Chapter 27 Alterations of Pulmonary Function PDF

Chapter 27 Alterations of Pulmonary Function  Signs and Symptoms of Pulmonary Disease  Dyspnea Subjective sensation of uncomfortable breathing Orthopnea Dyspnea when a person is lying flat Paroxysmal nocturnal dyspnea (PND) ...

Chapter 27 Alterations of Pulmonary Function  Signs and Symptoms of Pulmonary Disease  Dyspnea Subjective sensation of uncomfortable breathing Orthopnea Dyspnea when a person is lying flat Paroxysmal nocturnal dyspnea (PND)  Signs and Symptoms of Pulmonary Disease (Cont.)  Cough Acute cough Chronic cough  Abnormal sputum  Hemoptysis  Abnormal breathing patterns Kussmaul respiration (hyperpnea) Cheyne-Stokes respiration  Signs and Symptoms of Pulmonary Disease (Cont.)  Hypoventilation Hypercapnia  Hyperventilation Hypocapnia  Cyanosis  Clubbing  Pain  Clubbing Modified from Seidel, H.M., et al. (2011). Mosby’s guide to physical examination (7th ed.). Mosby.  Conditions Caused by Pulmonary Disease or Injury  Hypercapnia  Hypoxemia Hypoxemia versus hypoxia Ventilation–perfusion abnormalities Shunting  Acute respiratory failure Ventilation–Perfusion Abnormalities 1. A patient has bulbous enlargement of the distal segments of the fingers. Which disease is associated with this condition? A. Cystic fibrosis B. Acute pneumonia C. Sickle cell disease D. Acute myocardial infarction  Chest Wall Disorders  Chest wall restriction Compromised chest wall Deformation, immobilization, and obesity  Flail chest Instability of a portion of the chest wall Fracture of several ribs +/- sternum Flail Chest  Pleural Abnormalities  Pneumothorax Open Tension Spontaneous (primary) Secondary  Pleural Abnormalities (Cont.)  Pleural effusion Transudative effusion Exudative effusion Hemothorax Empyema Infected pleural effusion; pus Chylothorax  Pulmonary Disorders  Restrictive lung diseases Aspiration Passage of fluid and solid particles into the lungs Atelectasis Compression atelectasis Absorption atelectasis Surfactant impairment Bronchiectasis Persistent abnormal dilation of the bronchi Absorption Atelectasis  Pulmonary Disorders  Restrictive lung diseases Bronchiolitis Inflammatory obstruction of the small airways Most common in children Occurs in adults with chronic bronchitis, in association with a viral infection, or with inhalation of toxic gases Pulmonary fibrosis Idiopathic pulmonary fibrosis (IPF)  Pulmonary Disorders (Cont.) Inhalation disorders: Toxic gases Pneumoconiosis  Silica  Asbestos  Coal Allergic alveolitis  Extrinsic allergic alveolitis (hypersensitivity pneumonitis) – Allergic reaction from inhaled particles or fumes  Pulmonary Disorders (Cont.) Pulmonary edema Excess fluid in the lungs Pulmonary Edema  Pulmonary Disorders  Restrictive lung diseases Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) Characterized by acute lung inflammation and diffuse alveolocapillary injury Injury and inflammation to the alveocapillary membrane  Pulmonary edema Three phases:  Exudative  Proliferative  Fibrotic  Pulmonary Disorders (Cont.) Manifestations: Dyspnea and hypoxemia Hyperventilation and respiratory alkalosis Decreased tissue perfusion, metabolic acidosis, and organ dysfunction Increased work of breathing, decreased tidal volume, and hypoventilation Hypercapnia, respiratory acidosis Respiratory failure, decreased cardiac output, hypotension, and death  Pulmonary Disorders (Cont.) Diagnosis is based on a history of the lung injury, physical examination, analysis of blood gases, and radiological examination Supportive therapy  Pulmonary Disorders (Cont.)  ARDS and COVID-19 Severe COVID-19 is manifested as viral pneumonia- induced ARDS Advanced age is leading risk factor for developing severe COVID-19 Postmortem studies of patients who died as a result of COVID-induced ARDS had undetectable viral loads Cytotoxic effects of virus not main cause of death Rather, it is caused by the host’s failure to deactivate or modulate inflammation in order to promote lung tissue repair  Pulmonary Disorders (Cont.)  COVID-19 Viral loads peak before symptom onset Variability of symptoms Management: intubation, low tidal volume, prone positioning, ECMO  Pulmonary Disorders (Cont.)  Vaping and Lung Injury Electronic (e-) cigarettes Promoted as safer alternative to tobacco Recent evidence: associated with lung injury 2. Which statement is TRUE regarding acute respiratory distress syndrome (ARDS)? A. It is caused by injury to the bronchioles. B. It can cause severe pulmonary edema. C. It is most commonly caused by exposure to inhaled irritants. D. Macrophages are not involved in response.  