Week 10: Respiratory System Flashcards
1
Q
Respiratory System: Purpose and General Function
*Transport of oxygen from air to _________
*Oxygen is necessary for __________ metabolism.
*Removal of _______________ from the blood
*Carbon dioxide is a waste product from _____________.
A
*Transport of oxygen from air to blood
*Oxygen is necessary for cellular metabolism.
*Removal of carbon dioxide from the blood
*Carbon dioxide is a waste product from metabolism.
2
Q
Respiratory System:
-Two anatomical areas
Upper respiratory tract
* _______________
Lower respiratory tract
* ____________
A
Upper respiratory tract
* Resident flora
Lower respiratory tract
* Sterile
3
Q
Upper Respiratory Tract includes
A
Nasal cavity
Nasopharynx
Palatine tonsils
Oropharynx
Larynx
Trachea
4
Q
Nasal cavity
-Warming and moistening of _____
-Foreign material trapped by _________ secretions
A
-Warming and moistening of air
-Foreign material trapped by mucous secretions
5
Q
Nasopharynx
-Pharyngeal ___________ in posterior wall
A
-Pharyngeal tonsils in posterior wall
6
Q
Palatine tonsils
-_____________ tissue in posterior portion of the oral cavity
A
-Lymphoid tissue in posterior portion of the oral cavity
7
Q
Oropharynx
-Common passage for _________________
-Epiglottis protects opening into larynx.
* Closes over glottis at swallowing to prevent _____________
A
-Common passage for air and food
-Epiglottis protects opening into larynx.
* Closes over glottis at swallowing to prevent aspiration
8
Q
Trachea
-Lined by pseudostratified ciliated epithelium
-C-shaped rings of ____________
A
cartilage
9
Q
Larynx
-Two pairs of __________________
A
vocal cords
10
Q
Lower Respiratory Tract includes
_________________ (continuous branching)
-Trachea branches into:
* Right and left primary bronchi
* Secondary bronchi
* Bronchioles
* Terminal bronchioles
* Respiratory bronchioles
* Alveolar ducts
* ___________ —lined by simple squamous epithelium
and surfactant to reduce surface tension and
maintain inflation
>End point for inspired air
>Site of _____ exchange
A
Bronchial tree (continuous branching)
-Trachea branches into:
* Right and left primary bronchi
* Secondary bronchi
* Bronchioles
* Terminal bronchioles
* Respiratory bronchioles
* Alveolar ducts
* Alveoli—lined by simple squamous epithelium
and surfactant to reduce surface tension and
maintain inflation
>End point for inspired air
>Site of gas exchange
11
Q
Ventilation
- Process of ________________________
- Airflow depends on pressure ______________ (Boyle’s law).
- Air always moves from high-pressure area to low pressure area
A
- Process of inspiration and expiration
- Airflow depends on pressure gradient (Boyle’s law).
- Air always moves from high-pressure area to low pressure area
12
Q
- Inspiration—air moves from atmosphere into _________
A
lungs
-Atmospheric pressure higher than pressure in alveoli
13
Q
- Expiration—air moves from lungs into ____________
A
atmosphere
- Pressure in alveoli higher than in atmosphere
14
Q
_____________ is the amount of air exchanged with quiet inspiration and expiration.
A
Tidal volume
15
Q
Residual volume- Volume of air remaining in lungs after _____________________
A
maximum respiration
16
Q
Vital capacity
-Maximal amount of air that can be moved in and out of the lungs with a ___________________ inspiration and expiration
A
single forced
17
Q
Primary control centers for breathing
- Located in the ___________________
A
medulla and pons
18
Q
_________________ detect changes in carbon dioxide level, hydrogen ion, and oxygen
levels in blood or cerebrospinal fluid (CSF)
A
Chemoreceptors
19
Q
Central chemoreceptors
* Located in the ___________
Peripheral chemoreceptors
* Located in the ___________________
A
Central chemoreceptors
* Located in the medulla
Peripheral chemoreceptors
* Located in the carotid bodies
20
Q
Hypercapnia
-__________________ levels in the blood increase.
-Carbon dioxide easily diffuses into ______.
* Lowers pH and stimulates respiratory center
* Increased rate and depth of respiration (hyperventilation)
* Causes _____________________—nervous system depression
A
-Carbon dioxide levels in the blood increase.
-Carbon dioxide easily diffuses into CSF.
* Lowers pH and stimulates respiratory center
* Increased rate and depth of respiration (hyperventilation)
* Causes respiratory acidosis—nervous system depression
21
Q
Hypoxemia
-Marked decrease in _________
* Chemoreceptors respond.
* Imp. control mechanism in ind. w/ chronic lung disease—move to hypoxic drive
A
-Marked decrease in oxygen
* Chemoreceptors respond.
* Imp. control mechanism in ind. w/ chronic lung disease—move to hypoxic drive
22
Q
Hypocapnia
-Caused by low ________________ concentration (low partial pressure of Co2) in blood
* May be caused by ____________
-Excessive amounts of carbon dioxide expired
* Causes respiratory __________
A
-Caused by low carbon dioxide concentration (low partial pressure of Co2) in blood
* May be caused by hyperventilation
-Excessive amounts of carbon dioxide expired
* Causes respiratory alkalosis
23
Q
Factors Affecting Diffusion of Gases
-________________ gradient
-Thickness of the respiratory __________
[Fluid accumulation in alveoli or interstitial tissue impairs gas exchange]
-Total __________ area available for diffusion
[If part of alveolar wall is destroyed, surface area is reduced, so less exchange]
-________-perfusion ratio
[Ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exchange]
A
-Partial pressure gradient
-Thickness of the respiratory membrane
[Fluid accumulation in alveoli or interstitial tissue impairs gas exchange]
-Total surface area available for diffusion
[If part of alveolar wall is destroyed, surface area is reduced, so less exchange]
-Ventilation-perfusion ratio
[Ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exchange]
24
Q
Oxygen
-About ____ of oxygen is dissolved in plasma.
-Most is bound (reversibly) to ___________
-Binding and release of oxygen to hemoglobin depend on:
* PO2, PCO2, temperature, plasma pH
A
-About 1% of oxygen is dissolved in plasma.
-Most is bound (reversibly) to hemoglobin.
-Binding and release of oxygen to hemoglobin depend on:
* PO2, PCO2, temperature, plasma pH
25
Carbon dioxide
-Waste product from ________________
-About 7% dissolved in _____
-About 20% reversibly bound to _______
-Most diffuses into _____ blood cells
-Waste product from cellular metabolism
-About 7% dissolved in plasma
-About 20% reversibly bound to hemoglobin
-Most diffuses into red blood cells
26
Spirometry—pulmonary function test (PFT)
- Test pulmonary __________ and __________ times
- Test pulmonary volumes and airflow times
27
Arterial blood gas determination
-Checks oxygen, carbon dioxide, bicarbonate, _________
serum pH
28
_________ tolerance testing
-For patients with chronic pulmonary disease
Exercise
28
Oximetry
- Measures O2 _________
saturation
29
Radiography (Xray)
- Helpful in evaluating _______
- Evaluate infections
tumors
30
Bronchoscopy
- Perform _________
- Check site of lesion or bleeding.
biopsy.
