Pulmonary Alterations Summary Review PDF

## Summary Review of Pulmonary Alterations ### Manifestations of Pulmonary Alterations * **Dyspnea** is a feeling of breathlessness and increased respiratory effort. It is associated with respiratory and cardiac diseases and causes distress. * **Orthopnea** is dyspnea when a person is in the uprig...

## Summary Review of Pulmonary Alterations ### Manifestations of Pulmonary Alterations * **Dyspnea** is a feeling of breathlessness and increased respiratory effort. It is associated with respiratory and cardiac diseases and causes distress. * **Orthopnea** is dyspnea when a person is in the upright position and is associated with heart failure. * **Paroxysmal nocturnal dyspnea** occurs at night and requires the person to sit up straight for relief. * **Coughing** is a protective reflex that expels secretions and irritants from the lower airways; the cough reflex is mediated by the vagus nerve. * **Abnormal sputum** is a change in the amount, consistency, color, and odor of sputum. * **Hemoptysis** is expectoration of bloody mucus that can be caused by bronchitis, tuberculosis, abscesses, neoplasms, and other conditions that cause hemorrhage from damaged vessels. ### Abnormal Breathing Patterns * Abnormal breathing patterns are adjustments made by the body to minimize the work of respiratory muscles. They include Kussmaul, obstructed, restricted, gasping, and/or Cheyne-Stokes respirations, and sighing. ### Hypoventilation and Hyperventilation * **Hypoventilation** is decreased alveolar ventilation caused by airway obstruction, chest wall restriction, or altered neurologic control of breathing. Hypoventilation causes increased Paco2. * **Hyperventilation** is increased alveolar ventilation produced by anxiety, head injury, or severe hypoxemia. Hyperventilation causes decreased Paco2. ### Cyanosis and Clubbing * **Cyanosis** is a bluish discoloration of the skin caused by desaturation of hemoglobin, polycythemia, or peripheral vasoconstriction. * **Clubbing of the fingertips** is associated with diseases that disrupt the normal pulmonary circulation and cause chronic hypoxemia. * **Chest pain** can result from inflamed pleurae, the trachea, bronchi, or respiratory muscles. ### Hypercapnia and Hypoxemia * **Hypercapnia** is increased Paco2 caused by a decrease in minute volume (respiratory rate × tidal volume). * **Hypoxemia** is a reduced Pao2 caused by: * decreased oxygen content of inspired gas * hypoventilation * diffusion abnormality * ventilation-perfusion mismatch * shunting ### Acute Respiratory Failure * **Acute respiratory failure** is caused by inadequate gas exchange or ventilation (Pao2 ≤ 50 mmHg or Paco2 ≥ 50 mmHg and pH ≥ 7.25). ### Disorders of the Chest Wall and Pleura 1. If the chest wall is deformed, traumatized, immobilized, or made heavy by fat, the work of breathing is increased and ventilation is compromised by a decrease in tidal volume from compression of the lungs or impaired chest wall muscle function. 2. Flail chest results from rib or sternal fractures that disrupt the mechanics of breathing. 3. Pneumothorax is the accumulation of air in the pleural space. It can be caused by spontaneous rupture of weakened areas of the pleura or can be secondary to pleural damage caused by disease, trauma, or mechanical ventilation. 4. Tension pneumothorax is a life-threatening condition caused by trapping of air in the pleural space. 5. Pleural effusion is the accumulation of fluid in the pleural space, usually resulting from disorders that promote transudation or exudation from capillaries underlying the pleura but occasionally resulting from blockage or injury that causes lymphatic vessels to drain into the pleural space. 6. Empyema is the presence of pus in the pleural space (infected pleural effusion). The source of the pus is usually lymphatic drainage from sites of bacterial pneumonia. ### Pulmonary Disorders 1. Aspiration is passage of fluid and solid particles into the lung, usually from impaired swallowing and coughing. It frequently results in pneumonitis and pulmonary infection. 2. Atelectasis is the collapse of alveoli resulting from compression of the lung tissue, absorption of gas from obstructed alveoli, or impairment of surfactant. 3. Bronchiectasis is abnormal dilation of the bronchi usually secondary to another pulmonary disorder, usually infection or chronic inflammation. 4. Bronchiolitis is the inflammatory obstruction of small airways. It is most common in children. 5. Bronchiolitis obliterans organizing pneumonia is a complication of bronchiolitis obliterans in which the alveoli and bronchioles become filled with plugs of connective tissue. 6. Bronchiolitis obliterans syndrome is an inflammatory, fibrotic process that occurs as a complication of lung transplantation. 7. Pulmonary fibrosis is an excessive amount of connective tissue in the lung. It diminishes lung compliance and may be idiopathic or caused by disease; it results in decreased oxygen diffusion and hypoxemia. 8. Inhalation of noxious gases or prolonged exposure to high concentrations of oxygen can damage the bronchial mucosa or alveolocapillary membrane and cause inflammation or acute respiratory failure. 9. Pneumoconiosis is caused by inhalation of dust particles in the workplace, including coal dust (anthracosis), silica (silicosis), or asbestos. It causes chronic inflammation, pulmonary fibrosis, and susceptibility to lower airway infection and tumor formation. 10. Hypersensitivity pneumonitis (extrinsic allergic alveolitis) is an allergic or hypersensitivity reaction to many allergens. 