Respiratory System Fall 2024 NEW PDF

RESPIRATORY DISORDERS Chapter 5 INFECTIOUS DISORDERS: UPPER RESPIRATORY TRACT INFECTIONS: INFECTIOUS RHINITIS Viral rhinitis and common cold Usually caused by the rhinovirus ⚬ Highly contagious May also see a secondary bacterial infection Incubation period 2 3 days Manifestations...

RESPIRATORY DISORDERS Chapter 5 INFECTIOUS DISORDERS: UPPER RESPIRATORY TRACT INFECTIONS: INFECTIOUS RHINITIS Viral rhinitis and common cold Usually caused by the rhinovirus ⚬ Highly contagious May also see a secondary bacterial infection Incubation period 2 3 days Manifestations: sneezing, nasal congestion, nasal discharge, sore throat, nonproductive cough, malaise, myalgia, low-grade fever, hoarseness, headache, and chills INFECTIOUS DISORDERS: UPPER RESPIRATORY TRACT INFECTIONS: RHINOSINUSITIS Inflammation of the sinus cavities Rhinosinusitis is the preferred term for sinusitis Causes: viruses, bacteria, and fungi Exudate collects and blocks the sinus cavities Manifestations: facial pain, nasal congestion, fever, and sore throat INFECTIOUS DISORDERS: UPPER RESPIRATORY TRACT INFECTIONS: EPIGLOTTITIS Inflammation of the epiglottis Life-threatening! Causes: Haemophilus influenzae type B (Hib) (common infection in children) and throat trauma Manifestations: fever, sore throat, difficulty swallowing, drooling with mouth open, inspiratory stridor, respiratory distress, central cyanosis, anxiety, pallor, and assuming a sitting position INFECTIOUS DISORDERS: UPPER RESPIRATORY TRACT INFECTIONS: LARYNGITIS Inflammation of the larynx Usually self-limiting Causes: infection, increased upper respiratory exudate, and overuse Manifestations: hoarseness, weak voice or voice loss, tickling sensation and raw feeling in the throat, sore throat, dry cough, and difficulty breathing INFECTIOUS DISORDERS: UPPER RESPIRATORY TRACT INFECTIONS: LARYNGOTRACHEOBRONCHITIS Also referred to as: Croup Common viral infection in children, usually parainfluenza viruses and adenoviruses Larynx and surrounding area swell, leading to airway narrowing, obstruction, and respiratory failure Manifestations: nasal congestion, seal-like barking cough, hoarseness, inspiratory stridor, dyspnea, anxiety, and central cyanosis INFECTIOUS DISORDERS: UPPER RESPIRATORY TRACT INFECTIONS: INFLUENZA Flu Viral infection that may affect the upper and lower respiratory tract Highly adaptive virus Types ⚬Type A: most severe and most common in United States ⚬Type B: less severe ⚬Type C: usually causes small outbreaks U.S. flu season between October and March Incubation period of 1 4 days Can cause significant problems with children, elderly, and those who are immune compromised INFECTIOUS DISORDERS: UPPER RESPIRATORY TRACT INFECTIONS: INFLUENZA Manifestations: fever, headache, chills, dry cough, body aches, nasal congestion, sore throat, sweating, and malaise Prevention of transmission: hand washing, isolation and avoiding crowds, and annual vaccination INFECTIOUS DISORDERS: LOWER RESPIRATORY TRACT INFECTIONS: ACUTE BRONCHITIS Inflammation of the tracheobronchial tree or large bronchi Causes: viruses, bacterial, irritant inhalation, and allergic reactions Manifestations: productive and nonproductive cough, dyspnea, wheezing, low- grade fever, pharyngitis, malaise, and chest discomfort Diagnosis: history, physical examination, and X-ray INFECTIOUS DISORDERS: LOWER RESPIRATORY TRACT INFECTIONS: BRONCHIOLITIS Common acute More frequent in children inflammation of the younger than 1 year and bronchioles, usually during the winter months respiratory syncytial virus Manifestations: nasal drainage, nasal congestion, Can lead to atelectasis and cough, wheezing, rapid and respiratory failure shallow respirations, chest retractions, dyspnea, fever, tachycardia, and malaise PATHOPHYSIOLOGY OF PNEUMONIA Inflammation in the lungs > damage to bronchial mucous membranes and alveolocapillary membranes >infectious debris and exudate ⚬ Some microbes release toxins from cell walls > further damaging lung tissue Aspiration of oropharyngeal secretions is the most common route of lower respiratory tract infections PATHOPHYSIOLOGY OF PNEUMONIA Another route of infection is through inhalation of microorganisms that are released in the air (infected