Overview of Cardiopulmonary Disorders and Conditions

CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Overview of Cardiopulmonary Disorders and Conditions © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OUTLINE Lung Cancer Introduction Patient Education Cardiovascular Disorders Summary Coronary Artery Disease OBJECTIVES © Jones & BartlettAngina Learning,Pectoris LLC © Jones & Bartlett Learning, LLC Upon completion of this chapter, the reader should be NOT FOR SALEMyocardial OR DISTRIBUTION Infarction NOT FOR SALE OR DISTRIBUTION 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. Heart Failure © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 4. Describe the condition known as angina Cardiac Arrest NOT FOR SALE OR DISTRIBUTION 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 heart failure with right-sided ©Asthma Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC heart failure. NOTBronchitis FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 & BartlettCystic FibrosisLearning, LLC © JonesKEY &TERMS Bartlett Learning, LLC NOT FOR SALEPneumonia OR DISTRIBUTION NOTAngina FOR pectorisSALE OR DISTRIBUTIONGag reflex Legionnaires' Disease Anoxia Granuloma Pulmonary Vascular Disease Anthracosis Hemagglutinin Pulmonary Edema Arrhythmia Hemoptysis Pulmonary Hypertension © Jones & Bartlett Learning, LLCAsbestosis ©Histoplasmosis Jones & Bartlett Learning, LLC Pulmonary Embolism Asthma Hypercapnia Tuberculosis NOT FOR SALE OR DISTRIBUTIONAtelectasis NOTHypoxemia FOR SALE OR DISTRIBUTION Histoplasmosis Atherosclerosis Ischemia Pneumoconiosis Bronchiectasis Myocardial infarction Silicosis Bronchiolectasis Nasal flaring Anthracosis © Jones & Bartlett Learning, LLC Bronchiolitis© Jones & BartlettNeuraminidase Learning, LLC Asbestosis Bronchitis Pathogen NOTBerylliosis FOR SALE OR DISTRIBUTION BronchogenicNOT carcinoma FOR SALEPleural OR effusionDISTRIBUTION Respiratory Failure Carcinogens Pleurisy Pleural Disorders Consolidation Pneumoconiosis Pleurisy Dyspnea Pneumonia Pleural Effusion © Jones & Bartlett Learning, LLC © JonesDysrhythmia & Bartlett Learning,Pneumothorax LLC Pneumothorax Emphysema Pulmonary edema NOT FOR SALEHemothorax OR DISTRIBUTION NOTEpithelial FOR SALE OR DISTRIBUTIONPulmonary embolism Flail Chest 22

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Pulmonary fibrosis Stridor ■ Unstable angina: The pain increases in frequency © Jones &Pulmonary Bartlett Learning,hypertension LLCSurfactant © Jones and& Bartlett duration andLearning, is more easilyLLC induced. It indi- NOT FOR SALERespiratory OR acidosisDISTRIBUTIONThrombus NOT FORcates SALE a worsening OR DISTRIBUTION of coronary artery disease, which Respiratory failure Tuberculosis may progress to myocardial infarction. Sepsis Ventricular asystole ■ Variant angina: The pain is caused by coronary Silicosis Ventricular fibrillation artery spasm and may occur spontaneously. It may INTRODUCTION© Jones & Bartlett Learning, LLC not be related to physical© Jones exercise & or Bartlett emotional Learning, LLC stress. It is also known as Prinzmetal angina. Cardiovascular diseaseNOT is theFOR number SALE one OR cause DISTRIBUTION of ■ Microvascular angina: NOTImpairment FOR ofSALE the vasodi- OR DISTRIBUTION death 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 dis- The pain of angina may be relieved by rest and vaso- eases include hypertensive heart disease, angina and © Jones & Bartlett Learning, LLC dilation of the© coronaryJones &arteries Bartlett with medication.Learning, Angina LLC heart attacks, cardiac arrhythmias, and congestive pectoris is also referred to as cardiac pain. heartNOT failure. FOR Risk SALE factors OR for heartDISTRIBUTION diseases include NOT FOR SALE OR DISTRIBUTION obesity, smoking, alcoholism, and lack of exercise. Myocardial Infarction Pulmonary diseases result from circulatory disorders, immune diseases, congenital defects, central nervous When coronary blood flow is interrupted for extended system damage or diseases, environmental condi- periods, necrosis (tissue death) of part of the cardiac © Jones & tions,Bartlett and infection.Learning, LLC © Jonesmuscle & occurs. Bartlett Necrosis Learning, results LLCin myocardial infarc- NOT FOR SALEThis chapterOR DISTRIBUTION focuses on major cardiopulmonary NOTtion FOR. When SALE the ORcoronary DISTRIBUTION arteries are obstructed, this disorders. may result in either atherosclerosis, a spasm, or a thrombus. Myocardial infarction (MI) is also called heart attack. Cardiovascular Disorders Of the various types of cardiovascular disorders, heart Cardiovascular disease© Jones is described & Bartlett as any Learning,abnormal LLCattack is the leading cause of© death Jones in the & United Bartlett States. Learning, LLC condition characterizedNOT by FOR heart SALE or blood OR vessel DISTRIBUTION dys- When treatment is delayed,NOT mortality FOR is SALEhigh. Nearly 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 Coronary© Jones artery & diseaseBartlett is anLearning, abnormal conditionLLC that © Jones & Bartlett Learning, LLC mayNOT affect FOR the arteries SALE of ORthe heartDISTRIBUTION and produce varying NOT FOR SALE OR DISTRIBUTION 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 & pectorisBartlett is theLearning, classic symptom LLC of coronary artery dis-© Jones & Bartlett Learning, LLC NOT FOR SALEease; it resultsOR DISTRIBUTION from myocardial ischemia. NOT FOR SALE OR DISTRIBUTIONDamaged endothelium Angina Pectoris Normal smooth muscle cell Angina pectoris is a sudden outburst of chest pain frequently caused by myocardial© Jones anoxia & Bartlett as a result Learning, of ath- LLC Fatty© Jonesdeposits accumulate & Bartlett in muscle Learning, cell LLC erosclerosis or coronary artery spasm. Atherosclerosis NOT FOR SALE OR DISTRIBUTION NOTFatty FOR SALE OR DISTRIBUTION is a deposition of fat-containing substances collectively 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, shoulder,© and Jones down &the Bartlett left arm. Learning,It is often accompanied LLC by © Jones & BartlettFibers FibrousLearning, LLC Fats plaque feelingsNOT of FOR suffocation SALE that OR may DISTRIBUTION seem to indicate impend- NOT FOR SALE OR DISTRIBUTION ing death. Angina pectoris attacks are often related to emotional stress, eating, exertion, and exposure to intense cold. There are four types of angina: Large plaque obstructing artery © Jones & Bartlett■ Stable Learning, angina: The LLC pain is predictable in fre-© Jones & Bartlett Learning, LLC NOT FOR SALEquency OR DISTRIBUTION and duration and is relieved by rest andNOT FIGURE FOR 2–1SALE Development OR DISTRIBUTION of a deposition of fat-containing substances nitroglycerin. which form plaque and lead to arterial occlusion.

