Class 7&8 Flashcards
Manifestations of Pulmonary Diseases
Cough
Abnormal Sputum (evaluate color, amount, consistency)
Hemoptysis (spitting up blood)
Dyspnea (difficulty breathing, SOB, transient, chronic or positional) due to pulmonary congestion
Pain (from pleura, lung tissue or chest wall, sharp & localized, worse when cough or deep breathing, location & type can determine problem)
Digital Clubbing (ends of fingers & toes nails touch, associated with chronic hypoxia)
Abnormal breathing patterns
Cyanosis (bluish mucous membranes, reflects hypoxemia)
Kussmaul Respiration (hyperpnea)
Increased resp rate, rapid & deep
Can be due to obstruction, exercise
Cheyne-Stokes breathing
big breath/sigh & then becomes shallow, no breathing (apnea) then big sigh
Due to lack of proper oxygenation to brain and slow blood flow to brain stem
Hypercapnia
Associated with hypoventilation, increased CO2 in blood, results in respiratory acidosis
Can be due to hypoventilation, spinal cord injuries or paralysis of diaphragm
Manifestations: greater than 45 CO2, pH lower than 7.35, initially breathe fast & then becomes sleepy & disoriented, headaches, muscles twitching
Hypocapnia
Less CO2 in blood, hyperventilation
Results in respiratory alkalosis
Due to anxiety, acute head injury, pain & in response to conditions with insufficient oxygenation of the brain
Normal paO2 Level
80-100mmHg
Hypoxemia
Decrease of O2 in the blood
Proper breathing requires ventilation & perfusion so this leads to ventilation-perfusion abnormalities
Caused by altitude changes, vasoconstriction of all vessels, embolus thats clogging vessels, shunt (very low ventilation)
Results from problems with:
1. O2 delivery to alveoli
2. Diffusion of O2 from alveoli into blood
3. Perfusion of pulmonary capillaries
Hypoxia
Lack of oxygen in the entire body, not just the blood.
Common disorders of chest wall, pleura & lungs
Pneumothorax
Atelectasis
Pulmonary edema
Pneumothorax
Air present in thorax due to punctured lung (rupture in visceral pleura)
Can spontaneously occur due to bleds(holes punctured in lung)
The lack of negative pressure disrupts the equilibrium between elastic recoil forces of lung & chest wall causing the lung to collapse
Atelectasis
Individual alveoli collapse due to the air being absorbed out of the alveoli & no fresh air coming in.
2 types:
1. Compression: caused by external pressure causing alveoli to collapse
2. Absorption: caused by removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated O2 or anesthetic agents
Open pore of Kohn allows deep breathing
Shunt**
Pulmonary Edema
Excess water is pressent in the lung, caused by increased pressure to the lungs while the blood is pushing back up into the tissue
There is no ability to pick up extra fluid
Predisposing factors are heart disease**, acute respiratory distress, inhalation of toxic gases
Pneumonia
More prominent in the chronically ill or immunocompromised or elderly
Caused by bacteria, virus, & fungi (facilitated by exposure to large amounts of pathogens)
Risk factors: age, unconscious (inability to cough out secretions), smoking
Can lead to respiratory failure
Community acquired –> strep. pneumoniae, mycoplasma pneumonia
Hospital acquired –> staphy. aureus, pseudomonas aureus
Treat with antibiotics, antivirals, hydration & pulmonary hygiene
Pathophysiology of Pneumonia
- Breathe in bacteria that attract macrophages
- Macrophages put antigens on cell wall to instigate inflammatory response w/ lots of exudate
- Red hepatization (change appearance of lungs to look like liver due to exudate accumulation)
- Grey hepatization (RBC are broken down & lungs look grey like)
Clinical Manifestations of Pneumonia
Decreased O2 sats
Persistent coughing
Exudate present in cough (1st stage: yellow, 2nd stage: hemopytosis, 3rd stage: grey sputum)
Consolidation (decreased breathing sounds)
Tachypnia (rapid breathing)
Fatigue
Fever, leukocytosis, chills
Levels of Prevention for Pneumonia
Primary: pneumococcal vaccines for infants & influenza vaccines for older people, Hand hygiene
Secondary Level: Early recognition via chest x-ray, blood count, cultures, physical assessment
Tertiary Level: antibiotics, supportive treatmetn (O2, fluids, nutrition & rest)
Infant Pneumonia Manifestations
Signs of distress whilst breathing
Retraction of skin between ribs
Substernal caving
Nausea, Vomiting, Restlessness
Older Adults Pneumonia Manifestations
Confusion & delirium
Incontinent
Lathargic
Weak, high fall risk
Viral Pneumonia
Most common in infants
Can set the stage for a secondary bacterial infection
Enters upper resp tract & invades bronchi & alveoli
Replicate inside the cells & burst out forecefully causing widespread cell death
DO NOT USE ANTIBIOTIC THERAPY! Use antivirals
Acute Bronchitis
Caused by acute infection or inflammation of the lower airways
Caused by Respiratory Synyctial Virus (RSV)
Reoccurs as it doesn’t confer immunity
Common in infants, in the winter, transmitted via sneezing & secretions
Enters mucosal cells & burst out invading neighboring cells, living together in chunks (syncytial) which irritate tissue * mechanical obstruction
Acute Bronchitis Manifestations
Decreased sound Crackling Retraction of skin Tachypnea Tachycardia Chest pain
Treatment of Acute Bronchitis
Rest
Aspirin
Humidity
Cough suppressent
Tuberculosis
Aerosol Transmission
Primary TB (95% of cases)
Secondary TB
Diagnosed via mantoux test (positive test shows that you’ve been exposed to the virus)
Manifestations: extreme weight loss & hemopotysis
Primary TB
Inhalation of M. tuberculosis bacteria
Macrophages surround bacili forming a tubercule & then present antigen to T cells
Infected tissue within tubercle die (caseous necrosis)
Surrounded bacilli enter dormant phase
Secondary TB
Reinfection or reactivation of primary lesions & tubercle (possibly due to stress)
Caseous granuloma rupture
Bacteria spreads to lungs or other organs via blood stream & lympathic system
Obstructive Pulmonary Disease
Airway obstruction that is worse with expiration Signs are dyspnea & wheezing Asthma is the most common *** Chronic bronchitis Emphysema
Asthma
Chronic inflammation of the airway resulting from hyperresponsiveness of the airways to environmental allergens, microbes, exercise…, genetic predisposition.
