Patho/Pharm II - Respiratory

Subjective sensation of breathlessness

Increased respiratory rate

Dyspnea while lying flat

• Paroxysmal "attack or spasm"
• Nocturnal "PM"
• Dyspnea "SOB"
• = Wake up at night with dyspnea

the cessation of breathing

• 1. Kussmaul Respirations
• 2. Obstructed Breathing
• 3. Restrictive Breathing
• 4. Cheyne-Stokes Respirations
• 5. Hypoventilation 
• 6. Hyperventilation

Kussmaul Respirations

Obstructed Breathing

Cheyne-Stokes Respirations

• Hypoventilation
• **Increased Co2, metabolic acidosis

• Hyperventilation
• ** decreased CO2, metabolic alkalosis

• An explosive expiration that cleanses the lower airways
• The effectiveness depends on the depth of the inspiration and the degree to which the airways narrow which increases the velocity of expiratory gas.

Infection, inflammation, or cancer.

Coughing up of bright red blood. 

Bluish discoloration of the skin caused by decreased oxygenation of blood. Usually a late symptom.

• The painless, selective enlargement of distal segement of the digits (ie fingertips)
• Caused by chronic disease of the heart or lungs.

Pleural pain

*Infection and inflammation cause pleura to stretch during inspiration causing pain

excessive coughing

• Inadequate oxygenation of blood caused by 

• 1. Decreased oxygen inspiration - suffocation, high altitude
• 2. Hypoventilation- decreased LOC
• 3. Diffusion abnormalities- edema, fibrosis, emphysema
• 4. Abnormal ventialtion/perfusion rates- Most common asthma, bronchitis, pneumonia
• 5. Pulmonary right to left shunts- ARDS, atelectasis

• Increased carbon dioxide
• CO2>45
• leads to respiratory acidosis pH<7.35

• accumulation of fluid in the lungs
• **Classic symptom= pink, frothy sputum

Passage of solid particles into the lung. 

-Right lung is more susceptible.

• Collapse of the lung. 
• O2<50 , CO2>45

dilation and loss of elasticity of the walls of bronchi from chronic inflammation and degeneration

• An inflammatory obstruction of the small airways or bronchioles.   
• Common in children. Treated with antibiotics and steroids.

• Lung Abscess: pus-filled cavity in the lung surrounded by inflammed tissue and caused by an infection. 
• Usually abscesses rupture into an airway, producing a lot of sputum that gets coughed up. A ruptured abscess leaves a cavity in the lung that is filled with fluid and air.
• Staph or Klebsiella common causes of infection.

Work of breathing is increased and ventilation is compromised if the chest wall is deformed, immobilized, or made heavy by fat. 

Multiple rib fractures cause the ribs to be unstable leading to paradoxical movement on inspirationa and expiration. 

paradoxical movement= part of chest goes out while other goes in. 

• 1. smoke
• 2. ammonia
• 3. hydrogen chloride

• Presence of air in the pleural space.
• Makes it difficult for lungs to expand properly

Allows air to enter and exit the pleural space through penetration of the chest wall.

• Air enters and exits the pleural space without penetration of the chest wall. 
• 1. Spontaneous: emphysema, pneumonia
• 2. Traumatic: fractured rib
• 3. Iatrogenic: accidently induced by a physician/medical procedure-- chest Sx, mechanical ventilation

• Air leaks into the pleural space, but cannot escape. 
• Causes the affected lung to collapse ->mediastinal shift-> unaffected lung collapse-> severe respiratory and CV distress and death.

Presence of blood in the pleural space.

Presence of fluid in the pleural space. 

usually a secondary problem

• Presence of infected fluid in pleural space. 
• - uncommon but serious disorder occurs mostly in debilitated pt

• Inflammation of the pleura. 
• characterized by sudden onset, painful and difficult respiration, and exudation of fluid or fibrinous material into the pleural cavity—called also pleuritis

• 1. fibrotic or restrictive
• 2. inflammation, fibroids (scars), and disability
• 3. stiff and non-compliant

• 1. Pneumoconiosis - inhalation of inorganic materials like asbestosis, coal, talocosis, silicosis
• 2. Hypersensitivity- inhalation of organic dusts 
•          - Farmer's Lung: moldy hay
•          - Pigeon breeder's lung: birds

• 1. diminished lung volume
• 2. reduced diffusing capacity
• 3. varying degrees of hypoxemia

• 1. Identifying and removing the injurious agent
• 2. Suppress the inflammatory response
• 3. Preventing progression
• 4. Providing supportive Tx for pt with advance disease

• Excessive amount of fibrous or connective tissue in the lung. 
• (Excessive Scar tissue in the lung)

• Tiny grain-like bumps form (granulomas), clump together to form larger lumps that can attack other organs.
• T-lymphocyte alteration is thought to contribute.

