Respiratory Disorders Flashcards
Transmission of the Common Cold
Person to person
Fingers
Children
Portal of entry - nasal mucosa and conjunctival surface of eye
Three days after onset of symptoms = most contagious
Incubation 5 days
Survive more than 5hr on skin and surfaces
Common Cold: Causes
Viral infection of the upper respiratory tract
Rhinovirus, parainfluenza, syncytial, coronaviruses, adenovirusess
Common Cold: manifestations and treatment
Sore scratchy throat Profuse and watery rhinnorhea Congestion Sneezing and coughing Malaise and fatigue Headache
Rest
Antipyretic for children
OTC symptom management
Rhinosinusitis: causes
Conditions that obstruct or narrow the Ostia that drain sinuses
Viral upper respiratory tract infection or allergic rhinitis
Nasal polyps
Barotrauma
Swimming
Decongestant abuse
Dental infection
Rhinosinusitis: manifestations and treatment
Similar to common cold
Acute - rhinitis, facial pain, headache, purulent nasal drainage, fever, pain on bending
Chronic - nasal obstruction, fullness in ears, post nasal drip, hoarseness, chronic cough, loss of taste and smell, dull constant headache
Antibiotics
Intranasal corticosteroids
Mucolytic agents
Symptom relief
Influenza: Etiology
Viruses in the orthomyxoviridae family
A and B cause epidemics C is a mild infection
Antigen drift - rna alters during replication generating new H and N subtypes
Population is partially protected due to previous immunity
Epidemics
Antigen shift - rna recombination replaces both H and N antigens leaving all individuals susceptible
Pandemics
Influenza: transmission
More contagious than bacterial infections
Inhalation of droplet nuclei
Not contact
Infectious from 24hr before symptom onset to 5-10 days after sumps appear
1-4 day incubation
Influenza: pathogenesis
Healthy person - upper respiratory tract infection
Viral pneumonia
Viral leading to susceptibility to bacterial pneumonia
Attacks mucous secreting cells and epithelial cells damaging to expose basal layer allowing ECF to escape
Further down the bronchial tree secretions thicken promoting bacterial adhesion
Severe shedding of bronchial and alveolar cells
Promotes bacterial adhesion
Influenza: manifestations
Abrupt onset Fever Chills Rapid onset of profound - Malaise Muscle aching Headache Profuse watery nasal discharge Nonproductive cough Sore throat
Weakness cough and malaise may persist for weeks after resolution
Children - fever and febrile convulsions
Influenza: complications
Viral pneumonia - rapid progression of fever Tachypnea, cyanosis, hypotension, pulmonary fibrosis and death
Secondary complications - sinusitis, otitis media, bronchitis
Bacterial pneumonia - feeling better before return of fever, shaking, chills, chest pain, productive cough
Reye sydrome - rare complication in children given aspirin
Fatty liver and encephalitis
Influenza: immunization
Changed yearly in response to prediction
Effectiveness depends on age and immunocompetence and accuracy of prediction
Reduces severity and likelihood of catching it
Recommended - over 6months, high risk people, over 50, chronic health issues, immunosuppressive
Contraindicated - less than 6months, anaphylactic hypersensitivity, acute febrile illness, history of guillain barre syndrome
Pneumonia
Inflammation of parenchyma structures of the lung; lower lungs
Typical or atypical lobar or bronchopneumonia community or nosocomial
Risk factors - impaired host defences, chronic lung disease, airway instrumentation, mechanical ventilation
Community acquired pneumonia
Outside the hospital or dx within 48hr after admission
Bacterial or viral Streptococcus pneumoniae Haemophilus influenza Staphylococcus aureus Gram negative bacilli Etc
Hospital acquired pneumonia
After 48hr in hospital
Can determine from previous cultures and know which antibiotics have been effective
Bacteria Pseudomonas aeruginosa Staphylococcus aureus Enter after species Klebsiella pneumoniae Escherichia coli
Acute Bacterial Pneumonia (Typical)
Lobar - consolidation of part of all of a lobe
Bronchopneumonia - more than one lobe patchy
Lung below main bronchi is normally sterile despite frequent air entry of microorganism
