Patho/Pharm II - Respiratory
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Subjective sensation of breathlessness
Increased respiratory rate
Dyspnea while lying flat
- Paroxysmal "attack or spasm"
- Nocturnal "PM"
- Dyspnea "SOB"
- = Wake up at night with dyspnea
the cessation of breathing
Abnormal Breathing patterns
- 1. Kussmaul Respirations
- 2. Obstructed Breathing
- 3. Restrictive Breathing
- 4. Cheyne-Stokes Respirations
- 5. Hypoventilation
- 6. Hyperventilation
Slightly increased ventilatory rate, very large effortlest Vt
Slow ventilatory rate, large Vt, increased effort
Caused by disorders that stiffen the lungs
Alternating patterns of deep and shallow breathing and apnea
Inadequate alveolar ventilation in relation to metabolic demands
- **Increased Co2, metabolic acidosis
Alveolar ventilation that exceeds metabolic demands.
- ** decreased CO2, metabolic alkalosis
What does the effectiveness depend on?
- An explosive expiration that cleanses the lower airways
- The effectiveness depends on the depth of the inspiration and the degree to which the airways narrow which increases the velocity of expiratory gas.
Abnormal Sputum could be signs of...
Infection, inflammation, or cancer.
Coughing up of bright red blood.
Bluish discoloration of the skin caused by decreased oxygenation of blood. Usually a late symptom.
- The painless, selective enlargement of distal segement of the digits (ie fingertips)
- Caused by chronic disease of the heart or lungs.
What is the most common type of pain caused by pulmonary disorders?
*Infection and inflammation cause pleura to stretch during inspiration causing pain
Pain in the chest wall is usually due to ____ _____.
- Inadequate oxygenation of blood caused by
List the 5 causes of hypoxemia
- 1. Decreased oxygen inspiration - suffocation, high altitude
- 2. Hypoventilation- decreased LOC
- 3. Diffusion abnormalities- edema, fibrosis, emphysema
- 4. Abnormal ventialtion/perfusion rates- Most common asthma, bronchitis, pneumonia
- 5. Pulmonary right to left shunts- ARDS, atelectasis
- Increased carbon dioxide
- leads to respiratory acidosis pH<7.35
- accumulation of fluid in the lungs
- **Classic symptom= pink, frothy sputum
Passage of solid particles into the lung.
-Right lung is more susceptible.
- Collapse of the lung.
- O2<50 , CO2>45
dilation and loss of elasticity of the walls of bronchi from chronic inflammation and degeneration
- An inflammatory obstruction of the small airways or bronchioles.
- Common in children. Treated with antibiotics and steroids.
Abscess Formation and Cavitation
- Lung Abscess: pus-filled cavity in the lung surrounded by inflammed tissue and caused by an infection.
- Usually abscesses rupture into an airway, producing a lot of sputum that gets coughed up. A ruptured abscess leaves a cavity in the lung that is filled with fluid and air.
- Staph or Klebsiella common causes of infection.
Chest Wall Restriction
Work of breathing is increased and ventilation is compromised if the chest wall is deformed, immobilized, or made heavy by fat.
Multiple rib fractures cause the ribs to be unstable leading to paradoxical movement on inspirationa and expiration.
paradoxical movement= part of chest goes out while other goes in.
List 3 commonly encountered toxic gases...
- 1. smoke
- 2. ammonia
- 3. hydrogen chloride
- Presence of air in the pleural space.Makes it difficult for lungs to expand properly
Allows air to enter and exit the pleural space through penetration of the chest wall.
- Air enters and exits the pleural space without penetration of the chest wall.
- 1. Spontaneous: emphysema, pneumonia
- 2. Traumatic: fractured rib
- 3. Iatrogenic: accidently induced by a physician/medical procedure-- chest Sx, mechanical ventilation
- Air leaks into the pleural space, but cannot escape.
