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Respiratory System Disorders, Chapter 19

ISBN-13: 978-1-4377-0965-0, Pathophysiology for the Health Professions, Barbara E. Gould and Ruthanna M. Dyer
by

Rudy Pedri

on 15 October 2015

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Transcript of Respiratory System Disorders, Chapter 19

Respiratory System
Arterial or Venous Gases
The Respiratory system's main job is gas exchange, the uptake of oxygen from the atmosphere and the discharge of carbon dioxide.
Hypoxic Drive (COPD)
Manifestations of Respiratory Disorders
Respiratory Control
Each gas in a mixture diffuses according to its own partial pressure gradient.
Dalton's Law
Boyle's Law
Size increases pressure decreases
CO2 + H2O
H2CO3
H + HCO3
Increased RR will blow off CO2
Decreased RR will retain CO2
Alkalosis
Acidosis
bicarbonate
carbonic acid
20 parts bicarbonate and 1 part carbonic acid maintains pH at 7.35
Size decreases pressure increases
Medulla and pons
located on stem of brain
If cerbral edema occurs...
Air trapping mostly from emphysema patients
CO2 levels stay high
O2 levels stay slightly lower
Affects of Oxygen
giving oxygen will decrease respirations
therefore if O2 decreases, RR increases
Drive to breathe is linked to O2
O2 increases, RR decreases
Coughing
Sneezing
Sputum
Breathing rate and depth
Dyspnea
Cyanosis
Peripheral or central
Orthopnea
Pleural Pain
Croup
Treat with steroid and cold mist

Epiglottitis
May lead to intubation or tracheotomy (suffocation)

Bronchiolitis (Rrespiratory Syncytial Virus)
Cigarette smoke, winter months are causes.
Necrosis and inflammation in the bronchi, bronchioles, with edema, secretions and spasms.

Upper Respiratory Disorders
Infectious Rhinitis
Nasal congestion
Headache
sore throat
slight fever
cough from post nasal drip
Example
person complaining of inability to swallow saliva.
Sore throat, painful swallowing, has difficulty swallowing water.
child with cold like symptoms (describe) bad cough, has difficulty catching breathe when coughing.
Child 2y.o. SOB, RR 54, HR 160, BP 85/34, T 38.5, looks tired
Pneumonia
What causes it
How do you know the differences between the different types?
Distinguishing characteristics
Pneumonia?
Tuberculosis
Affects Immunocompromised Patients
HIV/AIDS
Malnourished
Other infection is ongoing
Stress
new drug resistant strain is making a comeback
Tuberculosis
somewhat resistant to drying
survives in dried sputum for weeks
no neurtophil reaction
Primarily affects lungs
Miliary or extrapulmonary if untreated
Destroyed by ultraviolet light, heat, alcohol, formaldehyde, glutaraldehyde
Primary Infection
Organism first enters body
Engulfed by macrophages
Local inflammation
migrate to local lymph nodes
Type IV inflammatory response begins
Caseation then takes about 6 - 8 weeks primary latent stage.
Secondary Infection
Re-infection - post latency
Host becomes immune compromised - TB releases and infection continues.
Necrosis
cavitation - erosion into bronchi and blood vessels - frothy bloody sputum (not pink tinged)
If bacteria is swallowed then GI tract can become infected.....
Signs and Symptoms
Systemic signs usually appear first
anorexia
malaise
fatigue
weight loss
PM low grade fever
night sweats
purulent sputum often contains blood
Pneumonias
Primary or Secondary
Viral or Bacterial
What's the differences
Sputum
Type of Cough
CXR
History
Lung Sounds
43 y.o male presenting with pain to chest, decreased air entry to RML, cough, sats of 91% on RA, cough for 4 days. no recent travel.
43 y.o male presenting with non-productive cough for 4 days, decreased air entry to bases, sats of 91% no recent travel
43 y.o male congested cough for 4 days, well groomed, appears to take care of himself, sats 91% on RA, crackles heard throughout all lung fields.
23 y.o. male crackles to upper apices, non-productive cough, recent cold that moved to chest. sats 94% RA.
Do you know the difference?
Lung Cancer
What would a tumor in the lungs do??????
Metaplasia --> Dysplasia
erosion of blood vessels
erosion of lung tissue
obstruction of airflow
dry persistent cough for weeks to months
hemoptysis
decreased AE below the tumor site
early signs
systemic signs
signs of metastases
paraneoplastic signs
Aspiration
What do you think of with this?
Adult
Child
causes of aspiration
CVA
post anesthetics
neurological disorders
eating while talking
Complications
Pneumonia
obstruction
Abscess
systemic effects
Signs and Symptoms
Sudden onset
chocking
loss of voice
stridor, hoarsness
Wheezing
Tachycardia
cardiac or respiratory arrest
Aspiration pneumonia is caused by multiple little aspirations that allows bacteria to grow.
COPD
Asthma
Bronchitis
Emphysema
Differences and Similarities
• Persistent productive cough
• Dyspnea
• Wheezing
• Detection on CXR
• Hemoptysis
• Pleural involvement
• Hemothorax
• Pneumothorax
• Pleural effusion
• Chest pain
• Hoarseness
• Compression of superior vena cava – facial edema and headache
• Atelectasis
• Dysphagia
• Anemia
• Weight loss
Signs and Symptoms
Vascular Disorders
Pulmonary Edema
Irreversible Damage
Debilitating
Could lead to cor pulmonale
Pink Puffers
Blue Bloaters
Pulmonary Embolus
• blood clot or mass obstructing a pulmonary artery
o immobility
o trauma
o surgery
o childbirth
o CHF
o dehydration
o increased coagulability
o cancer – increases coagulability
o bone marrow from a fracture
Anything that could cause homeostasis
Signs and Symptoms
Transient chest pain
cough
dyspnea
increased CP with Cough or deep breath
tachypnea
dyspnea
hemoptysis and fever
tachycardia
severe crushing CP
low blood pressure
weak pulse
LOC
• orthopnea
• rales – crackles
• frothy sputum – air mixed in with sputum
• possible blood-tinged – broken blood vessels
• cyanosis develops in the advanced stages.

