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Ch 19 Patho

Respiratory Disorders

The Lower Respiratory is considered? Sterile
The nasal cavities job is to? Warm and moisten incoming air and trap foreign material by mucus secretions
The nasopharynx is the site for? Pharyngeal tonsils in posterior wall
Palatine tonsils are made up of and found? Lymphoid tissue in posterior portion of the oral cavity
The Oropharynx is considered? The Common passageway for air and food
The Epiglottis? protects opening into larynx. Closes over glottis at swallowing to prevent aspiration
The Larynx holds? Two pairs of vocal cords
Process of inspiration and expiration is determned by? Airflow depends on pressure gradient from high to low area
Inspiration is? Atmospheric pressure higher than pressure in alveoli air moves from atmosphere into lungs
Expiration is? Pressure in alveoli higher than in atmosphere air moves from lungs into atmosphere
Tidal volume is the amount of air exchanged with quiet inspiration and expiration
Residual volume is Volume of air remaining in lungs after maximum respiration
Vital capacity is? Maximal amount of air that can be moved in and out of the lungs with a single forced inspiration and expiration
Primary control centers for breathing are located where? Located in the medulla and pons
Chemoreceptors detect changes in? carbon dioxide levels, hydrogen ions, and oxygen in blood or cerebrospinal fluid (CSF)
Central chemoreceptors are found? In the medulla
Peripheral chemoreceptors are found? in the carotid bodies
Hypoxemia is? Marked decrease in oxygen in which Chemoreceptors respond
Important control mechanism in individuals with chronic lung disease? move to hypoxic drive
Hypocapnia Caused by low carbon dioxide concentration in blood May be caused by hyperventilation Causes respiratory alkalosis
Factors Affecting Diffusion of Gases Thickness of the respiratory membrane Total surface area available for diffusion Ventilation-perfusion ratio need to match
Oxygen is? About 1% is dissolved in plasma Most is bound (reversibly) to hemoglobin
Binding/release of oxygen to hemoglobin depends on PO2 PCO2 Temperature Plasma ph
Carbon dioxideis? Waste product from cellular metabolism About 7% dissolved in plasma About 20% reversibly bound to hemoglobin Most diffuses into red blood cells
Sputum is? Yellowish-green, cloudy, thick mucus Often indication of a bacterial infection
Rusty or dark-colored sputum is a sign of? pneumococcal pneumonia
Very large amounts of purulent sputum with foul odor is? bronchiectasis
Thick, tenacious mucus is caused by? Asthma or cystic fibrosis
Hemoptysis is? Blood-tinged (bright red) frothy sputum associated with pulmonary edema
Kussmaul respiration is? Deep rapid respiration typical for acidosis may follow strenuous exercise
Labored respiration or prolonged inspiration or expiration cause? obstruction of airways
Wheezing or whistling sounds indicates? obstruction in small airways
Stridor is? High-pitched crowing noise indicates upper airway obstruction
Rales breathing is? Light bubbly or crackling sounds with serous secrteions
Rhonchi breathing is? Deeper or harsher sounds from thicker mucus
Absence breathing is? Nonaeration or collapse of lungs
Dyspnea is? Subjective feeling of discomfort May be due to increased carbon dioxide or hypoxemia Often noted on exertions such as climbing stairs
Severe dyspnea indicative of respiratory distress are? Flaring of nostrils Use of accessory respiratory muscles Retraction of muscles between or above ribs
Orrthopnea is? Occurs when lying down Usually due to pulmonary congestion
Paroxysmal nocturnal dyspnea is? Sudden acute type of dyspnea Common in patients with left-sided congestive heart failure
Cyanosis is? Bluish coloring of skin and mucous membranes Result of large amounts of unoxygenated hemoglobin in blood
Friction rub is? Soft sound produced as rough inflamed or scarred pleural move against each other
Clubbed digits results from? chronic hypoxia associated with respiratory or cardiovascular diseases
Changes in arterial blood gases cause? Hypoxemia Hypercapnea
