RESPIRATORY FUNCTION

I. Infection Disorders:

UPPER RESPIRATORY TRACT INFECTION (URTI)

1. INFECTION RHINITIS (التهاب مخاطية الأنف)

Refer to viral like coronavirus/adenovirus/rhinovirus (most frequent). Or cold (common).

There are more than 100 causative organisms, making it difficult to develop immunity.

Organism invades Epithelial Lining of the nasal mucosa.

Mild inflammation occurs; leads to nasal discharge, mucus production and shedding

epithelial cell.

(This physical and chemical barrier of resp. tract increase vulnerability to bacterial

invasions)

Secondary bacterial bacterial infection are commonly associated with viral infection, this

risk increase with chronic damage mucosa and cilia in smoking. (Bacterial inf.: otitis media,

rhinosinusitis, bronchitis, pneumonia) and its Complication for Rhinitis.)

Transmission way is close physical contact especially hand contact, that increase in rainy

and cold weather because of confined space.

Virus is highly contagious because it is eliminated in large numbers by the nasal mucosa,

and the virus can survive for several hours outside the body.

Incubation period is 2-7 days.

Diagnosis is based on symptoms.

2. RHINOSINUSITIS ( جيوب الأنفيةالتهاب ال )

Sinusitis: inflammation of the sinus cavities. (Rarely occurs without rhinitis)

Rhinosinusitis: rhinitis and sinusitis.

Caused by:

1. Virus (rhinovirus, influenza, adenovirus)

2. Bacteria (streptococcus pneumonia)

3. Fungi (Aspergillus)

Sign and Symptom

Sneezing Chills Headache Hoarseness Mild fever Sore throat

Nasal

congestion

Clear nasal

discharge

Lacrimation

(eye tearing)

Cough

(nonproductive)

Malaise Myalgia

Risk factor:

1. Environment (smoke)

2. Immunocompromised status (HIV infection)

3. Condition ↑ mucus production (asthma)

4. Nasal structural abnormality (nasal polyps)

Can be result of secondary bacterial infection (Allergic Rhinitis) which the drainage from

the sinus cavity has become blocked.

Streptococcus pneumonia and Hemophilus influenzae found in the upper airways of healthy

people.

Drainage accumulation provide good medium for bacterial growth.

Type:

1. Acute: up to 4 weeks.

2. Subacute: 4-12 weeks.

3. Chronic: more than 12 weeks, continue for months or years.

4. Recurrent: several attacks occur within year.

Complication:

1. Orbital cellulitis ( التهاب النسيج الخلوي)

2. Meningitis

3. Osteomyelitis

4. Abscess

Sign and symptom

Facial bone pain and

headache

Hyposmia (↓ ability to

smell)

Halitosis (foul-

smelling breath)

Purulent nasal

discharge

Nasal congestion Mouth breathing Fever and Malaise Sore throat

As exudate accumulates, pressure builds in sinus cavity which cause Facial bone pain and headache.

Location of pain can indicate which sinus is affected.

Diagnostic procedures include a history, physical examination, nasal cultures, sinus X-ray,

sinus computerized tomography (CT), and sinus transillumination.

3. EPIGLOTTITIS

Life-threatening condition of the epiglottis.

Causes include:

1. Group A beta hemolytic Streptococcus, Streptococcus pneumonia, and

Staphylococcus aureus. (common)

2. Throat trauma from events such as drinking hot liquids, swallowing a

foreign object, a direct blow to the throat, or smoking crack or heroin.

The inflammatory response that is triggered by these events causes the epiglottis to

quickly swell and block the air entering the trachea, leading to respiratory failure.

The bacteria can also travel to the bloodstream, leading to sepsis, which is also life

threatening.

Onset of clinical manifestations is typically rapid in children, developing in a matter of

hours, but occurs more slowly in adults, over a few days.

Diagnostic procedure includes visualization of the throat by a fiber-optic camera, x-ray,

cultures, ABGs, and CBC.

