Patho Chapter 20: Respiratory Inflammation and Infection

Dyspnea

most common symptom

shortness of breath; increased need for ventilation coupled with a subjective sensation of labored breathing

the etiology (cause) could be cardiac or pulmonary

Orthopnea

Dyspnea when lying flat

Cough

eliminates

Mechanical or chemical stimulation of the bronchial tree

can be Non-productive or productive (out mucus)

Expectoration or Sputum production

Coughing up of sputum

Infection: Yellow or green sputum

Minor bleeding: Pink-tinged sputum

Hemoptysis: coughing up blood

Atelectasis

Collapse of alveoli

May occur due to compressive force or obstruction preventing alveolar inflation

post-op- typically occurs within 72 hours of general anesthesia

Incentive spirometer- helps people to take slow, deep breaths

May increase pneumonia risk

Assessment finding: Diminished breath sounds (sounds good on one side), tachypnea, dyspnea, hypoxia

Respiratory failure

Failure to oxygenate blood or remove C02

Hypercapnic

High carbon dioxide

Associated with chronic diseases of the lung

Hypoxemic

Low oxygen

Normal carbon dioxide

Can be caused by acute disease of the lung

Respiratory distress

Accessory muscle use, tachypnea, cyanosis, retractions, nasal flaring, dyspnea

itis \= inflammation

inflammation can be caused by irritation, infection or both Infection: Viral, bacterial, fungal

Irritation: Physical injury, surgery, cancer, chemical agents, foreign bodies, immune reactions, etc.

Increased vascular permeability

This allows fluids, WBCs and platelets to travel to the site of injury

Warmth, redness, swelling

Cellular chemotaxis

the movement of an organism or entity in response to a chemical stimulus.

Systemic responses

Prostaglandins increase body temperature

Histamine increases mucus production

The effects of inflammation

can occur internally within an organ or externally on the surface of the body, depending on where the cell injury and inflammation are occuring.

Croup

a disease that causes swelling in the airways and problems breathing

Acute Rhinitis

Inflammation and irritation of nasal mucosa Causes: Viral (Rhinovirus and other viruses), Allergies Clinical Manifestations: Stuffed nose, nasal discharge, sneezing. Sore throat.

if Viral symptoms are: Nasal mucosa and turbinates are red;Yellow or green nasal discharge

if Allergies symptoms are: Nasal mucosa and turbinates are gray; Clear nasal discharge

Acute Pharyngitis

Inflammation and irritation of the pharynx
Causes: Viral, Bacterial ("Strep throat": Group A beta-hemolytic streptococcus)
Clinical Manifestations: Red, swollen, pharyngeal membranes and tonsils
Swollen tonsils, often covered with white exudate
Fever, malaise, sore throat

Acute Sinusitis

Inflammation of the facial sinuses and membranes of the nose

Causes Acute: Viral, bacterial, allergic reaction

Clinical Manifestations: Headache, facial pain or pressure over the sinus area, nasal obstruction, fatigue, purulent nasal discharge, fever, ear pain, dental pain, cough, decreased sense of smell, sore throat, sinus headache

Acute Tonsillitis

Infection and inflammation of tonsils may be caused by GABHS.

Patients with tonsillitis and enlarged cervical lymph nodes should be tested for EBV. Sore throat. Fever, malaise, anorexia, and pain with swallowing. May have earache with sore throat.

White exudate over tonsillar tissue.

Red inflamed pharynx.

Epiglottitis; epiglottis\=breathing bouncer

epiglottis is a small, movable "lid" just above the larynx that prevents food and drink from entering the windpipe

Inflammation and irritation of the epiglottis, blocked airway;911! Causes: Viral (Parainfluenza), Bacterial (Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus) Clinical Manifestations- Severe respiratory distress!

Laryngitis

Inflammation of the larynx
Cause: Viral, Bacterial (Haemophilus influenza)
Clinical Manifestations: Hoarseness, loss of the voice, High-pitched cough

Tracheitis

Inflammation of the trachea
Cause: Viral, Bacterial (Haemophilus influenza)
Clinical Manifestation: Raspy cough (May be productive), Expiratory wheezing, stridor as airways narrow

Laryngotracheobronchitis

Inflammation of the larynx, trachea, and bronchi \= Croup
Causes: usually by a virus, but may be bacterial in nature.

malaise

a general feeling of physical discomfort or uneasiness

Rhonchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways.

