Essentials of Human Diseases and Conditions 6 th edition

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1 Essentials of Human Diseases and Conditions 6 th edition Margaret Schell Frazier Jeanette Wist Drzymkowski Copyright 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1 Copyright 2016 by Elsevier Inc. All rights reserved. 1

3 Learning Objectives Lesson 9.1: The Respiratory System and Associated Conditions 1. Explain the process of respiration. 2. Discuss the causes and medical treatment for (a) the common cold, (b) sinusitis, and (c) pharyngitis. 3. Name the treatment of choice for nasal polyps. 4. Name some systemic disorders that might cause epistaxis. 5. Discuss the prognosis of cancer of the larynx. Copyright 2016 by Elsevier Inc. All rights reserved. 3

4 Learning Objectives Lesson 9.1: The Respiratory System and Associated Conditions (Cont.) 6. Define atelectasis and discuss some possible causes. 7. Compare the clinical pictures of (a) a patient with pulmonary embolism and (b) one with pneumonia. 8. List some health hazards of common molds. 9. List some possible causes of pulmonary abscess. Copyright 2016 by Elsevier Inc. All rights reserved. 4

5 Orderly Function of the Respiratory System Respiration made possible by ventilation and healthy lung tissue perfused by blood Breathing is controlled by central nervous system Pulmonary circulation Ø Pulmonary arteries carry deoxygenated blood Ø Pulmonary capillaries for gas exchange Ø Pulmonary veins return oxygenated blood to heart Lungs and kidneys maintain ph balance Copyright 2016 by Elsevier Inc. All rights reserved. 5

6 Respiration External: Oxygen inhaled from the air is exchanged with carbon dioxide Internal: The exchange of gases between the blood and tissue cells Inhaled and exhaled air passes through the respiratory tract Inspiration: Diaphragm contracts, causing air to be sucked into the lungs Expiration: Diaphragm relaxes, forcing air out of the lungs Copyright 2016 by Elsevier Inc. All rights reserved. 6

7 Structure of the Respiratory System From Patton KT, Thibodeau GA: The human body in health & disease, ed 6, Maryland Heights, MO, 2014, Elsevier. Copyright 2016 by Elsevier Inc. All rights reserved. 7

9 Symptoms of Respiratory Disorders Include: Ø Chest pain Ø Dyspnea (difficulty breathing) and shortness of breath Ø Hemoptysis (spitting up blood) Ø Dysphonia (hoarseness) Ø Chills and low- or high-grade fever Ø Wheezing Ø Fatigue Copyright 2016 by Elsevier Inc. All rights reserved. 9

10 Common Cold Can infect the nose and pharynx or larynx and various areas of lungs Symptoms depend on which virus is responsible Ø Nasal congestion and discharge, sneezing, watering eyes, sore throat, hoarseness of the voice and coughing Group of minor illnesses that can be caused by almost 200 different viruses Copyright 2016 by Elsevier Inc. All rights reserved. 10

11 Common Cold (Cont.) An ordinary cold should clear up in 4 or 5 days Ø Antihistamines help dry up nasal secretions, diminish itchy or watery eyes, and decrease flare from allergic reactions Ø Decongestants stimulate adrenergic receptors, induce vasoconstriction of blood vessels in the nose, throat, and sinuses Ø Cough suppressants lessen cough Copyright 2016 by Elsevier Inc. All rights reserved. 11

12 Sinusitis Frontal sinuses and the maxillary sinuses are most commonly involved Ø Headache, pain, drainage, and tenderness are symptoms Caused by viral, fungal, or bacterial infections Treatment Ø Saline and corticosteroid nasal sprays Ø Broad-spectrum antibiotics and decongestants Ø Antihistamines and oral corticosteroids Copyright 2016 by Elsevier Inc. All rights reserved. 12

Sinusitis From Damjanov I: Pathology for the health-related professions, ed 4, St

