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pulmonary lecture

1. PULMONARY SYSTEM Presenter - Joud alsaluli (20231439) - Nada alruwily (20231332) - Reem abdumanam (20231389) Instructor Dr. LAILA

2. Outline Discuss the acute respiratory failure disease with management Explain the cause, symptom and management of Acute Respiratory Distress Syndrome Describe the Chronic Obstructive Pulmonary and Asthma Disease the cause, symptom and management Outline the cause, symptom and management of Pulmonary embolism (PE) and pneumonia disease and drwnoing disease

3. Introduction The pulmonary system serves as a cornerstone of health and disease management, encompassing vital functions beyond mere gas exchange Its intricate anatomy and physiology intricately influence overall physiological balance and immune response, making it a focal point in healthcare. From acute respiratory distress to chronic obstructive pulmonary disease, understanding pulmonary function is paramount for effective diagnosis and treatment.

4. Anatomy and Physiology Pulmonary function evaluation encompasses a thorough assessment utilizing various modalities, including physical examination, diagnostic tests, and imaging studies. During the physical examination, healthcare providers auscultate lung sounds to detect abnormalities, inspect for signs of respiratory distress, and evaluate respiratory rate and effort. Diagnostic tests, such as spirometry and arterial blood gas analysis, provide quantitative measures of lung function and oxygenation, aiding in the diagnosis and monitoring of respiratory conditions.

5. Acute Respiratory Failure (ARF)

6. Pathophysiology Acute respiratory failure occurs when the respiratory system is unable to adequately exchange oxygen and carbon dioxide, leading to dangerously low oxygen levels or high carbon dioxide levels in the blood. sings and Symptoms Acute Respiratory Failure (ARF) symptoms comprise severe dyspnea, rapid and shallow breathing, mental confusion, cyanosis, increased heart rate, fatigue, anxiety, and difficulty speaking. These signs indicate a critical respiratory impairment, requiring urgent medical intervention for oxygenation and carbon dioxide elimination.

7. Etiology and risk factors: smoke tobacco product drink alcohol excessivelyhave a family history of respiratory disease or conditions Lung diseases (COPD, pneumonia, ARDS), Trauma Drug overdoses, Neuromuscular disorders Systemic conditions like sepsis. Any disruption in lung oxygen-carbon dioxide exchange may contribute to ARF.

8. Management Strategies of Acute Respiratory Failure (ARF) Acute Respiratory Failure (ARF) management involves addressing the root cause, utilizing strategies such as oxygen therapy and mechanical ventilation, and administering medications for symptom relief. Close monitoring, nutrition, and a multidisciplinary approach are crucial, with ICU admission in severe cases. Regular reassessment and collaboration ensure effective care. DIAGNOSING TAST: .CHEST X-ray .blood gas test Pulse oximetey

9. Acute Respiratory Distress Syndrome (ARDS) Pathophysiology Acute Respiratory Distress Syndrome (ARDS) is a severe lung condition marked by rapid onset of widespread inflammation in the lungs, leading to impaired oxygen exchange. Symptoms Sudden onset of severe shortness of breath Rapid and labored breathing, Low oxygen levels, Confusion, and cyanosis (bluish skin color). Patients may also experience extreme fatigue, rapid heart rate, and difficulty speaking due to respiratory distress.

10. Acute Respiratory Distress Syndrome (ARDS) Etiology and risk factors Severe lung injuries, such as pneumonia Sepsis Trauma, or inhalation of harmful substances. Inflammatory responses trigger widespread damage, leading to increased permeability of lung blood vessels and air sacs, resulting in fluid accumulation and impaired oxygenation. Potential complications lung damage, such as a collapsed lung (also called pneumothorax) due to injury from the breathing machine needed to treat the diseasePulmonary fibrosis (scarring of the lung)Ventilator-associated pneumonia

