Alterations of Pulmonary Function (ch 27), Exams of Nursing

Download Alterations of Pulmonary Function (ch 27) and more Exams Nursing in PDF only on Docsity! Alterations of Pulmonary Function (ch 27) Objectives: • Discuss signs/symptoms of pulm alterations • Correlated pathologic conditions to pulmonary disease/injury • Explain pathophysiology of specific pulmonary disease conditions Signs & Symptoms of Pulmonary Disease • Dyspnea ▪ Subjective sensation of uncomfortable breathing ▪ Orthopnea - Dyspnea when laying down. There is a change in pressure ▪ Paroxysmal nocturnal dyspnea (PND) sudden uncomfortable breathing at night • Normal breathing patterns ▪ 8-16 bpm ▪ TV (tidal volume) 400-800 mL. The amount of air going in & out, varies by individual and demand • Abnormal breathing patterns ▪ Kussmaul respirations (hyperpnea) - Slightly increased rate, large tidal volume, not expiratory pause ▪ Cheyne-Stokes respirations - Alternating periods of deep and shallow breathing - Apnea lasting 15-60 seconds is followed by ventilations that increase in volume until a peak is reached, then ventilations decrease again to apnea • Hypoventilation – inadequate alveolar ventilation relative to metabolic demand ▪ Hypercapnia – increase in PaCO2 d/t lack of ventilation; leads to resp. acidosis ▪ Caused by slowing down the central nervous system • Hyperventilation – alveolar ventilation exceeds metabolic demand ▪ Hypocapnia – disease in PaCO2 resulting in respiratory alkalosis ▪ Caused by extreme exertion, panic/anxiety, brain injury • Cough – protective reflex of explosive expiration caused by stimulated receptors ▪ Acute cough – resolves within 2-3 weeks d/t: asthma, upper respiratory infection, something caught in the throat, dryness ▪ Chronic cough > 3 weeks d/t long term smoking, GERD • Hemoptysis – coughing blood or bloody secretions d/t: TB, congestive heart failure, severe irritation • Cyanosis ▪ Bluish discoloration d/t decreased amount of Hb in blood, decreased cardiac output, cold exposure, anxiety, pulmonary right to left shunt • Pain ▪ Originates in pleura (membrane ling the lungs & thoracic cavity), airways or chest wall • Clubbing pg. 1 ▪ Enlargement of a distal segment of the digits caused by a pulmonary disease • Abnormal sputum ▪ Change in amount or quality of sputum Conditions caused by Pulmonary Disease or Injury • Hypoxemia – reduced O2 of arterial blood caused by resp. alterations ▪ Hypoxemia (low arterial oxygen) versus hypoxia (low oxygen in the tissue) ▪ Ventilation – perfusion abnormalities - Shunting • Acute respiratory failure inadequate gas exchange due to injury to the lungs, the chest wall or the nervous system. Could be a hypercapnia (too much CO2 b/c of a ventilation issue) or it could be a hypoxemia b/c the O2 exchange in the alveolar/capillary membrane isn’t allowing the O2 to come across. Depending on the cause, most often causes post-op • Pulmonary edema ▪ Excess water in the lungs ▪ M/C d/t a heart issue. When the lt ventricle fails it ↑ the pulmonary-capillary hydrostatic pressure b/c you get backup. If the lt ventricle backs up it backs up to the lt atrium, from the lt atrium to the pulmonary and if the hydrostatic pressure w/n the pulmonary capillaries ↑ it drives the water out b/c you haven’t changed the oncotic pressure you end up w/ water in the lungs ▪ Clinical manifestations- dyspnea (shortness of breath), hypoxemia, increased work of breathing; severe=pink, frothy sputum • Aspiration ▪ Passage of fluid and solid particles into the lungs’ d/t impaired swallow or cough reflux. It could also be a nervous system disorder (ALS, MS, Myasthenia gravis). Rt lung is more susceptible than the lt lung b/c the Rt lung has a straighter bronchiole. As a result you get inflammation that can lead to pneumonia or collapse of alveoli • Atelectasis ▪ Collapse of lung tissue. Two types; compressive & absorption (loss of air from obstructed alveoli) ▪ Sx of dyspnea, cough, fever, leukocytosis • Bronchiectasis ▪ Persistent abnormal dilation of the bronchi ▪ D/t obstruction (inflammation)- mucus (CF) • Bronchiolitis ▪ Inflammatory obstruction of the bronchioles ▪ Most common in children ▪ Occurs in adults with chronic bronchitis, in association with a viral infection, or with inhalation of toxic gases ▪ Sx of rapid ventilatory rate, marked use of accessory mm, non-prod cough, hyperinflated chest • Bronchiolitis obliterans pg. 2 • Can lead to obstruction and status asthmaticus • Symptoms include expiratory wheezing, dyspnea (difficult/labored breathing), and tachypnea (abnormally rapid breathing) • Peak flow meters, oral corticosteroids, inhaled beta-agonists, and anti-inflammatories used to treat Chronic Obstructive Pulmonary Disease • Chronic bronchitis ▪ Hypersecretion of mucus, chronic cough that lasts for at least 3 months of the year for at least 2 consecutive years ▪ Inspired irritants increase mucus production and the size and number of mucous glands increased risk of infection with all the mucus. Mucus does not all exchange of nutrients ▪ The mucus is