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Bronchogenic Carcinoma
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Lung Cancer (Cont.) Lung tumor effects Obstruction of airflow into a bronchus Causes abnormal breath sounds and dyspnea Inflammation and bleeding surrounding the tumor Cough, hemoptysis, and secondary infections Pleural effusion, hemothorax, pneumothorax Para neoplastic syndrome Occurs wen tumor cell secretes hormones or hormone-like substances Usual systemic effects of cancer
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Lung Cancer (Cont.) Early signs Persistent productive cough Detection on radiograph Hemoptysis Pleural involvement Chest pain Hoarseness, facial or arm edema, headache, dysphagia, or atelectasis
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Lung Cancer (Cont.) Systemic signs Weight loss, anemia, fatigue Paraneoplastic syndrome Indicated by signs of an endocrine disorder Related to the specific hormone secreted Signs of metastases Bone pain Cognitive deficits, motor deficits
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Lung Cancer (Cont.) Diagnostic tests Specialized helical CT scans and MRI Chest radiography Bronchoscopy Biopsy and mediastinoscopy
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Aspiration Passage of food, fluid, emesis, other foreign material into trachea and lungs Common problem in young children or individuals laying down when eating or drinking Result may be: Obstruction Aspirate is a solid object. Inflammation and swelling Aspirate is an irritating liquid. Predisposition to pneumonia
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Aspiration (Cont.) Potential complications Aspiration pneumonia Inflammationgas diffusion is impaired. Respiratory distress syndrome May develop if inflammation is widespread Pulmonary abscess May develop if microbes are in aspirate Systemic effects When aspirated materials (solvents) are absorbed into blood
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Aspiration (Cont.) Signs and symptoms Coughing and choking with dyspnea Loss of voice if total obstruction Stridor and hoarseness Characteristic of upper airway obstruction Wheezing Aspiration of liquids Tachycardia and tachypnea Nasal flaring, chest retractions, hypoxia In individuals with severe respiratory distress Cardiac or respiratory arrest
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Emergency Treatment for Aspiration
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Obstructive Sleep Apnea Result of pharyngeal tissue collapse during sleep Leads to repeated and momentary cessation of breathing Men are affected more often than women. Obesity and aging are common predisposing factors.
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Restrictive Lung Disorders Group of disorders with impaired lung expansion and reduced total lung capacity First group Abnormality of chest walllimits or impairs lung expansion Kyphosis or scoliosis, poliomyelitis, amyotrophic lateral sclerosis, botulism, muscular dystrophy Second group Diseases affecting the supporting framework of lungs Idiopathic pulmonary fibrosis, occupational diseases
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Pneumoconioses Chronic restrictive diseases resulting from long-term exposure to irritating particles Inflammationgradual destruction of connective tissue Functional areas of the lungs lost Onset insidious Dyspnea develops first Treatmentending exposure, treatment of infection
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Pneumoconioses (Cont.)
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Vascular Disorders: Pulmonary Edema Fluid collecting in alveoli and interstitial area Can result from many primary conditions Reduces amount of oxygen diffusing into blood Interferes with lung expansion May develop when: Inflammation in lungs is present. Increases permeability of capillaries Plasma protein levels are low. Decreases osmotic pressure of plasma Pulmonary hypertension develops.
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Pulmonary Edema (Cont.)
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Vascular Disorders
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Pulmonary Embolus
Blood clot or mass that obstructs pulmonary artery or any of
its branches Effect of embolus depends on material, size, and location Small pulmonary emboli might be silent unless they involve a large area of lung. Large emboli may cause sudden death. 90% of pulmonary emboli originate from deep vein thromboses in legs; are preventable
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Pulmonary Embolus (Cont.) Signs and symptoms Transient chest pain, cough, dyspneasmall emboli Larger emboliincreased chest pain with coughing or deep breathing; tachypnea and dyspnea develop suddenly. Laterhemoptysis and fever Hypoxiacauses anxiety, restlessness, pallor, tachycardia Massive emboli Severe crushing chest pain, low blood pressure, rapid weak pulse, loss of consciousness
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Pulmonary Embolus (Cont.)