4. LARYNGITIS

Inflammation of the larynx that is usually a result of an infection, increased upper

respiratory exudate, or overuse. (Viral infections are the most common cause.)

Laryngitis can also be associated with croup and epiglottitis.

The vocal cords become irritated and edematous because of the inflammatory

process, this inflammation distorts sounds, leading to hoarseness and in some cases

making the voice undetectable. Maybe, the airway can become blocked.

Sign and symptom

High fever Chills and shaking Dysphagia

Drooling with the mouth open Sore throat and hoarseness Mild inspiratory stridor

Sign and symptom

Hoarseness & Dry

cough

Leukocytosis (if

bacterial)

Sore, dry throat Swollen nodes of

the neck

Difficulty

breathing (in

children

Tickling sensation

and raw feeling in

the throat

Weak voice or voice

loss

Difficulty

breathing

(in children)

Diagnostic procedures for laryngitis include a history, physical examination, CBC, and

laryngoscopy. A biopsy may be conducted if symptoms persist, because throat cancer can

mimic acute laryngitis.

3. LARYNGO-TRACHEO-BRONCHITIS OR CROUP

Common viral infection in children 3 months to 3 years of age (Other children and adults may

infected).

Affects the larynx and trachea, but it may sometimes extend to the bronchi.

Croup was once a deadly disease caused by diphtheria bacteria. Now it’s mild but still be

dangerous.

Causative agents include:

❖ Parainfluenza viruses, adenoviruses, and respiratory syncytial virus.

❖ Bacterial infections, allergens, and irritants

How it happens?

1. Begins as an upper respiratory infection with nasal congestion and cough.

2. Larynx and surrounding area swell, leading to airway narrowing and obstruction.

3. Swelling can lead to respiratory failure.

Clinical manifestations worsen at night and usually resolve in about a week.

Sign and symptom

Low-grade fever Nasal congestion Inspiratory stridor Central cyanosis

Mild expiratory

wheezing

Dyspnea & Anxiety Hoarseness Seal-like barking

cough (because of

laryngeal swelling)

Diagnostic procedures for coup consist of a history, physical examination, X-rays (throat),

throat cultures, ABGs. And CBC.

A throat x-ray will reveal a narrowing of the trachea (often referred to as the steeple

sign) in 50% of cases.

4. ACUTE BRONCHITIS

It’s an inflammation of the tracheobronchial tree or large bronchi.

Young children, the elderly, and smokers are at the highest risk.

Caused by:

1. Viruses/most common (e.g., influenza, rhinovirus, respiratory syncytial virus, and

adenovirus).

2. Bacterial invasions (e.g., Streptococcus pneumoniae and Hemophilus influenzae)

3. Irritant inhalation (e.g., smoke, marijuana, pollution, and ammonia)

4. Allergic reactions are less frequent causes.

In acute bronchitis, the bronchial lining becomes irritated and the airways become narrowed

due to the results of the inflammatory process.

Clinical manifestations of acute bronchitis are usually mild and resolve in 7–10 days, but

coughing may linger for several weeks after the infection is resolved.

Sign and symptom

Chest discomfort Malaise Myalgia Dyspnea

Low-grade fever Pharyngitis Productive or

nonproductive

cough

Wheezing

Abnormal lung

sounds

Diagnostic procedures include CBC and chest X-ray.

5. INFLUENZA (FLU)

Its viral infection, viruses are highly adaptive and constantly mutate.

Affect upper and lower respiratory tract.

Type of flu

Type A Type B Type C

-Most common.

-Most serious.

-Cause epidemic deaths.

-subgroup is H1N1 or swine

flu.

-Found in humans and animals

(birds, etc…).

-Epidemic but milder than

type A.

-Found in humans.

- Causes sporadic cases and

minor, local outbreaks.

-Found in humans, pigs, dogs.

Type A flu has been found in aquatic birds for years without causing harm to them.

But mutation flu virus shows in poultry and swine.

Pigs can be infected by avian and human flu, when it infected together, the two types

may exchange genes.

