1. health and fitness
2. disease
3. heart disease

CHAPTER
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
Overview of Cardiopulmonary
Disorders and Conditions
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
OUTLINE
2
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
Lung Cancer
Patient Education
Summary
Introduction
Cardiovascular Disorders
Coronary Artery Disease
OBJECTIVES
© Jones & Bartlett
LLC
© Jones
& Bartlett Learning, LLC
Angina Learning,
Pectoris
Upon
completion
of this
chapter, the reader should be
NOT FOR SALE
OR DISTRIBUTION
NOT FOR SALE OR
DISTRIBUTION
Myocardial
Infarction
able to do the following:
Dysrhythmias
1. Compare emphysema and chronic bronchitis.
Hypertension
2. Define atelectasis and discuss possible causes.
Cardiomyopathy
3. Contrast the pathologic course of acute
Carditis
bronchitis with that of chronic
bronchitis.
©
Jones
&
Bartlett
Learning,
LLC
© Jones
& Bartlett Learning, LLC
Heart Failure
4.
Describe
the
condition
known
as
angina
NOT FOR SALE OR DISTRIBUTION
Cardiac Arrest NOT FOR SALE OR DISTRIBUTION
pectoris.
Respiratory Disorders
5. List the leading causes of lung cancer.
Newborn and Adult Respiratory Distress Syndrome
6. Distinguish among endocarditis, myocarditis,
Influenza
and pericarditis.
Swine Flu (H1N1)
7. Compare
left-sided
failureLearning,
with right-sided
©Asthma
Jones & Bartlett Learning, LLC
© Jones
& heart
Bartlett
LLC
heart
failure.
NOT
FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Bronchitis
8. Name the causes of cardiac arrhythmias.
Bronchiolitis
9. Describe the causes of pulmonary edema and
Bronchiectasis
explain how it affects oxygen levels.
Atelectasis
10. Explain the possible consequences of emboli.
Emphysema
© Jones & Bartlett
Learning, LLC
© Jones
Bartlett Learning, LLC
Cystic Fibrosis
KEY &
TERMS
NOT FOR SALE
OR
DISTRIBUTION
NOT
FOR
SALE
Pneumonia
Gag reflex
Angina pectoris OR DISTRIBUTION
Legionnaires' Disease
Granuloma
Anoxia
Pulmonary Vascular Disease
Hemagglutinin
Anthracosis
Pulmonary Edema
Hemoptysis
Arrhythmia
Pulmonary Hypertension
Histoplasmosis
Asbestosis
© Jones & Bartlett Learning, LLC
©Hypercapnia
Jones & Bartlett Learning, LLC
Pulmonary Embolism
Asthma
NOT
FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
Tuberculosis
Hypoxemia
Atelectasis
Histoplasmosis
Ischemia
Atherosclerosis
Pneumoconiosis
Myocardial infarction
Bronchiectasis
Silicosis
Nasal flaring
Bronchiolectasis
Anthracosis
Neuraminidase
Bronchiolitis
© Jones
& Bartlett Learning, LLC
© Jones & Bartlett
Learning, LLC
Asbestosis
Pathogen
Bronchitis
NOTBerylliosis
FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
Pleural effusion
Bronchogenic carcinoma
Respiratory Failure
Pleurisy
Carcinogens
Pleural Disorders
Pneumoconiosis
Consolidation
Pleurisy
Pneumonia
Dyspnea
Pleural Effusion
Pneumothorax
Dysrhythmia
© Jones & Bartlett
Learning, LLC
© Jones & Bartlett Learning,
LLC
Pneumothorax
Pulmonary edema
Emphysema
NOT FOR SALE
OR
DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
Hemothorax
Pulmonary embolism
Epithelial
Flail Chest
22
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 22
8/25/10 8:11 AM
Cardiovascular Disorders
Pulmonary fibrosis
Stridor
Respiratory failure
Sepsis
Silicosis
Tuberculosis
Ventricular asystole
Ventricular fibrillation
© Jones &Pulmonary
Bartlett Learning,
Surfactant
hypertension LLC
NOT FOR SALE
OR acidosis
DISTRIBUTION
Thrombus
Respiratory
■
23
Unstable angina: The pain increases in frequency
© Jones and
& Bartlett
Learning,
LLCinduced. It indiduration and
is more easily
NOT FORcates
SALE
OR
DISTRIBUTION
a worsening of coronary artery disease, which
may progress to myocardial infarction.
Variant angina: The pain is caused by coronary
artery spasm and may occur spontaneously. It may
not be related to physical exercise or emotional
© Jones & Bartlett Learning, LLC stress. It is also known ©
Jones & Bartlett Learning, LLC
INTRODUCTION
as Prinzmetal angina.
NOT
FOR of
SALE
OR DISTRIBUTION
NOT
FOR
SALE
DISTRIBUTION
Cardiovascular disease
is the
number
oneOR
cause
of
■ Microvascular angina: Impairment
the vasodideath in the United States. Coronary heart disease, as
lator reserve causes angina-like chest pain even
of 2000, is responsible for more than one out of every
though the patient’s coronary arteries are normal.
five deaths in the country annually. Common heart disThe pain of angina may be relieved by rest and vasoeases include hypertensive heart disease, angina and
dilation of the coronary arteries with medication. Angina
© Jones
& Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
heart
attacks, cardiac
arrhythmias,
and congestive
pectoris is also referred to as cardiac pain.
NOT
FOR
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
heart
failure.
RiskSALE
factorsOR
for heart
diseases include
obesity, smoking, alcoholism, and lack of exercise.
Myocardial Infarction
Pulmonary diseases result from circulatory disorders,
When coronary blood flow is interrupted for extended
immune diseases, congenital defects, central nervous
periods, necrosis (tissue death) of part of the cardiac
system damage or diseases, environmental condimuscle
Necrosis
results LLC
in myocardial infarc© Jones & tions,
Bartlett
Learning,
LLC
©
Jones
&occurs.
Bartlett
Learning,
and infection.
tion
.
When
the
coronary
arteries
are obstructed, this
NOT FOR SALE
OR DISTRIBUTION
This chapter
focuses on major cardiopulmonary NOT FOR SALE OR DISTRIBUTION
may
result
in
either
atherosclerosis,
a spasm, or a
disorders.
thrombus . Myocardial infarction (MI) is also called
heart attack.
Cardiovascular Disorders
Of the various types of cardiovascular disorders, heart
Cardiovascular disease
is described
as any Learning,
abnormal
attack is the leading cause of©
death
in the&United
States.
© Jones
& Bartlett
LLC
Jones
Bartlett
Learning, LLC
condition characterized
by
heart
or
blood
vessel
dysWhen
treatment
is
delayed,
mortality
is
high.
Nearly
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
function. Cardiovascular disease is the leading cause of
one-half of sudden myocardial infarction deaths occur
death in the United States.
before the patient can be hospitalized, usually within
■
Coronary Artery Disease
© Jones
& disease
Bartlett
Learning,
LLC that
© Jones & Bartlett Learning, LLC
Coronary
artery
is an
abnormal condition
NOT
SALEofOR
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
may
affectFOR
the arteries
the heart
and produce varying
pathologic effects, primarily reduced flow of oxygen and
nutrients to the myocardium. Atherosclerosis is the most
common type of coronary artery disease, and it is now
the leading cause of death in North America. Angina
© Jones & pectoris
Bartlett
Learning,
LLC of coronary artery dis© Jones & Bartlett Learning, LLC
is the
classic symptom
ease; it results
from myocardial ischemia.
NOT FOR SALE
OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Damaged
endothelium
Angina Pectoris
Angina pectoris is a sudden outburst of chest pain freas a result
of athquently caused by myocardial
© Jonesanoxia
& Bartlett
Learning,
erosclerosis or coronary artery spasm. Atherosclerosis
LLC
NOT
FOR
SALE
OR
DISTRIBUTION
is a deposition of fat-containing substances collectively
Normal smooth
muscle cell
© Jones & Bartlett Learning, LLC
Fatty FOR SALE OR DISTRIBUTION
NOT
Fatty deposits accumulate in muscle cell
streak
known as plaque in the lumen (opening) of the coronary
arteries that causes them to narrow (see Figure 2–1).