Atelectasis
nonareration - both ventilation and perfusion are altered
Different types
obstructive
compression
increased surface tension
fibrotic lung
postoperative
signs and symptoms
dyspnea
tachypnea
tachycardia
chest pain
possible mediastinum shift
Pleural Effusion
fluid that separates visceral pleura from parietal pleura
Pneumothorax
air in pleural cavity
right
left
left
right
Closed
spontaneous from inside - small tear in pleura
one lung impaired only
may be hypoxic
Open
puncture through chest wall
air enters cavity on inspiration and exits on expiration
May see a medistinum flutter
impairs venous return
Tension
flap of skin or object allow air in the chest but not out.
pleural space continues to fill with each breath increasing pressure
Tracheal deviation to unaffected side
severe hypoxia
cyanosis
compression of superior vena cava
if possible convert to an open pneumo then cover with occlusive dressing
Respiratory Distress
Infants
ARDS
Inflammation of the lungs
increased permeability of cells
Alveolar wall destruction
reduced gas exchange
reduced blood flow to lungs
difficulty in expanding lungs
Diffuse Atelectasis
Pulmonary Edema
Etiology
Severe Shock
inhalation of toxic chemicals
severe viral infections
toxins from systemic infections
fat emboli
aspiration of acidic gastric content
Lung Trauma
ARF
Ventilation
Quality
Mechanics
Oxygenation
pulmonary disorders
Pa02 <50
PaCO2 > 50
pH <7.3
Inadequate for life!
Chest Trauma
Neuromuscular disorders
Etiology
Signs and Symptoms
• Rapid shallow respirations
• Laboured breathing
• Tachycardia
• Headache
• Lethargy
• confusion
Respiratory Arrest
Emphysema
Acute on chronic condition
Hgb
Inside Lungs
Outside Lungs
Norma CXR
Legonnaires Pneumona
Pneumocysitis Carnii Pneumonia
T
Lobar Pneumonia
Viral Pneumonia
Bronchopneumonia
Structres
Upper Respiratory Tract
Lower Respiratory Tract
Smoking impairs the function of the cilia
This removes the bodies defense mechanisms to prevent infections
Right bronchus is larger and straighter
Bronchodilation results when sympathetic stimulation relaxes smooth muscle
Remember there are macrophages in the alveoli
inside surfaces of alveoli are covered with surfactant
Mediastinum is where your hear, major blood vessels, esophagus and trachea converge.
the pleura is comprosied of a double layer membrane with fluid seperating them
Ventilation
Pressure gradient
High pressure to low pressure
Sequence of events for inspiration to occur
10 steps for inspiration
1. Contraction of the diaphragm
2. Diaphragm flattens and descends
3. External intercostal muscles raise the ribs and sternum up and outwards
4. Increased size of thoracic cavity results in decreased pressure
5. Parietal pleura pulls the visceral pleura and lungs
6. Lungs expand with the visceral pleura
7. With lungs expanded, air flows into lungs
8. External intercostal muscles and diaphragm relax, decreasing size of the thorax
9. This results in increaed intralveolar pressure
10. Therefore air moes outward and expiration occurs
respiratory drive
What is the importance of this
steeple sign
Asymptomatic
If immune system is weak with primary then TB prgresses to active infection
Then Miliary or extrapulmonary TB may occur
Rapid progession through blood circulation
If no cough then they are NOT contagious
CONTAGIOUS with Cough
Cough is prolonged with increasing severity, associated with chest pain
Cycstic Fibrosis
1 in 3149 in whites and european ancenstry
1 in 12,163 in African ancenstry
Thick Sticky Mucus
Lungs
Pancreas
GI Tract
Liver
salivary glands
reproduction
Signs and Symptoms
meconium ileus
malnourtrion
diabetes
dehydration
biliary stenosis
salty skin
steatorrhea
chronic cough with frequent infections
growth delayed
Diagnostics
sweat is analyzed for Na content
X-rays for lung involvement
pulmonary function test
blood gas analysis
stools for fat content
Treatment
Multisystem
cotazym
high protein diet
low fat
avoid dehydration
chest physio - loosen secretion
bronchodilators
humidifiers
aggressive antibiotic treatment
oxygen therapy
Life span of children have extended into adulthood
1. direct effects of tumor
2. systemic signs of cancer
3. paraneoplastic syndromes
4. metastasis
inflammtion
thin coating inside lungs
eating and talking
occlusion of trachea or bronchus
atelectasis
ball-valve effect
some object swell in esophagus or bronchus
sharp pointed objects impale
Liquids
How thick is it?
oils
alcohol based
chemical irritant
solvents that get absorbed in blood
Chest retration
nasal flaring
no cough
atelectasis
dyspnea
cough
chest pain
Flail Chest
4 to 6 ribs are broken in 2 spots
rib section floats in and out with respirations
Mediastinal flutter can occur if section is large enough
The rib section moves paradoxically to the rest of the chest wall
Full transcript