Respiratory System Study Notes

Faculty Welcome & Introduction

• Office Hours/Contact Methods
• Syllabus & Topical Outline Review
• Activate Student Resources (in cover of text)
• Ice Breaker
• Respiratory Lecture
• NCLEX Questions
• Q&A
• Plans for Weeks 2 & 3

Respiratory System

Case Study 1

• 55 y/o woman admitted for COPD exacerbation
• Multiple hospitalizations over the last year related to exacerbations
• The hospital has seen a significant increase in the 30-day readmission for COPD
• Apply what we learn in this course to real-life clinical scenarios!

Review of Respiratory Anatomy

• Upper Respiratory Tract
  • Paranasal Sinuses
  • Pharynx, Tonsils, Adenoids
  • Trachea
• Lower Respiratory Tract
  • Lungs
  • Pleura
  • Mediastinum
  • Bronchi/Bronchioles
  • Alveoli

Functions of the Respiratory System

• Oxygen Transport!!!!
• What is oxygen transport?
  • Blood low in oxygen, high in carbon dioxide
  • Air moves in and out of alveolus
  • Oxygen diffuses into blood
  • Oxygen is transported around the body by red blood cells
  • Carbon dioxide diffuses from blood to be exhaled
  • Gases dissolve in moist mucus lining

VQ Mismatch

• Ventilation Perfusion Mismatch
• What is it? What causes it? Why is this important?
  • Ventilation impaired in the airway ie: pneumonia
  • Perfusion interrupted ie: PE

ABGs Normal Values

• pH: 7.35-7.45
• CO2: 35-45
• O2: 80-100
• HCO3: 22-26
• Respiratory Acidosis
  • pH < 7.35
  • CO2 > 35
• Respiratory Alkalosis
  • pH > 7.45
  • CO2 < 35
• Refer to page 289 for discussion of ABG’s if needed. SL 2013

Gerontologic Respiratory Changes

• Table on page 489
• There are both structural and functional changes
• Some of these include:
  • Decrease in cilia, mucous, and size of the airway
  • Decrease cough, gag, decrease surface area of capillary membranes
  • Decrease elasticity of alveolar sacs
  • Decrease protection to foreign particles
  • Decrease oxygen diffusion capacity
  • **Decrease response to hypoxia and hypercapnia (COPD)

Risk Factors for Respiratory Disease

• Smoking !!! #1 most significant contributor
• Exposure to secondhand smoke
• Personal family history of lung disease (what are some examples?)
• Genetic makeup (such as cystic fibrosis)
• Exposure to allergens and environmental pollution
• Dietary factors
• HIV
• Atypical immune responses such as asthma

Disparities in Pulmonary Health

• Tobacco use is more likely in rural areas
• Older African Americans and Hispanics are less likely to receive influenza and pneumonia vaccines than Caucasians
• Adults living below poverty are at a higher risk for asthma exacerbations, hospitalizations, and death
• African American men are 37% more likely to develop lung cancer than Caucasians
• (American Lung Association, 2016)

Some abnormal exam findings

• What is this called and when would we see it?

Abnormal Respiratory Patterns

• Bradypnea
• Tachypnea
• Hypoventilation
• Hyperventilation
• Apnea
• Cheyne-Stokes
• Biot’s Respirations
• Obstructive
• Which would you expect for our case study?

Diagnostic Evaluation

• Please be sure to review diagnostic evaluations at the end of chapter 20. There will be a few questions on your exam on diagnostics.

Upper Respiratory Disorders

• URI
  • What is an actual upper respiratory infection?
  • What causes it?
  • What happens during a URI?
• Rhinitis
  • Acute vs chronic
  • Allergic vs viral vs drug induced

Lower Respiratory Tract- Pneumonia

• Inflammation of the lung parenchyma
• Many different classifications
• ***Pneumonia and influenza are the most common causes of death from infectious disease in the United States!
• Classifications
  • CAP: Community Acquired
  • HAP: Hospital Acquired
  • HCAP: Health-Care Acquired
  • VAP: Ventilation Associated
  • Aspiration Pneumonia

Pathophysiology

• The upper airway protects the lower airway
• The lower airway is sterile
• Patients resistance to normal flora impaired
• Or aspiration of flora
• Bloodborne organism can enter pulmonary circulation
• Affects both ventilation and diffusion
• Alveoli develop an inflammatory reaction and exudates which interfere with diffusion of oxygen and CO2.
• WBC (mainly neutrophils) migrate into the alveoli

Patho continued

• Now areas of the lung are not adequately ventilated because of secretions and mucosal edema
• Partial occlusion of bronchi & alveoli
• Bronchospasm can occur
• Because of hypoventilation a V/Q mismatch occurs in these effected areas.
• Venous blood entering pulmonary circulation is now poorly oxygenated. Mixing of the unoxygenated and poorly oxygenated blood will eventually lead to arterial hypoemia

Pneumonia

• Risk Factors
  • Conditions with mucus
  • Immunosuppression
  • Smoking
  • Immobility
  • ETOH use
  • Age

Pneumonia

• Signs & Symptoms Vary
  • Pneumococcal – fever, chills, pleuritic chest pain, coughing, increased RR, SOB
  • Upper respir. Congestion sore throat, gradual & nonspecific: HA, low-grade fever, pleuritic pain, SOB, want to sit up, fatigue, sputum purulent
• Labs –Diagnostic Tests
  • CXR
  • Blood culture
  • Sputum

Pneumonia on CXR

Pneumonia Case Study

COPD

• Progressive in nature
• Inflammatory Process
• Airways narrow- excess mucus
• Scar tissue formation

Chronic Bronchitis VS Emphysema

Compare and Contrast

COPD

• Major Risk Factor
  • Environmental exposure – cigarettes
• Signs & Symptoms- progressive & worsen over time
  • Chronic cough
  • Sputum production
  • Dyspnea on exertion
  • Barrel chest
  • Clubbing
• Labs-Diagnostic tests
  • Pulmonary function tests
  • CXR – to rule out other dx
  • ABG

Pathophysiology

• COPD accelerates physiologic changes such decreasing VC, FEV1.
• Airflow limitation is progressive
• Lungs develop abnormal inflammatory response to particles, gasses, and other elements
• Inflammatory response occurs throughout the proximal and peripheral airways, lung parenchyma, and pulmonary vasculature.
• Airways narrow (due to chronic inflammation)

Patho continued

• Increased number of goblet cells in proximal airways
• Enlarged submucosal glands
• This leads to hypersecretion of mucous
• Thickening of airway wall in peripheral airways
• Inflammatory and structural changes in parenchyma (bronchioles and alveoli)
• Alveolar wall destruction and loss of elastic recoil
• Thickening of the lining of the vessel and hypertrophy of smooth muscle that can lead to pulmonary HTN

Asthma

• Lets start with this video to show details of asthma pathophysiology

Asthma Continued

• In the US, effects more than 18.7 million adults
• 35.2% have intermittent severity
• 64.8% have persistent severity
• Most common chronic disease in childhood
• Risk Factors
  • Smoking
  • Allergies
  • Female gender
  • Air pollution
  • Respiratory infection

NCLEX Questions

• Chapters 22, 23, 24
• Calling on 2 students at a time to answer each question