HLSC 301 Exam 2 Pulmonary

Hypercapnia

Respiratory Acidosis, Increased Paco2 = measured by ABG

Causes of Hypercapnia

hypoventilation: drugs/meds decreasing respiratory drive, disease of nervous system, spinal cord disease, disease at neuromuscular junction, thoracic cage changes, obstructions

Hypoxemia

Reduced Pao2 = measured by ABG 

Results from decreased O2 delivery to alveoli, diffusion into blood or perfusion

Hypoxia

Decreased oxygenation of cells/tissues

Respiratory Failure

Inadequate gas exchange with Pao2 ≤ 50 mm Hg or Paco2 ≥ 50 mmHg with pH ≤ 7.25

• Often a complication of surgery, worse in smokers

Acute Respiratory Failure

Life-threatening inability of the lungs to maintain adequate oxygenation

• Inadequate gas exchange with Pao2 ≤ 50 mm Hg or Paco2 ≥ 50 mm Hg with pH ≤ 7.25

Result of many respiratory conditions 

Complications of Acute Respiratory Failure

heart failure and death

Manifestations of Acute Respiratory Failure

shallow respirations, headache, tachycardia, dysrhythmias, lethargy, and confusion

Diagnosis of Acute Respiratory Failure

history, physical examination, arterial blood gases, chest X-ray, and complete blood counts

Treatment of Acute Respiratory Failure

oxygen therapy, endotracheal intubation with ventilation support, bronchodilators, antibiotics (if bacterial infection is present), corticosteroids, emboli precautions, and cardiac support

Infectious Rhinitis

• Common cold

• Usually caused by the rhinovirus

• Highly contagious

• May also see a secondary bacterial infection

• Incubation period = 2-3 days

Manifestations of Infectious Rhinitis

• sneezing, nasal congestion, nasal discharge, sore throat, nonproductive cough, malaise, myalgia, low-grade fever, hoarseness, headache, and chills

Diagnosis of Infectious Rhinitis

history and physical examination

Treatment of Infectious Rhinitis

antipyretics, analgesics, antihistamines, decongestants, antibiotics (if bacterial infection is present), humidifiers, and vitamin C

Preventing transmission

Sinusitis

Inflammation of the sinus cavities

Cause of Sinusitis 

virus, bacteria, and fungus, exudate collects and blocks the sinus cavities

Manifestations of Sinusitis

facial pain, nasal congestion, fever, and sore throat

Diagnosis of Sinusitis 

H & P, transillumination, sinus X-ray or CT scan

Treatment of SInusitis

decongestants, analgesics, and antibiotics (if bacterial)

Epiglottitis

• Inflammation of the epiglottis

• Life-threatening

Causes of Epiglottitis

Haemophilus influenza type B (Hib) (common infection in children) and throat trauma

Manifestations of Epiglottitis

fever, sore throat, difficulty swallowing, drooling with mouth open, muffled voice, inspiratory stridor, respiratory distress, central cyanosis, anxiety, pallor, and assuming a tripod position

Diagnosis of Epiglottits 

H & P, (DO NOT use tongue depressor!!), X-rays, visualization of the epiglottitis through a fiber-optic camera, cultures, ABG’s, and a CBC

Treatment of Epiglottitis 

Maintain airway and respiratory status (e.g., oxygen therapy, endotracheal intubation with mechanical ventilation, and tracheotomy), racemic epinephrine, corticosteroids, and antibiotics

Laryngitis

• Inflammation of the larynx

• Usually self-limiting and infectious of viral origin

Causes of Laryngitis

Infection, increased upper respiratory exudate, and overuse

Manifestations of Laryngitis

Hoarseness, weak voice or voice loss, tickling sensation and raw feeling in the throat, sore throat, dry cough, and difficulty breathing

Diagnosis of Laryngitis 

H & P, CBC, laryngoscopy, and biopsy (rule out cancer

Treatment of Laryngitis

Warm humidity, resting the voice, increasing fluid intake, treating the underlying cause, throat lozenges, gargling with salt water, and avoidance of decongestants

Laryngotracheobronchitis

Croup

• Common viral infection in children, usually parainfluenza viruses and adenoviruses

• Can be bacterial (S. aureus, diphtheria

• Larynx and subglottic area swell, leading to airway narrowing, obstruction, and respiratory failure

Manifestations of Laryngotracheobronchitis

Nasal congestion, seal-like barking cough, hoarseness, inspiratory stridor, dyspnea, anxiety, and cyanosis

Diagnosis of Laryngotracheobronchitis

H & P, X-rays (steeple sign), throat cultures, ABG’s

Treatment of Laryngotracheobronchitis

• Usually self-limiting but can be life threatening

• Include cool humidity, corticosteroids, and bronchodilators

Acute Bronchitis

• Inflammation of the tracheobronchial tree or large bronchi

Causes of Acute Bronchitis

• viruses, bacterial, irritant inhalation, and allergic reactions

Manifestations of Acute Bronchitis

• Productive and nonproductive cough, dyspnea, wheezing, low-grade fever, pharyngitis, malaise, and chest discomfort