31
Culture and sensitivity tests
- Sputum testing for presence of __________
- Determine antimicrobial sensitivity of pathogen
pathogens
32
General Manifestations of Respiratory Disease
Sneezing
- Reflex response to __________ in upper respiratory tract
* Assists in removing _________
* Associated with ___________ or foreign material
Sneezing
- Reflex response to irritation in upper respiratory tract
* Assists in removing irritant
* Associated with inflammation or foreign material
33
General Manifestations of Respiratory Disease
Coughing
- Irritation caused by ______________
- Inflammation or foreign material in _______ respiratory tract
- Caused by inhaled ________
Coughing
- Irritation caused by nasal discharge
- Inflammation or foreign material in lower respiratory tract
- Caused by inhaled irritants
34
General Manifestations of Respiratory Disease
Sputum
- Yellowish-green, cloudy, thick mucus
* Often indication of a ___________ infection
- Rusty or dark-colored sputum
* Usually sign of __________________
- Very large amounts of purulent sputum with foul odor
* May be associated with ______ectasis
- Yellowish-green, cloudy, thick mucus
* Often indication of a bacterial infection
- Rusty or dark-colored sputum
* Usually sign of pneumococcal pneumonia
- Very large amounts of purulent sputum with foul odor
* May be associated with bronchiectasis
35
General Manifestations of Respiratory Disease
Sputum cont.
-Thick, tenacious mucus
* ________ or _______________, blood-tinged sputum—may result from chronic cough; may also be sign of tumor or tuberculosis
- Hemoptysis
* Blood-tinged (bright red) frothy sputum, usually associated with pulmonary _____
-Thick, tenacious mucus
* Asthma or cystic fibrosis, blood-tinged sputum—may result from chronic cough; may also be sign of tumor or tuberculosis
- Hemoptysis
* Blood-tinged (bright red) frothy sputum, usually associated with pulmonary edema
36
General Manifestations of Respiratory Disease
Breathing patterns and characteristics
-Eupnea: * _______ rate
-Kussmaul respirations: * ______ _______ respirations—typical for acidosis; may follow
strenuous exercise
-Eupnea: * Normal rate
-Kussmaul respirations: * Deep rapid respirations—typical for acidosis; may follow
strenuous exercise
37
General Manifestations of Respiratory Disease
Breathing patterns and characteristics
-Labored respiration or prolonged inspiration or expiration
* Often associated with __________ of airways
-Wheezing or whistling sounds
* Indicate __________ in small airways
-Labored respiration or prolonged inspiration or expiration
* Often associated with obstruction of airways
-Wheezing or whistling sounds
* Indicate obstruction in small airways
38
General Manifestations of Respiratory Disease
Breathing patterns and characteristics
Stridor
* __________ crowing noise
* Usually indicates ______ airway obstruction
Stridor
* High-pitched crowing noise
* Usually indicates upper airway obstruction
39
Apnea is __________ of breathing
cessation
40
Breath sounds
- Rales or Crackles
* Light ______________ sounds, with serous secretions
- Rhonchi
* Deeper or harsher sounds from _________ mucus
- Wheeze
* Narrowing of airways causing ____________ sound
- Rales or Crackles
* Light bubbly or crackling sounds, with serous secretions
- Rhonchi
* Deeper or harsher sounds from thicker mucus
- Wheeze
* Narrowing of airways causing high pitch sound
41
Dyspnea
- Subjective feeling of __________
* May be caused by increased carbon dioxide or hypoxemia
* Often noted on exertion, such as climbing stairs
- Subjective feeling of discomfort
* May be caused by increased carbon dioxide or hypoxemia
* Often noted on exertion, such as climbing stairs
42
Severe dyspnea indicative of respiratory distress
- ________ of nostrils
- Use of accessory respiratory muscles
- Retraction of muscles between or above _____
- Flaring of nostrils
- Use of accessory respiratory muscles
- Retraction of muscles between or above ribs
43
Orthopnea
- Occurs when ____________
- Usually caused by pulmonary congestion
lying down
44
- Cyanosis
- ______ ________ of skin and mucous membranes
* Caused by large amounts of unoxygenated _________ in blood
- Bluish coloring of skin and mucous membranes
* Caused by large amounts of unoxygenated hemoglobin in blood
45
Pleural pain
- Results from________ __ _________ of parietal pleura
inflammation or infection
46
- Hypoxemia—________ oxygen in blood
- Hypercapnea—__________ carbon dioxide in blood
- Hypoxemia—inadequate oxygen in blood
- Hypercapnea—increased carbon dioxide in blood
47
Friction rub
- Soft sound produced as rough, inflamed, or _____ _______ move against each other
- Soft sound produced as rough, inflamed, or scarred pleural move against each other
48
Clubbed digits
- Result from chronic ________ associated with respiratory or cardiovascular diseases
* Painless, firm, fibrotic ___________ at the end of the digit
- Result from chronic hypoxia associated with respiratory or cardiovascular diseases
* Painless, firm, fibrotic enlargement at the end of the digit
49
Upper Respiratory Tract Infections
Common cold (infectious rhinitis)
- ____ infection
- More than ____ possible causative agents
- Spread through respiratory droplets
- Hand-washing and respiratory hygiene important in prevention
- Symptomatic treatment
- Secondary bacterial infections may occur.
* Usually caused by streptococci
* _________ exudate; systemic signs, such as fever
- Viral infection
- More than 200 possible causative agents
- Spread through respiratory droplets
- Hand-washing and respiratory hygiene important in prevention
- Symptomatic treatment
- Secondary bacterial infections may occur.
* Usually caused by streptococci
* Purulent exudate; systemic signs, such as fever
50
Upper Respiratory Tract Infections
Sinusitis
- Usually ________ infection
- _________ for headache and pain
- Course of _________ often required to eradicate infection
- Usually bacterial infection
- Analgesics for headache and pain
- Course of antibiotics often required to eradicate infection
51
Upper Respiratory Tract Infections
Laryngotracheobronchitis (croup)
- Common viral infection, particularly in _________
- Common causative organism- Parainfluenza viruses and __________
- Infection usually self-limited
- Common viral infection, particularly in children
- Common causative organism
* Parainfluenza viruses and adenoviruses
- Infection usually self-limited
52
Upper Respiratory Tract Infections
Epiglottitis
- Acute infection common in children ages _______ years
- Usually caused by Haemophilus influenza _________
- Rapid onset; fever and sore throat
- Drooling and difficulty swallowing, Heightened anxiety
- Swelling of the ________ , supraglottic area, and epiglottis; May obstruct airway; Spasm of larynx common if area is touched with instruments
- Treatment- Oxygen and antimicrobial therapy
- Acute infection common in children ages 3 to 7 years
- Usually caused by Haemophilus influenza type B
- Rapid onset; fever and sore throat
- Drooling and difficulty swallowing, Heightened anxiety
- Swelling of the larynx, supraglottic area, and epiglottis; May obstruct airway; Spasm of larynx common if area is touched with instruments
- Treatment- Oxygen and antimicrobial therapy
53
Upper Respiratory Tract Infections
Three groups of influenza viruses
Type A _____________
types B and C
- Viruses constantly mutate.
(most prevalent)
54
Upper Respiratory Tract Infections: Influenza (Flu)
Sudden, acute onset with _____, marked ______, aching ____ in the body
- May also cause viral pneumonia
- Mild case of influenza may be complicated by secondary bacterial pneumonia.
- Commonly, deaths in flu epidemics result from pneumonia.
Sudden, acute onset with fever, marked fatigue, aching pain in the body
- May also cause viral pneumonia
- Mild case of influenza may be complicated by secondary bacterial pneumonia.
- Commonly, deaths in flu epidemics result from pneumonia.
55
Upper Respiratory Tract Infections: Influenza (Flu) (Cont.)
-Treatment: Symptomatic and supportive
* Unless bacterial infection develops secondarily
-__________ drugs
* May reduce symptoms and duration
* Reduces risk to infect others
Prevention
- Respiratory _______!
- __________ is recommended for most individuals.