individual coughs, sneezes, talks) or contaminated respiratory therapy equipment Endotracheal tubes can become contaminated with bacteria that can enter the lungs Pneumococcus (Streptococcus pneumoniae) is the most common and lethal cause of outpatient and inpatient pneumonias Most common cause of viral CAP is influenza TYPES OF PNEUMONIA INFECTIOUS DISORDERS: LOWER RESPIRATORY TRACT INFECTIONS: PNEUMONIA Causes: infectious agents, injurious agents or events, and pulmonary secretion stasis Viral: usually mild, can lead to secondary bacterial pneumonia Bacterial: more common than viral, most often due to Streptococcus pneumoniae Aspiration pneumonia: from aspirated fluid entering the lungs ⚬Causes: impaired gag reflex, improper lower esophageal sphincter closure, inappropriate gastric tube placement Lobar pneumonia: confined to a single lobe Bronchopneumonia: most frequent type, a patchy pneumonia across several lobes Interstitial (atypical) pneumonia: occurs in the areas between the alveoli, routinely caused by viruses or by uncommon bacteria INFECTIOUS DISORDERS: LOWER RESPIRATORY TRACT INFECTIONS: PNEUMONIA Nosocomial pneumonia: develops more than 48 hours after a hospital admission Community-acquired pneumonia: acquired outside the hospital or healthcare setting Ventilator-associated pneumonia- occurs in patients that have been on mechanical ventilation for more than 48 hours INFECTIOUS DISORDERS: LOWER RESPIRATORY TRACT INFECTIONS: PNEUMONIA Manifestations: productive or nonproductive cough, fatigue, pleuritic pain, dyspnea, fever, chills, crackles or rales, pleural rub, tachypnea, and mental status changes (especially in the elderly) Prevention: hand washing, avoiding crowds, vaccinations, turning, coughing, deep breathing, and smoking cessation Complications: septicemia, pulmonary edema, lung abscess, and acute respiratory distress syndrome INFECTIOUS DISORDERS: LOWER RESPIRATORY TRACT INFECTIONS: TUBERCULOSIS Caused by the bacillus, Mycobacterium tuberculosis Fairly controlled until recently Resistant strains have developed in those immune compromised Most frequently occurs in the lungs, but can spread to other organs Carried by airborne droplets Primary infection occurs when bacillus first enters the body ⚬Macrophages engulf the microbe, causing a local inflammatory response ⚬Some bacilli travel to the lymph nodes, activating the type IV hypersensitivity reaction ⚬Granuloma and tubercle forms ⚬Caseous necrosis and Ghon complexes develop ⚬Bacilli can remain dormant for years; Usually asymptomatic, but will test positive THE PROCESS OF FORMATION OF TUBERCULOSIS INFECTIOUS DISORDERS: LOWER RESPIRATORY TRACT INFECTIONS: TUBERCULOSIS Manifestations: productive Secondary infection cough, hemoptysis, night occurs during reactivation sweats, fever, chills, fatigue, of dormant bacilli unexplained weight loss, ⚬Can spread to other organs anorexia, and symptoms ⚬Symptoms usually develop depending on other organ involvement Prevention: vaccination, respiratory precautions, adequate ventilation, and appropriate isolation  ALTERATIONS IN VENTILATION: ASTHMA Common chronic disorder that results in intermittent, reversible airway obstruction from a variety of triggers from infections to smoke Characterized by acute airway inflammation, bronchoconstriction, bronchospasm, bronchiole edema, and mucus production Extrinsic asthma: generally presents in childhood or adolescence ⚬ Increased IgE synthesis and airway inflammation, resulting in mast cell destruction and inflammatory mediator release ⚬ Mediator release causes bronchoconstriction, increased capillary permeability, and mucus production ⚬ Triggers: allergens such as food, pollen, dust, and medications Intrinsic asthma: nonallergic reaction that usually presents after age 35 ⚬ Triggers: upper respiratory infections, air pollution, emotional stress, smoke, exercise, and cold exposure NORMAL AIRWAY vs DURING ASTHMA EXACERBATION ALTERATIONS IN VENTILATION: ASTHMA Exercise-induced Drug-induced asthma: Nocturnal asthma: Occupational asthma: asthma: usually occurs potentially fatal attack usually occurs between caused by a reaction to 10 15 minutes after up to 12 hours post- 3:00 and 7:00 a.m. substances at work activity ingestion ⚬May be