2 Overview of Cardiopulmonary Disorders and Conditions OUTLINE
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
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