Respiratory System Diseases and Disorders

1. Respiratory System Diseases and Disorders

2. The Normal Respiratory System

3. Respiratory System Review What does it do? Warms and moistens inhaled air Obtains oxygen from the air Delivers oxygen to the blood for distribution Removes carbon dioxide from the blood Keeps us alive!

4. Key Structures Pharynx � the back of the throat Trachea � windpipe Larynx � voicebox Bronchi � trachea divides into two bronchi Bronchioles � airway branches in lungs Alveoli � air sacs in lungs, site of gas exchange Cilia � tiny hairlike cells trap foreign particles Diaphragm � muscle under the lungs necessary for respiration Pleura � serous membrane surrounding the lungs Pleural cavity � body cavity surrounding the lungs

8. Gas exchange in the capillary beds

9. Respiratory Distress Terms to Know

10. Respiratory Distress � Terms to Know

11. Respiratory Distress � Terms to Know

12. Respiratory Distress � Terms to Know

13. Breath Sounds

14. Assessing Breath Sounds When caring for patient�s it is important to auscultate (listening to sounds in the body) breath sounds to determine if breathing is �normal� or if there are �adventitious� or abnormal sounds. Adventitious sounds indicate there is a respiratory problem that could lead to more serious problems such as respiratory arrest or even death.

15. High-pitched, musical, whistling Constriction of bronchioles Talking Points Wheezing is a high-pitched, musical, whistling sound that is best heard initially on exhalation but may also be heard during inhalation in more severe cases. It is an indication of swelling and constriction of the inner lining of the bronchioles. Wheezing that is diffused (heard over all the lung fields) is a primary indication for the administration of a beta agonist medication by metered-dose inhaler or by small-volume nebulizer. Wheezing is usually heard in asthma, emphysema, and chronic bronchitis. It may also be heard in pneumonia, congestive heart failure, and other conditions when they cause bronchoconstriction. Talking Points Wheezing is a high-pitched, musical, whistling sound that is best heard initially on exhalation but may also be heard during inhalation in more severe cases. It is an indication of swelling and constriction of the inner lining of the bronchioles. Wheezing that is diffused (heard over all the lung fields) is a primary indication for the administration of a beta agonist medication by metered-dose inhaler or by small-volume nebulizer. Wheezing is usually heard in asthma, emphysema, and chronic bronchitis. It may also be heard in pneumonia, congestive heart failure, and other conditions when they cause bronchoconstriction.

16. Talking Points Rhonchi are very often heard in chronic bronchitis, emphysema, aspiration, and pneumonia as snoring or rattling noises. They indicate obstruction of the larger conducting airways of the respiratory tract by thick secretions of mucus. Once characteristic of rhonchi is that the quality of sound changes if the person coughs or sometimes even when the person changes position. Talking Points Rhonchi are very often heard in chronic bronchitis, emphysema, aspiration, and pneumonia as snoring or rattling noises. They indicate obstruction of the larger conducting airways of the respiratory tract by thick secretions of mucus. Once characteristic of rhonchi is that the quality of sound changes if the person coughs or sometimes even when the person changes position.

17. Talking Points Crackles are associated with fluid that has surrounded or filled the alveoli or very small bronchioles. The crackling sound is commonly associated with the alveoli and terminal bronchioles �popping� open with each inhalation. The bases of the lungs posteriorly will reveal crackles first because of the natural tendency of fluid to be pulled downward by gravity. Crackles may indicate pulmonary edema or pneumonia. This type of breath sound typically does not change with coughing or movement. Class Activity Have pairs of students practice listening to each other�s breath sounds in the proper locations. Knowledge Application Given several descriptions of breath sounds, students should be able to suggest general causes of abnormal sounds. Talking Points Crackles are associated with fluid that has surrounded or filled the alveoli or very small bronchioles. The crackling sound is commonly associated with the alveoli and terminal bronchioles �popping� open with each inhalation. The bases of the lungs posteriorly will reveal crackles first because of the natural tendency of fluid to be pulled downward by gravity. Crackles may indicate pulmonary edema or pneumonia. This type of breath sound typically does not change with coughing or movement. Class Activity Have pairs of students practice listening to each other�s breath sounds in the proper locations. Knowledge Application Given several descriptions of breath sounds, students should be able to suggest general causes of abnormal sounds.

