Essentials of Human Diseases and Conditions 4th edition

1
Essentials of Human Diseases and Conditions 4th
edition

• Margaret Schell Frazier
• Jeanette Wist Drzymkowski

2
Chapter 9 Diseases and Conditions of the
Respiratory System
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Learning Objectives

• Explain the process of respiration.
• Discuss the causes and medical treatment for (a)
  the common cold, (b) sinusitis, and (c)
  pharyngitis.
• Name the treatment of choice for nasal polyps.
• Discuss the prognosis of cancer of the larynx.

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Learning Objectives (cont'd.)

• Define atelectasis and discuss some possible
  causes.
• Name some systemic disorders that might cause
  epistaxis.
• Compare the clinical pictures of (a) a patient
  with pulmonary embolism and (b) one with
  pneumonia.

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Learning Objectives (cont'd.)

• List some possible causes of pulmonary abscess.
• Compare legionellosis with Pontiac fever.
• Explain who is at greatest risk for (a)
  respiratory syncytial virus pneumonia and (b)
  histoplasmosis.

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Learning Objectives (cont'd.)

• List the groups recommended to receive
  prophylactic use of influenza vaccines.
• Contrast the pathologic course of acute
  bronchitis with that of chronic bronchitis.
• Compare the pathology involved in bronchiectasis
  with that of pulmonary emphysema.

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Learning Objectives (cont'd.)

• Name and describe three causes of pneumoconiosis.
• Explain the difference between pneumothorax and
  hemothorax.
• Describe the presenting symptoms of pleurisy.
• Discuss contributing factors to and concern about
  the rising prevalence of pulmonary tuberculosis.

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Learning Objectives (cont'd.)

• Describe the clinical course of infectious
  mononucleosis.
• Explain the pathologic changes of the lungs in
  adult respiratory distress syndrome (ARDS).
• Name the leading cause of cancer deaths worldwide
  for both men and women.

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Learning Objectives (cont'd.)

• Discuss the early findings concerning the threat
  of a SARS epidemic.
• List some health hazards of common molds.

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Chapter 9Lesson 9.1
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Orderly Function of the Respiratory System
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Respiration

• Maintains life by supplying oxygen to organs,
  tissues and cells and allows removal of carbon
  dioxide.
• External respiration - in the lungs, oxygen
  inhaled from the air is exchanged with carbon
  dioxide from the blood.
• Internal respiration - exchange of gases between
  the blood and tissue cells

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Respiration (contd.)

• Pulmonary circulation
• Pulmonary arteries - carry deoxygenated venous
  blood from the heart to the lungs
• Pulmonary capillaries - where gas exchange occurs
• Pulmonary veins - return the freshly oxygenated
  blood to the heart for systemic circulation

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Orderly Function of the Respiratory System
(cont'd.)
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Diseases of the Respiratory System

• Causes
• Infection
• Circulatory disorders
• Tumors
• Trauma
• Immune diseases
• Inflammatory disturbances

• Congenital defects
• Central nervous system damage or diseases
• Environmental conditions

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Symptoms of Respiratory Disorder

• Chest pain
• Dyspnea (difficulty breathing)
• Productive or nonproductive cough (acute or
  chronic)
• Hemoptysis (spitting up blood)
• Dysphonia (hoarseness)
• Chills
• Low- or high-grade fever
• Wheezing
• Fatigue

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Upper Respiratory Tract Infections

• Common cold acute inflammatory process that
  affects the mucous membrane that lines the upper
  respiratory tract
• Sinusitis acute or chronic inflammation of the
  mucous membranes of the paranasal sinuses

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Upper Respiratory Tract Infections (cont'd.)

• Pharyngitis acute or chronic infection of the
  pharynx
• Laryngitis inflammation of the larynx, including
  the vocal cords

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Sinusitis

• Treatments for Sinusitis
• Broad-spectrum antibiotics
• Decongestants
• Antihistamines

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Pharyngitis

• Causes
• Viral infections - often an extension of
  bacterial streptococcal infection from tonsils,
  adenoids, nose, or tonsils (particularly in
  children)
• May be secondary to systemic viral infection such
  as chickenpox or measles

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Nasal Disorders

• Deviated septum crooked nasal septum (cartilage
  partition between the nostrils)
• Nasal polyps benign growths that form as
  consequence of distended mucous membranes
  protruding into the nasal cavity

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Nasal Disorders (cont'd.)