14 Pharyngitis Often involves inflammation of the tonsils, uvula, and palate, and sore throat with dryness, a burning sensation, or the sensation of a lump Most common cause is a viral infection Physical examination usually shows red, swollen mucous membranes Ø Using lozenges, mouthwashes, salt water gargles, an ice collar, and antiinflammatory medications may help Copyright 2016 by Elsevier Inc. All rights reserved. 14

15 Nasopharyngeal Carcinoma Classic clinical triad of symptoms is neck mass, nasal obstruction with epistaxis, and serous otitis media People from southern China, areas around the Mediterranean Sea, Southeast Asia, and the Arctic are at risk Surgery is usually not performed as treatment Ø Treated with radiation therapy with or without adjuvant chemotherapy Copyright 2016 by Elsevier Inc. All rights reserved. 15

16 Laryngitis Inflammation of the larynx sometimes interferes with breathing;; main symptom is hoarseness Caused by viral or bacterial infections, can be chronic or acute Laryngoscopic examination reveals mildly or highly inflamed mucosa Treatment Ø Voice rest and bed rest Ø Liberal fluid intake Ø Use of cough syrup Copyright 2016 by Elsevier Inc. All rights reserved. 16

17 Deviated Septum Causes narrowing and obstruction of the air passage May be of no consequence until aggravated by trauma to the nose Congenital anomaly is usually the cause Treatment is not usually necessary unless compromise of the air passage is noted The only possible prevention is avoiding trauma to the nose Copyright 2016 by Elsevier Inc. All rights reserved. 17

18 Deviated Septum (Cont.) From Monahan FD, Neighbors M: Medical-surgical nursing: foundations for clinical practice, ed 2, Philadelphia, 1998, Saunders. Copyright 2016 by Elsevier Inc. All rights reserved. 18

19 Nasal Polyps Can become large enough to obstruct the airway or affect sense of smell Polyps are caused by the overproduction of fluid in the cells of the mucous membrane Surgical removal is the treatment of choice, but steroid injection directly into polyps may help No specific preventive measures are known Copyright 2016 by Elsevier Inc. All rights reserved. 19

21 Anosmia Ability to taste liquids and food also is impaired or lost A chronic condition is the most common cause of anosmia Ø Intranasal swelling accompanying an upper respiratory condition causes temporary anosmia Treatment is aimed at the cause Ø Polyps are removed Ø Allergic rhinitis is treated with a series of injections Copyright 2016 by Elsevier Inc. All rights reserved. 21

22 Epistaxis (Nosebleed) Bleeding usually occurs from only one nostril with no explanation Nosebleeds that persist for 10 minutes after constant pressure is applied require immediate emergency care Common causes of epistaxis are colds and infections Mild hemorrhage may be controlled by applying constant direct pressure Copyright 2016 by Elsevier Inc. All rights reserved. 22

23 Tumors of the Larynx Benign or malignant growths on the larynx Dysphonia is usually the only symptom of a tumor on the larynx Two types of benign tumors: Papillomas and polyps Ø Caused by misuse or overuse of the vocal cords Benign growths treated with correction of vocal strain and reflux management If discovered early, malignant tumors may often be treated and cured with radiation Copyright 2016 by Elsevier Inc. All rights reserved. 23

25 Laryngeal Cancer Persistent hoarseness tends to occur early in the disease process and is the most common symptom Ø Other symptoms may include dysphagia, hemoptysis, chronic cough, referred pain to the ear, and stridor Major risk factors for development of laryngeal cancer are smoking and alcohol abuse Quality of life issues are often incorporated into the treatment plan Copyright 2016 by Elsevier Inc. All rights reserved. 25

26 Hemoptysis Sputum streaked or spotted with blood can be present with minor infections Profuse bleeding is present in severe lung infections Trauma, erosion of a vessel, calcification, or tumors can cause bronchial bleeding, as can inflammatory conditions Source of bleeding is treated once located Ø Ligation or surgical removal or repair of the involved vessels is indicated for severe bleeding Copyright 2016 by Elsevier Inc. All rights reserved. 26