Anginal pain usually radiates along the neck, jaw, shoulFibers Fibrous
der,©and
down&
theBartlett
left arm. Learning,
It is often accompanied
by
Jones
LLC
© Jones & Bartlett
Learning, LLC
Fats plaque
feelings of suffocation that may seem to indicate impendNOT
FOR
SALE
OR
DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
ing death.
Angina pectoris attacks are often related to emotional
stress, eating, exertion, and exposure to intense cold.
Large plaque obstructing artery
There are four types of angina:
■ Stable angina: The pain is predictable in fre© Jones & Bartlett
Learning, LLC
© Jones & Bartlett Learning, LLC
quency and duration and is relieved by rest and
Development of a deposition of fat-containing substances
NOT FOR SALEnitroglycerin.
OR DISTRIBUTION
NOTFIGURE
FOR 2–1
SALE
OR DISTRIBUTION
which form plaque and lead to arterial occlusion.
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 23
8/25/10 8:11 AM
24
CHAPTER 2
Overview of Cardiopulmonary Disorders and Conditions
1 hour of the onset of symptoms.
© Jones &Risk
Bartlett
factors Learning,
for myocardialLLC
infarction
NOT FOR SALE
ORfollowing:
DISTRIBUTION
include the
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
family history of MI
aging
■ gender
■ hypertension
© Jones & Bartlett Learning, LLC
■ elevated total cholesterol
NOT FOR SALE OR DISTRIBUTION
■ obesity
■ lifestyle
■ smoking
■ stress or type A personality
■ drug use (especially cocaine
© and
Jones
& Bartlett Learning, LLC
amphetamines)
NOT
FOR
OR DISTRIBUTION
The occlusion ofSALE
a coronary
artery
may result in ischemia and infarct
(death) of the myocardium, causing
sudden and severe left-sided chest
pain (see Figure 2–2).
■
■
© Jones & Bartlett Learning, LLC
NOT FOR SALE
OR DISTRIBUTION
Dysrhythmias
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
Clot
Damaged
© Jones & Bartlett Learning,
LLC
heart muscle
NOT FOR SALE OR DISTRIBUTION
A dysrhythmia (arrhythmia) is a disturbance of heart rhythm. The sinoatrial (SA) node generates normal FIGURE 2–2 Damage caused by myocardial infarction.
heart rhythms that©travel
through
Jones
& Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
the heart’s conduction
system.
This
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
causes the atrial and ventricular myocardium to contract and relax at a
than in the white population. It is also more prevalent
regular rate. This rate maintains circulation during variin people with less education and lower income. Durous levels of physical activity. Dysrhythmias range from
ing young ©
andJones
middle&
adulthood,
have a higher
mild
catastrophic
ventricular
fibrillation.LLC
© toJones
& Bartlett
Learning,
Bartlettmen
Learning,
LLC
incidence
of
hypertension,
but
thereafter,
women
have
a
Arrhythmias
are
usually
classified
according
to
their
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
higher incidence.
origin (either ventricular or supraventricular). Their
Risk factors for essential hypertension include the
effect on blood pressure as well as cardiac output (which
following:
may be influenced from where they originate) deter■ the aging process
mines how clinically significant they are. Common
■ family
history Learning, LLC
causes
of
arrhythmias
include
the
following:
© Jones & Bartlett Learning, LLC
© Jones
& Bartlett
■ obesity
■ congenital defects
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
■ high intake of sodium
■ drug toxicity
■ high intake of saturated fat
■ electrolyte imbalances
■ sleep apnea
■ myocardial infarction or ischemia
■ stress
■ excessive alcohol consumption
Hypertension
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
■ sedentary lifestyle
Hypertension is an NOT
elevation
in either
or diaNOT FOR SALE OR DISTRIBUTION
FOR
SALEsystolic
OR DISTRIBUTION
■ diabetes mellitus
stolic blood pressure. It occurs as either essential (pri■ tobacco use
mary) hypertension or secondary hypertension. Primary
hypertension is the most common type. Secondary
Cardiomyopathy
hypertension results from renal disease or other identifi©causes.
JonesMalignant
& Bartlett
Learning,
LLC form of Cardiomyopathy
© Jones
& Bartlett
Learning,
is a term
that generally
appliesLLC
to a
able
hypertension
is a severe
NOT FOR
SALE
OR
DISTRIBUTION
NOT
FOR
SALE
disease of the
heart
muscle
fibers.OR
It isDISTRIBUTION
the second most
hypertension
that
may be
either
primary or secondary.
common direct cause of sudden death (after coronary
Hypertension is a major cause of cardiac disease, renal
artery disease). The most common type of cardiomyopafailure, and stroke.
thy is the dilated form. Men and blacks are at greatest risk
Hypertension affects nearly 20% of adults in the
for dilated cardiomyopathy. Other risk factors include
United States. Risks for hypertension increase with age.
© Jones & Hypertension
Bartlett Learning,
LLC in the black population
© Jones
& Bartlett
Learning,
LLC pregnancy, viral
coronary
artery disease,
hypertension,
is more prevalent
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 24
8/25/10 8:11 AM
Respiratory Disorders
infections, and use of alcohol or illegal drugs. Hypertro-
anaerobic, and metabolic and respiratory acidosis
Carditis
and brain damage and death. Cardiac arrest is also called
cardiopulmonary arrest.
25
Bartlett initiation
Learning,
LLC
© Jones &phic
Bartlett
Learning,
LLC in that it is caused by ©
cardiomyopathy
is different
a Jones
occurs.&Immediate
of cardiopulmonary
resusNOT
FOR
SALE
OR
DISTRIBUTION
NOT FOR SALE
OR DISTRIBUTION
genetic abnormality.
citation (CPR) is required to prevent heart, lung, kidney,
Carditis is defined as inflammation of the heart and its
Respiratory Disorders
surrounding structures.
The several
types of
carditis LLC
© Jones
& Bartlett
Learning,
© Jones & Bartlett Learning, LLC
include pericarditis,
myocarditis,
and
endocarditis,
A respiratory disorder is anyNOT
abnormal
condition
theDISTRIBUTION
FOR
SALE ofOR
NOT FOR SALE OR DISTRIBUTION
each of which describes the portion of the heart that is
respiratory system. Respiratory disorders are characinflamed in the specific condition. Common causes of
terized by coughing, chest pain, dyspnea, hemoptysis,
the various forms of carditis include viral infections, bacproduction of sputum, and stridor. Less common sympterial infections, fungal infections, immune conditions,
toms include anxiety, arm and shoulder pain, headache,
myocardial
infarction,
trauma,
uremia, cancers,
© Jones
& Bartlett
Learning,
LLC certain hoarseness,©and
Jones
& Bartlett
Learning,
LLC
drowsiness.
There are
several varieties
medications,
radiation,
and
other
causes.
of respiratory
diseases
and
disorders.
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR DISTRIBUTION
Heart Failure
Newborn and Adult Respiratory Distress
Heart failure is the inability of the heart muscle to conSyndrome
tract with enough force to properly circulate the blood
Respiratory
distressLearning,
syndrome is LLC
an acute lung disease
© Jones & throughout
Bartlett Learning,
LLC of the left ventricle is
© Jones
& Bartlett
the body. Dysfunction
of newborns characterized by airless alveoli, inelastic
the mostOR
common
cause of heart failure. However, the
NOT FOR SALE
DISTRIBUTION
NOTlungs,
FORa SALE
OR DISTRIBUTION
respiration rate greater than 60 breaths per minright ventricle may also be dysfunctional, especially in
ute, nasal flaring, intercostal and subcostal retractions,
pulmonary disease (right ventricular failure).
grunting on expiration, and peripheral edema. The conThe most common form of heart failure is congestive
dition occurs most often in premature babies. It is caused
heart failure. It is called this because of the collection of
by a deficiency of pulmonary
surfactant
resulting in
Jones
Bartlett
Learning,
LLC
© Jones
&, Bartlett
Learning, LLC
fluid (congestion) in©the
lungs &
and
extremities.
