RESPIRATORY SYSTEM & PATHOPHYSIOLOGY

JANET J. NELSON RN,CMA

OBJECTIVESo 1. Identify and label structures of respiratory

system.o Describe functions of respiratory organso Explain physiology of respirationso Define four respiratory eventso Define respiratory capacity termso Distinguish between respiratory disorders

Do you know??

o What is snoring?o Why do we yawn?o What is a hiccup?o Can you breath and swallow at

the same time?

Respiratory Structures

Nasal cavity

Nose shapes and sizeso Provides airwayo Moistens and warms

airo Filters airo Resonating chamber

for speecho Olfactory receptors

Palate & Uvula

Paranasal Sinuses

PharynxNotice: Pharyngeal tonsilsPalatine tonsilsNasopharynxOropharynxLaryngopharynx and Epiglottis

Tonsils

#1 Pharyngeal Tonsil #3 Lingual Tonsil

#2 Palatine tonsil #4 Epiglottis

Larynx & Epiglottis

VIDEO http://www.bing.com/videos/search?q=epiglottis+video&mid=DE5E1D1F3ADC1DA51116DE5E1D1F3ADC1DA51116&view=detail&FORM=VIRE8

Vocal Folds

o Glottis is the space between the vocal cordso Laryngeal muscles control length and size of

opening by moving cartilageso Sound is produced by the vibration of vocal

cords as air is exhaled

Glottis

Animation of cough

o http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000039&ptid=17

Trachea

C-Shaped rings and esophagus

Bronchi & BronchiolesPrimary Bronchus

Secondary Bronchus

Tertiary Bronchus

Bronchiole

Alveoli

Notice:capillaries,smooth muscle and elastic fibers

Hilum

Mediastinum

Lungso How many lobes

on the right?o How many lobes

on the left?o Why the

differences?o What is the

cardiac notch?

Pleura

PNEUMOTHORAX HEMOTHORAX

Animation of breathing

o http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000018&ptid=17

Notice:**Diaphragm moves down and ribs move out with inspiration

**Expiration is passive with diaphragm & intercostal muscles relaxing

HYPERPNEA

Nerve Control

o Medulla Oblongata

o Ponso Phrenic Nerveo Intercostal

Nerves

Lung Capacityo Tidal Volumeo Inspiratory Reserve Volumeo Expiratory Reserve Volumeo Vital Capacityo VC=TV+IRV+ERVo Forced Vital Capacityo Residual Volume

Dissection 26 min

http://videos.med.wisc.edu/videos/1253

Format for Pathophysiology1. BRIEF DESCRIPTION 2. ETIOLOGY3. SYMPTOMS AND SIGNS (S&S)4. DIAGNOSIS (DX)5. PREVENTION AND TREATMENT (TX)6. PROGNOSIS (PX)

Types of Respirations

* Eupnea * Hypoxia

* Apnea * Suffocation

* Dyspnea * Asphyxia

* Hyperpnea * Cheyne Stokes

* Orthopnea * Cyanosis

* Tachypnea

* Anoxia

General Manifestationsof Respiratory Disease

Sneezing:

Coughing:Sputum: Yellowish-green, cloudy - bacterial

Rusty or dark-colored – pneumococcal pneumonia

Large amounts purulent with foul odor – bronchiectasis

Thick, tenacious mucous - asthma or cystic fibosis

Blood tinged – chronic cough, tumor or TB

Hemoptysis with frothy sputum – pulmonary edema

General Manifestations cont.

Breathing patterns may be altered in respiratory diseases. Normal 12-20/min

Kussmauls respirations:

Wheezing:

Stridor:

Breath sounds: Rales, Rhonchi, Absence of breath sounds

            

Lung sounds

The R.A.L.E. Repository

Green box on left---repository—normal—rales--wheeze

Tobacco Related DiseasesDestruction of respiratory ciliaAddictiveCarcinogenic (Lung and oral cancer)EmphysemaCOPDMICardiac arrhythmiasCVAPeripheral Artery DiseaseDuodenal and gastric ulcers“Crows feet”Low birth weigh infants for a smoking mom

Health Effects of Smoking

More than 4,000 individual compounds have been identified in tobacco and tobacco smoke. Among these are more than 60 compounds that are known carcinogens (cancer-causing agents). There are hundreds of substances added by manufacturers to cigarettes to enhance the flavor or to make the smoking experience more pleasant. Some of the compounds found in tobacco smoke include ammonia, tar, and carbon monoxide. Exactly what effects these substances have on the cigarette consumer’s health is unknown.

Health Effects of SmokingAbout half of all Americans who continue to smoke will die because of the habit. Each year, about 438,000 people die in the US from tobacco use. Nearly 1 of every 5 deaths is related to smoking.

Cigarettes kill more Americans

than alcohol, car accidents,

suicide, AIDS, homicide, and

illegal drugs combined.