- Causes the affected lung to collapse ->mediastinal shift-> unaffected lung collapse-> severe respiratory and CV distress and death.
Presence of blood in the pleural space.
Presence of fluid in the pleural space.
usually a secondary problem
- Presence of infected fluid in pleural space.
- - uncommon but serious disorder occurs mostly in debilitated pt
- Inflammation of the pleura.
- characterized by sudden onset, painful and difficult respiration, and exudation of fluid or fibrinous material into the pleural cavity—called also pleuritis
Interstitial Lung Disorders
1. aka ___ or ____
2. produce varying amounts of..... ___, ___, ___
3. cause lungs to become... ___ & ___
- 1. fibrotic or restrictive
- 2. inflammation, fibroids (scars), and disability
- 3. stiff and non-compliant
What are the two types of Occupational Lung Disorders
- 1. Pneumoconiosis - inhalation of inorganic materials like asbestosis, coal, talocosis, silicosis
- 2. Hypersensitivity- inhalation of organic dusts
- - Farmer's Lung: moldy hay
- - Pigeon breeder's lung: birds
3 patterns of lung dysfunction that the interstitial lung disorders share..
- 1. diminished lung volume
- 2. reduced diffusing capacity
- 3. varying degrees of hypoxemia
Treatment of interstitial lung disorders include....
- 1. Identifying and removing the injurious agent
- 2. Suppress the inflammatory response
- 3. Preventing progression
- 4. Providing supportive Tx for pt with advance disease
- Excessive amount of fibrous or connective tissue in the lung.
- (Excessive Scar tissue in the lung)
- Tiny grain-like bumps form (granulomas), clump together to form larger lumps that can attack other organs.
- T-lymphocyte alteration is thought to contribute.
NOT IN BLUEPRINT
- Acute Respiratory Failure = inadequate gas exchange
- - Signs = increased respiratory rate, use of accessory muscles, flushed face, Dyspnea, late sign is cyanosis, hypotension
- - ABGs= pH<7.30 , pO2<50, pCO2>50
Acute Respiratory Distress Syndrome = a form of pulmonary insufficiency that develops in the aftermath of a shock or shock-like state. Life-threatening.
increase in permeability of lungs leading to lungs that are wet, heavy, congested, hemorrhagic and stiff.
Clinical symptoms of ARDS
- Early symptoms mistaken as Stress!
- -Change in LOC, Dyspnea, Hypotension- late
- -Tachycardia, Tachypnea
- As syndrome progresses so will symptoms- labored breathing, cyanosis, grunting resp.
Treatment of ARDS
- ◦Treat the Hypoxia
- ◦Monitoring Parameters
- ◦Drug Therapy
- ◦Fluid Management
- ◦Psychosocial Support
Of all the Precipitating Factors for ARDS which are the highest correlators?
- ◦Multiple blood transfusions
- ◦Bone Fx
- ◦Prolonged hypotension
- ◦Pulmonary Contusion
What is the best treatment for ARDS?
- PREVENTION of atelectasis
- TCDB, early amb., etc.
What are some ways you can prevent atelectasis?
- -T C DB
- -Early Ambulation
- -Changes in position
- -Elevate HOB
What three lung diseases are grouped as COPD and what is COPD characterized by?
- Chronic Obstructive Pulmonary Disease
- 1. Emphysema
- 2. Bronchitis
- 3. Asthma - more acute but can be chronic
Primary cause of COPD
- a condition characterized by air-filled expansions in interstitial or subcutaneous tissues
- Tx= thin secretions, oxygen and bronchodialators
- Hypersecretion of mucous and chronic productive cough. - Usually leads to emphysema
- abnormal respoviveness of the air passages to a certain substance.
- there are widespread narrowing of smaller airways in attacks that end spontaneously or with treatment.
- ** there is a genetic tendency to developing asthma
- =cessation of air flow during sleep for a period of 10 seconds or longer.