Heart
alveolar collapse. Sometimes other symptoms include
failure may be classified
as FOR
left- orSALE
right-sided
failNOT FOR SALE OR DISTRIBUTION
NOT
ORheart
DISTRIBUTION
hyaline membrane formation, alveolar hemorrhage,
ure according to the side of the heart that is affected. It
decreased cardiac output, and severe hypoxemia. The
may also be classified as systolic or diastolic dysfunction
disease is self-limited; infants either die in 3 to 5 days or
based on the cardiac cycle involved.
recover completely with no aftereffects.
Left-sided heart failure is caused by ineffective left
In adults,
condition
causes Learning,
severe pulmonary
© Jones
& Bartlett
Learning,
LLCpumping
© this
Jones
& Bartlett
LLC
ventricular
contraction.
As the
left ventricle’s
congestion characterized by diffuse injury to alveolarability
fails,
cardiac
output
Because blood is no
NOT
FOR
SALE
ORfalls.
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
capillary membranes. Fulminating sepsis, especially
longer effectively pumped out, it backs up into the left
when gram-negative bacteria are involved, is the most
atrium and then into the lungs. This causes activity intolcommon cause. Adult respiratory distress syndrome
erance and dyspnea. If the condition persists, pulmonary
may occur after trauma, near drowning, aspiration of
edema and right-sided heart failure can result. Common
gastric acid, ingestion of
of left-sided
heartLLC
failure include hypertension,
© Jones & causes
Bartlett
Learning,
© Jones
& Bartlett Learning, LLC
certain herbicidal chemiaortic and
valve stenosis, and left ventricular
POINT TO REMEMBER
NOT FOR SALE
ORmitral
DISTRIBUTION
NOTcals,
FORand
SALE
OR DISTRIBUTION
inhalation
of
infarction.
Adults with sleep apnea may
corrosive chemicals (such
Right-sided heart failure is caused by ineffective right
cease breathing for 10 to
as chlorine and ammonia)
20 seconds hundreds of times
ventricular contraction. As a result, blood is not pumped
or certain drugs including
a night. The greatest danger of
with enough force through the right ventricle to the
barbiturates, chlordiazadult sleep apnea is the fatigue,
lungs. This causes blood
to back &
up Bartlett
into the right
atrium
© Jones
Learning,
LLC
© Jones
& Bartlett Learning, LLC
headache, drowsiness, and
epoxide, heroin, methaas well as the peripheral
The OR
patient
gains
NOT
FOR
SALE
OR
DISTRIBUTION
NOTcirculation.
FOR SALE
DISTRIBUTION
depression that
follows
during
done, propoxyphene, and
weight, develops peripheral edema, and the kidneys
waking hours.
salicylates.
(and other organs) become engorged. Right-sided heart
failure may be caused by pulmonary hypertension, pulInfluenza
monary embolus, or acute right ventricular infarction.
© Jones & Bartlett Learning, LLC
Jones
Bartlett
Learning,
LLC
Influenza is©caused
by a&virus
and manifests
itself as
the
Cardiac
Arrest
NOT FOR
SALE OR DISTRIBUTION
NOT
SALE
most common,
yetFOR
serious,
acute OR
upperDISTRIBUTION
respiratory tract
Cardiac arrest is a sudden cessation of cardiac output
infection in humans. Prior to acquired immunodefiand effective circulation. It is usually precipitated by
ciency syndrome (AIDS), influenza was the most recent
ventricular fibrillation or ventricular asystole. When
uncontrolled pandemic infection in human beings.
cardiac arrest occurs, delivery of oxygen and removal of
Each year in the United States, nearly 36,000 people die
© Jones & carbon
Bartlett
Learning,
LLCcell metabolism becomes
© Jones
& ofBartlett
Learning,
dioxide
ceases. Tissue
because
influenza-related
illnessLLC
during nonpandemic
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 25
8/25/10 8:11 AM
26
CHAPTER 2
Overview of Cardiopulmonary Disorders and Conditions
years. Although children are infected more than any age
© Jones & Bartlett Learning, LLC
© Jones &group,
Bartlett
Learning,
LLC illness and even death,
influenza
causes serious
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE
OR DISTRIBUTION
most commonly
in people aged 65 years or older.
Two types of influenza virus exist in humans: type A
and type B. Type A is the most common form, causing the
most severe disease symptoms. It is further divided into
subtypes that are based on two surface antigens: hemag© Jones & Bartlett Learning, LLC
glutinin (H) and neuraminidase (N). Influenza type B does
NOT
FORisSALE
OR DISTRIBUTION
not have any subtypes.
Influenza
more contagious
than
respiratory tract infections that arise from a bacterial
source. The disease is transmitted by aerosol droplets or
by direct contact with an infected person.
A person may inhale as few as three infected particles
© Jones & Bartlett Learning, LLC
and then contract influenza. Most people who become
NOT will
FOR
SALEsymptoms
OR DISTRIBUTION
infected
develop
of influenza, which
increases the likelihood of contagion. Because young
children are most likely to become infected with influenza, they are also most likely to spread the infection.
© Jones & Bartlett Learning, LLC
Swine Flu (H1N1)
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
Artery
Vein
Alveolus
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
Bronchiole
Swine flu was the original name used to describe novel
H1N1, a new influenza virus that causes illness in
humans. It was detected in the United States in April
2009, and also has been reported in Mexico, Canada,
and other countries.©This
virus &
spreads
from Learning,
person to
Jones
Bartlett
LLC
© Jones & Bartlett Learning, LLC
person, similar to theNOT
way that
regular
seasonal
influenza
NOT FOR SALE OR DISTRIBUTION
FOR SALE OR DISTRIBUTION
viruses spread.
The term swine flu was originally used because laboratory testing showed that many genes in this new virus
were very similar to influenza viruses that normally
Capillary
occur
in pigs in
America.
The virus
has spread
© Jones
& North
Bartlett
Learning,
LLC
© Jones & Bartlett Learning,
LLC
network
throughout
the
country
as
well
as
other
parts
of
the
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
world, and is very contagious.
The symptoms of the novel H1N1 flu virus in people
FIGURE 2–3 An acute episode of asthma.
are similar to the symptoms of seasonal flu and include
fever, cough, sore throat, runny or stuffy nose, body
headache,
chills, and
fatigue. A significant num© Jones & aches,
Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
ber of people who have been infected with this virus also
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
have reported diarrhea and vomiting. Also, like seasonal
flu, severe illnesses and deaths have occurred as a result
of illness associated with this virus. Vaccines that are
airways. This narrowing may reverse spontaneously or
currently available may be given either by injection or by
as a result of pharmacologic therapy (see Figure 2–3).
nasal instillation. © Jones & Bartlett Learning, LLC
Asthma may result from either
allergic &
orBartlett
nonallergic
© Jones
Learning, LLC
There are everyday actions that can help prevent
stimuli.
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
the spread of germs that cause respiratory illnesses like
Hyperreactivity in asthma may lead to airway obstrucinfluenza. The CDC recommends the use of oseltamivir
tion because of acute muscle spasms in the smooth
(Tamiflu) or zanamivir (Relenza) for the treatment or
tracheobronchial tree muscles. In addition to muscle
prevention of infection with novel H1N1 flu virus. Comspasms, the mucosa swells, which leads to edema. The
plications
of
H1N1
may
include
worsening
of
chronic
mucous glands
then increase
their production
of LLC
thick
© Jones & Bartlett Learning, LLC
© Jones
& Bartlett
Learning,
mucous.
conditions,
such
as
heart
disease,
diabetes,
asthma,
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
pneumonia, and respiratory failure.
Bronchitis
Asthma
Bronchitis is defined as inflammation of the mucous
Asthma is a disease that is characterized by increasing
membranes of the bronchi. Bronchitis is a type of chronic
© Jones & irritability
BartlettofLearning,
LLC tree. It involves acute,
© Jones
& Bartlett
Learning,
LLC
the tracheobronchial
obstructive
pulmonary
disease of
the larger airways.
NOT FOR SALE
DISTRIBUTION
NOTWhen
FORthe
SALE
DISTRIBUTION
episodicOR
paroxysmal
(sudden, intense) narrowing of the
airwayOR
mucosa
becomes inflamed, it leads to
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 26
8/25/10 8:11 AM
Respiratory Disorders
edema and submucosal gland enlarge-
© Jones &ment.
