Upload
frederica-stephens
View
221
Download
0
Tags:
Embed Size (px)
Citation preview
Pulmonary Pulmonary
RT 210 A&P RT 210 A&P
Unit AUnit A
Upper airwayUpper airway
NoseNose Warms, humidifies and filters gasWarms, humidifies and filters gas External opening-naresExternal opening-nares Conchae-nares to nasal pharynxConchae-nares to nasal pharynx Nasal conchae-turbinates, allows Nasal conchae-turbinates, allows
maximum air surface contactmaximum air surface contact Posterior nose is ciliated Posterior nose is ciliated
pseudostratified columnar epithelium pseudostratified columnar epithelium whose purpose is to filter, humidify and whose purpose is to filter, humidify and warmwarm
Upper airwayUpper airway
Mouth – oral cavityMouth – oral cavity Lined with stratified squamousLined with stratified squamous
Upper airwayUpper airway
PharynxPharynx Extends from base of skull to esophagus (about Extends from base of skull to esophagus (about
5 inches)5 inches) The nasal cavities and mouth to the point The nasal cavities and mouth to the point
where the airway and digestive tract separatewhere the airway and digestive tract separate Three partsThree parts
Nasopharynx (behind the nose)Nasopharynx (behind the nose) Aconchae to uvulaAconchae to uvula Lined with pseudostratified ciliated columnar epitheliumLined with pseudostratified ciliated columnar epithelium Purpose: gas conduction to airways, filters and houses Purpose: gas conduction to airways, filters and houses
adenoids (defense)adenoids (defense)
Upper airwayUpper airway
PharynxPharynx Three parts (con’t)Three parts (con’t)
Oropharynx (behind the mouth)Oropharynx (behind the mouth) Uvula to epiglottisUvula to epiglottis Function: defense, holds tonsils, gas conduction, Function: defense, holds tonsils, gas conduction,
food conduction, filtrationfood conduction, filtration Stratified squamous epitheliumStratified squamous epithelium
Upper airwayUpper airway
PharynxPharynx Three parts (con’t)Three parts (con’t)
Laryngopharynx (below the hyoid bone Laryngopharynx (below the hyoid bone behind the larynx)behind the larynx) Lined with stratified squamous epitheliumLined with stratified squamous epithelium Function: gas and food conductionFunction: gas and food conduction Larynx divides upper and lower airway at the Larynx divides upper and lower airway at the
vocal cordsvocal cords Opening to larynx at the glottisOpening to larynx at the glottis
Lower AirwayLower Airway
LarynxLarynx Functions:Functions:
Conduct gasConduct gas Protect lower airwayProtect lower airway CoughCough SpeechSpeech
Extends from c-3 to c-6Extends from c-3 to c-6
Lower AirwayLower Airway
Larynx (cont)Larynx (cont) Unpaired cartilageUnpaired cartilage
Epiglottis covers the superior larynx Epiglottis covers the superior larynx opening on swallowing, preventing food opening on swallowing, preventing food from entering tracheafrom entering trachea
Thyroid - adam’s appleThyroid - adam’s apple Cricoid - only complete ring of cartilageCricoid - only complete ring of cartilage
Lower AirwayLower Airway
Larynx (cont)Larynx (cont) Paired cartilagePaired cartilage
Arytenoid - allows vocal cord movementArytenoid - allows vocal cord movement Corniculate-supports walls of the larynxCorniculate-supports walls of the larynx Cuneiform-connect epiglottis to the Cuneiform-connect epiglottis to the
arytenoid cartilagearytenoid cartilage
Tracheobronchial TreeTracheobronchial Tree
Functions for air conductionFunctions for air conduction Pseudostratified ciliated columnar Pseudostratified ciliated columnar
epitheliumepithelium Layers (change further down T.B. tree):Layers (change further down T.B. tree):
Cartilaginous layerCartilaginous layer Lamina propria - contains vessels and Lamina propria - contains vessels and
nerves epitheliumnerves epithelium
Tracheobronchial TreeTracheobronchial Tree
Trachea (generation 0)Trachea (generation 0) Approximately 4.5 - 5.5 inches in length, or Approximately 4.5 - 5.5 inches in length, or
10-12 cm10-12 cm Approximately 1 inch in diameter, or 2-2.5 cmApproximately 1 inch in diameter, or 2-2.5 cm 16-20 c-shaped cartilage rings prevent 16-20 c-shaped cartilage rings prevent
collapsecollapse Anterior to esophagusAnterior to esophagus Ciliated pseudostratified columnar epitheliumCiliated pseudostratified columnar epithelium Divides at carina into 2 mainstem bronchusDivides at carina into 2 mainstem bronchus