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1 hour of the onset of symptoms. © Jones &Risk Bartlett factors Learning,for myocardial LLC infarction © Jones & Bartlett Learning, LLC NOT FOR SALEinclude theOR following: DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■ family history of MI ■ aging ■ gender ■ hypertension © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ■ elevated total cholesterol ■ obesity NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■ lifestyle ■ smoking ■ stress or type A personality ■ © drugJones use & (especially Bartlett cocaineLearning, LLC © Jones & Bartlett Learning, LLC and amphetamines) TheNOT occlusion FOR of SALE a coronary OR DISTRIBUTIONartery NOT FOR SALE OR DISTRIBUTION may result in ischemia and infarct Clot (death) of the myocardium, causing sudden and severe left-sided chest pain (see Figure 2–2). Damaged © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,heart LLC muscle NOT FOR SALEDysrhythmias OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION A dysrhythmia (arrhythmia) is a disturbance of heart rhythm. The sino- atrial (SA) node generates normal FIGURE 2–2 Damage caused by myocardial infarction. heart rhythms that© travel Jones through & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the heart’s conductionNOT system. FOR This SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION causes the atrial and ventricular myocardium to contract and relax at a regular rate. This rate maintains circulation during vari- than in the white population. It is also more prevalent ous levels of physical activity. Dysrhythmias range from in people with less education and lower income. Dur- mild© toJones catastrophic & Bartlett ventricular Learning, fibrillation. LLC ing young ©and Jones middle &adulthood, Bartlett menLearning, have a higher LLC NOTArrhythmias FOR areSALE usually OR classified DISTRIBUTION according to their incidence ofNOT hypertension, FOR SALE but thereafter, OR DISTRIBUTION women have a origin (either ventricular or supraventricular). Their higher incidence. effect on blood pressure as well as cardiac output (which Risk factors for essential hypertension include the may be influenced from where they originate) deter- following: mines how clinically significant they are. Common ■ the aging process © Jones & causesBartlett of arrhythmias Learning, include LLC the following: © Jones■ family& Bartlett history Learning, LLC NOT FOR SALE■ congenital OR DISTRIBUTION defects NOT FOR■ obesity SALE OR DISTRIBUTION ■ drug toxicity ■ high intake of sodium ■ electrolyte imbalances ■ high intake of saturated fat ■ myocardial infarction or ischemia ■ sleep apnea ■ stress Hypertension © Jones & Bartlett Learning, LLC■ excessive alcohol consumption© Jones & Bartlett Learning, LLC ■ sedentary lifestyle Hypertension is an NOTelevation FOR in eitherSALE systolic OR DISTRIBUTION or dia- NOT FOR SALE 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 hypertension results from renal disease or other identifi- Cardiomyopathy able© causes.Jones Malignant & Bartlett hypertension Learning, is a severeLLC form of Cardiomyopathy© Jones is a term& Bartlett that generally Learning, applies LLC to a hypertensionNOT FOR that SALE may be OR either DISTRIBUTION primary or secondary. disease of theNOT heart FOR muscle SALE fibers. OR It is DISTRIBUTION the second most Hypertension is a major cause of cardiac disease, renal common direct cause of sudden death (after coronary failure, and stroke. artery disease). The most common type of cardiomyopa- Hypertension affects nearly 20% of adults in the thy is the dilated form. Men and blacks are at greatest risk United States. Risks for hypertension increase with age. for dilated cardiomyopathy. Other risk factors include © Jones & HypertensionBartlett Learning, is more prevalent LLC in the black population© Jonescoronary & Bartlettartery disease, Learning, hypertension, LLC pregnancy, viral NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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infections, and use of alcohol or illegal drugs. Hypertro- anaerobic, and metabolic and respiratory acidosis © Jones &phic Bartlett cardiomyopathy Learning, is different LLC in that it is caused by ©a Jonesoccurs. & Immediate Bartlett initiationLearning, of cardiopulmonary LLC resus- NOT FOR SALEgenetic abnormality.OR DISTRIBUTION NOTcitation FOR SALE(CPR) is OR required DISTRIBUTION to prevent heart, lung, kidney, and brain damage and death. Cardiac arrest is also called Carditis cardiopulmonary arrest. Carditis is defined as inflammation of the heart and its surrounding structures.© Jones The several & Bartlett types ofLearning, carditis LLCRespiratory Disorders© Jones & Bartlett Learning, LLC include pericarditis,NOT myocarditis, FOR SALE and endocarditis,OR DISTRIBUTION A respiratory disorder is anyNOT abnormal FOR condition SALE ofOR the DISTRIBUTION each of which describes the portion of the heart that is respiratory system. Respiratory disorders are charac- inflamed in the specific condition. Common causes of terized by coughing, chest pain, dyspnea, hemoptysis, the various forms of carditis include viral infections, bac- production of sputum, and stridor. Less common symp- terial infections, fungal infections, immune conditions, toms include anxiety, arm and shoulder pain, headache, myocardial© Jones infarction, & Bartlett trauma, Learning, uremia, cancers, LLC certain hoarseness,© and Jones drowsiness. & Bartlett There are Learning, several varieties LLC medications,NOT FOR radiation, SALE and OR other DISTRIBUTION causes. of respiratoryNOT diseases FOR and SALE disorders. OR DISTRIBUTION

