Week 9- Respiratory Diseases Flashcards
Sneezing is a reflex response…
to irritation in the URT and acts to remove the irritant
Coughing may result from…
irritation due to nasal discharge dripping into the oropharynx or inflammation/ irritation in the LRT (ex. smoke inhalation)
Sputum
- Mucoid discharge from the respiratory tract
- Yellow-green, cloudy, thick- indicates a bacterial infection
- Resty/ dark sputum is usually associated with pneumonia
- Blood tinged sputum is associated with pulmonary edema
Breathing Patterns
- May be altered with resp disease
- Normal rate is 10-18/min, regular and effortless
Change:
- Kussmaul resps: deep, rapid, “air hunger”, typical with acidosis or following strenuous exercise (DKA)
- Wheezing: obstructions of the small airways
- Stridor: upper airway obstruction
Dyspnea (SOB)
- Subjective feeling of discomfort that occurs when a person is unable to inhale enough air
- Severe: accompanied with nasal flaring, accessory muscle use
- Orthopnea: SOB that occurs when the person is lying down, results as blood pools in the lungs
- PND: common with LVF
- Cyanosis: bluish discolouration of the skin resulting from large amounts of deoxygenated hemoglobin in the blood
Upper Respiratory Tract Infection
- Common cold is caused by a viral infection of the URT
- Spread through respiratory droplets, either directly inhaled or spread through touch
- Highly contagious as virus can survive for several days outside the body
Upper Respiratory Tract Infection Signs & Symptoms
- Red mucous membranes of the nose and pharynx
- Copious watery discharge
- Mouth breathing, change in voice tone
- Cough may develop from irritation of discharge
Treatment for URTI
- Acetaminophen for fever and headache
- Decongestants to reduce congestion
- Humidifiers- keep secretion liquid to aid in removal
Sinusitis
- Bacterial infection secondary to a cold or an allergy that has obstructed drainage of one or more of the paranasal sinuses
- Causes build up of the exudate which leads to severe pain in the face
Croup
- AKA Laryngotracheobronchitis
- Common viral infection most commonly in children between 1 and 2
- Begins as an upper respiratory condition with nasal congestion and cough
- The larynx and subglottic area become inflamed with swelling and exudate- leads to the characteristics “Barking Cough”; hoarse voice and inspiratory stridor
- Often more severe at night
Treatment for Croup
- Cool, moisturized air from a humidifier or shower
- Full recovery usually in several days
- Pre Hospital: nebulized epi, dexamethasone
Epiglottis
- Acute infection from a bacterial organisms
- Most common in children aged 3-7
- Infection causes swelling of the larynx, supraglottic area and epiglottis
- Onset is rapid, fever, and sore throat develop, and the child refuses to swallow
- Excessive drooling is present
- Child will appear anxious, mouth open, struggling to breathe
- Use caution when examining the throat- ensure you don’t cause complete obstruction of the airway
Epiglottis Treatment
- Treatment involves O2/ airway and management
Pneumonia
- May develop as a primary acute infection in the lungs or secondary to another respiratory or systemic condition
- Airways a risk following aspirations or inflammation in the lung, when fluids pool or cilia are reduced
- Most cases the organisms enter the lungs directly via inhalation or aspiration
- Can be classified as viral, bacterial or fungi
What are the types of pneumonia?
