Week 3 & 4

Acute respiratory conditions

(1) Provide an overview of the structure and aging of the respiratory system

(2) Discuss the pathophysiology, and clinical manifestations of Asthma and other common acute respiratory conditions

(3) Discuss the risks and potential complications of common acute respiratory conditions

(1) Provide an overview of the structure and aging of the respiratory system

The respiratory system includes structures like:

• nasal cavity

• pharynx

• larynx

• trachea

• bronchi

• bronchioles

• alveoli

• capillaries for gas exchange

Aging can affect:

• immune response

• mucus clearance

• cilia number

• respiratory muscle strength

• ribs

• elastin content

• cough

• chest wall compliance

• risk of infection

• pulmonary function

• gas exchange due to changes in these structures

These changes can lead to:

• decreased lung functions

• reduced vital capacity

• increased risk of respiratory conditions like infections and asthma

(2) Discuss the pathophysiology, and clinical manifestations of Asthma and other common acute respiratory conditions

1. Asthma

   • it is characterised by intermittent or persistent airway obstruction due to factors like:

     • bronchial hyperresponsiveness

     • excess mucus production

     • atopy

     • air trapping

   • this leads to symptoms such as:

     • wheezing

     • SOB

     • chest tightness

     • coughing

     • anxiety

   • Pathophysiological symptoms such as:

     • edema

     • mucus

     • muscle spasms cause resistance to airflow

     • impairing expiration and leading to air trapping and alveolar hyperinflation

   • This results in:

     • uneven ventilation/perfusion

     • decreased pulmonary blood flow

     • impaired gas exchange

     • ultimately, hypoxemia & hypercapnia

   • Clinical manifestations include:

     • respiratory distress

     • increased respiratory rate

     • use of accessory muscles for breathing

     • decreased oxygen saturation levels

   • Asthma diagnosis involves:

     • history

     • physical examination

     • pulmonary function tests

     • laboratory studies

     • chest X-ray

   • Treatment includes:

     • monitoring lung function

     • controlling environmental triggers

     • pharmacologic therapy

     • patient education with an action plan

2. Pulmonary Embolism (PE)

   • occurs when a thrombus dislodges and occludes a pulmonary vessel, leading to decreased blood flow and hypoxia

   • it commonly arises from deep veins due to factors like:

     • venous stasis

     • hypercoagulability

     • vessel injuries

   • Symptoms include:

     • sudden chest pain

     • dyspnea

     • tachypnea

     • tachycardia

     • anxiety

   • The obstruction causes:

     • ventilation-perfusion imbalances

     • decreased PaO2

     • pulmonary infarction

     • HTN

     • decreased cardiac output

     • systemic hypotension

     • shock

   • PE can be life threatening and requires prompt medical intervention to prevent complications

3. Atelectasis

   • is the collapse of lung tissue due to various factors like lack of lung expansion or post-operative complications

   • there are 2 types:

     • Absorption

     • Compression

   • This condition can lead to:

     • decreased pulmonary blood flow

     • impaired gas exchange

     • respiratory failure

   • Clinical manifestations may include:

     • hypoxemia

     • hypercapnia

   • Mechanisms of air trapping in atelectasis involve:

     • issues with air movement during inspiration & expiration

     • mucus

     • bronchial plugs

     • muscle wall collapse

     • alveolar wall issues

   • These factors contribute to uneven ventilation/perfusion and decreased alveolar ventilation, which ca result in impaired gas exchange and respiratory failure

4. Pneumothorax

   

   • occurs when air enters the pleural space due to a rupture in the pleura

   • In traumatic cases, like injury, air enters through the chest wall and parietal pleura

   • This disrupts the pressure balance, leading to lung collapse

   • Clinical manifestations include:

     • sudden chest pain

     • dyspnea

     • tachypnea

     • tachycardia

     • anxiety

   • Treatment involves:

