Pathophysiology Exam 3

adult respiratory distress syndrome: signs and symptoms

dyspnea, restlessness, rapid and shallow respirations, increased heart rate, combination of respiratory and metabolic acidosis

asthma: signs and symptoms

-cough, marked dyspnea, tight feeling in chest -wheezing -rapid and labored breathing -expulsion of thick or sticky mucus -tachycardia (may include pulsus paradoxus, pulses differs on inspiration and expiration) -hypoxia -respiratory alkalosis (initially caused by hyperventilation) -respiratory acidosis (cause by air trapping) -sever respiratory distress (hypoventilation leads to hypoxemia and respiratory acidosis) -respiratory failure (indicated by decreasing responsiveness, cyanosis)

aspiration: signs and symptoms

-coughing and choking with dyspnea -loss of voice if total obstruction -stridor and hoarseness (characteristics of upper airway obstruction) -wheezing (aspiration of liquids) -tachycardia and tachypnea -nasal flaring, chest retractions, hypoxia (in individuals with severe respiratory distress) -cardiac or respiratory arrest

obstructive lung diseases

-cystic fibrosis -lung cancer -aspiration -obstructive sleep apnea -asthma -COPD

endocrine treatment

-deficit may be treated with replacement therapy -excessive secretion may be treated with medications, surgery, or radiation

diabetes insipidus

-deficit of ADH -adenoma -may originate in the neurohypophysis (head injury or surgery, possible genetic problem, replacement treatment required)

emphysema

-destruction of alveolar walls and septae (leads to large, permanently inflated alveolar air spaces) -classified by specific location of changes -contributing factors: genetic deficiency/tendency, cigarettes, pathogenic bacteria

CF: diagnosis and treatment

-diagnosis: genetic testing, sweat test, testing of stool, radiography, pulmonary function tests, blood gas analysis -treatment: interdisciplinary approach (replacement therapy and well balanced diet, chest physiotherapy)

bronchopneumonia

-diffuse pattern of infection in both lungs -several species of microorganism may be the cause -inflammatory exudate forms in alveoli -onset tends to be insidious (moderate fever, cough, rales, productive cough with purulent sputum usually yellow/green) -antibacterial treatment

diabetes mellitus: complications

-directly related to duration and extent of abnormal blood glucose levels -many factors lead to fluctuations in serum glucose levels (variations in diet and alcohol use, change in physical activity, infection, vomiting) -complications may be acute or chronic

hypoglycemia shock: signs and symptoms

-disorientation and change in behavior -may appear impaired -anxiety or decreased responsiveness -decreased blood glucose level -decreased bp, increased heart rate -decreasing level of consciousness -immediate administration of glucose is requited to prevent brain damage

growth hormone (GH)

-dwarfism (deficit in growth hormone production and release) -gigantism (excess gh prior to puberty and fusion of epiphysis) -acromegaly (excess gh secretion in adults, often associated with adenoma, bones become broader and heavier, soft tissues grow leading to enlarged hands and feet and change in facial features)

lung tumor: signs and symptoms

-early signs: persistent productive cough, detection on radiograph, hemoptysis, pleural involvement, chest pain, hoarseness, facial or arm edema, headache, dysphagia, or atelectasis

chronic obstructive pulmonary disease (COPD)

-emphysema -chronic bronchitis -bronchiectasis

control of endocrine system

-endocrine and nervous system regulate metabolic activities -negative feedback system -positive feedback may be in a negative feedback loop (blood clotting, childbirth) -some hormones act as antagonists: calcitonin and parathyroid hormone, insulin and glucagon

breathing patterns and characteristics

-eupnea (normal rate) -kussmaul respirations (deep rapid respirations, typical for acidosis, may follow strenuous exercise) -labored respiration or prolonged inspiration or expiration (often associated with obstruction of airways) -wheezing or whistling sounds (indicate obstruction in small airways) -stridor (high pitched crowing noise, usually indicates upper airway obstruction)

inappropriate ADH syndrome

-excess ADH -may be temporary -triggered by stress -may be secreted by an ectopic source such as a tumor -treatment: diuretics, sodium supplements

diabetes mellitus: diagnostic tests

-fasting blood glucose level -glucose tolerance test -glycosylated hemoglobin test (clinical and subclinical diabetes, monitor glucose levels over several months)

