Class 7/8 - Alterations in Respiratory Function Flashcards
Differences in Respiratory Structure and Function (Age)
Infant/Child
- Obligatory nose breather for the first 4 weeks
- Airways narrower, neck muscles and trachea less developed
- Fewer alveoli
- Increased oxygen consumption due to higher BMR
Elderly
- Weaker gag reflexes, weaker cough
- Stiffer chest wall, weaker respiratory muscles
- Structural changes to vertebrae and supporting structures
Manifestations of Pulmonary Diseases
- Dyspnea: shortness of breath, not getting enough air
- Cough
- Abnormal sputum
- Hemoptysis (coughing up blood)
- Pain
- Clubbing of nail beds (>180 angle, it’s normal to have a v dent)
- Cyanosis: a bluish, purplish discolouration of the skin/mucous membranes. Central, around the lips (best indicator). Peripheral, fingertips
- Breathing patterns
1. Kussmaul - Lots of big breaths that are fairly fast
- Sustained breathing patern
- Results in excreting CO2 faster
- People with metabolic acidosis could breath like this (lungs compensating)
- Cheyne Stokes
- Breathing starts off as normal and gradually gets bigger
- Reaches maximal breath size and gradually gets smaller
- 10-15 seconds of apnea (no breathing)
- Cycle restarts
Respiratory Terminology
Ventilation: breathing
- Significant to how well the alveoli are working
Diffusion: gasses diffuse from the alveoli into the capillaries
Perfusion: blood flow
- CO2 diffuses from the cell back to the blood stream, to the heart, to the alveolus
Hypercapia
An increased of CO2 int he blood (PCO2 > 45 mmHg
Causes - things that affect breathing
- Neurological disorders
- Muscular disorders
- Diaphragm impairment
- Narcotic/opioids
- Having small breaths
Manifestations
- Drop in pH - respiratory acidosis
- Sleepiness: less responsive, affects consciousness
- Vasodilation: makes us pink and warm
- Headache: from the dilated blood vessels in the head
Hypoxemia
Low levels of oxygen in the blood stream
Can be measured by blood samples. Test for oxygen saturation and hemoglobin molecule and PO2
- PO2 drops with age, 1 mm each year > 60 yr
Caused by
- Not enough O2 in the atmosphere
- Low breathing rade
- Inadequate perfusion
- Diffusion through membranes
- Ventilation - perfusion (blood flowing mismatch)
1. Perfusion without ventilation - Shunt - Blood flow goes through the lungs but does not pick up O2, alveoli don’t work
2. Ventilation without perfusion - Dead Space - Alveoli works but there is no blood flow
- Not participating in air exchange
Manifestations
- Decreased LOC - restlessness, confusion, agitation
- Chest pain and abnormal heart rhythms
- Pale or cyanosis of finger/toe tips
Hypoxia
Low levels of oxygen in the tissues/organs
Respiratory Failure
Hypercapnic Respiratory Failure
- Failure to remove carbon dioxide adequately
Hypoxemic Respiratory Failure
- Failure to oxygenate adequalty
Can have both failures at the same tie
Pneumothroax
- Air in the thoracic cavity
- Air breaks the seal of the pleurae and moves in and out of the pleural space
- The pleural space keeps the membranes in a certain position in a vacuum to keep the lungs inflated, sealed with suction.