Lobar pneumonia- infection localized to one or more lobes
Bronchopneumonia- diffuse pattern or infection in both lungs, more often in the lower lobes
Legionnaires disease- gram negative bacteria that thrives in warm moist environments such as A/C’s and spas (diagnosed)
Viral Pneumonia- caused by influenza and respiratory viruses (begins with inflammation of the mucosa of the URT and then moves into the lungs
Primary Atypical Pneumonia (PAP)- viral and involves interstitial inflammation around the alveoli
Tuberculosis
- Infection that affects the lungs primarily, but may also invade other organs
- Transmitted by oral droplets released from a person with active infection inhaled into the lungs
Tuberculosis- Primary Infection
- Occurs when the microorganisms enter the lungs- fought off by your body’s immune system
- Creates a small area of necrotic tissue on the lungs visible on x-ray
- Stays dormant for years
- As long as the individual’s resistance and immune system are strong, they will remain asymptomatic
Tuberculosis- Secondary Infection
- Stage of active infection
- Often arises years after primary infection when resistance is down
- Creates a large area of necrosis in the lung tissue that form open area and erosion into the bronchi and blood vessels
Signs and symptoms of TB
- Primary: asymptomatic
- Secondary: initially- vague manifestations such as
- malaise
- fatigue and weight loss
- low grade fevers and night sweats
- cough is prolonged and gets increasingly severe
- Often contains blood
Cystic Fibrosis
- Genetic disorder (affecting the 7th chromosome) that results in a thick, sticky mucus secretion in the lungs
- Mucus obstructs airflow in the bronchioles causing air trapping and permanent damage to alveoli
- The stagnant mucus also creates a breeding ground for bacteria (infections are common)
Signs and Symptoms of Cystic Fibrosis
- Chronic cough and frequent respiratory infections (as lung damage proceeds, hypoxia, fatigue and exercise intolerance develop)
- Chest may appear over inflated due to air trapping
- Audible rhonchi
- Failure to meet the normal growth milestones due to chronic respiratory problems
- Dyspnea, tachypnea, accessory muscle use, cyanosis, diminished breath sounds
Treatment of Cystic Fibrosis
In Hospital:
- Therapy to minimize bronchial plugging and inhibit bacterial growth
- Treatment of infections with antibiotics
- Chest physiotherapy including coughing techniques to facilitate mucous removal
Pre-Hospital:
- Airway management
- Supplemental O2
- Bronchodilators to promote drainage
Aspiration
- Passage of food or fluid, vomit or drugs, or any other foreign material into the trachea or lungs
- Right lower lungs is most commonly affected
- Normally, a cough removes such material from the URT and the epiglottis and vocal cords from the LRT
Aspiration Solids
- Complete airway obstruction
- Collapse of the area of lung distal to the obstacle
- Ball valve effect- air goes in bit gets trapped (pneumo)
- Sharp objects- traumatizes the tissues and mucosa causing inflammation and bronchoconstriction
Aspiration Liquids
- Materials cause severe inflammation leading to narrowing of airways and increased secretions making the lungs difficult to expand
- Gas diffusion is impaired if alveoli are affected
- May be dissolved into the blood causing systemic effects
Sign and symptoms of Aspiration
- Coughing with dyspnea
- Stridor and hoarseness
- Wheezes with aspiration of liquids into the lungs
- Tachycardia and tachypnea as a response to SOB
- Complete obstruction- no sounds will be produced
Treatment of Aspiration
- Full obstruction: Abdominal thrust on adults and back blows on infants. If progresses to unconscious- CPR ensuring visualization of A/W
- Partial: encourage coughing, oxygen and supportive therapy, monitor for potential signs of pneumonia or infection
COPD (Chronic Obstructive Pulmonary Disease)
- Group of chronic respiratory disorders that are characterized by progressive tissue degeneration and obstruction of the airways
- Causes irreversible damage to the lungs
- Debilitating conditions
- Ex. emphysema, bronchitis, and asthma
Asthma