anthrax: inhalation signs

-fever and chills -chest discomfort -SOB -confusion or dizziness -cough -nausea, vomiting, or stomach pains -headache -sweats -extreme tiredness -body aches

anthrax: GI signs

-fever and chills -swelling of neck or neck glands -sore throat, painful swallowing, hoarseness -nausea, vomiting (bloody) -diarrhea (bloody) -headache -flushing and red eyes -stomach pain -fainting -swelling of abdomen

symptoms: COVID

-fever/chills -coughing/sneezing -difficulty breathing/SOB -fatigue -loss of taste -body aches -headaches -sore throat -nausea -confusion in older persons

tuberculosis: diagnostic tests

-first exposure or primary infection: indicated by positive tuberculin (skin) test results -active infections: acid fast sputum test, chest radiograph, sputum culture and sensitivity

flail chest: during inspiration

-flail or broken section moves inward rather than outward -inward movement of ribs prevents expansion of affected lung -large flail section can compress adjacent lung tissue (pushing air out of that section up the bronchus, stale air from damaged lung crosses into the outer lung with newly inspired air)

sever dyspnea indicative of respiratory distress

-flaring nostrils -use of accessory respiratory muscles -retraction of muscles between or above ribs

gas exchange

-flow of gases between the alveolar air and blood (external respiration) -gas exchange depends on the relative concentrations (partial pressures of gasses) -each gas in a mixtures moves along its partial pressure gradient, independent of other gases (Dalton's law)

pulmonary edema

-fluid collecting in alveoli and interstitial area (can result from many primary conditions, reduces amount of O2 diffusing into blood, interferes with lung expansion) -may develop when: inflammation in lungs is present (increases permeability of capillaries and plasma protein levels are low, decreases osmotic pressure of plasma and pulmonary hypertension develops)

histoplasmosis

-fungal infection caused by histoplasma capsulatum -spores can be inhaled on dust particles -common opportunistic infection -first stage often asymptomatic -second stage: granuloma formation and necrosis, cough, fatigue, fever, night sweats -treatment: antifungal agents

multiple endocrine neoplasia type 1

-gene mutation genetic disorder -tumors in various endocrine glands and digestive tract, lungs, and meninges -most tumors are noncancerous -large tumors can cause loss of gland function

anthrax: cutaneous signs

-group of blisters/bumps that may itch -swelling around the sore -painless open skin sore with black venter that develops from blisters/bumps -sores often of face, neck, arms, or hands

pulmonary embolus: prevention

-health teaching prior to surgery -antiembolic stockings -exercise to prevent thrombosis -use of anticoagulant drugs

radiography

-helpful in evaluating tumors -evaluate infections

pulmonary edema with increased congestion s/s

-hemoptysis -frothy sputum -hypoxemia increases -cyanosis develops in advanced stage

endocrine system

-hormones as chemical messengers -target receptors -negative feedback system -chemical structure (peptide, steroid)

HHNK manifestations

-hyperglycemia -severe dehydration (increased hematocrit, loss of turgor, increased heart rate and respirations) -electrolyte imbalances result in: neurologic deficits, muscle weakness, difficulties with speech, abnormal reflexes

DM acute complications

-hypoglycemia (insulin shock) -more common with insulin replacement treatment -may occur because of excess oral hypoglycemic drugs -excess insulin in circulation (glucose deficit in blood, can be life threatening or cause brain damage if untreated, often follows strenuous activity, dosage error, vomiting, skipping meal after taking insulin)

major endocrine glands

-hypothalamus -pituitary gland -pineal gland -thyroid -parathyroid glands -thymus -adrenal glands -pancreas -ovaries -testes

changes in arterial blood gases

-hypoxemia (inadequate O2 in blood) -hypercapnia (increased CO2 in blood)

emphysema: symptoms "pink puffer"