- Lung collapses inwards
Caused by
- Physical harm (stab wound)
- Weak alveoli that can pop and create a hole in the lung
Treatment:
- Put a tube in to reestablish suction in the pleural space (3/4 days)
Disorder of breathing in
Tension Pneumothorax
- Air enters the pleural space but can’t exit
- Every time we breath, air continues to enter but can’t get out. A flap of tissue usually acts as a one way valve
- Compresses heart and other lung
- Life threatening
Treatment
- A needle that acts as a two way vent
Disorder of breathing in
Atelectasis
- Collapse of alveoli
- Contributors: loss of surfactant or surgery
- Assessment: quiet lung sounds
Disorder of breathing in
Pulmonary Edema
Accumulation of water in the alveoli
- Commonly due to heart failure
- Increased blood volume in the capillaries pushes water out into the interstitial space, lungs and alveoli
Pneumonia
Inflammation/infection of the alveoli/terminal bronchioles
Etiology
- Infectious: bacteria (Streptococcus pneumoniae) virus
- Non-infectious: aspiration. Stomach contents sucked into the lungs
Pathophysiology
- Inhalation of organisms or aspiration of secretions
- First line of defnence is overwhelmed
- Activation of 2nd or 3rd line of defence (inflammation, B cells, T cells, alveoli and terminal bronchioles filled with exudate)
Risk Factors
- Young and elderly
- Smoking - affects cilia and ciliary action
- Immunosuppression
- Altered LOC/ difficulty swallowing
Categories
- Community-aquired pneumonia (CAP. Caused by S. pneumoniae
- Healthcare associated pneumonia (HCAP). Contact with the healthcare system, but not the hospital
- Hospital-acquired (nosocomial) pneumonia
- Ventilator associated (VAP)
Manifestations
- Fever
- O2 levels decrease, heart rate increases, respiratory rate increases
- Dyspnea
- Cough with abnormal sputum
- Crackling lung sounds
- Decreased level of consciousness (elderly)
Second most common hospital infection
Pneumococcal Pneumonia
- Caused by S. pneumoniae
- Has polysaccharide capsule that makes phagocytosis difficult
- Releases toxins that directly damages airway and the alveoli
- Inflammatory response: accumulation of fluid in the lungs
1. Red hepatization: bleeding in the lungs, they become more dense, solid.
2. Grey hepatization: breakdown of RBC’s, reabsorb components, not full off blood anymore, and not as dense or solid.
Primary level of prevention
- Pneumococcal vaccines for infants and 65+ populations
- Influenza vaccines for 65+ populations
- Vaccines for immunocompromised
- Good hand washing prevention
Secondary LOP
- Early recognition of signs and symptoms
- Chest x-ray, blood count, blood cultures, physical assessment
Tertiary LOP
- Antibiotics
- Supportive treatment (O2, fluids, nutrition, rest)
Acute Bronchiolitis
An acute infection or inflammation in the lower airways
- Common in infants and toddlers due to tiny airways.
- Due to viral illness, caused by respiratory syncytial virus (RSV)
- Reoccurs as infection, does not confer immunity
Manifestations
- Wheezing, stridor (high pitched wheezing sound), lung crackles, cyanosis, tachypnea, indrawing (inward movement above the sternum, bottom of ribcage and intercostal muscles)
Tuberculosis
Etiology
- Mycobacterium tuberculosis
- Acid-fast bacillus
- Airborne, can remain suspended for several hours
- Still very prevalent on a global scale
Pathophysiology
- Primary TB
- Previously unexposed
- Can either go into latency (95%) or can become ill (5%) - Secondary TB
- Re-activation of the first infection
- If we become immunosuppressed
- Another exposure
Manifestations
- Dyspnea - shortness of breath
- Persistent cough
- Bloody sputum
- Pleuritic pain
- Fever
- Night sweats
- Fatigue
- Weight loss
Extrapulmonary TB Infection
- Bacilli spread to other organs via blood stream or lymphatic vessels
- Meningitis
- Bones and joints
- Kidneys
- Pericarditis
- Peritonitis
- Liver
Chronic Obstructive Pulmonary Disease
60% of COPD patients have both emphysema and chronic bronchitis
Manifestations
- Coughing
- Whezing
- Dyspnea
- Hypoxemia
- Hypercapnia
- Barrel chest (increased A-P diameter)
Complications
- Pulmonary hypertension
