Respiratory System 9/4/2014 7:06:00 PM

Primary purpose:
Gas Exchange between the atmosphere and
blood

Upper Respiratory Tract:
Nose
Pharynx
Adenoids
Tonsils
Epiglottis
Larynx
Trachea

Lower Respiratory Tract
Bronchi
Bronchioles
Alveoli
Alveolar Ducts

*All LRT are located inside the lungs with exception to the
R and L main Bronchi
* Right lung= 3 lobes
* Left Lung= 2 Lobes

Upper Respiratory Tract
Nose is made of bone and cartilage divided by
the nasal septum
The inside of the nose is shaped into three
passages by projection called turbinates
Turbinates
o Increase the Surface Area of the nasal
mucosa
o Warms and moistens the air
Olfactory nerve endings are found in the roof
of the nose
Nasopharynx- adenoids, lymph
Oropharynx- Tonsils
Air
NoseSinusesNasopharynxoropharynxs
laryngopharynxepiglottislarynxtrachea
Carina respiratory bronchiolesalveoli
Vibrational sounds are made during
respiration leading to vocalization
Carina- aka. Angle of Louis/ bifurcation of
trachea
Lower Respiratory Tract
Right mainstem bronchi
o Shorter
o Wider
o Straighter
o greater risk for aspiration
Mainstem Bronchi
o Lobar
o Segmented
o Subsegmented
Respiratory bronchioles
o Most distant bronchioles
o Lined with smooth muscles-
vasoconstrict/ vasodilate
o Oxygen and CO2 exchange happens in
the respiratory bronchioles
o The area before the respiratory
bronchioles is only a conducting
pathway and is termed anatomic dead
space.
Normal Tidal Volume = 500ml and only 150
ml is inhaled.
Alveoli
o Primary site for gas exchange
o Interconnected by the Pores of Kohn
Surfactant
o Lipoprotein
o Lowers the surface tension in the
alveoli
o Reduces the amount of pressure
needed to inflate
o Decrease tendency of alveoli to
collapse
o Atelectasis- collapse airless alveoli
Blood Supply
o Pulmonary Circulation
Provides lung with blood
supply
Deoxygenated Blood
pulmonary artery pulmonary
capillariesalveolioxygenate
d blood pulmonary veinleft
atriumL ventricle aorta
systemic Circulation
o Bronchial Circulation
Bronchial arteries
Provides oxygen to the
pulmonary bronchi and
pulmonary tissues
Deoxygenated bloodAzygos
veininferior vena cava
Chest Wall
o 12 ribs
o Thoracic Cage- Ribs and Sternum
o Pleural Linings
Parietal pleura
With pain fibers
Irritation can cause
pain with each breath
Viscera pleura
Intra pleural space
20-25ml fluid
provides lubrication
increases cohesion =
lung expansion
o Pleural effusion
Fluid in intra pleural space
May be caused by blockage of
lymphatic drainage
Imbalance in intravascular
and oncotic pressure
Empyema-purulent
o Diaphragm
Major muscle of respiration
Inspiration- contacts
Phrenic nerves at C3 and C5
Air = from higher to lower
o Elastic Recoil
Tendency of the lungs to relax
after being stretched or
expanded
o Compliance
Measure of the ease of
expansion of the lungs
o Oxygen hemoglobin dissociation curve
Left
Right
Deliver oxygen more
readily to the tissues
Usually a
compensatory
mechanism
o Arterial Blood Gas
Determine oxygen status and
acid base balance
pH= 7.35-7.45
paO2 = 80-100 mmHg
paCO2 = 32-48 mmHg
HCO3- = 22-26 meq/L
o Mixed Venous blood gas
Use pulmonary artery catheter
Oxygen-tissue
o Oximetry
Finger
Toes
Ear Lobe
Bridge of the nose
Management:
No nail polish
No bright fluorescent
lights
Control of Respiration
Respiratory brain center- medulla
1. Chemoreceptor
responds to change in the chemical
composition of the fluid (pH PaCO2)
Acidosis- increase RR and tidal volume
Peripheral chemoreceptors
o located in the carotid bodies and
aortic bodies
o respond to decrease PaO2 and pH
2. Mechanical Chemoreceptors
located in the lungs, upper airways, chest wall
and diaphragm
stimulated by irritant, muscle stretching, and
alveolar wall distortion
Hering-Breuer reflex- prevents over distention
of the lungs\
Impulses are sent to the vagus nerve
Respiratory Defense Mechanism
Filtration
o Particles less than 1um is not filtered
Mucocillary Clearance System
o Mucocillary escalator
o Below larynx from trachea to
respiratory bronchioles
o Mucus- 100ml/day by goblet cells and
submucosal gland, IgA
o Ciliary action is impaired by
dehydration, smoking, inhalation of
high O2, infection and ingestion of
drugs
Cough Reflex
o Only effective above the
subsegmental level
Bronchoconstriction
Alveolar Macrophages
Adventitious sounds
o Egophony
o Bronchophony
o Whispered Pectoliloquy
Diagnostics
o Sputum Exam
