Diagnostic Tests

(Spirometry, Arterial blood gas determination, Oximetry, Exercise tolerance testing)

- Spirometry- pulmonary function test (PFT)

   + Tests pulmonary volumes and airflow times

- Arterial blood gas determination

   + Checks oxygen, carbon dioxide, bicarbonate, serum pH

- Oximetry

   + Measures O2 saturation

- Exercise tolerance testing

   + For patients with chronic pulmonary disease

Diagnostic Tests

(Radiography, Bronchoscopy, Culture and sensitivity tests)

- Radiography

   + Helpful in evaluating tumors

   + Evaluate infections

   + Evaluating calcifications in TB patients

- Bronchoscopy

   + Perform biopsy

   + Check site of lesion and bleeding

- Culture and sensitivity tests

   + Sputum testing for presence of pathogens

• Percussion- tapping on the chest to determine whether air filled or fluid filled

• Auscultation- using a stethoscope to listen to the chest

- Sneezing

   + Reflex response to irritation in upper respiratory tract

      * Assists in removing irritant

      * Associated with inflammation or foreign material

- Coughing

   + Irritation caused by nasal discharge

  + Inflammation or foreign material in lower respiratory tract

   + Caused by inhaled irritants

Both are performed to get rid of a pathogen

Exporants (mucinex) clear mucus

- Sputum

   + Yellowish-green, cloudy, thick mucus

       - Often indicate bacterial infection

   + Rusty or dark colored sputum

       - Usually sign of pneumococcal pneumonia

  + Very large amounts of purulent sputum with foul odor

       - May be associated with bronchiectasis

   + Thick, tenacious mucus

      - Asthma or cystic fibrosis, blood-tinged sputum- may result from chronic cough; may also be sign of tumor or tuberculosis

      - Hemoptysis: blood-tinged (bright red) frothy sputum usually pulmonary edema (left ventricle problems)

- Breathing patterns and characteristics

  + Labored respiration or prolonged inspiration or expiration

           * Often associated with obstruction of airways

      + Wheezing or whistling sounds

           * Indicate obstruction in small airways

      + Stridor

        * High-pitched crowing noise

        * Usually indicates upper airway obstruction (phlegm)

Respiratory patterns

(Tachypnea, bradypnea, apnea, cheyne- stokes respiration)

- Tachypnea

   + Rapid, superficial breathing

   + Regular or irregular rhythm

- Bradypnea

 + Slow respiratory rate, deeper than usual depth, regular rhythm

- Apnea

   +Cessation of breathing (snoring)

- Cheyne- Stokes respiration

   + Periodic breathing associated with periods of apnea, alternating regularly with a series of respiratory cycles, the respiratory cycle gradually increases, then decreases in rate and depth

    + Breathing pattern of people dying

- Dyspnea

   + Subjective feeling of discomfort or labored breathing

  * May be caused by increased carbon dioxide or hypoxemia

      * Often noted on exertion, such as climbing stairs

- Severe dyspnea indicative of respiratory distress

    + Flaring of nostrils

    + Use of accessory respiratory muscles

    + Retraction of muscles between or above ribs

- Orthopnea

    + Shortness of breath that occurs when lying down

    + Usually caused by pulmonary congestion

Upper Respiratory Tract Infection

(Common cold)

- Common cold (infectious rhinitis)

   + Viral infection

   + More than 200 possible causative agents

   + Spread through respiratory droplets

  + Hand washing and respiratory hygiene important in prevention

   + Symptomatic treatment

   + Secondary bacterial infections may occur

        * Usually caused by streptococci

        * Purulent exudate; systemic signs such as fever

Rhinosinusitis

(Sinusitis)

• Infection or allergy obstructs sinus drainage
• Acute: facial pain, headache, purulent nasal discharge, decreased sense of smell, fever
• Chronic: nasal obstruction, fullness in the ears, postnasal drip, hoarseness, chronic cough, loss of taste and smell, unpleasant breath, headache
• Main treatment is antibiotics and netti pot

• Usually bacterial infection

     + Analgesics for headache and pain

     + Course of antibiotics often required to eradicate infection

Upper Respiratory Tract Infections

(Flu- treatment and prevention)

- Treatment

   + Symptomatic and supportive

        * Unless bacterial infection develops

   + Antiviral drugs

        * May reduce symptoms and duration

        * Reduces risk to infect others

- Prevention

   + Respiratory hygiene!

   + Vaccination is recommended for most individuals

- Viral infection

- Three groups of influenza viruses

    + Type A (most prevalent), type B and C

   + Viruses constantly mutate (why it is hard to get right vaccine)

- Sudden, acute onset with fever, marked fatigue, aching pain in the body

    + May also cause viral pneumonia

  + Mild case of influenza may be complicated by secondary bacterial pneumonia

  + Commonly, deaths in flu epidemics result from pneumonia

- Laryngotracheobronchitis (croup)

     + Deals with larynx, trachea, and bronchi

     + Common viral infection, particularly in children

     + Common causative organism

            * Parainfluenza viruses and adenoviruses

     + Infection usually self-limited

- Upper airway

    + Croup

    + Epiglottitis

- Lower airway

    + Acute bronchiolitis

* Humidifiers hep breathing, make air cool and moist

Lower Respiratory Tract Infections

(Bronchiolitis)

- Caused by the respiratory syncytial virus (RSV)

- Transmitted by oral droplet

- Virus causes necrosis, inflammation in small bronchi and bronchioles

- Signs

     + Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise

- Treatment

       + Supportive and symptomatic

Lower Respiratory Infections

(Pneumonia)

- Classification of pneumonias based on:

     + Causative agent

             * Viral, bacterial, fungal

     + Anatomical location of infection

             * Throughout both lungs, or in one lobe

     + Pathophysiological changes

        * Changes in interstitial tissue, alveolar septae, alveoli

     + Epidemiological data

             * Nosocomial (hospital-acquired)

             * Community- acquired

Pneumonia- Inflammation of Alveoli and Bronchioles

(Typical vs. Atypical)

- Typical: bacteria in the alveoli

     + Lobar: affects an entire lobe of the lung

  + Bronchopneumonia (goes everywhere): patchy distribution over more than one lobe

           *Common cause of death in seniors

- Atypical

    + Viral and mycoplasma infections of the alveolar septum or interstitium

*Big in the 70s-80s*

- Caused