Respiratory Chapter 13

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 bronchus -Adenocarcinomas and bronchoalveolar cell carcinomas -Usually found on periphery of lung

Aspiration Complications

-Acute Respiratory Failure -Acute Respiratory Distress Syndrome (ARDS) -Bacterial Pneumonia

Flail Chest Complications

-Atelectasis (collapse lung) -Hypoxia (Decrease in O2 to tissue) -Mediastinal Flutter (shifting of tissues/organs that comprise the mediastinum to one side of the chest cavity. occurs with severe injury to chest causing entrapment of air in the pleural space)

Flail Chest Signs & Symptoms

-Chest pain -Shortness of breath

Pulmonary Edema Signs & Symptoms

-Cough -Orthopnea -Rales (abnormal rattling sound in lungs) -Hemoptysis -Sputum is frothy -Labored Breathing -Feels as if they are drowning -Hypoxemia increases -Cyanosis develops in the advanced stage.

Aspiration Signs & Symptoms

-Coughing and choking - Dyspnea -Stridor and hoarseness -Wheezing -Tachycardia (^HR) -Tachypnea (^Rapid Breathing)

Aspiration Risk Factors

-Dysphagia (difficulty swallowing) -Foreign Objects

Flail Chest Risk Factors

-Falls -Car Accidents

Pulmonary Edema Risk Factors

-Heart problems/Heart failure -History of pulmonary edema -History of lung disease: *Tuberculosis *Chronic obstructive pulmonary (COPD) *Vascular, or blood disorders

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

Cystic Fibrosis Signs & Symptoms

-Meconium ileus may occur at birth. -Salty skin -Signs of malabsorption -Steatorrhea, abdominal distention -Chronic cough & frequent respiratory infections -Failure to meet normal growth milestones

Pulmonary Embolism

-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 thigh -Virchow triad *Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels

Tuberculosis Risk Factors

-People living in crowded conditions -Immunodeficiency -Malnutrition -Alcoholism -Conditions of war -Chronic disease -HIV infection

Postoperative Atelectasis

-Restricted ventilation due to pain or abdominal distention; -Slow, shallow respirations due to anesthetics and analgesics; -Increased secretions due to the supine position; and decreased cough effort. -Occurs 24 to 72 hours after surgery, particularly abdominal surgery.

Pulmonary Embolism Signs & Symptoms

-Shortness of breath. -Chest pain -Cough -Leg pain/swelling -Cyanosis -Fever -Excessive sweating -Rapid/irregular heartbeat -Lightheadedness/dizziness

Pneumonia Signs & Symptoms

-Sudden onset -Systemic signs -High fever with chills, fatigue, -Leukocytosis -Dyspnea, tachypnea, tachycardia -Pleural pain -Rales -Productive cough -Typical rusty-colored sputum -Confusion and disorientation

Transudate Effusion

-Too much fluid is leaving capillaries. Increased Hydrostatic Pressure Decreased Oncotic Pressure in the blood vessels, leading to a shift of fluid out of the blood vessels into the pleural cavity. These effusions may occur secondary to liver or kidney disease.

Cyanosis

A bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.

Pleural Effusion

A pleural effusion is the presence of excessive fluid in the pleural cavity.

Paroxysmal Nocturnal Dyspnea

Attacks of Shortness of breath and coughing at night. It usually awakens the person from sleep, and may be quite frightening.

Clubbing

Chronic Hypoxia associated with respiratory or cardiovasucular disease. Painless, firm, fibrotic enlargement at the end of the digit.

Hypoventilation

Breathing slow = ^ carbon dioxide in the blood.

Hyperventilation

Breathing very fast.

COPD

Bronchiolitis: Caused by the respiratory syncytial virus (RSV) Transmitted by oral droplet Virus causes necrosis, inflammation in small bronchi and bronchioles Signs Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise Treatment Supportive and symptomatic

Pneumonia

Classification of pneumonias based on: Causative agent Viral, bacterial, fungal Anatomical location of infection Throughout both lungs, or consolidated in one lobe Pathophysiological changes Changes in interstitial tissue, alveolar septae, alveoli Epidemiological data Nosocomial (hospital-acquired) Community-acquired

Atelectasis

Collapse lung, alveoli deflates and blood flow is interfered. Signs & Symptoms: *Small area: -Asymptomatic *Large area: -Dyspnea -Coughing -Rapid Shallow Breathing -Increase Hearts Rate

Compression Atelectasis

Collapse of lung due to a mass such as a tumor exerts pressure on part of the lung and prevents air from entering the lung.

Hemoptysis

Coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. This can occur with lung cancer, infections: Tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions.