-increased CO2 retention (pink) -minimal cyanosis -purse lip breathing -dyspnea -hyperresonance on chest percussion -orthopneic -barrel chest -exertional dyspnea -prolonged expiratory time -speaks in short jerky sentences -anxious -use of accessory muscles to breath -thin appearance -weight loss -clubbed fingers

cystic fibrosis

-inherited (genetic) disorder: gene located on chromosome 7 -tenacious mucus from exocrine glands -primary effects seen in lungs and pancreas -lungs: mucus obstructs airflow in bronchioles and small bronchi, permanent damage to bronchial walls, infections are common -commonly caused by Pseudomonas aeruginosa and staphylococcus aureus

diabetes mellitus: initial stage

-insulin deficit: results in decreased transportation and use of glucose in many cells -blood glucose levels rise (hyperglycemia) -excess glucose found in urine -large urine volume -fluid loss through urine resulting in dehydration -dehydration causes thirst

hypothyroidism

-iodine deficit -hashimoto's thyroiditis (autoimmune disorder) -tumor (surgical removal or treatment of gland) -cretinism (results in short stature and sever cognitive deficits, untreated congenital hypothyroidism, may be related to iodine deficiency during pregnancy)

coughing

-irritation caused by nasal discharge -inflammation or foreign material in LRT -caused by inhaled irritants

hypoparathyroidism

-leads to hypocalcemia -weak cardiac muscle contractions -increased excitability of nerves (spontaneous contractions of skeletal muscle) -causes: tumor, congenital lack of parathyroid, surgery or radiation in neck region, autoimmune disease

tuberculosis: treatment

-long term treatment with combination drugs -length of treatment varies from 6 to 12 months -require monitoring and follow up (it is expensive) -laten TB: isoniazid (INH), rifapentine, rifampin -active TB: isoniazid, rifampin, ethambutol, pyrazinamide, streptomycin

hypoxemia

-marked decrease in O2 -chemoreceptors respond -important control mechanism in individuals with chronic lung disease (move to hypoxic drive)

acute respiratory failure

-may result from acute or chronic disorders: emphysema, combo of chronic and acute disorders, acute respiratory disorders, many neuromuscular diseases -signs may be masked or altered by primary problem -treatment: primary problem must be resolved, supportive treatment to maintain respiratory function

asthma: treatment

-measures for status asthmaticus (hospital care if no response to bronchodilator) -prophylaxis and treatment of chronic asthma: leukotriene receptor antagonists (block inflammatory response in presence of stimulus and not effective for treatment of acute attacks) -cromolyn sodium: prophylactic medication, inhalation on daily basis, useful for athletes and sports, no value during an acute attack

CF: GI tract

-meconium ileus in newborns -blockage of pancreatic ducts -salivary glands often mildly affected

CF: signs and symptoms

-meconium ileus occur at birth -salty skin (may lead to performing sweat test and diagnosis of CF) -signs of malabsorption (steatorrhea, abdominal distention) -chronic cough and frequent respiratory infections (increase overtime) -failure to meet normal growth milestones

tension pneumothorax

-most serious form -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 leads to increased pleural pressure and atelectasis

tuberculosis: causes

-mycobacterium tuberculosis transmitted by oral droplets from persons with active infection -occurs more frequently with: people in crowded conditions, immunodeficiency, malnutrition, alcoholism, conditions of war, chronic disease, HIV -TB is becoming an increasing serious problem because of: homelessness and crowding in shelters, HIV infection, lack of health care, multidrug resistant TB

primary atypical pneumonia

-mycoplasma pneumoniae, bacterial -common in older children and young adults -transmitted by aerosol (frequent cough, antibiotic therapy, viral for caused by flu A or B, adenoviruses, RSV, hoarseness, sore throat, headache, mild fever, malaise) -infection varies greatly in severity (usually self limiting)

common cold: signs and symptoms

-nasal congestion (copious watery discharge) -mouth breathing, change in tone of voice -sore throat -headache -slight fever -malaise -cough -infection and inflammation may spread to cause pharyngitis, laryngitis, or acute bronchitis

lung tumor effects

-obstruction of airflow into bronchus (causes abnormal breath sounds and dyspnea) -inflammation and bleeding surrounding the tumor (cough, hemoptysis, and secondary infections) -pleural effusion, hemothorax, pneumothorax -paraneoplastic syndrome (occurs when tumor cell secretes hormones or hormone like substances) -usual systemic effects of cancer

CF: reproductive tract

-obstruction of vas deferens (male) -obstruction of cervix (female)

diabetic ketoacidosis (DKA)

