Respiratory Diseases

1. Respiratory Diseases

2. Respiratory Review • What are the parts of the Upper Respiratory Tract? • What are the parts of the lower respiratory tract? • Where are the conchae? • What does the epiglottis do? • What is the lining around the lung?

3. Parts of the Respiratory System • Upper Respiratory Tract • Nose • Mouth Pharynx • Trachea to larynx • Lower Respiratory Tract • Lower trachea • Lungs

4. Functions of the Respiratory System • Oxygen Transport • Oxygen delivered to the cell • CO2 removed • Capillaries are close to cells & 02 diffuses from blood into interstitial tissue & cells • Respiration – gas exchange between atmospheric air & blood; blood & cell • Blood enters systemic vein to pulmonary circulation; 02 level is lower than in alveoli & O2 diffuses into circulation • CO2 is higher in blood & diffuses into alveoli

5. Pulmonary Perfusion • Actual blood flow through the lungs • What part of the heart sends blood to the lungs? • About 2% of the blood in the body never participates in gas exchange & enters the left side of the heart un-oxygenated • Pulmonary circulation is a low pressure system • Normal: Systole: 20 – 30 • Diasole: 5 – 15 in Pulm artery

6. Gas Exchange • What element is the highest concentration in the air that we breathe? • Atmospheric pressure at sea level is 760 mm Hg. High elevation?

7. Respiratory Disease • Main symptoms of most respiratory diseases to assess • Dyspnea • Cough • Sputum • Chest pain • Wheezing • Clubbing • Hemoptysis • cyanosis

8. Dyspnea • Difficulty breathing/shortness of breath • Acute diseases of the lungs produce more dyspnea than chronic • Orthopnea – difficulty breathing laying down • Identify causes to treat

9. Cough • Irritation of the mucous membranes in the respiratory tract • Causes by infection or airborne irritant • Chief protection against excess secretions in bronchi & bronchioles • May indicate serious disease

10. TYPES • Dry & hacky • Upper respiratory infection /viral • Irritated, high pitch • laryngotracheitis • Brassy – tracheal lesions • Wet, loose - bronchitis • Coughing at night may indicate left sided heart failure or bronchial asthma

11. Cough worse when lying down - post-nasal drip (sinusitis) • Cough after eating - aspiration

12. Sputum production • Thick, yellow or greenish indicate bacterial infection • Thin, clear indicates viral • Pink-tinged – tumor • Profuse, frothy, pink – pulmonary edema • Foul – smelling – lung abscess, fungal or anaerobic infection

13. Chest pain • Usually on the side of the issue • Occurs with • Pneumonia • Pulmonary embolism • Pleurisy • Patients usually state that is feels like “stabbing like a knife”

14. Wheezing • Bronchial constriction • Airway narrowing • High – pitched, musical

15. Hemoptysis • Coughing or expelling blood from the respiratory tract • Usual causes • Infection • Lung cancer • Lung vessel issues • Abnormal pulmonary artery/vein • Pulmonary emboli

16. Adventitious sounds • Crackles • Discrete, non-continuous • Delayed reopening of the deflated airways • Heard at end of inspiration • Sounds like rubbing hairs together • Pneumonia, bronchitis, CHF, pulmonary fibrosis • Wheezes

17. Sonorous wheezes • Larger bronchi or trachea • Heard in increased secretions • Like rubbing thumb & index finger together • From inflammation of pleural surface • Heard on inspiration & expiration

18. Upper Respiratory Tract Disorders • Cold • Sinusitis • Pharyngitis

19. Cold • Called a “cold” because there is usually no fever • Infectious & inflammation of the mucous membranes • Contagious because can be transmitted approx. 2 days before symptoms occur • Most common 3 x /year • September • Late January • End of April

20. S & S • Nasal congestion • Scratchy/sore throat • Sneezing • Tearing, watery eyes • Malaise • Fever • Chills • HA • Muscle aches

21. Cough sometimes due to mucous drainage • Cold virus tends to aggravate the herpes simplex virus • Symptoms lasts 5 days – 2 weeks • Fever indicates different URI • Caused by 100’s different viruses but most common is the RHINOVIRUS

