Sneezing - a reflex response to irritation in the upper respiratory tract and assists in removing the irritant, It is associated with inflammation or foreign material in the nasal passages
Coughing - may result from irritation cause by a nasal discharge dripping int o the oropharynx or from inflammation or foreign material in the lower respiratory tract or from inhaled irritants such as tobacco smoke. Cough reflex is controlled by a centre in the medulla and consists of coordinated actions that inspire air and then close the glottis and vocal cords.
Sputum or mucoid discharge from the respiratory tract may have significant characteristics depending on the abnormality causing it. Normal secretions are relatively clear, thin and colourless or cream colour.
-yellow-green cloudy and thick mucous are often indicative of a bacterial infection
-rusty or dark coloured sputum is usually a sign of pneumococcal pneumonia
-very large amounts of purulent sputum with foul odour may be associated with bronchiectasis
-thick, tenacious mucus may occur in patients with asthma or cystic fibrosis. Blood tinged secretions may result from a chronic cough and irritation that causes rupture of superficial capillaries, may also be a sign of TB or tumor.
-hemoptysis is blood tinged frothy sputum that is usually assoc with pulmonary edema.
Breathing patterns may be altered with respiratory disease
-eupnea is a normal rate of breathing
-Kussamaul respiration are deep rapid resp. typical for acidosis or may follow strenuous exercise
-laboured resp. or prolonged inspiration or expiration times are often associated with obstruction of airways
-wheezing or whistling sounds indicate an obstruction in the small airways
-stridor is a high pitched crowing noise that is usually indicative of an upper airway obstruction.
Breath Sounds - rhonchi and rales are abnormal sounds resulting from air mixing with excessive secretions in the lungs
-rales are light bubbly or crackling sounds assoc. with serous secretions
-rhonchi are deeper or harsher sounds from thicker mucous
-absence of breath sounds indicated non aeration or collapse of the lungs (atelectasis)
Dyspnea is a subjective feeling of discomfort that occurs when a person feels unable to inhale enough air. May be manifested with breathlessness or sob either with exertion or at rest.
-severe dyspnea may be accompanied by flaring of the nostrils, use of accessory respiratory muscles or retracting of the muscles between or above the ribs.
-orthopnea is dyspnea that occurs when the person is lying down. Pulmonary congestion develops as more blood pools in the lungs when the person lies down and also as the abdominal contents push upwards against the lungs. Raising the upper part of the body with pillows often facilitates breathing in persons with respiratory or cardiovascular disorders
-paroxysmal nocturnal dyspnea is a sudden acute type of dyspnea common in patients with left sided heart failure. During sleep body fluid is redistributed leading to pulmonary edema and the individual wakes up gasping for air and coughing.
Cyanosis is the bluish colouring of the skin and mucous membranes caused by large amounts of unoxygenated hemoglobin in blood
Pleural pain results from inflammation or infection of the parietal pleura. It is a cyclic pain that increases as the inflamed membrane is stretched with inspiration or coughing
Friction Rub may be heart, a soft sound produced as rough, inflammated or scarred pleural move against each other
Clubbed digits results from chronic hypoxia assoc. with respiratory or cardiovascular disease characterized by painless, firm, fibrotic enlargement at the end of the digit.
Changes in arterial blood gasses
-hypoxemia is inadequate oxygen in blood
-hypercapnea is increased carbon dioxide in blood
Severe dyspnea indicative of respiratory distress - flaring of nostrils, use of accessory muscles and retraction of muscle between or above the ribs
Orthopnea - occurs when lying down, usually caused by pulmonary congestion
Disease of poverty and crowding, immunodeficiency, malnutrition, alcoholism, conditions of war, chronic disease, HIV Infection.
Infection is caused by mycobacterium tuberculosis which is an acid fast aerobic slow growing bacillus. it primarily infects the lungs but may invade other organs. It is transmitted by droplets from person with active infection and can survive in dried sputum for weeks.
Is destroyed by UV light, heat, alcohol, glutaraldehyde, formaldehyde. The normal neutrophil response does not occur
Primary infection: when the organism first enters the lungs it is engulfed by microphages which causes local inflammation. if the cell mediated immunity is inadequate the mycobacteria reproduce and begin to destroy lung tissue. *CONTAGIOUS*
If cell mediated immunity is adequate: bacilli migrate to lymph nodes creating a granuloma, formation of tubercle, walled off and calcifying. Tubercle may be visible on x-ray, develops a latent infection meaning the individual has been infected and exposed but does not have the disease and is asymptomatic meaning they cannot transmit the disease.
Secondary or re-infection with TB - occurs when clients cell mediated immunity is impaired d/t: stress, malnutrition, HIV Infection, age. The mycobacteria begin to reproduce and infect the lung, this is Active tb and can be spread to others.
Military or extra pulmonary TB - rapidly progressive form more common in children <5 years old. results in early dissemination of other tissues,if lesions are not found in the lungs its not contagious, common symptoms include: weight loss, failure to thrive or measles.
Active TB (primary or secondary) when the organism is multiplying forming large areas of necrosis also known as cavitation. Cavitation promotes spread into other parts of the lungs. Cough, positive sputum and radiograph will show cavitation. Disease in this form is highly infective when there is close personal contact over a period of time.
Diagnostic tests - first exposure - indicative by positive tb skin test
Active infection - acid fast sputum test, chest x-ray, sputum culture and sensitivity
Treatment - long term treatment with a combination of drugs, length of treatment varies from 6-12 months. requires monitoring and treatment is very expensive.
Blood clot or mass that obstructs pulmonary artery or any of its branches
effects of embolus depends on material, size and location
small pulmonary emboli might be silent unless they involve a large area of the lung
large emboli may cause sudden death
90% of pulmonary emboli originate from DVT in legs and are preventable.
-transient chest pain, cough, dyspnea (SMALL EMBOLI)
-increased chest pain with coughing or deep breathing, tachypnea and dyspnea develop suddenly.
-later developing hemoptysis and fever
-hypoxia because of anxiety, restlessness, allow, tachycardia
-severe crushing chest pain, low bp, rapid weak pulse, loss of consciousness
-health teaching prior to surgery
-exercise to prevent thrombosis
-radiographs, lung scan, MRI, pulmonary angiography