-occurs in insulin dependent clients -more commonly seen in type 1 diabetes -results of insufficient insulin in blood -high blood glucose levels -mobilization and use of lipids to meet cellular needs result in production of ketoacids -may be initiated by infection or stress -may result from error dosage, infection, change in diet, alcohol intake, or exercise

hyperosmolar hypoglycemic nonketotic coma (HHNK)

-occurs in type 2 diabetes -insidious in onset and diagnosis may be missed -often occurs in older clients and assumed to be cognitive impairment -results in severe dehydration and electrolyte imbalances

tuberculosis: pathophysiology

-somewhat resistant to drying and many disinfectants -can survive in dried sputum for weeks -destroyed by UV light, heat, alcohol, glutaraldehyde, formaldehyde -normal neutrophil response does not occur -cell mediated immunity normally protection -primarily infects lungs, other organs may also be invaded

lung cancer: diagnostic tests

-specialized helical CT scans and MRI -chest radiography -bronchoscopy -biopsy and mediastinoscopy

diagnostic tests

-spirometry (pulmonary function test) -arterial blood gas determination -oximetry -exercise tolerance testing -radiography -bronchoscopy -culture and sensitivity test

culture and sensitivity tests

-sputum testing for presence of pathogens -determine antimicrobial sensitivity of pathogens (get sample before giving antibiotics)

asthma: acute episode

-stratus asthmaticus -persistent severe attack of asthma -does not respond to usual therapy -medical emergency -may be fatal because of severe hypoxia and acidosis

dyspnea

-subjective feeling of discomfort -may be caused by increased CO2 or hypoxemia -often noted on exertion, such as climbing stairs -paroxysmal nocturnal dyspnea (sudden acute type, common in patients with left sided CHF)

flu: treatment

-symptomatic and supportive -antiviral drugs: amantadine, zanamivir, oseltamivir -prevention is high recommended: respiratory hygiene and vaccinations

common cold: treatment

-symptomatic and supportive (unless bacterial infection develops secondarily) -antiviral drugs -may reduce symptoms and duration -reduces risks to infect others

pulmonary volumes

-tidal volume -residual volume -vital capacity -inspiratory reserve (IRV) -expiratory reserve (ERV) -total lung capacity (TLC)

small emboli

-transient chest pain -cough -dyspnea may occur

respiratory purpose and general function

-transport of oxygen from air to blood (oxygen is necessary for cellular metabolism) -removal of CO2 from blood (CO2 is a waste product from metabolism)

pneumothorax: emergency treatment

-transport to a hospital ASAP -an open pneumothorax or sucking wound is covered with an occlusive dressing or covering to prevent the air moving in and out of the pleural cavity -the dressing should be checked to ensure that a tension pneumothorax has not developed -penetrating objects should not be removed from the chest wall until medical assistance is available -if possible, tension pneumothorax should be converted to an open pneumothorax, by removing loose tissue or enlarging the opening

pneumocystis carinii pneumonia

-type of atypical pneumonia -occurs as an opportunistic infections -often found in patients with AIDS -appears to be inhaled -causes necrosis and diffuse interstitial inflammation -onset marked with difficulty breathing and nonproductive cough

flail chest: during expiration

-unstable fail section pushed outward by increasing intrathoracic pressure -large fail section: paradoxical movement of ribs alters airflow during expiration -air from unaffected lung moves across inro affected lung -hypoxia results from limited expansion and decreased inspiratory volume

2 anatomical areas of the respiratory system

-upper respiratory tract (resident flora) -lower respiratory tract (sterile)

sinusitis

-usually bacterial infection -analgesics for headache and pain -course of antibiotics often require to eradicate infection

infant respiratory distress syndrome

-usually related to premature birth -lack of surfactant in alveoli -poorly developed alveoli are difficult to inflate (diffuse atelectasis results, decreased pulmonary blood flow, pulmonary vasoconstriction, severe hypoxia) -poor lung performance and lack of surfactant (increased alveolar capillary permeability, fluid and protein are leaking into the interstitial are and alveoli, hyaline membrane formation)