27 Atelectasis Follows incomplete expansion of lobules or segments of the lung, with partial or complete collapse;; dyspnea is another symptom Caused by an obstruction in the bronchial tree Ø Compression atelectasis results when a tumor exerts pressure on the lung and does not allow air to enter Antibiotics, analgesics, surgical drainage of pleural effusion for treatment Copyright 2016 by Elsevier Inc. All rights reserved. 27

29 Pulmonary Embolism Size and location of the embolism and general physical condition of the patient determine consequences of interruption of blood supply Most common symptom is sudden onset of dyspnea and chest pain Emboli also may be composed of air, fat globules, a small piece of tissue, or a cluster of bacteria Copyright 2016 by Elsevier Inc. All rights reserved. 29

30 Pulmonary Embolism (Cont.) Lung scans and CT angiography of the chest are used to image the pulmonary blood flow Echocardiogram is also used to assess pulmonary artery pressure and right heart function Primary treatment is aimed at preventing a potentially fatal episode and maintaining cardiopulmonary integrity and adequate ventilation and perfusion Copyright 2016 by Elsevier Inc. All rights reserved. 30

32 Pneumonia The inflammation may be either unilateral or bilateral and involve all or only a portion of an infected lung Aspiration pneumonia results from aspiration of liquids or other material into the tracheobronchial tree Pneumonia usually is caused by viral or bacterial infections Copyright 2016 by Elsevier Inc. All rights reserved. 32

33 Treatment Options for Pneumonia Include: Ø Organism-specific antibiotics are prescribed for bacterial pneumonia Ø Penicillin is the drug of choice for a pneumococcal pneumonia Ø Mycoplasma infections may be treated with broadspectrum antibiotics Ø Fungal infections require the use of various antifungal medications, whereas viral infections are treated with specific antiviral agents Copyright 2016 by Elsevier Inc. All rights reserved. 33

Appearance of Pneumonia From Long BW, Frank ED, Ehrlich RA: Radiography essentials for limited

35 Health Hazards of Common Molds Toxic mold inside homes can cause allergic symptoms or unique/rare health conditions CDC information Ø Molds grow naturally in both the indoor and outdoor environments Ø Mold exposure does not always present a health problem Ø In most cases, mold can be removed by a thorough cleaning with commercial products Ø All molds should be treated the same Copyright 2016 by Elsevier Inc. All rights reserved. 35

36 Pulmonary Abscess Main symptoms are alternating chills and fever Causes Ø Often a complication of pneumonia caused by bacteria Ø Aspiration of food, foreign object, bronchial stenosis, or neoplasms Ø Septic embolism is carried to lung via pulmonary circulation Treatment of abscess is the use of antibiotics for a fairly long duration Copyright 2016 by Elsevier Inc. All rights reserved. 36

38 Learning Objectives Lesson 9.2: Other Conditions of the Respiratory System 10. Compare Legionnaires disease with Pontiac fever. 11. Explain who is at greatest risk for (a) respiratory syncytial virus (RSV) pneumonia and (b) histoplasmosis. 12. List the groups recommended to receive prophylactic use of influenza vaccines. 13. Recall what the acronym COPD stands for. 14. Contrast the pathologic course of acute bronchitis with that of chronic bronchitis. Copyright 2016 by Elsevier Inc. All rights reserved. 38

39 Learning Objectives Lesson 9.2: Other Conditions of the Respiratory System (Cont.) 15. Compare the pathology involved in bronchiectasis with that of pulmonary emphysema. 16. Name and describe three causes of pneumoconiosis. 17. Describe the presenting symptoms of pleurisy. 18. Explain the difference between pneumothorax and hemothorax. 19. Describe the cause of the instability of the chest wall in a patient with flail chest. Copyright 2016 by Elsevier Inc. All rights reserved. 39

40 Learning Objectives Lesson 9.2: Other Conditions of the Respiratory System (Cont.) 20. Discuss contributing factors to, and concern about, the rising prevalence of pulmonary tuberculosis (TB). 21. Describe the clinical course of infectious mononucleosis. 22. Explain the pathologic changes of the lungs in adult respiratory distress syndrome (ARDS). 23. Explain what determines the prognosis of sarcoidosis. Copyright 2016 by Elsevier Inc. All rights reserved. 40

