Transcript RESPIRATORY PATHOPHYSIOLOGY

RESPIRATORY SYSTEM & PATHOPHYSIOLOGY
OBJECTIVES
o1. Identify and label structures of respiratory system.
oDescribe functions of respiratory organs
oExplain physiology of respirations
oDefine four respiratory events
oDefine respiratory capacity terms
oDistinguish between respiratory disorders
Format for Pathophysiology
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BRIEF DESCRIPTION
ETIOLOGY
SYMPTOMS AND SIGNS (S&S)
DIAGNOSIS (DX)
PREVENTION AND TREATMENT (TX)
PROGNOSIS (PX)
Types of Respirations
* Eupnea
* Apnea
* Dyspnea
* Hyperpnea
* Orthopnea
* Tachypnea
* Anoxia
* Hypoxia
* Suffocation
* Asphyxia
* Cheyne Stokes
* Cyanosis
General Manifestations
of Respiratory Disease
Sneezing:
Coughing:
Sputum: Yellowish-green, cloudy - bacterial
Rusty or dark-colored – pneumococcal pneumonia
Large amounts purulent with foul odor – bronchiectasis
Thick, tenacious mucous - asthma or cystic fibosis
Blood tinged – chronic cough, tumor or TB
Hemoptysis with frothy sputum – pulmonary edema
General Manifestations cont.
Breathing patterns may be altered in respiratory diseases. Normal
12-20/min
Kussmauls respirations: is a deep and labored breathing pattern
Wheezing: whistling sound produced in the respiratory airways
during breathing
Stridor: high-pitched wheezing sound resulting from turbulent air
flow in the upper airway
Breath sounds:
Rales - clicking, rattling, or crackling noises that may be made by one or both
lungs of a human with a respiratory disease during inhalation,
Rhonchi- Rhonchi is the coarse rattling sound somewhat like snoring,
usually caused by secretion in bronchial airways
Absence of breath sounds
Tobacco Related Diseases
Destruction of respiratory cilia
Addictive
Carcinogenic (Lung and oral cancer)
Emphysema
COPD
MI
Cardiac arrhythmias
CVA
Peripheral Artery Disease
Duodenal and gastric ulcers
“Crows feet”
Low birth weigh infants for a smoking mom
Health Effects of Smoking
More than 4,000 individual compounds have been identified
in tobacco and tobacco smoke. Among these are more than
60 compounds that are known carcinogens (cancer-causing
agents).
There are hundreds of substances added by manufacturers
to cigarettes to enhance the flavor or to make the smoking
experience more pleasant. Some of the compounds found in
tobacco smoke include ammonia, tar, and carbon monoxide.
Exactly what effects these substances have on the cigarette
consumer’s health is unknown.
Health Effects of Smoking
About half of all Americans who continue to smoke
will die because of the habit. Each year, about
438,000 people die in the US from tobacco use.
Nearly 1 of every 5 deaths is related to smoking.
Cigarettes kill more Americans
than alcohol, car accidents,
suicide, AIDS, homicide, and
illegal drugs combined.
Health Effects of Smoking
Cigarette smoking accounts for at least 30% of all cancer
deaths. It is a major cause of cancers of the lung, larynx
(voice box), oral cavity, pharynx (throat), and esophagus, and
is a contributing cause in the development of cancers of the
bladder, pancreas, cervix, kidney, stomach, and some
leukemias.
About 87% of lung cancer deaths are caused by smoking.
Lung cancer is the leading cause of cancer death among both
men and women, and is one of the most difficult cancers to
treat. Fortunately, lung cancer is largely a preventable
disease.
Other risks of smoking
Higher incidence of SIDS & mothers that smoke
Children's asthma attacks and severity are worsened in home with
smoker.
Increase risk for hypertension
Leukoplakia
Gum recession
Stained teeth and halitosis
COPD
Chronic Obstructive Pulmonary Disease is a group of common
chronic respiratory disorders that are characterized by
progressive tissue degeneration and obstruction in the airways
of the lung.
These disorders are emphysema, chronic bronchitis and
asthma.
Fifth leading cause of death and disability in the U.S.
Features in common:
HO smoking
Dyspnea with progression in severity
Cough with frequent pulmonary infections
Hypoxia with retained Carbon dioxide
EMPHYSEMA
A serious, chronic lung condition where the alveoli enlarge, losing
elasticity and capillaries around alveoli are destroyed. (Permanently
inflated alveolar air spaces).
Patient loses the ability to exhale CO2 and must use incredible amount
of energy to exhale.
Etiology: cigarette smoking, environment pollutants, genetics.
Emphysema cont.
