PATHOPHYSIOLOGY MOD9 LECTURE

what are the two divisions of the respiratory system and their functions

• air conducting: delivers air (nose, mouth, trachea, bronchi, and bronchioles)

• gas exchange: swaps gases between air and blood (alveoli and capillaries)

function of mucus, cilia, and immune cells

protect the system from harmful inhaled particles/ foreign particles

function of the capillaries in the nose

warm and humidify the air to protect the system from drying and damage from cold

epiglottis function

closes larynx to prevent food and liquids from entering the lungs

number one cause to damage to the cilia

smoking

and ___ are vital to pulmonary function for ventilation (VIF)

elasricity and recoil

what is a surfactant and its function

a lipoprotein that reduces alveoli surface tension to prevent collapse

what is a part of the upper respiratory function

• nasal cavity

• pharynx

• larynx

what is part of the lower respiratory tract

• trachea

• primary bronchi

• lungs

what are adventitious breath sounds

abnormal breath sounds

what are the types of adventitious breath sounds

• crackles

• wheezing

• rhonchi

• stridor

• friction rubs

what does stridor sound like

• high pitched sound

** some kind of swelling leading to bronchoconstriction (partial obstruction or narrowing of the upper airway)

what does wheezing sound like and what type of patients would present with this breath sound

• high pitched sound

• seen in asthma patients

what does bronchi sound like and what type of patients would present with this breath sound

• low pitched

• seen in bronchitis patients

what does crackles sound like and what type of patients would present with this breath sound

• sounds like crumbling up paper or the sound you hear from the rice krispies cereal

• seen in pneumona and heart failure patients

** has some type of fluid, buildup, or congestion

** sound can be fine or course

what is inspiration and what does this have to do with the chest cavity

breathing in to acquire oxygen

** the chest cavity size changes to alter the pressure gradient

what is expiration and what do the muscles involved do

removing carbon dioxide out of the body through the lungs

• the diaphragm and external intercostal muscles relax

what is impaired ventilation

a problem of blocking airflow in and out of the lungs and into the bronchial tubes

what is diffusion and the two major process, and where does the exhange happen

1. oxygen is trying to get to all the cells

2. carbon dioxide is trying to escape through the lungs

** oxygen and carbon dioxide are exchanged at alveolar capillary junctions

what is impaired diffusion

restricted transfer of oxygen and carbon dioxide across the alveolar capillary junction

hypoxemia

• decreased oxygen in the arterial blood

• leads to a decrease in PaO2

hyoxia

oxygen deprivation in the cells

hypercapnia

increased carbon dioxide in the blood

how does a patient with respiratory problems present as

• hemoptysis

• expectorate sputum

• dyspnea

• orthopnea

• adventitious lung sounds

• barrel chest (AP:T is 1:2)

• systemic manifestations: changes to LOC, mentation

hemoptysis

blood in the sputum

orthopnea

cannot breathe laying flat

nosocomial

develops more than 48 hours after a hospital admission

community- acquired

acquired outside the hospital or healthcare setting

which is more aggressive: nosocomial or community acquired

nosocomial

what is another name for influenza

the Flu

influenza is a viral infection that may affect the

upper and lower respiratory tract

the influenza what type of virus

highly adaptive virus

clinical manifestations for influenza

• ABRUPT onset

• low grade fever

• chills

• dry cough

• profound malaise (overwhelming fatigue)

what is bronchitis

inflammation of the trachea or large bronchi, swelling, loss of ciliary function

what are the causes of penumonia

• infectious agents

• injurious agents or events

• pulmonary secretion stasis

difference between viral pneumonia and bacteria pneumonia

• viral: usually mild, can lead to secondary bacterial pneumonia

• bacterial: more common than viral, often due to streptococcus pneumoniae

aspiration pneumonia

from aspirated fluid (emesis, salvia) or food entering the lungs

bronchopneumonia

most frequent type, a patchy pneumonia across several lobe

interstitial (atypical) pneumonia

occurs in the areas between the alveoli, routinely caused by viruses or by uncommon bacteria

one common form of atypical pneumonia

COVID

clinical manifestations of penumonia

• productive or nonproductive cough

• fatigue

• pleuritic pain

• dyspnea

• fever

• chills

• crackles or rales

• pleural rub

• tachypnea

• mental status changes (especially in the elderly)

what develops in pneumonia and what can it lead to

hypoxia develops due to congestion of the airways leading to impaired oxygen diffusion