Risk Factors: Loss of cough reflex Damage to ciliates endothelium Impaired immune defences Antibiotic therapy Diabetes Smoking Chronic bronchitis Viral infections
Acute Bacterial Pneumonia: Pneumococcal Pneumonia
Most common
Streptococcus pneumoniae - attaches and colonized in mucus membranes of nasopharynx, but may not progress and will be carriers
Pyrogenic infection of the lungs, ears, sinuses, and meninges
Polysaccharide capsule - prevents digestion by phagocytes
Acute Bacterial Pneumonia: Pneumococcal Pneumonia
Manifestations and risk factors
Malaise, severe shaking chills, fever, watery sputum, limited breath sounds, fine crackles, pleuritic pain,
Sputum may become blood tinged to purulent
Asplenic person
Children with sickle cell
Acute Bacterial Pneumonia: Legionnaire Disease
Legionella pneumonphila
Transmission occurs when stagnant water containing the pathogen is aersolized into droplets and inhaled
Not airborne or person to person
Acute Bacterial Pneumonia: Legionnaire Disease
Manifestations and risk factors
Rapid onset - malaise, weakness, lethargy
Fever, dry cough, diarrhea, confusion, arthralgia, hyponatremia
Consolidation of lung tissues
Lack of normal temp pulse relationship
Tuberculosis: risk factors
Mycobacterium tuberculosis
Airborne droplet nuclei
Waxy cell wall - increases resistance to antibiotics and disinfection; slow to grow
Aerobic
Living in a country with high incidence
Crowded confined living conditions
Immunocompromised
Tuberculosis: Pathogenesis
Infected droplet nuclei inhaled and settles in alveoli
Macrophages engulf the bacilli and initiate cell mediated immune response - cannot completely kill
Bacilli continue to multiply
T-lymphocytes are activated in delayed hypersensitivity reaction releasing cytokines that kill bacilli and damage lung tissue
Ghon focus - circumscribed granuloma toys lesion containing remaining live and dead bacteria and immune cells
Ghon complex - combination of primary lung lesion and lymph node granulomas
Casious necrosis - [Continuous multiplication and cope of dead cells
Primary Tuberculosis: risk factors and manifestations
Forms in person previously unsensitized
Often asymptomatic and will develop latent TB - not active or transmissible
Risk factors: immunocompromised and very young children
Manifestations Insidious onset Fever Pleuritic pain Weight loss Fatigue Night sweats Cough Dyspnea Hematogenic dissemination - rare erosion of a blood vessel and transmission to other areas
Reactivated Tuberculosis: risk factors and manifestations
Reinfection from inhaled droplet nuclei or reactivated of healed primary ghon complex
A healthy person with latent TB becomes immunocompromised
Cavitation as the focus expands and epithelial damage can occur
RIsk factors: impaired body defence, cell mediated hypersensitivity response damages airway tissue creating cavitation
Manifestations: Pleuritic pain Low grade fever Night sweats Easy fatigue Anorexia Weight loss Cough (dry to purulent to blood tinged) Dyspnea Orthopnea Complication - pleural effusion
Risk factors of lung cancer
Smoking Chemical toxins Familial predisposition Site of metastasis Disease of the aging over 65yrs
Small Lung Cell Cancers
Rare to do surgery after diagnosis
Highly malignant
Tumors arise from the neuroendocine cells of the bronchial epithelium
Grow in clusters and may be able to secrete hormonally active product
Highest associated with smoking
Often metastasized on diagnosis
Paraneoplastic syndrome - SIDAH
Total 2yr survival is 20-40%
Non-Small Cell Lung Cancers: Squamous Cell Carcinoma
Central bronchi - diagnosed with sputum culture
Common in men and smokers
Metastasizes slower than others
Paraneoplastic syndrome - hypercalcemia
Non-Small Cell Lung Cancers: Adenocarcinoma
Bronchiolar and alveolar
Common in women and non smokers
Pleural fibrosis and scarring
Poorer prognosis than squamous - easy metastasis
Paraneoplastic syndrome - hematologic disorders
Non-Small Cell Lung Cancers: Large Cell Carcinoma
Periphery of the lung
Hard to diagnose
Poor prognosis; spreads early
Manifestations of Lung Cancer
Cough, wheeze, SOB
Anorexia, weight loss
Hemoptysis
Dull pain increasing with invasion into pleura