o Skin Test
o Bronchoscopy- steril saline, to obtain
specimen
o Lung Biopsy
o Thoracentesis
Upright
Elbows on table
o Pulmonary Function test
Upper Respiratory Tract 9/4/2014 7:06:00 PM
Problems in the Nasal and Paranasal
Sinuses
1. Deviated Septum
Deviation of a normally straight
nasal septum
Most Common Cause:
o Trauma
o Congenital Disproportion
Assessment
o Bent to one side
o Experience obstruction to
Nasal breathing
o Nasal edema
o Dryness of the nasal
mucosa with crusting and
bleeding (Epistaxis)
Medical Management
o Nasal allergy control
o Nasal septoplasty
2. Nasal Fracture
Most often caused by a substantial
blow in the middle of the face
Complications:
1. Airway obstruction
2. Epistaxis
3. Meningeal tears
4. Septal hematoma
5. Cosmetic deformity
Classifications
o Unilateral- little or no
displacement
o Bilateral- most common,
flattened look
o Complex fractures-
involves other adjacent
facial structures
Assessment
o Epistaxis- may be the only
initial sign
o Ecchymosis- raccoon eyes
o If the clear liquid is present
and glucose is present=
CSF
o 5-10 days after edema
then repair
Nursing Management
o Maintain airway- upright
position
o Reduce edema- ice therapy
o Prevent complications
o Provide emotional support
Medical Management
o Realign the fracture using
Open or closed
reduction
(Septoplasty,
Rhinoplasty)
3. Rhinoplasty
Surgical reconstruction of the nose
No NSAIDS/ Aspirin 2 weeks prior
surgery
Regional Anesthesia
Nasal packing
o removed the day after
sugery
o prevents bleeding or septal
hematoma
Nasal Splint
o Removed in 3-5 days
o Prevent scar tissue/ helps
maintain shape of nose
Normally experience ecchymosis
and edema for a short period
Maintain airway
4. Epistaxis
Causes:
o Trauma
o Foreign bodies
o Topical corticosteroids use
o Nasal spray abuse
o Street drug use
o Anatomic malformation
o Allergic rhinitis
o Tumor
Types
1. Anterior nasal bleeding -
Young adult
2. Posterior nasal bleeding
older adult, needs medical
attention
Nursing Management
o Keep patient Quiet
o Sitting position
o Apply direct pressure 10-15
min
o Insert small gauze pad
o Do not hyperextend the
neck-risk for aspiration
Medical Management
o Identify bleeding site
o Nasal Packing
5. Allergic Rhinitis
reaction of the nasal mucosa to
specific allergens
may be classified as:
o Intermittent less than 4x
a week or 4 weeks a year
o Persistent
IgE production mast cell and
basophils histamines,
prostaglandins,
leukotrienessneezing,itching,
rhinorrhea,congestioninfiltration
into tissues
6. Acute Viral Rhinitis
Common cold/ Acute coryza
Caused by: Adenovirus
Spread by: Airborne, droplet, direct
hand contact
Symptoms Include: Tickling,
irritation, sneezing, dryness of the
nasopharynx
Fatigue, Physical and emotional
stress, compromise immune status
increases susceptibility
Nursing Management
o Rest
o Increase Fluids
o Proper Diet
o Antipyretic and Analgesic
o Decongestant no more
than 3 days-rebound effect
Complications:
o Pharyngitis, sinusitis, otitis
media, tonsillitis and lung
infection
7. Influenza
Types: A, B, C
A and B only for humans
A is most common and causes
most serious epidemics and
pandemics
B can also cause regional
epidemics but milder
Type A Viruses are divided into
subtypes according to two surface
proteins
o Hemaglutin (H)- enables
virus to enter cell
o Neuroamidase (N)
facilitates cell to cell
transmission
Spread through droplet,inhalation
of aerosolized particles
Incubation period- 4 days
Peak Transmission- 1 day before
onset of symptoms
Clinical Manifestation:
o Cough, fever, myalgia,
headache and sore throat
Most common complication-
pneumonia
CDC- recommends everyone 6 mos
up to get flu vaccines around mid-
october (more effective)
Antiviral tamivir and xanamivir-
neuroamidase inhibitor
8. Sinusitis
inflammation/hypertrophy of the
mucosa narrows or blocks the ostia
secretion accumulates behind the
obstruction- promotss bacterial
growth
Classification:
o Bacterial- Streptococcus
pneumonia,
Haemophilisinfluenzae,
Moraxella catarrhalis
o Viral- follows RTI-
decreases ciliary transport
o Fungal- not common
Types:
o Acute-follows respiratory
tract infection
o Chronic usually
associated with allergies
and nasal polyps
Clinical Manifestation
o Acute:
Pain over affected
sinus, purulent
nasal drainage,
nasal obstruction,
congestion, fever,
malaise
Diagnosis: xray, CT Scan, nasal
bronchoscopy

