Case Study - Patient Diagnosis
redginger28
Chapter_029.pptxChapter 29
Alterations of Pulmonary Function
Signs and Symptoms of Pulmonary Disease (1 of 3)
Dyspnea
Subjective sensation of uncomfortable breathing
Orthopnea
Dyspnea when a person is lying down
Paroxysmal nocturnal dyspnea (PND)
Awaken at night gasping for air
Signs and Symptoms of Pulmonary Disease (2 of 3)
Cough
Acute cough
Chronic cough
Abnormal sputum
Hemoptysis
Abnormal breathing patterns:
Kussmaul respirations (hyperpnea)
Cheyne-Stokes respirations
Signs and Symptoms of Pulmonary Disease (3 of 3)
Hypoventilation
Hypercapnia
Hyperventilation
Hypocapnia
Cyanosis
Clubbing
Pain
Clubbing
Modified from Seidel HM et al: Mosby’s guide to physical examination, ed 7, St Louis, 2011, Mosby.
Conditions Caused by Pulmonary Disease or Injury
Hypercapnia
Increased carbon dioxide concentration in arterial blood
Hypoxemia
Reduced oxygenation of arterial blood
Hypoxemia vs. hypoxia
Ventilation-perfusion abnormalities
Shunting
Acute respiratory failure
Ventilation-Perfusion Abnormalities
Question 1
A patient has bulbous enlargement of the distal segments of the fingers. Which disease is associated with this condition?
Cystic fibrosis
Acute pneumonia
Sickle cell disease
Acute myocardial infarction
Note: No input needed to proceed
8
Question 1 Answer
Correct Answer: A
This condition describes clubbing, in which there is enlargement of the distal segment of the finger. It is associated with conditions of decreased oxygenation such as bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and congenital heart disease.
9
Chest Wall Disorders
Chest wall restriction
Compromised chest wall
Deformation, immobilization, and/or obesity
Flail chest
Instability of a portion of the chest wall
Flail Chest
Pleural Abnormalities (1 of 2)
Pneumothorax
Open pneumothorax
Tension pneumothorax
Spontaneous (primary) pneumothorax
Secondary pneumothorax
Pleural Abnormalities (2 of 2)
Pleural effusion: fluid in pleural space
Transudative (watery)
Exudative (WBCs and plasma proteins)
Hemothorax (blood)
Empyema (pus)
Chylothorax (chyle)
Restrictive Lung Diseases (1 of 6)
Aspiration
Passage of fluid and solid particles into the lungs
Atelectasis
Collapse of lung tissue
Types:
Compression atelectasis
Obstructive (absorption) atelectasis
Surfactant impairment (adhesive) atelectasis
Bronchiectasis
Persistent abnormal dilation of the bronchi
Restrictive Lung Diseases (2 of 6)
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
Excessive amount of fibrous tissue in lung
Idiopathic or caused by scar tissue
Restrictive Lung Diseases (3 of 6)
Inhalation disorders
Toxic gases
Pneumoconiosis
Silica
Asbestos
Coal
Hypersensitivity alveolitis
Allergic reaction from inhaled particles or fumes
Pulmonary edema
Excess water in the lungs
Restrictive Lung Diseases (4 of 6)
Restrictive Lung Diseases (5 of 6)
Acute respiratory distress syndrome (ARDS)
Acute lung inflammation and diffuse alveolocapillary injury that results from injury or severe inflammation
Bilateral infiltrates on chest radiograph
Low ratio of PaO2 to FiO2
Three phases:
Exudative (within 72 hours)
Proliferative (4 to 21 days)
Fibrotic (14 to 21 days)
Restrictive Lung Diseases (6 of 6)
Acute respiratory distress syndrome (ARDS)
Manifestations:
Dyspnea and hypoxemia despite supplemental oxygen
Hyperventilation and respiratory alkalosis
Decreased tissue perfusion, metabolic acidosis, and organ dysfunction
Increased work of breathing, decreased tidal volume, and hypoventilation
Hypercapnia, respiratory acidosis
Respiratory failure, decreased cardiac output, hypotension, and death
Question 2
Which of the following is TRUE regarding acute respiratory distress syndrome (ARDS)?
It is caused by injury to the bronchioles.
It can cause severe pulmonary edema.
It is most commonly caused by exposure to inhaled irritants.
Macrophages are not involved in response.
Note: No input needed to proceed
20
Question 2 Answer
Correct Answer: B
Acute respiratory distress syndrome (ARDS) is characterized by damage that is done to the alveolar capillary membrane and causes severe pulmonary edema. The most common cause of ARDS is either sepsis or multiple trauma. Macrophages, neutrophils, complement, and endotoxins are all important mediators.
