Ch. 5 Respiratory Function Flashcards
(206 cards)
0
Q
why is it common to develop a secondary bacterial infection with infectious rhinitis?
A
because the infectious organism invades the epithelial nasal mucosa. mild cellular inflammation leads to nasal discharge, mucus production, and the shedding of epithelial cells. this causes a break in the body’s first line of defense and so a secondary infection is more likely to occur
1
Q
viral upper respiratory infection most often caused by the rhinovirus. also known as the common cold.
A
infectious rhinitis
2
Q
why is the risk for secondary bacterial infections with infectious rhinitis further increased in people who smoke?
A
because there is chronic damage done by smoke to the mucosa and cilia
3
Q
how is infectious rhinitis transmitted?
A
close physical contact with the virus transmits the infection through exchanges with other humans and surfaces. Transmission may occur through both inhalation and contact
4
Q
does rainy and cold weather cause a person to get infectious rhinitis?
A
it doesn’t cause them to get the virus because of the weather, but when the weather is like this, there is increased congregation in confined spaces
5
Q
why is the infectious rhinitis virus so contagious?
A
because it is shed in large numbers from the nasal mucosa, and the virus can survive for several hours outside of the body
6
Q
how long is the incubation period for infectious rhinitis?
A
usually 2-3 days, but can be as long as 7
7
Q
what are the clinical manifestations of infectious rhinitis?
A
sneezing, nasal congestion or stuffiness, clear nasal discharge, sore throat, lacrimation, nonproductive cough, malaise, myalgia, low-grade fever, hoarseness, headache, chills
8
Q
an inflammation of the sinus cavities most often caused by a viral infection
A
sinusitis
9
Q
what things can cause sinusitis?
A
most often caused by a viral infection, but may also be caused by a bacterial infection
10
Q
what things can influence your risk of developing sinusitis?
A
environmental irritants, being immunocompromised, conditions that increase mucus production, and nasal structure abnormalities
11
Q
how can sinusitis develop as a secondary infection to infectious rhinitis or allergic rhinitis?
A
drainage from the sinus cavity has become blocked and this drainage accumulation provides a supportive medium for bacterial growth
12
Q
what two bacterias are commonly found in the upper respiratory tracts of healthy people?
A
Streptococcus pneumoniae and Haemophilus influenzae
13
Q
what are the different types of sinusitis and what are their time frames?
A
acute - up to 4 weeks
subacute - 4-12 weeks
chronic - 12+ weeks and can continue for several months or even years
recurrent - several attacks occur within a year
14
Q
why can facial bone pain accompany sinusitis?
A
as exudate accumulates, pressure builds in the sinus cavity which causes the pain and headache.
15
Q
what can the location of the pain in sinusitis indicate?
A
which sinus is affected
16
Q
what are the clinical manifestations of sinusitis?
A
facial bone pain, headache, nasal congestion, purulent nasal drainage, discharge, halitosis, mouth breathing, fever, sore throat, and malaise.
all but bone pain and headache may already be present when the infection develops
17
Q
what are complications that may develop with sinusitis?
A
orbital cellulitis, meningitis, osteomyelitis, and abscesses
18
Q
life-threatening condition of the epiglottis.
A
epiglottitis
19
Q
what are causes for epiglottitis?
A
Haemophilus influenza type B (Hib), Group A beta-hemolytic Streptococcus, Streptococcus pneumonia, Staphylococcus aureus, throat trauma from events such as drinking hot liquids, swallowing a foreign object, a direct blow to the throat, or smoking crack or heroine.
20
Q
what occurs during epiglottitis?
A
the inflammatory response is triggered, causing the epiglottis to quickly swell and block the air entering the trachea leading to respiratory failure. bacteria can also invade the blood stream leading to sepsis
21
Q
who is epiglottitis seen in more often?
A
more often seen in children 2-6 years, but with increasing rates of vaccinations, the trend may change
22
Q
what are the clinical manifestations of epiglottitis?
