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Essentials of Human Diseases and Conditions 4 th edition Margaret Schell Frazier Jeanette Wist Drzymkowski
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Chapter 9 Diseases and Conditions of the Respiratory System
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives Explain the process of respiration. Discuss the causes and medical treatment for (a) the common cold, (b) sinusitis, and (c) pharyngitis. Name the treatment of choice for nasal polyps. Discuss the prognosis of cancer of the larynx.
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.) Define atelectasis and discuss some possible causes. Name some systemic disorders that might cause epistaxis. Compare the clinical pictures of (a) a patient with pulmonary embolism and (b) one with pneumonia.
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.) List some possible causes of pulmonary abscess. Compare legionellosis with Pontiac fever. Explain who is at greatest risk for (a) respiratory syncytial virus pneumonia and (b) histoplasmosis.
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.) List the groups recommended to receive prophylactic use of influenza vaccines. Contrast the pathologic course of acute bronchitis with that of chronic bronchitis. Compare the pathology involved in bronchiectasis with that of pulmonary emphysema.
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.) Name and describe three causes of pneumoconiosis. Explain the difference between pneumothorax and hemothorax. Describe the presenting symptoms of pleurisy. Discuss contributing factors to and concern about the rising prevalence of pulmonary tuberculosis.
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.) Describe the clinical course of infectious mononucleosis. Explain the pathologic changes of the lungs in adult respiratory distress syndrome (ARDS). Name the leading cause of cancer deaths worldwide for both men and women.
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont'd.) Discuss the early findings concerning the threat of a SARS epidemic. List some health hazards of common molds.
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Chapter 9 Lesson 9.1
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Orderly Function of the Respiratory System
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Respiration Maintains life by supplying oxygen to organs, tissues and cells and allows removal of carbon dioxide. External respiration - in the lungs, oxygen inhaled from the air is exchanged with carbon dioxide from the blood. Internal respiration - exchange of gases between the blood and tissue cells
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Respiration (cont’d.) Pulmonary circulation Pulmonary arteries - carry deoxygenated venous blood from the heart to the lungs Pulmonary capillaries - where gas exchange occurs Pulmonary veins - return the freshly oxygenated blood to the heart for systemic circulation
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Orderly Function of the Respiratory System (cont'd.)
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Causes: Infection Circulatory disorders Tumors Trauma Immune diseases Inflammatory disturbances Congenital defects Central nervous system damage or diseases Environmental conditions Diseases of the Respiratory System
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Chest pain Dyspnea (difficulty breathing) Productive or nonproductive cough (acute or chronic) Hemoptysis (spitting up blood) Dysphonia (hoarseness) Chills Low- or high-grade fever Wheezing Fatigue Symptoms of Respiratory Disorder
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Common cold: acute inflammatory process that affects the mucous membrane that lines the upper respiratory tract Sinusitis: acute or chronic inflammation of the mucous membranes of the paranasal sinuses Upper Respiratory Tract Infections
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pharyngitis: acute or chronic infection of the pharynx Laryngitis: inflammation of the larynx, including the vocal cords Upper Respiratory Tract Infections (cont'd.)