Heart Failure Newborn and Adult Respiratory Distress Heart failure is the inability of the heart muscle to con- Syndrome tract with enough force to properly circulate the blood Respiratory distress syndrome is an acute lung disease © Jones & throughoutBartlett Learning,the body. Dysfunction LLC of the left ventricle is© Jones & Bartlett Learning, LLC of newborns characterized by airless alveoli, inelastic the most common cause of heart failure. However, the NOT FOR SALE OR DISTRIBUTION NOTlungs, FOR a SALErespiration OR rate DISTRIBUTION greater than 60 breaths per min- right 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 con- The 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 fluid (congestion) in© the Jones lungs &and Bartlett extremities. Learning, Heart LLC © Jones & Bartlett Learning, LLC alveolar collapse. Sometimes other symptoms include failure may be classifiedNOT as FORleft- or SALE right-sided OR heart DISTRIBUTION fail- NOT FOR SALE OR 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, this condition causes severe pulmonary ventricular© Jones contraction. & Bartlett As theLearning, left ventricle’s LLC pumping © Jones & Bartlett Learning, LLC congestion characterized by diffuse injury to alveolar- abilityNOT fails, FOR cardiac SALE output OR falls. DISTRIBUTION Because blood is no 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 intol- common 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 © Jones & causesBartlett of left-sided Learning, heart LLC failure include hypertension,© Jones & Bartlett Learning, LLC certain herbicidal chemi- aortic and mitral valve stenosis, and left ventricular POINT TO REMEMBER NOT FOR SALE OR DISTRIBUTION NOTcals, FOR and SALE inhalation OR DISTRIBUTION of infarction. corrosive chemicals (such Adults with sleep apnea may Right-sided heart failure is caused by ineffective right as chlorine and ammonia) cease breathing for 10 to ventricular contraction. As a result, blood is not pumped 20 seconds hundreds of times or certain drugs including with enough force through the right ventricle to the a night. The greatest danger of barbiturates, chlordiaz- lungs. This causes blood© Jones to back &up Bartlettinto the right Learning, atrium LLC © Jonesadult sleep & apnea Bartlett is the fatigue,Learning, LLC epoxide, heroin, metha- headache, drowsiness, and as well as the peripheral circulation. The patient gains NOT FOR SALE OR DISTRIBUTIONdone, propoxyphene, and NOTdepression FOR thatSALE follows OR during DISTRIBUTION weight, develops peripheral edema, and the kidneys salicylates. waking hours. (and other organs) become engorged. Right-sided heart failure may be caused by pulmonary hypertension, pulmonary embolus, or acute right ventricular infarction. Influenza © Jones & Bartlett Learning, LLC Influenza is© caused Jones by a& virus Bartlett and manifests Learning, itself asLLC the CardiacNOT FOR Arrest SALE OR DISTRIBUTION most common,NOT yet FOR serious, SALE acute ORupper DISTRIBUTION respiratory tract Cardiac arrest is a sudden cessation of cardiac output infection in humans. Prior to acquired immunodefi- and 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 & carbonBartlett dioxide Learning, ceases. Tissue LLC cell metabolism becomes© Jonesbecause & ofBartlett influenza-related Learning, illness LLC during nonpandemic NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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years. Although children are infected more than any age © Jones &group, Bartlett influenza Learning, causes seriousLLC illness and even death,© Jones & Bartlett Learning, LLC NOT FOR SALEmost commonly OR DISTRIBUTION in people aged 65 years or older. NOT FOR SALE OR DISTRIBUTION 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 hemag- subtypes that are based© Jones on two surface& Bartlett antigens: Learning, LLC © Jones & Bartlett Learning, LLC glutinin (H) and neuraminidase (N). Influenza type B does not have any subtypes.NOT Influenza FOR is SALE more contagious OR DISTRIBUTION than NOT FOR SALE OR DISTRIBUTION 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 Jones may & inhaleBartlett as few Learning, as three infected LLC particles © Jones & Bartlett Learning, LLC and then contract influenza. Most people who become infectedNOT willFOR develop SALE symptoms OR DISTRIBUTION of influenza, which NOT FOR SALE OR DISTRIBUTION increases the likelihood of contagion. Because young Artery children are most likely to become infected with influ- Vein enza, they are also most likely to spread the infection. Alveolus © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Swine Flu (H1N1) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Swine flu was the original name used to describe novel Bronchiole 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 Jones virus &spreads Bartlett from Learning,person to LLC © Jones & Bartlett Learning, LLC person, similar to theNOT way that FOR regular SALE seasonal OR influenzaDISTRIBUTION NOT FOR SALE OR DISTRIBUTION viruses spread. The term swine flu was originally used because labo- ratory testing showed that many genes in this new virus were very similar to influenza viruses that normally occur© Jonesin pigs in& NorthBartlett America. Learning, The virus LLC has spread © Jones & Bartlett Learning,Capillary LLC network throughoutNOT FOR the SALEcountry OR as well DISTRIBUTION as other parts of the 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 © Jones & aches,Bartlett headache, Learning, chills, and LLC fatigue. A significant num-© Jones & Bartlett Learning, LLC NOT FOR SALEber of people OR DISTRIBUTIONwho have been infected with this virus alsoNOT 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, LLCAsthma may result from either© Jones allergic &or Bartlett nonallergic Learning, LLC There are everydayNOT actions FOR that SALE can ORhelp DISTRIBUTIONprevent stimuli. NOT FOR SALE OR DISTRIBUTION the spread of germs that cause respiratory illnesses like Hyperreactivity in asthma may lead to airway obstruc- influenza. 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. Com- spasms, the mucosa swells, which leads to edema. The plications© Jones of H1N1 & Bartlett may include Learning, worsening LLC of chronic mucous glands© Jones then increase & Bartlett their productionLearning, of LLCthick conditions,NOT FOR such SALE as heart OR disease, DISTRIBUTION diabetes, asthma, mucous. 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 & irritabilityBartlett of Learning, the tracheobronchial LLC tree. It involves acute,© Jonesobstructive & Bartlett pulmonary Learning, disease ofLLC the larger airways. NOT FOR SALEepisodic OR paroxysmal DISTRIBUTION (sudden, intense) narrowing of theNOT When FOR the SALE airway OR mucosa DISTRIBUTION becomes inflamed, it leads to