A
high fever, chills and shaking, sore throat and hoarseness, dysphagia, drooling with the mouth open, mild inspiratory stridor, respiratory distress, central cyanosis, anxiety irritability or restlessness, pallor, assuming a tripod position, often leaning slightly foreward
23
Q
central cyanosis
A
blue discoloration of the mouth and lips
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mild inspiratory stridor
a harsh, high-pitched sound made as a result of air turbulence
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what is a priority if epiglottitis is suspected?
maintaining the airway and stabilizing respiratory status
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an inflammation of the larynx that is usually a result of an infection, increased upper respiratory exudate, irritants, or over use
laryngitis
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what is the most common cause of laryngitis?
viral infections
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what occurs during laryngitis?
the vocal cords become irritated and edematous because of the inflammatory process. this inflammation distorts sounds, leading to hoarseness and in some cases making the voice undetectable. occasionally the airways can become blocked
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what two diseases can laryngitis be associated with?
croup and epiglottitis
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what are the clinical manifestations of layrngitis?
hoarseness, weak voice or voice loss, tickling sensation and raw feeling in the throat, sore dry throat, dry cough, swollen nodes of the neck, leukocytosis (if bacterial), difficulty breathing in children
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how long do the manifestations of laryngitis usually last?
less than a week
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common viral infection in which outbreaks and epidemics occur in autumn to early winter, but cases can occur sporadically year round
laryngotracheobronchitis or croup
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who does croup most often affect?
children 3 months - 3 years of age
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what are common causes of croup?
parainfluenza viruses, adenoviruses, and respiratory syncytial virus. can also be caused by bacterial infections, allergens, and irritants
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what occurs with croup?
usually begins as an upper respiratory infection with nasal congestion and cough. The larynx and surrounding area swell, leading to airway narrowing and obstruction. this can also lead to respiratory failure. clinical manifestations worsen at night and can eventually lead to respiratory failure
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clinical manifestations of croup
low-grade fever, nasal congestion, seal-like barking cough, hoarsenss, inspiratory stridor, mild expiratory wheezing, dyspnea, anxiety, cyanosis
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inflammation of the tracheobronchial tree or large bronchi
acute bronchitis
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what is acute bronchitis most commonly caused by?
a wide range of viruses, bacterial invasion, irritant inhalation, allergic reactions
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who have the highest risk for developing acute bronchitis?
young children, the elderly, smokers
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what occurs during acute bronchitis?
the airways become irritated and narrowed due to the results of the inflammatory process
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what are the clinical manifestations of acute bronchitis?
productive or nonproductive cough, dyspnea, wheezing, abnormal lung sounds, low-grade fever, pharyngitis, malaise, myalgia, chest discomfort
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how long do the clinical manifestations of acute bronchitis usually last?
usually last 7-10 days and are mild, but coughing may linger for several weeks after the infection is resolved
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what is epiglottitis often misdiagnosed as? what is the distinct difference between the two?
it is often misdiagnosed as croup, but a distinct difference in manifestations can help you distinguish between the two. with epiglottitis the patients look worse than the sound and with croup they sound worse than they look due to the seal-like barking cough. additionally cough is not usually seen with epiglottits
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viral infection that may infect the upper and lower respiratory tract
influenza
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most common type of influenza virus which is usually responsible for the most serious epidemics and global pandemics. found in humans and many animals
type a influenza
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type of flu in which outbreaks can also cause regional epidemics, but the disease is generally milder. found in humans primarily
type b
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type of influenza that causes sporadic cases and minor, local outbreaks. has never been connected with a large epidemic. found in humans, pigs, and dogs
type c
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when is the flu season in the US? how is the flu spread? who are most likely to be infected with the flu?
November-March. transmitted through the inhalation or contact with respiratory droplets. children are two to three times more likely to contract the virus than adults and they frequently spread the virus to others
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who are persons at greater risk for negative outcomes with the flu?
children, elderly, immunocompromised, pregnant women, and individuals with preexisting chronic diseases
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what are deaths associated with the flu often the result of?
secondary bacterial pnuemonia
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what is the incubation period of the flu? peak transmission risk? what about for children and immunocompromised patients?
incubation period is 1-4 days
peak transmission risk starts at approximately 1 day before the onset of the symptoms and lasts 4-7days afterward in adults
children can spread the virus for more than 10 days and be infectious for 6 days before the onset of symptoms
severely immunocompromised patients can spread the virus for weeks or months
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how does the flu differ from the common cold?
