Respiratory System Diseases

1
Respiratory System Diseases

• Pathophysiology By DrAqeela Bano

2
Review of Anatomy Physiology
3
UPPER RESPIRATORY TRACT

• RESPIRATORY MUCOSA
• lined with ciliated mucus producing cells
• 125cc/ day
• purifies air
• NOSE
• paranasal sinuses
• frontal, maxillary, sphenoid, ethmoid
• lighten skull
• sound resonant chambers
• conchae (3 pairs)
• warm humidify air
• lacrimal ducts
• olfactory receptors

4
UPPER RESPIRATORY TRACT

• PHARYNX
• 3 parts Nasopharynx, Oropharynx, Laryngopharynx
• Tonsils(3 pairs)
• pharyngeal (adenoids)
• palatine
• lingual
• Eustachian (auditory) tubes open into nasopharynx
• equalizes pressure between middle ear the
  outside
• LARYNX
• composed of pieces of cartilage
• Thyroid cartilage Adams apple
• epiglottis glottis

5
LOWER RESPIRATORY TRACT

1. TRACHEA
2. composed of C- shaped cartilaginous rings
3. called windpipe

6
LOWER RESPIRATORY TRACT

• BRONCHI, BRONCHIOLES, ALVEOLAR DUCT,
  ALVEOLI
• Gas exchange occurs in alveoli
• occurs via Passive Diffusion
• Respiratory Membrane
• 2 cell thick layer
• surfactant reduces surface tension to keep
  alveoli distended
• lining of alveolus (alveolar epithelium)
• lining of capillary ( capillary endothelium)

7
LOWER RESPIRATORY TRACT
8
LOWER RESPIRATORY TRACT

• Lungs Pleura
• Right Lung 3 lobes Left Lung 2 lobes
• lower part of lung resting on diaphragm Base of
  lung
• upper part of lung under clavicle Apex of lung
• Pleura serous membrane (i.e. secretes some
  fluid)
• Parietal Pleura lines thoracic cavity
• Visceral Pleura lines organs (viscera)

9
(No Transcript)
10
Respiratory System Diseases General Outline

• INFECTIOUS DISEASES
• Upper
• Upper respiratory infection
• Croup
• Epiglottitis
• Flu (Influenza)
• Lower
• Bronchiolitis
• Pneumonia
• TB
• Fungal diseases

11
RESPIRATORY SYSTEM DISEASES
12
RESPIRATORY SYSTEM DISEASES GENERAL OUTLINE

• 2) COPD (chronic obstr. pulm. dis)
• Emphysema
• Chronic bronchitis
• 3) Restrictive lung diseases
• Chest wall abnormalities
• Connective tissue abnormalities
• Pneumoconioses
• 4) Obstructive lung diseases
• Cystic fibrosis
• Cancer
• Aspiration pneumonia
• Asthma

13
RESPIRATORY SYSTEM DISEASES GENERAL OUTLINE

• 5) Vascular disorders
• Pulmonary edema
• Pulmonary embolism
• 6) Expansion disorders
• Atelectasis
• Pleural effusion
• Pneumothorax
• Resp. distress syndrome
• Infant
• adult

14
Manifestations of Pulmonary Disease

• Sneezing reflex response to irritation of upper
  respiratory tract
• Coughing reflex response to irritation of lower
  respiratory tract
• Sputum production
• If yellowish- green ------ infection
• If rusty ------- blood pus pneumococcal
  pneumonia
• If bloody , called hemoptysis ---- usually
  frothy --- seen in pulm. Edema
• Also seen in pulm. TB cancer
• Large amounts foul bronchiectasis
• Thick sticky asthma, cystic fibrosis

15
Manifestations of Pulmonary Disease

• Breathing patterns
• Labored (dyspnea) , wheezing, stridor
• Breath sounds
• Normal, rales, rhonchi, decreased breath
  sounds
• Dyspnea --- discomfort feeling when cant get
  enough air
• Orthopnea dyspnea lying down
• Cyanosis --- not a reliable early indicator of
  hypoxia

16
UPPER RESPIRATORY TRACT INFECTIONS

• Definition
• Acute inflammatory process that affects
• mucus membrane of the upper respiratory
• tract
• Includes one or more of the following
• Problems
• Rhinitis also called Coryza
• Pharyngitis
• Laryngitis
• Sinusitis

17
Upper Respiratory Infection (URI)

• S/S low-grade fever, malaise, sore throat,
  discharge
• Incubation period short ----- 2-3 days
• As a rule bacterial diseases short incubation
• viral diseases long
  incubation except URIs
• Etiology over 200 different viruses have been
  implicated, can get secondary bacterial
  infection.
• Tx symptomatic

18
PATHOPHYSIOLOGY
19

• INFLUENZA
• 1) Viral types---- A,B, C
• .They mutate constantly thus preventing effective
  immune defense for prolonged time periods
• 2) Short incubation ---- 3 days
• Distinguishing features from simple URI
• High fever in flu (usually lasts 4-5 days)
• Flu gives both an upper a lower resp.
  tract infections at the same time, whereas URI
  just gives upper tract infection
• Death may result from pneumonia

20
LOWER RESPIRATORY INFECTIOUS DISEASES
21
Pneumonia

• Definition
• It is an inflammatory process of the lung
  parenchyma that is commonly caused by infectious
  agents.

22
Classification of pneumonia

• According to causes
• Bacterial (the most common cause of pneumonia)
• Viral pneumonia
• Fungal pneumonia
• Chemical pneumonia (ingestion of kerosene or
  inhalation of irritating substance)
• Inhalation pneumonia (aspiration pneumonia)

23
Classification of pneumonia

• According to areas involved
• Lobar pneumonia if one or more lobe is involved
• Broncho-pneumonia the pneumonic process has
  originated in one or more bronchi and extends to
  the surrounding lung tissue.