Diagnosis of Acute Bronchitis

H & P, and X-ray

Treatment of Acute Bronchitis

Antipyretics, analgesics, antihistamines, decongestants, cough suppressants, bronchodilators, increasing fluid intake, avoiding smoke, and humidifying air, antibiotics (only if secondarily infected by bacteria)

Bronchiolitis

• Common viral infection of the bronchioles, usually respiratory syncytial virus (RSV)

• More frequent in children < 1 year and during the winter months

• Can lead to atelectasis and respiratory failure

• Worse in “preemies”

Manifestations of Bronchiolitis

Nasal drainage, nasal congestion, cough, wheezing, rapid and shallow respirations, chest retractions, dyspnea, fever, tachycardia, and malaise

Diagnosis of Bronchiolitis

H&P, CXR, mucus swab, CBC, and ABG

Treatment of Bronchiolitis

oxygen therapy, intubation, cool humidity, increased fluids, keeping the child calm, bronchodilators, and corticosteroids

Influenza

• Flu

• Viral infection that may affect the upper and lower respiratory tract

• Highly-adaptive virus

Manifestations of Influenza

Fever, headache, chills, dry cough, body aches, nasal congestion, sore throat, sweating, and malaise

Diagnosis of Influenza

H&P, rapid flu screen, and flu culture

Treatment of Influenza

antiviral agents, increasing fluids, rest, antipyretics, and analgesics

COVID-19

• The Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) virus causes coronavirus disease.

• Coronaviruses have been around for many years.

• This new coronavirus was first reported in Wuhan, People’s Republic of China in December 2019 and led to a respiratory pandemic, declared March 11, 2020 by the WHO.

• Transmission via respiratory droplets and aerosols between people

Manifestations of COVID-19

Fever, cough, fatigue, loss of smell/taste, congestion, conjunctivitis, sore throat, HA, myalgia, arthralgia, n/v, diarrhea, chills, dizziness, SOB, confusion, sleep disorders

Diagnosis of COVID-19

H&P, Rapid testing, PCR testing, CBC, coagulation testing, sputum cultures, CXR, CT chest

Treatment of COVID-19

Supportive measures (viral infection), oxygen (mechanical ventilation), Paxlovid® (anti-viral), Evusheld® (monoclonal antibodies), antibiotics if secondary infection, steroids

Complications of COVID-19

Severe disease – pneumonia, ARDS, shock, coagulation defects, encephalopathy, heart failure, acute kidney injury, death

Prevention of COVID-19

Handwashing, staying home when ill (quarantine versus isolation), Vaccinations

Pneumonia

Infection in lower respiratory tract

• Infectious agents, injurious agents or events, and pulmonary secretion stasis

• Viral

• Usually mild

• Can lead to secondary bacterial pneumonia

• Bacterial

• More common than viral

• Most often Streptococcus pneumoniae

• Aspiration of oropharyngeal secretions, inhalation of microorganisms, bacteremia

• Alveolar macrophages necessary for immune response

• Cellular debris, exudate can fill acini/terminal bronchioles (consolidation)

Manifestations of Pneumonia

productive or non-productive cough, fever, chills, fatigue, pleuritic pain, dyspnea, crackles or rales, dullness on percussion, pleural rub, tachypnea, and mental status changes

Complications of Pneumonia

septicemia, pulmonary edema, lung abscess, and acute respiratory distress syndrome

Diagnosis of Pneumonia

H&P, CXR, CT scan, sputum & blood cultures, CBC, ABG’s, and bronchoscopy, VQ mismatch & hypoxemia

Treatment of Pneumonia

Antibiotics, oxygen therapy, bronchodilators, corticosteroids, antipyretics, analgesics, intubation with ventilator support, chest physiotherapy, increased fluids, rest, and swallowing studies (if aspiration)

Prevention of Pneumonia

hand washing, avoiding crowds, vaccinations, turning, coughing, deep breathing, and smoking cessation

Bronchopneumonia

• Most frequent type

• A patchy pneumonia throughout several lobes

Lobular Pneumonia

• Confined to a single lobe

Interstitial pneumonia or atypical

• Occurs in the areas between the alveoli

• Routinely caused by viruses or by uncommon bacteria

Nosocomial pneumonia

• Develops more than 48 hours after a hospital admission

• Higher mortality

• Common complication in the ICU

• Especially those on mechanical ventilation

Community-acquired pneumonia

Acquired outside the hospital or healthcare setting

Aspiration pneumonia

Impaired gag reflex, improper lower esophageal sphincter closure, inappropriate tube-feeding placement

Legionnaires’ Disease

• Pneumonia caused by Legionella pneumophila

• Thrives in warm, moist environments, particularly air conditioning systems and spas