the flu usually has sudden onset of symptoms
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what are the clinical manifestations of the flu
fever, headache, chills, dry cough, body aches, nasal congestion, sore throat, sweating, malaise, vomiting and diarrhea
typically fever and body aches last 3-5 days while cough and fatigue may last for 2+ weeks
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common viral infection of the bronchioles which is most frequently caused by the respiratory syncytial virus (RSV). most often occurs in children less than 1 year of age and incidence increases in the fall and winter months
bronchiolitis
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what are some lower respiratory tract infections?
bronchiolitis, pneumonia, tuberculosis,
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what are some causes for bronchiolitis?
RSV, parainfluenza, influenza, adenoviruses, and metapneumoviruses
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is bronchiolitis common in children?
yes, nearly all children will have an RSV infection by the time they are 2 years old
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what happens during bronchiolitis?
when the virus infects the bronchioles, these small airways become inflamed and swollen. As a result of the inflammatory process, mucus collects in these airways. The combination of edema and mucus prevents air flow into the alveoli
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how is RSV transmitted?
through contact with or inhalation of infected respiratory droplets
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what are factors that contribute to the development of bronchiolitis?
neonatal prematurity, asthma, family history, and cigarette smoke exposure
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what are the clinical manifestations of bronchiolitis?
nasal drainage, nasal congestion, cough, wheezing, abnormal lung sounds (ronchi or rales), rapid shallow respirations, labored breathing, dyspnea or tachypnea, fever, tachycardia, malaise
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inflammatory process caused by numerous infectious agents and injurious agents or events
pneumonia
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what is the most common cause of pneumonia? how common is it?
streptococcus pneumoniae is responsible for 75% of all cases of pneumonia
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what are the most common viral causes of pneumonia?
influenza, parainfluenza, and RSV
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which type of pneumonia is more mild, viral or bacterial?
viral pneumonia is more mild, but without intervention it can lead to bacterial pneumonia
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what are some irritating agents or events that can lead to pneumonia?
aspiration of gastric contents, endotracheal intubation, respiratory suctioning, and inhalation of smoke or chemicals
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when does aspiration pneumonia frequently occur?
when the gag reflex is impaired because of a brain injury or anesthesia
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how can aspiration lead to pneumonia?
gastric contents and tube feeding formulas irritate lung tissue and trigger the inflammatory response which increases mucus production, which can in turn lead to atelectasis and penumonia. tube-feeding formulas also contain sugar and protein in which bacteria grow.
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why does the stasis of pulmonary secretions lead to pneumonia?
when the cilia cannot remove the bacteria laden mucus, the bacteria flourish in the lungs and cause pneumonia
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what activities can keep mucus in the lungs moving?
activities such as movement, talking, and coughing keep secretions moving and adequate hydrations keep secretions thin, decreasing the chance of getting pneumonia
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what is pneumonia classified based on?
the causative agents, location in the lung, or where it was acquired
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pneumonia that is confined to a single lobe and is described based on the affected lobe
lobar pneumonia
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what are the types of pneumonias classified based upon the causative agent?
viral pneumonia, bacterial pneumonia, aspiration pneumonia, pneumonia caused by stationary pulmonary secretions
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what are the types of pneumonia that are classified based on location in the lung?
lobar pneumonia, bronchopneumonia, interstitial pneumonia
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the most frequent type of pneumonia and is patchy pneumonia spread through several lobes
broncopneumonia
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atypical pneumonia. occur in the areas between the alveoli and is routinely caused by viruses or uncommon bacteria
interstitial pneumonia
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what is the difference between viral and bacterial pneumonia with regards to the cough?
viral cough is nonproductive while bacterial is productive
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what is the difference between viral and bacterial pneumonia's fever?
viral pneumonia is a low grade fever while bacterial has a higher fever
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what is the difference between viral and bacterial pneumonia's white blood cell count?
viral is normal/low while bacterial is elevated
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what is the difference between viral and bacterial pneumonia's x-ray scan?
viral pneumonia shows minimal change while bacterial shows infiltrates
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what is the difference between viral and bacterial pneumonia in severity?
viral is less severe while bacterial is more severe
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what are the two types of pneumonia classified on where it was acquired?