thicker than normal ▪ Bronchodilators, expectorants, and chest physical therapy used to treat • Emphysema ▪ Abnormal permanent ▪ Loss of elastic recoil ▪ Centriacinar emphysema ▪ Panacinar emphysema Respiratory Tract Infections • Pneumonia ▪ Community – acquired pneumonia - Streptococcus pneumoniae ▪ Hospital- acquired (nosocomial) pneumonia ▪ Pneumococcal pneumonia ▪ Viral pneumonia • Tuberculosis (leading cause of death in the world caused by infection) ▪ Mycobacterium tuberculosis ▪ Acid-fast bacillus ▪ Airborne transmission ▪ Tubercle formation (granulomas lesion, the tissue goes through necrosis) ▪ Caseous necrosis (cheesy) ▪ Positive tuberculin skin test (PPD) ▪ Asymptomatic • 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 Pulmonary Vascular Disease pg. 5 • Pulmonary embolism ▪ Sx: Dyspnea (shortness of breath), tachypnea (↑ respiratory rate), agitation, anxiousness, tachycardia (↑ HR), pain w/ inspiration ▪ Occlusion of pulmonary arteries in the lungs ▪ Pulmonary emboli commonly arise from the deep veins in the thigh ▪ Virchow triad: a way of classifying predisposing factors to a pulmonary embolis. Venous stasis, hypercoagulable state (oral contraceptives in combination w/ smoking and smoking itself, pregnancy, polycythemia, any kind of clotting disease. Antibodies in SLE) and injury to the endothelial (most often secondary to a trauma, can be caused by sepsis especially gram neg bacteria, burns and surgery) • Pulmonary hypertension: ↑ in pressure especially in the pulmonary artery. Usually due to a hypoxemia which causes vasoconstriction of the pulmonary arterials, as a result of the constriction it causes an ↑ in the workload of the right heart. 3 main contributors: ↑ in the pulmonary blood flow ↑ hydrostatic pressure, left atrial pressure b/c the left ventricle is failing, ↑ to resistance of flow ▪ Early symptoms exercise intolerance, dyspnea, fainting. Over time you can develop hoarseness ▪ Mean pulmonary artery pressure 5 to 10 mmHg above normal or above 20 mmHg ▪ Classifications (didn’t spend much time on these) - Pulmonary arterial hypertension - Pulmonary venous hypertension - Pulmonary hypertension due to respiratory disease or hypoxemia - Pulmonary hypertension due to thrombotic or embolic disease - Pulmonary hypertension due to diseases of the pulmonary vasculature • Primary pulmonary hypertension (more rare, most often in females, secondary to pserosis HIV) ▪ Idiopathic: any disease or condition which arises spontaneously or for which the cause is unknown • Diseases of the respiratory system and hypoxemia are more common causes of pulmonary hypertension Cor Pulmonale • Pulmonary heart disease ▪ Right ventricular hypertrophy ▪ Secondary to pulmonary hypertension ▪ Pulmonary hypertension creates congestion of the liver Cancer • Lip cancer (more common in men due to tobacco chewing) ▪ Most common form - Exophytic: tending to grow outward beyond the surface epithelium from which it orginates pg. 6 ▪ Stages • Laryngeal cancer ▪ Forms - Carcinoma of the true vocal cords (most common) - Supraglottic - Subglottic • Lung Cancer * (most common cancer death) ▪ Bronchogenic carcinomas mostly epithelial tissue ▪ Most common cause is cigarette smoking - Heavy smokers have a 20 times’ greater chance of developing lung cancer that nonsmokers - Smoking is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder ▪ Environmental or occupational risk factors are also associated with lung cancer ▪ Non-small cell lung cancer includes - Squamous cell carcinoma a. Usually hilar (centrally located), producing a non-productive cough & hemoptysis (coughing up blood), very slow growing, they don’t often metastasize to other areas. They do trigger pneumonia, atelectasis (complete or partial collapse of the entire lung or area) - Adenocarcinoma a. Often times in the periphery, the lowest correlation to smoking, most often caused by environmental toxins and occupational carcinogens. Often asymptomatic and found on a chest x-ray in the elderly. ▪ Large cell carcinoma (undifferentiated) - Don’t look like a lung cell at all, they cause a distortion of the trachea causes inflammation and aspiration ▪ Small cell carcinoma - Especially smokers. ~ 20% of all the bronchogenic cancers. Oatcell carcinoma. The worst prognosis, they grow rapidly. Early metastasis and they spread throughout the lung. They are deadly, high death rate. They cause ectopic hormone release ▪ Evolution - TNM classification a. Tumor b. Nodal involvement c. Metastasis - Surgery, chemotherapy, and radiation Mr. Brennan, age 63, has smoked cigarettes since he was 14. He has a long history of gradually increasing dyspnea. Currently, he has a chronic morning cough productive of only scant white sputum. Mr. Brennan has been losing weight and now feels fatigued and weak at all times. Upon examination, he has a barrel chest. His diagnosis is emphysema. Answer the following questions about Mr. Brennan’s condition to deepen your understanding of emphysema 1. What assessment questions should you ask Mr. Brennan? pg. 7