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edema and submucosal gland enlarge- © Jones &ment. Bartlett Damage Learning, occurs to theLLC epithelial Air flow obstructed© Jones & Bartlett Learning,Nonaeration LLC and collapse NOT FOR SALEcells and OR cilia DISTRIBUTION in the respiratory tract. NOT FOR SALE OR DISTRIBUTION The most obvious symptom is the production of sputum. Acute bronchitis has a short, severe course of duration,© which Jones subsides & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC without any long-term effects. Chronic bronchitis leads to NOTexcessive FOR mucous SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION production and coughing. It can be reversed after the removal of the irritant and is complicated by respiratory Remaining air diffuses into tissues and is not replaced tract© Jonesinfections. & BartlettChronic bronchitis Learning, LLC © Jones & Bartlett Learning, LLC can lead to right-sided heart failure, acuteNOT respiratory FOR SALE failure, OR and DISTRIBUTIONpulmo- NOT FOR SALE OR DISTRIBUTION nary hypertension. Acute bronchitis is often caused Obstruction in bronchus by viruses, and the primary cause of © Jones & chronicBartlett bronchitis Learning, is smoking LLC or expo- © Jones & Bartlett Learning, LLC sure to certain respiratory irritants. Atelectasis NOT FOR SALERisk factors OR include DISTRIBUTION the following: NOT FOR SALE OR DISTRIBUTION ■ history of smoking ■ air pollution ■ occupational exposure ■ heredity © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ■ reduced lung function Children of parents NOTwho smoke FOR are SALE at OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION higher risk for pulmonary infections, which may cause bronchitis.

Bronchiolitis© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC BronchiolitisNOT FOR (respiratory SALE OR syncytial DISTRIBUTION 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 © Jones & thatBartlett obstructs Learning, the small LLC respiratory © Jones & Bartlett Learning, LLC airways. Bronchiolitis can range from a NOT FOR SALE OR DISTRIBUTION FIGURE 2–4 ObstructiveNOT FOR atelectasis. 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© Jones because &these Bartlett Learning, LLC © Jones & Bartlett Learning, LLC patients have larger airwaysNOT FOR and can SALE tolerate OR the DISTRIBUTIONswelling bronchiectasis. Today, more effectiveNOT FOR antibiotics SALE exist OR to 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 Atelectasis Bronchiectasis© Jones & is Bartlett characterized Learning, by permanent LLC bronchi Atelectasis© is Jones defined &as Bartlett imperfect Learning, expansion, whichLLC andNOT bronchiole FOR SALEdilation. OR This DISTRIBUTION occurs because of the refers to incompleteNOT FOR expansion SALE of ORa lung DISTRIBUTION or part of a lung destruction of muscle and elastic supporting tissue (see Figure 2–4). This condition can occur due to air- caused by inflammation and infection. Bronchiectasis way obstruction, increased lung recoiling (due to loss of is a secondary disease to either obstruction or a per- pulmonary surfactant), or lung compression (which may sistent infection. In past decades, necrotizing bacterial occur in pleural effusion or pneumothorax). Atelectasis © Jones & pneumoniaBartlett Learning,conditions that LLC were complications of mea-© Jonesmay be & present Bartlett at birth, Learning, develop inLLC the neonatal period, NOT FOR SALEsles, influenza, OR DISTRIBUTION pertussis, or tuberculosis often causedNOT or FOR develop SALE later inOR life. DISTRIBUTION

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Emphysema is caused by a virus that attacks bronchiolar epithelial © Jones & Bartlett Learning, LLC © Jonescells, eventually& Bartlett spreading Learning, to the lungLLC alveoli. Secondary NOT FOR SALEEmphysema OR DISTRIBUTIONcauses the destruction of alveolar ducts,NOT FOR SALE OR DISTRIBUTION alveoli, and respiratory bronchioles, which creates pneumonia ensues from lung damage caused by bacteria enlarged air spaces. The loss of many of the alveoli spreading from another infection (anywhere in the body) reduces air exchange with the blood. As emphysema pro- or a noxious chemical. Aspiration pneumonia occurs gresses, the patient experiences increased shortness of from the inhalation of foreign matter (such as food or gag reflex breath following only© minimal Jones exertion. & Bartlett The mostLearning, com- LLCvomitus) into the bronchi. An© impairedJones & Bartlett, old Learning, LLC age, debilitating diseases, decreased levels of conscious- mon cause of emphysemaNOT isFOR the inhaling SALE of OR smoke DISTRIBUTION from NOT FOR SALE OR DISTRIBUTION tobacco products. Stopping smoking usually stops, or at ness, and surgical procedures are all potential causes of least slows, the progression of the disease. However, lung aspiration pneumonia. damage from emphysema is usually irreversible. Chronic obstructive pulmonary disease has, as its most common Legionnaires’ Disease components,© Jones both & Bartlett emphysema Learning, and chronic LLC bronchitis. Legionnaires’© diseaseJones is &a typeBartlett of bronchopneumonia. Learning, LLC It NOT FOR SALE OR DISTRIBUTION is caused byNOT a gram-negative, FOR SALE