Ghon complexes develops
    • -Bacilli can remain dormant for years
    • -Usually asymptomatic
    • -Will test positive now
  34. Tuberculosis
    • •Secondary infection
    • -Reactivation of dormant bacilli
    • -Can spread to other organs
    • -Symptoms usually develop

    • •Manifestations: productive cough, hemoptysis,night sweats, fever, chills, fatigue, unexplained weight loss, anorexia, and
    • symptoms depending other organ involvement
  35. Tuberculosis
    •Diagnosis: skin test (Mantoux), Chest X-ray, computerized tomography , and sputum culture

    •Treatment: antimicrobial combination therapy for at least 6 months

    •Prevention: vaccination, respiratory precautions, adequate ventilation, and appropriate isolation
  36. Severe Acute Respiratory Syndrome (SARS)
    •The incubation period = 2–7 days

    •First stage includes flulike syndrome that lasts 3–7 days

    • •Second stage includes a dry cough, dyspnea,
    • congestion, hypoxia, and liver damage

    • •Third stage includes severe
    • and sometimes fatal respiratory distress
  37. Severe Acute Respiratory Syndrome (SARS)
    •Diagnosis: history,physical examination, and chest X-ray

    •Treatment: oxygen therapy,bronchodilators, antiviral drugs, and endotracheal intubation with mechanical ventilation
  38. Asthma
    •Chronic disorder that results in intermittent, reversible airway obstruction

    •Characterized by acute airway inflammation, bronchoconstriction, bronchospasm, bronchiole edema, and mucus production

    • •A variety of triggers from infections to smoke
    • Extremely common
  39. Types of Asthma
    • •Extrinsic asthma
    • -Increased IgE synthesis and airway inflammation, resulting in mast cell destruction and inflammatory mediator release

    -Mediator release cause bronchoconstriction, increased capillary permeability, and mucus production

    -Generally presents in childhood or adolescence

    -Triggers: allergens such as food, pollen, dust, and medications
  40. Types of Asthma
    • •Intrinsic asthma
    • -Not an allergic reaction
    • -Usually presents after age 35 years

    •Triggers: upper respiratory infections, air pollution, emotional stress, smoke, exercise, and cold exposure
  41. Types of Asthma
    • •Nocturnal asthma
    • -Usually occurs between 3:00 and 7:00 a.m.

    •May be related to circadian rhythms – at night, cortisol and epinephrine levels decrease, while histamine levels increase, leading to bronchoconstriction
  42. Types of Asthma
    • •Exercise-induced asthma
    • -Usually occurs 10–15 minutes after activity

    •Symptoms can linger for an hour

    •May be a compensatory mechanism to warm and moisten the airways

    •Followed by a refractory period begins within 30 minutes and can last 90 minutes
  43. Types of Asthma
    • •Occupational asthma
    • -Caused by a reaction to substances at work

    •Symptoms develop over time, worsening with each exposure and improving when away from work
  44. Types of Asthma
    • •Drug-induced asthma
    • -Frequently caused by aspirin –prevents the conversion of prostaglandins, which stimulate leukotriene
    • release, a powerful bronchoconstrictor
    • •Can be fatal
    • -Reactions can be delayed up to 12 hours after drug ingestion
  45. Stages of an Asthma Attack
    • •Stage one
    • -Related to bronchospasms, and it is usually signaled by coughing

    •Peaking within 15 to 30 minutes,inflammatory mediators responsible include leukotrienes, histamine, and some interleukins
  46. Stages of an Asthma Attack
    • •Stage two
    • -Peaks within 6 hours of symptom onset
    • -Result of airway edema and mucus production
    • -The alveolar hyperinflation causes air trapping
    • -Bronchospasm,smooth muscle contraction, inflammation, and mucus production combine to narrow the airways
  47. Asthma (Manifestations/Asthma)
    •Manifestations: wheezing, shortness of breath, dyspnea, chest tightness, cough, tachypnea, and anxiety

    • •Status Asthmaticus
    • -Life-threatening, prolonged asthma attack that does not respond to usual treatment

    •Can lead to respiratory alkalosis and respiratory failure quickly
  48. Asthma (Diagnosis &Treatment)
    •Diagnosis: history,physical examination, pulmonary function tests, arterial blood gases, complete blood counts, challenge testing, and allergen testing

    •Treatment: corticosteroids,bronchodilators, beta agonists, nebulizer treatments, leukotriene mediators, mast cell stabilizers, anticholinergics, develop an asthma plan, avoid triggers,keep environment clean, limit environmental fabrics, filter indoor air, and maintain a healthy immune system
  49. Chronic Obstructive Pulmonary Disease (COPD)
    •Debilitating chronic disorders characterized by irreversible, progressive tissue degeneration and airway obstruction