Tracheobronchial TreeTracheobronchial Tree
Mainstem Bronchus (generation 1)Mainstem Bronchus (generation 1) RightRight
20-30 degree angle – less acute angle20-30 degree angle – less acute angle Shorter and wider than leftShorter and wider than left
LeftLeft 40-60 degree angle – more acute angle40-60 degree angle – more acute angle Smaller and longer than rightSmaller and longer than right Structurally similar to tracheaStructurally similar to trachea
Tracheobronchial TreeTracheobronchial Tree
Lobar bronchi (generation 2)Lobar bronchi (generation 2) Right mainstem divides into 3 lobar Right mainstem divides into 3 lobar
divisions (accommodates 3 lobes)divisions (accommodates 3 lobes) UpperUpper MiddleMiddle LowerLower
Left mainstem divides into 2 lobar (2 lobes)Left mainstem divides into 2 lobar (2 lobes) UpperUpper LowerLower
Tracheobronchial TreeTracheobronchial Tree
Segmental Bronchi (generation 3) are Segmental Bronchi (generation 3) are named to the segments they representnamed to the segments they represent Right upper lobeRight upper lobe
ApicalApical PosteriorPosterior AnteriorAnterior
Right middle lobeRight middle lobe LateralLateral MedialMedial
Tracheobronchial TreeTracheobronchial Tree
Segmental Bronchi (generation 3) are Segmental Bronchi (generation 3) are named to the segments they representnamed to the segments they represent Right lower lobeRight lower lobe
SuperiorSuperior Medial basalMedial basal Anterior basalAnterior basal Lateral basalLateral basal Posterior basalPosterior basal
Tracheobronchial TreeTracheobronchial Tree Segmental Bronchi (generation 3) are Segmental Bronchi (generation 3) are
named to the segments they representnamed to the segments they represent Left upper lobeLeft upper lobe
Apical-posterior* (upper division)Apical-posterior* (upper division) Anterior (upper div.)Anterior (upper div.) Superior lingula (lower div.)Superior lingula (lower div.) Inferior lingula (lower division)Inferior lingula (lower division)
Left lower lobeLeft lower lobe SuperiorSuperior Anteromedial*(antero basal)Anteromedial*(antero basal) Lateral basalLateral basal Posterior basalPosterior basal **Some authors feel that the left lung should be numbered so Some authors feel that the left lung should be numbered so
that there are eight segments, the apical-posterior is that there are eight segments, the apical-posterior is numbered 1 and anteromedial is numbered 6 numbered 1 and anteromedial is numbered 6
Tracheobronchial TreeTracheobronchial Tree
Subsegmental bronchi (generation #4-Subsegmental bronchi (generation #4-9)9) Diameter from 1-4 mmDiameter from 1-4 mm Tubes greater than 1 mm with connective Tubes greater than 1 mm with connective
tissue are bronchitissue are bronchi Bronchioles (generation # 10-15)Bronchioles (generation # 10-15)
Less than 1 mmLess than 1 mm No connective tissueNo connective tissue Decreasing number of goblet cell/ciliaDecreasing number of goblet cell/cilia Ciliated cuboidal epitheliumCiliated cuboidal epithelium
Tracheobronchial TreeTracheobronchial Tree
Terminal bronchioles (generation# 16)Terminal bronchioles (generation# 16) About 0.5mm in diameterAbout 0.5mm in diameter Cuboidal epithelium to squamous Cuboidal epithelium to squamous
epitheliumepithelium Clara cells may secrete mucous/surfactantClara cells may secrete mucous/surfactant End of conducting airwaysEnd of conducting airways Canals of LambertCanals of Lambert
Parenchyma of the LungParenchyma of the Lung
PurposePurpose Gas exchange between alveolar air/bloodGas exchange between alveolar air/blood called external respirationcalled external respiration
Start at the respiratory bronchiolesStart at the respiratory bronchioles Generation #17-19Generation #17-19 Gas exchange is beginning to occurGas exchange is beginning to occur Some cuboidal but mostly squamousSome cuboidal but mostly squamous
Alveolar Ducts (generation Alveolar Ducts (generation #20-22)#20-22)
Alveoli separated by septal wallsAlveoli separated by septal walls
Alveolar Sacs (generation Alveolar Sacs (generation #23)#23)
Clusters of 15-20 alveoliClusters of 15-20 alveoli Walls are other alveoliWalls are other alveoli
AlveoliAlveoli