21
Obstructive Lung Diseases (1 of 8)
Narrowing of airways resulting in airway obstruction that is worse with expiration
Accessory muscles of expiration required
Increased work of breathing
Dyspnea and wheezing
Obstructive Lung Diseases (2 of 8)
Asthma
Chronic inflammation of the airways
Causes bronchial hyperresponsiveness, constriction of airways, and reversible airflow obstruction
Pulsus paradoxus, status asthmaticus
Symptoms include expiratory wheezing, dyspnea, and tachypnea
Peak flow meters, corticosteroids, beta agonist inhalers, and anti-inflammatories used to treat
Obstructive Lung Diseases (3 of 8)
Obstructive Lung Diseases (4 of 8)
Chronic obstructive pulmonary disease (COPD)
Characterized by persistent airflow limitation
Usually progressive
Most common chronic lung disease in world
Risk factors
Tobacco smoke
Occupational dusts and chemicals
Air pollution
Any factor affecting lung growth during gestation and childhood
Obstructive Lung Diseases (5 of 8)
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
Obstructive Lung Diseases (6 of 8)
Emphysema
Abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis
Inherited deficit of α1-antitrypsin
Loss of elastic recoil
Air trapping
Obstructive Lung Diseases (7 of 8)
Obstructive Lung Diseases (8 of 8)
Question 3
Which of the following is TRUE regarding the pathophysiology of asthma?
IgA is the major factor.
There is decreased vascular permeability.
Inflammation results in hyperresponsiveness.
The inflammatory process is caused by the loss of bronchial smooth muscle spasm.
Note: No input needed to proceed
30
Question 3 Answer
Correct Answer: C
Asthma is caused by increased bronchial smooth muscle spasm and increased vascular permeability. IgE is the major factor. There is increased capillary permeability. Inflammatory mediators cause vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchospasm), and mucus secretion from mucosal goblet cells with narrowing of the airways and obstruction to airflow.
31
Respiratory Tract Infections (1 of 5)
Acute bronchitis
Acute infection or inflammation of the airways or bronchi
Commonly follows a viral illness
Acute bronchitis causes symptoms similar to those of pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates
Respiratory Tract Infections (2 of 5)
Pneumonia
Lower respiratory tract infection
Caused by bacteria, viruses, fungi, protozoa, or parasites
Types:
Community acquired (CAP)
Streptococcus pneumoniae
Influenza
Healthcare acquired (HCAP)
Ventilator-associated (VAP)
Respiratory Tract Infections (3 of 5)
Respiratory Tract Infections (4 of 5)
Tuberculosis
Infection by Mycobacterium tuberculosis
Leading cause of death from curable infectious disease in the world
Airborne transmission
Tubercle formation
Caseous necrosis
Tuberculin skin test
Respiratory Tract Infections (5 of 5)
Abscess formation and cavitation
Abscess
Necrosis
Cavitation
Pulmonary Vascular Disease (1 of 5)
Pulmonary embolism
Occlusion of a portion of the pulmonary vascular bed by an embolus
Blood clot, tissue fragment, lipids, foreign body, air bubble, amniotic fluid
Pulmonary emboli commonly arise from the deep veins in the lower leg
Pulmonary Vascular Disease (2 of 5)
Pulmonary Vascular Disease (3 of 5)
Pulmonary artery hypertension
Mean pulmonary artery pressure 5 to 10 mm Hg above normal or above 25 mm Hg
Caused by heritable defects, drugs, venoocclusive disease, lung or heart disease, systemic disorders, and chronic pulmonary embolism
Pulmonary Vascular Disease (4 of 5)
Cor pulmonale
Secondary to pulmonary hypertension
Pulmonary hypertension creates chronic pressure overload in the right ventricle
Right ventricular enlargement
Pulmonary Vascular Disease (5 of 5)
Malignancies of the Respiratory Tract (1 of 3)
Laryngeal cancer
Forms:
Carcinoma of the true vocal cords (most common)
Supraglottic
Subglottic (rare)
Hoarseness, dyspnea, and cough
Malignancies of the Respiratory Tract (2 of 3)
Redrawn from del Regato JA et al: Ackerman and del Regato’s cancer, ed 2, St Louis, 1985, Mosby.
Malignancies of the Respiratory Tract (3 of 3)
Lung cancer
Nearly 80% caused by cigarette smoking
Smokers with COPD have even greater risk
Environmental, occupational, and genetic risk factors are also associated
Types:
Non–small cell cancer:
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma
Small cell lung carcinoma—from neuroendocrine tissue
Question 4
A patient has right ventricular enlargement secondary to pulmonary hypertension. Which of the following would be the most likely diagnosis?
Cor pulmonale
Acute bronchitis
Pulmonary embolism
Pulmonary thromboembolism
Note: No input needed to proceed
45
Question 4 Answer
Correct Answer: A
Cor pulmonale consists of right ventricular enlargement and failure. Acute bronchitis is an acute infection or inflammation of the airways. Pulmonary embolism is occlusion of a portion of the pulmonary vascular bed by an embolus. Pulmonary thromboembolism is obstruction of a pulmonary vessel by a thrombus.
46