This “reassorted” flu can spread from pigs to humans.

Risk factor:

1. Immunocompromised Pt.

2. Pregnant women.

3. Severely obese.

4. Chronic diseases.

“Often deaths associated with the flu are a result of secondary bacterial pneumonia.”

Incubation period 1–4 days.

Transmission period: (persons can spread the virus for…)

a) Adult: 1 day before symptoms occurs and lasting 4–7 days after.

b) Children: more than 10 days.

c) Young: 6 days before symptoms occurs.

d) Severely immunocompromised persons: for weeks or months.

Flu differs from the common cold in that the flu usually has a sudden onset of symptoms. See table (5-2)

Sign and symptom

Fever Headache Chills Sweating Malaise

Dry cough Body aches Sore throat Nasal congestion Vomiting & diarrhea

• Vomiting and diarrhea more common in children than adult.

• Fever and body aches last 3–5 days, cough and fatigue last 2 or more week.

Diagnostic procedures include a history, physical examinations, rapid flu screen, and flu

culture (a nasal culture that tests for the presence of the virus).

Four types of seasonal flu vaccinations are produced: regular seasonal flu vaccine, high-

dose vaccine, intradermal vaccine, and intranasal flu vaccine.

The vaccines are grown in fertilized chicken eggs for approximately 10 months. So should

not be administered to persons with egg allergies. Also, it should not be given to children

younger than 6 months and people with a history of Guillain- Barre syndrome and people

with active febrile illness should wait to be vaccinated until after the illness resolves.

LOWER RESPIRATORY TRACT INFECTION (LRTI)

1. Bronchiolitis(التهاب القصيبات)

Acute inflammation of the bronchi.

Viral infection: respiratory syncytial virus (RSV). Can also cause by an emerging

paramyxovirus.

➢ Virus infects the bronchioles.

➢ Small airways become inflamed and swollen.

➢ Mucus collects in these airways by inflammatory process.

➢ Combination of edema and mucus prevents airflow into the alveoli.

Risk factor:

a) Children younger than 1 year of age.

b) Fall and winter months.

c) Neonatal prematurity.

d) Asthma family history.

e) Smoke exposure.

Transmission method by contact with or inhalation of infected respiratory droplets.

Sign and symptom

Nasal drainage

and

congestion.

Rhonchi or

rales lung

sound.

Rabid, shallow

respirations.

Labored

breathing.

Dyspnea or

tachypnea.

Fever. Malaise. Tachycardia. wheezing Cough.

Diagnostic procedures include a history, physical examination, chest X-ray, mucus swab,

CBC,and ABGs.

It can progress into atelectasis and respiratory failure.

2. Pneumonia (الاتهاب الرئوي)

Caused by:

Infectious agents (e.g., bacteria, viruses, and fungi)

Injurious agents (e.g., aspiration and smoke).

Streptococcus pneumoniae is responsible for 75% of all cases of pneumonia.

Viral pneumonia is usually mild and heals without intervention, but it can lead to virulent

bacterial pneumonia

Pneumonia is classified based on the causative agent and its location in the lung. See table

(5-4).

Summary for these type:

1) Lobar pneumonia: confined to a single lobe and is described based on the affected lobe.

2) Bronchopneumonia: most frequent, and spread throughout several lobes.

3) Interstitial pneumonia: occurs in the areas between the alveoli.

4) Aspiration pneumonia: inflammatory response increases mucus production, which can in

turn lead to atelectasis and pneumonia.

5) Legionnaires’ disease: caused by Legionella pneumophilia, not contagious, Persons with a

weakened immune system are at highest risk, can be fatal if untreated.

Symptoms appear 10–14 days post exposure (N&V, diarrhea)

6) Mycoplasma pneumoniae: affects people younger than 40 yr. or who live or work in

crowded places, usually mild, but it can be serious.

Symptom is skin rash, arthralgia, and hemolysis.