Air spaces that contain capillary wallsAir spaces that contain capillary walls Approximately 300-600 million totalApproximately 300-600 million total Simple squamous epitheliumSimple squamous epithelium Alveolar communication – pores of Alveolar communication – pores of
Kohn (collateral ventilation)Kohn (collateral ventilation)
Three types of alveolar cellsThree types of alveolar cells
Type IType I Squamous epithelium – thin and flatSquamous epithelium – thin and flat 95% of alveolar cells95% of alveolar cells Allows gas diffusionAllows gas diffusion
Type II (Clara Cells)Type II (Clara Cells) High metabolic rateHigh metabolic rate Produce surfactantProduce surfactant
Type IIIType III Pneumocystic macrophagesPneumocystic macrophages Ingest and eliminates foreign bodiesIngest and eliminates foreign bodies
The LungThe Lung
LocationLocation In thoraxIn thorax Surrounds heart in mediastinumSurrounds heart in mediastinum Superior to the diaphragmSuperior to the diaphragm Surrounded by pleura in the thoraxSurrounded by pleura in the thorax
Parietal pleura - on the thoraxParietal pleura - on the thorax Visceral pleura - on the lungVisceral pleura - on the lung Small potential space between the two Small potential space between the two
filled with small amount of serous fluid filled with small amount of serous fluid which decreases friction which decreases friction
StructureStructure
Upper lungUpper lung Apices – apexApices – apex Extends 1-2 inches above clavicleExtends 1-2 inches above clavicle Root or hilum is attachment of mainstem Root or hilum is attachment of mainstem
bronchus and arteriesbronchus and arteries
BaseBase Shape is concave due to diaphragmShape is concave due to diaphragm Right side is higher than the left due to the Right side is higher than the left due to the
liverliver
StructureStructure
Bony thoraxBony thorax Surrounds and protects the lungSurrounds and protects the lung Aids in ventilation Aids in ventilation
SternumSternum 18 cm long18 cm long PartsParts
Manubrium - superior portionManubrium - superior portion Body or Gladiolus - middle portionBody or Gladiolus - middle portion Xiphoid process – inferior portionXiphoid process – inferior portion
Notch above is the suprasternal notchNotch above is the suprasternal notch Trachea is palpable behind itTrachea is palpable behind it
StructureStructure
Sternum (cont)Sternum (cont) Junction of manubrium and body is the Junction of manubrium and body is the
Angle of LouisAngle of Louis The point of tracheal bifurcation (carina)The point of tracheal bifurcation (carina)
True ribsTrue ribs Pairs 1-7Pairs 1-7 Connect directly to the sternumConnect directly to the sternum
False ribsFalse ribs Pairs 8-10Pairs 8-10 Connect to the sternum indirectly via the costal Connect to the sternum indirectly via the costal
cartilagecartilage
StructureStructure
Sternum (cont)Sternum (cont) Floating ribsFloating ribs
Pairs 11 and 12Pairs 11 and 12 No attachment to sternum or other ribsNo attachment to sternum or other ribs May also be called false ribsMay also be called false ribs
StructureStructure
MediastinumMediastinum HeartHeart Great vesselsGreat vessels TracheaTrachea EsophagusEsophagus Thymus glandThymus gland Lymphatic structuresLymphatic structures NervesNerves ThymusThymus
Mucus Production and Mucus Production and Movement Movement
Goblet CellsGoblet Cells In the surface of the tracheobronchial treeIn the surface of the tracheobronchial tree Secrete mucusSecrete mucus
Submucosal GlandsSubmucosal Glands Below the lamina propriaBelow the lamina propria Secrete mucus & bronchial secretionsSecrete mucus & bronchial secretions
Mucus CompositionMucus Composition 95% water95% water 2% glyco protein2% glyco protein 1 % carbohydrate1 % carbohydrate
Mucus Production and Mucus Production and Movement Movement
Mucus Composition (cont)Mucus Composition (cont) Traces of lipid, debris, DNA, and foreign bodiesTraces of lipid, debris, DNA, and foreign bodies 100 – 150 ml produced daily100 – 150 ml produced daily Traps foreign bodiesTraps foreign bodies
Mucus BlanketMucus Blanket Continuous blanket of mucus over the Continuous blanket of mucus over the
tracheobronchial treetracheobronchial tree LayersLayers
Sol layerSol layer * Near the tissue* Near the tissue
* Is more liquid* Is more liquid Gel layerGel layer
* Near air* Near air * Is more thick* Is more thick
Mucus Production and Mucus Production and Movement Movement
