Pulmonary Medicine

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Chapter 32

• Pulmonary Medicine

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Introduction

• Respiratory system
• Provides body with oxygen
• Eliminates carbon dioxide
• Helps protect body from environmental contaminants

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Common Respiratory Disorders

• Upper respiratory disorders
• Lower respiratory disorders

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Upper Respiratory Disorders

• Caused by
• Infectious microorganisms
• Allergic reactions that produce inflammation
• Also considered upper respiratory disorders
• Acute rhinitis
• Sinusitis
• Pharyngitis
• Tonsillitis
• Laryngitis

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Lower Respiratory Disorders

• Acute
• Bronchitis
• Pneumonia
• Chronic
• Asthma
• Chronic bronchitis
• Emphysema

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Bronchitis

• Inflammation of mucous membranes of bronchi
• Most prominent symptom
• Productive cough
• Treatment
• Antibiotics
• Smoking cessation
• Rest
• Increased fluid intake
• Cough suppressants

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Pneumonia

• Bacterial or viral infection in the alveoli
• Diagnostic tests include
• Analysis of sputum specimen
• Chest x-ray

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Bacterial Pneumonia

• Symptoms
• More sudden and severe in onset
• Fever, cough, chills, dyspnea
• Treatment
• Antibiotics
• Bed rest
• Symptomatic medications

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Viral Pneumonia

• Symptoms
• More gradual in onset
• Treatment
• Bed rest
• Hospitalization

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Checkpoint Question 1

• What are the characteristic symptoms of bacterial
  and viral pneumonia?

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Answer

• The onset of bacterial pneumonia is usually
  sudden and severe symptoms include fever cough,
  chills, and dyspnea. This type of pneumonia is
  typically localized. In contrast, the onset of
  viral pneumonia is usually gradual symptoms
  include fever and a hacking cough. Unlike
  bacterial pneumonia, viral pneumonia tends to be
  spread throughout the lung fields.

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Asthma

• Reversible inflammatory process involving the
  bronchi and bronchioles
• Symptoms
• Dyspnea Wheezing
• Coughing Cyanosis
• Treatment
• Considered a chronic disorder
• Many medications available
• Nebulized breathing treatment with a
  bronchodilator

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Checkpoint Question 2

• What are factors that may trigger an asthma
  attack?

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Answer

• Factors that may trigger an asthma attack are
  environmental allergens, irritants, infections,
  stress, cold air, or exercise.

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Chronic Obstructive Pulmonary Disease (COPD)

• Chronic bronchitis and emphysema
• Caused by smoking over long period of time

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Chronic Bronchitis

• Chronic inflammation and swelling of airways with
  excessive mucus production, obstruction of
  bronchi, and trapping of air behind mucus plugs
• Prone to develop respiratory infections

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Emphysema

• Walls of damaged alveoli become stretched and
  break down

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Patients diagnosed with COPD

• Process not usually reversible/curable
• Progression can be slowed
• Prescribed exercise regimen
• Proper use of medications
• Good nutrition
• Home oxygen therapy

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Checkpoint Question 3

• What two disease processes are present in a
  patient with chronic obstructive pulmonary
  disease (COPD)?

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Answer

• The two disease processes in a patient with COPD
  are chronic bronchitis and emphysema.

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Tuberculosis

• Infectious disease caused by Mycobacterium
  tuberculosis
• Symptoms
• Productive cough
• Night sweats
• Malaise
• Treatment
• Antibiotic therapy that lasts for months

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Common Cancers of the Respiratory System

• Laryngeal cancer
• Lung cancer

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Laryngeal Cancer

• Most commonly seen in heavy smokers and
  alcoholics
• Symptoms
• Hoarseness that lasts longer than 3 weeks
• Feeling a lump in the throat
• Pain and burning in throat when drinking citrus
  juice or hot liquids
• Treatment
• Radiation
• Laryngectomy

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Lung Cancer

• Most common cause of death in men and women
• 80 lung cancer patients are smokers
• Symptoms present late in the disease
• Chronic cough Hemoptysis
• Wheezing Chest pain
• Dyspnea
• Treatment
• Surgery, radiation, chemotherapy
• May improve patients prognosis

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Checkpoint Question 4

• What factor appears to contribute to both
  laryngeal cancer and lung cancer?

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Answer

• Cigarette smoking may contribute to both
  laryngeal cancer and lung cancer.

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Common Diagnostic and Therapeutic Procedures

• Physical examination of the respiratory system
• Sputum culture and cytology
• Chest x-ray
• Bronchoscopy
• Pulmonary function tests
• Arterial blood gases
• Pulse oximetry

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Physical Examination of the Respiratory System

• Consists of four parts
• Inspection
• Palpation
• Percussion
• Auscultation
• Patient should be sitting up and all clothing
  removed from waist up

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Checkpoint Question 5

• What are the four parts of the chest examination?

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Answer

• The four parts of the chest examination are
  inspection, percussion, palpation, and
  auscultation.

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Sputum Culture and Cytology

• Sputum cultures obtained to aid with diagnosis
  and treatment
• Obtain specimen that patient has coughed up and
  expectorated from lower airways
• Medical assistant processes specimen and prepares
  laboratory request

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Chest X-ray

• Help in diagnosis of pulmonary problems
• Two views often ordered
• Posterior to anterior (PA) view
• Lateral view
• Medical assistant may need to schedule x-ray and
  request results

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Bronchoscopy

• Endoscopic procedure where lighted scope is
  inserted into trachea and bronchi for direct
  visualization
• Requires patients written consent
• Usually performed in outpatient surgical setting
• Also used therapeutically

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Pulmonary Function Tests

• Performed using a spirometer that measures the
  amount of air a patient can move in and out of
  lungs
• Physician gains information concerning mild,
  moderate, or severe obstructive or restrictive
  disease

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Arterial Blood Gases (ABG)

• Measures pH and the pressures of oxygen and
  carbon dioxide in arterial blood
• Results can indicate
• Whether lungs are adequately exchanging gases
• Metabolic acid-base problems
• Not routinely performed in medical office

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Pulse Oximetry

• Pulse oximeter used to determine percentage of
  oxygen saturation of capillary blood cells
• Obtain as baseline for patients
• With chronic respiratory conditions
• Experiencing respiratory symptoms

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Checkpoint Question 6

• What are the ways the physician can obtain
  information to help diagnose respiratory
  disorders?

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Answer

• The methods for diagnosing respiratory disorders
  are physical examination, peak flowmeter
  readings, sputum cultures, chest x-rays,
  bronchoscopy, pulmonary function tests, arterial
  blood gases, and pulse oximeter readings.