22. Treatment • No cure • Treat symptoms • Increase fluid intake • Rest • Prevention of chilling • Decongestants • Antihistamines • Vitamin C

23. HA & Muscle aches • Ibuprofen • acetominophen • Sore throat • Warm salt gargle

24. Sinusitis • Where are the sinuses? • Acute • Begins as a URI or allergic rhinitis • Nasal congestion blocks the sinus cavities which causes bacteria to grow • Most common: Streptococcus pneumoniae, H influenza • S & S • Pressure • Pain • Purulent sinus drainage

25. Treatment • Decrease mucus membranes swelling with a decongestant • Guaifenisin to expel mucus • Antibiotics of choice for 7 – 10 days • Amoxicillin • Augmentin • Bactrim

26. Guaifenesin • Brand name: Mucinex • Given PO • Thins secretions to be expels easier • CI: children under 4; Pregnancy • Precautions: drink plenty of water/fluid • SE: HA, N & V

27. Acute Pharyngitis • Febrile inflammation of the throat • Usually caused by a virus • If caused by Streptococcus A; what is it called? • Symptoms • Fiery, red throat pyrexia • Swollen tonsils (exudate) malaise • hoarseness

28. Treatment • Viral • Analgesic (Tylenol, Ibuprofen) • Bacterial • PCN • Erythromycin • Cephlasporin • Patient should throw away his/her toothbrush at risk for re-contamination

29. Tonsillitis & Adenoiditis • Tonsils & Adenoids • Both contain lymphatic tissue • Tonsils are in the oropharynx • Adenoids are in the nasopharynx • Infections in the adenoids usually accompany infections of the tonsils

30. Causes • Group A streptococci is most common • S & S • Sore throat • Fever • Snoring • Difficulty swallowing

31. Enlarged adenoids causes: • Mouth breathing • Earaches • Draining ears • Frequent colds • Bronchitis • Foul smelling breath • Noisy respiration

32. Treatment • Chronic tonsillitis – tonsillectomy • Numerous otitis media - adnoidectomy • Penicillin is the drug of choice for infection • Hemorrhage is a potential complication • Monitor HR • Monitor temperature • Evaluate vomitus

33. Acute Respiratory Distress Syndrome • May become fatal within 48 hours of diagnosis • Usually results from another type of trauma • Fracture • Fat emboli • Pulmonary contusion • Form of pulmonary edema

34. S & S • Hypoxemia • Crackles & sonorous wheezes • Blood Tests • Show Respiratory acidosis (increase CO2) • Show Metabolic acidosis (decrease bicarb) • Decling O2 sat

35. COPD • Chronic Obstructive Pulmonary Disease • Long term pulmonary disorders with air flow resistance • Include: Asthma, chronic bronchitis, & emphysema • Contributing factors: smoking, allergies, family history

36. Asthma • Classified as Mild, Moderate, or Severe • Mild – occurrence less than 2 x/week • S & S • Cough dyspnea • Wheezing • Chest tightness

37. Moderate – daily • Nighttime symptoms 5x/month • Normal or below normal gas exchange • Cough Wheezing • Chest tightness dyspnea • Severe – greatly affects activity • Below normal air exchange • Continuous • Cough Wheezing • Chest tightness Dyspnea

38. Tests • Pulmonary function test • IgE - elevated in allergic reaction • Chest X ray • Treatment • Long – acting inhalers • Corticosteroids • Albuterol (attacks)

39. Albuterol • Bronchodilator • Prevents bronchospasms related to exercise induced asthma • May be inhaled or given PO • CI: hypersensitivity, CV disorders, hyperthyroidism, DM • SE: nervousness, tremors, dizziness, insomnia, HA, tachycardia, palpitations, N & V, hypokalemia, muscle cramps • Interactions: MAO inhibitors, antidepressants, beta blockers

40. Emphysema • Abnormal, permanent enlargement of the air space that destroys alveoli • Affects tissue changes unlike asthma & bronchitis • Results from Deficiency of protein or smoking • S & S • Dyspnea on exertion • Barrel – shaped chest • Prolonged expiration • Decreased breath sounds

41. Treatment • Bronchodialators • Mucolytics to thin secretions • Antibiotics for any infections • O2 therapy • corticosteroids