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Sinusitis Treatments for Sinusitis Broad-spectrum antibiotics Decongestants Antihistamines
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pharyngitis Causes: Viral infections - often an extension of bacterial streptococcal infection from tonsils, adenoids, nose, or tonsils (particularly in children) May be secondary to systemic viral infection such as chickenpox or measles
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Nasal Disorders Deviated septum: crooked nasal septum (cartilage partition between the nostrils) Nasal polyps: benign growths that form as consequence of distended mucous membranes protruding into the nasal cavity
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Nasal Disorders (cont'd.) Anosmia: impairment or loss of the sense of smell Epistaxis (nosebleed): hemorrhage from the nose
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Nasal Polyps Nasal Polyps - benign growths that form as a consequence of distended mucous membranes protruding into nasal cavity Causes: overproduction of fluid in the cells of the mucous membrane, often the result of allergic rhinitis
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Epistaxis (nosebleed) First aid: Mild hemorrhage - controlled by applying direct, constant pressure on either side of nose for 5 to 10 minutes Persistent bleeding - treated with local application of epinephrine followed by cauterization or nasal packing Severe - surgical ligation of bleeding artery
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Disorders of the Larynx Tumors of the larynx: benign or malignant growths on the larynx Laryngeal cancer: neoplasm of the larynx The larynx is the most common site for head and neck tumors
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Atelectasis Atelectasis (collapsed lung): airless or collapsed state of the pulmonary tissue Caused by an obstruction in bronchial tree; may be mucous plug, foreign object, or bronchogenic cancer Complication – pneumonia Risk factors: obesity, upper abdominal or chest surgery, neuromuscular weakness or any pulmonary disease
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Disorders Pulmonary embolism: occurs when a blood clot or other material, such as a foreign body or tumor, lodges in and blocks an artery in the pulmonary circulation Pneumonia: inflammation of the lungs due to infection
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Embolism Occurs when embolism is lodged in artery and interrupts blood supply Uncomplicated embolism - cough, chest pain, low- grade fever and apprehension More extensive - dyspnea, tachypnea (at least 20 breaths/minute), chest pain, occasional hemoptysis Massive embolism - sudden onset of cyanosis, shock and death
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumonia Causes of Pneumonia: Bacterial infection- Pneumococci Staphylococci Group A hemolytic streptococci Haemophilus influenzae type B Klebsiella pneumoniae types 1 and 2 Atypical pneumonia caused by legionella, mycoplasma and chlamydia agents
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumonia (cont’d.) Causes of Pneumonia: Virus Adenoviruses Influenza viruses Syncytial viruses May also be caused by damage to lungs, such as inhalation of poisonous gas such as chlorine or aspiration of foreign matter
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Chapter 9 Lesson 9.2
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Severe acute respiratory syndrome (SARS): Highly contagious new mutation of the Corona virus Symptoms: Sudden onset of fever Mild sore throat Muscle aches Dry, unproductive cough Severe Acute Respiratory Syndrome
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Common molds: fungal growths that grow naturally indoors or outdoors, especially where there is a constant supply of moisture Health Hazards of Common Molds
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Home: professional cleaning and/or reconstruction Cleaning with weak bleach and water solution (1:10) Discard moldy items Ensuring adequate ventilation, using paint with mold inhibitors, cleaning bathrooms with mold killing products, promptly removing flooded carpets Methods of Preventing Mold Growth
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Disorders Pulmonary abscess: area of contained infectious material in the lung Causes: Often a complication of pneumonia caused by bacteria Aspiration of food, foreign object, bronchial stenosis or neoplasms Septic embolism is carried to lung via pulmonary circulation
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Disorders (cont'd.) Legionellosis (Legionnaires disease): pneumonia caused by the bacterium Legionella pneumophila Pontiac fever: milder form of legionellosis
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pulmonary Disorders (cont'd.) Respiratory syncytial virus pneumonia (RSV): inflammatory and infectious condition of the lungs Histoplasmosis: fungal disease originating in the lungs caused by inhalation of dust containing Histoplasma capsulation
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Groups at risk for RSV Children younger than three years old Elderly individuals Patients with compromised respiratory systems Infants who were premature or who have a congenital cardiac defect or preexisting pulmonary disorder
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Influenza Influenza: Highly contagious, acute viral disease that occurs in annual outbreaks
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Influenza (cont’d.) At risk of complications of influenza: Persons over 50 years of age Residents of nursing homes Patients with chronic pulmonary cardiac disorder (including asthma) Patients with chronic metabolic disease (diabetes), renal dysfunction, hemoglobinopathies, immunosuppression Children and teens receiving long-term aspirin Health care employees
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute and chronic bronchitis: inflammation of the mucous membrane lining the bronchi COPD includes: Chronic bronchitis Bronchiectasis Asthma Emphysema Cystic fibrosis pneumoconiosis Chronic Obstructive Pulmonary Disease (COPD)
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute and Chronic Bronchitis Acute - symptoms subside within a week, cough may continue for 2-3 weeks Physical signs within lungs are few or absent Chronic - inflammation persists and worsens, often occurs after colds or flu Obstructive and asthmatic symptoms appear Dyspnea, scattered rales and wheezing
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Chronic Obstructive Pulmonary Disease (cont'd.)