     • removing air from the pleural space to re-expand the lung

5. Pleural effusion

   • is the accumulation of excess fluid in the pleural space

   • it can be caused by various conditions like infections, heart failure, or cancer

   • The pathophysiology involves an imbalance between fluid production and absorption in the pleural space, leading to fluid buildup

   • This can case symptoms such as:

     • chest pain

     • difficulty breathing (dyspnea)

     • rapid breathing (tachypnea)

     • fast heart rate (tachycardia)

   • Diagnosis is usually done through imagine tests like X-rays or ultrasounds

   • Treatment may involve:

     • addressing the underlying cause

     • draining the fluid

     • medication

6. Aspiration

   • occurs when foreign substances are inhale into the respiratory tract

   • it can lead to:

     • inflammation

     • infection

     • respiratory distress

   • Pathophysiology involves the entry of substances like food or liquids into the airways, causing irritation, inflammation, and potential blockage

   • Clinical manifestations include:

     • coughing

     • wheezing

     • chest pain

     • SOB

     • in severe cases, aspiration pneumonia

   • Aspiration can lead to serious complications like lung abscess or respiratory failure if not managed promptly

   • Treatment involves:

     • supportive care

     • antibiotics for infections

     • bronchoscopy to remove the aspirated material

7. Pneumonia

   • is an infection that inflames the air sacs in one or both lungs

   • it can be caused by bacteria, viruses, or fungi

   • The pathophysiology involves the invasion of the lung tissue by the infectious agent, leading to an inflammatory response

   • This response causes the air sacs to fill with pus and other liquid, making it difficult to breathe

   • Types of pneumonia:

     • Community-acquired pneumonia

       • Streptococcus pneumoniae

       • Mycoplasma pneumoniae

       • Influenza, Legionella

     • Hospital-acquired (nosocomial) pneumonia

       • Staphylococcus aureus by fungi, protozoans

   • Clinical manifestations include:

     • cough

     • fever

     • chills

     • difficulty breathing

     • In severe cases, pneumonia can lead to complications such as respiratory failure

   • Risk factors for pneumonia include:

     • age

     • underlying lung disease

     • smoking

     • malnutrition

   • Treatment usually involves:

     • antibiotics for bacterial pneumonia

     • antiviral medications for viral pneumonia

     • supportive care to relieve symptoms

8. Bronchiolitis

   • is a common lower respiratory tract infections, often seen in children under 2 years old

   • it is mainly caused by the respiratory syncytial virus (RSV)

   • Clinical manifestations include symptoms like:

     • runny nose (rhinorrhoea)

     • cough

     • poor feeding

     • labored breathing (dyspnea)

   • Bronchiolitis is highly contagious

   • The pathophysiology involves inflammations and obstruction of the small airways in the lungs, leading to symptoms and potential complications

9. Croup (Acute laryngotracheobronchitis)

   • is an acute condition affecting the upper airway, commonly seen in children aged 6 months to 5 years

   • it is often caused by viruses like:

     • parainfluenza

     • infleunza A

     • RSV

   • The microorganism enters the upper airway, triggering an inflammatory response that leads to swelling and oedema in the upper airway

   • This swelling can cause upper airway obstruction, resulting in symptoms like a seal-like barking cough

   • The inflammation and oedema increase resistance to airflow, leading to increased negative pressure in the chest and potential collapse of the upper airway

   • Clinical manifestations of croup include a:

     • barking cough, which is distinctive, and the condition is usually self-limiting but may require glucocorticoids to reduce inflammation if severe

(3) Discuss the risks and potential complications of common acute respiratory conditions

Review of the Respiratory System

(1) Review the structure and function of the Respiratory system, related to breathing and respiration and perfusion.

(2) Introduce tests relating to measurement of ventilation

(3) Gain an overview of the development of the respiratory system in the unborn.

(4) Consider the effects of aging on the respiratory system

(1) Review the structure and function of the Respiratory system, related to breathing and respiration and perfusion.