11. Pulmonary edema is the presence of excess water in the lung caused by disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability. A common cause is left-sided heart failure, which increases the hydrostatic pressure in the pulmonary circulation. 12. ALI/ARDS results from an acute, diffuse inflammatory injury to the alveolocapillary membrane and decreased surfactant production, which increases membrane permeability and causes pulmonary edema and atelectasis. 13. Obstructive pulmonary disease is characterized by airway obstruction that causes difficult expiration. Obstructive disease can be acute or chronic and includes asthma, chronic bronchitis, and emphysema. 14. Asthma is a chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyperresponsiveness, mucosal edema, airway constriction, and variable obstruction to airflow that is reversible. Obstruction is caused by episodic airway epithelial exposure to antigen with attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased production of mucus. 15. COPD is the coexistence of two primary phenotypes, chronic bronchitis and emphysema, which frequently overlap each other. 16. The asthma-COPD overlap syndrome is a phenotype of chronic respiratory disease where there is an overlap of the clinical symptoms of asthma and COPD. 17. Chronic bronchitis is chronic inflammation of the bronchi that causes airway obstruction resulting from bronchial smooth muscle hypertrophy, increases in the size and number of epithelial mucous glands and goblet cells, and increased production of thick, tenacious mucus. 18. Emphysema results from destruction of elastin in the alveolar septa and loss of passive elastic recoil, leading to airway collapse, obstruction to gas flow during expiration, and air trapping. 19. Emphysema in which septal deterioration is caused by $a_1$-antitrypsin deficiency or old age tends to be panacinar. 20. Emphysema in which septal deterioration results from smoking tends to be centriacinar. 21. Paraseptal emphysema is associated with large bullae formation. 22. Upper respiratory tract infections are the most common cause of short-term disability in the United States and include rhinitis (the common cold), pharyngitis, and laryngitis. 23. Serious lower respiratory tract infections which occur most often in older adults and individuals with impaired immunity or underlying disease, include pneumonia and tuberculosis. 24. Acute bronchitis is acute infection or inflammation of the large airways or bronchi; it is usually self-limiting and caused by viruses. 25. Pneumonia is an infection of the lower respiratory tract and can be categorized as community-acquired (CAP), healthcare-associated (HCAP), hospital-acquired (HAP), or ventilator-associated (VAP). 26. Pneumococcal pneumonia is an acute lung infection resulting in an inflammatory response with four phases: (a) consolidation, (b) red hepatization, (c) gray hepatization, and (d) resolution. 27. Viral pneumonia is an acute, self-limiting lung infection usually caused by the influenza virus. 28. TB is a lung infection caused by M.Tuberculosis (tubercle bacillus) and can also invade other organs. The bacterium is successful as a pathogen because it can survive within macrophages, resist lysosomal killing, multiply within the entran into a stage of dormancy rendering itself extremely resistant to host defense and drug treatment. 29. Bacilli may remain dormant within the tubercles for life; or if the immune system becomes compromised, they may cause recurrence of active disease. 30. Abscesses are circumscribed areas of destruction of lung parenchyma with suppuration usually resulting from aspiration pneumonia. 31. Acute bronchitis is acute infection or inflammation of the airways or bronchi usually caused by a virus. 32. Pulmonary vascular diseases are caused by embolism or hypertension in the pulmonary circulation. 33. PE is occlusion of a portion of the pulmonary vascular bed by a thrombus (most common), a tissue fragment, or an air bubble. Depending on its size and location, the embolus can cause hypoxic vasoconstriction, pulmonary edema, atelectasis, pulmonary hypertension, shock, and even death. 34. Pulmonary artery hypertension (pulmonary artery pressure) is defined as a mean pulmonary artery pressure greater than 25 mmHg at rest. It is caused by: * elevated left ventricular pressure * increased blood flow through the pulmonary circulation * obliteration or obstruction of the vascular bed, or * active constriction of the vascular bed produced by hypoxemia or acidosis. 35. Cor pulmonale is right ventricular enlargement caused by chronic pulmonary hypertension. Cor pulmonale progresses to right ventricular failure if the pulmonary hypertension is not reversed. 36. Laryngeal cancer occurs primarily in men and represents less than 1% of all cancers. Squamous cell carcinoma of the true vocal cords is most common and manifests with a clinical symptom of progressive hoarseness. 37. Lung cancer, the most frequent cause of cancer death in the United States, is commonly caused by smoking of cigarettes or tobacco. 38. Cancer cell types include non-small cell lung cancer (squamous cell carcinoma, adenocarcinoma, large cell undifferentiated carcinoma) and neuroendocrine tumors (small cell carcinoma and bronchial carcinoid tumors). Other tumors include small cell (oat cell) carcinoma, bronchial adenoma, adenocystic tumors (cylindromas), mucoepidermoid carcinomas (bronchial tumors), and mesothelioma. Each type arises in a characteristic site or type of tissue, causes distinctive clinical manifestations, and differs in likelihood of metastasis and prognosis.