nosocomial pneumonia and communit-acquired pneumonia
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pneumonia that develops 48 hours after a hospital admission
nosocomial pneumonia
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pneumonia that is acquired outside the hospital or healthcare setting
community-acquired pneumonia
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what people are at risk for developing pneumonia and having serious complications?
children, the elderly, immunocompromised individuals, those with existing chronic disease conditions, smokers, and alcoholics
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what are complications that can occur in high risk patients with pneumonia?
sepitcemia, pulmonary edema, lung abscess, pleural effusion, and acute respiratory distress syndrome
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what are the clinical manifestations of pneumonia?
productive or nonproductive cough, fatigue, pleuritic pain, dyspnea, fever, chills, abnormal lung sounds, pleural rub, tachypnea, mental status changes, leukocytosis
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In the US, who are TB rates most common around?
Asians, Native Hawaiians, and other Pacific Islanders
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what causes TB?
Mycobacterium tuberculosis, a slow-growing aerobic bacillus that is somewhat resistant to the body's immune efforts
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how is TB transmitted?
from person-to-person through the inhalation of tiny infected aerosol droplets
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how long is the bacillus that causes TB able to live in dried sputum? what things can kill it?
it can live in dried sputum for weeks. it can be killed by uv light, heat, alcohol, glutaraldehyde, and formaldehyde
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do many people come into contact with the TB bacillus?
yes, many people contract TB, but do not develop the disease because of an intact, healthy immune system or early treatments. only people with an active TB infection can spread the disease
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why is TB considered an opportunistic infection?
it is most likely to thrive in people with a weakened immune system
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who are at risk individuals for TB?
immune deficiency, malnutrition, diabetes mellitus, and alcoholism. Povery, overcrowding, homelessness, and drug abuse can also increase the risk of TB development
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what are the two stages of TB pathogenesis?
primary TB infection and secondary TB infection
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what occurs during a primary TB infection?
macrophages engulf the microbe causing a local inflammatory response. some bacilli travel to the lymph nodes and activate a type IV hypersensitivity reaction. lymphocytes and macrophages congregate to form a granuloma which contains some live bacilli, forming a tubercle. caseous necrosis develops in the center of the tubercle. An intact immune system can resist this development so the lesions remain small, become walled off by fibrous tissue, and calcify. the bacilli can remain dormant and viable in the tubercle for years as long as the immune system is intact
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in this stage of TB, the individual has been infected with the virus, but is still asymptomatic
primary TB infection
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in this phase of TB the bacillus can spread throughout the lungs and to other organs
secondary or active TB infection
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what are the clinical manifestations of the secondary infection phase of TB?
productive cough, hemoptysis, night sweats, fever, chills, fatigue, unexplained weight loss, anorexia, miscellaneous symptoms depending on other organ involvement
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what does treatment of TB require?
an average of 6-9 months of antimicrobial therapy. combination therapy is recommended to prevent the emergence of resistant strains
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why is compliance a common problem in treating TB?
because of the length of therapy and the medication side effects
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why is combination therapy recommended with TB?
because the bacillus is slow growing and has a high mutation rate when it is exposed to monotherapy
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what are some strategies to prevent the transmission of TB?
respiratory precautions, adequate ventilation, placing the patient in a negative-pressure isolation room, and the bacillus vaccination in some countries
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chronic pulmonary disease that produces intermittent, reversible airway obstruction and is characterized by airway infalmmation, bronchoconstriction, bronchospasm, bronchiole edema, and mucus production
asthma
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who are at risk for having asthma?
women are more likely to have asthma than men, boys are more likely to have asthma than girls, mixed race and African America adults and children. lower socioeconomic status, obesity, smoke exposure, family history
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what is asthma classified based on?
usually classified based upon cause and by severity
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what are the types of asthma based on cause?
extrinsic, intrinsic, nocturnal, exercise induced, occupational, or drug induced
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what are the types of asthma based upon severity?
mild intermittent, mild persistent, moderated persistent, and severe persistent
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result of increased IgE synthesis and airway inflammation which leads to mast cell destruction and inflammatory mediatory release
extrinsic asthma
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what are some triggers of extrinsic asthma?