Obstruction of Nose and Sinuses
1. Nasal Polyps
benign mucous membrane masses
that form slowly in response to
repeated inflammation of the sinus
or nasal mucosa.
Bluish glossy projection in the
nares
Manifestations include nasal
obstruction, discharge and speech
distortion
Endoscopic or laser surgery can
remove nasal polyps but
recurrence is common
Topical or systemic corticosteroids
may slow growth
2. Foreign Bodies
Organic foreign bodies produce a
local inflammatory reaction and
produces nasal discharge which
may become purulent and foul
smelling

Problems of Pharynx
1. Acute Pharyngitis
Acute inflammation of the
pharyngeal walls
May include tonsils, palate or
uvula.
Can be caused by:
o Viral
most common
o Bacterial
strep throat usually
caused by B-
hemolytic
streptococcal
invasion
o Fungal
Candidiasis
prolonged used of
corticosteroids
immunosuppressed
Clinical Manifestation
o Scratchy Throat
o Dysphagia- difficulty in
swallowing
o Viral and Bacterial- no
presence of patch yellow
exudates
o Fungal- irregular patches
Predispose to Rheumatic Heart
Disease or Post streptococcal
glomerulonephritis
Diptheria- pseudomembrane
present
Nursing Management
o Goal: infection control,
symptomatic relief and
prevetion of secondary
complication
o Swish the preparation as
long as possible before
swallowed
2. PeritonsillarAbcess
Complication of Acute Pharyngitis/
Acute Tonsillitis
Bacterial infection invades one or
two tonsils
Clinical Manifestation:
o High Fever
o Leukocytosis
o Hot Potato Voice
o Chills
Management:
o IV Antibiotic Therapy
o Needle aspiration/ incision
drainage
o Tonsillectomy

