1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.1 Alterations of Pulmonary Function Chapter 26

2. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.2 Signs and Symptoms of Pulmonary Disease  Dyspnea  Subjective sensation of uncomfortable breathing  Orthopnea Dyspnea when a person is lying down  Paroxysmal nocturnal dyspnea (PND)

3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.3 Signs and Symptoms of Pulmonary Disease (cont’d)  Cough  Acute cough  Chronic cough  Abnormal sputum  Hemoptysis  Abnormal breathing patterns:  Kussmaul respirations (hyperpnea)  Cheyne-Stokes respirations

4. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.4 Signs and Symptoms of Pulmonary Disease (cont’d)  Hypoventilation  Hypercapnia  Hyperventilation  Hypocapnia  Cyanosis  Clubbing  Pain

5. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.5 Clubbing

6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.6 Conditions Caused by Pulmonary Disease or Injury  Hypercapnia  Hypoxemia  Hypoxemia versus hypoxia  Ventilation-perfusion abnormalities Shunting  Acute respiratory failure

7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.7 Ventilation-Perfusion

8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.8 Chest Wall Disorders  Chest wall restriction  Compromised chest wall Deformation, immobilization, and/or obesity  Flail chest  Instability of a portion of the chest wall

9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.9 Flail Chest

10. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.10 Pleural Abnormalities  Pneumothorax  Open pneumothorax  Tension pneumothorax  Spontaneous pneumothorax  Secondary pneumothorax

11. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.11 Pneumothorax

12. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.12 Pleural Abnormalities  Pleural effusion  Transudative effusion  Exudative effusion  Hemothorax  Empyema Infected pleural effusion  Chylothorax

13. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.13 Pulmonary Disorders  Restrictive lung diseases:  Aspiration Passage of fluid and solid particles into the lungs  Atelectasis Compression atelectasis Absorption atelectasis  Bronchiectasis Persistent abnormal dilation of the bronchi

14. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.14 Absorption Atelectasis

15. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.15 Pulmonary Disorders  Restrictive lung diseases:  Bronchiolitis Inflammatory obstruction of the small airways Most common in children Occurs in adults with chronic bronchitis, in association with a viral infection, or with inhalation of toxic gases  Pulmonary fibrosis Ideopathic

16. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.16 Pulmonary Disorders (cont’d)  Restrictive lung diseases (cont’d)  Inhalation disorders: Toxic gases Pneumoconiosis  Silica  Asbestos  Coal Allergic alveolitis  Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

17. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.17 Pulmonary Disorders (cont’d)  Restrictive lung diseases (cont’d)  Pulmonary edema Excess water in the lungs

18. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.18 Pulmonary Edema

19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.19 Pulmonary Disorders  Restrictive lung diseases (cont’d)  Acute respiratory distress syndrome (ARDS) Fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury Injury to the pulmonary capillary endothelium Inflammation and platelet activation Surfactant inactivation Atelectasis

20. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.20 Pulmonary Disorders (cont’d)  Restrictive lung diseases (cont’d)  Acute respiratory distress syndrome (ARDS) (cont’d) Manifestations:  Hyperventilation  Respiratory alkalosis  Dyspnea and hypoxemia  Metabolic acidosis  Hypoventilation  Respiratory acidosis  Further hypoxemia  Hypotension, decreased cardiac output, death

21. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.21 Pulmonary Disorders (cont’d)  Restrictive lung diseases (cont’d)  Acute respiratory distress syndrome (ARDS) (cont’d) Evaluation and treatment  Physical examination, blood gases, and radiologic examination  Supportive therapy with oxygenation and ventilation and prevention of infection  Surfactant to improve compliance

22. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.22 Acute Respiratory Distress Syndrome (ARDS)

23. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.23 Pulmonary Disorders  Obstructive lung diseases  Airway obstruction that is worse with expiration  Common signs and symptoms Dyspnea and wheezing  Common obstructive disorders: Asthma COPD Emphysema Chronic bronchitis

24. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.24 Asthma

25. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.25 Pulmonary Disorders  Obstructive lung diseases: Asthma  Chronic inflammatory disorder of the airways  Inflammation results from hyperresponsiveness of the airways  Can lead to obstruction and status asthmaticus  Symptoms include expiratory wheezing, dyspnea, and tachypnea  Peak flow meters, oral corticosteroids, inhaled beta-agonists, and anti-inflammatories used to treat

26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.26 Pulmonary Disorders (cont’d)  Obstructive lung diseases: COPD

27. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.27 Obstructive Pulmonary Disease

28. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.28 Chronic Obstructive Pulmonary Disease

29. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.29 Chronic Obstructive Pulmonary Disease (cont’d)

30. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.30 Pulmonary Disorders  Obstructive lung diseases: chronic bronchitis  Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years  Inspired irritants increase mucus production and the size and number of mucous glands  The mucus is thicker than normal  Bronchodilators, expectorants, and chest physical therapy used to treat

31. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.31 Pulmonary Disorders (cont’d)  Obstructive lung diseases: emphysema  Abnormal permanent enlargement of the gas- exchange airways accompanied by destruction of alveolar walls without obvious fibrosis  Loss of elastic recoil  Centriacinar emphysema  Panacinar emphysema

32. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.32 Pulmonary Disorders (cont’d)  Respiratory tract infections: pneumonia  Pneumococcal  Viral

33. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.33 Pneumococcal Pneumonia

34. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.34 Pulmonary Disorders  Respiratory tract infections  Tuberculosis Mycobacterium tuberculosis Acid-fast bacillus Airborne transmission Tubercle formation Caseous necrosis Positive tuberculin skin test (PPD)

35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.35 Pulmonary Disorders (cont’d)  Respiratory tract infections—acute bronchitis  Acute infection or inflammation of the airways or bronchi  Commonly follows a viral illness  Acute bronchitis causes similar symptoms to pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates

36. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.36 Pulmonary Disorders (cont’d)  Abscess formation and cavitation  Abscess  Consolidation  Cavitation

37. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.37 Pulmonary Disorders (cont’d)  Pulmonary vascular disorders: Pulmonary embolus  Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble  Pulmonary emboli commonly arise from the deep veins in the thigh  Virchow triad Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels

38. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.38 Pulmonary Embolism

39. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.39 Pulmonary Disorders  Pulmonary vascular disorders: Pulmonary hypertension  Mean pulmonary artery pressure 5 to 10 mm Hg above normal or above 20 mm Hg  Primary pulmonary hypertension Idiopathic  Diseases of the respiratory system and hypoxemia are more common causes

40. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.40 Pulmonary Disorders (cont’d)  Pulmonary vascular disorders: Pulmonary hypertension (cont’d)  Classifications: Pulmonary arterial hypertension Pulmonary venous hypertension Pulmonary hypertension due to a respiratory disease or hypoxemia Pulmonary hypertension due to thrombotic or embolic disease Pulmonary hypertension due to diseases of the pulmonary vasculature

41. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.41 Pulmonary Hypertension

42. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.42 Pulmonary Disorders  Pulmonary vascular disorders: Cor pulmonale  Pulmonary heart disease Right ventricular enlargement Secondary to pulmonary hypertension Pulmonary hypertension creates chronic pressure overload in the right ventricle

43. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.43 Pulmonary Disorders (cont’d)  Malignancies of the respiratory tract  Lip Most common form—exophytic Stages  Laryngeal Forms:  Carcinoma of the true vocal cords (most common)  Supraglottic  Subglottic

44. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.44 Lip Cancer

45. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.45 Laryngeal Cancer

46. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.46 Pulmonary Disorders  Malignancies of the respiratory tract  Lung (bronchogenic) Most common cause is cigarette smoking Heavy smokers have a 20 times’ greater chance of developing lung cancer than nonsmokers Smoking is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder Environmental or occupational risk factors are also associated

47. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc.47 Pulmonary Disorders (cont’d)  Malignancies of the respiratory tract (cont’d)  Lung Types:  Non-small cell cancer: –Squamous cell carcinoma –Adenocarcinoma –Large cell carcinoma  Small cell cancer—from neuroendocrine tissue so see ectopic hormone secretion (paraneoplastic); large size