-Treatment: Symptomatic and supportive
* Unless bacterial infection develops secondarily
- Antiviral drugs
* May reduce symptoms and duration
* Reduces risk to infect others
Prevention
- Respiratory hygiene!
- Vaccination is recommended for most individuals.
56
Type A H1N1 Influenza
-This virus contains genes from ____ , _____, , and human flu strains.
-Usually affects children and teens younger than ___ years
-Healthy young adults also at high risk
-High mortality rate caused by acute respiratory syndrome
>Pulmonary edema, Pneumonia, Requires ICU care
-This virus contains genes from pig, bird, and human flu strains.
-Usually affects children and teens younger than 20 years
-Healthy young adults also at high risk
-High mortality rate caused by acute respiratory syndrome
>Pulmonary edema, Pneumonia, Requires ICU care
57
Scarlet Fever
- Caused by group A β-hemolytic ___________ (S. pyogenes)
Symptoms
- Typical “_________" tongue
- Fever, sore throat
- Chills, vomiting, abdominal pain, malaise
Treatment- _________
- Caused by group A β-hemolytic Streptococcus (S. pyogenes)
Symptoms
- Typical “strawberry” tongue
- Fever, sore throat
- Chills, vomiting, abdominal pain, malaise
Treatment- Antibiotics
58
Lower Respiratory Tract Infections: Bronchiolitis
- Caused by the __________________
- Transmitted by oral droplet
- Virus causes _______, inflammation in small bronchi and bronchioles
Signs
- Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise
Treatment- Supportive and symptomatic
- Caused by the respiratory syncytial virus (RSV)
- Transmitted by oral droplet
- Virus causes necrosis, inflammation in small bronchi and bronchioles
Signs
- Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise
Treatment- Supportive and symptomatic
59
Lower Respiratory Tract Infections: Pneumonia
- Classification of pneumonias based on:
- __________ agent
* Viral, bacterial, fungal
- Anatomical __________ of infection
* Throughout both lungs, or consolidated in one lobe
- Pathophysiological _______
* Changes in interstitial tissue, alveolar septae, alveoli
- Epidemiological data
* Nosocomial (hospital-acquired)
* Community-acquired
- Causative agent
* Viral, bacterial, fungal
- Anatomical location of infection
* Throughout both lungs, or consolidated in one lobe
- Pathophysiological changes
* Changes in interstitial tissue, alveolar septae, alveoli
- Epidemiological data
* Nosocomial (hospital-acquired)
* Community-acquired
60
Lobar Pneumonia
- __________ pneumonia
- Community-based, often in healthy young adults
- Usually caused by ____________ pneumoniae
- Infection localized in one or more ______
* Inflammation and vascular congestion—exudate forms in the alveoli
* Exudate contains fibrin and forms a consolidated mass
* Exudate produces rusty sputum
- Adjacent pleurae frequently involved
-Infection may spread to pleural cavity—empyema
Manifestations
- Sudden onset
- Systemic signs
* High fever with chills, fatigue, leukocytosis
- Dyspnea, tachypnea, tachycardia
- Pleural pain
- Rales
- Productive cough
* Typical rusty-colored sputum
- Confusion and disorientation
- Bacterial pneumonia
- Community-based, often in healthy young adults
- Usually caused by Streptococcus pneumoniae
- Infection localized in one or more lobes.
* Inflammation and vascular congestion—exudate forms in the alveoli
* Exudate contains fibrin and forms a consolidated mass
* Exudate produces rusty sputum
- Adjacent pleurae frequently involved
-Infection may spread to pleural cavity—empyema
Manifestations
- Sudden onset
- Systemic signs
* High fever with chills, fatigue, leukocytosis
- Dyspnea, tachypnea, tachycardia
- Pleural pain
- Rales
- Productive cough
* Typical rusty-colored sputum
- Confusion and disorientation
61
Bronchopneumonia
-Diffuse pattern of infection in both lungs
- Several species of microorganisms may be the cause.
- Inflammatory _______ forms in alveoli
- Onset tends to be insidious
- Moderate fever, cough, rales
- Productive cough with ________ sputum—usually yellow or green
- ____________ treatment
-Diffuse pattern of infection in both lungs
- Several species of microorganisms may be the cause.
- Inflammatory exudate forms in alveoli
- Onset tends to be insidious
- Moderate fever, cough, rales
- Productive cough with purulent sputum—usually yellow or green
- Antibacterial treatment
62
Legionnaires’ Disease
-Caused by Legionella pneumophila
- Thrives in __________ environments
- Often ___________- infection
- Difficult to identify—requires special culture medium
Untreated infections
- Cause severe congestion and consolidation
- Necrosis in the lung
- Possibly _____
-Caused by Legionella pneumophila
- Thrives in warm, moist environments
- Often nosocomial infection
- Difficult to identify—requires special culture medium
Untreated infections
- Cause severe congestion and consolidation
- Necrosis in the lung
- Possibly fatal
63
Primary Atypical Pneumonia
- M____________ pneumoniae—bacterial
- Common in older children and young adults
- Transmitted by aerosol
- Frequent cough, ________ therapy
- Viral form caused by influenza A or B, adenoviruses, RSV
- Unproductive cough, hoarseness, sore throat, headache, mild fever, malaise
- Infection varies greatly in severity.
- Infection is usually self-limiting.
- Mycoplasma pneumoniae—bacterial
- Common in older children and young adults
- Transmitted by aerosol
- Frequent cough, antibiotic therapy
- Viral form caused by influenza A or B, adenoviruses, RSV
- Unproductive cough, hoarseness, sore throat, headache, mild fever, malaise
- Infection varies greatly in severity.
- Infection is usually self-limiting.
64
Severe Acute Respiratory Syndrome (SARS)
-Acute respiratory infection
- Causative microbe—SARS-associated ________
- Transmission by respiratory droplets—close contact
First signs
* Fever, headache, myalgia, chills, anorexia, possibly diarrhea
Later signs
* Effect on _______ evident—dry cough, marked dyspnea; areas of interstitial congestion, hypoxia; __________________ may be required.
-Acute respiratory infection
- Causative microbe—SARS-associated coronavirus
- Transmission by respiratory droplets—close contact
First signs
* Fever, headache, myalgia, chills, anorexia, possibly diarrhea
Later signs
* Effect on lungs evident—dry cough, marked dyspnea; areas of interstitial congestion, hypoxia; mechanical ventilation may be required.
65
Severe Acute Respiratory Syndrome (SARS) (Cont.)
Treatment
- Antivirals, glucocorticoids
- High ________ rate
Risk factors (monitored to prevent outbreaks)
* Travel to endemic or epidemic area
* Close contact with such a traveler
- Presence of a cluster of undiagnosed ________________ cases
- Employment involving close contact with the virus
* Active cases quarantined until clear of infection
- Antivirals, glucocorticoids
- High fatality rate
Risk factors (monitored to prevent outbreaks)
* Travel to endemic or epidemic area
* Close contact with such a traveler
- Presence of a cluster of undiagnosed atypical pneumonia cases
- Employment involving close contact with the virus
* Active cases quarantined until clear of infection
66
Tuberculosis
Cause
- ____________ tuberculosis transmitted by oral droplets from persons w/ active infection
- Occurs more frequently with:
* People living in ________ conditions
* ______deficiency
* Malnutrition
* Alcoholism
* Conditions of ____
* _________ disease
* HIV infection
Cause
- Mycobacterium tuberculosis transmitted by oral droplets from persons w/ active infection
- Occurs more frequently with:
* People living in crowded conditions
* Immunodeficiency
* Malnutrition
* Alcoholism
* Conditions of war
* Chronic disease
* HIV infection
67
Tuberculosis (Cont.)
