alterations of pulmonary function:

• pulmonary disease is often classified as

  • acute or chronic

  • obstructive or restrictive

  • infectious or noninfectious

signs and symptoms of pulmonary disease:

• pulmonary disease have many signs and symptoms (the most common symptoms are cough and dyspnea)

• dyspnea

  • subjective sensation of uncomfortable breathing and feeling of unable to get enough air

  • orthopnea

    • dyspnea when a person is lying down

    • orthopnea is generally relieved by sitting up in a forward leaning position

  • paroxysmal nocturnal dyspnea is caused by fluid in the lungs

  • dyspnea causes

    • decreased ph, increased PaCO2, an decreased PaO2

    • decreased blood flow to the medulla oblongata

      • causes alternating periods of deep and shallow breathing

    • fatigue of the intercostal muscles and diaphragm

• abnormal breathing patterns

  • kussmaul respirations (hyperpnea)- characterized as a slightly increased ventilatory rate; large, tidal volumes; and no expiratory pause

  • cheyne-stokes respirations- characterized by alternating deep and shallow breathing

• hypoventilation- inadequate alveolar ventilation in relation to metabolic demand

• hyperventilation- alveolar ventilation exceeds metabolic demand - lungs remove co2 faster - respiratory alkalosis can result

  • hyperventilation causes hypocapnia (reduced co2 in blood, not necessarily bad in short term)

• cough- important reflex

  • acute cough

  • chronic cough

• hemoptysis- coughing blood

• cyanosis is bluish discoloration of the skin and mucous membrane caused by

  • increasing amount or desaturated or reduced hemoglobin in blood

  • usually develops when 5g of Hb is desaturated

• pain- caused by pulmonary disorders

• clubbing- the selective bulbous enlargement of the distal segment of a digit and is commonly associated w diseases that interfere with oxygenation of the blood

• abnormal sputum- color, consistency, odor, and amount

conditions caused by pulmonary disease or injury:

• hypercapnia- increased co2 in arterial blood caused by hypoventilation

• hypoxemia- reduced oxygenation of arterial blood

  • high altitudes may produce hypoxemia through decreased inspired oxygen

  • hypoxemia is most commonly caused by abnormal ventilation-perfusion ratio

  • pulmonary emboli causes alveolar dead space- alveolar is ventilated but not perfused

• acute respiratory failure- inadequate gas exchange (hypoxemia or hypercapnia)

• pulmonary edema

  • excess water in the lungs

  • edema and pulmonary fibrosis cause hypoxemia by impairing diffusion through the alveolocapillary membrane

  • the most common cause of edema is left sided heart failure

  • pulmonary edema usually begins when pulmonary capillary wedge pressure or left atrial pressure is 20mmhg

• aspiration

  • passage of fluid and solid particles into the lungs due to impaired swallowing mechanism and cough reflex

• atelectasis- collapse of lung tissue

  • compression atelectasis- caused by external pressure

  • absorption atelectasis- the collapse of lung tissue caused from the lack of collateral ventilation through the pores of Kohn

• bronchiectasis

  • persistent abnormal dilation of the bronchi

  • in varicose bronchiectasis, constrictions and dilations deform the bronchi

    

• bronchiolitis

  • inflammatory obstruction of the small airways

  • most common in children

  • occurs in adults w chronic bronchitis, in association with a viral infection, or with inhalation of toxic gasses

• bronchiolitis obliterans

  • late stage fibrotic disease of the airways

  • can occur w all causes of bronchiolitis

pleural abnormalities:

• pneumothorax- the presence of gas or air in the pleural caused by rapture in visceral pleura

  • open pneumothorax- air pressure in pleural space equals barometric pressure

    • the lung no longer has the negative pressure environment it uses in order to expand

  • tension pneumothorax- involves a site of pleural rupture that acts as a one way valve, permitting air to enter on inspiration, but preventing its escape by closing during expiration

    • air builds up, putting pressure on the lung and compressing it

• pleural effusion- the presence of fluid in the pleural space

  • transudative effusion- the fluid is watery and diffuses out of the capillaries as a result of increased blood pressure or decreased capillary oncotic pressure

  • exudative effusion- is less watery and contains high concentration of wbcs

• empyema

  • involves an infected pleural effusion, the presence of pus in the pleural space, and a complication of respiratory infection, usually pneumonia

conditions caused by pulmonary disease or injury:

• pulmonary fibrosis

  • excessive amount of fibrous or connective tissue in the lung

• chest wall restriction

  • compromised chest wall

    • caused by neuromuscular disease, gross obesity, severe kyphoscoliosis (lateral bending and rotation of the spinal column, w distortion of thoracic cage)

• (flail chest- when multiple adjacent ribs are fractured in 2+ places which causes a section of the chest to lose stability causing it to move in the opposite direction that it should during breathing (it follows the lungs with pressure, inhalation = negative pressure in flail chest so goes in (instead of forcing air in bc the chest cant move) and vice versa)