DM chronic complications

-vascular problems (increased incidence of atherosclerosis, changes may occur in small and large arteries) -microangiopathy (changes in microcirculation) -cataracts (opacity of lens in eye, related to abnormal metabolism of glucose) -pregnancy (complications in both mother and fetus may occur, increased incidence of spontaneous abortions) -infants born to diabetic mothers: increased size and weight for date, may experiences hypoglycemia in first hours postnatally

common cold

-viral infection -more than 200 possible causative agents -spread through respiratory droplets -hand washing and respiratory hygiene important in prevention -symptomatic treatment -secondary bacterial infections may occur (usually caused by streptococci, purulent exudate, systemic signs such as fever)

influenza

-viral infection -three groups: type A (most common), type B and C -viruses constantly mutate -sudden acute onset with fever, marked fatigue, aching pain in the body -may cause viral pneumonia -mild case of influenza may be complicated by secondary bacterial pneumonia -commonly, death in flu epidemics result from pneumonia

sputum

-yellow/green, cloudy, thick mucus (often indication of bacterial infection) -rusty or dark color (usually sign of pneumococcal pneumonia) -very large amounts of purulent sputum with foul odor (may be associated with bronchiectasis) -thick, tenacious mucus (asthma/cystic fibrosis, blood tinged sputum may result from chronic cough or be a sign of tumor/tuberculosis) -hemoptysis (blood tinged bright red frothy sputum, usually associated with pulmonary edema)

hypocapnia

-caused by low CO2 concentration (low partial pressure of CO2) in blood -may be caused by hyperventilation (excessive amounts of CO2 expired) -causes respiratory alkalosis

bronchiolitis

-caused by respiratory syncytial virus (RSV) -transmitted by oral droplets -virus causes necrosis, inflammation in small bronchi and bronchioles -signs: wheezing, dyspnea, rapid shallow breaths, cough, rales, chest retractions, fever, malaise -treatment: supportive and symptomatic

larger emboli

-chest pain -tachypnea -dyspnea develops suddenly -later, hemoptysis and fever are present -hypoxia stimulate a sympathetic response with anxiety and restlessness, pallor, and tachycardia

COPD: symptoms

-chronic airflow limitation -easily fatigued -frequent respiratory infections -use accessory muscles to breath -orthopneic -cor pulmonale (late in disease) -skinny -pursed lip breathing -chronic cough -barrel chest -dyspnea -prolonged expiratory time -bronchitis (increased sputum) -clubbed digits

pneumoconiosis

-chronic restrictive disease resulting from long term exposure to irritating particles -inflammation results in gradual destruction of connective tissue -onset insidious (dyspnea develops first) -treatment: ending exposure, treatment of infection

atelectasis

-collapsed lung -obstruction in bronchus -air flow obstructed, remaining air diffuses into tissues and is not replaced -small areas are asymptomatic -large areas have dyspnea, increased heart and respiratory rates, and chest pain

URT infections

-common cold -sinusitis -epiglottitis -influenza -scarlet fever

laryngotracheobronchitis (croup)

-common viral infection, particularly in children -common causative organism: parainfluenza viruses and adenoviruses -infection usually self limited

pulmonary embolus

-blood clot or mass that obstructs pulmonary artery or any of its branches -effect of embolus depends on material, size, and location -small pulmonary emboli might be silent unless they involve a large area of lung -large emboli may cause sudden death -90% of pulmonary emboli originate from deep vein thromboses in legs (they are preventable)

cyanosis

-bluish coloring of the skin and mucus membranes -caused by large amounts of unoxygenated hemoglobin in blood

asthma

-bronchial obstruction -occurs in persons with hypersensitive or hyperresponsive airways -may occur in childhood or have an adult onset -often family history or allergic conditions -pathophysiological changes of bronchi and bronchioles: inflammation of the mucosa with edema, bronchoconstriction (caused by contraction of smooth muscle), increased secretion of thick mucus in airways, changes create obstructed airways (partial or total)

LRT infections

-bronchiolitis -pneumonia -sever acute respiratory syndrome -COVID -TB -histoplasmosis -anthrax

scarlet fever

-caused by group A B hemolytic streptococcus (s. pyogenes) -symptoms: strawberry tongue, fever, sore throat, chills, vomiting, abdominal pain, malaise -treatment: antibiotics

legionnaires' disease

-caused by legionella pneumophila (thrives in warm, moist environments, often nosocomial) -difficult to identify, requires special culture medium -untreated infections: cause sever congestion and consolidation, necrosis in the lung, possibly fatal

thyroid disorders

-2 thyroid hormones released in response to TSH -disorders may result from pituitary or thyroid gland dysfunction -goiter -hyperthyroidism (Graves' disease) -hypothyroidism