S&S: Onset is insidious…dyspnea, hyperventilation,
barrel chest, pursed lips with exhalation, anorexia
with weight loss.
DX: Chest X-ray, PFT.
TX: Avoid irritants, stop smoking, pulmonary rehab
programs, bronchodilators, O2, antibiotics with
infection, maintain nutrition.
PX: Some reversal of airway obstruction with S&S
improvement can be obtained initially, but long
term the prognosis is less favorable.
Permanently inflated
Alveoli
Barrel Chest
DISTENTED ALVEOLI IN EMPHYSEMA.
NOTICE THE CO2 TRAPPED IN THE
ALVEOLI EVEN AFTER DEATH
CHRONIC BRONCHITIS
The mucosa of the Lower respiratory tract
become severely inflamed and produce excessive
mucous.
Impaired ventilation is the result, with increase
risk of pneumonia. (Remember smokers are
missing cilia).
Etiology: HO cigarette smoking or living in urban
industrial area.
S&S: constant cough, tachypnea, SOB, thick &
purulent sputum, rhonchi & cough worse in a.m.,
cyanosis, weight loss and signs of cor pulmonale.
Chronic Bronchitis
cont.
DX: History, chest X-ray, PFT
and bronchoscopy.
View:MedlinePlus Interactive Tutorials:
Bronchoscopy
TX: Reducing exposure to irritants, prompt
treatment of infection, Use of expectorants,
bronchodilators and low flow O2.
PX: Guarded; although consistent treatment can
slow the progression.
Voluminous sero-mucinous secretion in the trachea in a
patient with chronic bronchitis.
ASTHMA
Chronic condition of increased reactivity of the
tracheobronchial tree.
Two types: Extrinsic-involves acute episodes triggered
by a hypersensitivitiy reaction to an inhaled allergen.
Intrinsic, with an adult onset, is a response to other
stimuli, e.g. cold, exercise, stress, irritants like smoke.
Genetics plays a part in etiology.
Characterized by episodes of reversible airway
obstruction, due to, bronchoconstriction, mucous
production and mucosa edema.
Asthma cont.
S&S: cough, dyspnea, wheezing, possible sternal
retractions, thick and tenacious mucous, tachycardia,
hypoxia.
DX: The best tool is a PFT during attack, then chest Xray shows hyperinflation, allergy test, and a CBC with
elevated eosinophils.
TX: Minimize attacks, use of bronchiodilators.
PX: Acute episodes can be life threatening.
Status astmaticus: is a persistent severe attack of
asthma that does not respond to therapy. It may be
fatal.
LUNG CANCER
Lung cancer is common site of both primary and
secondary lung cancer.
Primary lung cancer is 90% HO smoking. Low cure
rate-less than 7% survive over 5 years.
Secondary: Metastasis develop as cancer cells travel in
blood and lymph from heart to first small vessels in the
the lungs.
Etiology: Smoking (cilia missing and not able to
remove the carcinogens caught in mucous),
occupational exposure of chemicals e.g silica,
asbestos.
Cancer cont.
S&S: Insidious, because “smokers cough” masks S&S.
Early: persistent productive cough, hemoptysis, dyspnea,
+ Chest X-ray. Chest pain as the pleura and/or
mediastinum involved.
DX: Chest X-ray, bronchoscopy with biopsy.
TX: Complete resection of the diseased lung, but with
rapid metastasis, often not a choice. Radiation and
chemotherapy but many tumors are not responsive.
PX: Continues to be poor, unless tumor is in very early
stages of development.
Left lung cancer
The lymphatic and circulatory system can deliver cancer cells to the lung = secondary cancer
PULMONARY TUBERCULOSIS
An infectious and inflammatory disease of the lungs,
acquired by inhaling droplets containing bacteria.
Etiology: Mycobacterium tuberculosis is causative agent.
The primary lesion is usually in lung with bacteria surviving
in dried form for months.
. The infection begins with a primary lesion
which causes necrosis, fibrosis and
calcification. The infection than goes
dormant for possible years.
S&S: Vague with anorexia, malaise, fatique, weight loss.
Later- low grade fever, night sweats,hemoptysis, chest pain
and weakness.
TB Cont.
DX: Mantoux test, Chest X-ray, (walled off lesions are
identified), positive sputum culture.
TX: Drug therapy with multiple antituberculosis agents.
Contacts of patient must receive prophylactic treatment
for one year and receive TB testing.
TB is considered infectious; therefore good handwashing
and respiratory precautions must be practiced. Place
patient in isolation with HCW using N-95 respirator mask
& room air is vented for UV ray exposure.