• Not contagious

• spread through aerosolized droplets

• Higher risk in the immune compromised

• Can be life-threatening

Diagnosis of Legionnaires’ Disease

urine test for Legionella antigens

Pneumocystis jiroveci Pneumonia

• Caused by fungus: Pneumocystosis jiroveci

• Opportunistic infection

• Especially common in those with HIV or undergoing organ transplantation

Diagnosis of PJP

sputum culture

Treatment of PJP

Antibiotics

Tuberculosis

• Caused by the bacillus Mycobacterium tuberculosis

• Carried by airborne droplets – highly contagious

• Most frequently occurs in the lungs, but can spread to other organs

• Resistant strains have developed

• Leading cause of death from curable infectious disease in the world

Manifestations of Tuberculosis

Insidious onset, productive cough, hemoptysis, night sweats, fever, chills, fatigue, unexplained weight loss, anorexia, and symptoms depending on other organ involvement

Latent Infection of Tuberculosis

• Bacillus first enters the body

• Localized nonspecific pneumonitis

• Macrophages engulf the microbe causing a local inflammatory response

• Some bacilli travel to the lymph nodes, activating the type IV hypersensitivity reaction

• Granulomatous lesion (tubercle) forms

• Scar tissue grows around the tubercle

• Caseous necrosis and Ghon complexes develops

• Bacilli can remain dormant for years (or life)

• Usually asymptomatic

• Will test positive now

Active Infection of Tuberculosis

• Reactivation of dormant bacilli

• Can spread to other organs: nervous system, bone, & renal

• Symptoms develop

Diagnosis of Tuberculosis

H & P, skin test (Mantoux), serological testing, CXR, CT scan, and sputum culture (may take up to 6 weeks!)

Treatment of Tuberculosis

antimicrobial combination therapy for at least 6 months

Prevention of Tuberculosis

vaccination, respiratory precautions, adequate ventilation, and appropriate isolation

Flail chest

• Results from fracture of multiple

ribs OR fracture of sternum & several ribs

• Instability of chest wall

• Paradoxical movement with

breathing

• Inhalation moves chest wall in

• Exhalation moves chest wall out

Pneumothorax

Air in the pleural cavity from ruptured pleura

• Decreases negative pressure of pleural space – lung recoils by collapsing toward the hilum

Risk factors for Pneumothorax

smoking, tall stature, and history of lung disease or previous pneumothorax

Manifestations of Pneumothorax

sudden chest pain, chest tightness, dyspnea, tachypnea, decreased breath sounds & hyperresonance over the affected area, asymmetrical chest movement, trachea and mediastinum deviation, anxiety, tachycardia, pallor, and hypotension

Diagnosis of Pneumothorax

H&P, decreased/absent breath sounds, hypoxemia, deviated trachea, hypotension, CXR, CT scan, and arterial blood gases (ABG’s)

Treatment of Pneumothrorax

Removal of the air and reestablishing negative pressure, immediate treatment required, pleurodesis, thoracoscopic gluing

• Thoracentesis and chest drainage tube

Primary (spontaneous) pneumothorax

• Occurs when a small air blister (bleb) on the top of the lung ruptures

• Blebs are caused by a weakness in the lung tissue

• Usually mild

Secondary pneumothorax

Develops in people with preexisting lung disease, chest trauma, ruptured bleb/bulla, mechanical ventilatio

Open (communicating) pneumothorax

• Air pressure in pleural space equals barometric pressure

• Air enters on inhalation and leaves on exhalation

Tension pneumothorax

• Most serious type

• Site of pleural rupture acts as a one-way valve

• Air enters on inspiration but unable to exit on exhalation

• Excess air pressure pushes against recoiled lung causing compression

atelectasis and pushes mediastinum – shifting the heart and great vessels

Edema

fluid collects in airspaces themselves

Effusion 

fluid around the lungs collects between lung and chest wall

Pleural Effusion

• Excess fluid in the pleural cavity

• Fluid may include exudate, transudate, blood, chyle, and pus

• Can impair breathing

• May also see pleurisy – inflammation of the pleural membranes

Manifestations of Pleural Effusion

dyspnea, chest pain, tachypnea, compression atelectasis, tracheal deviation, absent lung sounds and dullness over affected area, tachycardia, and pleural friction rub

Diagnosis of Pleural Effusion

H & P, CXR, CT, ABG, complete blood gases, and thoracentesis

Treatment of Pleural Effusion

Small amounts drained by lymphatics, thoracentesis, chest drainage tube, and antibiotics

Transudative Pleural Effusion

Occurs due to increaased hydrostatic pressure or low plasma oncotic pressure

Exudative Pleural Effusion

Occurs due to inflammation and increased capillary permeability

Hemothorax

• Blood in the pleural space

Cause of Hemothorax

Traumatic injury, surgery, rupture, malignancy that

damages blood vessels

Treatment of Hemothorax

Underlying cause, treat like an effusion

Chylothorax

• Chyle in the pleural space

• Milky fluid of lymph & fat

Empyema

• Pus (microorganism & cellular debris) in the pleural space

• Often complication of pneumonia, surgery, trauma, bronchial obstruction

Manifestations of Empyema

Fever, tachycardia, cyanosis, cough, pleural pain,