hypercapnia

-CO2 levels in blood increase -CO2 easily diffuses in CSF -lowers pH and stimulates respiratory center -increased rate and depth of respirations (hyperventilation) -causes respiratory acidosis (nervous system depression)

adrenal cortex

-Cushing's syndrome -Addison's Disease

COVID 19

-SARS Co V2 virus -originated in Wuhan, China -caused worldwide pandemic -rapid attachment and damage to lung cells -subsequent variants infect URT -can cause cytokine storm immune reaction -elderly, immunocompromised, those with comorbidities (ex: diabetes, obesity) are at risk -diagnosis: antibody (serological) tests or PCR test -treatment: various therapeutic regimens such as hydroxyquinilone, Remdesivir, Ivermectin, monoclonal antibodies (3 vaccines available, 2 are mRNA vaccines)

lung cancer

-about 90% of cases are related to smoking -bronchogenic carcinoma: most common type of primary malignant lung tumor, arises from bronchial epithelium -squamous cell carcinoma: usually develops from epithelial lining of a brnochus -adenocarcinomas and bronchoalveolar cell carcinomas: usually found on periphery of lung

epiglottis

-acute infection (common in children 3-7 years old) -usually caused by haemophilus influenzae type B -rapid onset, fever and sore throat -child sits in tripod position -drooling and difficulty swallowing -heightened anxiety -swelling of the larynx, supraglottic area, and epiglottis (may obstruct airway, spasm of larynx if touched) -treatment: oxygen and antimicrobial therapy

sever acute respiratory syndrome (SARS)

-acute respiratory infection -causative microbe: SARS associated corona -transmission by respiratory droplets (close contact) -first signs: fever headache, myalgia, chills, anorexia, diarrhea -later signs: effects on lungs evident, dry cough, dyspnea, areas of interstitial congestion, hypoxia, mechanical ventilation mat be required -treatment: antivirals, glucocorticoids -high fatality rate -risk factors: travel to endemic or epidemic area, close contact with traveler -presence of a cluster of undiagnosed atypical pneumonia cases -employment involving close contact with the virus (active cases quarantined until clear of infection)

pituitary hormones

-adenomas are the most common cause of pituitary disorders -effect of mass (may cause pressure in the skull: headaches seizures, drowsiness, visual deficits) -effect on hormone secretion: dependent on cells and location involved, may cause excessive or decreased release of hormones

endocrine disorders

-all disorders reflect impaired control or feedback -deficit of hormone or reduced effects or excessive hormone levels

aspiration: potential complications

-aspiration pneumonia: inflammation, gas diffusion is impaired -respiratory distress syndrome: may develop if inflammation is widespread -pulmonary abscess: may develop if microbes are in aspirate -system effects: when aspirated materials (solvents) are absorbed into blood

secondary pneumothorax

-associated with underlying respiratory disease -rupture of an emphysematous bleb on lung surface or erosion by a tumor or tubercular cavitation

primary TB infection

-asymptomatic -when organism first enters lungs -engulfed by macrophages (local inflammation) -if cell mediated immunity is inadequate mycobacterium reproduce and begin to destroy lung tissue -contagious

expansion disorders

-atelectasis -pleural effusion -pneumothorax -flail chest -infant respiratory distress syndrome -acute respiratory failure

open pneumothorax

-atmospheric air enters the pleural cavity through an opening in the chest wall -sucking wound (large opening in chest wall)

anthrax

-bacterial infection by gram positive bacilli -spores can be viable for long periods of time -skin, respiratory, or digestive tract: cutaneous form, inhalation form, GI form

lobar pneumonia

-bacterial pneumonia -community based (often in healthy young adults) -usually caused by streptococcus pneumonia -infection localized in one or more lobes (inflammation and vascular congestion, exudate forms in alveoli, exudate contains fibrin and forms a consolidated mas, exudate produces sputum) -adjacent pleurae frequently involved -infection may spread to pleural cavity (empyema) -manifestations: sudden onset, systemic signs, dyspnea, tachypnea, tachycardia, pleural pain, rale, productive cough (rusty colored sputum) -confusion/disorientation

diabetes mellitus

-basic problem is inadequate insulin effects in receptor tissues -deficit of insulin secretion -production of insulin antagonists -diabetes results in abnormal carbohydrate, protein, and fat metabolism