Problems of Trachea and Larynx
1. Airway Obstruction
may be complete or partial
Complete airway obstruction needs
immediate medical emergency
Symptoms include:
o Stridor
o Use of accessory muscles
o Suprasternal and
intercostal retractions
o Wheezing
o Restlessness
o Tachycardia
o Cyanosis
Interventions
o Heimlich Maneuver
o Circothyroidotomy
o Endotracheal intubation
o Tracheosotomy
2. Tracheosotomy
opening/stoma that results from
tracheotomy (surgical incision into
trachea)
Percutaneous Tracheostomy-
performed at bedside for
emergency purposes
Obturator
Swallowing Dysfunction
o Blue coloring
o Tracheobronchial secretion
for glucose
Speech with Tracheosotomoy
o Deflate cuff
o Fenestrated tube
Remove the inner
cannula
Deflate cuff
Place the
decannulation cap
3. Head and Neck Cancer
Men are affected more than women
Squamous cell carcinoma
Closely related to tobacco and
alcohol use
Clinical Manifestation
o Early:
Persistent unilateral
sore throat
Otalgia (Ear Pain)
Hoarseness
o Late
Pain
Dysphagia
Decreased mobility
of the tongue
Airway obstruction
Cranial nerve
neuropathies
Leukoplakia/erythr
oplakia (Patches)
Diagnostics
o PET
o CT
o MRI
o Laryngoscopy
Stages of Disease is based on:
o Tumor Size
o Number of locations
involved nodes
o Extent of metastasis
Treatment
o Brachytherapy: localized
method of delivering
radiation
o Radiation therapy
o Surgery
o Chemotherapy
o Cordectomy: Partial
removal of one vocal cord
o Hemilaryngetomy: removal
of one vocal cord or part of
a cord
Requires temporary
tracheosotmoy
o Supraglotticlaryngectomy:
removes structures above
the false cords and
epiglottis
Requires temporary
tracheosotomy
Can speak
o Both hemilaryngectomy
and
supreglotticlaryngectomy
allow the voice to be
preserved
o Total Laryngectomy: entire
larynx and preepiglottic
region
Permanent
tracheosotomy
o Radial Neck Dissection
Total laryngectomy
Management:
o Parenteral fluids 24-48
hrs post op
o High Fowlers/Semi fowlers-
decrease edema
o Supraglottic Swallow
Start with
carbonated
beverages
Avoid thin and
watery fluid
o Normal saline bolus via the
tracheosotomy tube is not
recommended to assist
thickened secretions as this
causes hypoxia and
damage to the epithelial
cells following
laryngectomy