Bartlett
Learning,
LLC
Damage
occurs to the
epithelial
NOT FOR SALE
cells andOR
ciliaDISTRIBUTION
in the respiratory tract.
27
© Jones
Air flow obstructed
& Bartlett Learning,
LLC
Nonaeration
and collapse
NOT FOR SALE OR DISTRIBUTION
The most obvious symptom is the production of sputum.
Acute bronchitis has a short, severe
course of duration, which subsides
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
without any long-term effects. Chronic
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
bronchitis leads to excessive mucous
production and coughing. It can be
reversed after the removal of the irriRemaining air diffuses into
tant and is complicated by respiratory
tissues and is not replaced
tract infections. Chronic bronchitis
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
can lead to right-sided heart failure,
NOT
FOR
SALE
OR
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
acute respiratory failure, and pulmonary hypertension.
Obstruction in
Acute bronchitis is often caused
bronchus
by viruses, and the primary cause of
chronic bronchitis is smoking or expo© Jones & sure
Bartlett
Learning, LLC
© Jones & Bartlett Learning, LLC
Atelectasis
to certain respiratory irritants.
NOT FOR SALE
OR
DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
Risk factors include the following:
■ history of smoking
■ air pollution
■ occupational exposure
■ heredity
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
■ reduced lung function
NOT FOR SALE OR DISTRIBUTION
FORare
SALE
OR DISTRIBUTION
Children of parents NOT
who smoke
at
higher risk for pulmonary infections,
which may cause bronchitis.
Bronchiolitis
© Jones & Bartlett Learning, LLC
Bronchiolitis
NOT FOR(respiratory
SALE ORsyncytial
DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
viral infection) commonly affects the
lower respiratory tract and is usually
caused by the respiratory syncytial
virus (RSV). It causes inflammation
obstructs
the smallLLC
respiratory
© Jones & that
Bartlett
Learning,
© Jones & Bartlett Learning, LLC
airways. Bronchiolitis can range from a FIGURE 2–4 Obstructive atelectasis.
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
minor infection lasting only a few days
to a severe infection causing dangerous
respiratory distress. In older children
and adults, usually a mild upper respiratory infection occurs
because&
these
© Jones
Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
patients have larger airways and can tolerate the swelling
bronchiectasis. Today, more effective antibiotics exist to
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
of the airways with fewer symptoms than when it affects
treat the conditions that previously led to bronchiectasis,
infants.
so its occurrence is rarer.
Bronchiectasis
© Jones &isBartlett
Learning,
LLC bronchi
Bronchiectasis
characterized
by permanent
Atelectasis
LLC
Atelectasis©isJones
defined &
asBartlett
imperfectLearning,
expansion, which
NOT
FOR SALE
DISTRIBUTION
NOT FOR
SALEof OR
DISTRIBUTION
and
bronchiole
dilation.OR
This
occurs because of the
refers to incomplete
expansion
a lung
or part of a lung
destruction of muscle and elastic supporting tissue
(see Figure 2–4). This condition can occur due to aircaused by inflammation and infection. Bronchiectasis
way obstruction, increased lung recoiling (due to loss of
is a secondary disease to either obstruction or a perpulmonary surfactant), or lung compression (which may
sistent infection. In past decades, necrotizing bacterial
occur in pleural effusion or pneumothorax). Atelectasis
© Jones & pneumonia
Bartlett Learning,
LLC
© Jones
Bartlett
Learning,
LLC
conditions that
were complications of meamay be&present
at birth,
develop in
the neonatal period,
NOT FOR SALE
OR DISTRIBUTION
NOTorFOR
SALE
OR
sles, influenza,
pertussis, or tuberculosis often caused
develop
later in
life.DISTRIBUTION
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 27
8/25/10 8:11 AM
28
CHAPTER 2
Overview of Cardiopulmonary Disorders and Conditions
Emphysema
is caused by a virus that attacks bronchiolar epithelial
© Jones
& Bartlett
Learning,
LLCalveoli. Secondary
© Jones & Bartlett Learning, LLC
cells, eventually
spreading
to the lung
Emphysema causes the destruction of alveolar ducts,
NOT
FOR
SALE
OR
DISTRIBUTION
NOT FOR SALE
OR DISTRIBUTION
pneumonia ensues from lung damage caused by bacteria
alveoli, and respiratory bronchioles, which creates
spreading from another infection (anywhere in the body)
enlarged air spaces. The loss of many of the alveoli
or a noxious chemical. Aspiration pneumonia occurs
reduces air exchange with the blood. As emphysema profrom the inhalation of foreign matter (such as food or
gresses, the patient experiences increased shortness of
vomitus) into the bronchi. An impaired gag reflex, old
breath following only
The most
com- LLC
©minimal
Jonesexertion.
& Bartlett
Learning,
© Jones & Bartlett Learning, LLC
age, debilitating diseases, decreased levels of consciousmon cause of emphysema is the inhaling of smoke from
SALE
ORofDISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
ness, and surgical proceduresNOT
are allFOR
potential
causes
tobacco products. Stopping smoking usually stops, or at
aspiration pneumonia.
least slows, the progression of the disease. However, lung
damage from emphysema is usually irreversible. Chronic
Legionnaires’ Disease
obstructive pulmonary disease has, as its most common
Legionnaires’
a type
of bronchopneumonia.
It
components,
emphysema
and chronicLLC
bronchitis.
© Jonesboth
& Bartlett
Learning,
© disease
Jonesis &
Bartlett
Learning, LLC
is caused by a gram-negative, rod-shaped microorganism
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
known as Legionella pneumophila. It is one of the three
Cystic Fibrosis
or four most common causes of community-acquired
Cystic fibrosis is a chronic dysfunction of the exocrine
pneumonia. The microorganism is often found in warm
glands that affects multiple organ systems. The disstanding water.
ease affects both males and females, and it is the most
It was
recognized
for the firstLLC
time as an epidemic
© Jones & common
Bartlettfatal
Learning,
LLC
©
Jones
& Bartlett
Learning,
genetic disease in white children. Cystic
of severe (and even fatal) pneumonia that developed
NOT FOR SALE
OR
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
fibrosis is
accompanied
by many complications and now
among delegates to the 1976 American Legion concarries an average life expectancy of 32 years. The disorvention, hence its name. The convention was held in a
der is characterized by chronic airway infection leading
Philadelphia hotel, with the infection traced to the hotel’s
to bronchiectasis, bronchiolectasis, exocrine pancreatic
water-cooled air conditioning system. Healthy people
insufficiency, intestinal dysfunction, abnormal sweat
can contract legionnaires’ disease,
but the&risk
is highest
©
Jones
&
Bartlett
Learning,
LLC
© Jones
Bartlett
Learning, LLC
gland function, and reproductive dysfunction. Cystic
among those who smoke tobacco products and perNOT FOR SALE OR DISTRIBUTION
FOR
OR DISTRIBUTION
fibrosis is inherited,NOT
and the
geneSALE
on chromosome
7 is
sons with chronic diseases and impaired cell-mediated
responsible for the disease.
immunity.
Signs and symptoms may become apparent soon after
birth, or they may develop in childhood. Cystic fibrosis
Pulmonary Vascular Disease
primarily attacks the lungs and digestive system, proVascular lung
disorders&include
pulmonary
edema,LLC
pul©
Jones
&
Bartlett
Learning,
LLC
© Jones
Bartlett
Learning,
ducing copious thick, sticky mucus that accumulates to
monary
hypertension,
and
pulmonary
embolus,
all
of
NOT
FOR ducts.
SALE
OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
block
glandular
Pancreatic
changes occur, with fat
which
are
discussed
in
the
following
sections.
and fiber replacing normal tissue. Sweat gland dysfunction results in increased concentrations of salt in the
Pulmonary Edema
sweat, and normal growth and health are reduced.