• Anosmia impairment or loss of the sense of smell
• Epistaxis (nosebleed) hemorrhage from the nose

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Nasal Polyps

• Nasal Polyps - benign growths that form as a
  consequence of distended mucous membranes
  protruding into nasal cavity
• Causes
• overproduction of fluid in the cells of the
  mucous membrane,
• often the result of allergic rhinitis

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Epistaxis (nosebleed)

• First aid
• Mild hemorrhage - controlled by applying direct,
  constant pressure on either side of nose for 5 to
  10 minutes
• Persistent bleeding - treated with local
  application of epinephrine followed by
  cauterization or nasal packing
• Severe - surgical ligation of bleeding artery

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Disorders of the Larynx

• Tumors of the larynx benign or malignant growths
  on the larynx
• Laryngeal cancer neoplasm of the larynx
• The larynx is the most common site for head and
  neck tumors

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Atelectasis

• Atelectasis (collapsed lung) airless or
  collapsed state of the pulmonary tissue
• Caused by an obstruction in bronchial tree may
  be mucous plug, foreign object, or bronchogenic
  cancer
• Complication pneumonia
• Risk factors obesity, upper abdominal or chest
  surgery, neuromuscular weakness or any pulmonary
  disease

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Pulmonary Disorders

• Pulmonary embolism occurs when a blood clot or
  other material, such as a foreign body or tumor,
  lodges in and blocks an artery in the pulmonary
  circulation
• Pneumonia inflammation of the lungs due to
  infection

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Pulmonary Embolism

• Occurs when embolism is lodged in artery and
  interrupts blood supply
• Uncomplicated embolism - cough, chest pain,
  low-grade fever and apprehension
• More extensive - dyspnea, tachypnea (at least 20
  breaths/minute), chest pain, occasional
  hemoptysis
• Massive embolism - sudden onset of cyanosis,
  shock and death

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Pneumonia

• Causes of Pneumonia
• Bacterial infection-
• Pneumococci
• Staphylococci
• Group A hemolytic streptococci
• Haemophilus influenzae type B
• Klebsiella pneumoniae types 1 and 2
• Atypical pneumonia caused by legionella,
  mycoplasma and chlamydia agents

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Pneumonia (contd.)

• Causes of Pneumonia
• Virus
• Adenoviruses
• Influenza viruses
• Syncytial viruses
• May also be caused by damage to lungs, such as
  inhalation of poisonous gas such as chlorine or
  aspiration of foreign matter

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Chapter 9Lesson 9.2
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Severe AcuteRespiratory Syndrome

• Severe acute respiratory syndrome (SARS) Highly
  contagious new mutation of the Corona virus
• Symptoms
• Sudden onset of fever
• Mild sore throat
• Muscle aches
• Dry, unproductive cough

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Health Hazards ofCommon Molds

• Common molds fungal growths that grow naturally
  indoors or outdoors, especially where there is a
  constant supply of moisture

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Methods of Preventing Mold Growth

• Home professional cleaning and/or reconstruction
• Cleaning with weak bleach and water solution
  (110)
• Discard moldy items
• Ensuring adequate ventilation, using paint with
  mold inhibitors, cleaning bathrooms with mold
  killing products, promptly removing flooded
  carpets

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Pulmonary Disorders

• Pulmonary abscess area of contained infectious
  material in the lung
• Causes
• Often a complication of pneumonia caused by
  bacteria
• Aspiration of food, foreign object, bronchial
  stenosis or neoplasms
• Septic embolism is carried to lung via pulmonary
  circulation

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Pulmonary Disorders (cont'd.)

• Legionellosis (Legionnaires disease) pneumonia
  caused by the bacterium Legionella pneumophila
• Pontiac fever milder form of legionellosis

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Pulmonary Disorders (cont'd.)

• Respiratory syncytial virus pneumonia (RSV)
  inflammatory and infectious condition of the
  lungs
• Histoplasmosis fungal disease originating in the
  lungs caused by inhalation of dust containing
  Histoplasma capsulation

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Groups at risk for RSV

• Children younger than three years old
• Elderly individuals
• Patients with compromised respiratory systems
• Infants who were premature or who have a
  congenital cardiac defect or preexisting
  pulmonary disorder

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Influenza

• Influenza
• Highly contagious, acute viral disease that
  occurs in annual outbreaks

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Influenza (contd.)

• At risk of complications of influenza
• Persons over 50 years of age
• Residents of nursing homes
• Patients with chronic pulmonary cardiac disorder
  (including asthma)
• Patients with chronic metabolic disease
  (diabetes), renal dysfunction, hemoglobinopathies,
  immunosuppression
• Children and teens receiving long-term aspirin
• Health care employees

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Chronic Obstructive Pulmonary Disease (COPD)

• Acute and chronic bronchitis inflammation of the
  mucous membrane lining the bronchi
• COPD includes
• Chronic bronchitis
• Bronchiectasis
• Asthma
• Emphysema
• Cystic fibrosis
• pneumoconiosis

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Acute and Chronic Bronchitis

• Acute - symptoms subside within a week, cough may
  continue for 2-3 weeks
• Physical signs within lungs are few or absent
• Chronic - inflammation persists and worsens,
  often occurs after colds or flu
• Obstructive and asthmatic symptoms appear
• Dyspnea, scattered rales and wheezing

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Chronic Obstructive Pulmonary Disease (cont'd.)
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Effects of Smoking

• Cancer of oral cavity, larynx, esophagus
• Lung cancer
• Peptic ulcer
• Chronic bronchitis
• Emphysema
• Myocardial infarction
• Systemic atherosclerosis
• Cancer of pancreas
• Cancer of bladder

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Chronic Obstructive Pulmonary Disease (cont'd.)