rod-shaped OR DISTRIBUTION microorganism Cystic Fibrosis known as Legionella pneumophila. It is one of the three 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 dis- standing water. ease affects both males and females, and it is the most It was recognized for the first time as an epidemic © Jones & commonBartlett fatal Learning, genetic disease LLC in white children. Cystic© Jones & Bartlett Learning, LLC of severe (and even fatal) pneumonia that developed NOT FOR SALEfibrosis isOR accompanied DISTRIBUTION by many complications and nowNOT FOR SALE OR DISTRIBUTION among delegates to the 1976 American Legion con- carries an average life expectancy of 32 years. The disor- vention, 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 gland function, and© reproductive Jones & Bartlettdysfunction. Learning, Cystic LLC © Jones & Bartlett Learning, LLC among those who smoke tobacco products and per- fibrosis is inherited,NOT and the FOR gene SALE on chromosome OR DISTRIBUTION 7 is NOT FOR SALE OR DISTRIBUTION 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, pro- ducing© Jones copious & thick, Bartlett sticky Learning,mucus that accumulates LLC to Vascular lung© Jonesdisorders & include Bartlett pulmonary Learning, edema, LLC pul- blockNOT glandular FOR ducts.SALE Pancreatic OR DISTRIBUTION changes occur, with fat monary hypertension,NOT FOR and SALE pulmonary OR DISTRIBUTION embolus, all of and fiber replacing normal tissue. Sweat gland dysfunc- which are discussed in the following sections. tion results in increased concentrations of salt in the sweat, and normal growth and health are reduced. Pulmonary Edema Cystic fibrosis is considered a fatal disease. However, Pulmonary edema is a condition wherein fluid collects © Jones & earlyBartlett diagnosis Learning, and treatment LLC have greatly increased© Jonesin the lung& Bartlett alveoli and Learning, interstitial tissues.LLC This accumula- NOT FOR SALElife expectancy OR DISTRIBUTION during the past few decades. TreatmentNOT tion FOR of fluidSALE reduces OR diffusedDISTRIBUTION oxygen levels in the blood involves supportive measures that help the child to lead and interferes with the lungs’ ability to expand. Pulmo- as 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 Pneumonia © Jones & Bartlett Learning, LLCdisease is the most common cause© Jones of pulmonary & Bartlett edema. Learning, LLC Pneumonia is definedNOT as lung FOR inflammation SALE OR with DISTRIBUTION fluid NOT FOR SALE OR DISTRIBUTION that fills the alveoli and bronchioles. It may develop Pulmonary Hypertension either as a primary acute lung infection or secondary Pulmonary hypertension is the elevation of pressure to another condition that reduces lung tissue resistance in the pulmonary vessels. This condition is common in (either© Jones a respiratory & Bartlett or systemic Learning, condition). LLC Pneumonia preexisting© cardiac Jones or &pulmonary Bartlett diseases, Learning, but it LLC may is a risk after any aspiration or lung inflammation, when also result from the condition known as pulmonary fluidsNOT may FOR collect, SALE or when OR defense DISTRIBUTION mechanisms (such as fibrosis. TheNOT actual FOR cause SALE of pulmonary OR DISTRIBUTION hypertension is the cilia in the trachea) are reduced. unknown, but it tends to occur in members of the same Primary pneumonia may be caused by the inhala- family. Conditions that produce hypoxemia, such as tion or aspiration of a bacterium or virus. Bacterial alveolar hypoventilation, chronic obstructive pulmonary © Jones & pneumoniaBartlett Learning,is caused by LLCa bacterium such as staphylo-© Jonesdisease, & high Bartlett altitudes, Learning, and smoke LLCinhalation, often cause coccus, klebsiella, or streptococcus. Viral pneumonia secondary pulmonary hypertension. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Pulmonary Embolism © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Pulmonary embolism is a condition resulting from NOTa FOR SALE OR DISTRIBUTION NOT FOR SALEblood clot OR or DISTRIBUTION fat (lipid) deposit that has formed in a peripheral blood vessel and then broken free to lodge in a blood vessel in one of the lungs (see Figure 2–5). Pulmo- Embolism nary embolism is a potentially life-threatening condition. lodges in pulmonary Its major risk factors© include Jones any &conditions Bartlett that Learning, produce LLC artery © Jones & Bartlett Learning, LLC venous stasis, increasedNOT coagulation FOR SALE ability, OR or changes DISTRIBUTION 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 Jones mentioned& Bartlett risk Learning, factors include LLC pregnancy, © Jones & Bartlett Learning, LLC sepsisNOT, congestive FOR SALE heart failure, OR DISTRIBUTION and tumors. 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 mil- travels to © Jones & lionBartlett new cases Learning, of tuberculosis LLC occur every year world-© Jones & Bartlett Learning,right side LLC NOT FOR SALEwide, with OR approximately DISTRIBUTION 3 million people dying fromNOT FOR SALE OR DISTRIBUTIONof heart 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 pathogen can also invade other© Jones body organs, & Bartlett such as theLearning, bones, LLC © Jones & Bartlett Learning, LLC gastrointestinal tract,NOT and kidneys.FOR SALE Tuberculosis OR DISTRIBUTION lesions 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 patient’s environment and health status. Reinfection Embolism occurs© Jones more often & Bartlett when a patientLearning, is malnourished, LLC in © Jones & Bartlett Learning,originates LLC in lower poorNOT health, FOR living SALE in crowded OR DISTRIBUTION or unsanitary conditions, NOT FOR SALE OR DISTRIBUTIONbody or has various other illnesses. An increase of tuberculosis has been seen in the United States due to the prevalence FIGURE 2–5 The development of pulmonary embolism. of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEHistoplasmosis OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Histoplasmosis is a fungal disease that originates in the lungs from the inhalation of dust containing Histo- plasma capsulatum. It is common in the midwestern pneumoconiosis relate to the patient’s history of expo- United States and occurs as an opportunistic infection, sure, and this factor is important in correctly diagnosing commonly in AIDS ©patients. Jones In &these Bartlett cases, the Learning, fungus LLCthe patient’s individual lung condition.