Myalgias

muscle pain and aches

Cachexia

weakness and wasting of the body due to severe chronic illness

Acute bronchitis

Inflammation of the bronchi and bronchioles
Cause: Viral infection, Bacterial infection, Inhalation of toxic gases or chemicals
Inflammatory response in the bronchial tree
Clinical Manifestations: Productive cough (10-20 days), Pleuritic chest pain, Fever, sore throat general malaise
Assessment findings: Rhonchi heard over lungs, wheezing

Pneumonia

Inflammation of the lung tissue in which alveolar air spaces fill with purulent, inflammatory cells and fibrin.

Causes: Viral infection, Bacterial infection, Inhalation of chemicals, Aspiration of contents from the oropharynx or stomach

Clinical Presentation: Initial symptoms: Cough, Fever, Chills, Sputum production, myalgias Followed by: Pleuritic (sudden and intense sharp) chest pain, Dyspnea, Hemoptysis

Assessment findings: Tachypnea, use of accessory muscles, tachycardia, crackles

Crackles

Alveoli opening and closing against fluid

Pneumonia background information

causes more deaths in the U.S. than any other nfection

Pneumonia is categorized according to where the infection first occurs

Community acquired: Streptococcus pneumoniae

Hospital acquired: Within 48 hours of hospital admission Ventilator associated

Pneumonia People at Risk

Very young and very old, immunosuppressed, cancer, COPD, smoking influenza infection

Pneumonia development

Inflammation of lung tissue
Alveoli air spaces fill with fluid
which creates Reduced gas exchange
then Hypoxia and Hypercapnia develops

Lung Abscess

Walled-off, localized collection of infectious materials that results in tissue necrosis

Complication of pneumonia

Abscess will rupture leaving the cavity filled with fluid. Fluid obstructs the airway leading to respiratory distress

Clinical manifestations: Copious amounts of foul-smelling sputum, productive cough, chills, fever, chest pain, malaise, anorexia

Assessment findings: Diminished breath sounds, crackles

Tuberculosis (TB)

Infection and inflammation of lung(s)
Causes: Mycobacterium tuberculosis, most commonly affects the lungs
Clinical presentation: Chronic cough with purulent sputum, Hemoptysis, Weight loss, Anorexia, Chest pain, Low-grade fever with night sweats
Assessment findings: Crackles, lymphadenopathy
Many persons exhibit NO significant physical findings.
In immunosuppressed patients, classic symptoms are often absent.
Screening: Mantoux tuberculin skin test (PPD test) (TB Skin Test)
Only indicates exposure and sensitization
Minimum treatment: 6 months

Tuberculosis development

Immune response walls off the infection forming a tubercle.
A tubercle contains WBCs, bacteria, and fibrous tissue. Scar tissue grows around the tubercle ultimately leading to necrotic lung tissue.

Tuberculosis (TB) Background Information

Top 10 causes of death

Spread via airborne droplets
WBCs cannot kill TB
TB can affect the adrenal glands, vertebrae, meninges and lymph nodes.
High risk: Immunosuppressed patients (HIV/AIDS), nursing home residents, prisoners

2 forms of Tuberculosis

Latent and TB disease (Active)

Latent Tuberculosis

dormant/inactive
no symptoms
non-infectious
can become active
TB at any time
can't spread from person to person

TB disease (active tuberculosis)

active
can dissestimate/spread in the body
has symptoms and clinical evidence
can spread from person to person
can cause death if not treated

hemoglobin

• Hemoglobin is a protein found in red blood cells.

• It is responsible for carrying oxygen from the lungs to the body's tissues.

• Desaturation of hemoglobin leads to tissue hypoxia

Oxygen Saturation

Percentage of hemoglobin

saturated by oxygen, recorded as Sa02.

Erythropoietin (EPO)

very important hormone

Secreted by the kidneys in response to hypoxia due to any condition

Stimulates bone marrow to produce more RBCs

Central chemoreceptors

Respond to an increase in carbon dioxide (Hypercapnia) and a decrease in pH (Acidosis)

Peripheral chemoreceptors

Respond to a decrease in oxygen in the blood (Hypoxemia)

The *normal* stimulus to breathe is

hypercapnia

Compliance

The degree of ease with which a lung is inflated

Ventilation

Process of inspiration and expiration of air through the airway and lungs

Perfusion

Movement of blood through the body, taking oxygen to the cells

Ventilation-perfusion ratio (V-Q ratio)

Ratio of the amount of air reaching the alveoli compared to the amount of blood reaching the alveoli

Hemopytsis

coughing up blood

Anoxia

total absence of oxygen

\-emia

blood

if you are hypoxic then you

must be hypoxemic

Stridor

 variable, high-pitched respiratory sound that can be assessed during breathing

Tuberculosis Formation steps

1. There is exposure to M. tuberculosis

2. M. Tuberculosis infects lungs

3. Infectious bacteria walled off into lungs

4. Lung tubercules form

5. Infectious bacteria emerge from tubercles