The respiratory system consists of the lungs, airways, and muscles involved in breathing

• Air is inhaled through the nose or mouth, travels down the trachea, and enters the lungs through bronchial tubes

• In the lungs, oxygen is exchanged for carbon dioxide in tiny air sacs called alveoli

• This process is known as respiration

Perfusion, the process of oxygenated blood being delivered to tissues, os facilitated by the respiratory system through the exchange of gases in the alveoli

• the diaphragm and intercostal muscles play a crucial role in breathing by expanding and contracting the chest cavity to allow air in and out of the lungs

Overall, the respiratory system ensures the intake of oxygen and removal of carbon dioxide, supporting the body’s metabolic functions

(2) Introduce tests relating to measurement of ventilation

The tests relating to the measurement of ventilation include:

• Tidal Volume (TV)

  • which measures the volume of air breathed in and out during quiet breathing

• Vital Capacity (VC)

  • is the maximum air amount inhaled and exhaled with forced breathing

• Forced Vital Capacity

  • measures the maximum air exhaled forcefully

• Forced Expiratory Volume in 1 second (FEV1)

  • measures the maximum air exhaled in one second

• Residual Volume (RV)

  • is the air volume left in the lungs after forceful exhalation

• Total Lung Capacity (TLC)

  • is the total air amount in maximally expanded lungs, calculated as the sum of RV and VC

These tests provide valuable information about lung function and can help diagnose respiratory conditions

(3) Gain an overview of the development of the respiratory system in the unborn.

The development of the respiratory system in the unborn goes through 5 stages:

1. Embryonic stage (0-7 weeks)

2. Psuedogladular stage (7-16 weeks)

3. Canalicular stage (16-25 weeks)

4. Saccular stage (25-36 weeks)

5. Alveolar stage (36 weeks - 6-8 years)

During these stages, the lungs undergo significant growth and maturation, with the alveolar stage being the final stage where the alveoli, responsible fir gas exchange, continue to develop postnatally.

This process is crucial for the unborn to be able to breathe independently after birth

(4) Consider the effects of aging on the respiratory system

Aging affects the respiratory system in various ways

• With age, there is a reduction in elastic fibers in the lungs, decreased respiratory muscle strength, and reduced cilia activity

  • Additionally, there is a decrease in cough efficiency, making older individuals more vulnerable to respiratory infections

• The ribs can calcify, the vertebrae can develop osteoporosis, and the alveoli can become “baggy”, leading to decreased lung function

• These changes can result in diminished ventilatory response to hypoxia and hypercapnia, making older individuals more susceptible to ventilatory failure or pnuemonia

• Nerves triggering coughing become less sensitive, further compromising the respiratory defense mechanisms

Acid/Base Regulation

(1) Review the basics – acids and bases (alkali)

(2) Discuss the role of hydrogen ion concentration in cellular function and dysfunction

(3) Describe how buffering systems help prevent significant fluctuations in pH

(4) Differentiate between respiratory and metabolic acid-base disorders by causes and mechanisms of compensations

(1) Review the basics – acids and bases (alkali)

1. Acids

   • are substances that donate protons (H+) when dissolved in water

   • they can be identified by their sour taste, ability to turn blue litmus paper red, and their corrosive nature

   • Examples of acids include:

     • hydrochloric acid (HCl) found in the stomach

     • Citric acid in citrus fruits

     • Acetic acid in vinegar

   • Acids plays a crucial role in various chemical reactions and are essential in many biological processes

2. Bases

   • also known as alkalis, are substances that receive protons (H+)

   • they can neutralize acids by accepting hydrogen ions

   • Examples of bases include:

     • metal hydroxides like sodium hydroxide (NaOH) & Potassium hydroxide (KOH)

     • in the context of cellular function, bases help maintain the pH balance by counteracting the acidic effects of hydrogen ions

     • This balance is crucial for various cellular processes to function optimally

(2) Discuss the role of hydrogen ion concentration in cellular function and dysfunction

Hydrogen ion concentration plays a crucial role in cellular function and dysfunction