• Acute Respiratory Failure = inadequate gas exchange
• - Signs = increased respiratory rate, use of accessory muscles, flushed face, Dyspnea, late sign is cyanosis, hypotension
• - ABGs= pH<7.30 , pO2<50, pCO2>50

Acute Respiratory Distress Syndrome = a form of pulmonary insufficiency that develops in the aftermath of a shock or shock-like state. Life-threatening. 

increase in permeability of lungs leading to lungs that are wet, heavy, congested, hemorrhagic and stiff.

• Early symptoms mistaken as Stress!
• -Change in LOC, Dyspnea, Hypotension- late
• -Tachycardia, Tachypnea
• -Fever
• -Cough
• As syndrome progresses so will symptoms- labored breathing, cyanosis, grunting resp.

• ◦Treat the Hypoxia
• ◦Monitoring Parameters
• ◦Drug Therapy
• ◦Fluid Management
• ◦Psychosocial Support

• ◦Sepsis
• ◦Aspiration
• ◦Multiple blood transfusions
• ◦Bone Fx
• ◦Prolonged hypotension
• ◦Burns
• ◦Pancreatitis
• ◦Pneumonia
• ◦Pulmonary Contusion

• PREVENTION of atelectasis
• TCDB, early amb., etc. 

• -T C DB
• -Early Ambulation 
• -Changes in position
• -Elevate HOB

• Chronic Obstructive Pulmonary Disease
• 1. Emphysema
• 2. Bronchitis
• 3. Asthma - more acute but can be chronic

DIFFICULTY BREATHING

SMoking

• a condition characterized by air-filled expansions in interstitial or subcutaneous tissues
• Tx= thin secretions, oxygen and bronchodialators

• Hypersecretion of mucous and chronic productive cough. 
• - Usually leads to emphysema

• abnormal respoviveness of the air passages to a certain substance.
• there are widespread narrowing of smaller airways in attacks that end spontaneously or with treatment.
• ** there is a genetic tendency to developing asthma

• =cessation of air flow during sleep for a period of 10 seconds or longer. 
• (occurs 30 or more times over 7 hours of sleep)

• -caused by obstruction of upper airway
• -common in obesity, middle aged men
• - "Pickwickian syndrome": named after charles dickens book

• cessation of respiratory drive so there is no movement of chest or abdomen
• causes= encephalitis, brain stem infarction, polio

mixture of central and obstructive apnea

• = dysfunction of endocrine system to produce abnormally thick secretions of mucous
• -Genetic
• -Glands most effected = resp, pancreatic, sweat
• - Can Dx prenatally through sweat test

an acute, inflammatory infection of the lungs caused by bacteria, virus, fungi, protozoa or parasites

elderly, immunocompromised, alcoholics, smokers, decreased LOC, malnurished, immobilized, people with preexisting lung diseases

• 1. Aspiration - infected sneeze, cough, talk = airborn droplets
• 2. Contaminated respiratory equipment
• 3. Bacteria in blood spread to lungs

• Streptococcus pneumonia
• accounts for 90% of all bacterial pneumonias
• vaccine available

• Viral pneumonia influenza (Type A)
• predisposes the patient to bacterial pneumonia

Mycoplasma pneumonia

Pneumocystis Carcinii Pneumonia (PCP)

• = a serious type of bacterial pneumonia
• •Widely found in H2O. Discovered in 1976.

• •Highest risk: chronic disease or impaired immune system
• •Prognosis= 20-30% mortality rate in previously healthy individuals. Can be as high as 80% in immunosuppresed individuals

Tuberculosis= A chronic infectious pulm./exo pulm disease that affects the lungs and can invade other body systems like kidneys, bones and lymph nodes

positive skin test (may also be positive with dormant TB), a sputum culture and a chest x-ray

• immune impaired through...
• 1. poor nutrition
• 2. diabetes
• 3. steroid use
• 4. chemotherapy

airborne droplets

• • Isolation precautions for active TB = private, negative pressure rooms 
• •Antibiotic therapy to control active or dormant bacteria and prevent transmission. Drugs depend on the
• individual, bacteria and the presence of the active disease. 
• •In the past a combination of 2 drugs has been sufficient today combinations of 4
• drugs may be used: INH, Rifampin, Pyrazinamide and either Streptomycin or Ethambutal.

• - fatigue, lethargy
• - weight loss, anorexia
• - low grade fever in afternoon
• - night sweats

= Obstruction of pulmonary artery by a thrombus (DVT) that becomes dislodged and carried to lung

• 1. venostasis-prolonged bedrest
• 2. venous injury -surgery or fracture
• 3. increased blood coaguability
• 4. Disease- CHF, lung, MI

• BEST TREATMENT = PREVENTION -- TCDB, EARLY AMB., ETC
• - analgesic, bronchodilator, antibiotic, oxygen, sedative, bedrest

3 factors leading to thrombosis - stasis, hypercoaguability, intimal changes (injury or change in vessel)

• -Smoking = LEAD
• - evvironmental and occupational hazards
• - family history
• - reccurring pulm. inflam
• - vitamin A deficiency

Squamous Cell Carcinoma

Small cell carcinoma

Adenocarcinoma

Large Cell Carcinoma