Cystic fibrosis is considered a fatal disease. However,
Pulmonary edema is a condition wherein fluid collects
© Jones & early
Bartlett
Learning,
LLC have greatly increased
© Jones
& Bartlett
Learning,
LLC This accumuladiagnosis
and treatment
in the lung
alveoli and
interstitial tissues.
life expectancy
during the past few decades. Treatment
of fluid
reduces
oxygen levels in the blood
NOT FOR SALE
OR DISTRIBUTION
NOTtion
FOR
SALE
OR diffused
DISTRIBUTION
involves supportive measures that help the child to lead
and interferes with the lungs’ ability to expand. Pulmoas normal a life as possible, along with the prevention of
nary edema may result from predisposing factors, such
pulmonary infections.
as acute respiratory distress syndrome, heart disease,
and inhalation of toxic gases. Of these factors, heart
©
Jones
&
Bartlett
Learning,
LLC
© Jones
& Bartlett
Learning, LLC
disease is the most common cause
of pulmonary
edema.
Pneumonia
NOT
FOR
SALE ORwith
DISTRIBUTION
Pneumonia is defined
as lung
inflammation
fluid
that fills the alveoli and bronchioles. It may develop
either as a primary acute lung infection or secondary
to another condition that reduces lung tissue resistance
(either
a respiratory
or systemic
condition).
Pneumonia
© Jones
& Bartlett
Learning,
LLC
is a risk after any aspiration or lung inflammation, when
NOT
SALE
OR
DISTRIBUTION
fluids
mayFOR
collect,
or when
defense
mechanisms (such as
the cilia in the trachea) are reduced.
Primary pneumonia may be caused by the inhalation or aspiration of a bacterium or virus. Bacterial
is caused by LLC
a bacterium such as staphylo& pneumonia
Bartlett Learning,
©
coccus, klebsiella, or streptococcus. Viral pneumonia
© Jones
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Pulmonary Hypertension
Pulmonary hypertension is the elevation of pressure
in the pulmonary vessels. This condition is common in
preexisting cardiac or pulmonary diseases, but it may
© Jones & Bartlett Learning, LLC
also result from the condition known as pulmonary
NOT
FOR
OR DISTRIBUTION
fibrosis. The
actual
causeSALE
of pulmonary
hypertension is
unknown, but it tends to occur in members of the same
family. Conditions that produce hypoxemia , such as
alveolar hypoventilation, chronic obstructive pulmonary
disease, high altitudes, and smoke inhalation, often cause
Jones
& Bartlett Learning, LLC
secondary pulmonary hypertension.
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 28
8/25/10 8:11 AM
Respiratory Disorders
29
Pulmonary Embolism
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
Pulmonary embolism is a condition resulting from a
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE
ORorDISTRIBUTION
blood clot
fat (lipid) deposit that has formed in a
peripheral blood vessel and then broken free to lodge in a
Embolism
blood vessel in one of the lungs (see Figure 2–5). Pulmolodges in
nary embolism is a potentially life-threatening condition.
pulmonary
Its major risk factors©
include
any &
conditions
that
produce LLC artery
Jones
Bartlett
Learning,
venous stasis, increased coagulation ability, or changes in
NOT FOR SALE OR DISTRIBUTION
the walls of blood vessels.
Pathological changes that can cause pulmonary
embolism include dehydration, immobility, decreased
venous return, or injury. Conditions that are related to
the©
previously
riskLearning,
factors include
pregnancy,
Jones mentioned
& Bartlett
LLC
© Jones
sepsis, congestive heart failure, and tumors.
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
& Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Tuberculosis
Tuberculosis is the main cause of death from a single
Embolism
infectious agent throughout the world. More than 8 miltravels to
right side
© Jones & lion
Bartlett
Learning,
LLC occur every year world© Jones & Bartlett Learning,
LLC
new cases
of tuberculosis
of heart
wide, with
3 million people dying from
NOT FOR SALE
ORapproximately
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
the disease. It is caused by Mycobacterium tuberculosis,
a bacterium resistant to destruction that can survive in
calcified, necrotic lesions for long periods of time.
Tuberculosis mostly affects the lungs, but the patho© Jones
& Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
gen can also invade other
body organs,
such as the
bones,
gastrointestinal tract,
and kidneys.
Tuberculosis
lesions
NOT FOR SALE OR DISTRIBUTION
NOT
FOR SALE
OR DISTRIBUTION
cause the death of affected tissue, which is sloughed off,
and the formation of cavities.
Resistance to secondary tuberculosis depends on the
Embolism
patient’s environment and health status. Reinfection
originatesLLC
© Jones
& Bartlett
Learning,
LLC
© Jones & Bartlett Learning,
occurs
more often
when a patient
is malnourished,
in
in lower
poor
health,
living
in crowded
or unsanitary conditions,
NOT
FOR
SALE
OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
body
or has various other illnesses. An increase of tuberculosis
FIGURE 2–5 The development of pulmonary embolism.
has been seen in the United States due to the prevalence
of human immunodeficiency virus (HIV) infection and
acquired immunodeficiency syndrome (AIDS).
© Jones & Bartlett Learning, LLC
Histoplasmosis
NOT FOR SALE
OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
Histoplasmosis is a fungal disease that originates in
the lungs from the inhalation of dust containing Histopneumoconiosis relate to the patient’s history of expoplasma capsulatum. It is common in the midwestern
sure, and this factor is important in correctly diagnosing
United States and occurs as an opportunistic infection,
Jones
Bartlett
Learning,
LLC
© JonesPneumoconiosis
& Bartlett Learning, LLC
the patient’s individual lung condition.
commonly in AIDS ©
patients.
In &
these
cases, the
fungus
often occurs after years of inhaling
inorganic
dustOR
par- DISTRIBUTION
NOT FOR
SALE
NOTquickly
FOR throughout
SALE ORthe
DISTRIBUTION
disseminates or spreads
entire
ticles, resulting in progressive fibrosis of lung tissue. The
body. Histoplasmosis is similar to tuberculosis in that
most common causes of pneumoconiosis are the dusts
its first stage usually involves an asymptomatic, limited
of coal, asbestos, and silica. Other potential causes are
infection followed by a second active infection. This
beryllium, cadmium, cement, clays, fiberglass, cobalt,
second infection involves the formation of granuloma
Jonesand
& Bartlett
Learning,
LLC
Jones
& Bartlett
LLC
aluminum, ©
iron,
and talc.
The mostLearning,
common types
of
and©necrosis
consolidation
in the lungs,
sometimes
pneumoconiosis
discussed
in the
sections.
NOT FOR
SALE
OR DISTRIBUTION
NOTare
FOR
SALE
ORfollowing
DISTRIBUTION
spreading
to other
organs.
Pneumoconiosis
Silicosis
Pneumoconiosis involves any change in the lungs due
inhaling inorganic dust particles (usually in the work& toBartlett
Learning, LLC
©
place). Environmentally acquired lung diseases such as
© Jones
NOT FOR SALE OR DISTRIBUTION
Silicosis affects workers who have continually inhaled
the inorganic dust compound known as silicon dioxide,
Jones & Bartlett Learning, LLC
which is found in sand, flint, quartz, and many other
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 29
8/25/10 8:11 AM
30
CHAPTER 2
Overview of Cardiopulmonary Disorders and Conditions
stones. Silicosis is characterized by the development of
However, oxygenation failure is not caused by hyper-
© Jones
& Bartlett
Learning,
LLC in diseases that
© Jones &nodular
Bartlett
Learning,
LLCThe incidence is highest
fibrosis
in the lungs.
ventilation.
Oxygenation
failure occurs
NOT
FOR
SALE
OR
DISTRIBUTION
NOT FOR SALE
OR DISTRIBUTION
among industrial
workers exposed to silica powder duraffect the alveoli or interstitial lung tissues. These dising manufacturing, in those who work with ceramics,
sand, or stone, and in those who mine silica. Silicosis is
also known as grinder’s disease or quartz silicosis.
eases include the following:
■ alveolar edema
■ emphysema
■ fungal infections
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
■ leukemia
Anthracosis
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
■ lobar pneumonia
Anthracosis is a chronic lung disease characterized by
■ lung carcinoma
the deposit of coal dust in the lungs. It is also charac■ tuberculosis
terized by the formation of black nodules on the bron■ various pneumoconioses
chioles that result in focal emphysema. The condition
Ventilatory
failure is characterized by increased arterial
occurs
in coal&miners
and Learning,
is aggravatedLLC
by cigarette
© Jones
Bartlett
© Jones
& Bartlett Learning, LLC
carbon
dioxide.