- Right-sided heart failure (Cor pulmonale)
Chronic Bronchitis
Chronic inflammation of the bronchi
- Productive cough that alsts for at least 3 months of the year and for at least 2 consecutive years
Caused by
- Exposure to cigarette smoke, air pollution and infection
Bronchial edema
- Swelling of the bronchiole walls
- Excessive production of mucus (thick and tenacious/ persistent and sticky)
Emphysema
Breathing out is harder than normal
- Air trapping
- Hyperinflation of lungs
Permanent damage to terminal bronchioles and alveoli
- Destruction of walls between alveoli
- Destruction of accompanying capillary bed
- Floppy terminal bronchioles
- Loss of elasticity of alveoli (expansion and recoil)
Etiology
- Smoking and chronic exposure to environemtn irritants
- Genetic - lack of enzyme alpha 1 antritrypsin
Asthma
- Chronic disease with flares
- Hypertrophy of smooth muscles
- Edema of bronchiole walls
- Increased number of mucous producing cells
- Number of people affected by asthma keeps on increasing but the mortality has flattened out
Manifestations
- Dyspnea
- Cough
- More sputum
- Sometimes hemoptysis
- Cyanosis
Treatment
- Long term control
- Minimize exposure to triggers
- Peak flow monitors
- Corticosteroids, inhaled, oral
- Mast cell stabilizers
- IgE inhibitors - Quick relief medications
- Beta 2 agonists
- Anticholinergic inhalers
Status Asthamticus
Life threatening asthmatic attack that does not respond to normal treatment
- Persistent shortness of breath
- Inability to speak in complete sentences
- Agitations, confusion
- Accessory muscle use
- Possible decrease in wheezing
Lung Cancer
Epidemiology
- # 1 cause of cancer deaths in men/women in Canada/USA
- Overall 5 year survival rate is 15%
- Inuit population was once cancer free, now has one of the steepest rates of lung cancer anywhere in the owrld
- 60-80% are smokers
Risk factors
- Smoking
- Heavy smokers have a 20x greater chance of developing lung cancer than nonsmokers
- Smoking is also related to cancers of the larynx, oral cavity, pancreas, esophagus and urinary bladder - Other
- Second hand smoke
- Exposure to workplace toxins, radiation, pollution, tuberculosis
Tumour types
- Small cell tumours (neuroendocrine tumours)
- Also known as small cell carcinoma
- Highest correlation with smoking
- Grows rapidly, aggressively
- Metastasize early, worst prognosis
- Produces ectopic hormones (first sign that the tumour is there) - Non-small cell tumours (75-80%)
a. Large cell carcinoma (10%)
- Undifferentiated
- Rapid growth
- Grows centrally
b. Adenocarcinoma (35-40%)
- Moderate speed of growth
- Arise from glands
- Grow peripherally
- Pleuritic pain
c. Squamous cell carcinoma (30%)
- Grows centrally
- Slowest growing
Manifestations
- Often attribute to side effects of smoking
- Once severe enough, disease is often advances
- Cough
- Increased sputum
- Hemoptysis
- Atelectasis (due to obstruction)
- Wheezing (narrowed airways)
- Pleuritic chest pain
- Hypoexmia
- Hypercapnia
Cystic Fibrosis
Epidemiology
- Autosomal recessive disorder
- In Canada 1/3600 children born have CF
- Primarily caucasians
- Mostly affects the lungs, but also affects sweat glands, the pancreas and GI system
Etiology
- The gene mutation on a single gene (chromosome #7)
- Affects the production and function of a protein
- The gene mutations causes abnormal cystic fibrosis transmembrane conductance regulator (CFTCR) protein
- Abnormal chloride channels in cell membrane
- Results in altered levels of sodium and chloride
Results Lungs - Dehydrated and thick mucus in the lungs - Impaired cilia activity - Recurrent lung infections and colonization with pseudomonas aeruginosa and Staphylococcus aureus - Cough, recurrent pneumonia, wheezing GI Tract - Impaired exocrine pancreatic function - Altered GI function Skin - Salt travels to the skin surface
Diagnosis
- Look at manifestations
- Blood test and sweat test, looking for high chloride concetration
- Genotyping, newborn screening
Treatment
- Pulmonary health
- Chest physio, respiratory medication, antibiotic therapy
- Lung transplant
- Nutrition, enzyme replacement.