18. Upper Respiratory Diseases

19. Upper Respiratory Diseases The Common Cold Caused by as many as 200 strains of viruses Infection provides no immunity. Relatively contagious. Inflammation of the mucous membrane lining the URT causing nasal congestion. Treated with antipyretics for fever and antihistamines for congestion. No cure. Secondary sinus infection can occur and may need antibiotics.

20. Upper Respiratory Diseases Sinusitis Caused by viruses, bacteria and allergens. Inflammation of the mucous membrane linings causing pressure, pain and headache. More common in children. Diagnoses with physical exam, patient history, x-ray and endoscopic sinuscopy. Treated with decongestants and antihistamines.

21. Upper Respiratory Diseases Tonsillitis, Pharyngitis, Laryngitis Caused by viruses, bacteria or other pathogens. Causes inflammation, difficulty swallowing and redness and pain in the throat. Treatment includes antibiotics if bacterial, rest, fluids and humidified air.

22. Upper Respiratory Diseases Influenza Caused by a virus. Sudden onset (within 2 days of exposure) and varied severity. Symptoms include chills, fever, cough, sore throat, runny nose, chest pain, muscle aches (myalgia) and GI disorders (Nausea/vomiting). Can be very serious in the elderly, immuno-suppressed and children. Can lead to pneumonia and/or death. Treatment includes rest, fluids, antipyretics, and antibiotics for secondary infections. Vaccine available.

23. Lower Respiratory Diseases

24. Lower Respiratory Diseases Asthma Characterized by hypersensitivity to allergens such as dust, mold, pollen,, animal dander and foods. Most often starts in childhood. Causes constriction of smooth muscle in the bronchi/bronchioles, spasms, dyspnea, excessive mucus secretion and wheezing. Can be triggered by anxiety, emotion, infection, bronchitis, exposure to cigarette smoke, aerosol sprays, perfumes, or sudden overexertion/exercise. Treatment includes bronchodilators, ephedrine sprays, epinephrine injections, and cortisone. The most severe form of an asthma attack is called status asthmaticus which can result in respiratory failure and/or death.

26. Lower Respiratory Diseases Cystic Fibrosis Hereditary disease affecting the bodies exocrine glands causing excessive secretion of thick mucus. In the lungs mucus is secreted from the trachea and bronchi which blocks the air passages. Symptoms include dyspnea, wheezing, persistent cough, thick sputum, collapsed lung. Increases susceptibility to bacterial infections. Treatment includes antibiotics for secondary infection, respiratory therapy.

29. Lower Respiratory Diseases Chronic Obstructive Pulmonary Disorder (COPD) Includes a number of diseases in which the exchange of respiratory gases is ineffective. Includes chronic bronchitis, emphysema and chronic asthma. Progressive (worsens over time). Caused by long term exposure to lung irritants. Most commonly cigarette smoke. Causes coughing, mucus production, wheezing, dyspnea, shortness of breath, chest tightness, use of accessory muscles, barrel chest, tripoding. Treatment includes bronchodilators, inhaled steroids, oxygen, and management of complications.

31. Lower Respiratory Diseases Bronchitis Inflammation of the mucous membranes of the bronchi. May be acute or chronic. Most serious in children, elderly, chronically ill. Caused by lung irritants such as industrial fumes, automobile exhaust, viruses and bacteria. Causes chest pain, dyspnea, cough, purulent drainage and fever. Treatment includes humidified air, vapors, sprays and cough medicines. Exacerbated (made worse) by flu or colds.

32. Lower Respiratory Diseases Bronchogenic Carcinoma Most common type of lung cancer. Malignant tumor grows in the lumen of the bronchus causing lung collapse (pneumothorax). Few early symptoms. Late symptoms include persistent cough, hemoptysis, anorexia, weight loss, weakness and dyspnea. 80% of lung cancer is related to cigarette smoking. Treatment includes surgery, radiation, chemotherapy.