PX: Early and complete treatment offers an excellent
prognosis. Other organs can be involved without
adequate treatment.
Typical X-ray of TB
After treatment
Respiratory Syncytical Virus
This viral, infective condition is most common in
young & elderly. RSV is one of the most important
causes of lower respiratory tract illness and can be
fatal.
Etiology: RSV is the causative agent. The greatest
occurrence is during the winter months. Premature
infants are at greatest risks. Most people have
experienced several RSV infections in their life. Most
are self limiting. RSV is spread by contact with infective
secretions.
RSV Cont.
S&S: Cold-like symptoms with nasal congestion, otitis
media, cough and URI. As the virus progresses
downward to the lower respiratory tract, the patient
experiences fever, malaise, lethargy, cough and dyspnea.
DX: The clinical picture and thorough PE are key. If
necessary a nasal lavage with viral culture can be
ordered.
TX: Palliative. Hospitalization may be necessary to
ensure adequate respiration.
CYSTIC FIBROSIS
CF is a chronic dysfunction of the exocrine
glands affecting multiple body systems; it is
the most common fatal genetic disease.
Etiology: It is an inherited disorder and is
transmitted as an autosomal recessive trait.
Each of us inherits two CFTR genes, one from each parent.
Children who inherit an abnormal CFTR gene from each parent will have
CF.
•Children who inherit an abnormal CFTR gene from one parent and a
normal CFTR gene from the other parent will not have CF. They will
be CF carriers.
CF CONT.
S&S:May be apparent soon after birth or develop in
childhood.Primarily attacks the lungs and digestive tract
with production of copious thick and sticky mucous that
accumulates and blocks glandular ducts.
Meconium ileus
Salty sweat (Mom notices with kiss, positive sweat test)
Signs of malabsorption (steatorrhea,& abd.distention)
Chronic cough and respiratory infections
Failure to meet normal growth milestones
DX: Sweat test, check stools for fat content and
trypsin (pancreatic enzyme) PFT, Chest X-ray, ABG.
CF Cont.
TX: CF is considered a fatal disease. However, with
early diagnosis and treatment, the life expectancy has
improved greatly during the past few decades. High
calorie, high NaCl diet, postural drainage, pancreatic
enzyme supplementation, O2 prn. Lung transplants
are a last resort.
URI
Include: coryza, sinusitis, laryngotracheobronchitis, epiglottitis, & influenza.
Viral etiology for cold, croup and influenza.
Bacterial for sinusitis and epiglottitis.
Secondary bacterial infection may follow
viral.
S&S: Cold and flu-red, swollen mucous
membranes of nose & pharynx with
increase secretions, rhinorrhea, maybe sore
throat and fever. The infection advancing to
larynx causes hoarseness and cough
(bronchi).
URI cont.
S&S: Colds are usually 7 days in duration while the flu
is sudden with fever, fatique lasting for weeks. Croupbarking cough,(due to edema and mucous with
possible obstruction) with hoarse voice and inspiratory
stridor. Epiglottitis-”red ball obstruction”, severe sore
throat, refuse to swallow, anxious breathing and
inspiratory stridor.
DX: History and exam.
TX: Viral-palliative, Prevention of influenza with
immunization. Bacterial-antibiotics, supportive care.
PX: Good with treatment. Secondary infections common.
LRI
Include: bronchiolitis (RSV), acute bronchitis, &
pneumonia.
Etiology: Acute bronchitis may be bacterial
secondary infection following URI, or result of
irritative inhalants. Pneumonia may be primary or
secondary, bacterial or viral. May follow aspiration
when fluids pool or cilia are reduced.
Classifications of pneumonia:
The causative agent
Anatomic location
Pathophysiologic changes.
LRI cont.
S&S: Acute bronchitis is often preceded by URI. Cough
is initially dry and nonproductive and then changes to
viscid and later abundant and mucoid or
mucopurulent. Pneumonia S&S vary: cough, fever, SOB
while at rest, chills, chest pain, cyanosis and
hemoptysis.
DX: History, exam, chest X-ray, sputum C&S.
TX: antibiotics, expectorants, broncholdilators.
PX” Bronchitis can lead to pneumonia. Pneumonia can
range from mild to life threatening, being the 5th
leading cause of death in the US.
Pneumonia fills the lung's alveoli with fluid, keeping oxygen
from reaching the bloodstream. The alveolus on the left is
normal, while the alveolus on the right is full of fluid from
pneumonia.
Pneumonia as seen on chest x-ray. A: Normal chest x-ray. B:
Abnormal chest x-ray with shadowing from pneumonia in the right
lung (left side of image).