Exam 3 patho: Respiratory Alterations part 2

What type of virus is the flu?

RNA virus

How is the flu transmitted?

Respiratory droplets

Precautions that must be taken around someone with the flu

When within 6 feet of the patient you must wear a face shield and goggles

There are 3 types of influenza (A, B, C). Why is type A more common?

• Type A is Most common and most serious because they undergo the most antigenetic shifts (mutations each year)

• Type B and C are less common and less serious because there are fewer antigenetic shifts

How long does it take for symptoms of the flu to show up (incubation period)?

1-4 days

Who should we be most concerned about with the flu? (4)

• Elderly 65+ (most people who die)

• young kids under 5 (bc their immune system isn’t as developed)

• Pregnant women

• Immunocompromised people (diabetes mellitus (type 1))

What are the 3 types of flu infections?

• Upper respiratory infection

• Viral pneumonia

• Bacterial pneumonia

Upper respiratory infection flu

Infection that affects epithelial cells and cilia

Symptoms of upper respiratory infection flu (4)

• Runny nose

• Fever

• Chills

• Malaise

Why do you get a runny nose when you get an upper respiratory infection flu?

Runny nose because the epithelial cells of the respiratory tract are impacted

Symptoms of viral pneumonia flu infection

• Non-productive cough

• Malaise

• Headache

What causes the symptoms of viral pneumonia flu infection?

Inflammation between the alveoli

• makes the immune system more susceptible and increases risk of bacterial infection

Bacterial flu infection

Purpose of flu vaccine

• Will lessen the symptoms (VERY important for immunodeficient people)

• Won’t completely make you immune

Clinical manifestations of the flu (7)

• Fever and chills, rigors

• Malaise

• Muscle aching

• Headache

• Nasal congestion

• Non productive cough

• Sore throat

Malaise

general feeling of discomfort, illness, or uneasiness whose exact cause is difficult to identify

Secondary complications of the flu

• Sinusitis

• Otitis media (ear infection)

• Bronchitis

• Croup

How long do the respiratory symptoms of the flu last?

10 days

What type of virus is SARS-CoV-2?

Single-stranded RNA virus

How is SARS-CoV-2 transmitted?

Droplet

Labwork done for COVID (2)

• +PCR (nasal swab)

• Radiography (bilateral lower-lobe infiltrates on x-ray)

Labwork to do for hospitalized patients for COVID

• leukopenia?

• elevated ESR & CRP and cytokines (TNF‐a, IL‐1, IL‐6)?

• elevated PT, low platelets, elevated d‐dimer and fibrinogen?

Complications from COVID

• ARDS

• Kidney failure

• Strokes

• Incubation

Early and late stages of COVID

• Early: migration of COVID and makes T-cells ineffective (?)

• Late: leads to thickening of the alveolar cells

  • If the gas exchange has further to go to exchange CO2 and O2, you will get severe hypoxemia

Flu vs COVID

Acute respiratory distress syndrome (ARDS)

Severe lung diseases caused by a variety of direct and indirect insults, which involves inflammation of lung parenchyma

What can inflammation of lung parenchyma from ARDS cause?

• Hypoxemia due to impaired gas exchange

• Multiple organ failure

Risk factors to contract ARDS

• **Sepsis

• Pneumonia

• Chest trauma

Berlin definition of ARDS

• X-ray — bilateral opacities = on both sides and is hazy

  • Consistent with pulmonary edema, but the heart is a normal size so it’s not HF

  • The edema occurs due to the inflammatory process — accumulation of WBCs

• PF ratio <300 (PaO2/FiO2 ratio)

  • FiO2 — fraction of inspired O2

  • When it gets to 150 it’s really bad

What happens when exudate enters the alveoli during ARDS?

Blocks CO2 and O2 gas exchange

• also loses surfactant

What cells go into the alveoli when exudate enters the alveoli in ARDS? What do they do?

Neutrophils enter alveoli and release:

• inflammatory mediators

• proteolytic enzymes

• ROS

What is the most common protease enzyme released during ARDS? What does it impact?

Elastase

• impacts the elasticity of the lungs

What happens when there is endothelial damage due to acute lung injury in ARDS?

O2 and CO2 exchange can’t occur effectively

What happens when there is epithelial damage due to acute lung injury in ARDS?