7) Severe acute respiratory syndrome (SARS): caused by a coronavirus (SARS-CoV),

Transmission through inhalation, close or oral-fecal contact, SARS has high mortality and

morbidity rates, incubation period 2–7 days.

SARS stage:

➢ First stage as flu-like syndrome (e.g., fever, chills …), lasts 3–7 days.

➢ Second stage a dry cough and dyspnea, lungs become damaged, occur several days later,

interstitial congestion and hypoxia progress rapidly.

➢ Third stage liver damage can occur, severe and sometimes fatal respiratory distress can

develop.

8) Middle East respiratory syndrome (MERS-CoV): first reported in Saudi Arabia, spread through

close contact.

Compression of viral and

bacterial pneumonia

viral Bacterial

Cough Nonproductive Productive

Fever Low High

WBC Normal Elevated

Severity Less More

Antibiotic No Yes

Pneumonia is also classified according to where it is acquired.

1) Nosocomial pneumonia: develops more than 48 hours after a hospital admission. Eg: (VAP).

2) Community-acquired pneumonia: acquired outside hospital.

Sign and symptom

Productive or

nonproductive

cough.

Crackles or

rales lung

sounds.

Mental status

changes

(elderly)

Pleuritic pain Pleural rub

Fatigue Dyspnea Fever Chills Leukocytosis

Diagnostic procedures include: A history, physical examination, chest X-ray, sputum culture,

CBC, ABGs, and bronchoscopy.

3. Tuberculosis:

Caused by Mycobacterium tuberculosis.

Transmission through inhalation of tiny infected aerosol droplets (Only people with active

TB can spread the disease).

Risk factor:

1) Weakened immune system (e.g., AIDS and cancer).

2) Malnutrition.

3) DM.

4) Alcoholism.

TB most frequently involves the lungs, it can also affect other organs and tissues (e.g., liver,

brain, and bone marrow).

Stages of TB:

1) Primary TB:

a. Occurs when the bacillus first enters the body.

b. Macrophages engulf the microbe, causing a local inflammatory response.

c. Some bacilli travel to the lymph nodes, activating the type IV hypersensitivity reaction.

d. Lymphocytes and macrophages congregate to form a granuloma.

e. The granuloma contains some live bacilli, forming a tubercle.

f. Caseous necrosis, a cottage cheese–like material, develops in the center of the tubercle

g. An intact immune system can resist this development, so the lesions remain small,

become walled off by fibrous tissue, and calcify.

h. Bacilli can remain dormant and viable in the tubercle for years as long as the immune

system is intact. In this phase, the individual has been infected by the bacilli and remains

asymptomatic.

2) Secondary infection:

When the primary infection can no longer be controlled.

Can spread throughout the lungs and to other organs.

See figure (5-17).

Sign and symptom

Productive cough Night sweats Chills

Hemoptysis (coughing up

blood or bloody sputum)

Fever and Fatigue Unexplained weight loss

Diagnostic procedures include TB skin test, a small amount of a purified protein derivative tuberculin

is injected just below the dermis. If the person has been infected by the bacilli, a local reaction

(e.g. Redness and induration) will occur. Being vaccinated by the BCG or being treated from TB will

produce a false negative reaction. On the other hand, children and immunosuppressed patient will

not have enough ability to generate a positive response.

Also, we use chest X-ray, CT-scan, and Nucleic acid amplification.

II. alterations in ventilation

1. ASTHMA.( الربو)

Chronic, intermittent, reversible airway obstruction.

It is characterized by acute airway inflammation, bronchoconstriction,

bronchospasm, bronchiole edema, and mucus production.

Result from increase urbanization and pollution (smoking).

Risk factors:

• Women more than men. Boys more than girls.

• Lower socioeconomic status.

• Obesity, smoke exposure, and family history

Classified according to cause:

Extrinsic Intrinsic Nocturnal Exercise-induced Occupational Drug-

induced

-Result of

increased

(IgE)

synthesis and

airway

inflammation,

which leads to

mast cell

destruction

and

inflammatory

mediator

release.