Side Effects of Radiation
o Dry mouth (xerostomia)
most frequent side effect of
radiation
Rinse with Warm
water
Pilocarpine
hydrochloride
Increase
saliva
production
Start
before
radiation
therapy for
90 days
o Fatigue
o Stomatitis,
o Irritation
Use prescribed
lotion but not 2 hrs
before treatment
o Ulceration
Voice Rehabilitation
o Blom-Singer prosthetis-
most commonly used voice
prothesis
o Electrolarynx
Creates speech
with sound waves
Corner of the
mouth
o Artificial Larynx
Neck
o Esophageal Speech
Swallowing air
trapping it in the
esophagus and
then releasing it to
create sound
Stoma Care
o Wash around the stoma
daily with moist cloth
o Remove entire tube at least
daily
o Cover with scarf, loose
short or crocheted shield
o Wear plastic collar when
showering
Lower Respiratory Tract 9/4/2014 7:06:00 PM
Lower Respiratory Tract Infections
1. Acute Bronchitis
Inflammation of the bronchi
Usually occurs with or after a viral
upper respiratory tract infection
Most common Symptom:
o Cough (10-20 days)
o Headache
o Malaise
o Shortness of breath
o Mildly elevated temp
No evidence of consolidation/
infiltrates as compared to
pneumonia
If due to an influenza virus, meds
must be initiated within 48 hrs of
the onset of symptoms
2. Pertussis
Highly contagious
Gram negative bacillus Bordetella
pertussis
Whooping Cough (6-10 weeka)
Respiratory/Saliva Droplet
3. Penumonia
acute inflammation of the lung
parenchyma
sulfa drugs and penicillin
4
th
leading cause of death in the
Philippines
Pneumocytisjiroveci
Cytomegalovirus- viral pneumonia
Cause:
o Aspiration
Chemical
Pneumonitis
Bacterial infection-
most common
cause
o Inhalation
o Hematogenous Spread
Typre of Pneumonia
o 1. Community Aquired
Pneumonia
onset in the
community or
during the first 2
days of
hospitalization
Streptococcus
pneumoniae
o 2. Hospital acquired
Pneumonia
occurring 48 hours
or longr after
hospitalization
admission
o 3. Ventilatory Associated
Pneumonia
more than 48 hours
after endotracheal
intubation
o 4. Health Care- associated
Pneumonia
new onset of
pneumonia who:
was
hospitalized
in an acute
care
hospital for
2 days or
longer
within 0
days of
infection
resided in a
long term
care facility
received
recent iv
antibiotic
therapy,
chemo, or
wound care
within the
past 30
days of the
current
infection
attended a
hospital/
hemodyalisi
s clinic
o Diagnostics
Bilateral alveolar
pattern of
infiltration-
legionella
Consolidation- S
pneumonia or
Klebsiella
Cavitary Shadows-
S. aureus,
Mycobaterium TB
o Pathophy
Congestion
Red Hepatization-
massive dilation of
capillaries
Grapy
Hepatization-
condsolidation of
fibrin and
leukocytes
Resolution
o Clinical Manifestations
Fever
Chills
Shortness of breath
Productive cough
with purulent
sputum
Consolidation
Bronchial breath
sounds
Dull
Increased Fremitus
Crackles- M
pneumonia,
legionella,
Chlamydia
pneumonia
o Complications:
PLEURISY
Pleural Effusion
Atelectasis
Bacteremia-
bacterial infection
in blood
Lung abcess
Empyema-purulent
exudate in the
pleural cavity
Pericarditis
Meningitis
Endocarditis
3. Tuberculosis
Mycobacterium tuberculosis gram
positive
Airborne Droplet
Factors of transmission:
o Number of organisms
expelled in the air
o Concentration of organisms
o Length of time of exposure
o Immune system of the
exposed person
Risk Factors:
o Elderly
o Urban poor
o Immuno compromised
o Smokers
o Malnutrition
o Diabetes
Classifications of TB
o Class 0- No TB exposure
o Class 1- TB exposure no
infection
o Class 2- Latenet TB
infection, no Disease
o Class 3- Clinically Active
o Class 4- TB but not
clinically active
o Class 5- TB suspect
Clinical Manifestations
o Active TB
Fatigue
Malaise
Night sweats
Unexplained weight
loss
Low grade fever
Complications
o Miliary TB
Spread to all body
organs by invading
blood stream
o Pleural effusion and
empyema
o Tuberculosis Pneumonia
o Other organ involvement
Diagnostics
o Tuberculin skin test
(Mantoux Test)
o Chest xray
o Bacteriologic
Drugs
o BCG
o Isoniazid-peripheral
neuropathy
o Rifampin-orange urine
o Pyrazinamide-
o Ethambutol-ocular toxicity,
optic neuritis
4. Atypica Mycobacteria
closely resembles TB
Mycobateriumavium complex
o Commonly found in water
Treatment similar to TB
5. Pulmonary Fungal Infection
Caused by inhalation of spores
Skin testing, serology and biopsy
to identify
Amphotericin B via IV standard
therapy
6. Lung Abscess
cavity in the lung parenchyma
containing purulent material
formed by necrosis of lung tissue
caused by bacteria aspirated from
the GI / oral cavity
Superior segments of lower lobe
and posterior part of upper lobe-
most commonly affected area
Foul smelling / sour tasting sputum
Clinical Manifestation
o Cough producing purulent
sputum (Dark Brown) foul
smelling sour tasting
o Hemoptysis
o Dullness and crackles
Diagnostics
o Chest xray
Solitary cavilary
lesions with fluid
Management
o Antibiotic therapy
o Chest physiotherapy
o Postural drainage
o Dental hygiene
o Lobectomy
o Pneumonectomy
7. Environmental Lung Disease
results from inhaled dust or
chemicals
Major Groups:
o Pneumoconiosis
Caused by
inhalation and
retention of dust
particles
dust in the lungs
ex. Silicosis (silica
dust-mining),
asbestosis
(construction),
beryliosis (aircraft)
o Chemical Pneumonitis
Exposure to toxic
chemical fumes
Pulmonary edema
Ex. Silo fillers
disease (Nitrogen
oxide fermentation
of vegetarian)
o Hypersensitivity
pneumonitis
Allergic
Bird fanciers lung;
Farmers lung
8. Lung Cancer
Risk Factors: Smoking, Exposure to
carcinogens..etc
Female smokers pose a greater risk
in developing lung cancer than men
smokers
Segmental bronchi or upper lobe of
lungs
Common site of metastic growth
o Liver
o Brain
o Bones
o Scalene lymph nodes
o Adrenal glands
Paraneoplastic Syndrome
o Consequence of presence
of cancer in the body
Early Manifestations
o Persistent pneumonitis
Fever chills and
cough
o Perisitent cough with blood
tinge sputum
o Chest pain
o Dyspnea
o Wheezing
Late Manifestation
o Hoarseness
Diagnostics
o Chest xray
Lung mass/
infiltrate
o MRI
o PET
o CT
o Biopsy
o Bronchoscopy
o Mediastinoscopy
o Video assisted
Thoracoscopy
Stage I,II and IIIA are surgical
candidates
Stages depends on tumor size,
location and degree of invasion
Other Lung tumors:
o Hemartomas: most
common congenital
o Chondromas: arise in
bronchial cartilage
o Leiomyomas: myomaos
smooth non striated
muscles
o Mesotheliomas-from
visceral pleura