- Somewhat resistant to drying and many _________
- Can survive in dried sputum for weeks
- Destroyed by __________ light, heat, alcohol, glutaraldehyde, formaldehyde
- Normal ________ response does not occur
- Cell-mediated immunity normally protection
- Primarily affects _____; other organs may also be invaded
- Somewhat resistant to drying and many disinfectants
- Can survive in dried sputum for weeks
- Destroyed by ultraviolet light, heat, alcohol, glutaraldehyde, formaldehyde
- Normal neutrophil response does not occur
- Cell-mediated immunity normally protection
- Primarily affects lungs; other organs may also be invaded
68
Tuberculosis
Primary infection
- When organism first enters the lungs
* Engulfed by __________—local inflammation
* If cell-mediated immunity is inadequate:
-Mycobacteria reproduce and begin to destroy _____________
* This form of disease is contagious!
- When organism first enters the lungs
* Engulfed by macrophages—local inflammation
* If cell-mediated immunity is inadequate:
-Mycobacteria reproduce and begin to destroy lung tissue.
* This form of disease is contagious!
69
Tuberculosis (Cont.)
- If cell-mediated immunity is adequate:
- Some bacilli migrate to _____________ —granuloma—formation of tubercle (contains live bacilli)—walled off and calcifying
- Tubercle may be visible on chest radiograph.
- Bacilli may remain viable in a ______________ for years.
- Individual’s resistance and immune responses high, bacilli remain walled off
- Primary or latent infection—individual has been exposed and infected, but does not have disease and is asymptomatic
- Individual_______ transmit disease
- If cell-mediated immunity is adequate:
- Some bacilli migrate to lymph nodes—granuloma—formation of tubercle (contains live bacilli)—walled off and calcifying
- Tubercle may be visible on chest radiograph.
- Bacilli may remain viable in a dormant stage for years.
- Individual’s resistance and immune responses high, bacilli remain walled off
- Primary or latent infection—individual has been exposed and infected, but does not have disease and is asymptomatic
- Individual cannot transmit disease
70
Tuberculosis (Cont.)
Secondary or re-infection with TB
- Occurs when client’s____________________ is impaired because of:
* Stress
* Malnutrition
* HIV infection
* Age
- Mycobacteria begin to reproduce and infect lung.
- Active TB, which can be spread to others!
cell-mediated immunity
71
Miliary or extrapulmonary tuberculosis
______ progressive form more common in children < 5 years
* Early dissemination to other ________
* If lesions are not found in the lungs, this is not ___________
* Common symptoms include weight loss, failure to thrive, and other infections such as measles.
Rapidly progressive form more common in children < 5 years
* Early dissemination to other tissues
* If lesions are not found in the lungs, this is not contagious.
* Common symptoms include weight loss, failure to thrive, and other infections such as measles.
72
Tuberculosis (Cont.)
Active TB (primary or secondary)
- Organisms multiply, forming large areas of ________
* Cause large open areas in lung—cavitation
- Cavitation promotes spread into other parts of lung.
* Infection may spread into pleural cavity.
- Cough, positive sputum, radiograph showing cavitation
- Disease in this form is highly infectious when there is close personal contact over a period of time.
Active TB (primary or secondary)
- Organisms multiply, forming large areas of necrosis.
* Cause large open areas in lung—cavitation
- Cavitation promotes spread into other parts of lung.
* Infection may spread into pleural cavity.
- Cough, positive sputum, radiograph showing cavitation
- Disease in this form is highly infectious when there is close personal contact over a period of time.
73
Tuberculosis (Cont.)
Diagnostic tests
- First exposure or primary infection
* Indicated by positive________ (skin) test results
- Active infections
* Acid-fast sputum test
* Chest radiograph
* Sputum culture and sensitivity
Treatment
- Long-term treatment with a combination of drugs
- Length of treatment varies from 6 to 12 months.
tuberculin
74
Tuberculosis (Cont.)
-Effective treatment requires monitoring and follow-up and is expensive.
TB is becoming an increasingly serious problem because of:
- Homelessness and _________ in shelters
- _____ infection
- Lack of health care
- Multidrug __________ TB
- Homelessness and crowding in shelters
- HIV infection
- Lack of health care
- Multidrug resistant TB
75
Histoplasmosis
________ infection
- Caused by Histoplasma capsulatum
* Spores can be inhaled on dust particles.
- Common opportunistic infection
- First stage often asymptomatic
Second stage
- Granuloma formation and ________
- Cough, fatigue, fever, night sweats
Treatment—__________ agents
Fungal infection
- Caused by Histoplasma capsulatum
* Spores can be inhaled on dust particles.
- Common opportunistic infection
- First stage often asymptomatic
Second stage
- Granuloma formation and necrosis
- Cough, fatigue, fever, night sweats
Treatment—antifungal agents
76
Anthrax
Bacterial infection by __________ bacilli
-Inhalation anthrax
- _______ symptoms
- Severe acute respiratory distress
-Shock caused by release of toxins
- High ______ rates
Treatment with antimicrobial agent ciprofloxacin
-Animal vaccine available
* Recommended for people working with the organism or
in other professions that might cause exposure
Bacterial infection by gram-positive bacilli
-Inhalation anthrax
- Flulike symptoms
- Severe acute respiratory distress
-Shock caused by release of toxins
- High fatality rates
Treatment with antimicrobial agent ciprofloxacin
-Animal vaccine available
* Recommended for people working with the organism or
in other professions that might cause exposure
77
Cystic Fibrosis
Inherited (genetic) disorder
- Gene located on chromosome ___
- Tenacious mucus from exocrine glands
-Primary effects seen in lungs and _________
Lungs
-Mucus obstructs airflow in bronchioles and small bronchi.
-Permanent damage to bronchial walls
-Infections are common.
* Commonly caused by Pseudomonas aeruginosa and Staphylococcus aureus
Inherited (genetic) disorder
- Gene located on chromosome 7
- Tenacious mucus from exocrine glands
-Primary effects seen in lungs and pancreas
Lungs
-Mucus obstructs airflow in bronchioles and small bronchi.
-Permanent damage to bronchial walls
-Infections are common.
* Commonly caused by Pseudomonas aeruginosa and Staphylococcus aureus
78
Cystic Fibrosis (Cont.)
Digestive tract
- Meconium ileus in newborns
- Blockage of pancreatic ducts
- Obstruction of _____ ducts
- Salivary glands often mildly affected
Reproductive tract
- Obstruction of vas deferens (male)
- Obstruction of _______ (female)
Sweat glands- Sweat has high _____________ content.
Digestive tract
- Meconium ileus in newborns
- Blockage of pancreatic ducts
- Obstruction of bile ducts
- Salivary glands often mildly affected
Reproductive tract
- Obstruction of vas deferens (male)
- Obstruction of cervix (female)
Sweat glands- Sweat has high sodium chloride content.
79
Cystic Fibrosis (Cont.)
Signs and symptoms
Meconium ileus may occur at birth.
-_______ skin * May lead to performing sweat test and diagnosis of cystic fibrosis
Signs of _________
* Steatorrhea, abdominal distention
Chronic cough and frequent respiratory infections
* Tend to increase over time
Failure to meet normal _______ milestones
Signs and symptoms
Meconium ileus may occur at birth.
-Salty skin * May lead to performing sweat test and diagnosis of cystic fibrosis
Signs of malabsorption
* Steatorrhea, abdominal distention
Chronic cough and frequent respiratory infections
* Tend to increase over time
Failure to meet normal growth milestones
80
Cystic Fibrosis (Cont.)