Layers (cont)Layers (cont) CiliaCilia
* Hair-like projections* Hair-like projections
* Extend into the sol layer * Extend into the sol layer Mucociliary escalatorMucociliary escalator
* Formed by mucus blanket * Formed by mucus blanket and ciliaand cilia
* Cilia move in a wave like * Cilia move in a wave like fashionfashion
* Moves mucus upward at * Moves mucus upward at 2cm per minute 2cm per minute toward the mouth toward the mouth
* Means to remove the * Means to remove the mucus from the lungmucus from the lung
Mucus Production and Mucus Production and Movement Movement
SputumSputum Mucus, saliva and nasal secretionsMucus, saliva and nasal secretions Mobilized and expelled by coughMobilized and expelled by cough
Alveolar Fluid Alveolar Fluid
SurfactantSurfactant Detergent-like phospholipidDetergent-like phospholipid Decreases surface tensionDecreases surface tension Prevents alveolar collapsePrevents alveolar collapse Continuously produced, secreted, and Continuously produced, secreted, and
eliminatedeliminated
Muscles of VentilationMuscles of Ventilation
DiaphragmDiaphragm Separates thorax and abdomenSeparates thorax and abdomen Muscular hemi-diaphragmsMuscular hemi-diaphragms Normally dome-shapedNormally dome-shaped Right side higher than left due to liverRight side higher than left due to liver Flatten on inspirationFlatten on inspiration Phrenic nerve stimulatesPhrenic nerve stimulates Major muscle of ventilationMajor muscle of ventilation Normal diaphragmatic excursion is 1.5cm Normal diaphragmatic excursion is 1.5cm
during quiet breathingduring quiet breathing May increase to 6-10cm during labored May increase to 6-10cm during labored
ventilationventilation
Muscles of VentilationMuscles of Ventilation
Intercostal MusclesIntercostal Muscles Between ribsBetween ribs 2 layers2 layers
Internal - helps with exhalationInternal - helps with exhalation External - helps with inhalationExternal - helps with inhalation
T- 1 to T- 11 innervationT- 1 to T- 11 innervation External-contraction pulls ribs up and outExternal-contraction pulls ribs up and out
Increases anterior-posterior chest diameter Increases anterior-posterior chest diameter for inspirationfor inspiration
Internal-contraction pulls ribs down and in Internal-contraction pulls ribs down and in for forced expiration for forced expiration
Muscles of VentilationMuscles of Ventilation
Accessory MusclesAccessory Muscles Elevate and stabilize chest for labored Elevate and stabilize chest for labored
breathingbreathing Neck and shoulder musclesNeck and shoulder muscles
ScaleneScalene SternocleidomastoidSternocleidomastoid TrapeziumTrapezium PectoralisPectoralis
Muscles of VentilationMuscles of Ventilation
Expiratory MusclesExpiratory Muscles Normally passiveNormally passive Muscles of forced exhalationMuscles of forced exhalation
External obliqueExternal oblique Rectus abdominusRectus abdominus Internal obliqueInternal oblique Transverse abdominusTransverse abdominus
Types of BreathingTypes of Breathing
EupneaEupnea Normal breathingNormal breathing 12-20 breaths per minute12-20 breaths per minute
Hyperventilation: Rapid and/or deep Hyperventilation: Rapid and/or deep breathingbreathing
Hypoventilation: Slow and/or shallow Hypoventilation: Slow and/or shallow breathingbreathing
Dyspnea: Labored or difficult breathingDyspnea: Labored or difficult breathing Apnea: No breathing occursApnea: No breathing occurs
Types of BreathingTypes of Breathing
Biot’s BreathingBiot’s Breathing Several short breaths followed by long, Several short breaths followed by long,
irregular periods of apneairregular periods of apnea Caused by brain damage and increased ICPCaused by brain damage and increased ICP
Cheyne-Stokes BreathingCheyne-Stokes Breathing Increasing and decreasing depth and rate Increasing and decreasing depth and rate
of respirations followed by periods of of respirations followed by periods of apneaapnea
Caused by CHF, decreased blood flow to Caused by CHF, decreased blood flow to respiratory center, and brain damagerespiratory center, and brain damage
Types of BreathingTypes of Breathing
Kussmaul BreathingKussmaul Breathing Deep gasping type of respirationDeep gasping type of respiration Caused by diabetic acidosisCaused by diabetic acidosis