secondary or re-infection with TB

-occurs when client's cell mediated immunity is impaired because of: stress, malnutrition, HIV infection, age -mycobacterium begin to reproduce and infect lungs -active TB, which can spread -symptoms: anorexia, malaise, fatigue, weight loos, low grade fever, night sweats, cough is prolonged, sputum becomes purulent and often contains blood -organisms multiply, forming large areas of necrosis (cause large open areas in lung, cavitation) -cavitation promotes spread into other parts of the lung (infection may spread into other parts of the lung) -cough, positive sputum, radiograph showing cavitation -highly contagious

orthopnea

-occurs when lying down -usually caused by pulmonary congestion

intrinsic asthma

-onset during adulthood -hyperresponsive tissue in airway initiates attack -stimuli include: respiratory infections, stress, exposure to cold, inhalation of irritants, exercise, drugs

chronic bronchitis: signs and symptoms

-overweight -cyanotic -elevated hemoglobin -peripheral edema -bronchi and wheezing -inflammation, obstruction, repeated infection (history of smoking or living in urban/industrial area) -mucosa inflamed and swollen -hypertrophy and hyperplasia of mucus glands -fibrosis and thickening of bronchial wall -low oxygen levels -dyspnea/fatigue -pulmonary hypertension and cor pulmonale -tachypnea, SOB -frequent thick and purulent secretions -hypercapnia -polycythemia

aspiration

-passage of food, fluid, emesis, or other foreign material into trachea and lungs -common problem in young children or individuals laying down when eating or drinking -results may be: obstruction (aspirate is a solid object), inflammation and swelling (aspirate is an irritating liquid), predisposition to pneumonia -Heimlich maneuver is used for emergency treatment

bronchoscopy

-perform biopsy -check site of lesion or bleeding

adrenal medulla

-pheochromocytoma -benign tumor of the adrenal medulla (secretes epinephrine, norepinephrine, and possibly other substances) -occasionally multiple tumors -headache, heart palpitations, sweating, intermittent or constant anxiety

pleural effusion

-presence of excessive fluid in the pleural cavity -causes increased pressure in pleural cavity (separation of pleural membranes) -exudative effusions (response to inflammation) -transudate effusions (watery/hydrothorax effusions, result of increased hydrostatic pressure or decreased osmotic pressure in blood vessels)

control of ventilation

-primary control centers for breathing located in the medulla and pons -chemoreceptors detect changes in CO2 levels, hydrogen ions, and O2 levels in blood or cerebrospinal fluid

vascular disorders

-pulmonary edema -pulmonary embolus

pulmonary embolus: diagnosis

-radiography -lung scan -MRI -pulmonary angiography

breath sounds

-rales (light bubbly or crackling sounds, with serous secretions) -rhonchi (deeper or harsher sounds from thicker mucus) -absence (nonaeration or collapse of lungs)

ketoacidosis

-rapid deep respirations (Kussmaul's respirations) -acetone breath (a sweet fruity smell) -lethargy and decreased responsiveness indicate depression of the CNS owing to acidosis and decreased blood flow)

miliary or extrapulmonary TB

-rapidly progressive form more common in children 5 years and younger -early dissemination to other tissues -if lesions are not found in lung it is not contagious -common symptoms: weight loss, failure to thrive, other infections such as measles

sneezing

-reflex response to irritation in the URT -assists in removing irritant -associated with inflammation or foreign material

hyperthyroidism

-related to autoimmune factor -hypermetabolism and increased stimulation of SNS (increased body temp, sweating, soft silky hair and skin, reduced BMI, insomnia, hyperactivity)

infant respiratory distress syndrome: signs and symptoms

-respiratory difficulties may be evident at birth -respirations rapid and shallow -frothy sputum and expiratory grunt -bp falls -cyanosis and peripheral edema -severe hypoxemia and decreased responsiveness -irregular respirations with periods of apnea (decreased breath sounds)

clubbed digits

-result from chronic hypoxia associated with respiratory or cardio diseases (painless, firm, fibrotic enlargement at the end of the digit) -common in COPD patients