Diagnosis
-_______ testing
-Sweat test
-Testing of stool
-Radiography, pulmonary function tests
-Blood gas analysis
Treatment
-Interdisciplinary approach
* Replacement therapy and well-balanced _____
* ______ physiotherapy
Diagnosis
-Genetic testing
-Sweat test
-Testing of stool
-Radiography, pulmonary function tests
-Blood gas analysis
Treatment
-Interdisciplinary approach
* Replacement therapy and well-balanced diet
* Chest physiotherapy
81
Lung Cancer
-About 90% of cases are related to __________
___________ carcinoma
-Most common type of primary malignant lung tumor
-Arises from bronchial epithelium
Squamous cell carcinoma
- Usually develops from __________ lining of a bronchus
Adenocarcinomas and bronchoalveolar cell carcinomas
-Usually found on periphery of ______
-About 90% of cases are related to smoking.
Bronchogenic carcinoma
-Most common type of primary malignant lun tumor
-Arises from bronchial epithelium
Squamous cell carcinoma
- Usually develops from epithelial lining of a bronchus
Adenocarcinomas and bronchoalveolar cell carcinomas
-Usually found on periphery of lung
82
Lung tumor effects
-Obstruction of ________ into a bronchus
* Causes abnormal breath sounds and dyspnea
-Inflammation and bleeding surrounding the tumor
* Cough, hemoptysis, and secondary infections
- Pleural effusion, hemothorax, pneumothorax
- Paraneoplastic syndrome occurs when tumor cell secretes ________________
- Usual systemic effects of cancer
-Obstruction of airflow into a bronchus
* Causes abnormal breath sounds and dyspnea
-Inflammation and bleeding surrounding the tumor
* Cough, hemoptysis, and secondary infections
- Pleural effusion, hemothorax, pneumothorax
- Paraneoplastic syndrome
* Occurs wen tumor cell secretes hormones or hormonelike substances
- Usual systemic effects of cancer
83
Lung Cancer (Cont.)
Early signs
- Persistent productive cough
- Detection on radiograph
- Hemoptysis
- Pleural involvement
- Chest pain
- Hoarseness, facial or arm edema, headache, dysphagia, or atelectasis
Systemic signs
- ___________, _________, __________
Early signs
- Persistent productive cough
- Detection on radiograph
- Hemoptysis
- Pleural involvement
- Chest pain
- Hoarseness, facial or arm edema, headache, dysphagia, or atelectasis
Systemic signs
- Weight loss, anemia, fatigue
84
Paraneoplastic syndrome
-Indicated by signs of an _______________
* Related to the specific _________ secreted
Paraneoplastic syndrome
-Indicated by signs of an endocrine disorder
* Related to the specific hormone secreted
85
Lung cancer
Signs of metastases
- _____ pain
- _________ deficits, motor deficits
Signs of metastases
-Bone pain
-Cognitive deficits, motor deficits
86
Lung Cancer (Cont.)
Diagnostic tests
-Specialized helical CT scans and ____
- _______ radiography
-Bronchoscopy
-Biopsy and mediastinoscopy
Treatment
-Surgical resection or lobectomy
-Chemotherapy and _________
-Photodynamic therapy
Diagnostic tests
-Specialized helical CT scans and MRI
-Chest radiography
-Bronchoscopy
-Biopsy and mediastinoscopy
Treatment
-Surgical resection or lobectomy
-Chemotherapy and radiation
-Photodynamic therapy
87
Aspiration
-Passage of food, fluid, emesis, other foreign material into _________&__________
- Common problem in young children or ppl ________________ when eating or drinking
Result may be:
_______________
* Aspirate is a solid object.
Inflammation and swelling
* Aspirate is an irritating liquid.
Predisposition to ______________
-Passage of food, fluid, emesis, other foreign material into trachea and lungs
- Common problem in young children or ppl laying down when eating or drinking
Result may be:
Obstruction
* Aspirate is a solid object.
Inflammation and swelling
* Aspirate is an irritating liquid.
Predisposition to pneumonia
88
Aspiration (Cont.)
Potential complications
Aspiration pneumonia
* Inflammation—gas ____________ is impaired.
Respiratory distress syndrome
* May develop if ____________ is widespread
Pulmonary __________
* May develop if microbes are in aspirate
Systemic effects
* When aspirated materials (solvents) are absorbed into blood
Aspiration pneumonia
* Inflammation—gas diffusion is impaired.
Respiratory distress syndrome
* May develop if inflammation is widespread
Pulmonary abscess
* May develop if microbes are in aspirate
Systemic effects
* When aspirated materials (solvents) are absorbed into blood
89
Aspiration (Cont.)
Signs and symptoms
- Coughing and _________ with dyspnea
- Loss of ______ if total obstruction
- Stridor and hoarseness * Characteristic of upper airway obstruction
- Wheezing * Aspiration of _________
- Tachycardia and tachypnea
- Nasal flaring, chest retractions, hypoxia * ________ respiratory distress
- Cardiac or respiratory arrest
- Coughing and choking with dyspnea
- Loss of voice if total obstruction
- Stridor and hoarseness * Characteristic of upper airway obstruction
- Wheezing * Aspiration of liquids
- Tachycardia and tachypnea
- Nasal flaring, chest retractions, hypoxia * severe respiratory distress
- Cardiac or respiratory arrest
90
Obstructive Sleep Apnea
-Result of _____________ tissue collapse during sleep
-Leads to repeated and momentary ___________ of breathing
-Men are affected more often than women.
- Obesity and ________ are common predisposing factors.
Treatment
-Continuous positive airway pressure pump (_____________)
-Oral appliances that reduce collapse of pharyngeal tissue
-Result of pharyngeal tissue collapse during sleep
-Leads to repeated and momentary cessation of breathing
-Men are affected more often than women.
- Obesity and aging are common predisposing factors.
Treatment
-Continuous positive airway pressure pump (CPAP machine)
-Oral appliances that reduce collapse of pharyngeal tissue
91
Asthma
- ____________ obstruction
- Occurs in persons with hypersensitive or hyperresponsive __________
- May occur in childhood or have an adult onset
- Often family history of _________ conditions
Asthma
- Bronchial obstruction
- Occurs in persons with hypersensitive or hyperresponsive airways
- May occur in childhood or have an adult onset
- Often family history of allergic conditions
92
Extrinsic asthma
-Acute episodes triggered by _______ ____ ______________ reactions
Intrinsic asthma
-Onset during ______________
-Hyperresponsive tissue in airway initiates attack.
-Stimuli include:
* Respiratory infections
* Stress
* Exposure to cold
* Inhalation of irritants
* Exercise
* Drugs
Extrinsic asthma
-Acute episodes triggered by type I hypersensitivity reactions
Intrinsic asthma
-Onset during adulthood
-Hyperresponsive tissue in airway initiates attack.
-Stimuli include:
* Respiratory infections
* Stress
* Exposure to cold
* Inhalation of irritants
* Exercise
* Drugs
93
Asthma (Cont.)
-Pathophysiological changes of _______________________
-Inflammation of the mucosa with ________
- Bronchoconstriction * Caused by contraction of smooth muscle
-Increased secretion of thick mucus * In airways
- Changes create ____________ airways, partial or total.
-Pathophysiological changes of bronchi and bronchioles
-Inflammation of the mucosa with edema
- Bronchoconstriction * Caused by contraction of smooth muscle
-Increased secretion of thick mucus * In airways
- Changes create obstructed airways, partial or total.
94
Asthma:
Signs and Symptoms
-Cough, marked dyspnea, tight feeling in chest
- Wheezing
- ______ and labored breathing
-Expulsion of thick or sticky ______
-Tachycardia
- Hypoxia
- Respiratory alkalosis- Initially caused by ____________
- Respiratory acidosis- Caused by ______________
- Severe respiratory distress
- Hypoventilation leads to hypoxemia and respiratory acidosis.