Tachypnea: Respiratory rate >20 bpmTachypnea: Respiratory rate >20 bpm Bradypnea: Respiratory rate < 12Bradypnea: Respiratory rate < 12
Regulation of BreathingRegulation of Breathing
Medullary Respiratory CenterMedullary Respiratory Center Medulla is lowest part of brain stemMedulla is lowest part of brain stem Contains widely dispersed respiratory Contains widely dispersed respiratory
neuronsneurons Dorsal Respiratory GroupsDorsal Respiratory Groups
Mainly inspiratory neurons Mainly inspiratory neurons Send impulses to diaphragm and external Send impulses to diaphragm and external
intercostals musclesintercostals muscles
Regulation of BreathingRegulation of Breathing
Ventral Respiratory GroupsVentral Respiratory Groups Inspiratory neuronsInspiratory neurons
Abduct vocal cordsAbduct vocal cords Increase diameter of glottisIncrease diameter of glottis Innervate diaphragm and external Innervate diaphragm and external
intercostalsintercostals Expiratory neuronsExpiratory neurons
Send impulses to internal intercostals and Send impulses to internal intercostals and abdominal expiratory musclesabdominal expiratory muscles
Regulation of BreathingRegulation of Breathing Pontine Respiratory CentersPontine Respiratory Centers
Pons is located above the medulla on the Pons is located above the medulla on the brain stembrain stem
Apneustic centerApneustic center Sends signals to promote a prolonged, Sends signals to promote a prolonged,
unrestrained inspirationunrestrained inspiration Vagal and pneumotaxic center impulses hold Vagal and pneumotaxic center impulses hold
the stimulatory effect in checkthe stimulatory effect in check Pneumotaxic centerPneumotaxic center
Controls inspiratory timeControls inspiratory time Strong signals increase respiratory rateStrong signals increase respiratory rate Weak signals prolong inspiration and increase Weak signals prolong inspiration and increase
tidal volumestidal volumes
Reflex Control of BreathingReflex Control of Breathing
Hering-Breuer Inflation ReflexHering-Breuer Inflation Reflex Stretch receptors located in smooth Stretch receptors located in smooth
muscle of large and small airwaysmuscle of large and small airways When stimulated they send a signal via When stimulated they send a signal via
vagus nerve to the medullary center to vagus nerve to the medullary center to stop further inspirationstop further inspiration
In adults it is activated at a tidal volume of In adults it is activated at a tidal volume of about 800 to 1000 mlabout 800 to 1000 ml
CoughCough One of the most common symptoms One of the most common symptoms
associated with lung diseaseassociated with lung disease Powerful protective mechanism for the Powerful protective mechanism for the
lung and airwayslung and airways Caused by mechanical, chemical, Caused by mechanical, chemical,
inflammatory, or thermal stimulation of inflammatory, or thermal stimulation of the cough receptorsthe cough receptors
Made up of three phasesMade up of three phases Inspiratory phaseInspiratory phase Compression phaseCompression phase Expulsion phaseExpulsion phase
CoughCough
Causes and Clinical PresentationCauses and Clinical Presentation Acute cough most often associated with Acute cough most often associated with
viral infection of the upper airwayviral infection of the upper airway Chronic cough often associated with Chronic cough often associated with
postnasal drip, asthma, COPD, postnasal drip, asthma, COPD, gastroesophageal reflux, and left gastroesophageal reflux, and left ventricular failureventricular failure
CoughCough
DescriptionsDescriptions The type of cough present should be The type of cough present should be
documented using commonly accepted documented using commonly accepted adjectives.adjectives. Productive—mucus is produced with the coughProductive—mucus is produced with the cough Effective—a strong coughEffective—a strong cough Weak—ineffectiveWeak—ineffective Dry—no secretions presentDry—no secretions present Chronic productive—patient produces phlegm Chronic productive—patient produces phlegm
most days for at least 3 weeksmost days for at least 3 weeks
Sputum ProductionSputum Production
Sputum is the mucus expelled from the Sputum is the mucus expelled from the tracheobronchial tree that has been tracheobronchial tree that has been contaminated by the mouth.contaminated by the mouth.