• In cellular function,

  • hydrogen ions are involved in maintaining the normal pH level within cells, which is vital for various cellular to function optimally

  • for example,

    • enzymes, which are essential for biochemical reactions in cells, have an optimal pH range for their activity, and any significant deviation in hydrogen ion concentration can affect their function

• In cellular dysfunction,

  • an imbalance in hydrogen ion concentration can lead to acid-base disorders, disrupting cellular activities

  • For instance,

    • acidosis, which is characterised by increased hydrogen ion concentration, can interfere with normal cellular functions and lead to serious conditions like hyperkalemia

• Therefore, maintaining the balance of hydrogen ions is crucial for proper cellular function and overall health

(3) Describe how buffering systems help prevent significant fluctuations in pH

• Buffering systems help prevent significant fluctuations in pH by quickly neutralizing excess acids or bases in the body

• The plasma buffer system, respiratory system, and kidneys work together to maintain pH homeostasis

• For example,

  • the respiratory system responds rapidly to pH changes by adjusting CO2 levels

  • the kidneys, although slower to react, can continue buffering for extended periods by excreting H+ ions and regulating bicarbonate levels

• By working in tandem, these systems ensure that pH remains within the normal range, preventing acidosis or alkalosis

(4) Differentiate between respiratory and metabolic acid-base disorders by causes and mechanisms of compensations

Respiratory base disorders are caused by changes in carbon dioxide levels, leading to acidosis (elevated pCO2) alkalosis (low pCO2) due to hypoventilation or hyperventilation, respectively.

Metabolic base disorders result from changes in bicarbonate levels, causing acidosis (reduced HCO3-) or alkalosis elevation of HCO3-) due to non-carbonic acid accumulation or excessive loss of metabolic acids

Compensatory mechanisms involve the kidneys and lungs regulating bicarbonate and carbon dioxide levels to restore pH balance

1. Respiratory acidosis

   • is caused by elevated pCO2 due to alveolar hypoventilation, leading to a decrease in pH

   • The compensation mechanism involves the kidneys retaining bicarbonate (HCO3-) to help normalize pH levels

2. Metabolic acidosis

   • is characterised by reduced HCO3- levels or an increase in non-carbonic acids, lowering pH

   • the compensation mechanism for metabolic acidosis involves the respiratory system increasing ventilation to eliminate carbon dioxide, this raising pH levels

Trauma & Abuse

(1) Understand the impact of adverse childhood events on the individual, whanau and community.

(2) Identify anatomical and pathophysiological changes in child trauma.

(3) Discuss impact of adverse childhood events on adult life

(4) Describe neuroplasticity of the brain

(1) Understand the impact of adverse childhood events on the individual, whanau and community.

Adverse childhood events can have profound impacts on individuals, families (whanau), and communities

• Individuals may exhibit behavioural reactions like:

  • anger

  • avoidance

  • anxiety

  • low confidence

• Families can experience:

  • stress

  • gried

  • feelings of failure

• Communities may see:

  • increased violence

  • aggression

  • lack of trust

These events can lead to a rang of emotional, psychological, and social challenges that affect the overall well-being of individuals, families, and communities

The long-term effects can include relationships, and even societal problems like crime and substance abuse

It is crucial to address these impacts through support systems, therapy, and community interventions to mitigate and lasting consequences of adverse childhood events

(2) Identify anatomical and pathophysiological changes in child trauma.