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Effects of Smoking Cancer of oral cavity, larynx, esophagus Lung cancer Peptic ulcer Chronic bronchitis Emphysema Myocardial infarction Systemic atherosclerosis Cancer of pancreas Cancer of bladder
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 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 Chronic Obstructive Pulmonary Disease (cont'd.)
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Causes of Bronchiectasis Pneumonia Recurrent airway infections Tuberculosis Bronchial obstruction Inhalation of corrosive gas Complication of cystic fibrosis or other childhood infection such as measles and pertussis Immune deficiency
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumoconiosis: any disease of the lung caused by long-term dust inhalation Chronic Obstructive Pulmonary Disease (cont'd.)
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Chapter 9 Lesson 9.3
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pleurisy Pleurisy (pleuritis): inflammation of membranes surrounding the lungs and lining the pleural cavity Symptoms Sharp, needle-like pain that increases with inspiration and coughing May also experience fever, chills, and shallow breathing
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pleurisy (cont’d.) Wet - when fluid is present, causes compression of pulmonary tissue and dyspnea Dry - pleura fluid decreases in volume, resulting in dryness between the pleura; layers rub together and become congested and edematous
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumothorax and Hemothorax Pneumothorax: collection of air or gas in the pleural cavity that results in a collapsed or partially collapsed lung Hemothorax: accumulation of blood and other fluids in the pleural cavity
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pneumothorax Symptoms of Collapsed Lung Severe shortness of breath Sudden sharp chest pain Falling blood pressure Rapid weak pulse Shallow and weak respirations May be cyanotic and anxious
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Tuberculosis Pulmonary tuberculosis: chronic, acute, or subacute infection of the lungs by Mycobacterium tuberculosis Acquired by inhaling a dried droplet nucleus that contains the tubercle bacillus
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Infectious Mononucleosis Infectious mononucleosis (Epstein-Barr virus infection): acute herpesvirus infection (glandular fever) Symptoms: Lymphadenopathy Fever that typically peaks in afternoon Listlessness, malaise, chills, anorexia Sore throat, fever, headache, fatigue, and cervical generalized lymphadenopathy
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Adult respiratory distress syndrome (ARDS): severe pulmonary congestion characterized by acute respiratory distress and hypoxemia Symptoms: Sudden, severe dyspnea with rapid, shallow respirations Inspiratory intercostals and suprasternal retractions along with cyanosis or mottled skin May also have rales, rhonchi and wheezes Adult Respiratory Distress Syndrome
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. ARDS - trauma causes increased capillary permeability in the lungs, pulmonary edema, and resulting respiratory failure Alveoli fill within 12 - 24 hours of injury, and then tend to collapse at end of expiration, leaving less pulmonary tissue for gas exchange Result: low pulmonary compliance, pulmonary hypertension, hypoxemia Adult Respiratory Distress Syndrome (cont’d.)
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Lung Cancer Lung cancer: cancerous condition caused by repeated carcinogenic irritation to bronchial epithelium, leading to increased rates of cell division Leading cause of death worldwide in both men and women, 30% of all cancer deaths
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Lung Cancer (cont’d.) 4 major types: Non-small cell lung cancer (NSCLC) Squamous cell carcinoma - 30% of all lung cancers Adenocarcinoma - 40% Large cell carcinoma - 10% Small cell lung cancer (SCLC) - occurs almost exclusively in smokers Small cell carcinoma - 20%
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Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Lung Cancer (cont’d.) Prognosis for patients with lung cancer is generally poor 5-year for all stages and types of lung cancer combined is 15% Prevention: Cessation of smoking Cessation of smoking Avoidance of exposure to second hand smoke Avoidance of exposure to second hand smoke
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