Chest Trauma and Thoracic Injuries
1. Blunt trauma
cheststruck by and object
2. Penetrating trauma
gunshot, stab wound
3. Pneumothorax
air in the pleural space
partial or complete lung collapse
lung volume decrease as air
trapped increases
blunt force trauma
may be accompanied by
pneumothorax
Types:
o Closed
Most common form
of spontaneous
pneumothorax
Caused by rupture
of small blebs in
the visceral pleura
Most commonly
due to smoking
From broken
ribs/laceration
o Open
Caused by an
opening in the
chest wall
Stab
wound/gunshot
Cover with dressing
immediately
Do not remove
object until
physician is there
o Tension Pneumothorax
Air in pleural space
cannot escape
causing tension to
organs
Emergency
treatment:
puncture 4
th
and 5
th

ICS
o Hemothorax
Blood in pleural
space
Autotransfusion
ready
o Chlyothorax
Lymphatic fluid in
pleural space
Management:
Pleurodesis,
Octreotide
o Clinical Manifestation
Tachycardia
Dyspnea
4. Fracured Ribs
most common is 5-10
th
rib
treat pain
5. Flail Chest
results from fracture of two or
more ribs
mifest rapid shallow breathing and
tachycardia
6. Chest Tubes and Pleural Drainage
Chest tube insertion
o At the bedside of ER
Flutter or Heimlich valve
Pleural Drainage
o SEE NOTES OF OTHER
PEOPLE
7. Chest tube removal
suction is discontinued
15 min before=pain med
8. Chest surgery
Thoracotomy
o Opening of the thoracic
cavity
o Median-heart
o Lateral
Anterolateral
4-5
th
ICS
wedge
resection
Posterolateral
Lung
Video Assisted Thoracic Surgery

Restrictive Respiratory Disorders
-disorders that alter the ability of the chest
wall and diaphragm to move with respiration
Categories:
Extrapulmonary
o Lung is normal
Intrapulmonary
o Lung is the cause
1. Pleural Effusion
abnormal collection of fluid in the
pleural space
N= 5-15ml
Factors that may cause pleural
effusion:
o Decrease oncotic pressure
o Increase capillary
permeability
o Bleeding
o Decrease lymphatic
clearance
o Infection
Types:
o Transudative
Non inflammatory
condition
Accumulation of
protein poor, cell
poor fluid
Heart failure is the
most common
cause
Caused by:
Increased
hydrostatic
pressure
Decrease
oncotic
pressure
o Exudative
Increased capillary
permeability
Secondary to
malignancies
Empyema
o Purulent fluid in plueral
space
o Caused by pneumonia, TB,
lung abcess, infection
o Complication: fibrothorax
o Management: Chest Tube
Drainage
Trapped lung
o Can occur with effusion and
empyema
o Occurse when visceral
pleura becomes encased
with fiborous peel and
prevents lung expansion
o Decortication-surgical
procedure to remove
pleural peel
Clinical Manifestations
o Progressive Dyspnea
o Dullness
o Distant breath sounds
2. Thoracentesis
aspiration of intrapleural fluid
1-1.2L is removed at a time
rapid removal may cause
hypotension, hypoxemia or
pulmonary edema
3. Pluerisy
Pleuritis
Inflammation of the pleura
Most common cause is pneumonia,
TB, chest trauma, infarctions,
neoplasms
Abrupt pain and sharp in onset
aggrevated upon inspiration
Rapid shallow breathing
4. Atelectasis
lung collapse
most common cause: obstruction
of small airways with secretion
Deep Breathing Exercises