- Disease that involve periodic episodes of severe but reversible bronchial obstruction in person with hypersensitive/ hyper responsive airways
- May be acute (single episode) or chronic (long term condition)
- Can be triggered by an inhaled antigen (extrinsic) or respiratory infections, exposure to cold, exercise, drugs, stress (intrinsic)
- Extrinsic is more commonly in children and symptoms disappear by adulthood
- Intrinsic is more commonly developed during adulthood
Pathophysiology of Asthma
- Bronchi and bronchioles respond to the stimuli in 3 ways:
1. Inflammation of the mucosa with edema
2. Constriction of smooth muscle (bronchosonstriction)
3. Increased secretions of thick mucus in the passages
Partial obstruction of the bronchioles results in…
Air trapping and hyperinflation of the lungs
- Air passes in the areas distal to the obstruction and is only partially expired
- Air builds up and the pt. tries to force the expiration which leads to collapse of the bronchial walls
- Residual volume increases- becomes more difficult to breathe fresh air and cough to remove the mucus (hyperinflation analogy)
Total obstruction of the bronchioles results…
When the mucus plugs completely block flow of the already narrowed passages
- This lead to non aeration of the tissue distal
- Air in the distal area diffuse out is not replaced resulting in collapse of that section of the lung
- O2 demands increase as the body senses the stress response to hypoxia as the pt. fights for air
Status Asthmaticus/ Asthma Exacerbation
- Status: persistent, severe attack that does not respond to therapy
- Fatal secondary to hypoxia and cardiac arrhythmias
- Exacerbation: severe narrowing of the airways in an asthma attack to the point that no air is able to pass through
- Results in no RR and no breath sounds- “silent chest”
Signs and Symptoms of Asthma
- Cough, dyspnea, tightness in the chest
- Agitation as obstruction increases
- Wheezes as air passes through narrowed bronchioles
- Rapid, labored breathing with accessory muscle use
- Thick, tenacious mucus coughed up
- Tachycardia
- Resp failure- decreased LOC, cyanosis
Treatment of Asthma
- Minimize the exposure to known irritants
- Good ventilation
Acute attacks:
- Bronchodilators- acts as Beta 2 receptors to relax smooth bronchial muscles
- Epi 1:1,000- decreases airway edema and is a beta 2 agnoist
- O2
- Airway management
Emphysema
- Destruction of the alveolar walls which lead to large, permanently inflamed alveolar air spaces
- Often called “Pink Puffers”
What several factors can contribute to this destruction?
- Genetic deficiency of the protein present to inhibit breakdown of elastase during an inflammatory response
- Cigarette smoking stimulate the release of elastase
What is the patho of Emphysema?
Breakdown of alveolar walls results in:
1. Loss of surface for gas exchange
2. Loss of elastic fibres affecting lung recoil
3. Altered V/Q ratios
4. Decreased support for bronchial structures leading to obstruction of airflow in expiration
5. Thickening of bronchial walls leading to narrowed airways
6. Difficult expiration leads to air trapping and increased Residual volumes and over inflation
7. Fixation of ribs in inspiratory position (barrel chest)
8. Hypercapnia
9. Hypoxic drive as pt’s respiratory centre adapts to high CO2 levels and fails to be the respiratory centres regulatory mechanism
10. The larger air spaces (blebs) can create the tissues and pleural membranes around the bleb to rupture, causing a pneumothorax
11. Frequent infection as secretions are difficult to remove
12. Pulmonary HTN and Cor pulmonale develops as pulmonary blood vessels are destroyed causing increase pressure in the pulmonary circulation
Sign and Symptoms of Emphysema
- Dyspnea initially on exertion, then even at rest
- Hyperventilation with prolonged expiratory phases and accessory muscle use
- Barrel chest from hyperinflation
- Tripod positioning to facilitate breathing
- Fatigue contributes to weight loss- often these patients are extremely thin
- Clubbed fingers- vascular endothelial growth factor (VEGF)
- Polycythemia- increased red blood cells
Treatment of Emphysema
- Bronchodilators