Hoarseness - laryngeal nerve involvement
SVC syndrome - tumors compression of superior vena cava interrupting blood flow
Pleural effusion
Metastasis to brain, bone, liver
Paraneoplastic syndromes
Paraneoplastic Manifestations of Lung Cancer
Not related to metastasis - caused by substances secreted by the tumor
Weakness and wasting of proximal muscles - pelvic and shoulder girdles
Anorexia
Cachexia
Fever
Hypercalcemia
Hematology disorders - DIC, migratory thrombophlebitis
Hypoxemia: causes
Inadequate amount of 02
Disease of the respiratory system
Dysfunction of the neurological system
Alterations in circulatory function
Produces it effects through tissue hypoxia - compensatory mechanisms to adapt
Hypoxia with 99% o2 sat due to severe anemia
Cyanosis without sign and symptoms of hypoxemia due to too much Hgb
Hypoxemia: manifestations
Cyanosis
Tachycardia
Vasoconstriction - increase in BP
Personality changes, restlessness, uncoordinated muscle movements, euphoria, impaired judgement, delirium, stupor, coma
Chronic - increased ventilation, pulmonary vessel vasoconstriction, increased production of RBC
Hypercapnia: causes
Hypoventilation Mismatching of ventilation and perfusion Increase in metabolic rate and high carbohydrate diet Activity Fever Disease
Hypercapnia: manifestations
Acid base balance problems
Kidney, NS, and cardiovascular function
Respiratory depression and altered mental status
Lung Inflation issues
Compression of lung by fluid accumulation = pleural effusion
Complete or partial collapse due to air in the pleural cavity = pneumothorax
Collapse of a segment of the lung = atalectasis
Pleural Effusion: types
abnormal collection of fluid in the pleural cavity
Capillaries filter into parietal space
Interstitial spaces in lungs and peritoneal cavity
Transudate: hydrothorax - CHF, renal failure, nephrosis, liver failure
Exudate: bacterial pneumonia, viral infection, pulmonary infection
Purulent: empyrean - infection of the pleural cavity
Chyle: chylothorax - milky lymph fluid accumulation - trauma, inflammation malignancy
Sanguineous: hemothorax - aneurysm rupture, injury, surgery
Pleural Effusion: manifestations
Decreased Lung expansion Dullness on percussion Diminished breath sounds Hypoxemia may occur Dyspnea Tachypnea Pleuritic pain, WBC increase, fever
Pneumothorax
Air in the pleural space causing partial or complete lung collapse
SOB
Dyspnea
Hypoxemia
Ipsilateral = affected side
Pneumothorax: Spontaneous
Rupture of an air filled bleb on the surface of the lung
Allows atmospheric air to enter the pleural cavity and lung collapses of its own recoil
Primary - healthy person; non smoker
Secondary - underlying lung disease (emphysema, asthma, TB, sarcoidosis, CF)
ipsilateral chest pain Tachypnea Dyspnea Asymmetry of the chest Hyper-resonant percussion Decreased or absent breath sounds over area of pneumothorax
Pneumothorax: Traumatic
Penetrating or non penetrating chest injury
Fractured or dislocated ribs that penetrate the pleura - hemothorax may accompany
Medical procedures, central line insertion, intubation, CPR complication
Pneumothorax: Tension
Intrapleural pressure becomes greater than atmospheric pressure
Air can enter but cannot leave
Complication of mechanical ventilation
Laceration of lung and pressure on SVC - cardiac and respiratory compromise
Pleural space increases in size, mediastinum compression, tracheal shift, pressure on SVC
Pleuritis
Pleuritic pain with abrupt onset
Causes
Viral infections
Pneumonia
Pain characteristics
Unilateral
Pain with DB
May be referred to shoulder
Musculoskeletal vs bronchial vs myocardial pain
Musc - bilateral, worse with movement and associated with contraction
Bronchi - substernal, dull, worse with coughing, not affected by DB
Myocardial - substernal, not affected by respirations
Atelectasis: causes
Incomplete expansion of the alveoli
Causes
Obstruction - anaesthesia, limited mobility, low hydration
Compression - pt lying in bed, pneumothorax, pleural effusion
Increased recoil - loss of surfactant
Primary - lung have never fully expanded
Secondary - aspiration of amniotic fluid
Acquired - obstruction
Atelectasis: manifestations