Phlegm is the term used to describe Phlegm is the term used to describe mucus strictly from the mucus strictly from the tracheobronchial tree.tracheobronchial tree.
Sputum ProductionSputum Production Causes and DescriptionsCauses and Descriptions
Caused by inflammation of the mucus secreting Caused by inflammation of the mucus secreting glands that line the airwaysglands that line the airways
Inflammation occurs with infection, cigarette Inflammation occurs with infection, cigarette smoke, and allergies.smoke, and allergies.
Sputum should be described as to the color, Sputum should be described as to the color, consistency, quantity, time of day, odor, and consistency, quantity, time of day, odor, and presence of blood.presence of blood.
Thick but clear sputum is consistent with Thick but clear sputum is consistent with dehydration.dehydration.
Pink frothy sputum is consistent with pulmonary Pink frothy sputum is consistent with pulmonary edema.edema.
Thick, purulent (pus-containing) sputum is Thick, purulent (pus-containing) sputum is consistent with infection.consistent with infection.
HemoptysisHemoptysis
CausesCauses Persistent strong coughingPersistent strong coughing Acute infectionAcute infection Bronchogenic carcinomaBronchogenic carcinoma Cardiovascular diseaseCardiovascular disease TraumaTrauma Anticoagulant therapyAnticoagulant therapy
HemoptysisHemoptysis
DescriptionsDescriptions Streaky hemoptysis refers to blood-tinged Streaky hemoptysis refers to blood-tinged
sputum.sputum. Massive hemoptysis refers to more than Massive hemoptysis refers to more than
400 ml of blood in 3 hours or 600 ml in 24 400 ml of blood in 3 hours or 600 ml in 24 hours. It is consistent with trauma, lung hours. It is consistent with trauma, lung cancer, tuberculosis, and bronchiectasis. It cancer, tuberculosis, and bronchiectasis. It also is more common in patients on also is more common in patients on anticoagulant therapyanticoagulant therapy
HemoptysisHemoptysis
Hemoptysis versus HematemesisHemoptysis versus Hematemesis Determining if the blood is from the lung Determining if the blood is from the lung
versus the stomach is important.versus the stomach is important. Blood from the lung is often associated Blood from the lung is often associated
with pulmonary symptoms.with pulmonary symptoms. Blood from the stomach is associated with Blood from the stomach is associated with
GI symptoms (see Table 3-4 CARC p. 33)GI symptoms (see Table 3-4 CARC p. 33)
Shortness of Breath Shortness of Breath (Dyspnea)(Dyspnea)
Dyspnea is a common symptom of Dyspnea is a common symptom of patients with lung or cardiac problems.patients with lung or cardiac problems.
Subjectiveness of DyspneaSubjectiveness of Dyspnea Dyspnea is a subjective complaint that Dyspnea is a subjective complaint that
varies with pathologic and psychological varies with pathologic and psychological variables.variables.
The degree of dyspnea may not correlate The degree of dyspnea may not correlate with objective measures of impairment.with objective measures of impairment.
Dyspnea should always be investigated Dyspnea should always be investigated even if initial tests are normal.even if initial tests are normal.
Shortness of Breath Shortness of Breath (Dyspnea)(Dyspnea)
Dyspnea Scoring SystemDyspnea Scoring System A variety of scoring systems have developed A variety of scoring systems have developed
to help quantify dyspnea at a single point in to help quantify dyspnea at a single point in time to help track changes with treatment.time to help track changes with treatment.
The visual analog scales use a straight line The visual analog scales use a straight line 10 cm long. The patient marks a dash on the 10 cm long. The patient marks a dash on the line consistent with the level of dyspnea line consistent with the level of dyspnea currently experienced.currently experienced.
The Modified Borg Scale uses a 0 to 10 The Modified Borg Scale uses a 0 to 10 scale.scale.
Many other tools are also available. Each has Many other tools are also available. Each has its own advantages and disadvantages.its own advantages and disadvantages.
Shortness of Breath Shortness of Breath (Dyspnea)(Dyspnea)
Causes, Types, and Clinical Presentation of Causes, Types, and Clinical Presentation of DyspneaDyspnea
Dyspnea tends to occur when the patient Dyspnea tends to occur when the patient experiences increased WOB, increased drive to experiences increased WOB, increased drive to breathe, and/or decreased ventilatory capacity.breathe, and/or decreased ventilatory capacity.