Sinusitis is? Usually bacterial infection Analgesics for headache and pain Course of antibiotics often required to eradicate infection
Laryngotracheobronchitis (croup)is? Common viral infection, particularly in children Parainfluenza viruses and adenoviruses causitive organisms Infection usually self-limited
Epiglottitis is? Acute infection Common in children ages 3 to 7 Usually caused by H. influenzae type B Rapid onset; fever and sore throat Child sits in tripod position Drooling and difficulty swallowing Heightened anxiety Swelling Treatment Oxygen and antimicrobial therapy
Influenza treatment include what? Symptomatic and supportive Antiviral drugs Vaccination
Type A H1N1 Influenza is? This virus contains genes from pig, bird, and human flu strains. More commonly affects children and teens under age 20 Healthy young adults also at high risk High mortality rate due to acute respiratory syndrome
Bronchiolitis is? Caused by the respiratory syncytial virus (RSV) Transmitted by oral droplet Virus causes necrosis and inflammation in small bronchi and bronchioles. Signs Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise Treatment Supportive and symptomatic
Pneumonia is? Causative agent Viral, bacterial, fungal Throughout both lungs, or consolidated in one lobe Changes in interstitial tissue, alveolar septae, or alveoli Nosocomial (hospital-acquired) Community-acquired
Lobar pneumonia – bacterial pneumonia is? Community-based, often in healthy young adults Usually caused by Streptococcus pneumoniae Infection localized in one or more lobes Infection may spread to pleural cavity – empyema
Manifestations of Lobar Pneumonia? Sudden onset High fever with chills, fatigue, leukocytosis Dyspnea, tachypnea, tachycardia Pleural pain Rales Confusion and disorientation
Bronchopneumonia is? Diffuse pattern of infection in both lungs Several species of microorganisms may be the cause Inflammatory exudate forms in alveoli Onset tends to be insidious Antibacterial treatments
Legionnaires’ disease is? Caused by Legionella pneumophila Thrives in warm, moist environments Often nosocomial infection Difficult to identify – requires special culture medium
Untreated Legionnaires’ disease causes? Cause severe congestion and consolidation Necrosis in the lung Possibly fatal
Primary atypical pneumonia is? Mycoplasma pneumoniae – bacterial Viral form caused by influenza A or B, adenoviruses, and RSV
Tuberculosis Etiology? M. tuberculosis transmitted by oral droplets from persons with active infection People living in crowded conditions, immunodeficiency, malnutrition, alcoholism, conditions of war, chronic disease, HIV infection
Usual cause M. tuberculosis? Somewhat resistant to drying and many disinfectants Can survive in dried sputum for weeks Destroyed by ultraviolet light, heat, alcohol, glutaraldehyde, formaldehyde Normal neutrophil response does not occur Primarily affects lungs; other organs may be invaded, too
Primary infection of TB? Engulfed by macrophages – local inflammation If cell-mediated immunity is inadequate: Mycobacteria reproduce and begin to destroy lung tissue This form of disease is contagious
Secondary or reinfection TB is? cell-mediated immunity is impaired due to: Stress Malnutrition HIV infection Age Mycobacteria begin to reproduce and infect lung
Active TB (either primary or secondary) is? Organisms multiply, forming large areas of necrosis Cavitation promotes spreading into other parts of lung Cough, positive sputum, radiograph showing cavitation
Treatment of TB? Long-term treatment with a combination of drugs Length of treatment varies from 6 months to 1 year
Histoplasmosis is? Fungal infection Caused by Histoplasma capsulatum Granuloma formation and necrosis Cough, fatigue, fever, night sweats Treatment – antifungal agents
Cystic Fibrosis? Inherited (genetic) disorder Gene located on chromosome seven Tenacious mucus from exocrine glands Primary effects seen in lungs and pancreas Mucus obstructs airflow in bronchioles and small bronchi Permanent damage to bronchial walls Infections are common
Cystic Fibrosis Digestive tract? Meconium ileus in newborns Blockage of pancreatic ducts Obstruction of bile ducts
