RESPIRATORY DISEASES NUR124 – SESSION 5 Nadeeka Jayasinghe

OBJECTIVES Discuss pathophysiology, symptoms, diagnosis, treatment of:  Respiratory Failure  Pleural Effusions  Lung Cancer  Bronchiectasis  Occupational Lung Disease  Traumatic Disorders Of The Lung

RESPIRATORY FAILURE  A process where the respiratory system fails in one or both of its gas exchange functions 1. Oxygenation 2. Carbondioxide elimination  Hypoxic(Type 1) or Hypercapneic (Type 2)

HYPOXIX RESP FAILURE (TYPE 1)  Arterial oxygen tension (PaO2) <60mmHg with low or normal arterial carbon dioxide tension (PaCO2).  Most common form of respiratory failure  Can be associated with most lung diseases which involve fluid overload or alveloar collapse  Examples : Cardiogenic/non-cardiogenic pulmonary edema, pneumonia

HYPERCAPNEIC RESP FAILURE  Arterial carbondioxide tension (PCO2) higher than 50mmHg. (Hypercapniea)  Can lead to hypoxemia if they are breathing in room air  Blood pH will be less than 7.35  Can develop over minutes to hours  The pH levels depend on the bicarbonate levels in the body which in turn is depedant

RESP FAILURE - CAUSES  Abnormalities in any of the components of the respiratory system including the airway, alveoli, central nervous system (CNS), peripheral nervous system, respiratory muscles and chest wall.  Pharmacological, structural and metabolic disorders of the CNS may lead to respiratory depression. This leads to hypoventilation or hypercapnea. (tumors in brain stem, sedatives, overdoses)

RESP FAILURE - CAUSES  Disorders of the peripheral nervous system

RESP FAILURE - DIAGNOSIS  Arterial Blood Gases  Chest xray  ECG (not essential but can rule out possible cardiac causes )  Pulmonary function tests

PLEURAL EFFUSIONS  WHERE IS THE PLEURAL SPACE OF THE LUNG?  Definition?

PLEURAL EFFUSIONS  The pleura is the thin membrane that lines the surface of the lungs and inside the chest wall outside the wall.  A pleural effusion is an abnormal amount of fluid around the lung.  Normally, 5-10ml of fluid is in the pleural space allowing the lungs to move smoothly during respiration.

CAUSES OF PLEURAL EFFUSIONS  Congestive heart failure  Pneumonia  Liver disease (cirrhosis)  End stage renal disease  Nephrotic syndrome  Cancer  Pulomonary embolism  Lupus and other autoimmune conditions

Why does excessive fluid accumulate?  Due to fluid overload – congestive heart failure, renal and hepatic disease.  Inflammation – pneumonia, autoimmune disease

SYMPTOMS  Shortness of breath  Chest pain upon breathing (pleuritic)  Fever  Cough  Decreased chest movement and breath sounds on affected side  Bronchial breathing

Diagnosis  Auscultation and percussion (very difficult to rule out)  Chest xray – (white space at the base of lungs)  CT scan  Ultrasound – assists with drainage of fluid

TREATMENT – Pleural effusions  Thoracentesis – a needle is inserted into the chest wall between the 6/7/8 th intercostal space on mid-axillary line into the pleural space and fluid is drained out.  Pleural tap may be left in for a few hours to drain fluid over time  Fluid can be used to determine – protein content, cell count, infection (via culture), fungus, gram stain, lipids etc.

LUNG CANCER  Pulmonary carcinoma  Small cell carcinoma vs non small cell carcinoma  80-90% of lung cancers are from long term tobacco smoke exposure  10%-15% occur in patients who have never smoked (genetics, pollution, asbestos exposure, second hand smoking)

SYMPTOMS  Respiratory : coughing, hemoptysis, wheezing, shortness of breath  Systemic: weight loss, fever, clubbing of the fingernails, fatigue  Symptoms due to the mass pressing on adjecant structures: chest pain, bone pain, superior vena cava obstruction, swallowing difficulty

DIAGNOSIS  CT SCAN  LUNG BIOPSY (via brochoscope and/or CT guided biopsy)

Treatment  Surgery : Pulmonary function tests must first reveal that the patient is well for surgery. Lobectomy, wedge resection and pneumonectomy are options.  Radiotherapy: Can be given with chemotherapy. For patients who are not suitable for surgery  Chemotherapy: Improves survival but has severe side effects.