what is tuberculosis caused by

mycobacterium tuberculosis

tuberculosis is carried by

airborne droplets

** just by the patient breathing, it allows the transmission to occur

in tuberculosis, the primary infection occurs when ___ first enters the body

bacillus

in tuberculosis, some bacilli travel to the lymph nodes, activating what type of hypersenstivity reactions

type IV hypersensitivity reactions

bacilli can remain ____ for years and is usually ____ but will test ____

can remain dormant but is usually asymptomatic but will test positive

clinical manifestations for tuberculosis

• productive cough

• hemoptysis

• night sweats

• fever

• chills

• unexplained weight loss

asthma

common chronic disorder that results in intermittent, reversible airway obstruction from a variety of triggers from infections to smoke

asthma is characterized by

acute airway inflammation, bronchoconstrictiion, bronchospasm, bronchiole edema, and mucus production

extrinsic asthma

generally presents in childhood or adolescence

intrinsic asthma

nonallergic reaction that usually presents after age 35

with extrinsic asthma, mediator release causes

bronchoconstriction, increased capillary permeability, and mucus production

when a patient states they grew out of their asthma, which type of asthma is that

extrinsic asthma

clinical manifestations of asthma

• wheezing

• shortness of breath

• dyspnea

• chest tightness

• cough

• tachypnea

• anxiety

what is status asthmaticus

often- fatal, prolonged asthma attack unresponsive to usual treatment

status asthmaticus can lead to

• respiratory alkalosis

• respiratory failure

debilitating chronic disorders is characterized by

irreversible, progressive tissue degeneration and airway obstruction

causes of COPD

smoking, pollution, chemical irritants, and genetic mutation

chronic bronchitis

characterized by inflammation of the bronchi, a productive cough, and excessive mucus production

what is emphysema

destruction of the alveolar walls leads to large, permanently inflated alveoli

in emphysema, what is deficient and is it necessary for

enzyme necessary for kung remodeling is deficient

in emphysema, the loss of what leads to what

loss of elastic recoil and hyperinflation of the alveoli, leading to air trapping —> this leads to a barrel chest appearance

what are the causes of emphysema

genetic predisposition and smoking

clinical manifestations of emphysema

• dyspnea upon exertion

• diminished breath sounds

• wheezing

• chest tightness

• tachypnea

• hypoxia

• hypercapnia

• increased anterior- posterior throacic diameter (Barrel Chest) from (1:2 to 1:1)

• activity intolerance

• anorexia

• malaise

what is cystic fibrosis

life- threatening condition resulting in severe lung damage and nutrition deficits

what does cystic fibrosis affect

the cells that produce mucus, sweat, saliva, and digestive secretions

** the secretions become thick and tenacious

cystic fibrosis is caused by

autosomal recessive mutation on seventh chromosome

complications of cystic fibrosis

• atelectasis

• recurrent infections

• respiratory failure

• malabsorption

• malnutrition

• electrolyte imbalance

• sterility

• infertility

clinical manifestations of cystic fibrosis

• salty skin

• steatorrhea

• frequent respiratory infections

• clubbing

what is the second most common cancer

lung cancer

clinical manifestations of lung cancer

• persistent cough or a change in usual cough

• dyspnea

• frequent respiratory infections

• fatigue

what is pleural effusion

excess fluid in the pleural cavity, which may include exudates, transudates, blood, and pus and can impair breathing

in pleural effusion, you may also see ___ which can cause

pleurisy which is inflammation of the pleural membranes

clinical manifestations of pleural effusion

• chest pain

• absent lung sounds

• dullness over the affected area

• pleural friction rub

what is pneumothorax

air in the pleural cavity, which can cause lung to collapse

risk factors of pneumothorax

• smoking

• tall stature

  • history of lung disease or previous pneumothorax

spontaneous pneumothorax

where air enters from an opening in the internal airways

traumatic pneumothorax

result of a blunt or penetrating injury to the chest

tension pneumothorax

the most serious type, can cause affected lung to collapse

** due to trapped air in the pleural space or air from a positive pressure mechanical ventilator

clinical manifestations of pneumothorax

• sudden chest pain

• decreased breath sounds over the affected area

• asymmetrical chest movement

• trachea and mediastinum deviation

what is atelectasis

collapse of the alveoli

clinical manifestations of acute respiratory failure

• hypoxia

• hypercapnia

what is acute respiratory distress syndrome

a condition of severe acute inflammation and pulmonary edema without evidence of fluid overload or impaired cardiac function

clinical manifestations of acute respiratory distress syndrome

hypoxemia

hypoventilation

increase PaCO2

hyperventilation

respiratory alkalosis (lightheadedness and paresthesia)