Ventilation may also be reduced by the
smoking.
no specific
for anthracosis,
NOT There
FOR isSALE
OR treatment
DISTRIBUTION
NOT
FOR
SALE OR DISTRIBUTION
following:
which is also known as black lung disease or coal work■ depression of the respiratory center by barbiturates
er’s pneumoconiosis.
or opiates
Asbestosis
■
hypercapnia
■
hypoxia
© Jones & Asbestosis
Bartlett is
Learning,
LLC
© Jones
& Bartlett Learning, LLC
a chronic lung
disease caused by the inha■ intracranial diseases
NOT FOR SALE
DISTRIBUTION
NOT FOR
SALE
ORneuromuscular
DISTRIBUTION
lation ofOR
asbestos
fibers, resulting in the development of
■ lesion
of the
system or thoracic
alveolar, interstitial, and pleural fibrosis. Asbestos mincage
ers and workers are most frequently affected. Asbestosis
■ trauma
sometimes occurs in others who have been exposed to
Respiratory failure in preexisting chronic lung diseases
asbestos building materials. The disease is characterized
may be precipitated by added stress, such as with cardiac
© Jones
& Bartlett
LLC
© Jones & Bartlett Learning, LLC
by small linear opacities
throughout
the lungs,Learning,
as shown
failure, anesthesia, surgery, or upper respiratory tract
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
SALE ORresults
DISTRIBUTION
on chest X-rays. The
disease
is progressive,
in
infections.
shortness of breath, and eventually develops into respiratory failure. Cigarette smoking and continuous asbestos
Pleural Disorders
exposure aggravate the condition, and fatal mesothelial
The pleura is a double-layered membrane that encases
tumors sometimes occur. There is no treatment for
the lungs. The
mediastinum
separates
the right and
left
©
Jones
&
Bartlett
Learning,
LLC
© Jones
& Bartlett
Learning,
LLC
asbestosis.
pleural
cavities.
Pleural
disorders
include
pleurisy,
pleuNOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
ral effusion, pneumothorax, hemothorax, and flail chest.
Berylliosis
Beryllium is an element
Pleurisy
POINT TO REMEMBER
used in fluorescent powPleurisy is an inflammation of the pleura, also called
Severe altitude sickness
ders, metal alloys, and in
© Jones includes
& Bartlett
Learning,
© Jones
& Bartlett
pleuritis.
It causes Learning,
intense pain LLC
during breathing and
a condition
called high-LLC
the nuclear power induspulmonary
edema. This
is
usually
secondary
to
other
diseases
or infections.
NOT FORaltitude
SALE
OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
try. A small percentage
condition causes nausea and
Pleurisy
also
may
result
from
injury
or
the
presence of
of workers exposed to
vomiting, rapid heart rate and
a
tumor.
breathing, and a cyanotic (blue)
beryllium dust or vapor
cast to the skin.
de velop an immune
Pleural Effusion
which
dam© Jonesresponse,
& Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
ages the lungs. Symptoms include fever, fatigue, cough,
Pleural effusion is defined as the presence of excessive
NOT FOR
ORof DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
shortness of breath, night sweats, loss of appetite, and
fluid in the pleural cavity. Normally,
smallSALE
amounts
weight loss. Radiographs show granuloma scars in the
fluid are present, providing lubrication for the pleural
lungs, and pulmonary function tests show impaired
membranes. Usually only one lung is affected by pleural
breathing.
effusion, but sometimes both lungs are affected. This
is because ©
each
lung is&enclosed
a separate pleural
© Jones & Bartlett Learning, LLC
Jones
Bartlettin Learning,
LLC
membrane. The effects of pleural effusion depend on the
Respiratory
Failure
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
amount, rate of accumulation, and type of fluid.
Respiratory failure is the inability of the cardiovascular and pulmonary systems to maintain an adequate
Pneumothorax
exchange of oxygen and carbon dioxide in the lungs.
It may be caused by a failure in either oxygenation or
Pneumothorax is a collection of air or gas in the pleural
© Jones & ventilation.
Bartlett Learning,
LLC
© Jones
Bartlett
Learning,
Oxygenation
failure is characterized by
cavity.&
This
results in
a collapsedLLC
or partially collapsed
hypoxemia,
can initially lead to hyperventilation.
(seeSALE
Figure OR
2–6).DISTRIBUTION
When pneumothorax is caused by
NOT FOR SALE
ORwhich
DISTRIBUTION
NOTlung
FOR
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 30
8/25/10 8:11 AM
Lung Cancer
© Jones &Parietal
Bartlett
pleura Learning, LLC
NOT FOR Air
SALE
in the OR DISTRIBUTION
31
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
pleural space
Multiple
fractured
ribs
Wound site
Lung
Collapsed
lung
© Jones & Bartlett Learning, LLC
Heart
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
Visceral
pleura
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
Diaphragm
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
FIGURE 2–7 Flail-chest injury.
FIGURE 2–6 Pneumothorax.
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
trauma or a malignant tumor, blood or fluid may also be
respiration, decreased breath sounds, and uneven chest
present in the cavity. Tension pneumothorax describes
expansion. Flail chest is a medical emergency and may be
a life-threatening condition of excessive pleural cavity
life threatening.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
pressure.
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALEPneumothorax
OR DISTRIBUTION
Lung Cancer
POINT TO REMEMBER
can be either
The lungs are common sites of both primary and secspontaneous or
Pneumothorax may be treated
ondary types of cancer. Lung cancer is the leading cause
by covering the chest wound
traumatic. Spontaof cancer deaths in both men and women in the United
with an impermeable bandage,
neous pneumotho©
Jones
& Bartlett
© Jones
& Bartlett
Learning,
LLC
passing
a chest
tube throughLearning, LLC
States. Increases
in lung
cancer incidence
and deaths
rax occurs when an
the
thoracic
wall
into
the
pleural
during the past
years are
closely
related
to increased
NOT FOR SALE OR DISTRIBUTION
NOT60FOR
SALE
OR
DISTRIBUTION
opening is present
cavity, and applying suction to
smoking
of
tobacco
products.
Nearly
95%
of primary
on a lung’s surface.
the tube.
lung
tumors
are
of
the
type
known
as
bronchogenic
It can be caused
carcinoma. The remaining 5% includes bronchial gland
by erosion of the alveoli (due to disease or tumors),
tumors, fibrosarcomas, and lymphomas. The lung is also
increased respiratory pressure, or a spontaneous tear in
a common
site of metastasis
fromLLC
cancers in other parts
© Jones & tissue.
Bartlett
Learning,
LLC
©
Jones
& Bartlett
Learning,
Traumatic pneumothorax occurs when the pleuof
the
body.
There
are
four
major
categories
of bronchoNOT FOR SALE
OR
DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
ral cavity’s integrity is breached due to trauma (including
genic
carcinomas:
stabbing, gunshots, or crushing of the chest).
■ adenocarcinoma
■ large cell carcinoma
Hemothorax
■ small cell carcinoma
©
Jones
&
Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
■ squamous cell lung carcinoma
Hemothorax is the accumulation of blood and fluid in
Secondhand
smoke
in
the
environment
has resulted
NOT
FOR SALE
OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
the pleural cavity. The patient experiences symptoms
in
a
significant
number
of
cases
of
bronchogenic
carcithat are similar to those of pneumothorax. Hemothorax
noma. The risk of developing cancer is higher in persons
is life threatening and requires emergency medical care.
who begin smoking early in life, continue for many years,
Trauma or the erosion of a pulmonary vessel may cause
and smoke more than one pack of cigarettes per day
blood to enter the pleural space.
© Jones & Bartlett Learning, LLC
Bartlett Learning, LLC
(considered©toJones
be heavy&smokers).