41 Learning Objectives Lesson 9.2: Other Conditions of the Respiratory System (Cont.) 24. Name the leading cause of cancer deaths worldwide for both men and women. 25. Explain the possible health consequences of smoking tobacco. Copyright 2016 by Elsevier Inc. All rights reserved. 41

42 Legionellosis (Legionnaires Disease and Pontiac Fever) Legionnaires disease is more severe;; the milder form is Pontiac fever Ø Legionnaires produces severe pneumonia-like symptoms Ø Symptoms of Pontiac fever include a high fever and muscle aches Both disorders are caused by L. pneumophila Antibiotic therapy is initiated before diagnosis is made Pontiac fever usually resolves itself Copyright 2016 by Elsevier Inc. All rights reserved. 42

43 Respiratory Syncytial Virus (RSV) Pneumonia RSV causes cold-like symptoms, including nasal congestion, otitis media, and coughing Respiratory syncytial virus is the causative agent of RSV pneumonia Ø Greatest occurrence of these annual epidemic infections is during the winter months Antipyretics are prescribed for fever, and antibiotics are given for otitis media Inhalation of 3% hypertonic saline is used to treat RSV Copyright 2016 by Elsevier Inc. All rights reserved. 43

44 Histoplasmosis Many patients with histoplasmosis are asymptomatic at onset Ø As the fungus disseminates, patient reports dyspnea and loss of energy to the point of incapacitation Histoplasmosis is caused by the fungus H. capsulatum, which is carried by dust and is inhaled Antifungal drugs itraconazole, fluconazole, and amphotericin B, are used to treat more severe or progressive disease Copyright 2016 by Elsevier Inc. All rights reserved. 44

45 Influenza Characterized by inflammation of respiratory tract mucous membranes, a severe protracted cough, fever, headache, and sore throat Transmission is from person to person by inhalation of the virus in airborne mucus discharge Known viruses that cause influenza are designated as orthomyxovirus types A, B, and C Copyright 2016 by Elsevier Inc. All rights reserved. 45

46 Influenza (Cont.) Acute uncomplicated influenza with recovery is the most frequently encountered Influenza outbreaks may be sporadic or epidemic Transmission is from person to person by inhalation of the virus in airborne mucus discharge Bed rest, increased fluid intake, a light diet, and use of antipyretic and analgesic drugs are helpful Copyright 2016 by Elsevier Inc. All rights reserved. 46

47 H1N1 (Swine Flu) Novel influenza A (H1N1) virus is a highly unusual mix of swine, bird, and human flu viruses Contagious and spread from human to human Can range from mild to severe Symptoms of H1N1 in people are similar to the symptoms of regular human flu H1N1 susceptible to oseltamivir (Tamiflu) and zanamivir (Relenza) Copyright 2016 by Elsevier Inc. All rights reserved. 47

48 Chronic Obstructive Pulmonary Disease (COPD) Describes a condition of slow and irreversible progressive airway obstruction COPD encompasses: Ø Chronic bronchitis Ø Bronchiectasis Ø Asthma Ø Emphysema Ø Cystic fibrosis Ø Pneumoconiosis Copyright 2016 by Elsevier Inc. All rights reserved. 48

49 Acute and Chronic Bronchitis Acute: Deep, persistent, productive cough is the main symptom Chronic: Inflammation persists and becomes worse for at least 3 months of the year for 2 years Acute bronchitis is part of a general URI Ø Begins after a common cold or other viral infections The same bacteria known to cause pneumonia may be responsible for chronic bronchitis Copyright 2016 by Elsevier Inc. All rights reserved. 49

50 Treatment of Bronchitis Because acute bronchitis usually is caused by a viral infection, no specific treatment is prescribed, except measures that will relieve symptoms Treatment of chronic bronchitis is based on the stage of the disease Ø Low-flow oxygen therapy may be administered as needed for hypoxemia Ø Postural drainage and percussion are techniques used to help loosen and expectorate thick mucus Copyright 2016 by Elsevier Inc. All rights reserved. 50