related to ⚬Symptoms can linger ⚬Symptoms develop ⚬Frequently caused circadian rhythms for an hour over time, worsening by aspirin prevents at night, cortisol and ⚬May be a with each exposure the conversion of epinephrine levels compensatory and improving when prostaglandins, decrease, while mechanism to warm away from work which stimulate histamine levels and moisten the leukotriene release, a increase, leading to airways powerful bronchoconstriction ⚬Followed by a bronchoconstrictor refractory period that begins within 30 minutes and can last 90 minutes ALTERATIONS IN VENTILATION: ASTHMA Manifestations: wheezing, Stage one of an asthma Stage two of an asthma shortness of breath, dyspnea, attack peaks within 15 to 30 attack peaks within 6 hours chest tightness, cough, minutes of symptom onset tachypnea, and anxiety ⚬Related to ⚬Result of airway edema bronchospasms, and and mucus production usually signaled by ⚬The alveolar hyperinflation coughing causes air trapping ⚬Inflammatory mediators ⚬Bronchospasm, smooth responsible include muscle contraction, leukotrienes, histamine, inflammation, and mucus and some interleukins production combine to narrow the airways PATHOGENESIS OF ASTHMA ALTERATIONS IN VENTILATION: ASTHMA Status asthmaticus: an often- fatal, prolonged asthma attack unresponsive to usual treatment Can quickly lead to respiratory alkalosis and respiratory failure ALTERATIONS IN VENTILATION: CHRONIC OBSTRUCTIVE PULMONARY DISEASE Debilitating chronic disorders characterized by irreversible, progressive tissue degeneration and airway obstruction Severe hypoxia and hypercapnia can lead to respiratory failure Can also lead to cor pulmonale (right-sided heart failure caused by high blood pressure in the lungs due to chronic lung disease) Causes: smoking, pollution, chemical irritants, and genetic mutation Often asymptomatic early or masked by smoking Often one disease or a mixture of two diseases chronic bronchitis and emphysema PATHOGENESIS - COPD ALTERATIONS IN VENTILATION: CHRONIC BRONCHITIS Characterized by inflammation of the bronchi, a productive cough, and excessive mucus production Complications: frequent respiratory infections and respiratory failure Manifestations: hypoventilation, hypoxemia, cyanosis, hypercapnia, polycythemia, clubbing of fingers, dyspnea at rest, wheezing, edema, weight gain, malaise, chest pain, and fever  ALTERATIONS IN VENTILATION: EMPHYSEMA Destruction of the alveolar walls leads to large, permanently inflated alveoli Enzyme necessary for lung remodeling is deficient Loss of elastic recoil and hyperinflation of the alveoli, leading to air trapping Causes: genetic predisposition and smoking Increased anterior- posterior chest Manifestations: dyspnea upon exertion, circumference (barrel diminished breath sounds, wheezing, chest chest) tightness, tachypnea, hypoxia, hypercapnia, increased anterior posterior thoracic diameter (from 1:2 to 1:1), activity intolerance, anorexia, and malaise ALTERATIONS IN VENTILATION: CYSTIC FIBROSIS Life-threatening condition resulting in severe lung damage and nutrition deficits Affects cells that produce mucus, sweat, saliva, and digestive secretions (Secretions become thick and tenacious) Caused by autosomal recessive mutation on seventh chromosome, leading to abnormality in protein involved in chloride cellular transport Complications: atelectasis, recurrent infections, cor pulmonale, respiratory failure, malabsorption, malnutrition, electrolyte imbalances, sterility, and infertility Manifestations: meconium ileus, salty skin, steatorrhea, fat-soluble vitamin deficiency, chronic cough, hypoxia, fatigue, activity intolerance, audible rhonchi, and delayed growth and development ALTERATIONS IN VENTILATION: CYSTIC FIBROSIS  ALTERATIONS IN VENTILATION: LUNG CANCER Second most common cancer May occur as a primary or secondary tumor Deadliest of the cancers in men and women Smoking is the most significant risk factor, either first-hand or second-hand Small cell carcinoma, also known as oat-cell carcinoma, occurs almost exclusively in heavy smokers (less frequent) Non-small-cell carcinoma, also known as bronchogenic carcinoma, is the most common type of malignant lung cancer ⚬ Very aggressive lung cancer ⚬ Several subgroups