Not all smokers
develop
lung cancer;
therefore, there
NOT FOR SALE OR DISTRIBUTION
NOT FOR
SALE
OR DISTRIBUTION
Flail Chest
is probably a genetic factor involved. Occupational
exposure to carcinogens such as silica, asbestos, or vinyl
Flail chest is a condition of instability in the chest wall due
to multiple rib fractures. If it is not corrected, hypoxia
chloride is another major cause of lung cancer. The risk
will occur. The most common chest injuries occur from
is greatly increased if a second factor (such as cigarette
© Jones & automobile
Bartlett Learning,
© Jones
& Bartlett
Learning,
LLC
accidents and LLC
falls (see Figure 2–7). This consmoking)
is also present
in an occupationally
exposed
dition isOR
characterized
by sharp pain, shallow and rapid
NOT FOR SALE
DISTRIBUTION
NOTindividual.
FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 31
8/25/10 8:11 AM
32
CHAPTER 2
Overview of Cardiopulmonary Disorders and Conditions
Education
© Jones &hypertension.
Bartlett Learning, LLC
© Jones &Patient
Bartlett Learning,
LLC
Respiratory
therapists
must
be
up
to
date
on
the
latest
NOT
FOR
SALE
ORis DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
2. Atelectasis
defined as imperfect expansion,
failure, acute respiratory failure, and pulmonary
information concerning H1N1 flu (commonly referred
referring to incomplete expansion of a lung or
to as swine flu). They should advise patients who are at
part of a lung. This condition can occur due to
highest risk of contracting H1N1 flu to be especially careairway obstruction, increased lung recoiling (due
ful. These include pregnant women, children younger
to loss of pulmonary surfactant), or lung comthan age 5 years, adults
older than&age
65 years,Learning,
and those LLC
© Jones
Bartlett
© Jones & Bartlett Learning, LLC
pression (which may occur in pleural effusion or
with chronic medicalNOT
conditions,
as diabetes,
heart
NOT FOR
SALE
ORatDISTRIBUTION
FOR such
SALE
OR DISTRIBUTION
pneumothorax). Atelectasis
may be
present
disease, asthma, and kidney disease. Respiratory therabirth, develop in the neonatal period, or develop
pists must educate patients about proper hand washing,
later in life.
wearing protective masks, avoiding using utensils that
3. Acute bronchitis has a short, severe duration,
other family members might use, and avoiding going to
which subsides without any long-term effects.
work
they show
signs of infection.
© ifJones
& Bartlett
Learning, LLC
© Jones & Bartlett Learning, LLC
Chronic bronchitis leads to excessive mucous
NOT FOR SALE OR DISTRIBUTION
NOT FOR
SALE ItOR
production
and coughing.
canDISTRIBUTION
be reversed after
SUMMARY
the removal of the irritant and is complicated
Cardiovascular diseases include carditis, coronary artery
by respiratory tract infections. Chronic brondisease, hypertension, heart failure, and myocardial
chitis can lead to right-sided heart failure, acute
infarction. Angina pectoris is a condition of chest pain
respiratory failure, and pulmonary hyperten© Jones & often
Bartlett
Learning,
© Jones &sion.
Bartlett
Learning, LLC
caused
by anoxia,LLC
atherosclerosis, or coronary
Acute bronchitis is often caused by viruses,
NOT FOR SALE
OR DISTRIBUTION
NOT FOR and
SALE
OR DISTRIBUTION
artery spasm.
Hypertension is a major cause of cardiac
the primary
cause of chronic bronchitis is
disease, renal failure, and stroke. A common form of
smoking or exposure to certain respiratory irriheart disease is called congestive heart failure, which
tants. Risk factors include history of smoking, air
may be related to pulmonary conditions. Common
pollution, occupational exposure, heredity, and
respiratory conditions include asthma, bronchitis, and
reduced lung function.
Jones
& Bartlett
LLC4. Angina pectoris is a sudden
© Jones
& Bartlett Learning, LLC
emphysema—all of ©
which
are aggravated
by Learning,
smoking.
outburst of chest pain
FORanoxia,
SALEatheroOR DISTRIBUTION
NOT FOR
SALEdisease
OR DISTRIBUTION
Common forms of pulmonary
vascular
include
myocardial
frequently caused by NOT
edema, hypertension, and embolism, as well as other
sclerosis, or coronary artery spasm. Anginal pain
potentially deadly pulmonary conditions, including
usually radiates along the neck, jaw, shoulder,
pneumonia, tuberculosis, histoplasmosis, and pneumoand down the left arm. It is often accompanied by
coniosis. When the lungs cannot adequately exchange
feelings of suffocation that may seem to indicate
© Jones
& Bartlett
Learning,
© Jones & Bartlett Learning, LLC
oxygen
and carbon
dioxide,
respiratoryLLC
failure may
impending death. Angina pectoris attacks are
NOT
FOR
SALE
DISTRIBUTION
NOT
FOR
SALE stress,
OR DISTRIBUTION
occur.
Lung
cancer
is theOR
deadliest
type of cancer in the
often
related
to emotional
eating, exertion,
United States.
and exposure to intense cold. Angina pectoris is
also referred to as cardiac pain.
LEARNING GOALS
5. Increases in lung cancer incidence and deaths
during the past 60 years are closely related to
These learning goals correspond to the objectives at the
© Jones & beginning
BartlettofLearning,
© Jones &increased
Bartlett
Learning,
LLC
smoking
of tobacco
products. Secondthe chapter,LLC
providing a clear summary of
NOT FOR SALE
OR
DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
hand smoke in the environment has resulted in a
the chapter’s most important points.
significant number of cases of bronchogenic car1. Emphysema causes the destruction of alveocinoma. The risk of developing cancer is higher in
lar ducts, alveoli, and respiratory bronchioles,
persons who begin smoking early in life, continue
causing enlarged air spaces. As emphysema
for many years, and smoke more than one pack of
progresses, the patient experiences increased
© Jones
& Bartlett
Learning,
LLC cigarettes per day (considered
© Jones
& heavy
Bartlett
Learning, LLC
to be
smokshortness of breath
following
only minimal
exerNOT
FOR
SALE
OR
NOT
FOR
SALE
OR
DISTRIBUTION
ers). Not all smokers develop lung cancer; there- DISTRIBUTION
tion. The most common cause of emphysema
fore, there is probably a genetic factor involved.
is the inhaling of smoke from tobacco prodOccupational exposure to carcinogens, such as
ucts. Lung damage from emphysema is usually
silica, asbestos, or vinyl chloride, is another major
irreversible. Chronic obstructive pulmonary
cause of lung cancer. The risk is greatly increased
disease has, as its most common components,
© Jones
& Bartlett Learning, LLC
Jones
& Bartlett
Learning,
LLC
if a ©
second
factor
(such as cigarette
smoking)
both emphysema and chronic bronchitis. BronNOTchitis
FOR
SALE
OR
DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
is also present in an occupationally exposed
is defined as inflammation of the mucous
individual.
membranes of the bronchi. Bronchitis is a type
6. Endocarditis is inflammation of the inner layer
of chronic obstructive pulmonary disease of the
of the heart, known as the endocardium. Myolarger airways. The most obvious symptom is the
carditis is inflammation of the middle layer of
production of sputum. Chronic bronchitis leads
© Jones & Bartlett
Learning, LLC
© Jones &the
Bartlett
Learning,
LLC
heart, known
as the myocardium.
Myocarto excessive mucous production and coughing.
NOT FOR SALE Chronic
OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
ditis is the type of carditis that is most likely to
bronchitis can lead to right-sided heart
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 32
8/25/10 8:11 AM
Review Questions
cause sudden death. Pericarditis is inflammation
33
3. Describe how cystic fibrosis affects the lungs and
© Jones &the
Bartlett
Learning, LLC
© Jones & Bartlett
Learning,
of the
outer layerLLC
of the heart, known as the
sweat glands.
NOT
FOR
SALE
OR
NOT FOR SALEpericardium.
OR DISTRIBUTION
4. List the factorsDISTRIBUTION
that interfere with oxygenation of
7. Left-sided heart failure is caused by ineffective
the blood in patients with emphysema.
left ventricular contraction. As the left ventricle’s pumping ability fails, cardiac output falls.