-Triggers

include

allergens such

as food,

pollen, dust,

and

medications.

-Presents in

childhood or

adolescence.

-Not an

allergic

reaction.

- Triggers

include upper

respiratory

infections, air

pollution,

emotional

stress, smoke,

exercise, and

cold exposure.

- Presents

after age 35

years

-Related to

circadian rhythms.

- at 3:00 - 7:00

a.m

-Cortisol and

epinephrine levels

decrease, while

histamine levels

increase. Changes

in these naturally

occurring

substances lead to

bronchoconstricti

on.

-more common

-10–15 minutes after

physical activity

ends.

- Symptoms longer

for hour.

Airway be cool and

dry during exercise,

and asthmatic

symptoms is warm

and moisten the

airways. Then

refractory period

begins 30- 90

minutes. (During this

time, if person is

rechallenged with

vigorous exercise,

bronchospasm not

happen)

-Caused by a

reaction to

substances

encountered at

work.

-Symptoms

develop over

time, and

improving away

from work.

-Caused by

aspirin and

can be fatal.

- Aspirin and

other drugs

prevent the

conversion

of

prostaglandi

ns, which

stimulate

leukotriene

release—a

powerful

Broncho

constrictor.

Classified according to severity:

a) Mild intermittent

b) Mild persistent

c) Moderate persistent

d) Severe persistent

“Asthma attacks are the body’s response to bronchial inflammation.”

Stage of acute asthma attack:

• Stage 1 related to bronchospasm and is usually signaled by coughing. Peaking within 15 to

30 minutes, the inflammatory mediators responsible for this stage include leukotrienes,

histamine, and some interleukins.

• Stage 2 peaks within 6 hours of symptom onset. This stage is a result of airway edema and

mucus production. The alveolar hyperinflation causes air trapping. Bronchospasm, smooth

muscle contraction, inflammation, and mucus production combine to narrow the airways.

Sign and symptom

Wheezing Anxiety Cough

Shortness of breath Chest tightness Dyspnea and Tachypnea

Status asthmaticus: life-threatening, prolonged asthma attack that does not respond to usual

treatment.

Diagnostic procedures include: a history, physical examination, pulmonary function tests,

chest X-ray, ABGs, CBC, challenge testing, and allergen testing.

2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). مرض الانسداد الرئوي المزمن

Its irreversible, progressive tissue degeneration and airway obstruction.

Can impair an individual’s ability to work and function independently.

Severe hypoxia and hypercapnia can lead to respiratory failure.

Lead to drive from the need to expel excess carbon dioxide to the need to raise oxygen

levels, and to cor pulmonale.

Is often asymptomatic in its early stages or is masked by smoking symptoms. ( Symptoms

usually present around 60 years of age)

COPD is often one of or a mixture of two diseases (chronic bronchitis and emphysema)

Risk factor:

• Cigarette smoking.

• Inhalation of pollution and chemical irritants.

• Women.

• Individuals of lower socioeconomic status. Or persons with a history of asthma.

3. CHRONIC BRONCHITIS.(التهاب الشعب الهوائية المزمن)

Its inflammation of the bronchi, a productive cough, and excessive mucus production.

Differs from acute bronchitis is not necessarily caused by an infection and symptoms

persist longer.

Major risk factor is cigarette smoking.

The inflammatory response results in mucous gland hyperplasia, edema, excessive mucus

production, bronchoconstriction, and cough in defense against inhaled irritants. So Airway

resistance affects inspiratory and expiratory air flow.

Impaired pulmonary defenses (e.g., cilia damage and decreased phagocytic activity)

result in frequent respiratory infections and, in some cases, respiratory failure.

Sign and symptom

Hypoventilation Hypoxemia Hypercapnia Polycythemia

Cyanosis (blue bloater) Wheezing and rhonchi Chest pain & Dyspnea Weight gain

Edema Fever Malaise Clubbing of fingers

Diagnostic procedure for chronic bronchitis consist of a history (persistent, productive

cough for at least 3 months in a year for 2 consecutive years), physical examination, chest

X-ray, pulmonary function tests, ABGs, and CBC.