-Respiratory failure
-Indicated by decreasing responsiveness, cyanosis
-Cough, marked dyspnea, tight feeling in chest
- Wheezing
- Rapid and labored breathing
-Expulsion of thick or sticky mucus
-Tachycardia
- Hypoxia
- Respiratory alkalosis- Initially caused by hyperventilation
- Respiratory acidosis- Caused by air trapping
- Severe respiratory distress
- Hypoventilation leads to hypoxemia and respiratory acidosis.
-Respiratory failure
-Indicated by decreasing responsiveness, cyanosis
95
_____________________
- Persistent severe attack of asthma
* Does not respond to usual therapy
* Medical emergency!
* May be fatal because of severe hypoxia and acidosis
Status asthmaticus
96
Asthma: Treatment
General measures
- ______________ for allergic reactions
- Avoidance of triggering factors
-Good _____________ of environment
- Swimming and walking
-Use of maintenance _________ or drugs
Measures for acute attacks
-Controlled breathing techniques
-Inhalers * Bronchodilators
-________________
- Skin tests for allergic reactions
- Avoidance of triggering factors
-Good ventilation of environment
- Swimming and walking
-Use of maintenance inhalers or drugs
Measures for acute attacks
-Controlled breathing techniques
-Inhalers * Bronchodilators
-Glucocorticoids
97
Asthma: Treatment (Cont.)
Measures for status asthmaticus
- Hospital care if no response to ______________
Prophylaxis and treatment for chronic asthma
- Leukotriene receptor antagonists * Block inflammatory resp. in presence of stimulus
* Not effective for treatment of acute attacks
- Cromolyn sodium
* Prophylactic medication
* Inhalation on a _______ basis
* Useful for athletes and sports enthusiasts
* No value during an acute attack
Measures for status asthmaticus
- Hospital care if no response to bronchodilator
Prophylaxis and treatment for chronic asthma
- Leukotriene receptor antagonists * Block inflammatory resp. in presence of stimulus
* Not effective for treatment of acute attacks
- Cromolyn sodium
* Prophylactic medication
* Inhalation on a daily basis
* Useful for athletes and sports enthusiasts
* No value during an acute attack
98
Chronic Obstructive Pulmonary Disease
Group of ________ respiratory disorders
- Causes irreversible and progressive damage to ______
- Debilitating conditions that may affect individual’s ability to work
- May lead to the development of cor pulmonale
- Respiratory ________ may occur.
Group of chronic respiratory disorders
- Causes irreversible and progressive damage to lungs
- Debilitating conditions that may affect individual’s ability to work
- May lead to the development of cor pulmonale
- Respiratory failure may occur.
99
Chronic Obstructive Pulmonary Disease: Emphysema
-Destruction of alveolar walls and septae > Leads to large, permanently inflated alveolar _____________
-Classified by specific __________ of changes
Contributing factors
- ___________ deficiency or tendency
-Cigarette smoking
- Pathogenic ____________
-Destruction of alveolar walls and septae > Leads to large, permanently inflated alveolar air spaces
-Classified by specific location of changes
Contributing factors
- Genetic deficiency or tendency
-Cigarette smoking
- Pathogenic bacteria
100
Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)
Breakdown of alveolar wall results in:
- Loss of surface area for gas ___________
- Loss of pulmonary ___________
- Loss of elastic ______
- Altered ventilation-perfusion ratio
- Decreased support for other structures
Fibrosis
- ___________ airways
- ___________ walls
- Interference with passive expiratory airflow
Breakdown of alveolar wall results in:
- Loss of surface area for gas exchange
- Loss of pulmonary capillaries
- Loss of elastic fibers
- Altered ventilation-perfusion ratio
- Decreased support for other structures
Fibrosis
- Narrowed airways
- Weakened walls
- Interference with passive expiratory airflow
100
Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)
Progressive difficulty with expiration
- Air ______________ and increased residual volume
- Over___________ of the lungs
- Fixation of ribs in an respiratory position, increased anterior-posterior diameter of thorax (barrel chest)
- Flattened _____________ (on radiographs)
Progressive difficulty with expiration
- Air trapping and increased residual volume
- Overinflation of the lungs
- Fixation of ribs in an respiratory position, increased anterior-posterior diameter of thorax (barrel chest)
- Flattened diaphragm (on radiographs)
101
Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)
Advanced emphysema and loss of tissue
- Adjacent damaged ________ coalesce, forming large air spaces.
- Pneumothorax * Occurs when pleural membrane surrounding large blebs ruptures
- Hypercapnia becomes marked.
- ___________ becomes driving force of respiration
- Frequent infections
- Pulmonary hypertension and cor pulmonale may develop in late stage.
Advanced emphysema and loss of tissue
- Adjacent damaged alveoli coalesce, forming large air spaces.
- Pneumothorax * Occurs when pleural membrane surrounding large blebs ruptures
- Hypercapnia becomes marked.
- Hypoxia becomes driving force of respiration
- Frequent infections
- Pulmonary hypertension and cor pulmonale may develop in late stage.
102
Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)
Signs and symptoms
- Dyspnea * Occurs first on exertion
-Hyperventilation with prolonged expiratory phase * Development of barrel chest
- Anorexia and fatigue * Weight loss
- Clubbed fingers
- Diagnostic tests
- Chest radiography and pulmonary function tests
Signs and symptoms
- Dyspnea * Occurs first on exertion
-Hyperventilation with prolonged expiratory phase * Development of barrel chest
- Anorexia and fatigue * Weight loss
- Clubbed fingers
- Diagnostic tests
- Chest radiography and pulmonary function tests
103
Chronic Obstructive Pulmonary Disease: Emphysema (Cont.)
Treatment
- Avoidance of respiratory ________
- ____________ against influenza and pneumonia
- Pulmonary rehabilitation
- Appropriate breathing techniques
-Adequate nutrition and hydration
* Improves energy levels, resistance to infection
- Bronchodilators, antibiotics, oxygen therapy as condition advances
- Lung ___________ surgery
Treatment
- Avoidance of respiratory irritants
- Immunization against influenza and pneumonia
- Pulmonary rehabilitation
- Appropriate breathing techniques
-Adequate nutrition and hydration
* Improves energy levels, resistance to infection
- Bronchodilators, antibiotics, oxygen therapy as condition advances
- Lung reduction surgery
104
Chronic Bronchitis
- Inflammation, obstruction, repeated infection, ________________ twice for 3+ months
in 2 years
* History of cigarette smoking or living in urban or industrial area
- Mucosa inflamed and swollen
- Hypertrophy and hyperplasia of mucous glands
- Fibrosis and thickening of ___________ wall
- Low oxygen levels
- Severe dyspnea and fatigue
- Pulmonary hypertension and cor pulmonale
- Inflammation, obstruction, repeated infection, chronic cough twice for 3+ months
in 2 years
* History of cigarette smoking or living in urban or industrial area
- Mucosa inflamed and swollen
- Hypertrophy and hyperplasia of mucous glands
- Fibrosis and thickening of bronchial wall
- Low oxygen levels
- Severe dyspnea and fatigue
- Pulmonary hypertension and cor pulmonale
105
Chronic Bronchitis (Cont.)
Signs and symptoms
- Constant productive _________
- Tachypnea and shortness of breath
-Frequent thick and purulent _________
- Cough and rhonchi more severe in the ____________
- Hypoxia, cyanosis, hypercapnia * Caused by airway obstruction
- Polycythemia, weight loss, signs of cor pulmonale possible
* As vascular damage and pulmonary hypertension progress
Signs and symptoms
- Constant productive cough
- Tachypnea and shortness of breath
-Frequent thick and purulent secretions
- Cough and rhonchi more severe in the morning
- Hypoxia, cyanosis, hypercapnia * Caused by airway obstruction
- Polycythemia, weight loss, signs of cor pulmonale possible
* As vascular damage and pulmonary hypertension progress
106
Chronic Bronchitis (Cont.)