WEB SITES
Because blood is no longer effectively pumped
http://hypertensionweb.info/result.php?Keywords=
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
out, it backs up into the left atrium and then
Hypertension
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
into the lungs. This causes activity intolerance
http://www.cancer.org/docroot/PED/content/PED_10_
and dyspnea. If the condition persists, pulmo2X_Cigarette_Smoking.asp
nary edema and right-sided heart failure can
http://www.cdc.gov/niosh/topics/pneumoconioses/
result. Common causes of left-sided heart failure
http://www.emedicinehealth.com/angina_pectoris/
include hypertension, aortic and mitral valve stearticle_em.htm
© Jones
& Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
nosis, and left ventricular infarction.
http://www.healthnewsflash.com/conditions/
NOT Right-sided
FOR SALE
OR
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
heart failure is caused by ineffecrespiratory_failure.php
tive right ventricular contraction. As a result,
http://www.lungcancer.org/
blood is not pumped with enough force through
http://www.medicinenet.com/high_blood_pressure/
the right ventricle to the lungs. This causes blood
article.htm
to back up into the right atrium as well as the
http://www.nei.nih.gov/health/histoplasmosis/index.asp
© Jones & Bartlett
Learning,
LLC
©
Jones
& Bartlett Learning, LLC
peripheral circulation. The patient gains weight,
http://www.webmd.com/asthma/
NOT FOR SALE develops
OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
peripheral edema, and the kidneys
http://www.webmd.com/a-to-z-guides/pneumonia(and other organs) become engorged. Righttopic-overview
sided heart failure may be caused by pulmonary
hypertension, pulmonary embolus, or acute right
REVIEW QUESTIONS
ventricular infarction.
©
Jones
&
Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
Multiple Choice
8. A dysrhythmia (arrhythmia) is a disturbance of
NOT
FOR SALE OR DISTRIBUTION
NOT
FOR causes
SALEofOR
DISTRIBUTION
Common
arrhythmias
Select the best response to each
question.
heart rhythm.
include congenital defects, drug toxicity, elec1. Cancer in which of the following sites is the leadtrolyte imbalances, and myocardial infarction or
ing cause of cancer death in males?
ischemia.
A. prostate
9. Pulmonary edema is a condition wherein fluid
B. pancreas
© Jones
& Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
collects in the lung alveoli and interstitial tisC. lung
NOT
FOR
OR DISTRIBUTION
sues.
ThisSALE
accumulation
of fluid reduces diffused
D. NOT
colon FOR SALE OR DISTRIBUTION
oxygen levels in the blood and interferes with the
2. Chronic dilation and distention of the bronchial
lungs’ ability to expand. Pulmonary edema may
walls is called
result from predisposing factors, such as acute
A. hemoptysis
respiratory distress syndrome, heart disease, and
B. pneumoconiosis
© Jones & Bartlett
Learning,
© Jones &C.Bartlett
Learning, LLC
inhalation
of toxicLLC
gases. Of these factors, heart
bronchiectasis
NOT FOR SALE disease
OR DISTRIBUTION
NOT
FOR
SALE
OR
is the most common cause of pulmonary
D. atelectasisDISTRIBUTION
edema.
3. An area of dead cells due to lack of oxygen is
10. An emboli may cause eventual death if untreated.
called
When an embolism occurs in the pulmonary
A. ischemia
system, it may be caused by any conditions that
B. infarction
© Jones
Bartlett
Learning, LLC C. atresia
© Jones & Bartlett Learning, LLC
produce venous
stasis, &
increased
coagulation
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
ability, or changes in the walls of blood vessels.
D. gangrene
Pathological changes that can cause pulmo4. A collection of air or gas in the pleural cavity that
nary embolism include dehydration, immobility,
results in a collapsed lung is referred to as
decreased venous return, or injury. Conditions
A. emphysema
that are related to the previously mentioned risk
B. pneumoconiosis
© Jones
Bartlett
Learning,
LLC
Jones & Bartlett Learning, LLC
factors&include
pregnancy,
sepsis,
congestive
C. ©
bronchiectasis
NOTheart
FOR
SALE
OR
DISTRIBUTION
NOT
FOR SALE OR DISTRIBUTION
failure, and tumors.
D. pneumothorax
5. When the heart is pumping inadequately to meet
CRITICAL THINKING QUESTIONS
the needs of the body, the condition is called
A. cor pulmonal
1. Explain why there is an extensive network of capB. congestive heart failure
illaries in skeletal muscles and in the liver.
© Jones & Bartlett
Learning, LLC
© Jones &C.Bartlett
Learning, LLC
arrhythmia
2. Explain why an embolus may cause a larger
NOT FOR SALE infarction
OR DISTRIBUTION
NOT
FOR
SALE
OR
D. myocardialDISTRIBUTION
infarction
than an atheroma with a thrombus.
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 33
8/25/10 8:11 AM
34
CHAPTER 2
Overview of Cardiopulmonary Disorders and Conditions
6. An abnormally slow heart rate is known as
© Jones & Bartlett
Learning, LLC
A. bradycardia
NOT FOR SALE B.
ORtachycardia
DISTRIBUTION
12. Which of the following is the most common
© Jones &cause
Bartlett
Learning, LLC
of emphysema?
NOT FOR A.
SALE
OR
DISTRIBUTION
bronchogenic
cancer
C. heart block
B. pneumothorax
D. ventricular fibrillation
C. pulmonary edema
7. Stasis of blood flow from immobility, injury
D. smoking cigarettes
to a vessel, or predisposition to clot formation
13. Which of the following cardiovascular disorders
© Jones & Bartlett Learning, LLC is the leading cause of©death
Jones
& Bartlett Learning, LLC
increases the risk of
in the United States?
NOT
FOR
SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
A. pulmonary embolism
A. myocardial infarction
B. emphysema
B. hypertension
C. pneumothorax
C. stroke
D. chronic obstructive pulmonary disease
D. angina pectoris
8. Which of the following is an occupational disease
14. Which of the following is the cause of primary
© Jones
& Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
that causes progressive, chronic inflammation
pulmonary hypertension?
NOT
FOR
SALE
OR
DISTRIBUTION
FOR SALE OR DISTRIBUTION
and infection in the lungs due to inhalation of
A. NOT
hypoxemia
inorganic dust?
B. pulmonary embolism
A. emphysema
C. pneumonia
B. pneumothorax
D. unknown
C. pneumoconiosis
15. Tuberculosis primarily affects the
© Jones & Bartlett
Learning, LLC
© Jones &A.Bartlett
Learning, LLC
D. bronchiectasis
brain
NOT FOR SALE
OR DISTRIBUTION
NOT FOR B.
SALE
9. Fluid
shift into the extravascular spaces of the
liver OR DISTRIBUTION
lungs with accompanying dyspnea and coughing
C. kidneys
is indicative of
D. lungs
A. myocardial infarction
B. pulmonary edema
CASE STUDY
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
C. angina pectoris
A
52-year-old
man
who
worked
for 15
yearsSALE
in the nuclear
NOT
FOR
OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
D. pneumothorax
power industry began to have symptoms of lung prob10. Which of the following is a common disease of the
lems, including coughing, shortness of breath, fatigue,
lower respiratory tract that frequently is caused
loss of appetite, fever, night sweats, and weight loss.
by the respiratory syncytial viral infection?
Chest X-rays showed granuloma scars in his lungs. His
A. bronchiolitis
pulmonary ©
function
tests
impaired
breathing.
© Jones
&
Bartlett
Learning,
LLC
Jones
& revealed
Bartlett
Learning,
LLC
B. atelectasis
1.
What
is
the
probable
diagnosis
of
his
condition?
NOT
SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
C.FOR
bronchiectasis
2. What medication should this patient receive to
D. pulmonary edema
relieve his symptoms?
11. Which of the following is a major cause of cardiac
disease, renal failure, and stroke?
A. emphysema
© Jones & Bartlett
Learning,
© Jones & Bartlett Learning, LLC
B. heart
failure LLC
NOT FOR SALE C.
ORhypertension
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
D. asthma
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
84379_CH02_022_034.pdf 34
8/25/10 8:11 AM