squamous cell carcinoma, adenocarcinoma, and bronchoalveolar carcinoma ALTERATIONS IN VENTILATION: LUNG CANCER Complications: airway obstruction, lung tissue inflammation, fluid accumulation, and paraneoplastic syndrome (immune system reaction) Manifestations: persistent cough or a change in usual cough, dyspnea, hemoptysis, frequent respiratory infections, chest pain, hoarseness, weight loss, anemia, fatigue, and other symptoms specific to site of metastasis Alterations in Ventilation: Pleural Effusion Excess fluid in the pleural cavity, which may include exudates, transudates, blood, and pus and can impair breathing May also see pleurisy inflammation of the pleural membranes Manifestations: dyspnea, chest pain, tachypnea, tracheal deviation, absent lung sounds and dullness over the affected area, tachycardia, and pleural friction rub  Air in the pleural cavity, which can cause lung to collapse ALTERATIONS IN VENTILATION: Risk factors: smoking, tall stature, and history of lung disease PNEUMOTHORAX or previous pneumothorax Spontaneous pneumothorax: where air enters from an opening in the internal airways BLEB ⚬Primary spontaneous pneumothorax: usually mild ￭Occurs when a small air blister (bleb) on the top of the lung ruptures ← ￭Blebs are caused by a weakness in the lung tissue ⚬Secondary spontaneous pneumothorax: more severe and even life- threatening ￭Develops in people with preexisting lung disease Traumatic pneumothorax: result of a blunt or penetrating injury to the chest Tension pneumothorax: the most serious type, can cause affected lung to collapse ⚬Occurs when the pressure in the pleural space is greater than the atmospheric pressure ⚬Due to trapped air in the pleural space or air from a positive-pressure mechanical ventilator ALTERATIONS IN VENTILATION: PNEUMOTHORAX Manifestations: sudden chest pain, chest tightness, dyspnea, tachypnea, decreased breath sounds over the affected area, asymmetrical chest movement, trachea and mediastinum deviation, anxiety, tachycardia, pallor, and hypotension Pneumothorax PULMONARY EMBOLISM Usually caused by a thrombus (blood clot most common) Can also be caused by fat (from bone marrow esp. following femur fracture), air, or a foreign body Can result in: ⚬ Embolus with infarction (death of lung tissue) ⚬ Embolus without infarction (does not cause permanent lung injury) ⚬ Massive occlusion (occludes a major portion of pulmonary circulation) ⚬ Multiple pulmonary emboli ALTERATIONS IN VENTILATION AND PERFUSION: ATELECTASIS Causes: surfactant deficiencies, bronchus Collapse of the alveoli obstruction, lung tissue compression, increased surface tension, and lung fibrosis Manifestations: diminished Prevention: increasing breath sounds, dyspnea, mobility, coughing, and tachypnea, asymmetrical deep breathing; effective lung movement, anxiety, pain management; and restlessness, tracheal incisional splinting deviation, and tachycardia X-RAY NORMAL V/S ATELECTASIS ALTERATIONS IN VENTILATION AND PERFUSION: ACUTE RESPIRATORY FAILURE Life-threatening inability of the lungs to Result of many maintain adequate respiratory conditions oxygenation Manifestations: shallow respirations, headache, Complications: heart tachycardia, failure and death dysrhythmias, lethargy, and confusion  CORONAVIRUS DISEASE 2019 (COVID-19) Caused by severe acute respiratory syndrome coronavirus 2 (virus) Transmitted primarily person to person through respiratory droplets Median incubation period is 5.2 days (most will develop symptoms in 11.5-15.5 days) Virus invades lung cells, myocytes, and endothelial cells of the vascular system, resulting in inflammatory changes These changes contribute to lung injury pathogenesis, hypoxia-related myocyte injury, body immune response, increased damage of myocardial cells, intestinal and cardiopulmonary changes BODY SYSTEMS AFFECTED BY COVID Respiratory system is the primary system affected (multiple infiltrates of both lungs may be present) Cardiovascular system (thrombi, inflammation of cardiac muscle, cardiac arrhythmias, heart failure, acute coronary syndrome) GI system (diarrhea, N/V, abdominal pain) Potential neuropathic properties (headache, dizziness, seizures, decreased LOC, agitation, confusion) How COVID Affects Your Lungs VIDEO