Childhood trauma can lead to anatomical and pathophysiological changes in the brain

For example, prolonged exposure to stress hormones like cortisol can impact the development of brain regions involved in emotional regulation and memory, such as the amygdala and hippocampus

These changes can result in alterations in brain structure and function, affecting a child’s ability to cope with stress and regulate emotions

Additionally, trauma can disrupt the formation of neural connections and impact neurotransmitter systems, leading to long-term changes in brain circuitry and functioning

These alterations may contribute to symptoms of anxiety, depression, and other mental health issues commonly seen in individuals who have experienced childhood trauma

(3) Discuss impact of adverse childhood events on adult life

Adverse childhood events can have a significant impact on adult life

Individuals who experience ACEs are at a higher risk of mental and physical illnesses, as well as engaging in dysfunctional behaviours in adulthood

These experiences can lead to difficulties in regulating emotions, forming healthy relationships, and coping with stress

The trauma from childhood can manifest in various ways in adulthood, such as:

• increased anxiety

• depression

• substance abuse

• even physical health issues like heart disease or diabetes

Additionally, ACEs can affect cognitive function and decision-making abilities, leading to challenges in work, relationships, and overall well-being

Overall, the impact of adverse childhood events on adult life is profound and can have long-lasting consequences on an individual’s mental, emotional, and physical health

(4) Describe neuroplasticity of the brain

Neuroplasticity refers to the brain’s ability to reorganize itself by forming new neural connections throughout life

• this process allows the brain to adapt to new experiences, learn new information, and recover from injuries

• involves changes in brain structure, such as global volumetric changes, limbic circuitry, frontal regions, cerebellum, and structural connectivity

It is influenced by both genetics and environmental factors, shaping brain development

For example, trauma can impact brain development by affecting the reptillian brain, limbic system, and neocortex, leading to challenges in cognition, emotional regulation, and survival instincts

Overall, neuroplasticity plays a crucial role in how the brain responds to various stimuli and experiences, highlighting its dynamic and adaptive nature

High Risk Behaviours

(1) Describe the neuroscience of high risk behaviours

(2) Discuss possible pathophysiology of suicide and risk factors

(3) Discuss possible pathophysiology of self harm and risk factors

(1) Describe the neuroscience of high risk behaviours

High-risk behaviours involve actions that can lead to harm or negative consequences

In terms of neuroscience, these behaviours are often linked to the brain’s reward system.

• when engaging in high-risk behaviours, the brain’s reward pathways, particularly the release of dopamine, can be activated

• This activation reinforces the behaviours, making it more likely to be repeated despite the potential negative outcomes

Additionally, factors like genetics, environment, and past experiences can influence an individual’s propensity for engaging in high-risk behaviours by affecting brain function and decision-making processes

These behaviours can become ingrained due to neuroplasticity, where the brain adapts and changes in response to repeated behaviours

(2) Discuss possible pathophysiology of suicide and risk factors

The possible pathophysiology of suicide involves factors like low levels of brain-derived neurotrophic factor (BDNF) and serotonin,

• Low BDNF levels are lined to suicide, major depression, PTSD, schizophrenia, and OCD

Post-mortem studies show reduced BDNF in the hippocampus and prefrontal cortex

Serotonin, a neurotransmitter, is believed to be low in those who die by suicide, with evidence of reduced breakdown product levels in the cerebral spinal fluid

Risk factors for suicide include:

• history of depression

• anxiety

• previous suicide attempts

• PTSD

• family history

• genetic vulnerability

• ethnicity

• age

• poverty

• psychosis

• knowing someone who died by suicide

These factors, along with demographic, distal, proximal factors, and suicidal ideation, contribute to the complex pathophysiology of suicide

(3) Discuss possible pathophysiology of self harm and risk factors

Self-harm, or Non-Suicidal Self-Injury (NSSI), can be influenced by various risk factors

The possible pathophysiology involves a complex interplay of psychological and biological factors

Individuals may engage in self-harm as a maladaptive coping mechanism to deal with emotional distress, trauma, or mental health issues like anxiety and depression

Isolation, being bullied, and adverse childhood experiences (ACEs) can also contribute to self-harm behaviour

The presence of previous NSSI and exposure to NSSI in peers can normalize and reinforce self-harm tendencies

Additionally, underlying mental health conditions can increase the likelihood of engaging in self-harm as a way to regulate emotions or numb psychological pain

Overall, self-harm can be a manifestation of deeper emotional struggles and a cry for help

