Respiratory Diseases

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Respiratory Diseases
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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?

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Parts of the Respiratory System

• Upper Respiratory Tract
• Nose
• Mouth Pharynx
• Trachea to larynx
• Lower Respiratory Tract
• Lower trachea
• Lungs

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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

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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

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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?

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Respiratory Disease

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

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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

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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

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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

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

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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

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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

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Wheezing

• Bronchial constriction
• Airway narrowing
• High pitched, musical

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Hemoptysis

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

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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

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• 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

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Upper Respiratory Tract Disorders

• Cold
• Sinusitis
• Pharyngitis

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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

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S S

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

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• 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 100s different viruses but most common
  is the RHINOVIRUS

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Treatment

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

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• HA Muscle aches
• Ibuprofen
• acetominophen
• Sore throat
• Warm salt gargle

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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

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

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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

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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

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

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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

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

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

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

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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

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

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COPD

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

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Asthma

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

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• 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

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

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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

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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

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