obstructive sleep apnea

-result of pharyngeal tissue collapse during sleep -leads to repeated and momentary cessation of breathing -men are affected more often than women -obesity and aging are common predisposing factors -treatment: continuous positive airway pressure pump (CPAP machine) and oral appliances that reduce collapse of pharyngeal tissue

adult respiratory distress syndrome

-results from injury to the alveolar wall and capillary membrane -causes the release of chemical mediators (increased permeability of alveolar capillary membranes, increase fluid and protein in interstitial area and alveoli, damage to surfactant producing cells, diffuse necrosis and fibrosis if patient survives) -often associated with multiple organ dysfunction or failure -multitude of predisposing factors

massive emboli

-severe crushing chest pain -low blood pressure -rapid weak pulse -loss of consciousness

general manifestations of respiratory disease

-sneezing -coughing -sputum -breathing patterns and characteristics -breath sounds -dyspnea -cyanosis -pleural pain -friction Rub -clubbed digits -changes in arterial blood gases

if cell mediated immunity is inadequate in TB:

-some bacilli migrate to lymph nodes, granuloma formation of tubercle (contains live bacilli) walled off and calcifying -tubercle may be visible on chest radiograph -bacilli may remain viable in a dormant stage for years -individuals resistance and immune responses high, bacilli remain walled off -primary or latent infection, individual has been exposed and infected but does not have disease and is asymptomatic -individual cannot transmit disease

vital capcity

max amount of air that can be moved in and out of the lungs with a single forced inspiration and expiration (4600 mL)

expiratory reserve (ERV)

max volume of air expired following a passive expiration (1100 mL)

oximetry

measures O2 saturation

residual volume

volume of air remaining in lungs after max respiration (1200 mL)

CHAPTER 16

ENDOCRINE SYSTEM DISORDERS

CHAPTER 13

RESPIRATORY SYSTEM DISORDERS

hypoxic drive

a "backup system" to control respiration; senses drops in the oxygen level in the blood

extrinsic asthma

acute episodes triggered by type 1 hypersensitivity reactions

closed pneumothorax

air can enter pleural cavity from internal airways (no opening in chest wall)

pneumothorax

air in the pleural cavity caused by a puncture of the lung or chest wall

pneumothorax: signs and symptoms

atelectasis, dyspnea, cough, chest pain, breath sounds reduced, unequal chest expansion, hypoxia, interference with venous return leads to hypotension

arterial blood glass determination

checks O2, CO2, bicarbonate, and serum pH

pneumonia

classification based on: -causative agent: viral, bacterial, fungal -anatomical location of infection: throughout both lungs, or consolidate in one lobe -pathophysiological changes: changes in interstitial tissue, alveolar septae, alveoli -epidemiological data: nosocomial (hospital acquired) or community acquired

chronic bronchitis

clinical diagnosis: daily productive cough for three months or more in at least two consecutive years (more severe in morning)

mild pulmonary edema s/s

cough, orthopnea, rales

endemic goiter

enlargement of the thyroid gland due to lack of iodine in the diet

what is caused by frequent inhalation of irritating particles such as silica?

fibrosis and loss of compliance

exercise tolerance testing

for patients with chronic pulmonary disease

antidiuretic hormone (ADH)

hormone produced by the neurosecretory cells in the hypothalamus that stimulates water reabsorption from kidney tubule cells into the blood and vasoconstriction of arterioles

steroid

lipids that enter the cell nucleus to initiate transcription directly

peripheral chemoreceptors

located in the carotid bodies

central chemoreceptors

located in the medulla

inspiratory reserve (IRV)

max amount of air that can be inhaled in excess of normal quiet inspiration (3000 mL)

nonsteroids

need a secondary messenger system to activate transcription in the nucleus

PCO2

partial pressure of carbon dioxide

PO2

partial pressure of oxygen

flail chest

results from fracture of ribs which allows ribs to move independently during respiration

pleural pain

results from inflammation or infection of parietal pleura

friction rub

soft sound produced as rough, inflamed, or scarred pleural move against each other

CF: sweat glands

sweat has high sodium chloride content

simple or spontaneous pneumothorax

tear on the surface of the lung

spirometry (pulmonary function test)

test pulmonary volumes and airflow times

tidal volume

the amount of air exchanged with quiet inspiration and expiration (500 mL)

total lung capacity (TLC)

total volume of air in the lungs after maximal inspiration (5800 mL)