34. Lower Respiratory Diseases Pneumonia Caused by an infection and acute inflammation of the lung in which the air spaces in the lungs become filled with fluid or pus. This can cause a collapse of the alveoli which is known as atelectasis. Symptoms include dyspnea, fever, chest pain, fatigue, chills, and a productive cough. Lobar Pneumonia is inflammation of a section or lobe of the lung and caused by streptococcus pneumoniae. Treatment includes antibiotics

35. Lower Respiratory Diseases Pneumonia cont. Bronchopneumonia is pneumonia focused in the small bronchi with a diffuse pattern of inflammation. More common in debilitated patients Commonly caused by infection and aspiration of gastric contents. Primary Atypical Pneumonia (walking pneumonia) is caused by pathogens including viruses and a bacteria called mycoplasma pneumoniae. More common in adolescents and young adults.

36. Lower Respiratory Diseases Pneumonia cont. Secondary Pneumonia which is caused by some other disease that weakens the lungs or the body�s immune system. May develop in postoperative patients, bedridden patients, chronic respiratory patients or influenza infected patients. Legionnaire�s Disease which is caused by the bacterium Legionella pneumophila. Different from other pneumonias as it has flu like symptoms. Treated with antibiotics (Erythromycin).

38. Lower Respiratory Diseases Pleurisy (Pleuritis) Inflammation of the pleural membranes. Can be a complication of pneumonia, tuberculosis or other lung diseases. Symptoms include sharp, stabbing pain upon inspiration. Treatment includes antibiotics, heat application and rest.

39. Lower Respiratory Diseases Tuberculosis (once called Consumption) Chronic infection causing inflammation leading to necrosis (tissue death). Healing causes fibrosis and calcifications that develop into tubercles. Can spread to the brain, kidney and bones. Symptoms include persistent coughing, hemoptysis, weight loss, low grade fever, night sweats. Caused by the bacteria Mycobacterium tuberculosis. Transmitted in contaminated sputum. Treated with long term (18 months) antibiotics (rifampin, isoniazid, ethambutol).

40. Respiratory Disease Diagnosis and Procedures

41. Respiratory Disease Diagnosis and Procedures Bronchoscopy / Laryngoscopy / Thoracoscopy Chest X-ray / CT scan / MRI Pulmonary function tests (incintive spirometry & peak flow meters (breathing), pulse oximetry (non-invasive O2 level), ABG�s (invasive O2/CO2/pH level)) Lung biopsy Thoracentesis Tracheostomy Tuberculin test (Mantoux, PPD) Oxygen Therapy (Nasal Cannula, Non Rebreather, Bag Valve Mask)

42. Pulmonary Ventilation Spirometer � instrument used to measure the volume of air exchanged in breathing. Spirogram � graphic recording of changing volumes. TV � tidal volume: approximately 500ml. The amount of air moved in and out of the lungs during normal quiet breathing.

43. Pulmonary Ventilation IRV � Inspiratory Reserve Volume: the amount of air that can be forcibly inspired over and above normal inspiration. ERV � Expiratory Reserve Volume: the amount of air that can be forcibly exhaled after expiring the tidal volume VC � Vital Capacity: the largest amount of air that can be breathed in and out in one respiratory cycle.

44. Pulmonary Ventilation RV � Residual Volume: air that remains in the lungs after a forceful expiration. Helps to maintain alveolar patency and prevents lung collapse. Pulse Oximetry � measures oxygen saturation or O2 sat. Normal is 97 to 99%. At 92 to 96% the patient needs supplemental oxygen. At 86 to 91% the patient has hypoxemia. At 85% the patient needs ET intubation, BVM or ventilator. Below 70% is life threatening.

45. Prevention and Protection

46. Ways to protect your lungs and prevent lung disease: If you don't smoke, don't start! If you smoke or use tobacco, quit Avoid second hand smoke. Fight germs by washing your hands and covering your coughs and sneezes Do your part to control outdoor air pollution and keep the air we breathe clean. Get moving! Regular physical exercise is good for your whole body and especially your lungs. Wear a protective mask when you work with chemicals and report unsafe working conditions.

47. Helpful Websites: http://www.youtube.com/watch?v=YG0-ukhU1xE&feature=related http://www.youtube.com/watch?v=QPBZOohj2a0&feature=related http://www.youtube.com/watch?v=9C5RFb1qWT8&feature=related http://www.youtube.com/watch?v=NnuaHGW1cwU&feature=related http://www.youtube.com/watch?v=d9PgKVeH8Pk&feature=related http://www.med.ucla.edu/wilkes/lungintro.htm