Can lead to obstruction (air becomes pressurized increasing difficulty of breathing & hyperinflation, hypercapnia & hypoxia will lead to resp acidosis) & staus asthamticus
Symptoms: expiratory wheezing, dyspnea & tachypnea
Systemic Complications of Asthma
Panic coughing not enough air intake use of accessory muscles prolonged expiratory phase heart & resp rate increase Might be a secondary reaction (another influx of mediators that set on another response)
Asthma Treatments
Peak flow meters (measures how narrow your airways are)
Oral corticosteroids
Inhaled beta-agonists
Anti-inflammatories (histamines), cause secretions to dry up
Rescuer Puffers: Beta 2 agonist, provides bronchodilation
Controller Puffers: Corticosteroids, reduces inflammation
Emphysema
Permanent enlargement of acini (terminal broncioles & alveoli) due to destruction of walls between alveoli, accompanying capillary bed & walls between terminal bronchioles
Genetic cause:(Primary Emphysema) lack of alpha 1 antitrypsine enzyme (develop emphysema at a very young age & quicken via smoking)
Emphysema Manifestations
Air trapping due to loss of elastic recoil
Hyperinflation of lungs
Increased work of breathing
Barrel Chesting –> airs is stuck in it, diameter of lungs get larger from over expanding lungs
Pink puffer –> breathing quickly, leaning & breathing
Pneumothorax
2 types:
1. Centriacinar: septal destruction occurs in resp bronchioles & alveolor ducts causing inflammation (smokers)
2. Panacinar: involves entire acinus with damage more random (more common inolder people & with that deficiency)
Chronic Bronchitis
Usually pts have bronchitis & emphysema
Hypersecretion of mucus & chronic productive cough that last for at least 3 months of the year for 2 consecutive years
Hypertrophy & hyperplasia results in lots of mucous
Inspired irritants (smoke, pollution, infection) increase mucus production & size & number of mucous glands
Inflammation of bronchi
Hypersecretion of thick tenacious mucus
Chronic Bronchitis Manifestations
Hypercapnia
Crackling
Expiratory phase is longer
Labored breathing
decreased exercise tolerance
Polycythemia (Increased RBC count to compensate for O2 loss but doesn’t help)
Pulmonary Hypertension: causes pulmonary artery constriction due to resp acidosis, which increase pulmonary artery pressure. Right side of heart has to work harder to push blood (Cor pulmonale –> right side heart failure)
Chornic Bronchitis - Blue Bloater
Dependent edema (increased volume, pressure & cyanosis because of deoxygenation) due to back up of blood in venous system (due to pulmonary hypertension) Retain a lot of CO2 (hypoxic drive begins & breathing is stimulated due to decresaed O2 levels)
Cystic Fibrosis
Autosomal recessive disease with mutation on chromosome 7
Mutation of gene affects the cystic fibrosis transmembrane conductance regulator (CFTR) resulting in decreased chloride absorption in epithelial cell membranes
Affects primarily caucasians
Mostly affects lungs, but also the sweat glands, pancreas & GI system
Cystic Fibrosis Manifestations
Increased salt in sweat
Dehydrated
Thick mucus in lungs
Impaired exocrine pancreatic function (leads to issues with digestion & absorption)
Cystic Fibrosis Effects on Lungs
Increase mucus production pluggin airways
Decreased cilia motility
Chronic inflammation
excess neutrophils which cause direct damage to structural proteins of the lungs
Wheezes, cough, recurrent pneumonia, GI-pancreatic enzyme & insulin deficiency
Recurrent lung infections caused by Pseudomonas aeroguinosa & staphy. aureus
Diagnosed via sweat test, genotyping, newborn screening,
Cystic Fibrosis Treatments
Chest physio, resp medication, antibiotic therapy, enzyme replacement, dietary adjustment
Lung Cancer
Bronchogenic carcinomas, common cause is smoking. (20X greater chance)
Risk factors: environmental or occupational exposure, second-hand smoke, genetic predisposition.
Results in Obstruction & tissue compression, tissue breakdwon, extopic hormone secretion, changes in organ function due to inflammation & cellular damage
Lung Cancer Tumor Types
Non-small lung cancer (squamous cell carcinoma, adenocarcinoma (moderate growth, tumor arising for glands), include nonproductive cough or hemoptysis)
Large cell carcinoma (undifferentiated with dark nuclei, rapid growth rate)
Small cell carcinoma (very rapid growth rate associated with extopic hormone production of PTH, ACTh, ADH)
Lung Cancer Symptoms
Chronic cough Hoarseness of voice Weight loss Hemoptysis Difficulty breathing Shortness of Breath Facial swelling & distended jugular veins Hypercalcemia Cushing Syndrome Water retention & hypotonic overload Weakness of shoulder muscles Wheezing Pleural effusion(fluid in pleura) Retrosternal (pain in sternum)
