Module 4 – respiratory system

Key Terms

 Acute bronchitis: is an acute infection or inflammation of the airways or

bronchi and is usually self-limiting.

 Asthma: obstruction is caused by exacerbation episodes of bronchial

inflammation, bronchiole mucosal oedema, bronchospasm and increased

mucus production.

 Bronchiolitis: is a rather common, viral-induced lower respiratory tract

(bronchiolar) infection that occurs almost exclusively in infants and young

toddlers.

 Chronic bronchitis: is a chronic infection or inflammation of the airways or

bronchi

 Chronic obstructive pulmonary disease (COPD): is a syndrome that

includes the pathological lung changes consistent with emphysema, chronic

bronchitis or chronic asthma.

 Croup: is an acute inflammation of the upper airways and almost always

occurs in children between 6 months and 5 years of age. In 85% of cases,

croup is caused by a virus. Airway obstruction occurs in the subglottic region

of the trachea, just below the vocal cords.

 Cyanosis: is a bluish discoloration of the skin and mucous membranes

caused by increasing amounts of desaturated or reduced haemoglobin (which

is bluish) in the blood

 Cystic fibrosis: is an autosomal recessive inherited disease that results from

defective epithelial chloride ion transport. Although cystic fibrosis affects

many organs the most important effects are on the lungs and in 90% of

cases, chronic pulmonary infections eventually lead to respiratory failure and

death.

 Diluents: The agent most commonly used to dilute respiratory secretions is

normal saline, administered by ultrasonic nebulizer.

 Dyspnoea: is the subjective sensation of uncomfortable breathing, the

feeling of not being able to get enough air. Sometimes referred to as difficulty

in breathing.

 Emphysema: is abnormal permanent enlargement of gas-exchange airways

accompanied by destruction of alveolar walls. Obstruction results from

changes in lung tissue.

 Expectorants: act by an irritant action on the mucous membranes, which

increases the secretion of mucus from bronchial secretory cells, facilitating

ciliary action and productive coughing and soothing and lubricating dry

tissues.

 Haemoptysis: is the coughing up of blood or bloody secretions.

 Hypercapnia: increased carbon dioxide in the arterial blood (increased

PaO2).

 Hypoxaemia: reduced oxygenation of arterial blood (reduced PaO2)

 Hypoxia: reduced oxygenation of cells in tissues e.g. oxygen saturations

below 90%.
 Mucolytic drugs: exert a disintegrating effect on mucus, facilitating removal

of mucus or other exudates from the lung, bronchi or trachea by postural

drainage, coughing, spitting or swallowing e.g. acetylcystine

 Muscarinic antagonists: one of the many pharmacological effects of

muscarinic receptor antagonists (antimuscarinic drugs) such as atropine is

inhibition of bronchial secretions. Dries secretions. E.g. ipratropium

 Non-small cell lung cancer: Squamous cell carcinoma accounts for about

30% of bronchogenic carcinomas. These tumors are typically located near the

hilum and project into the bronchi. Adenocarcinoma (meaning that the tumor

arises from the glands) constitutes 35–40% of all bronchogenic carcinomas.

 Orthopnoea: dyspnea when a patient is lying down.

 Pertussis: is caused by the bacterium Bordetella pertussis. The symptoms

are thick secretions, a chronic cough and spasm following coughing fits,

which give a characteristic ‘whoop’ sound — hence the common name

‘whooping cough’

 Pneumonia: is infection of the lower respiratory tract caused by bacteria,

viruses, fungi, protozoa or parasites. The alveoli and terminal bronchioles fill

with infectious debris and exudate.

 Pulmonary embolism: is occlusion of a portion of the pulmonary vascular

bed by an embolus, which can be a thrombus (blood clot), tissue fragment,

lipids (fats), foreign body or an air bubble (air embolism). More than 90% of

pulmonary emboli result from clots formed in the veins of the legs and pelvis.
 Small cell lung cancer: Small cell carcinomas constitute 15–20% of

bronchogenic carcinomas. Most of these tumors are central in origin

 Status asthmaticus: defined as a severe asthmatic episode that does not

respond to pharmacological management.

 Tuberculosis: is an infection caused by Mycobacterium tuberculosis, a

bacterium that usually affects the lungs but may invade other body systems.

Inflammation in the lung causes activation of alveolar macrophages and

neutrophils.

Pulmonary Disorders

Obstructive lung disease:

 Causes airway obstruction, making expiration difficult.

 Includes asthma, chronic bronchitis, and emphysema.

Asthma

 Type 1 hypersensitivity immune response involving lymphocytes, IgE, mast

cells, and eosinophils.
 Triggered by irritants or allergens.
 Exposure to allergens:
 Leads to bronchoconstriction, bronchiole airway oedema,
bronchospasm, inflammation, mucus overproduction.
 Management: Avoid triggers, reduce inflammation, treat acute symptoms.

Bronchitis

 Acute bronchitis:
 Caused by bacterial infection
 Requires patient history, respiratory assessment, sputum MC&S, if
severe CXR, ABG
 Routine care includes chest physiotherapy, supplemental oxygen as
prescribed by Dr, vital sign observations, respiratory observations
monitor all input and output via fluid balance chart, administer
oxygen as prescribed and other general care.
  Chronic bronchitis:

 Persistent airway inflammation, thick mucus production, and

smooth muscle hypertrophy leading to obstruction.