24
(No Transcript)
25
RADIOLOGIC IMAGE OF BRONCHOPNEUMONIA
26
RADIOLOGIC IMAGE OF LOBAR PNEUMONIA
27
Mode of transmission

• WAYS YOU CAN GET PNEUMONIA INCLUDE
• Bacteria and viruses living in your nose,
  sinuses, or mouth may spread to your lungs.
• You may breathe some of these germs directly into
  your lungs (droplets infection).
• You breathe in (inhale) food, liquids, vomit, or
  fluids from the mouth into your lungs (aspiration
  pneumonia).

28
Predisposing factors

• 1. Immuno-suppresed patients
• 2. Cigarette smoking
• 3. Difficult swallowing (due to stroke,
  dementia,parkinsons disease, or other
  neurological conditions)
• 4. Impaired consciousness ( loss of brain
  function due to dementia, stroke, or other
  neurological conditions)

29
Predisposing factors

• 5. Chronic lung disease (COPD, bronchostasis)
• 6. Frequent suction
• 7. Other serious illness such as heart disease,
  liver cirrhosis, and DM
• 8. Recent cold, laryngitis or flu.

30
PATHOPHYSIOLOGY OF PNEUMONIA
31
(No Transcript)
32
CLINICAL MANIFESTATION OF PNEUMONIA

• Shaking chills
• Rapidly rising fever ( 39.5 to 40.5 degree)
• Stabbing chest pain aggravated by respiration and
  coughing

33
CLINICAL MANIFESTATION OF PNEUMONIA

• Tachypnea, nasal flaring
• Patient is very ill and lies on the affected side
  to decrease pain
• Use of accessory muscles of respiration e.g.
  abdomen and intercostals muscles

34
CLINICAL MANIFESTATIONS..

• Cough with purulent, blood tinged, rusty sputum
• Shortness of breath
• Flushed cheeks
• Loss of appetite, low energy, and fatigue
• Cyanosed lips and nail beds

35
DIAGNOSTIC TESTS FOR PNEUMONIA

• History taking
• Physical examination
• Chest x-ray
• Blood test
• Sputum culture

36
MEDICAL MANAGEMENT OF PNEUMONIA

• Antibiotic, depending on sputum and blood culture
• Oxygen therapy
• Chest physiotherapy

37
NURSING INTERVENTIONS FOR PNEUMONIA

• Maintain a patent airway and adequate oxygenation
• Obtain sputum specimens as needed.
• Use suction if the patient cant produce a
  specimen.
• perform chest physiotherapy.

38
NURSING INTERVENTIONS FOR PNEUMONIA

• Provide a high calorie, high protein diet of soft
  foods.
• To prevent aspiration during nasogastric tube
  feedings, check the position of tube, and
  administer feedings slowly.
• To control the spread of infection, dispose
  secretions properly.

39
NURSING INTERVENTIONS FOR PNEUMONIA

• Provide a quiet, calm environment, with frequent
  rest periods.
• Monitor the patients ABG levels, especially if
  hes hypoxic.
• Assess the patients respiratory status.
  Auscultate breath sounds at least every 4 hours.

40
NURSING INTERVENTIONS FOR PNEUMONIA

• Monitor fluid intake and output.
• Evaluate the effectiveness of administered
  medications.
• Explain all procedures to the patient and family.

41
PREVENTIVE MEASURES

• Frequent turning of bed ridden patients and early
  ambulation as much as possible.
• Coughing and breathing techniques.
• Sterilization of respiratory therapy equipment
• Suctioning of secretion in the unconscious who
  have poor cough and swallowing reflexes, to
  prevent aspiration of secretions and its
  accumulation.

42
COMPLICATIONS

• Acute respiratory distress syndrome (ARDS)
• Pleural effusion
• Lung abscesses
• Respiratory failure (which requires mechanical
  ventilator)
• Sepsis, which may lead to organ failure

43
BRONCHITIS

• LOWER RESPIRATORY TRACT INFECTION

44
BRONCHITIS

• DEFINITION
• Bronchitis is defined as the inflammation
  or infection of bronchi and bronchioles.
• Depending on the duration of disease , it
  can be
• 1. Acute (lasts for few days)
• 2. Chronic (for prolonged time)

45
BRONCHITIS

• CAUSES FOR ACUTE TYPE
• 1. Viral infections 90
• Influenza virus A,B ,adenovirus ,
  respiratory syncytial virus.
• 2. Bacterial infections 10
• Mycoplasma pneumoniae, streptococcus
  pneumoniae

46
BRONCHITIS

• PREDISPOSING FACTORS
• Chronic sinusitis
• Chronic obstructive pulmonary disease
• Asthma
• Bronchiectasis
• Smoking and second hand smoke.
• Alcoholism

47
BRONCHITIS

• Clinical manifestations
• SYMPTOMS
• History of dry or productive cough 5- 10 days
• Body aches
• Chest pain on coughing
• Soar throat

48
BRONCHITIS

• SIGNS
• Mild to moderate fever
• Increased respiratory rate
• Increased heart rate
• Wheezing on auscultation

49
BRONCHITIS

• MANAGEMENT
• Goals of management are
• To releive the symptoms
• To prevent the Pneumonia
• Treatment
• Symptomatic treatment to relieve the pain, fever
  and cough
• Increase the rest time
• Increase the hydration(8-10 glasses of water)
• Avoid the aggravating factors

50
(No Transcript)