Lose surfactant

What occurs between these to get from endothelial damage to ARF?

1. Acute lung injury

2. Endothelial damage

3. ?

4. ?

5. ?

6. ?

7. Acute respiratory failure

1. Acute lung injury

2. Endothelial damage

3. Activation of neutrophils and platelets

4. Release of inflammatory cytokines

5. Increased alveolocapillary permeability with alveolar flooding (edema)

6. V/Q (ventilation-perfusion) mismatch and hypoxemia

7. Acute respiratory failure

What occurs between these to get from epithelial damage to ARF?

1. Acute lung injury

2. Endothelial damage

3. ?

4. ?

5. ?

6. ?

7. Acute respiratory failure

What occurs between these to get from endothelial damage to ARF?

1. Acute lung injury

2. Epithelial damage

3. Type II pneumocyte damage (surfactant-secreting cells)

4. Decreased surfactant

5. Atelectasis and decreased lung compliance

6. Decreased tidal volume and hypercapnia

7. Acute respiratory failure

Pulmonary embolism

a blood clot travels to the lungs and becomes lodged in a pulmonary artery and will prevent BF

Air pulmonary embolus

occurs when air enters the venous system and travels to the pulmonary circulation, potentially blocking blood flow to the lungs

• can occur during a surgical procedure

Fat pulmonary embolus

fat deposit flows into lungs and blocks BF to lungs

Plaque pulmonary emboli

plaque that broke off of the vessel wall and travels to a pulmonary artery and blocks BF

Amniotic pulmonary emboli

amniotic fluid, fetal cells, or other debris enter the mother's bloodstream during pregnancy or childbirth

The damage to a patient’s lung due to a pulmonary embolism depends on… (2)

• Size of embolus

• Degree of BF obstruction

Small pulmonary embolism manifestations

• may not have symptoms

• subtle change in oxygenation

Moderate pulmonary embolism manifestations (5)

• Respiratory changes

• SOB

• RR increased

• O2 intake affected (decreased O2 exchange)

• Pleural chest pain

Massive pulmonary embolism manifestations (6)

• Very obvious and occur quickly

• SOB immediately

• O2 decreases

• Tachycardia

• Chest pain from inflammatory process

• JVD bc blood is backing up

Due to a massive pulmonary embolism, blood may not be able to go through lungs, which could result in the heart… (2)

• it can majorly strain the R side of the heart

• if blood can’t get to the L side of the heart it will be damaged

Pulmonary embolism diagnosis methods (3)

• Bloodwork

• Radiology studies

• EKG

How does blood work identify if there is a pulmonary embolism?

D-dimer indicates the breakdown of the coaggulation factors, indicating a clot

How does an EKG aid in pulmonary embolism diagnosis?

• EKG of legs can help determine if it was a DVT that broke off

• Can help determine R heart strain

Hypoxemic

Inadequate exchange of O2 between alveoli and capillaries

Treatment for hypoxemia

O2 delivery

Hypercapnia

increased levels of CO₂ in BS due to inadequate ventilation of lungs

Treatment for hypercapnia

Must have a ventilator or something non-invasive (CPAP) to help force air in, and for CO2 out of the body

Hypoxemia neurological manifestations (4)

• Delirium

• Restlessness

• Confusion

• Anxious

Hypoxemia respiratory manifestation

Tachypnea

Hypoxemia cardiovascular manifestations — initial and late

Initial:

• Tachycardia

• Hypertension

• Possible arrhythmias

Late:

• Bradycardia

• Hypotension

Hypoxemia skin color manifestation

Cyanosis

Hypercapnia carbon dioxide narcosis

high levels of carbon dioxide in the blood lead to decreased consciousness, potentially causing confusion, lethargy, coma, and even death

Hypercapnia neurological manifestations (3)

• headache

• disorientation

• progressive somnolence (abnormal drowsiness or excessive sleepiness)

Hypercapnia cardiovascular manifestations

acidosis causes depressed cardiac contractility

Hypercapnia respiratory manifestations

decreased respiratory muscle contractility

Hypercapnia skin manifestations

Warm and flushed

Why can hypercapnia cause respiratory acidosis?

because CO2 is an acid and there is more present

Does high CO2 level cause vasodilation or vasoconstriction? Why?

Vasodilation because acidity causes BV smooth muscle relaxation