Cystic Fibrosis Reproductive tract? Obstruction of vas deferens (male) Obstruction of cervix (female)
Cystic Fibrosis Sweat glands? Sweat with high sodium chloride content
Cystic Fibrosis Signs and symptoms? Salty skin Signs of malabsorption Chronic cough and frequent respiratory infections Failure to meet normal growth milestones
Cystic Fibrosis treatment? Replacement therapy and well-balanced diet Chest physiotherapy
Aspiration Passage of food, fluid, emesis, other foreign material into trachea and lungs Common problem in young children or individuals laying down when eating/drinking Obstruction Aspirate is a solid object Inflammation and swelling Aspirate is an irritating liquid Predisposition to pneumonia
Aspiration signs and symptoms Coughing and choking with dyspnea Stridor and hoarseness Tachycardia and tachypnea Nasal flaring, chest retractions, hypoxia Cardiac or respiratory arrest
Asthma Bronchial obstruction In persons with hypersensitive or hyperresponsive airways May occur in childhood or have an adult onset Often family history of allergic conditions
Extrinsic asthma Acute episodes triggered by type I hypersensitivity reactions
Intrinsic asthma Onset during adulth Hyperresponsive tissue in airway initiates attack
Asthma Pathophysiologic changes of bronchi and bronchioles Inflammation of the mucosa with edema Bronchioconstriction Increased secretion of thick mucus Changes create obstructed airways, partially or totally
Asthma – Signs and Symptoms Cough, marked dyspnea, tight feeling in chest Wheezing Rapid and labored breathing Expulsion of thick or sticky mucus Tachycardia Hypoxia
Asthma – Signs and Symptoms Respiratory alkalosis Respiratory acidosis Severe respiratory distress Respiratory Failure
Asthma – Acute Episode Persistent severe attack of asthma
Chronic Obstructive Pulmonary Disease Group of chronic respiratory disorders Causes irreversible and progressive damage to lungs May lead to the development of cor pulmonale Respiratory failure may occur
Emphysema Destruction of alveolar walls and septae Leads to large, permanently inflated alveolar air spaces Contributing factors Genetic deficiency Genetic tendency Cigarette smoking Pathogenic bacteria
Breakdown of alveolar wall from Emphysema Loss of surface area for gas exchange Loss of pulmonary capillaries Loss of elastic fibers Altered ventilation-perfusion ratio Decreased support for other structures
Fibrosis from empysema Narrowed airways Weakened walls Interference with passive expiratory airflow
Emphysema Progressive difficulty with expiration Air trapping and increased residual volume Overinflation of the lungs Fixation of ribs in an respiratory position, increased anterior-posterior diameter of thorax (barrel chest) Flattened diaphragm (on radiograph
Emphysema signs and symptoms Dyspnea Hyperventilation with prolonged expiratory phase Anorexia Fatigue Clubbed fingers
Bronchiectasis Irreversible abnormal dilation of the medium-sized bronchi
Pulmonary Edema Fluid collecting in alveoli and interstitial area
Tension pneumothorax Result of an opening through chest wall and parietal pleura or from a tear in the lung tissue and visceral pleura Air entry into pleural cavity on inspiration but hole closes on expiration, trapping air > increased pleural pressure and atelectasis
Upper Respiratory has Resident Flora
Hypercapnia Carbon dioxide levels in the blood increase Carbon dioxide easily diffuses into CSF Lowers pH and stimulates respiratory center Increased rate and depth of respirations (hyperventilation Causes respiratory acidosis – nervous system depression
Common cold (infectious rhinitis) Viral infection More than 100 possible causative agents Spread through respiratory droplets Handwashing and respiratory hygiene important in prevention Symptomatic treatment Secondary bacterial infections may occur
Influenza (Flu) Viral infection Type A (most prevalent), types B and C Viruses constantly mutate Sudden, acute onset with fever, marked fatigue, aching pain in the body May also cause viral pneumonia
Created by: cdanella



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