51 Chronic Obstructive Pulmonary Disease (COPD) (Cont.) Bronchiectasis: Permanent, irreversible dilation or distortion of one or more bronchi, resulting from destruction of muscular and elastic portions of bronchial walls Pulmonary emphysema: Chronic obstructive pulmonary disorder characterized by destructive changes in alveolar walls and irreversible enlargement of alveolar air spaces Copyright 2016 by Elsevier Inc. All rights reserved. 51

52 Bronchiectasis Usually bilateral and involves the lower lobes of the lungs Chronic cough producing large quantities of sputum is the main symptom May be caused by repeated damage to the bronchial wall caused by recurrent airway infections Antibiotics and bronchodilators are prescribed;; postural drainage is encouraged Copyright 2016 by Elsevier Inc. All rights reserved. 52

54 Pulmonary Emphysema Pulmonary emphysema interferes with both the breathing process and gas exchange in the lungs Ø Alveoli become enlarged, which precipitates destruction of the alveolar walls and damage to the adjacent capillary walls Long-term cigarette smoking appears to be a contributing factor Drug therapy: 2 -Adrenergic sympathomimetic drugs alone in combination with corticosteroids Copyright 2016 by Elsevier Inc. All rights reserved. 54

56 Pneumoconiosis Refers to a number of occupational diseases that cause progressive, chronic inflammation, fibrosis, and infection in the lungs The onset of symptoms can be insidious, with dyspnea on exertion being the first Usually takes at least 10 years of continual daily exposure to develop Anthracosis: Also known as black lung or coal miner s lung Copyright 2016 by Elsevier Inc. All rights reserved. 56

58 Pneumoconiosis (Cont.) Silicosis: Affects workers who are stone masons or metal grinders or who work in quarries Treatment is directed toward relieving symptoms and includes: Ø Administration of bronchodilators Ø Oxygen therapy Ø Chest physical therapy to help remove secretions Ø The use of short-term corticosteroid drugs Copyright 2016 by Elsevier Inc. All rights reserved. 58

59 Pleurisy (Pleuritis) Symptoms Ø Sharp, needle-like pain that increases with inspiration and coughing Ø May also experience fever, chills, and shallow breathing Pleurisy is usually secondary to other diseases or infections Ø Two types: Wet and dry Antibiotic therapy and analgesics to control the pain may be given Copyright 2016 by Elsevier Inc. All rights reserved. 59

61 Pneumothorax Symptoms Ø Severe shortness of breath Ø Sudden, sharp chest pain Ø Falling blood pressure and rapid, weak pulse Pneumothorax can be spontaneous or traumatic Ø Spontaneous pneumothorax occurs when an opening is present on the surface of a lung Ø Traumatic pneumothorax occurs when the integrity of the pleural cavity is breached Copyright 2016 by Elsevier Inc. All rights reserved. 61

62 Treatment of Pneumothorax Patient is more comfortable in a Fowler or a semi-fowler position and may require oxygen An occlusive dressing is placed over any sucking wound to seal the portal of entry and to prevent additional air from entering the chest cavity A thoracostomy is performed to withdraw air from the cavity Copyright 2016 by Elsevier Inc. All rights reserved. 62

64 Hemothorax Signs of hemorrhage include pale and clammy skin, a weak and thready pulse, and falling blood pressure Blood enters the pleural space, which causes the lung to collapse Treatment: Lung must be reexpanded, usually by thoracostomy with closed drainage to evacuate the blood The prognosis for a hemothorax is guarded Copyright 2016 by Elsevier Inc. All rights reserved. 64

65 Flail Chest The patient with flail chest experiences severe pain and dyspnea and is cyanotic and extremely anxious Direct trauma to the chest wall that fractures three or more adjacent ribs is the cause of flail chest First responder emergency care employs measures to stabilize the chest wall until surgical repair is possible Copyright 2016 by Elsevier Inc. All rights reserved. 65