• Bronchiectasis permanent, irreversible dilation
  or distortion of one or more bronchi, resulting
  from destruction of muscular and elastic portions
  of bronchial walls
• Pulmonary emphysema chronic obstructive
  pulmonary disorder characterized by destructive
  changes in alveolar walls and irreversible
  enlargement of alveolar air spaces

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Causes of Bronchiectasis

• Pneumonia
• Recurrent airway infections
• Tuberculosis
• Bronchial obstruction
• Inhalation of corrosive gas
• Complication of cystic fibrosis or other
  childhood infection such as measles and pertussis
• Immune deficiency

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Chronic Obstructive Pulmonary Disease (cont'd.)

• Pneumoconiosis any disease of the lung caused by
  long-term dust inhalation

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Chapter 9Lesson 9.3
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Pleurisy

• Pleurisy (pleuritis) inflammation of membranes
  surrounding the lungs and lining the pleural
  cavity
• Symptoms
• Sharp, needle-like pain that increases with
  inspiration and coughing
• May also experience fever, chills, and shallow
  breathing

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Pleurisy (contd.)

• Wet - when fluid is present, causes compression
  of pulmonary tissue and dyspnea
• Dry - pleura fluid decreases in volume, resulting
  in dryness between the pleura layers rub
  together and become congested and edematous

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Pneumothorax and Hemothorax

• Pneumothorax collection of air or gas in the
  pleural cavity that results in a collapsed or
  partially collapsed lung
• Hemothorax accumulation of blood and other
  fluids in the pleural cavity

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Pneumothorax

• Symptoms of Collapsed Lung
• Severe shortness of breath
• Sudden sharp chest pain
• Falling blood pressure
• Rapid weak pulse
• Shallow and weak respirations
• May be cyanotic and anxious

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Tuberculosis

• Pulmonary tuberculosis chronic, acute, or
  subacute infection of the lungs by Mycobacterium
  tuberculosis
• Acquired by inhaling a dried droplet nucleus that
  contains the tubercle bacillus

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Infectious Mononucleosis

• Infectious mononucleosis (Epstein-Barr virus
  infection) acute herpesvirus infection
  (glandular fever)
• Symptoms
• Lymphadenopathy
• Fever that typically peaks in afternoon
• Listlessness, malaise, chills, anorexia
• Sore throat, fever, headache, fatigue, and
  cervical generalized lymphadenopathy

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Adult Respiratory Distress Syndrome

• Adult respiratory distress syndrome (ARDS)
  severe pulmonary congestion characterized by
  acute respiratory distress and hypoxemia
• Symptoms
• Sudden, severe dyspnea with rapid, shallow
  respirations
• Inspiratory intercostals and suprasternal
  retractions along with cyanosis or mottled skin
• May also have rales, rhonchi and wheezes

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Adult Respiratory Distress Syndrome (contd.)

• ARDS - trauma causes increased capillary
  permeability in the lungs, pulmonary edema, and
  resulting respiratory failure
• Alveoli fill within 12 - 24 hours of injury, and
  then tend to collapse at end of expiration,
  leaving less pulmonary tissue for gas exchange
• Result low pulmonary compliance, pulmonary
  hypertension, hypoxemia

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Lung Cancer

• Lung cancer cancerous condition caused by
  repeated carcinogenic irritation to bronchial
  epithelium, leading to increased rates of cell
  division
• Leading cause of death worldwide in both men and
  women, 30 of all cancer deaths

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Lung Cancer (contd.)

• 4 major types
• Non-small cell lung cancer (NSCLC)
• Squamous cell carcinoma - 30 of all lung cancers
• Adenocarcinoma - 40
• Large cell carcinoma - 10
• Small cell lung cancer (SCLC) - occurs almost
  exclusively in smokers
• Small cell carcinoma - 20

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Lung Cancer (contd.)

• Prognosis for patients with lung cancer is
  generally poor
• 5-year for all stages and types of lung cancer
  combined is 15
• Prevention
• Cessation of smoking
• Avoidance of exposure to second hand smoke