- Airway management and O2- 2lpm or 2lpm above home levels unless severe SOB
- CPAP
Chronic Bronchitis
- Significant changes to the bronchi resulting from constant irritation from smoking or exposure to pollutants
- Effects are irreversible and progressive
- Results in inflammation and obstruction to the bronchi, repeated infections and chronic coughing
- Clinically diagnosed with a cough with sputum production occurring at least 3 months of the year for at least 2 consecutive years
Pathophysiology of Bronchitis
- Mucosa is inflamed and swollen
- Hypertrophy of mucous glands and increased secretion are produced
- Chronic irritation and inflammation lead to thickening of bronchial walls and further obstruction
- Secretions pool and are difficult to remove
- Low 02 levels- cyanosis will be evident
- “Blue Bloaters”- edema, cyanosis and low O2 levels
- Severe dyspnea and fatigue interfere with nutrition
- Pulmonary HTN results
Signs and Symptoms of Bronchitis
- Constant, productive cough
- Tachypnea
- SOB
- Frequent secretion that are thick
- Rhonchi- usually more prevalent in the morning as secretions have pooled
- Cyanosis and hypoxia
Treatment of Chronic Bronchitis
- Airway management- O2/BVM
- Bronchodilators
- CPAP
Pulmonary Embolus
- Blood clot or mass of other material that obstructs the pulmonary artery or branch of it, blocking blood flow through the lung tissue
Effects of a pulmonary embolus depends on the size and location of the clot
- Small are often asymptomatic
- Large emboli often affect the respiratory system but also the cardiovascular system causing right sided failure and decreased cardiac output
Sign and Symptoms of Pulmonary Embolus
- Transient chest pain that often increases with coughing or deep breathing
- Cough
- SOB
- Tachypnea
- Hypoxia stimulate sympathetic response- anxiety, restlessness, tachycardia
Massive emboli can cause:
- Crushing chest pain
- Low BO
- Rapid, weak pulse
- LOC
Atelectasis
- Non aeration or collapse of a lung or part of a lung leading to decreased gas exchange or hypoxia
- When the alveoli becomes airless, they shrivel up
- This interferes with blood flow through the lungs and alters both ventilation and perfusion
- If the lungs are not re inflated quickly, the lung tissue can become necrotic and permnantely damaged
Sign and Symptoms of Atelectasis
- Small are are asymptomatic
Large area:
- Dyspnea
- Tachycardia
- Tachypnea
- Chest expansion may appear abnormal as asymmetrical
Treatment for Atelectasis
- Focus on airway management and support
Pleural Effusion
- Presence of excessive fluid in the pleural cavity
- Normally small amounts are present for lubrication
- Both lungs may be involved but often just 1 is as each lung has it own pleural sac
- Pleurisy may follow- inflammation/ swelling of the pleural membranes
- The fluids create higher pressure which prevents normal lung expansion, leading to atelectasis
Sign and symptoms of pleural effusion
- Dyspnea
- Chest pain
- Tachypnea
- Tachycardia
- Absence of breath sounds over affected area
- Trachea; deviation
- Hypotension
ARDS- Adult Respiratory Distress Syndrome
- Restrictive disorder
- Secondary to an injury- sepsis, shock, burns, aspiration, smoke inhalation
- Usually occurs 1-2 days after an injury
- Often associated with multiple organ dysfunction
ARDS Pathophysiology
- Changes to the lungs result from injury to the alveolar wall and capillary membranes
- This leads to an increased alveolar permeability - increased fluid in the alveolar area of the lungs
- This results in:
1. Decreased diffusion of O2
2. Reduced blood flow to the lungs
3. Difficulty in expanding the lungs
4. Reductions in tidal volumes
5. Excess fluids predispose to the pt. to pneumonia or CHF
Sign and Symptoms of ARDS
- Dyspnea
- Restlessness
- Rapid, shallow respirations
- Tachycardia
- Accessory muscle use as lung congestion increases
- Crackles
- Productive cough with frothy sputum
Acute Respiratory Failure
- End result of many pulmonary disorders
- Happens when there are inadequate O2 and CO2 levels for the body’s need at rest
- CNS including the respiratory control centre is affected
- Ends in resp arrest- cessation of resp activity