allergens such as food, pollen, dust, and medication
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what occurs during extrinsic asthma?
the inflammatory mediators in response to the trigger causes bronchoconstriction, increased capillary permeability, and mucus production
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when does extrinsic asthma generally present?
in childhood or adolescence
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when does intrinsic asthma usually present?
after age 35
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what are intrinsic triggers?
upper respiratory infections, air pollution, emotional stress, smoke, exercise, and cold exposure
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when is nocturnal asthma likely to occur?
between 3 and 7 am, and is though to be related to circadian rhythms
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what causes nocturnal asthma?
at night, cortisol and epinephrine levels decrease while histamine levels increase. changes in these naturally occurring substances lead to bronchoconstriction
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when does exercise induced asthma occur?
10-15 minutes after physical activity ends, and symptoms can linger for up to an hour
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what causes exercise induced asthma?
the airways become cool and dry during exercise and asthmatic symptoms may be a compensatory mechanism to warm and moisten the airways
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what is the refractory period that occurs with exercise induced asthma?
following each episode, a refractory period begins within 30 minutes and can last up to 90 minutes. during this time, little or no bronchospasm can be induced even if the person is rechallenged with vigorous exercise
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asthma that is caused by reaction to substances encountered at work. symptoms develop over time, worsening with each exposure and improving when away from work
occupational asthma
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asthma frequently caused by asprin that can be fatal
drug-induced asthma
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reactions of drug induced asthma can be delayed up to how many hours
up to 12 hours after drug ingestion
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how does drug-induced asthma develop?
aspirin and other drugs prevent the conversion of prostaglandins which stimulate leukotriene release with is a powerful bronchoconstrictor
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regardless of the classification system what are asthma attacks?
the body's response to bronchial inflammation
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what is stage I of an acute asthma attack?
primarily related to bronchospasm, and is usually signaled by coughing. peaking within 15-30 minutes, the inflammatory mediators responsible for this stage include leukotrienes, histamine, and some interleukins
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stage II of an asthma attack
peaks within 6 hours of symptom onset. this stage is a result of airway edema and mucus production. the alvelolar hyperinflation causes air trapping. bronchospasm, smooth muscle contraction, inflammation, and mucus production combine to form narrow airways
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what are the clinical manifestations of an asthma attack?
wheezing, shortness of breath, dyspnea, chest tightness, cough, tachypnea, anxiety
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life-threatening prolonged asthma attack that does not respond to usual treatment. what is the most important thing to do in these cases?
stats asthmaticus. maintaining an airway is critical
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what complication can develop with status asthmaticus
acid-base imbalances. particularly respiratory alkalosis due to expelling too much CO2 in tachypnea
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can asthma be cured?
no, but its symptoms can be controlled.
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what can happen if an asthma attack is not treated? what if long-term asthma is left uncontrolled?
if it is not treated promptly, asthma attacks can lead to impaired gas exchange and death. left untreated, long term asthma can result in bronchial damage and scarring. the goals of treatment are to minimize the occurrence and severity of asthma attacks
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a group of chronic respiratory disorders characterized by irreversible, progressive tissue degeneration and airway obstruction
chronic obstructive pulmonary disease (COPD)
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what happens with COPD?
the chronic hypercapnia shifts the normal breathing drive from the need to expel excess CO2 to the need to raise oxygen levels. Severe hypoxia and hypercapnia can lead to respiratory failure. COPD can lead to cor pulmonale, right-sided heart failure due to lung disease
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are risk factors for the development of COPD?
the most significant contributing factor is cigarette smoking. inhalation of pollution and chemical irritants. caucasians, women, lower socioeconomic status, persons with a history of asthma
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why are prevalence rates of COPD probably underestimated?
it is asymptomatic in its early phases or it is masked by smoking symptoms
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when do symptoms usually present?
around 60 years of age
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COPD is a mixture of what two diseases?
chronic bronchitis and emphysema
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an obstructive respiratory disorder characterized by inflammation of the bronchi, a productive cough, and excessive mucus production
chronic bronchitis
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how does chronic bronchitis differ from acute?
chronic is not necessarily caused by an infection and symptoms last longer than they do with acute. cigarette smoking is the greatest contributing factor
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what occurs during chronic bronchitis?