    •Severe hypoxia and hypercapniacan lead to respiratory failure

    •Oxygen begins to drive breathing

    •Can also lead to cor pulmonale

    •Causes: smoking, pollution,chemical irritants, and genetic mutation
  50. Chronic Obstructive Pulmonary Disease
    •Often asymptomatic early or masked by smoking

    •Two main conditions: chronic bronchitis and emphysema
  51. Chronic Bronchitis
    • •“Blue bloaters”
    • -Characterized by inflammation of the bronchi, a productive cough, and excessive mucus production

    •Complications: frequent respiratory infections and respiratory failure
  52. Chronic Bronchitis (Mnifestations/Diagnosis)
    • •Manifestations: hypoventilation, hypoxemia, cyanosis, hypercapnia, polycythemia, clubbing of fingers, dyspnea at
    • rest, wheezing, edema, weight gain, malaise, chest pain, and fever

    •Diagnosis: history (persistent, productive cough for at least 3 months in a year for 2 consecutive years), physical examination, chest X-ray, pulmonary function tests, arterial blood gases, and complete blood counts
  53. Chronic Bronchitis (Treatment)
    •Treatment: oxygen therapy (in limited amounts), bronchodilators, corticosteroids, antibiotics (if bacterial infection is present), postural drainage, chest physiotherapy, and increased hydration
  54. Emphysema
    • •“Pink puffers”
    • -Destruction of the alveolarwalls leads to large, permanently inflated alveoli
    • -Enzyme necessary for lung remodeling is deficient
    • -Loss of elastic recoil and hyperinflation of the alveoli, leading to air trapping

    •Causes: genetic predisposition and smoking
  55. Emphysema (Manifestations/Diagnosisi)
    •Manifestations: dyspnea upon exertion, diminished breath sounds, wheezing, chest tightness, tachypnea, hypoxia, hypercapnia, activity intolerance, anorexia, and malaise

    •Diagnosis: same as chronic bronchitis

    •Treatment: same as chronic bronchitis with addition of pursed-lip breathing
  56. Cystic Fibrosis
    • •Life-threatening condition resulting in severe lung damage and nutrition deficits
    • -Affects cells that produce mucus, sweat, saliva, and digestive secretions
    • -Secretions become thick and tenacious

    • •Caused by mutation on seventh chromosome, leading to abnormality in protein involved in chloride
    • cellular transport
    • -Autosomal recessive
  57. Cystic Fibrosis (Complications/Manifestations)
    •Complications: atelectasis, recurrent infections, cor pulmonale, respiratory failure, malabsorption, malnutrition, electrolyte imbalances, sterility, and infertility

    • •Manifestations: meconium ileus,salty skin, steatorrhea,
    • fat soluble vitamin deficiency, chronic cough, hypoxia, fatigue, activity intolerance, audible rhonchi, and delayed growth and development
  58. Cystic Fibrosis (Diagnosos/Treatment)
    •Diagnosis: sweat and stool analysis, chest X-rays, pulmonary function tests, and arterial blood gases

    • •Treatment
    • -Replace pancreatic enzyme, bile salt, and fat soluble
    • vitamin
    • -High-protein and low-fat diet
    • -Increased fluid intake
    • -Intensive chest physiotherapy
  59. Cystic Fibrosis (Treatment cont)
    • -Postural drainage
    • -Coughing exercises
    • -Humidified air
    • -Bronchodilators
    • -Regular, moderate exercise
    • -Early, aggressive treatment of infections with antibiotics
    • -Oxygen therapy
    • -Heart-lung transplant
  60. Lung Cancer
    •Third most common cancer

    • •May occur as a primary or secondary tumor
    • -Deadliest of the cancer in men and women

    •Smoking is the most significant risk factor, either first-hand or second-hand
  61. Types of Lung Cancer
    • •Small cell carcinoma
    • -AKA oat cell carcinoma
    • -Occurs almost exclusively in heavy smokers
    • -Less frequent

    • •Non–small cell carcinoma
    • -AKA bronchogenic carcinoma
    • -Most common type of malignant lung cancer
    • -Very aggressive lung cancer

    • •Several subgroups—squamous cell
    • carcinoma, adenocarcinoma, and bronchioalveolar carcinoma
  62. Lung Cancer (Complications/Manifestations)
    • •Complications: airway obstruction, lung tissue inflammation, fluid accumulation, and paraneoplastic
    • syndrome

    • •Manifestations: persistent cough or a change in usual cough, dyspnea, hemoptysis, frequent respiratory infections, chest
    • pain, hoarseness, weight loss, anemia, fatigue, and other symptoms specific to site of metastasis
  63. Lung Cancer
    •Diagnosis: history, physical examination, chest X-ray, computed tomography, magnetic resonance imaging, bronchoscopy,sputum studies, biopsy, positron emission tomography, bone scans, and pulmonary function tests

    • •Treatment:
    • -Usually palliative
    • -Includes: chemotherapy,radiation, and surgery
  64. Atelectasis
    •Collapse of the alveoli