© Jones Pneumoconiosis & Bartlett Learning, LLC disseminates or spreadsNOT quickly FOR throughoutSALE OR the DISTRIBUTION entire often occurs after years of inhalingNOT FOR inorganic SALE dust OR par- DISTRIBUTION body. Histoplasmosis is similar to tuberculosis in that ticles, resulting in progressive fibrosis of lung tissue. The its first stage usually involves an asymptomatic, limited most common causes of pneumoconiosis are the dusts infection followed by a second active infection. This of coal, asbestos, and silica. Other potential causes are second infection involves the formation of granuloma beryllium, cadmium, cement, clays, fiberglass, cobalt, and© necrosis Jones and & Bartlettconsolidation Learning, in the lungs, LLC sometimes aluminum, ©iron, Jones and talc. & Bartlett The most Learning, common types LLC of spreadingNOT FOR to other SALE organs. OR DISTRIBUTION pneumoconiosisNOT are FOR discussed SALE in theOR following DISTRIBUTION sections.

Pneumoconiosis Silicosis Pneumoconiosis involves any change in the lungs due Silicosis affects workers who have continually inhaled © Jones & toBartlett inhaling inorganicLearning, dust LLC particles (usually in the work-© Jonesthe inorganic & Bartlett dust compound Learning, known LLC as silicon dioxide, place). Environmentally acquired lung diseases such as which is found in sand, flint, quartz, and many other NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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stones. Silicosis is characterized by the development of However, oxygenation failure is not caused by hyper- © Jones &nodular Bartlett fibrosis Learning, in the lungs. LLC The incidence is highest© Jonesventilation. & Bartlett Oxygenation Learning, failure occursLLC in diseases that NOT FOR SALEamong industrialOR DISTRIBUTION workers exposed to silica powder dur-NOTaffect FOR the SALE alveoli OR or interstitialDISTRIBUTION lung tissues. These dis- ing manufacturing, in those who work with ceramics, eases include the following: sand, or stone, and in those who mine silica. Silicosis is ■ alveolar edema also known as grinder’s disease or quartz silicosis. ■ emphysema ■ © Jones & Bartlett Learning, LLC fungal infections © Jones & Bartlett Learning, LLC Anthracosis ■ leukemia NOT FOR SALE OR DISTRIBUTION■ lobar pneumonia NOT FOR SALE OR DISTRIBUTION Anthracosis is a chronic lung disease characterized by ■ the deposit of coal dust in the lungs. It is also charac- lung carcinoma ■ 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© Jones in coal &miners Bartlett and Learning,is aggravated LLC by cigarette © Jones & Bartlett Learning, LLC carbon dioxide. Ventilation may also be reduced by the smoking. There is no specific treatment for anthracosis, NOT FOR SALE OR DISTRIBUTION following: NOT FOR SALE OR DISTRIBUTION which is also known as black lung disease or coal work- ■ depression of the respiratory center by barbiturates er’s pneumoconiosis. or opiates ■ hypercapnia Asbestosis ■ © Jones & Bartlett Learning, LLC © Jones hypoxia& Bartlett Learning, LLC Asbestosis is a chronic lung disease caused by the inha- ■ intracranial diseases NOT FOR SALElation of OR asbestos DISTRIBUTION fibers, resulting in the development ofNOT FOR■ lesion SALE of theOR neuromuscular DISTRIBUTION system or thoracic alveolar, interstitial, and pleural fibrosis. Asbestos min- cage 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 © Jones & Bartlett Learning, LLCmay be precipitated by added© stress, Jones such & as Bartlettwith cardiac Learning, LLC by small linear opacities throughout the lungs, as shown failure, anesthesia, surgery, or upper respiratory tract on chest X-rays. TheNOT disease FOR is progressive,SALE OR results DISTRIBUTION in infections. NOT FOR SALE OR DISTRIBUTION 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 asbestosis.© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION pleural cavities.NOT Pleural FOR disorders SALE ORinclude DISTRIBUTION pleurisy, pleural effusion, pneumothorax, hemothorax, and flail chest. Berylliosis Beryllium is an element POINT TO REMEMBER Pleurisy used in fluorescent pow- Pleurisy Severe altitude sickness ders, metal alloys, and in is an inflammation of the pleura, also called © Jones includes& Bartlett a condition Learning, called high- LLC © Jonespleuritis. & Bartlett It causes Learning,intense pain LLCduring breathing and the nuclear power indus- altitude pulmonary edema. This is usually secondary to other diseases or infections. NOT FOR SALE OR DISTRIBUTIONtry. A small percentageNOT FOR SALE OR DISTRIBUTION condition causes nausea and Pleurisy also may result from injury or the presence of vomiting, rapid heart rate and of workers exposed to a tumor. breathing, and a cyanotic (blue) beryllium dust or vapor cast to the skin. develop an immune Pleural Effusion © Jones response,& Bartlett which Learning, dam- LLC © Jones & Bartlett Learning, LLC ages the lungs. Symptoms include fever, fatigue, cough, Pleural effusion is defined as the presence of excessive shortness of breath, NOTnight FORsweats, SALE loss of ORappetite, DISTRIBUTION and fluid in the pleural cavity. Normally,NOT FOR small SALE amounts OR of DISTRIBUTION 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 © Jones & Bartlett Learning, LLC is because ©each Jones lung is& enclosed Bartlett in Learning,a separate pleural LLC RespiratoryNOT FOR Failure SALE OR DISTRIBUTION membrane.NOT The effects FOR of SALE pleural effusionOR DISTRIBUTION depend on the amount, rate of accumulation, and type of fluid. Respiratory failure is the inability of the cardiovascular and pulmonary systems to maintain an adequate exchange of oxygen and carbon dioxide in the lungs. Pneumothorax 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, Oxygenation LLC failure is characterized by© Jonescavity. & This Bartlett results inLearning, a collapsed LLC or partially collapsed NOT FOR SALEhypoxemia, OR which DISTRIBUTION can initially lead to hyperventilation.NOT lung FOR (see SALE Figure OR2–6). DISTRIBUTIONWhen pneumothorax is caused by