The adjectives patients use to describe their The adjectives patients use to describe their dyspnea may correlate with the underlying dyspnea may correlate with the underlying pathology. For example, patients with CHF tend to pathology. For example, patients with CHF tend to feel the sensation of “suffocation.” Asthmatics often feel the sensation of “suffocation.” Asthmatics often describe dyspnea by saying they have “tightness in describe dyspnea by saying they have “tightness in their chest.”their chest.”
Acute dyspnea is associated with acute illnesses Acute dyspnea is associated with acute illnesses such as asthma, pneumonia, pneumothorax, etc.such as asthma, pneumonia, pneumothorax, etc.
Chronic dyspnea is almost always progressive. It is Chronic dyspnea is almost always progressive. It is most often seen in patients with COPD and CHF.most often seen in patients with COPD and CHF.
Shortness of Breath Shortness of Breath (Dyspnea)(Dyspnea)
DescriptionsDescriptions Paroxysmal nocturnal dyspnea (PND) is often seen Paroxysmal nocturnal dyspnea (PND) is often seen
in CHF patients. It is associated with the collection in CHF patients. It is associated with the collection of fluid in the lung during sleep.of fluid in the lung during sleep.
Orthopnea is also associated with CHF.Orthopnea is also associated with CHF. Trepopnea (dyspnea while lying on one side) is less Trepopnea (dyspnea while lying on one side) is less
common but is seen in patients with unilateral common but is seen in patients with unilateral disorders.disorders.
Platypnea (dyspnea in the upright position) is not Platypnea (dyspnea in the upright position) is not common but implies a disorder is present that common but implies a disorder is present that causes increased shunting of blood from right to causes increased shunting of blood from right to left when the upright position is assumed.left when the upright position is assumed.
Egan defines trepopnea & platypnea differently from above with both being in Egan defines trepopnea & platypnea differently from above with both being in the upright position, and platypnea being relieved by the patient lying the upright position, and platypnea being relieved by the patient lying
downdown
Chest PainChest Pain
Chest pain is the cardinal symptom of Chest pain is the cardinal symptom of heart disease.heart disease.
Chest pain may be seen in patients Chest pain may be seen in patients with lung disease when the pleural with lung disease when the pleural lining is abnormal.lining is abnormal.
Classic chest pain associated with Classic chest pain associated with heart disease is known as angina, and heart disease is known as angina, and it signals a medical emergency.it signals a medical emergency.
Chest PainChest Pain Pulmonary Causes of Chest PainPulmonary Causes of Chest Pain
Pain associated with lung disease is most Pain associated with lung disease is most often the result of pleural inflammation.often the result of pleural inflammation.
Pneumonia and pulmonary infarction may Pneumonia and pulmonary infarction may cause pleural pain.cause pleural pain.
DescriptionsDescriptions Chest pain from heart disease is often described Chest pain from heart disease is often described
as aching, squeezing, pressing, or viselike. It as aching, squeezing, pressing, or viselike. It often increases with exercise.often increases with exercise.
Patients with pleuritic chest pain may be leaning Patients with pleuritic chest pain may be leaning toward one side and describe the pain as toward one side and describe the pain as stabbing or burning. They state the pain stabbing or burning. They state the pain increases with deep breathing.increases with deep breathing.
Dizziness and Fainting Dizziness and Fainting (Syncope)(Syncope)
Syncope is a temporary loss of Syncope is a temporary loss of consciousness due to reduced blood consciousness due to reduced blood flow and oxygen to the brain.flow and oxygen to the brain.
Syncope is caused by a large variety of Syncope is caused by a large variety of disorders from something as simple as disorders from something as simple as dehydration to serious cerebral dehydration to serious cerebral thrombosis.thrombosis.
Patients with lung disease who cough Patients with lung disease who cough very forcefully may experience syncope.very forcefully may experience syncope.
Dizziness and Fainting Dizziness and Fainting (Syncope)(Syncope)
DescriptionsDescriptions Some patients experience syncope when Some patients experience syncope when
they suddenly stand up. This is often they suddenly stand up. This is often associated with orthostatic hypotension.associated with orthostatic hypotension.
Cough syncope occurs with severe Cough syncope occurs with severe coughing and is the result of reduced coughing and is the result of reduced venous return due to high intrathoracic venous return due to high intrathoracic pressures.pressures.