Health Effects of Smoking

Cigarette smoking accounts for at least 30% of all cancer deaths. It is a major cause of cancers of the lung, larynx (voice box), oral cavity, pharynx (throat), and esophagus, and is a contributing cause in the development of cancers of the bladder, pancreas, cervix, kidney, stomach, and some leukemias. About 87% of lung cancer deaths are caused by smoking. Lung cancer is the leading cause of cancer death among both men and women, and is one of the most difficult cancers to treat. Fortunately, lung cancer is largely a preventable disease.

Other risks of smoking

Higher incidence of SIDS & mothers that smokeChildren's asthma attacks and severity are worsened in home with smoker.Increase risk for hypertensionLeukoplakiaGum recession Stained teeth and halitosis

COPDChronic Obstructive Pulmonary Disease is a group of common chronic respiratory disorders that are characterized by progressive tissue degeneration and obstruction in the airways of the lung.

These disorders are emphysema, chronic bronchitis and asthma.

Fifth leading cause of death and disability in the U.S.

Features in common:

HO smoking

Dyspnea with progression in severity

Cough with frequent pulmonary infections

Hypoxia with retained Carbon dioxide

EMPHYSEMAA serious, chronic lung condition where the alveoli enlarge, losing elasticity and capillaries around alveoli are destroyed. (Permanently inflated alveolar air spaces).

Patient loses the ability to exhale CO2 and must use incredible amount of energy to exhale.

Etiology: cigarette smoking, environment pollutants, genetics.

Emphysema cont.S&S: Onset is insidious…dyspnea, hyperventilation, barrel chest, pursed lips with exhalation, anorexia with weight loss.DX: Chest X-ray, PFT. TX: Avoid irritants, stop smoking, pulmonary rehab programs, bronchodilators, O2, antibiotics with infection, maintain nutrition.PX: Some reversal of airway obstruction with S&S improvement can be obtained initially, but long term the prognosis is less favorable.

Barrel Chest

Permanently inflated Alveoli

DISTENTED ALVEOLI IN EMPHYSEMA.NOTICE THE CO2 TRAPPED IN THE ALVEOLI EVEN AFTER DEATH

CHRONIC BRONCHITISThe mucosa of the LR tract become severely inflamed and produce excessive mucous.Impaired ventilation is the result, with increase risk of pneumonia. (Remember smokers are missing cilia).Etiology: HO cigarette smoking or living in urban industrial area.S&S: constant cough, tachypnea, SOB, thick & purulent sputum, rhonchi & cough worse in a.m., cyanosis, weight loss and signs of cor pulmonale.

Chronic Bronchitiscont.

DX: History, chest X-ray, PFT and bronchoscopy.View:MedlinePlus Interactive Tutorials: BronchoscopyTX: Reducing exposure to irritants, prompt treatment of infection, Use of expectorants, bronchodilators and low flow O2.PX: Guarded; although consistent treatment can slow the progression.

Voluminous sero-mucinous secretion in the trachea in a patient with chronic bronchitis.

ASTHMAChronic condition of increased reactivity of the tracheobronchial tree.Two types: Extrinsic-involves acute episodes triggered by a hypersensitivitiy reaction to an inhaled allergen. Intrinsic, with an adult onset, is a response to other stimuli, e.g. cold, exercise, stress, irritants like smoke.Genetics plays a part in etiology.Characterized by episodes of reversible airway obstruction, due to, bronchoconstriction, mucous production and mucosa edema.

Asthma cont.

S&S: cough, dyspnea, wheezing, possible sternal retractions, thick and tenacious mucous, tachycardia, hypoxia.DX: The best tool is a PFT during attack, then chest X-ray shows hyperinflation, allergy test, and a CBC with elevated eosinophils.TX: Minimize attacks, use of bronchiodilators.PX: Acute episodes can be life threatening. Status astmaticus: is a persistent severe attack of asthma that does not respond to therapy. It may be fatal.

                                                                                                      

Google Image Result for http://kidshealth.org/broadcast/article_images/article43940/1115822895616.button_asthma

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LUNG CANCERLung cancer is common site of both primary and secondary lung cancer.Primary lung cancer is 90% HO smoking. Low cure rate-less than 7% survive over 5 years.Secondary: Metastasis develop as cancer cells travel in blood and lymph from heart to first small vessels in the the lungs.Etiology: Smoking (cilia missing and not able to remove the carcinogens caught in mucous), occupational exposure of chemicals e.g silica, asbestos.

Cancer cont.S&S: Insidious, because “smokers cough” masks S&S. Early: persistent productive cough, hemoptysis, dyspnea, + Chest X-ray. Chest pain as the pleura and/or mediastinum involved.DX: Chest X-ray, bronchoscopy with biopsy.TX: Complete resection of the diseased lung, but with rapid metastasis, often not a choice. Radiation and chemotherapy but many tumors are not responsive.PX: Continues to be poor, unless tumor is in very early stages of development.

Left lung cancer

The lymphatic and circulatory system can deliver cancer cells to the lung = secondary cancer

PULMONARY TUBERCULOSISAn infectious and inflammatory disease of the lungs, acquired by inhaling droplets containing bacteria.Etiology: Mycobacterium tuberculosis is causative agent. The primary lesion is usually in lung with bacteria surviving in dried form for months.. The infection begins with a primary lesion which causes necrosis, fibrosis and

calcification. The infection than goes dormant for possible years.