Cheynes-Strokes

Deep & Rapid breathing followed by a gradual decrease that results in APNEA. Pattern repeats, with each cycle usually taking 30 seconds to 2 minutes.

Kussmaui Respiration

Deep & Rapid respirations or "air hunger" typically a state of acidosis or may follow strenuous exercise

Dyspnea

Difficult or labored breathing

Lung Cancer Signs & Symptoms

Early signs: -Persistent cough -Hemoptysis -Pleural involvement -Chest pain -Hoarseness -Facial or Arm Edema -Headache -Dysphagia -Atelectasis Systemic signs: -Weight loss, anemia, fatigue -Paraneoplastic syndrome *Indicated by signs of an endocrine disorder -Related to the specific hormone secreted Signs of metastases: -Bone pain -Cognitive & Motor deficits

Pulmonary Edema

Fluid collecting in the alveoli and interstitial area. This accumulation of fluid reduces the amount of oxygen diffusing into the blood and interferes with lung expansion, also reducing oxygenation of the blood.

Hemothorax

Fluid is blood resulting from trauma, cancer, or surgery.

Pulmonary Edema Complications

Hypoxia can potentially lead to diminished oxygen delivery to different body organs, such as the brain.

Empyema

Occurs when the fluid is a result of infection, often related to pneumonia.

Exudative Effusions

Inflammation from a tumor, in which increased capillary permeability allows fluid containing protein and white blood cells to leak into the pleural cavity.

Obstructive/Resorption Atelectasis

Obstruction of the airways or collapse lung due to mucus, tumor, or foreign objects.

Aspiration (298)

Passage of food, fluid, emesis, other foreign material into trachea and lungs

Pneumoconioses

Pneumoconioses are chronic restrictive diseases resulting from long-term exposure to irritating particles such as asbestos. -Coal workers disease/Anthracosis from coal dust in coal mines. -Silicosis from Silica in Stone-cutting, sand-blasting, & mines. -Asbestosis from Asbestos found in insulation & shipbuilding. -Farmer's lung from Fungal spores found in Hay

Orthopnea

Shortness of breath (dyspnea) that occurs when lying flat. Causing the person to have to sleep propped up in bed or sitting in a chair.

Tuberculosis

Primary infection When organism first enters the lungs 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! Miliary or extrapulmonary tuberculosis Rapidly progressive form more common in children < 5 years Early dissemination to other tissues If lesions are not found in the lungs, this is not contagious. Common symptoms include weight loss, failure to thrive, and other infections such as measles. Active TB (primary or secondary) Organisms multiply, forming large areas of necrosis. Cause large open areas in lung—cavitation Cavitation promotes spread into other parts of lung. Infection may spread into pleural cavity. Cough, positive sputum, radiograph showing cavitation Disease in this form is highly infectious when there is close personal contact over a period of time.

Increased surface tension in alveoli

Pulmonary Edema or Respiratory Distress Syndrome prevents expansion of the lung.

Adult Respiratory Distress Syndrome (318)

Results from injury to the alveolar wall and capillary membrane Causes the release of chemical mediators Increases permeability of alveolar capillary membranes Increased fluid and protein in interstitial area and alveoli Damage to surfactant-producing cells Diffuse necrosis and fibrosis if patient survives Multitude of predisposing conditions Often associated with multiple organ dysfunction or failure

Flail Chest

Segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall.

Open Pneumothorax

The collapsing of lung due to air accumulation in the pleural space from outside body through opening in thorax & parietal pleura. Cause: Puncture wound through chest wall. Effect: Atelectasis and air enters cavity with each inspiration & leaves with each expiration. S&S: -"Sucking" noise -Tracheal Swing -Decrease in BP -Moderate Hypoxemia

Tension Pneumothorax

The collapsing of lung due to air accumulation in the pleural space through the thorax or tear in lung surface. Cause: -Open; puncture through thorax -Closed; tear in lung surface Both w/ flap or one-way valve. Effect: -Atelectasis air enters with each expiration -Flap closes w/ expiration & air pressure ^ in the cavity. -Unaffected lung increasingly compressed by mediastinal shift = reducing venous return to heart

Pneumothorax (314)

The collapsing of lung due to air accumulation in the pleural space. Signs & Symptoms: -Increased labored respirations -Dyspnea -Tachycardia -Pleural Pain -Asymmetrical chest movements

Closed Pneumothorax

The collapsing of lung due to air accumulation in the pleural space. From the inside lung through tear in the visceral pleura. Cause: Spontaneous, Idiopathic, Ruptured emphysematous bleb (COPD) Alveoli is damaged due to stretching & Rupture Effect: Atelectasis (collapse of lung) & lung leaks as lung collapses. S&S: -Breath sounds absent -Hypoxemia