Tachypnea Dyspnea Cyanosis Hypoxemia Absence of breath sounds Diminished lung expansion Intercostal retractions
Bronchial Asthma
Chronic inflammatory airway disorder of the pulmonary airways
Not the upper airways
Exaggerated by hypersensitivity response Seasonal Exercise induced Drug induced Occupational
Bronchoconstriction, increased permeability, increased mucous production
Bronchial Asthma: pathophysiology
Exposure to allergen, T helper stimulates B cell to differentiate in to IgE producing plasma cells
IgE pairs up with allergens and binds to mast cells which release histamine
Inflammatory mediators released by activated immune cells
Extrinsic - type one hypersensitivity
Intrinsic - no allergen component
Atopic Asthma (extrinsic): result of
Extrinsic allergen or antigen
Genetic predisposition to the development of an immediate hypersensitivity reaction to common antigens
Can be triggered by intrinsic factors
Childhood exposure
Genetics
Other allergies
Atopic Asthma (extrinsic): manifestations
Early phase
Chemical mediator release from presensitized IgE mast cells
Histamine, interleukins, prostaglandins = mucosal edema, bronchospasm, wheezing, cough, dyspnea
Parasympathetic response = increased permeability and mucous
Late phase
Inflammation and increased airway responsiveness; mediators continue to be released
Epithelial damage, edema, changes in mucocilliary function, decreased clearance of secretions, increased airway responsiveness
Non-atopic Asthma (intrinsic): triggers
Respiratory infection Exercise Inhaled irritants Emotions Hormones GI reflux Aspirin and NSAIDs
Asthma Symptoms
Accessory muscles SOB Dyspnea Fatigue Hypoxemia and hypercapnia Wheeze Cough Chest tightness Tachypnea Anxiety Tachycardia and increased BP Status asthmatics Respiratory failure
Chronic Obstructive Pulmonary Disease: risk factors
Smoking Heredity Occupational dust and chemicals Airway infections Asthma and airway hypersensitivity
Chronic Obstructive Bronchitis: pathogenesis
Major and small airways
Increased mucous production and chronic productive cough
Inflammation and obstruction of the major and small airways
Risk factors: smoking, men, middle age, recurrent respiratory infection
Hypersecretion in large airways
Hypertrophy of submucosal glands in trachea and bronchi in response to toxins
Inflammation infiltration
Fibrosis of bronchial wall
Chronic Obstructive Bronchitis: manifestations
Chronic productive cough
Blue bloater - hypercapnia, hypoxemia, polycythemia and right sided HF leading to fluid retention
Pursed lip breathing
Tripod position
Emphysema: pathogenesis
Small airways
Enlargement of airspaces and destruction of lung tissue
Inflammatory response release pro teases that digest elastin and alveolar walls = loss of lung elasticity and enlargement of distal spaces
Slowly debilitating with acute exacerbates
Risk factors: smoking, hereditary deficits in antitrypsin
Emphysema: manifestations
Barrel chest
Weight loss
Pink Puffer - lack of cyanosis, use of accessory muscles, pursed lip breathing
Decreased breath sounds
Diaphragmatic fatigue and acute respiratory failure
Pulmonary Embolism: causes
Blood borne substance lodges in branch of pulmonary artery
Thrombus injected during IV infusion or DVT or oral contraceptives
Fat mobilized from bone marrow after fracture
Amniotic fluid entering maternal circulation after childbirth
Pulmonary Embolism: Pathogenesis
Most arise from a DVT
Reflex is bronchoconstriction in the affected area
Ventilation without perfusion
Impaired gas exchange loss of alveolar surfactant
Pulmonary HTN and rt sided HF may result
Pulmonary Embolism: manifestations
Dyspnea Tachypnea Pleuritic pain Cough Sanguinous sputum Hypoxemia Tachycardia Angina Anxiety Fever Loss of consciousness Tripod position
Cor Pulmonale
Causes rt sided HF secondary to respiratory disease (pulmonary HTN)
Decreased lung ventilation Pulmonary vasoconstriction Increased workload on rt heart Decreased oxygenation Kidney releases erythropoietin = more RBC = polycythemia = blood more viscous Increased workload on the heart
Constriction to raise pulmonary vasc
Back pressure from lungs increase heart workload on rt heart from vena cava