Interstitial Lung Disease
Diffuse parenchymal lung disease
1. Ideopathic pulmonary Fibrosis
chronic progressive disorder in
adults
chronic inflammation and formation
of scar tissue in the connective
tissue
Clinical manifestation:
o Exertional dyspnea
o Nonproductive cough
o Inspiratory crackles
2. Sarcoidosis
chronic multisystem granulomatous
disease of unknown cause that
primarily affects the lungs
may involve skin, eyes, liver
kidney, heart and lymph nodes
Manifestations: dyspnea , cough
and chest pain

Vascular Lung Disorder
1. Pulmonary Edema
abnormal accumulation of fluid in
the alveoli and interstitial spaces of
the lungs
medical emergency
most common cause is L sided HF
2. Pulmonary Embolism
blockage of pulmonary artery by a
thrombus, fat, air or tissue
lower lung lobes are more
commonly affected
lethal pulmonary emboli most
commonly originate in the femoral
or iliac veins
Complication:
o Pulmonary infaction( death
of lung tisse)
Occlusion of large
or medium sized
vessel
Insufficient
collateral blood
flow
Preexisting lung
disease
Results in alveolar
necrosis and
hemorrhage
o Pulmonary Hypertension
Diagnostics
o Spiral CT scan
o Ventilation perfusion scan
v/q scan
Xenon
radioscope
o D-dimer
Measures amount
of crossed linked
fibrin fragments
o Pulmonary angiography

Pulmonary Hypertension
1. Primary Pulmonary Hypertension
severe progressive disease
mean pulmonary arterial pressure
greater than 25mmHg at rest or
30mmHg after exercise
increases the workload of the heart
causing right ventricular
hypertrophy (corpulmonale)
Treatment:
o Diuretic therapy: relieves
dyspnea and edema
o Anticoagulant
o Hypoxia= pulmonary
constrictor
o Ca channel blocker- dilates
vessels
Drugs
o Prostacyclines
Epoprostenol
Indwelling
catheter
6 min half
life
Treprostinil
Subcutaneo
us or IV
4hrs half
life
Iloprost
Inhalation
6-9 times a
day
o Endothelin receptor
blockers
Blocks hormone
endothelin
(vasoconstrictor)
Both can be given
orally
Monthly liver test
risk for
hepatotoxicity
Bosentan
Ambrisentan
o Phosphodieserase inhibitor-
prolongs vasodilatory effect
of Nitric oxide
Sildenafil
Milrinone
Surgical Intervention
o Lung transplant
o Atrial septostomy- right to
left shunt
o PTE (pulmonary
thromboendarterectomy
2. Secondary pulmonary hypertension
occurs when a primary disease
causes a chronic increase in
pulmonary artery pressure
3. CorPulmonale
enlargement of R ventricle
secondary to disease of the lung,
thorax, pulmonary ciculation
pulmonary hypertension is usually
a preexisting condition with
corpulmonale
most common cause is COPD
Manifestations:
o Dyspnea
o Lethargy
o Fatigue
o Right ventricular
hypertrophy
o Increase intensity in the
second heart sound
4. Lung transplantation
Candidate
o Should not have a
malignancy for 2 years,
Renal or liver insufficiency
or HIV
Bronchiolitis obliterans
o Obstructive airway disease
causing occlusion
o Chronic rejection in lung
transplant patients