Overview- Respiratory Dz & Pneumonia

Question 1

What anatomic parts make up the upper airways?

Answer 1

nares
nasal passages
pharynx
larynx
trachea

Question 2

What anatomic parts make up the lower airways?

Answer 2

mainstem bronchi
bronchioles
alveoli

Question 3

What occurs in the alveoli?

Answer 3

gas exchange between the airways and the circulatory system

Question 4

Describe 3 protective mechanisms that are used by the upper airways to prevent passage of foreign materials to the lower airways

Answer 4

1. Turbinates of nasal passages – alter the direction of airflow through the nose, allowing larger particles to be filtered out via cilia to the pharynx where they are swallowed and eliminated
2. Coating of mucous on all surfaces exposed to air – traps foreign particles preventing them from reaching the alveoli
3. Ciliated epithelial cells that cover respiratory tract – beat together toward pharynx to propel particles caught in mucous out of the respiratory tract where they are either swallowed or coughed out of the body

Question 5

What is the mucociliary elevator?

Answer 5

The cilia that beat together toward the pharynx to help propel any particles caught in the mucous out of the respiratory tract to the pharynx where they will either be swallowed or coughed out

Question 6

Describe 2 protective mechanisms that are used by the lower airways to remove any foreign material

Answer 6

1. particles that remain suspended in the air within the alveoli are expelled during expiration
2. particles that are trapped within the alveolar fluid are removed via alveolar macrophages or carried away by the lymphatic system of the lungs

Question 7

Explain the purpose of the cough reflex and how it works

Answer 7

an irritant stimulates nervous impulses –> impulses are sent to brain –> triggers a sudden inspiration of air, closure of epiglottis, and forceful contraction of the abdominal and expiratory muscles –> when vocal cords and epiglottis suddenly open, air within lungs is forcefully expelled outward –> foreign particles are expelled with it

Question 8

What does bronchoconstriction do to the airway?

Answer 8

decreases the diameter of the bronchiole, which impedes airflow so air can no longer travel freely and easily into the alveoli

Question 9

What is the underlying physiology of bronchoconstriction?

Answer 9

Parasympathetic nerves get activated via inflammatory Dz or via reflexes stimulated by the presence of irritants on the epithelial surfaces –> nerves release acetylcholine –> this causes small muscles around the bronchioles to constrict

Question 10

What is another physiological reason bronchioles constrict?

Answer 10

Histamine production by mast cells and a substance called slow reactive substance of anaphylaxis; mast cells in lungs are stimulated by allergens (dust, pollen)

Question 11

What are the 2 consequences of bronchoconstriction?

Answer 11

1. inability of air to flow easily though the airways

2. stimulation of a cough reflex

Question 12

4 Clinical signs suggestive of respiratory Dz

Answer 12

dyspnea
tachypnea
respiratory effort
inspiratory or expiratory noises

Question 13

What are 2 signs that may indicate respiratory or cardiac dz?

Answer 13

coughing

cyanosis

Question 14

What pathological changes in the respiratory tract lead to dyspnea, tachypnea, respiratory effort, and breathing noises?

Answer 14

• bronchoconstriction decreases amount of air that will easily flow into lungs (dyspnea, shortness of breath)
• constriction of bronchioles can lea to turbulence in air flow (wheezing sounds on expiration)
• lack of adequate gas exchange at the level of the alveoli decreases O2 content in circulation (cyanotic MM)

Question 15

What is a productive cough and what causes it?

Answer 15

• occurs when there is an accumulation of particulate matter within the lower airways
• material within the lower airways is often expelled with the cough

Question 16

When is a productive cough typically seen?

Answer 16

infectious processes (bacteria, fungi) within the lungs

Question 17

What is a non-productive cough and what causes it?

Answer 17

occurs if irritants are foreign particles (dust, chemical fumes), or with an alteration in structure of the airways; not material is produced because cough is not caused by an accumulation of material

Question 18

When is a non-productive cough commonly seen?

Answer 18

chronic small airway dz

Question 19

Define pneumonia & consolidation

Answer 19

pneumonia- inflammation of lungs with consolidation

consolidation- solidification; process of becoming solid

Question 20

How does pneumonia result in a productive cough?

Answer 20

Remember, inflammation leads to increased permeability of membranes, including membranes that line the alveoli. This allows fluid to leak into the alveoli, which inhibits the flow of air into the alveolar space;

Alveoli continue to fill with fluid and debris and regions of the lung tissue become consolidated and can’t fill with air. Accumulation of material = productive cough

Question 21

What are the 2 ways infectious agents may lead to pneumonia?

Answer 21

1. Airborne – inhalation of infectious agents –> irritation –> inflammation in certain area of the lung
2. Blood-borne – infectious agents gain access to lung tissue via circulatory system leading to irritation throughout the entire lung tissue

Question 22

How does aspiration pneumonia develop?

Answer 22

• due to a complication of patient not being able to swallow appropriately
• gastric contents get inhaled into lung tissue and begin as chemical pneumonia that often progresses to bacterial pneumonia

Question 23

Conditions that may predispose a patient to aspiration pneumonia

Answer 23

anesthesia/sedation

megaesophagus

Question 24

What is nebulization?

Answer 24

inhaled steam therapy

Question 25

How does nebulization therapy help Tx pneumonia?

Answer 25

moistens the accumulated material making it easier to expel

Question 26

What is coupage?

Answer 26

firm, but gentle, patting on the chest walls

Question 27

How does coupage therapy help pneumonia patients?

Answer 27

helps the body break up the material consolidating in the lungs and stimulates the cough reflex

Question 28

2 things that might be needed when handling a patient in respiratory distress

Answer 28

1. admin of supplemental O2 (via O2 cage is best way)

2. sedation

Question 29

4 important Hx questions to ask the owner with a patient exhibiting signs suggestive of respiratory Dz

Answer 29

1. When did the clinical signs begin?
2. How long has this episode been occurring?
3. Is this the first episode?
4. Was there any exposure to anything abnormal?