Treatment
- Cessation of ___________ and reduction of exposure to irritants
- Treatment of infection
- ____________ for prophylaxis
- Expectorants
- Bronchodilators
- Appropriate chest therapy * Including postural drainage and percussion
-Low-flow oxygen
- Nutritional supplements
Treatment
- Cessation of smoking and reduction of exposure to irritants
- Treatment of infection
- Vaccination for prophylaxis
- Expectorants
- Bronchodilators
- Appropriate chest therapy * Including postural drainage and percussion
-Low-flow oxygen
- Nutritional supplements
107
Bronchiectasis
- Usually a secondary condition
- Irreversible abnormal ___________ of the mediumsized __________ (primarily)
- May be saccular or elongated
-Arises from recurrent _____________ and infection
- Leads to obstruction of airways, weakening of muscle and elastic fibers in bronchial walls, or both
- Infecting organisms
- Usually mixed * Streptococci, staphylococci, pneumococci, H. influenzae
- Usually a secondary condition
- Irreversible abnormal dilation of the mediumsized bronchi (primarily)
- May be saccular or elongated
-Arises from recurrent inflammation and infection
- Leads to obstruction of airways, weakening of muscle and elastic fibers in bronchial walls, or both
- Infecting organisms
- Usually mixed * Streptococci, staphylococci, pneumococci, H. influenzae
108
Bronchiectasis (Cont.)
Signs and symptoms
- Chronic ________
- Production of copious amounts of purulent, foulsmelling _______
Treatment
-Antibiotics
-Bronchodilators
-Chest physiotherapy
- Treatment of primary condition
Signs and symptoms
- Chronic cough
- Production of copious amounts of purulent, foulsmelling sputum
Treatment
-Antibiotics
-Bronchodilators
-Chest physiotherapy
- Treatment of primary condition
109
Restrictive Lung Disorders
Group of disorders with impaired lung _____________ and reduced total lung capacity
First group
- Abnormality of __________ —limits or impairs lung expansion
* Kyphosis or scoliosis, poliomyelitis, amyotrophic lateral sclerosis, botulism, muscular dystrophy
Second group
-Diseases affecting the supporting ___________ of lungs
* Idiopathic pulmonary fibrosis, occupational diseases
Group of disorders with impaired lung expansion and reduced total lung capacity
First group
- Abnormality of chest wall—limits or impairs lung expansion
* Kyphosis or scoliosis, poliomyelitis, amyotrophic lateral sclerosis, botulism, muscular dystrophy
Second group
-Diseases affecting the supporting framework of lungs
* Idiopathic pulmonary fibrosis, occupational diseases
110
Pneumoconioses
- Chronic restrictive diseases resulting from long-term exposure to _______________
-Inflammation—gradual destruction of connective tissue
- Functional areas of the lungs lost
-Onset insidious
-Dyspnea develops first
- Treatment—ending exposure, treatment of infection
- Chronic restrictive diseases resulting from long-term exposure to irritating particles
-Inflammation—gradual destruction of connective tissue
- Functional areas of the lungs lost
-Onset insidious
-Dyspnea develops first
- Treatment—ending exposure, treatment of infection
111
Vascular Disorders: Pulmonary Edema
- _______ collecting in alveoli and interstitial area
- Can result from many primary conditions
- Reduces amount of _________ diffusing into blood
- Interferes with lung expansion
May develop when:
- Inflammation in lungs is present. * Increases permeability of capillaries
Plasma protein levels are low. * Decreases osmotic pressure of plasma
-Pulmonary hypertension develops.
- Fluid collecting in alveoli and interstitial area
- Can result from many primary conditions
- Reduces amount of oxygen diffusing into blood
- Interferes with lung expansion
May develop when:
- Inflammation in lungs is present. * Increases permeability of capillaries
Plasma protein levels are low. * Decreases osmotic pressure of plasma
-Pulmonary hypertension develops.
112
Pulmonary Edema (Cont.)
Signs and symptoms
-Cough, orthopnea, rales—in mild cases
- Hemoptysis
- Frothy, blood-tinged _______
Treatment
- Treat causative factors.
- Supportive care
- Possibility of positive-pressure _____________ ventilation
Signs and symptoms
-Cough, orthopnea, rales—in mild cases
- Hemoptysis
- Frothy, blood-tinged sputum
Treatment
- Treat causative factors.
- Supportive care
- Possibility of positive-pressure mechanical ventilation
113
Pulmonary Embolus
- _________________ that obstructs pulmonary artery or any of its branches
- Effect of embolus depends on material, size, and location
- Small pulmonary emboli might be “silent” unless they involve a large area of lung.
- Large emboli may cause ___________.
- 90% of pulmonary emboli originate from deep vein thromboses in legs; are preventable
- Blood clot or mass that obstructs pulmonary artery or any of its branches
- Effect of embolus depends on material, size, and location
- Small pulmonary emboli might be “silent” unless they involve a large area of lung.
- Large emboli may cause sudden death.
- 90% of pulmonary emboli originate from deep vein thromboses in legs; are preventable
114
Pulmonary Embolus (Cont.)
Signs and symptoms
- Transient chest pain, cough, dyspnea—small emboli
- Larger emboli—increased ____________ with coughing or deep breathing; tachypnea and dyspnea develop suddenly.
* Later—__________ and fever
* Hypoxia—causes anxiety, restlessness, pallor, tachycardia
- Massive emboli
* Severe crushing chest pain, low blood pressure, rapid weak pulse, loss of ___________
Signs and symptoms
- Transient chest pain, cough, dyspnea—small emboli
- Larger emboli—increased chest pain with coughing or deep breathing; tachypnea and dyspnea develop suddenly.
* Later—hemoptysis and fever
* Hypoxia—causes anxiety, restlessness, pallor, tachycardia
- Massive emboli
* Severe crushing chest pain, low blood pressure, rapid weak pulse, loss of consciousness
115
Pulmonary Embolus (Cont.)
Prevention
-Health teaching prior to surgery
- Antiembolic ___________
- ___________ to prevent thrombosis
-Use of anticoagulant drugs
Diagnosis
- Radiography, lung scan, MRI, pulmonary angiography
Prevention
-Health teaching prior to surgery
- Antiembolic stockings
- Exercise to prevent thrombosis
-Use of anticoagulant drugs
Diagnosis
- Radiography, lung scan, MRI, pulmonary angiography
116
Pulmonary Embolus (Cont.)
Treatment
- Assessment of risk factors
- Prolonged ___________ and compression stockings
-Surgically Inserted filter into vena cava (some cases)
-__________ or streptokinase
- Mechanical ventilation
- Embolectomy
Treatment
- Assessment of risk factors
- Prolonged bed rest and compression stockings
-Surgically Inserted filter into vena cava (some cases)
-Heparin or streptokinase
- Mechanical ventilation
- Embolectomy
117
Expansion Disorders- Atelectasis
- Nonaeration or _________ of lung or part of a lung
- Leads to ___________ gas exchange and hypoxia
- Alveoli become _________
- Collapse and inflammation or atrophy occur.
-Process interferes with _________ flow through the lung.
- Both ventilation and perfusion are altered.
- Affects oxygen diffusion
- Nonaeration or collapse of lung or part of a lung
- Leads to decreased gas exchange and hypoxia
- Alveoli become airless.
- Collapse and inflammation or atrophy occur.