11. Acute Respiratory Distress Syndrome (ARDS) Management strategies and tretment In the management of Acute Respiratory Distress Syndrome (ARDS), supportive care is employed to optimize oxygenation and address the underlying cause. Treatment involves the use of mechanical ventilation with low tidal volumes, positive end-expiratory pressure (PEEP), and sometimes prone positioning. Crucial elements for patient recovery include supportive measures such as fluid management, sedation, and addressing complications. DIAGNOSING TAST: Sputum cultures and analysisTests for possible infections

12. Pulmonary embolism (PE) Pathophysiology : - Pulmonary embolism (PE) is a life-threatening condition characterized by the sudden blockage of one or more pulmonary arteries in the lungs, usually by blood clots that travel from the legs or other parts of the body.

13. Pulmonary embolism (PE) Pathophysiology : Pulmonary embolism (PE), an obstruction of the pulmonary artery by an embolus, affects lung tissue, the pulmonary circulation, and the function of the right and left sides of the heart. Most emboli (>90%) arise from deep venous thromboses (DVTs) . Distribution of emboli is related to the size of emboli and blood flow. Very large emboli have an effect in a large artery; however, the thrombus may break up and block several smaller vessels Effects of acute pulmonary artery obstruction: Over perfusion of the uninvolved lung. Development of post embolic pulmonary edema

14. Pulmonary embolism (PE) Etiology and risk factors: - Surgery or prolonged immobilization - Heart failure, acute myocardial infarction - Diabetes mellitus - Estrogen administration and Pregnancy - Trauma - Burns - Obesity

15. Pulmonary embolism (PE) Signs and Symptoms - Sudden onset of chest pain (usually pleuritic) - cough, and hemoptysis - Dyspnea, and tachypnea - increased work of breathing - Tachycardia, diffuse chest discomfort, reduced blood pressure - Anxiety, restlessness, apprehension, agitation, syncope

16. Diagnostic study findings of Pulmonary embolism (PE) Laboratory: ABG levels may indicate respiratory alkalosis D-dimer, which may be nonspecific, but if normal makes the diagnosis of PE less likely Cardiac enzymes Frequently leads to misdiagnosis of congestive heart failure. Pulmonary angiography: Most definitive test CT- angio or CT-PA very sensitive and done more often than pulmonary angiography. Electrocardiogram (ECG): In massive PE may reveal “P pulmonale,” right-axis deviation, or incomplete or new righty bundle branch block. Chest radiograph:Nonspecific Useful to detect other things causing similar symptoms. Lower-extremity Doppler ultrasonography: Negative findings on serial ultrasonographic scans reduce the likelihood of PE.

17. Pulmonary embolism (PE) * Management and treatment : - O2 administration, as needed - Early ambulation, turning, promotion of coughing and deep breathing - Use of elastic stockings, pneumatic compression stockings (if not contraindicated) - Adequate fluid intake to avoid dehydration - Anticoagulant therapy, heparin or low-molecular-weight heparin, Warfarin - Placement of filter device in inferior vena cava Potential complications: - Bleeding

18. Pathophysiology: Etiology and risk factors Signs Pathophysiology: Etiology and risk factors Signs and symptoms: chronic cough and sputum production. Wheezing Chest expansion may be normal Various forms of tobacco inhalation which include cigarette smoking—the most important factor and the major toxic stimulus, cigars and vaping Environmental pollution, occupational exposure the presence of chronic cough with sputum production on a daily basis for a minimum of 3 months a year for not less than 2 successive years Chronic bronchitis: dyspnea on exertion and eventually dyspnea at rest. Skin color often pinkish because the patient is well oxygenated Weight loss, inability to perform ADLs Barrel chest and Pursed-lip breathing Anatomic alteration of the lung characterized by an abnormal enlargement of the air spaces distal to the terminal, nonrespiratory bronchioles, accompanied by destructive changes in the alveolar walls. Emphysema: Chronic obstructive pulmonary disease (COPD)