4. EMPHYSEMA. (انتفاخ الرئة)

It’s a destruction of the alveolar walls, leading to large, permanently inflated alveoli.

Lung tissue normally re-models during periods of growth related to infections, enzymes are

involved in this process to prevent excessive tissue damage.

If Enzyme deficiency from genetic predisposition or smoking, this leading to structural

changes.

Structural changes turns the alveoli into large, irregular pockets with gaping holes, which in

turn limits the amount of oxygen entering the bloodstream, so elastic fibers and surfactant

that normally keep the alveoli open are slowly destroyed, then alveoli collapse during

expiration, trapping air in the lungs.

Coughing is usually not a symptom.

Sign and symptom

Dyspnea upon exertion Tachypnea & Hypercapnia Hypoxia

Diminished breath sounds ↑anterior–posterior thoracic

diameter (1:1)

Anorexia

Wheezing Chest tightness Chest a “barrel” appearance Malaise

Diagnosis are the same procedures that used for chronic bronchitis.

5. CYSTIC FIBROSIS.

Presents at birth (chromosome 7) and it’s Life-threatening.

Related to a protein involved in sodium, chloride, and water cellular transport, lungs and

pancreas are primarily affected

Causes severe lung damage and nutrition deficits.

✓ It changes the cells that produce mucus, sweat, saliva, and digestive

secretions.

✓ As a result, these normally thin secretions become thick and

tenacious.

✓ Rather than lubricating the respiratory tract, the secretions occlude

airways, ducts, and passageways.

Obstruction in airway may leading to permanent damage (Infections are recurrent and

contribute to the progressive lung destruction).

Mucus stagnates, becoming a prime medium for bacterial growth.

Complication:

• Bronchiectasis and emphysema-like changes.

• Respiratory failure (cause of death).

• Cor pulmonale (right-sided heart failure).

Complication in GI system:

• In digestive tract, mucus blocks the intestines, producing a meconium ileus in

the newborn.

• Blocks pancreas ducts, leading to a pancreatic enzyme excretion deficit

• Malabsorption and malnutrition develop

• Trapped digestive enzymes lead to damage pancreatic tissue.

• Disease may happen: Diabetes mellitus and osteoporosis. //Cirrhosis and Electrolyte

imbalances. //Sterility and infertility.

Sign and symptom appear at birth and progressively worsen throughout the life span.

Sign and symptom

Meconium ileus Salty skin & Fatigue Steatorrhea Voracious appetite

Hypoxia & Dyspnea Digital clubbing Activity intolerance Delayed growth and

development

Fat-soluble vitamin

deficiency

Chronic cough with

tenacious sputum

Frequent respiratory

infections

Audible rhonchi and

wheezing

Diagnostic procedure can be done prenatally, at age of 2-3 weeks sweat analysis can be

conducted, the delta F 508 test is used to detect chromosome 7 mutation and is done if a

false negative sweat test is suspected, stool can be conducted to detect pancreatic content,

X-rays, pulmonary function tests, and ABGs.

6. LUNG CANCER.

Second most often diagnosed cancer. (Smoking)

Lung cancers are divided into two types:

1. Small-cell carcinoma or oat-cell carcinoma: occurs in heavy smokers, is less frequent than

non-small-cell cancers.

2. Non-small-cell carcinoma or bronchogenic carcinoma: most common type of malignant

lung cancer.

Classify of very aggressive lung cancer: squamous cell carcinoma, adenocarcinoma, and

bronchi alveolar carcinoma.

Tumors in the lungs lead to several issues:

• Airway obstruction

• Inflammation of lung tissue, eliciting coughing and contributing to infections.