-Process interferes with blood flow through the lung.
- Both ventilation and perfusion are altered.
- Affects oxygen diffusion
118
Atelectasis (Cont.)
Mechanisms that can result in atelectasis
- Obstructive or resorption atelectasis
* Caused by total ___________ of airway
- Compression atelectasis
* Mass or tumor exerts _________ on part of the lung.
- Increased surface tension in ________
* Prevents expansion of lung
- Fibrotic tissue in lungs or pleura
* May restrict expansion and lead to collapse
- Postoperative atelectasis * Can occur after surgery
- Obstructive or resorption atelectasis
* Caused by total obstruction of airway
- Compression atelectasis
* Mass or tumor exerts pressure on part of the lung.
- Increased surface tension in alveoli
* Prevents expansion of lung
- Fibrotic tissue in lungs or pleura
* May restrict expansion and lead to collapse
- Postoperative atelectasis * Can occur after surgery
119
Atelectasis (Cont.)
Signs and symptoms
- Small areas are asymptomatic.
- Large areas
* Dyspnea
* Increased heat and _____________ rates
* Chest pain
Signs and symptoms
- Small areas are asymptomatic.
- Large areas
* Dyspnea
* Increased heat and respiratory rates
* Chest pain
120
Expansion Disorders- Pleural Effusion
- Presence of excessive ________ in the pleural cavity
- Causes increased ____________ in pleural cavity
- Separation of pleural membranes
-Exudative effusions - Response to inflammation
Transudate effusions
- Watery effusions (hydrothorax)- Result of increased hydrostatic pressure or decreased osmotic pressure in blood vessels
- Presence of excessive fluid in the pleural cavity
- Causes increased pressure in pleural cavity
- Separation of pleural membranes
-Exudative effusions - Response to inflammation
Transudate effusions
- Watery effusions (hydrothorax)- Result of increased hydrostatic pressure or decreased osmotic pressure in blood vessels
121
Pleural Effusion (Cont.)
Signs and symptoms
- Dyspnea
- Cyclic _______ pain
- Increased respiratory and heart rates
Treatment
- Remove underlying cause to treat respiratory impairment.
- Analyze ______ to confirm cause.
- Chest ______________ , thoracocentesis to remove fluid and relieve pressure
Signs and symptoms
- Dyspnea
- Cyclic chest pain
- Increased respiratory and heart rates
Treatment
- Remove underlying cause to treat respiratory impairment.
- Analyze fluid to confirm cause.
- Chest drainage, thoracocentesis to remove fluid and relieve pressure
122
Pneumothorax
- ____ in pleural cavity
- Closed pneumothorax
- Air can enter pleural cavity from internal airways— no opening in chest wall
- Simple or spontaneous pneumothorax
* Tear on the surface of the lung
- Secondary pneumothorax
* Associated with underlying __________ disease
* Rupture of an emphysematous bleb on lung surface or erosion by a tumor or tubercular cavitation
- Air in pleural cavity
- Closed pneumothorax
- Air can enter pleural cavity from internal airways— no opening in chest wall
- Simple or spontaneous pneumothorax
* Tear on the surface of the lung
- Secondary pneumothorax
* Associated with underlying respiratory disease
* Rupture of an emphysematous bleb on lung surface or erosion by a tumor or tubercular cavitation
123
Pneumothorax (Cont.)
-Open pneumothorax
-Atmospheric air enters the pleural cavity though an opening in the ______ wall.
-“Sucking” wound
* Large opening in chest wall
-Tension pneumothorax
* Most serious form
* Result of an opening through chest wall and parietal pleura or from a tear in the __________________ and visceral pleura
* Air entry into pleural cavity on inspiration but hole closes on expiration
* Trapping air leads to increased pleural pressure and ____________
-Open pneumothorax
-Atmospheric air enters the pleural cavity though an opening in the chest wall.
-“Sucking” wound
* Large opening in chest wall
-Tension pneumothorax
* Most serious form
* Result of an opening through chest wall and parietal pleura or from a tear in the lung tissue and visceral pleura
* Air entry into pleural cavity on inspiration but hole closes on expiration
* Trapping air leads to increased pleural pressure and atelectasis
124
Flail Chest
- Results from fractures of _______, which allow ribs to move independently during respiration
- During inspiration
- Flail or broken section moves inward rather than outward.
- Inward movement of ribs prevents ____________ of affected lung.
- Large flail section can compress adjacent lung tissue.
* Pushing air out of that section—up the bronchus
* Air (stale) from damaged lung crosses into the other lung with newly inspired air.
- Results from fractures of ribs, which allow ribs to move independently during respiration
- During inspiration
- Flail or broken section moves inward rather than outward.
- Inward movement of ribs prevents expansion of affected lung.
- Large flail section can compress adjacent lung tissue.
* Pushing air out of that section—up the bronchus
* Air (stale) from damaged lung crosses into the other lung with newly inspired air.
125
Flail Chest (Cont.)
- During expiration
- Unstable fail section pushed ___________ by increasing intrathoracic pressure.
-Large flail section
* Paradoxical movement of ribs alters ____________ during expiration.
-Air from unaffected lung moves across into affected lung.
- __________ results from limited expansion and decreased inspiratory volume.
- During expiration
- Unstable fail section pushed outward by increasing intrathoracic pressure.
-Large flail section
* Paradoxical movement of ribs alters airflow during expiration.
-Air from unaffected lung moves across into affected lung.
- Hypoxia results from limited expansion and decreased inspiratory volume.
126
Infant Respiratory Distress Syndrome
- Usually related to ___________ birth
- Lack of surfactant in alveoli
- Poorly developed alveoli are difficult to _________
- Diffuse atelectasis results.
-Decreased pulmonary blood flow—pulmonary vasoconstriction—severe hypoxia
- Poor lung perfusion and lack of surfactant
- Increased alveolar capillary permeability
- Fluid and protein leak into interstitial area and alveoli, hyaline membrane formation
- Usually related to premature birth
- Lack of surfactant in alveoli
- Poorly developed alveoli are difficult to inflate.
- Diffuse atelectasis results.
-Decreased pulmonary blood flow—pulmonary vasoconstriction—severe hypoxia
- Poor lung perfusion and lack of surfactant
- Increased alveolar capillary permeability
- Fluid and protein leak into interstitial area and alveoli, hyaline membrane formation
127
Adult Respiratory Distress Syndrome
- Results from ________ to the alveolar wall and capillary membrane
- Causes the release of chemical ___________
* Increases ____________ of alveolar capillary membranes
* Increased fluid and protein in interstitial area and alveoli
* Damage to surfactant-producing cells
* Diffuse necrosis and fibrosis if patient survives
- Multitude of predisposing conditions
- Often associated with multiple organ dysfunction or failure
- Results from injury to the alveolar wall and capillary membrane
- Causes the release of chemical mediators
* Increases permeability of alveolar capillary membranes
* Increased fluid and protein in interstitial area and alveoli
* Damage to surfactant-producing cells
* Diffuse necrosis and fibrosis if patient survives
- Multitude of predisposing conditions
- Often associated with multiple organ dysfunction or failure
128
Acute Respiratory Failure
-May result from ______________ disorders
- Emphysema
-Combination of chronic and acute disorders
-Acute respiratory disorders
-Many neuromuscular diseases
- Signs may be masked or altered by primary problem
Treatment
-________________ must be resolved
- Supportive treatment to maintain respiratory function
-May result from acute or chronic disorders
- Emphysema
-Combination of chronic and acute disorders
-Acute respiratory disorders
-Many neuromuscular diseases
- Signs may be masked or altered by primary problem
Treatment
-Primary problem must be resolved
- Supportive treatment to maintain respiratory function