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© Jones &Parietal Bartlett pleura Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR AirSALE in the OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION pleural space Multiple Wound site fractured Lung ribs Collapsed © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC lung NOT FOR SALE OR DISTRIBUTIONHeart NOT FOR SALE OR DISTRIBUTION Visceral pleura

FIGURE 2–6 Pneumothorax. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 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© Jones of excessive& Bartlett pleural Learning, cavity LLClife threatening. © Jones & Bartlett Learning, LLC pressure. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Pneumothorax Lung Cancer POINT TO REMEMBER can be either The lungs are common sites of both primary and sec- Pneumothorax may be treated spontaneous or ondary types of cancer. Lung cancer is the leading cause by covering the chest wound traumatic. Sponta- of cancer deaths in both men and women in the United with an impermeable bandage, neous pneumotho- ©passing Jones a chest & Bartletttube through Learning, LLC States. Increases© Jones in lung & Bartlettcancer incidence Learning, and deaths LLC rax occurs when an the thoracic wall into the pleural during the past 60 years are closely related to increased NOT FOR SALE OR DISTRIBUTIONopening is present NOT FOR SALE OR DISTRIBUTION cavity, and applying suction to smoking of tobacco products. Nearly 95% of primary the tube. on a lung’s surface. 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 from cancers in other parts © Jones & tissue.Bartlett Traumatic Learning, pneumothorax LLC occurs when the pleu-© Jones & Bartlett Learning, LLC of the body. There are four major categories of broncho- NOT FOR SALEral cavity’s OR integrity DISTRIBUTION is breached due to trauma (includingNOT FOR SALE OR DISTRIBUTION genic carcinomas: stabbing, gunshots, or crushing of the chest). ■ adenocarcinoma ■ large cell carcinoma Hemothorax ■ small cell carcinoma Hemothorax is the accumulation© Jones & ofBartlett blood and Learning, fluid in LLC■ squamous cell lung carcinoma© Jones & Bartlett Learning, LLC the pleural cavity. TheNOT patient FOR experiences SALE OR symptoms DISTRIBUTION Secondhand smoke in theNOT environment FOR SALE has resulted OR DISTRIBUTION that are similar to those of pneumothorax. Hemothorax in a significant number of cases of bronchogenic carci- is life threatening and requires emergency medical care. noma. The risk of developing cancer is higher in persons Trauma or the erosion of a pulmonary vessel may cause who begin smoking early in life, continue for many years, blood to enter the pleural space. and smoke more than one pack of cigarettes per day © Jones & Bartlett Learning, LLC (considered© to Jones be heavy & smokers). Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Not all smokersNOT FOR develop SALE lung cancer;OR DISTRIBUTION therefore, there Flail Chest is probably a genetic factor involved. Occupational Flail chest is a condition of instability in the chest wall due exposure to carcinogens such as silica, asbestos, or vinyl 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 & automobileBartlett Learning,accidents and LLCfalls (see Figure 2–7). This con-© Jonessmoking) & Bartlett is also present Learning, in an occupationally LLC exposed NOT FOR SALEdition is OR characterized DISTRIBUTION by sharp pain, shallow and rapidNOT individual. FOR SALE OR DISTRIBUTION

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Patient Education failure, acute respiratory failure, and pulmonary © Jones & Bartlett Learning, LLC © Jones &hypertension. Bartlett Learning, LLC Respiratory therapists must be up to date on the latest NOT FOR SALE OR DISTRIBUTION NOT FOR2. AtelectasisSALE OR is DISTRIBUTIONdefined as imperfect expansion, 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 care- airway obstruction, increased lung recoiling (due ful. These include pregnant women, children younger to loss of pulmonary surfactant), or lung com- than age 5 years, adults© Jonesolder than & age Bartlett 65 years, Learning, and those LLC © Jones & Bartlett Learning, LLC pression (which may occur in pleural effusion or with chronic medical conditions, such as diabetes, heart NOT FOR SALE OR DISTRIBUTIONpneumothorax). AtelectasisNOT FOR may beSALE present OR at DISTRIBUTION disease, asthma, and kidney disease. Respiratory thera- birth, 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© ifJones they show & Bartlettsigns of infection. Learning, LLC © Jones & Bartlett Learning, LLC Chronic bronchitis leads to excessive mucous NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION SUMMARY production and coughing. It can be reversed after the removal of the irritant and is complicated Cardiovascular diseases include carditis, coronary artery by respiratory tract infections. Chronic bron- disease, hypertension, heart failure, and myocardial chitis can lead to right-sided heart failure, acute infarction. Angina pectoris is a condition of chest pain © Jones & Bartlett Learning, LLC © Jones &respiratory Bartlett Learning,failure, and pulmonaryLLC hyperten- often caused by anoxia, atherosclerosis, or coronary sion. Acute bronchitis is often caused by viruses, NOT FOR SALEartery spasm. OR DISTRIBUTION Hypertension is a major cause of cardiacNOT FOR andSALE the primaryOR DISTRIBUTION cause of chronic bronchitis is disease, renal failure, and stroke. A common form of smoking or exposure to certain respiratory irri- heart 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 © Jones & Bartlett Learning, LLC reduced lung function.