67 Pulmonary Tuberculosis (TB) Acquired by inhaling a dried droplet nucleus that contains the tubercle bacillus With primary TB, patient is asymptomatic The tubercle bacillus M. tuberculosis causes TB and is spread by droplet nuclei Ø As the body s defense mechanisms respond to the bacterial invasion, antigens are produced, which cause necrosis, followed by fibrosis and calcification of the affected tissue Treatment dependent on whether TB is latent or active Copyright 2016 by Elsevier Inc. All rights reserved. 67

Tuberculosis (TB) From Kumar V, Cotran R, Robbins S: Robbins basic pathology, ed 8,

69 Infectious Mononucleosis: Epstein-Barr Virus (EBV) Infection Symptoms Ø Lymphadenopathy Ø Fever that typically peaks in afternoon Ø Listlessness, malaise, chills, anorexia Ø Sore throat, fever, headache, fatigue, cervical and generalized lymphadenopathy Mononucleosis is caused by the EBV, a herpesvirus Acute treatment: Force bed rest and fluid intake Copyright 2016 by Elsevier Inc. All rights reserved. 69

Tonsils Infected by Mononucleosis From Sigler B: Ear, nose, and throat disorders Mosby's

71 Symptoms Adult Respiratory Distress Syndrome (ARDS) Ø Sudden, severe dyspnea with rapid, shallow respirations Ø Inspiratory intercostals and suprasternal retractions along with cyanosis or mottled skin Ø Rales, rhonchi, and wheezes may also be present ARDS is considered secondary to some agent that precipitates increased capillary permeability in the lungs, pulmonary edema, and respiratory failure Copyright 2016 by Elsevier Inc. All rights reserved. 71

72 Adult Respiratory Distress Syndrome (ARDS) (Cont.) Alveoli fill within 12 to 48 hours of injury, and then tend to collapse at end of expiration, leaving less pulmonary tissue for gas exchange Ø Low pulmonary compliance, pulmonary hypertension, decreased functional residual capacity, and hypoxemia result The patient receives supportive care only Ø Efforts are made to correct the underlying cause of ARDS Copyright 2016 by Elsevier Inc. All rights reserved. 72

73 Sarcoidosis Patients may have no complaints or mild to severe symptoms, depending on the site of the lesions and the degree of involvement The exact cause is not certain Ø The disorder is thought to be a malfunction of the immune system or caused by a virus Sarcoidosis abates spontaneously Corticosteroid therapy, such as prednisone, helps to relieve severe symptoms Copyright 2016 by Elsevier Inc. All rights reserved. 73

74 Lung Cancer Leading cause of cancer death worldwide in both men and women, 30% of all cancer deaths The most common symptom is cough with or without sputum production Other symptoms may include dyspnea, hemoptysis, chest pain, and weight loss Two main types by histology: Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) The primary risk factor for development of lung cancer is cigarette smoking Copyright 2016 by Elsevier Inc. All rights reserved. 74

Lung Carcinomas From Damjanov I: Pathology for the health-related professions, ed

76 Diagnosis and Treatment of Lung Cancer Many patients are symptomatic at the time of diagnosis, some may be diagnosed following a chest radiograph Ø Testing is also done to look for specific biomarkers that may affect treatment choice, such as gene mutations in epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase Treatment decisions are based on the type of tumor and the stage of the tumor Copyright 2016 by Elsevier Inc. All rights reserved. 76

77 Prognosis and Prevention of Lung Cancer Prognosis for patients with lung cancer is generally poor Ø Five-year survival rate for all stages and types of lung cancer combined is 15% Ø Prevention Cessation of smoking Avoidance of exposure to secondhand smoke Copyright 2016 by Elsevier Inc. All rights reserved. 77

Respiratory Diseases and Disorders

Chapter 9 Respiratory Diseases and Disorders Anatomy and Physiology Chest, lungs, and conducting airways Two parts: Upper respiratory system consists of nose, mouth, sinuses, pharynx, and larynx Lower