the inflammatory response results in mucous gland hyperplasia, edema, excessive mucus production, bronchoconstriction, and cough in defense against inhaled irritants. Airway resistance affects inspiratory and expiratory flow. impaired pulmonary defenses result in frequent infections, and in some cases respiratory failure
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what does airway resistance with chronic bronchitis result in?
hypoxemia, hypoventilation, cyanosis, hypercapnia, polycythemia, clubbing of fingers, and dyspnea at rest
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what are the clinical manifestations of chronic bronchitis?
abnormal lung sounds, edema, weight gain, malaise, fever, pain
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obstructive respiratory disorder that results in the destruction of alveolar walls leading to large, permanently inflated alveoli
emphysema
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does lung tissue remodel with emphysema?
lung tissue normally remodels with periods of growth and repair related to infections and inflammation. enzymes are involved in this process to prevent excessive tissue damage.
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what occurs during emphysema?
enzyme levels are decreased due to smoking or a predisposition. smoking initiates inflammation causing changes in enzyme levels and leading to structural changes. emphysema gradually turns the alveoli into large, irregular pockets with gaping holes which in turn limit the amount of oxygen entering the blood stream. the elastic fibers and surfactant that normally keep the alveoli open are slowly destroyed so the alveoli collapse during expiration, trapping the air in the lungs. terminal bronchioles are narrowed but inspiration is not effected
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what are the clinical manifestations of emphysema?
dyspnea upon exertion, diminished breath sounds, wheezing, chest tightness, tachypnea, hypoxia, hypercapnia, activity intolerance, anorexia, and malaise
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common inherited respiratory disorder that is present at birth. it causes severe lung damage and nutrition deficits. most often affects caucasians
cystic fibrosis
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what occurs during cystic fibrosis?
the cells that produce mucus, sweat, saliva, and digestive secretions are changed. as a result, these normally thin secretions become thick and tenacious and instead of lubricating the respiratory tract, they occlude the airways, ducts, and passageways
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how is cystic fibrosis passed down?
autosomal recessive pattern related to chromosome 7. the genetic deficit is related to a protein involved in sodium, chloride, and water cellular transport
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what organs are primarily affected with cystic fibrosis?
the lungs and pancreas, but other organs may also be affected
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what things can develop because of cystic fibrosis?
atelectasis as airways are obstructed. mucus stagnates and becomes a primary medium for bacterial growth. recurrent infections contribute to progressive lung destruction. bronchiectasis and emphysema-like changes are common as fibrosis and obstructions advance. respiratory failure is the most common cause of death of people with cystic fibrosis
152
what occurs with cystic fibrosis in the digestive tract?
the mucus blocks the intestins, producing a meconium ileus in the newborn. it also blocks the pancreas ducts leading to pancreatic enzyme excretion deficit. malabsorption and malnutrition develop. trapped digestive enzymes damage the pancreatic tissue, contributing to the development of diabetes mellitus and osteoporosis. blocked bile ducts add to malabsorption issues and increase the risk for development of cirrhosis. salivary glands are only mildly affected. sweat glands produce sweat high in sodium chloride, which causes electrolyte imbalances with a lot of sweating. obstructions in the reproductive system can lead to sterility and infertility
153
what is the progression of clinical manifestations with cystic fibrosis?
may appear at birth and progressively worsen. lung function often starts declining in early childhood
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what are the clinical manifestations of cystic fibrosis?
meconium ileus, salty skin, steatorrhea, fat-soluble vitamin deficiency, voracious appetite, chronic cough with tenacious sputum, frequent respiratory infections, hypoxia, audible rhonchi and wheezing, dyspnea, fatigue, activity intolerance, digital clubbing, delayed growth and development, complication development
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second most often diagnosed lung cancer in men and women and the leading cause of cancer in the US
lung cancer
156
what contributes to the majority of lung cancer cases
smoking
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what can the risk for development of lung cancer be directly related to?
the length of time a person smokes and the number of cigarettes the person smokes. secondhand smoke also contributes to the development. inhalation of chemicals and chronic lung disease also increase the risk for development
158
how do tumors develop so easily in the lung tissue?