Pulmonary Disorders  Obstructive lung diseases Airway obstruction that is worse with expiration Common signs and symptoms Dyspnea and wheezing Common obstructive disorders Asthma COPD Emphysema Chronic bronchitis Asthma  Pulmonary Disorders  Obstructive lung diseases: asthma Chronic inflammatory disorder of the airways Inflammation results from hyper-responsiveness of the airways Can lead to obstruction and status asthmaticus Symptoms include expiratory wheezing, dyspnea, and tachypnea Peak flow meters, corticosteroids, beta-agonists, and anti-inflammatories used to treat  Pulmonary Disorders (Cont.)  Obstructive lung diseases: COPD Characterized by persistent airflow limitation Usually progressive Most common chronic lung disease in the world Risk factors Tobacco smoke Occupational dusts and chemicals Air pollution Any factor affecting lung growth during gestation and childhood Chronic Obstructive Pulmonary Disease  Chronic Obstructive Pulmonary Disease (Cont.)  Pulmonary Disorders  Obstructive lung diseases: chronic bronchitis Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years. Inspired irritants increase mucus production and the size and number of mucous glands Mucus is thicker than normal. Bronchodilators, expectorants, and chest physiotherapy used to treat.  Pulmonary Disorders (Cont.)  Obstructive lung diseases: emphysema Abnormal permanent enlargement of the gas- exchange airways accompanied by destruction of alveolar walls without obvious fibrosis Inherited deficit of α1-antitrypsin Loss of elastic recoil 3. Which statement is TRUE regarding the pathophysiology of asthma? A. IgA is the major factor. B. There is decreased vascular permeability. C. Inflammation results in hyper-responsiveness. D. Inflammatory process is caused by the loss of bronchial smooth muscle spasm.  Pulmonary Disorders  Respiratory tract infections: acute bronchitis Acute infection or inflammation of the airways or bronchi Commonly follows a viral illness Acute bronchitis causes symptoms similar to those of pneumonia, but does not demonstrate pulmonary consolidation and chest infiltrates  Pulmonary Disorders (Cont.)  Respiratory tract infections: pneumonia Lower respiratory tract infection Caused by bacteria, viruses, fungi, protozoa, or parasites Health care-acquired (HCAP), community acquired (CAP), hospital acquired (HAP), and ventilator- associated (VAP)  Pulmonary Disorders (Cont.) Pneumococcal Most common and most lethal Intense inflammatory response Viral Seasonal and usually self-limiting Usually preceded by viral URI Pneumococcal Pneumonia  Pulmonary Disorders  Respiratory tract infections Tuberculosis Mycobacterium tuberculosis Acid-fast bacillus Airborne transmission Tubercle formation Caseous necrosis Positive tuberculin skin test (PPD)  Pulmonary Disorders (Cont.)  Abscess formation and cavitation Consolidation Abscess Cavitation  Pulmonary Disorders (Cont.)  Pulmonary vascular disorders: pulmonary embolus Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble Pulmonary emboli commonly arise from the deep veins in the lower leg Virchow triad Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels Pulmonary Embolism  Pulmonary Disorders  Pulmonary vascular disorders: pulmonary artery hypertension (PAH) Mean pulmonary artery pressure >25 mm Hg at rest Idiopathic pulmonary arterial hypertension (IPAH) Unclear multifactorial mechanisms Diseases of the respiratory system and hypoxemia are more common causes  Pulmonary Disorders (Cont.) Classifications: No known cause or associated with inheritance, medications or toxins, connective tissue disease or infection Attributable to left ventricular disease Caused by chronic lung disease or hypoxia, or both Chronic thromboembolic pulmonary hypertension Caused by other multifactorial mechanisms including blood, metabolic, and systemic disorders Pulmonary Hypertension and Cor Pulmonale  Pulmonary Disorders  Pulmonary vascular disorders: cor pulmonale Pulmonary heart disease Right ventricular enlargement Secondary to pulmonary hypertension Pulmonary hypertension creates chronic pressure overload in the right ventricle  Pulmonary Disorders (Cont.)  Malignancies of the respiratory tract Laryngeal Forms:  Carcinoma of the true vocal cords (most common)  Supraglottic  Subglottic is rare  Laryngeal Cancer Redrawn from del Regato, J.A., et al. (1985). Ackerman and del Regato’s cancer (2nd ed.). Mosby.  Pulmonary Disorders  Malignancies of the respiratory tract Lung (bronchogenic) Leading cause of cancer death in Canada Most common cause is cigarette smoking Environmental or occupational risk factors are also associated  Pulmonary Disorders (Cont.) Lung Types:  Non–small cell cancer – Squamous cell carcinoma – Adenocarcinoma large cell carcinoma  Large cell carcinoma  Small cell (oat cell) carcinoma—from neuroendocrine tissue 4. A patient has right ventricular enlargement secondary to pulmonary hypertension. Which would be the most likely diagnosis? A. Cor pulmonale B. Acute bronchitis C. Pulmonary embolism D. Pulmonary thromboembolism