Chronic Obstructive Pulmonary Disease (COPD)

 Chronic obstructive pulmonary disease (COPD) is the coexistence of

chronic bronchitis, emphysema and sometimes asthma
 Causes hypoxaemia and hypercapnia, leading to respiratory failure.
 Emphysema:

 Destruction of the alveolar septa

 Loss of passive elastic recoil

 Lead to airway collapse and obstruct gas flow during expiration

- expiration becomes difficult because loss of elastic recoil reduces

the volume of air that can be expired passively and air is trapped in
the lungs. Air trapping causes an increase in expansion of the chest,
which puts the muscles of ventilation at a mechanical disadvantage.
This results in increased workload of breathing.

Infections of the Pulmonary System

Pneumonia

 Causes: Bacterial (Streptococcus pneumoniae), viral, fungal.

 The alveoli and terminal bronchioles fill with infectious debris and
exudates and further damage can lead to fibrin deposition.

 Symptoms: Fever, chills, productive cough, pleural pain, dyspnoea,

haemoptysis.
 Diagnosis: High WBC count, CXR showing infiltrates.

Tuberculosis (TB)

 Caused by: Mycobacterium tuberculosis.

 Forms tubercles in the lungs, which may remain dormant or reactivate.

Bronchiolitis

 Inflammatory obstruction of small airways, most common in children.

Croup

 Acute respiratory illness of young children

 Infection, swelling of upper trachea (parainfluenza virus).

 Symptoms: Seal-like barking cough, rhinorrhoea, sore throat, fever.
 respiratory stridor and barking cough

Cystic Fibrosis

 Genetic disorder (autosomal recessive) causing thick mucus buildup in

lungs and digestive system.
 Leads to chronic bacterial infections (e.g., Pseudomonas aeruginosa,
Staphylococcus aureus).

Pulmonary Blood Flow & Pressure Alterations

 Pulmonary vascular diseases are caused by embolism or hypertension in

the pulmonary circulation.

Pulmonary Embolism

 Blockage in pulmonary circulation by thrombus, air bubble, or tissue

fragment.
 Can cause hypoxia, pulmonary oedema, shock, death.

- Pulmonary embolism is occlusion of a portion of the pulmonary

vascular bed by a thrombus (most common), tissue fragment or air
bubble. Depending on its size and location, the embolus can cause
hypoxic vasoconstriction, pulmonary oedema, atelectasis,
pulmonary hypertension, shock and even death.

Clinical Manifestations of Pulmonary Alterations

Hypercapnia (High CO₂ Levels in arterial blood)

 Most causes of hypercapnia are a result of decreased drive to

breathe or an inadequate ability to respond to ventilatory
stimulation.
 Some of these causes include:

(1) depression of the respiratory centre in the brainstem by narcotic

drugs such as morphine and heroin
 (2) diseases of the medulla, including infections of the central
nervous system or trauma

(3) thoracic cage abnormalities, as in chest injury

(4) large airway obstruction, as in tumours or sleep apnoea

(5) increased work of breathing or physiological dead space, as in

emphysema.

Hypoxaemia (Low Blood Oxygen)

 decreased oxygen content of inspired gas, (2) hypoventilation and

(3) diffusion abnormality at the alveolar level.

 Hypoxaemia can also be caused by central nervous system

disorders or depression of the respiratory centre in the brainstem by
drugs such as morphine and heroin; and result in a decreased drive
to breathe.

Hypoxia (Low Tissue Oxygen)

 Caused by hypoxaemia, low blood pressure, blood loss, or poor circulation.

Dyspnoea

 Shortness of breath, common in respiratory disorders.

Haemoptysis

 Coughing up blood, seen in bronchitis, Tuberculosis, lung cancer,

hemorrhages.

Cyanosis

 Bluish skin discoloration due to low oxygenated haemoglobin levels.

 caused by desaturation of haemoglobin, polycythaemia or peripheral
vasoconstriction.

- Respiratory tidal volume (TV) or size of breath multiplied by

respiratory rate (RR) equals minute volume (MV). E.g. an average
size adult male has a 700ml TV multiplied by a RR of 18/min =
12,600 mls/min or 12.5 litres/min minute volume.

- Therefore you can assume a MV of 12.5 litres/min is required to

maintain normal cellular metabolism and normal cellular
oxygenation for this adult male.
 Pharmacotherapy
Oxygen Therapy

 Used to treat hypoxia (administered via nasal prongs, hudson masks).

Mucoactive Drugs

 Mucolytics - (e.g., acetylcysteine) break down thick mucus.

 Expectorants - help remove mucus from the lungs/ removal of sputum

Asthma Medications

 Treating asthma involves

- educating the patient

- regular monitoring of lung function

- progress and compliance

- avoiding trigger factors

- stepwise use of various antiasthma drugs.

Medications:

 Reliever

o bronchodilator

o Short-acting β2 agonists, xanthines and antimuscarinic agents

o e.g Ventolin

 Controllers:

o Long-acting β2 agonists
o e.g Salmeterol

 Preventers:
 o Inhaled corticosteroids, leukotriene-receptor antagonists and mast-
cell stabilisers
o E.g Pulmicort

Cough Suppressants

 Used for non-productive coughs

 opioid antitussives

Antibiotics

 Used for bacterial pneumonia, tuberculosis, COPD infections.

Medications Overview