the lungs provide an optimal environment for tumor growth and development. carcinogens can seek reguge in the many nooks and crannies of the air passages, having an opportunity to cause cellular changes. the scores of blood vessels supplying the lungs serve as entrance points for distant cancer cells to gain access, and those vessels furnish the cancer with a rich blood source to facilitate its growth
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type of lung cancer that occurs most exclusively in heavy smokers and is less frequent than the other type. often referred to as oat-cell carcinoma
small-cell carcinoma
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type of lung cancer that is the most common malignant type and accounts for 75% of all cases. very aggressive and is classified into several subgroups. often referred to as bronchogenic carcinoma
non-small-cell carcinoma
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what issues can tumors in the lungs lead to?
airway obstruction, inflammation of lung tissue eliciting cough and contributing to infections, fluid accumulation in the pleural space, paraneoplastic syndrome
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endocrine dysfunction associated with hormone secretion from a lung tumor
paraneoplastic syndrome
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what are the clinical manifestations of lung cancer? why are they insidious?
they are insidious because they resemble the signs of smoking. persistent cough or a change in usual cough, dyspnea, hemptysis, frequent respiratory infections, chest pain, hoarseness, weight loss, anorexia, anemia, fatigue, other symptoms specific to the site of metastasis
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the accumulation of excess fluid in the pleural cavity
pleural effusion
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what can the excessive fluid in the pleural cavity with pleural effusion do?
can compress the lung and limit expansion during inhalation. may affect one or both lugns
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what are the types of fluid that can accumulate and cause pleural effusion? what do they come from?
exudates due to inflammation, transudate due to increased hydrostatic pressure, blood due to trauma, and pus due to infection
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what does the consequences of pleural effusion depend on?
the type, location, amount, and fluid accumulation rate.
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what can occur with large amounts of fluid in pleural effusion?
large amounds of fluids can cause the pleural membranes to seperate, preventing their cohesion during inhalation. lack of cohesion impedes full expansion, leading to atelectasis and a pneumothorax. large effusions can also impair venous return in the inferior vena cava and cardiac filling by putting pressure on those structures
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how does pleurisy relate to pleural effusion?
it can precede or follow the effusion, or occur independently
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inflammation of the pleural membranes which leads to swollen and irregular tissue, often associated with pneumonia and creates friction in the pleural membranes
pleural effusion
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what are the clinical manifestations of pleural effusion?
dyspnea, chest pain usually sharp and worsening with inhalation, tachypnea, tracheal deviation, diminished or absent lung sounds over the affected area, dullness to percussion over the affected area, tachycardia, pleural friction rub
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air in the pleural cavity
pneumothorax
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what things can lead to atelectasis with pneumothorax?
the presence of atmospheric air in the pleural cavity and the separation of pleural membranes can lead to atelectasis. the resulting pressure can cause partial or complete collapse of a lung
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what treatments do a small and large pneumothorax need?
a small pneumothorax causes mild symptoms and may heal on its own while a larger one generally requires aggressive treatment to remove the air and reestablish pulmonary negative pressure
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what are the risk factors for the development of a pneumothorax?
smoking, thin and tall stature, history of lung disease or previous pneumothorax, men 20-40 years of age
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develops when air enters the pleural cavity from an opening in the internal airways
spontaneous pneumothorax
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occurs when a small blister or bleb (caused by weakness in the lung tissue)on the top of the lung ruptures due to changes in air pressure
primary spontaneous pneumothorax
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are primary spontaneous pneumothoraxes usually serious?
no they are usually mild because pressure from the collapsed portion of the lung may in turn collapse the bleb
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develops in people with preexisting lung disease. in these cases the pneumothorax occurs because the diseased lung tissue is weakened
secondary spontaneous pneumothorax
180
which is more severe, a secondary spontaneous pneumothorax or a primary spontaneous pneumothorax?
a secondary one. it is life threatening because diseased tissue can create a larger opening, allowing more air to enter the pleural space. additionally, pulmonary disease reduces lung reserves, making further reduction in lung function more serious
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pneumothorax that occurs due to any blunt trauma or penetrating injury to the chest
traumatic pneumothorax
182
most serious type of pneumothorax
tension pneumothorax
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occurs when the pressure in the pleural space is greater than the atmospheric pressure
tension pneumothorax
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what does the increased pressure in the lungs with a tension pneumothorax stem from?