Swelling of the Ankles Swelling of the Ankles (Dependent Edema)(Dependent Edema)
Patients with chronic hypoxemia often Patients with chronic hypoxemia often develop right heart failure.develop right heart failure.
Right heart failure leads to reduced venous Right heart failure leads to reduced venous return and increased hydrostatic pressure in return and increased hydrostatic pressure in the peripheral venous blood vessels especially the peripheral venous blood vessels especially in the dependent tissues (e.g., ankles).in the dependent tissues (e.g., ankles).
Ankle edema thus can be a sign of chronic Ankle edema thus can be a sign of chronic lung disease.lung disease.
Ankle edema may also simply be a sign of Ankle edema may also simply be a sign of heart disease not associated with lung diseaseheart disease not associated with lung disease
Swelling of the Ankles Swelling of the Ankles (Dependent Edema)(Dependent Edema)
DescriptionsDescriptions Pitting edema is present when the Pitting edema is present when the
edematous tissue is pressed inward and it edematous tissue is pressed inward and it does not return to its normal position does not return to its normal position immediately.immediately.
Fever, Chills, and Night Fever, Chills, and Night SweatsSweats
DescriptionsDescriptions Sustained fever is a continuously elevated Sustained fever is a continuously elevated
fever that varies little during a 24-hour period.fever that varies little during a 24-hour period. Remittent fever is continuously elevated but Remittent fever is continuously elevated but
has larger variations and spikes in a 24-hour has larger variations and spikes in a 24-hour period.period.
Intermittent fever refers to spikes in body Intermittent fever refers to spikes in body temperature cycling with periods of normal or temperature cycling with periods of normal or subnormal temperatures.subnormal temperatures.
Fever is a concern because it may signal Fever is a concern because it may signal infection and it increases oxygen infection and it increases oxygen consumption.consumption.
Fever, Chills, and Night Fever, Chills, and Night SweatsSweats
Fever with Pulmonary DisordersFever with Pulmonary Disorders PneumoniaPneumonia Lung abscessLung abscess TuberculosisTuberculosis EmpyemaEmpyema A lack of fever does not rule out infection.A lack of fever does not rule out infection.
Headache, Altered Mental Headache, Altered Mental Status, and Personality Status, and Personality
ChangesChanges Lung disease can lead to headache when Lung disease can lead to headache when
chronic hypoxemia or hypercarbia is present.chronic hypoxemia or hypercarbia is present. Sudden changes in personality are common Sudden changes in personality are common
in patients with chronic lung disease and may in patients with chronic lung disease and may be due to hypoxia, medications, or be due to hypoxia, medications, or psychologic issues.psychologic issues.
RTs must be sensitive to personality changes RTs must be sensitive to personality changes because they may be indicative of acute lung because they may be indicative of acute lung problems in the patient with chronic lung problems in the patient with chronic lung diseasedisease
SnoringSnoring Incidence and CausesIncidence and Causes
Snoring occurs in about 5% to 10% of children and Snoring occurs in about 5% to 10% of children and 10% to 30% of adults.10% to 30% of adults.
Snoring is caused by excessive narrowing of the Snoring is caused by excessive narrowing of the upper airway with breathing during sleep. The upper airway with breathing during sleep. The airway narrowing increases with inspiration and airway narrowing increases with inspiration and lessens during exhalation.lessens during exhalation.
Obesity is the most common cause of obstructive Obesity is the most common cause of obstructive sleep apnea.sleep apnea.
Enlarged tonsils, a large tongue, a short thick neck, Enlarged tonsils, a large tongue, a short thick neck, and nasal obstruction may contribute to the upper and nasal obstruction may contribute to the upper airway narrowing during sleep.airway narrowing during sleep.
Alcohol and sleeping medications can also make Alcohol and sleeping medications can also make snoring worsesnoring worse
SnoringSnoring
Clinical PresentationClinical Presentation Patients with obstructive sleep apnea Patients with obstructive sleep apnea
always snore during sleep.always snore during sleep. OSA patients will complain of excessive OSA patients will complain of excessive
daytime sleepiness because their sleep daytime sleepiness because their sleep continuity is abnormal.continuity is abnormal.
OSA patients may also complain of poor OSA patients may also complain of poor concentration skills, bedwetting, concentration skills, bedwetting, impotence, high blood pressure, and other impotence, high blood pressure, and other complaintscomplaints