S&S: Vague with anorexia, malaise, fatique, weight loss. Later- low grade fever, night sweats,hemoptysis, chest pain and weakness.

TB Cont.DX: Mantoux test, Chest X-ray, (walled off lesions are identified), positive sputum culture.TX: Drug therapy with multiple antituberculosis agents. Contacts of patient must receive prophylactic treatment for one year and receive TB testing.TB is considered infectious; therefore good handwashing and respiratory precautions must be practiced. Place patient in isolation with HCW using N-95or HEPA respirator mask & room air is vented for UV ray exposure.PX: Early and complete treatment offers an excellent prognosis. Other organs can be involved without adequate treatment.

Typical X-ray of TB After treatment

Respiratory Syncytical VirusThis viral, infective condition is most common in young & elderly. RSV is one of the most important causes of lower respiratory tract illness and can be fatal.

Etiology: RSV is the causative agent. The greatest occurrence is during the winter months. Premature infants are at greatest risks. Most people have experienced several RSV infections in their life. Most are self limiting. RSV is spread by contact with infective secretions.

RSV Cont.S&S: Cold-like symptoms with nasal congestion, otitis media, cough and URI. As the virus progresses downward to the lower respiratory tract, the patient experiences fever, malaise, lethargy, cough and dyspnea.

DX: The clinical picture and thorough PE are key. If necessary a nasal lavage with viral culture can be ordered.

TX: Palliative. Hospitalization may be necessary to ensure adequate respiration.

CYSTIC FIBROSISCF is a chronic dysfunction of the exocrine glands affecting multiple body systems; it is the most common fatal genetic disease.

Etiology: It is an inherited disorder and is transmitted as an autosomal recessive trait.

Each of us inherits two CFTR genes, one from each parent.Children who inherit an abnormal CFTR gene from each parent will have CF.

•Children who inherit an abnormal CFTR gene from one parent and a normal CFTR gene from the other parent will not have CF. They will be CF carriers.

CF CONT.S&S:May be apparent soon after birth or develop in childhood.Primarily attacks the lungs and digestive tract with production of copious thick and sticky mucous that accumulates and blocks glandular ducts.

Meconium ileusSalty sweat (Mom notices with kiss, positive sweat test)Signs of malabsorption (steatorrhea,& abd.distention) Chronic cough and respiratory infectionsFailure to meet normal growth milestones

DX: Sweat test, check stools for fat content and trypsin (pancreatic enzyme) PFT, Chest X-ray, ABG.

CF Cont.TX: CF is considered a fatal disease. However, with early diagnosis and treatment, the life expectancy has improved greatly during the past few decades. High calorie, high NaCl diet, postural drainage, pancreatic enzyme supplementation, O2 prn. Lung transplants are a last resort.

URI

Include: coryza, sinusitis, laryngotracheo-bronchitis, epiglottitis, & influenza.

Viral etiology for cold, croup and influenza. Bacterial for sinusitis and epiglottitis. Secondary bacterial infection may follow viral.

S&S: Cold and flu-red, swollen mucous membranes of nose & pharynx with increase secretions, rhinorrhea, maybe sore throat and fever. The infection advancing to larynx causes hoarseness and cough (bronchi).

URI cont.S&S: Colds are usually 7 days in duration while the flu is sudden with fever, fatique lasting for weeks. Croup-barking cough,(due to edema and mucous with possible obstruction) with hoarse voice and inspiratory stridor. Epiglottitis-”red ball obstruction”, severe sore throat, refuse to swallow, anxious breathing and inspiratory stridor.DX: History and exam.TX: Viral-palliative, Prevention of influenza with immunization. Bacterial-antibiotics, supportive care.PX: Good with treatment. Secondary infections common.

LRIInclude: bronchiolitis (RSV), acute bronchitis, & pneumonia.Etiology: Acute bronchitis may be bacterial secondary infection following URI, or result of irritative inhalants. Pneumonia may be primary or secondary, bacterial or viral. May follow aspiration when fluids pool or cilia are reduced.Classifications of pneumonia:

The causative agentAnatomic locationPathophysiologic changes.

LRI cont.

S&S: Acute bronchitis is often preceded by URI. Cough is initially dry and nonproductive and then changes to viscid and later abundant and mucoid or mucopurulent. Pneumonia S&S vary: cough, fever, SOB while at rest, chills, chest pain, cyanosis and hemoptysis.

DX: History, exam, chest X-ray, sputum C&S.

TX: antibiotics, expectorants, broncholdilators.

PX” Bronchitis can lead to pneumonia. Pneumonia can range from mild to life threatening, being the 5th leading cause of death in the US.

Pneumonia fills the lung's alveoli with fluid, keeping oxygen from reaching the bloodstream. The alveolus on the left is normal, while the alveolus on the right is full of fluid from pneumonia.

Pneumonia as seen on chest x-ray. A: Normal chest x-ray. B: Abnormal chest x-ray with shadowing from pneumonia in the right lung (left side of image).

REVIEW

http://msjensen.cehd.umn.edu/webanatomy/timed/default.asp

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