due to trapped air in the pleural space or from air entering from a positive-pressure mechanical ventilator. the force of the air can cause the affected lung to collapse completely and shift the heart toward the uncollapsed lung, compressing the unaffected lung and the heart
185
how does a tension pneumothorax progress?
rapidly and it will be fatal if not quickly treated
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what are the clinical manifestations of pneumothorax?
sudden chest pain over the affected lung, chest tightness, dyspnea, tachypnea, decreased breath sounds over the affected area,
asymmetrical chest movement, trachea and mediastinum deviation toward unaffected side, anxiety, tachycardia, pallor, hypotension
187
sudden failure of the respiratory system often as a result of fluid accumulation in the alveoli
acute respiratory distress syndrome (ARDS), AKA - shock lung, wet lung, and stiff lung
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form of ARDS that involves an acute hypoxemia resulting from a systemic event or pulmonary event that is not cardiac in origin. slightly less severe form
acute lung injury AL
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what conditions can precipitate ARDS
prolonged shock, burns, aspiration, smoke inhalation
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how quickly does ARDS develop?
rapidly, often within 90 minutes of a systemic inflammatory response or 48 hours of a lung injury
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what are risk factors for the development of ARDS?
chronic lung disease, alcoholism, age 65+, mechanical ventilatoin
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how often is ARDS fatal?
1/3 of cases. individuals who survive will fully recover but it may take them as long as a year
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what occurs during ARDS?
injury to the alveoli and capillary membranes leads to the release of chemical inflammatory mediators which increase capillary permeability, promote fluid and protein accumulation in the alveoli, and damage the surfactant producing cells. lung damage progresses as neutrophils migrate to the site, releasing proteases and other mediators. a hyaline membrane or thin layer of tissue forms in the alveoli and causes them to become stiff. increased platelet aggregation promotes microemboli development.
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what do the events of ARDS result in?
decreased gas exchange, reduced pulmonary blood flow, and limited lung expansion
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ARDS is a serious condition that can lead to what complications?
respiratory failure, respiratory and metabolic acidosis, pulmonic fibrosis, pneumothorax, bacterial lung infections, decreased lung function, renal failure, stress ulcer, thromboembolism, muscle wasting, memor, cognitive, and emotional issues
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what are the clinical manifestations of ARDS?
dyspnea, labored shallow respirations, abnormal lung sounds, productive cough with frothy sputum, hypoxia, cyanosis, fever, hypotension, tachycardia, restlessness, confusion, lethargy, and anxiety
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incomplete alveolar expansion or collapse of the alveoli that occurs when the walls of the alveoli stick together
atelectasis
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what are the possible causes of atelectasis?
surfactant deficiencies, bronchus obstruction, lung tissue compression, increased surface tension, lung fibrosis
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what can atelectasis lead to?
alveoli are not filled with air so they shrivel up and this ventilation issue can impair blood flow through the lung. ineffective ventilation and perfusion impair gas exchange
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what will happen to the respiratory rate with atelectasis that only affects a small area?
if only a small area is affected, the respiratory rate will increase to control CO2 levels.
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what can occur if they alveoli are not reinflated quickly with atelectasis?
necrosis, infection, and permanent lung damage
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what are the clinical manifestations of atelectasis?
diminished breath sounds, dyspnea, tachypnea, asymmetrical lung movement, anxiety, restlessness, tracheal deviation, tachycardia
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serious, life-threatening condition that can be the result of many disorders. oxygen levels become dangerously low or CO2 levels become dangerously high. the nervous system is quickly affected by the lack of oxygen and the gas level becomes progressively worse as the patients condition worsens. respiratory acidosis develops as the carbon dioxide levels rise
acute respiratory failure (ARF)
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what does the hypoxia and acidosis trigger with ARF?
a reflex pulmonary vasoconstriction which further impairs gas exchange and increased cardiac workload. the heart decompensates from the lack of oxygen which could lead to cardiac arrest. respiratory arrest may occur as the respiratory system ceases all activity from the strain
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what are the clinical manifestations of ARF?
shallow respirations, headache, tachycardia, dysrhythmias, lethargy, confusion