- (occurs 30 or more times over 7 hours of sleep)
- -caused by obstruction of upper airway
- -common in obesity, middle aged men
- - "Pickwickian syndrome": named after charles dickens book
- cessation of respiratory drive so there is no movement of chest or abdomen
- causes= encephalitis, brain stem infarction, polio
mixture of central and obstructive apnea
- = dysfunction of endocrine system to produce abnormally thick secretions of mucous
- -Glands most effected = resp, pancreatic, sweat
- - Can Dx prenatally through sweat test
an acute, inflammatory infection of the lungs caused by bacteria, virus, fungi, protozoa or parasites
Who is at risk of developing pneumonia?
elderly, immunocompromised, alcoholics, smokers, decreased LOC, malnurished, immobilized, people with preexisting lung diseases
What are the routes organisms use to enter the lungs?
- 1. Aspiration - infected sneeze, cough, talk = airborn droplets
- 2. Contaminated respiratory equipment
- 3. Bacteria in blood spread to lungs
What is the most common type of bacterial pneumonia?
- Streptococcus pneumonia
- accounts for 90% of all bacterial pneumonias
- vaccine available
What is the most common type of viral pneumonia?
- Viral pneumonia influenza (Type A)predisposes the patient to bacterial pneumonia
Which type of pneumonia are school age children most likely to acquire?
Which type of fatal pneumonia are AIDS patient most likely to develop?
Pneumocystis Carcinii Pneumonia (PCP)
- = a serious type of bacterial pneumonia
- •Widely found in H2O. Discovered in 1976.
- •Highest risk: chronic disease or impaired immune system
- •Prognosis= 20-30% mortality rate in previously healthy individuals. Can be as high as 80% in immunosuppresed individuals
Tuberculosis= A chronic infectious pulm./exo pulm disease that affects the lungs and can invade other body systems like kidneys, bones and lymph nodes
How is active TB diagnosed?
positive skin test (may also be positive with dormant TB), a sputum culture and a chest x-ray
How might dormant TB become reactivated?
- immune impaired through...
- 1. poor nutrition
- 2. diabetes
- 3. steroid use
- 4. chemotherapy
How is TB transmitted?
Treatment for TB
- • Isolation precautions for active TB = private, negative pressure rooms
- •Antibiotic therapy to control active or dormant bacteria and prevent transmission. Drugs depend on the
- individual, bacteria and the presence of the active disease.
- •In the past a combination of 2 drugs has been sufficient today combinations of 4
- drugs may be used: INH, Rifampin, Pyrazinamide and either Streptomycin or Ethambutal.
Clincal manifestations of TB include:
- - fatigue, lethargy
- - weight loss, anorexia
- - low grade fever in afternoon
- - night sweats
= Obstruction of pulmonary artery by a thrombus (DVT) that becomes dislodged and carried to lung
Predisposing factors for developing PE
- 1. venostasis-prolonged bedrest
- 2. venous injury -surgery or fracture
- 3. increased blood coaguability
- 4. Disease- CHF, lung, MI
BEST treatment of PE?
and other ways to treat
- BEST TREATMENT = PREVENTION -- TCDB, EARLY AMB., ETC
- - analgesic, bronchodilator, antibiotic, oxygen, sedative, bedrest
What is Virchow's triad
3 factors leading to thrombosis - stasis, hypercoaguability, intimal changes (injury or change in vessel)
What are the risk factors of developing lung cancer?
- -Smoking = LEAD
- - evvironmental and occupational hazards
- - family history
- - reccurring pulm. inflam
- - vitamin A deficiency
Squamous Cell Carcinoma
"Oat Cell carcinoma"
-Strongest correalation to smoking
-Grows rapidly, early and widely
Small cell carcinoma
NSCLC accts for 30-35%
- arises from glands
- weakest correalation to smoking
- slow and unpredictable
NSCLC accts for 10-15%
-Grow to distort trachea and cause carina to widen
-surgical treatment is limited
Large Cell Carcinoma
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