19. Diagnostic study findings Management of patient care and treatment Potential complications: 1- Hospital-associated infections 2- Inability to wean or liberate from the ventilator 1- Positioning: Keep the head of the bed elevated 30 to 45 degrees 2- Carefully administer O2 using the lowest FiO2 that produces adequate oxygenation; observe for CO2 retention. 3- Observe for signs of fluid overload; monitor intake and output closely. 4- Monitor ABG levels; notify the physician immediately if PaO2 drops below the patient’s known baseline or target level 5- Advocate for the administration of influenza and pneumococcal vaccine. ABG analysis: Hypoxemia and often hypercapnia Polycythemia on complete blood count (CBC) Chronic bronchitis: ABG analysis—may be normal or abnormal, depending on the type and severity Chest radiographs often show low, flattened diaphragms. In severe emphysema Emphysema: Chronic obstructive pulmonary disease (COPD)

20. Asthma and status asthmatic Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, causing recurrent episodes of wheezing, coughing, chest tightness, and shortness of breath. Status asthmaticus is a severe and life-threatening exacerbation of asthma that does not respond to standard treatments.

21. Asthma and status asthmatic Etiology and risk factors: Respiratory infection b. Allergic reaction to inhaled antigen (pollen, grass, perfume, smoke) c. Poor bronchodilator use and management d. Idiosyncratic reaction to aspirin or other nonsteroidal anti-inflammatory medications e. Emotional stress, exercise f. Occupational or environmental exposure (air pollution) g. Use of nonselective β- blocking agents h. Mechanical stimulation (coughing, laughing, and cold air inhalation) i . Sinusitis, reflux esophagitis j Genetic predisposition

22. Asthma and status asthmatic Signs and symptoms: - dyspnea, wheezing, cough, and chest tightness. - Physical exhaustion, inability to sleep or rest, anxiety c. - Difficulty speaking in sentences, minimal chest excursion with inspiration - Production of thick, tenacious sputum - Expiratory wheezes or rhonchi (as air and secretions move through narrowed airways).

23. Asthma and status asthmatic Diagnostic study findings: - Evidence of infection (e.g., positive sputum culture results). - Elevated WBC count - ABG analysis: May initially show low normal or decreased PaCO2, increased pH, and decreased PaO2 In severe asthmatic attacks, progression to a “normal” or increased PaCO2 level may be a sign of impending respiratory failure. - Chest radiograph may be normal. Used to confirm or rule out a diagnosis of pneumonia, pneumothorax, or other condition that mimics asthma.

24. Asthma and status asthmatic Management of patient care and treatment: - Positioning , Keep the head of the bed elevated 30 to 45 degrees to maximize ventilation. - Administer BiPAP, CPAP, heliox (helium and oxygen mixture). - Intubation and mechanical ventilation become necessary. - Administer fluids and humidification to keep airway secretions thin and easily expectorated - Perform close objective monitoring of ABG values, acid-base status, and ventilatory parameters

25. Pneumonia Pneumonia is an inflammatory lung condition often caused by infection, including bacteria, viruses, or fungi. It leads to the air sacs in the lungs filling with pus or other fluids, impairing oxygen exchange. Symptoms Fever Cough Shortness of breath Chest pain, and sputum production. Patients may experience fatigue and weakness, and the severity can range from mild to severe, with more intense symptoms in older adults and those with weakened immune systems.

26. Pneumonia Etiology and risk factors Bacterial, viral, or fungal infections affecting the lungs. Common bacterial culprits include streptococcus pneumoniae. Viral causes often involve influenza and respiratory syncytial virus (rsv). Aspiration of stomach contents, inhalation of harmful substances, or underlying health conditions may also contribute to pneumonia development. Diagnosis test . CHEST X-ray .blood gas test Pulse oximetey

27. Pneumonia Management Strategies and treatment Pneumonia management involves prompt initiation of antibiotics for bacterial pneumonia and antivirals for viral cases. Supportive care includes pain relief, fever reducers, and adequate hydration. Oxygen therapy and, in severe cases, mechanical ventilation may be necessary. Regular monitoring and addressing complications contribute to optimizing recovery.