Pharmacology in Mental Health

(1) Be able to explain one commonly prescribed medication from each major class of mental health medications

1. Anxiolytics (Anti-anxiety, Sedatives, Hypnotics)

   • Alprazolam (Xanax) is benzodiazepine used to treat anxiety disorders

2. Anti-psychotics (Typical and Atypical)

   • Aripiprazole (Abilify) is an atypical antipsychotic used to treat schizophrenia and bipolar disorder

3. Anti-depressants

   • Sertraline (Zoloft) used to treat depression and anxiety disorders

4. Stimulants

   • Methylphenidate (Ritalin) is a common stimulant used to treat attention deficit hyperactivity disorder (ADHD)

(2) Describe the effects on the CNS, indications for use, and Adverse effects and associated risks for:

• Anxiolytics (Anti-anxiety, Sedatives, Hypnotics)

  • Anxiolytics like Benzodiazepine (Diazepam/Valium) act of GABA receptors in the CNS, causing sedation and reducing anxiety by affecting the amygdala in the limbic system

  • They are used for anxiety and panic disorders, and in alcohol withdrawal

  • Adverse effects include:

    • fatigue

    • drowsiness

    • muscle weakness

    • risk of dependence

    • requiring a long withdrawal period

  • They are contraindicated in conditions like COPD and liver disease due to potential complications

  • These medications have CNS depressant effects, are indicated for anxiety-related conditions, and carry risks for side effects and dependency

• Anti-psychotics (Typical and Atypical)

  • Atypical anti-psychotics like Quetiapine (Seroquel) act on CNS receptors for Dopamine and Serotonin, providing a calming effect

    • they are used for acute and chronic psychosis, schizophrenia and bipolar disorder

    • Adverse effects include:

      • increased suicide risk

      • hypotension

      • metabolic syndrome exacerbation

      • dizziness

      • weight gain

  • Typical anti-psychotics like Haloperidol (Serenace) at on multiple CNS neurotransmitter receptors, especially Dopamine, leading to extrapyramidal effects

    • they are indicated for psychosis, schizophrenia, and alcoholic delusions

    • Adverse effects include:

      • extrapyramidal effects (movement disorders)

      • dizziness

      • constipation

      • confusion

      • drowsiness

• Anti-depressants

  • like Fluoxetine (Prozac)

  • the CNS effects involve inhibiting the reuptake of serotonin, leading to increased serotonin levels in the synaptic space, which helps regulate mood

  • Indications for use include treating:

    • depression

    • anxiety

    • bulimia nervosa

    • OCD

    • premenstrual dysphoric disorder

    • panic disorder

    • PTSD

  • Adverse effects and associated risks may include:

    • initial increased risk of suicidal thoughts

    • weight loss

    • nausea

    • vomitting

    • headaches

    • rashes

    • dizziness

• Stimulants

  • like amphetamines and methylphenidate

  • have CNS effects by stimulating neuron activity in excitatory pathways, affecting parts of the brain like the cerebral cortex and limbic region

  • These drugs are indicated for ADHD treatment

  • However, they come with adverse effects and risk such as potential:

    • addiction

    • insomnia

    • headache

    • irritability

    • nausea

  • Prolonged use can lead to:

    • mood changes

    • depression

    • agitation

    • psychosis

  • These drugs act on neurotransmitters like dopamine & norepinephrine, impacting:

    • focus

    • attention

    • impulse control in individuals with ADHD

(3) Be able to describe the difference between a chemical name, generic name and brand name

• The chemical name refers to the exact molecular structure of a drug, providing detailed information about it composition

• The generic name is the official name of the drug, usually derived from its chemical name and recognised by health professionals world wide

• The brand name is the trademarked name given by the pharmaceutical company marketing the drug

• It is unique to that specific company and is used for marketing purposes

For example,

the chemical name for Aspirin is Acetylsalicylic acid, the generic name is Aspirin, and the brand name could be Bayer Aspirin