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Expansion Disorders
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Atelectasis Nonaeration or collapse of lung or part of a lung Leads to decreased gas exchange and hypoxia Alveoli become airless. Collapse and inflammation or atrophy occur. Process interferes with blood flow through the lung. Both ventilation and perfusion are altered. Affects oxygen diffusion
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Atelectasis (Cont.) Mechanisms that can result in atelectasis Obstructive or resorption atelectasis Caused by total obstruction of airway Compression atelectasis Mass or tumor exerts pressure on part of the lung. Increased surface tension in alveoli Prevents expansion of lung Fibrotic tissue in lungs or pleura May restrict expansion and lead to collapse Postoperative atelectasis Can occur after surgery
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Atelectasis (Cont.)
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Atelectasis (Cont.) Signs and symptoms Small areas are asymptomatic. Large areas Dyspnea Increased heat and respiratory rates Chest pain
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Pleural Effusion Presence of excessive fluid in the pleural cavity Causes increased pressure in pleural cavity Separation of pleural membranes Exudative effusions Response to inflammation Transudate effusions Watery effusions (hydrothorax) Result of increased hydrostatic pressure or decreased osmotic pressure in blood vessels
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Pleural Effusion (Cont.) Signs and symptoms Dyspnea Cyclic chest pain Increased respiratory and heart rates
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Pneumothorax Air in pleural cavity Closed pneumothorax Air can enter pleural cavity from internal airwaysno opening in chest wall Simple or spontaneous pneumothorax Tear on the surface of the lung Secondary pneumothorax Associated with underlying respiratory disease Rupture of an emphysematous bleb on lung surface or erosion by a tumor or tubercular cavitation
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Types of Pneumothorax
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Pneumothorax (Cont.) Open pneumothorax Atmospheric air enters the pleural cavity though an opening in the chest wall. Sucking wound Large opening in chest wall Tension pneumothorax Most serious form Result of an opening through chest wall and parietal pleura or from a tear in the lung tissue and visceral pleura Air entry into pleural cavity on inspiration but hole closes on expiration Trapping air leads to increased pleural pressure and atelectasis
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Emergency Treatment for Pneumothorax
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Flail Chest Results from fractures of ribs, which allow ribs to move independently during respiration During inspiration Flail or broken section moves inward rather than outward. Inward movement of ribs prevents expansion of affected lung. Large flail section can compress adjacent lung tissue. Pushing air out of that sectionup the bronchus Air (stale) from damaged lung crosses into the other lung with newly inspired air.
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Flail Chest (Cont.) During expiration Unstable fail section pushed outward by increasing intrathoracic pressure. Large flail section Paradoxical movement of ribs alters airflow during expiration. Air from unaffected lung moves across into affected lung. Hypoxia results from limited expansion and decreased inspiratory volume.
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Flail Chest Injury
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Infant Respiratory Distress Syndrome Usually related to premature birth Lack of surfactant in alveoli Poorly developed alveoli are difficult to inflate. Diffuse atelectasis results. Decreased pulmonary blood flowpulmonary vasoconstriction severe hypoxia Poor lung perfusion and lack of surfactant Increased alveolar capillary permeability Fluid and protein are leaking into the interstitial area and alveoli, hyaline membrane formation
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Infant Respiratory Distress Syndrome (Cont.)
Signs and symptoms
Respiratory difficulties may be evident at birth or shortly thereafter. Respirations rapid and shallow, with chest retractions and flaring of nares. Frothy sputum and expiratory grunt Blood pressure falls. Cyanosis and peripheral edema Severe hypoxemia and decreased responsiveness Irregular respirations with periods of apnea Decreased breath sounds
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Adult Respiratory Distress Syndrome
Results from injury to the alveolar wall and capillary membrane
Causes the release of chemical mediators Increases permeability of alveolar capillary membranes Increased fluid and protein in interstitial area and alveoli Damage to surfactant-producing cells Diffuse necrosis and fibrosis if patient survives Multitude of predisposing conditions Often associated with multiple organ dysfunction or failure
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Adult Respiratory Distress Syndrome (Cont.) Signs and symptoms Dyspnea Restlessness Rapid, shallow respiration Increased heart rate Combination of respiratory and metabolic acidosis
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Adult Respiratory Distress Syndrome (Cont.)
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Acute Respiratory Failure May result from acute or chronic disorders Emphysema Combination of chronic and acute disorders Acute respiratory disorders Many neuromuscular diseases Signs may be masked or altered by primary problem
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