• Fluid accumulation in the pleural space

• Paraneoplastic syndrome

Sign and symptom

Hemoptysis Dyspnea Anorexia Fatigue Anemia

Chest pain Hoarseness Weight loss Persistent cough or

a change in usual

cough

Frequent

respiratory

infections

Diagnostic procedures for lung cancer include a history, physical examination, chest X-ray,

CT, MRI, bronchoscopy, sputum studies, positron emission tomography- bone scans, and

pulmonary function tests.

7. PLEURAL EFFUSION.

It’s accumulation of excess fluid in the pleural cavity.

Fluid that can accumulate:

1. Exudates (due to inflammation)

2. Transudates (due to ↑ hydrostatic pressure)

3. Blood (due to trauma)

4. Pus (due to infection).

Normally, a very small amount of fluid drained from the lymphatic system is present in this

space to lubricate the constantly moving lungs.

Excessive fluid in the pleural cavity can compress the lung and limit expansion during

inhalation.

Large amounts of fluids can cause the pleural membranes to separate, preventing their

cohesion during inhalation & can also impair venous return in the inferior vena cava and cardiac

filling by putting pressure on those structures.

The result depends on fluid type, location, amount, and accumulation rate.

Inflammation of pleural (pleuritis) is often associated with pneumonia and creates friction in

the pleural membranes.

Diagnostic procedures for pleural effusion include a history, Physical examination, chest X-

ray, CT, ABGs, CBC, and thoracentesis (needle aspiration of fluid) with subsequent

examination of fluid.

8. PNEUMOTHORAX.

It’s air in the pleural cavity.

Can lead to atelectasis (The presence of atmospheric air in the pleural cavity and the

separation of pleural membranes).

Can cause a partial or complete collapse of a lung.

Large pneumothorax requires aggressive treatment to remove the air and reestablish

pulmonary negative pressure. However small pneumothorax causes mild symptoms and may

heal on its own.

Sign and symptom

Dyspnea Tachycardia Tachypnea Pleural friction rub

(pleurisy

Chest pain

(sharp, worsening

with inhalation)

Tracheal deviation

(toward unaffected

side)

Diminished or absent

lung sounds over

affected area.

Dullness to

percussion over the

affected area

Risk factors:

• Smoking.

• Tall stature.

• History of lung disease or previous pneumothorax.

Types based on their cause:

1. Spontaneous pneumothorax:

→ When air enters the pleural cavity from an opening in the internal airways.

→ Primary spontaneous pneumothorax occurs when a small air blister (bleb) on the top of

the lung ruptures.

→ A primary spontaneous pneumothorax is usually mild because pressure from the collapsed

portion of the lung may, in turn, collapse the bleb.

→ A secondary spontaneous pneumothorax develops in people with preexisting lung disease (

more severe and even life-threatening )

2. Traumatic pneumothorax:

→ From a blunt or penetrating injury to the chest.

→ Can occur during certain medical procedures, such as chest tube insertion.

3. Tension pneumothorax:

→ Most serious type.

→ Occur when the pressure in the pleural space is greater than the atmospheric pressure.

→ This increased pressure arises due to trapped air in the pleural space or entering air

from a positive-pressure mechanical ventilator.

→ The force of the air can cause the affected lung to collapse completely and shift the

heart toward the uncollapsed lung (Mediastinal shift)

→ Tension pneumothorax progresses rapidly and is fatal if not treated quickly.

Sign and symptom

Chest tightness Anxiety Pallor Hypotension Dyspnea

Sudden chest

pain over the

affected lung.

Trachea and

mediastinum

deviation toward

unaffected side.

Tachypnea &

Tachycardia

↓breath sounds

over the

affected area

Asymmetrical

chest movement

Diagnostic procedures for pneumothorax consist of a history, physical examination, chest

X-ray, CT, and ABGs.

9. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS).

It’s sudden failure of respiratory system, result of fluid accumulation in the alveoli, and it

develops rapidly,

Other names: shock lung, wet lung, stiff lung.

Acute lung injury (ALI) refers to a somewhat less severe form of ARDS.