• inhalation disorders

  • exposure to toxic gasses

  • pneumoconiosis- any change in the lungs caused by inhalation or inorganic dust particle

    • silicosis and asbestosis

      • caused by inhalation of inorganic dust particles (ex. silicon)

      • cause inflammation and cellular apoptosis of lung cells

pulmonary disorders:

• acute respiratory distress syndrome (ards)

  • is a fulminant (sudden development or rapid progression) form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury

  • injury to the pulmonary capillary endothelium

  • inflammation leads to complement cascade and platelet activation

    • complement cascade releases inflammatory mediators such as proteolytic enzymes, oxygen free radicals, prostaglandins, leukotrienes, and platelet activating factor

  • increased capillary permeability causes pulmonary edema

  • surfactant is inactivated and type 2 alveolar cells are impaired, this causes alveoli and respiratory bronchioles to fill w fluid

  • manifestations

    • rapid, shallow breathing

    • respiratory alkalosis

    • dyspnea

    • decreased lung compliance

    • unresponsive hypoxemia

    

obstructive pulmonary disease:

• in obstructive pulmonary disease either more force is required to expire a given volume of air, or emptying of the lungs is slowed, or both

• airway obstruction that is worse w expiration

• common signs and symptoms

  • dyspnea and wheezing

• common obstructive disorders

  • asthma

  • emphysema

  • chronic bronchitis- caused when h influenzae and streptococcus pneumoniae bacteria become embedded in the airway secretions

    • manifestations: decreased exercise tolerance, wheezing, shortness of breath, and productive cough

• asthma

  • immunoglobulin e may contribute to the pathophysiology of asthma

    • inflammatory mediators such as histamine, prostaglandins, and leukotrienes are produced in asthma

    • manifestations: inspiratory and expiratory wheezing, dyspnea, nonproductive cough, and tachypnea

    • elimination of the causative agent is the most successful treatment for asthma

chronic obstructive pulmonary disease:

• chronic bronchitis

  • hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years

  • inspired irritants increase mucous production and the size and number of mucous glands

  • the mucous is thicker than normal

• emphysema

  • abnormal permanent enlargement of the gas exchange airways accompanied by destruction of alveolar walls without obvious fibrosis

  • loss of elastic recoil

  • centriacinar emphysema

  • panacinar emphysema

  • manifestations: dyspnea on exertion, use of accessory muscles, tachypnea, and prolonged expiration

respiratory tract infections:

• the most common route of lower respiratory tract infection is aspiration of oropharyngeal secretions

• tuberculosis

  • caused by mycobacterium tuberculosis

    • an acid fast bacillus that usually infects the lungs but may invade other organs

  • airborne transmission (highly contagious)

  • tubercle formation

    • in tuberculosis, the body wall off the bacilli in a tubercle by stimulating apoptotic infected macrophages that activate cytotoxic cells

  • caseous necrosis

  • positive tuberculin skin test (ppd)

  • treatment: antibiotic (type of drug and duration depends in individuals health history)

• acute bronchitis

  • acute infection or inflammation of the airways or bronchi

  • commonly follows a viral illness

  • acute bronchitis causes similar symptoms to pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates

• chronic bronchitis

  • pathophysiology: increase in the number and size of mucous glands and goblet cells in airway epithelium

pulmonary vascular disease:

• pulmonary embolism

  • occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble

  • pulmonary emboli commonly arise from the deep veins in the thigh

  • the impact of embolus depends on the extend of pulmonary blood flow obstruction, the size of affected vessel, the nature of embolus, and the secondary effects

cancer:

• lip cancer

  • most prevalent in men

  • the most common form of lip cancer is exophytic

• laryngeal cancer

  • increased by the amount of tobacco smoked

  • combination of alcohol and smoking increases the risk of

lung cancer:

• primary lung cancer arises from the bronchi within lungs, therefore called bronchogenic carcinomas

• bronchogenic carcinomas

• most common cause is cigarette smoking

  • heavy smokers have a 20 times greater chance of developing lung cancer than nonsmokers

  • smoking is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder

• environmental or occupational risk factors are also associated with lung cancer

• other types of lung cancer are classified into small cell lung carcinoma and non small cell lung carcinoma

• non small cell lung cancer

  • squamous cell carcinoma- slow growing tumor that produces a productive cough and airway obstruction in addition to pneumonia and atelectasis (partial or complete collapse of a lung or lobe of a lung due to the alveoli losing air (either bc they become deflated or filled w fluid))

  • adenocarcinoma

• small cell carcinoma

  • secretion of antideuretic hormone is the most common paraneoplastic syndrome associated with small cell lung cancer

• other lung cancers:

  • bronchial carcinoid tumors

  • adenocystic tumors (cylindromas)

  • mucoepidermoid carcinomas

  • mesotheliomas