28. Pathophysiology Ventilator-Associated Pneumonia (VAP) is a lung infection that occurs in patients on mechanical ventilation. Ventilator-Associated Events (VAE) is a broader term encompassing respiratory complications during mechanical ventilation, including infections and non-infectious issues, often requiring further evaluation and intervention. SIGNS AND Symptoms Fever Increased respiratory rate, and changes in oxygenation. Ventilator-associated events (vae) may manifest similarly, indicating potential respiratory complications in patients receiving mechanical ventilation, often necessitating further evaluation and intervention. Ventilator Associated Pneumonia (VAP) and Event (VAE )

29. Ventilator Associated Pneumonia (VAP) and Event (VAE ) Ventilator-Associated Pneumonia (VAP) is mainly caused by bacterial colonization of the ventilator system, facilitated by invasive procedures and prolonged mechanical ventilation. Ventilator-Associated Events (VAE) can result from various factors, including infections and non-infectious causes, contributing to respiratory complications in ventilated patients. Etiology and risk factors

30. Ventilator Associated Pneumonia (VAP) and Event (VAE ) Management And Treatmant Ventilator-Associated Pneumonia (VAP) management involves strict adherence to infection control measures, early diagnosis, and appropriate antibiotic treatment. Ventilator-Associated Events (VAE) management requires addressing underlying causes, optimizing ventilation strategies, and monitoring patient responses to prevent complications and improve outcomes.

31. Drowning is the process of experiencing respiratory impairment due to submersion or immersion in liquid, leading to oxygen deprivation and, in severe cases, respiratory failure. Symptoms Drowning symptoms include coughing Gasping Difficulty breathing In severe cases, loss of consciousness. It may present subtly or be sudden, and victims often struggle to stay afloat. Drowning

32. Causes of Drowning Drowning occurs when the airway is submerged in water, leading to oxygen deprivation. Causes include accidental submersion in pools, rivers, or other water bodies, inability to swim, alcohol consumption impairing judgment, and inadequate supervision, particularly in children. Environmental factors, like rough waters or currents, can also contribute to drowning incidents. Drowning

33. Management Strategies Drowning management involves immediate rescue and resuscitation efforts, including cardiopulmonary resuscitation (CPR) to restore breathing and circulation. Hospitalization may be necessary for further evaluation and monitoring. Prevention measures, such as water safety education, lifeguard presence, and vigilant supervision, play a crucial role in reducing drowning incidents. Drowning

34. Assessment In evaluating patients presenting with symptoms suggestive of viral myocarditis, it is imperative to consider a broad range of differential diagnoses to ensure accurate diagnosis and appropriate management. Conditions such as acute coronary syndrome, pericarditis, and pulmonary embolism can manifest with chest pain and dyspnea , mimicking the clinical presentation of myocarditis. Additionally, non-cardiac etiologies such as gastrointestinal disorders, musculoskeletal pain, or anxiety-related symptoms may also present similarly. .

35. Assessment In ventilated patients, pneumonia and ventilator-associated events (VAE) present with specific clinical features. Pneumonia manifests as fever, purulent sputum, and new or progressive infiltrates on chest imaging. Patients with VAE exhibit signs such as worsening oxygenation, increased ventilator settings, or new pulmonary infiltrates without evidence of pneumonia.

36. References MedilinePlus . (2022). Lung disease: Medlineplus medical encyclopedia . MedlinePlus . https://medlineplus.gov/ency/article/000066.htm Bates, D. V., & Flaschen , J. H. (2024). Occupational lung disease . Encyclopædia Britannica. https://www.britannica.com/science/respiratory-disease/Occupational-lung-disease PubMed. ( n.d. ). Journal of Respiratory Diseases: JRD . Open Access Pub. https://openaccesspub.org/journal/respiratory-diseases/aim-and-scope

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