    • •Causes: surfactant deficiencies, bronchus obstruction, lung tissue compression, increased surface tension, and lung fibrosis
    • -Ventilation and perfusion problem

    • •Manifestations: diminished breath sounds, dyspnea, tachypnea, asymmetrical lung movement, anxiety,
    • restlessness, tracheal deviation, and tachycardia
  65. Atelectasis (Diagnosis)
    •Diagnosis: history, physical examination, chest X-ray, CT, bronchoscopy, arterial blood gases, and complete blood counts
  66. Atelectasis (Treatment)
    • •Treatment:
    • -Treat underlying causes and reinflate the alveoli

    • •Include: antibiotics, incentive spirometry,
    • continuous positive airway pressure, endotracheal
    • intubation with ventilation support

    •Prevention: increasing mobility, coughing, and deep breathing, effective pain management, and postoperative incisional splinting
  67. Pleural Effusion
    •Excess fluid in the pleural cavity

    • •Fluid may include exudates,transudate,blood, and pus
    • -Can impair breathing

    •May also see pleurisy –inflammation of the pleural membranes

    • Manifestations: dyspnea,chest pain, tachypnea,
    • tracheal deviation, absent lung sounds and dullness over affected area, tachycardia, and pleural friction rub
  68. Pleural Effusion (Diagnosis/Treatment)
    • •Diagnosis: history, physical examination, chest X-ray,
    • computed tomography, arterial blood gases, complete blood gases, and thoracentesis

    •Treatment: thoracentesis, chest drainage tube, and antibiotics
  69. Pneumothoarax
    • •Air in the pleural cavity
    • -Can cause lung to collapse

    •Risk factors: smoking, tall stature, and history of lung disease or previous pneumothorax
  70. Types of Pneumothoarax
    • •Spontaneous pneumothorax
    • -Air enters from an opening in the internal airways

    • •Primary spontaneous pneumothorax
    • -Occurs when a small air blister (bleb) on the top of the lung ruptures
    • -Blebs are caused by a weakness in the lung tissue
    • -Usually mild

    • •Secondary spontaneous pneumothorax
    • -Develops in people with preexisting lung disease
    • -Can be more severe and life threatening
  71. Types of Pneumothoarax
    • •Traumatic pneumothorax
    • -Result of any blunt or penetrating injury to the chest

    • •Tension pneumothorax
    • -Most serious type
    • -Occurs when the pressure in the
    • pleural space is greater than the atmospheric pressure due to trapped air in the pleural space or entering air from a positive-pressure mechanical ventilator
    • -Can cause the affected lung to collapse completely and shift the heart
  72. Pneumothoarax (Manifestations/Diagnosis)
    • •Manifestations: sudden chest pain, chest tightness, dyspnea, tachypnea, decreased breath sounds over the affected
    • area, asymmetrical chest movement, trachea and mediastinum deviation, anxiety, tachycardia, pallor, and
    • hypotension

    •Diagnosis: history, physical examination, chest X-ray, computed tomography, and arterial blood gases
  73. Pneumothoarax (Treatment)
    • •Treatment:
    • -Removal of the air and reestablishing negative pressure
    • -Includes: thoracentesis and chest drainage tube
  74. Acute Respiratory Distress Syndrome
    •Rapidly developing respiratory failure

    •Results from fluid accumulation in the alveoli due to a systemic or pulmonary event that is not cardiac in origin

    • •Causes: shock, burns, aspiration, and smoke
    • inhalation acute hypoxemia
  75. Acute Respiratory Distress Syndrome
    • •Complications: respiratory and metabolic
    • acidosis, pulmonary fibrosis, pneumothorax, bacterial infections, decreased lung function, muscle wasting, memory, cognitive, and emotional issues, and death

    •Manifestations: dyspnea, labored and shallow respirations, rales, productive cough with frothy sputum, hypoxia, cyanosis, fever, hypotension, tachycardia, restlessness, confusion, lethargy, and anxiety
  76. Acute Respiratory Distress Syndrome(Diagnosis/Treatment)
    •Diagnosis: history, physical examination, arterial blood gases, chest X-ray, computed tomography, and complete blood counts

    •Treatment: endotracheal intubation with mechanical ventilator, oxygen therapy, corticosteroids, and antibiotics (if bacterial infections are present), and emboli precautions
  77. Acute Respiratory Failure
    • •Life-threatening inability of the lungs to maintain adequate oxygenation
    • -Result of many respiratory conditions

    •Complications: heart failure and death

    •Manifestations: shallow respirations, headache, tachycardia, dysrhythmias, lethargy, and confusion
  78. Acute Respiratory Failure(Diagnosis/Treatment)
    • •Diagnosis: history, physical examination,
    • arterial blood gases, chest X-ray, and complete blood counts

    • •Treatment: oxygen therapy, endotracheal
    • intubation with ventilation support, bronchodilators, antibiotics (if bacterial infection is present), corticosteroids, emboli precautions, and cardiac support