This condition involves an acute hypoxemia resulting from a systemic event (e.g., trauma,

septicemia, etc…) or a pulmonary event (e.g., toxic gas inhalation, pneumonia, etc…). But not

cardiac event.

Risk factors:

1. Presence of a chronic lung disease.

2. Smoking and alcoholism.

3. Age greater than 65 years.

4. Mechanical ventilation.

How It Happen?

❖ Injury to the alveoli and the capillary membranes leads to the release of chemical inflammatory

mediators.

❖ These mediators increase capillary permeability, promote fluid and protein accumulation in the

alveoli, and damage surfactant producing cells.

❖ These events result in decreased gas exchange, reduced pulmonary blood flow, and limited lung

expansion.

❖ Diffuse atelectasis and reduced lung capacity ensue.

❖ Lung damage progresses as neutrophils migrate to the site, releasing proteases and other

mediators once there.

❖ A hyaline membrane—a thin layer of tissue—forms in the alveoli and causes them to become stiff.

❖ Additionally, increased platelet aggregation promotes micro-emboli development.

❖ If the patient survives, scattered necrosis and fibrosis are apparent throughout the lungs.

Complications: • Respiratory and Renal failure.

• Respiratory and metabolic acidosis.

• Pulmonary fibrosis.

• Pneumothorax.

• Bacterial lung infections.

• Decreased lung function.

• Stress ulcer and Muscle wasting.

• Thromboembolism.

• Memory, cognitive, and emotional issues (due to brain damage as a result of the hypoxia)

Diagnostic procedures for ARDS consist of a history, physical examination, ABGs, chest X-

ray, CT, and CBC.

III. Alteration in ventilation and perfusion

1. ATELECTASIS.

It’s incomplete alveolar expansion or collapse of the alveoli when the walls of the alveoli

stick together.

Caused by:

1. Surfactant deficiencies

2. Bronchus obstruction

3. Lung tissue compression

4. Increased surface tension

5. Lung fibrosis

When alveoli are not filled with air, they shrivel much like raisins

Complication:

• Impair blood flow through the lung.

• Impair gas exchange.

• If small area affected, the respiratory rate will increase in an attempt to control

carbon dioxide levels.

• The larger the area affected, the more severe the symptoms experienced.

• Necrosis, infection (e.g., pneumonia), and permanent lung damage can occur if the alveoli

are not reinflated quickly.

Sign and symptom

Dyspnea Tachypnea Anxiety Tachycardia

Tracheal deviation Restlessness Diminished breath

sounds

Asymmetrical lung

movement

Diagnostic procedures for atelectasis include a history, physical examination, chest X-ray,

CT, bronchoscopy, ABGs, and CBC.

Sign and symptom

Dyspnea & Anxiety Hypotension & Fever Confusion & Lethargy Hypoxia & Cyanosis

Rales and rhonchi lung

sounds.

Productive cough with

frothy sputum

Tachycardia &

Restlessness

Labored (requiring the

use of accessory

muscles), shallow

respirations

2. ACUTE RESPIRATORY FAILURE (ARF)

It’s a life-threatening.

Can result from a variety of disorders (e.g., COPD, asthma, ARDS, etc…)

O2 levels become dangerously low (less than 50 mm Hg) or CO2 levels become dangerously

high (greater than 50 mm Hg).

Low O2 levels observed in ARF are not sufficient to meet the body’s metabolic needs, and

the nervous system quickly becomes affected by the shortage of oxygen.

Respiratory acidosis develops as the carbon dioxide levels rise.

The heart decompensates from the lack of oxygen, which could lead to cardiac arrest. And

Respiratory arrest may occur.

Hypoxia and acidosis trigger a reflex Pulmonary Vasoconstriction, further Impairing Gas Exchange and Increasing

Cardiac Workload.

Sign and symptom

Shallow respirations Headache Tachycardia

Dysrhythmias Lethargy Confusion

Diagnostic procedures for ARF consist of a history, physical examination, ABGs, chest

electrocardiogram (BKG), and CBC.