BRONCHIECTASIS  A disease where the lung is abnormally widened due to mucus blockage  Can develop at any age. But common at birth (congenital bronchiectasis)  Infection - TB, influenza, pneumonia, cystic fibrosis  Due to a blockage in your airway: due to a mass, or an inhalation of a solid (food etc)

BRONCHIECTASIS  Mucus to build up causes bacteria growth and severe infection. Over time, the airways loses it’s ability to ventilate adequately.  Can lead to respiratory failure, heart failure and collapsed lung.

Symptoms  Shortness of breath  Hemoptysis  Wheezing  Chest pain  Fatigue  General lethargy and feeling unwell

Diagnosis  Chest CT scan  Chest xray – will show airway abnormalities  Blood tests – infection, other conditions that may be contributing factors  Lung function tests – capacity of lungs, if breathing volumes are affected  Bronchoscopy – blockages of airway, bleeding etc.

Treatment  Treatment of underlying conditions  Antibiotic therapy  Chest Physiotherapy  Bronchodilators, steroids, oxygen  Surgery

OCCUPATIONAL LUNG DISEASES  Broad group diagnosis  Inhalation of dust, chemical and proteins  “Pneumoconiosis” – diseases associated with inhaling mineral dust  The exposure of different particles result in different diseases Asbestos exposure - Asbestosis Silicon exposure – Silicosis Coal / mineral dust - Pneomoconiosis

OCCUPATIONAL LUNG DISEASE 1. ASBESTOSIS:  Asbestos – used for industrial work – breaks into fibers when shattered  Industrialization exposed large communities to asbestosis but symptoms did not develop till later in life  Asbestosis causes scarring, fibrosis, lung cancer, pleural effusions, plaques.  Dyspnoea

OCCUPATIONAL LUNG DISEASE 2. SILICOSIS:  Develops decades after exposure  Silica nodules in the lungs  Acute (higher mortality) vs chronic silicosis (silicotic nodules develop into lesions)  Silicosis increases risk of TB and immune related diseases (systemic arthritis and SLE)  Associated with increased risk of lung cancer

OCCUPATIONAL LUNG DISEASES 3. PNEMOCONIOSIS (CWP):  Long term exposure to coal dust  Also known as black lung – small spots in upper lungs that reflect coal inhalation  Progresses into fibrosis. Similar to Silicosis – destroys lung architecture  Exposure to coal dust – airflow obstruction, chronic bronchitis, rheumatoid arthritis  Stomach cancer has been associated with coal ingestion

TRAUMATIC DISORDERS OF THE LUNG 1. PNEUMOTHORAX:  An abnormal collection of air or gas in the pleural space that separates the lung from the chest wall  Spontaneous pneumothorax – occurs without an apparent cause in the absence of lung disease  Secondary pneumothorax – occurs in the presence of significant lung pathology

TRAUMATIC DISORDERS OF THE LUNG  In a minority of cases, the amount of air in the chest increases markedly when a one-way valve is formed by an area of damaged tissue, leading to a tension pneumothorax. This condition is a medical emergency.

Causes (Pneumothorax)  Physical trauma to the chest wall  Blasts  Complication from a medical or surgical intervention  Long term mechanical ventialation

Signs and symptoms  Shortness of breath  Chest pain (mild to severe – depending on stage)  Hypoxia – leads to cyanosis  Hypercapnia – confusion

DIAGNOSIS  Chest xray  CT scan  Auscultation  Observation and assessment of changes in patient condition (tracheal deviation, changes to the shape of chest wall)

Management  Not all pneumothoraces require treatment  Immediate needle decompression (if in an emergency setting)  Chest tube insertion  Pleurodecis (