© Jones & Bartlett Learning, LLC emphysema—all of which are aggravated by smoking. 4. Angina pectoris is a sudden outburst of chest pain Common forms of pulmonaryNOT FOR vascular SALE disease OR DISTRIBUTION include frequently caused by NOTmyocardial FOR anoxia, SALE athero- OR DISTRIBUTION 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 pneumo- and down the left arm. It is often accompanied by coniosis. When the lungs cannot adequately exchange © Jones & Bartlett Learning, LLC feelings© Jones of suffocation & Bartlett that may Learning, seem to indicate LLC oxygen and carbon dioxide, respiratory failure may impending death. Angina pectoris attacks are occur.NOT Lung FOR cancer SALE is the OR deadliest DISTRIBUTION type of cancer in the oftenNOT related FOR to emotional SALE stress,OR DISTRIBUTION 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 These learning goals correspond to the objectives at the during the past 60 years are closely related to © Jones & beginningBartlett ofLearning, the chapter, LLC providing a clear summary of© Jones &increased Bartlett smoking Learning, of tobacco LLC products. Second- NOT FOR SALEthe chapter’s OR DISTRIBUTIONmost important points. NOT FOR handSALE smoke OR in DISTRIBUTION the environment has resulted in a 1. Emphysema causes the destruction of alveo- significant number of cases of bronchogenic car- lar ducts, alveoli, and respiratory bronchioles, cinoma. The risk of developing cancer is higher in causing enlarged air spaces. As emphysema persons who begin smoking early in life, continue progresses, the patient experiences increased for many years, and smoke more than one pack of shortness of breath© Jones following & Bartlett only minimal Learning, exer- LLC cigarettes per day (considered© Jones to be& heavyBartlett smok- Learning, LLC tion. The mostNOT common FOR SALEcause of OR emphysema DISTRIBUTION ers). Not all smokers developNOT FOR lung cancer;SALE there- OR DISTRIBUTION is the inhaling of smoke from tobacco prod- fore, there is probably a genetic factor involved. ucts. Lung damage from emphysema is usually Occupational exposure to carcinogens, such as irreversible. Chronic obstructive pulmonary silica, asbestos, or vinyl chloride, is another major cause of lung cancer. The risk is greatly increased © Jonesdisease & has, Bartlett as its most Learning, common LLCcomponents, © Jones & Bartlett Learning, LLC both emphysema and chronic bronchitis. Bron- if a second factor (such as cigarette smoking) NOTchitis FOR is definedSALE asOR inflammation DISTRIBUTION of the mucous is alsoNOT present FOR inSALE an occupationally OR DISTRIBUTION exposed membranes of the bronchi. Bronchitis is a type individual. of chronic obstructive pulmonary disease of the 6. Endocarditis is inflammation of the inner layer larger airways. The most obvious symptom is the of the heart, known as the endocardium. Myo- carditis is inflammation of the middle layer of © Jones & Bartlettproduction Learning, of sputum. LLC Chronic bronchitis leads© Jones & Bartlett Learning, LLC to excessive mucous production and coughing. the heart, known as the myocardium. Myocar- NOT FOR SALE ChronicOR DISTRIBUTION bronchitis can lead to right-sided heartNOT FOR ditisSALE is the OR type DISTRIBUTION of carditis that is most likely to

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cause sudden death. Pericarditis is inflammation 3. Describe how cystic fibrosis affects the lungs and © Jones & Bartlettof the Learning, outer layer LLC of the heart, known as the© Jones &the Bartlett sweat glands. Learning, LLC NOT FOR SALE pericardium.OR DISTRIBUTION NOT FOR4. ListSALE the factors OR DISTRIBUTION 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© Jonesis no longer & Bartlett effectively Learning, pumped LLChttp://hypertensionweb.info/result.php?Keywords=© Jones & Bartlett Learning, LLC out, it backs up into the left atrium and then NOT FOR SALE OR DISTRIBUTIONHypertension 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, pulmo- 2X_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/ © Jonesinclude &hypertension, Bartlett Learning, aortic and mitral LLC valve ste- article_em.htm© Jones & Bartlett Learning, LLC nosis, and left ventricular infarction. NOT FOR SALE OR DISTRIBUTION http://www.healthnewsflash.com/conditions/NOT FOR SALE OR DISTRIBUTION Right-sided heart failure is caused by ineffec- respiratory_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 © Jones & Bartlettto back Learning, up into the LLC right atrium as well as the© Joneshttp://www.nei.nih.gov/health/histoplasmosis/index.asp & Bartlett Learning, LLC peripheral circulation. The patient gains weight, NOT FOR SALE OR DISTRIBUTION NOThttp://www.webmd.com/asthma/ FOR SALE OR DISTRIBUTION develops peripheral edema, and the kidneys http://www.webmd.com/a-to-z-guides/pneumonia- (and other organs) become engorged. Right- topic-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 8. A dysrhythmia (arrhythmia) is a disturbance of Multiple Choice heart rhythm.NOT Common FOR causesSALE of OR arrhythmias DISTRIBUTION Select the best response to eachNOT question. FOR SALE OR DISTRIBUTION include congenital defects, drug toxicity, elec- 1. Cancer in which of the following sites is the lead- trolyte imbalances, and myocardial infarction or ing cause of cancer death in males? ischemia. A. prostate ©9. Jones Pulmonary & Bartlett edema is Learning, a condition whereinLLC fluid B. ©pancreas Jones & Bartlett Learning, LLC collects in the lung alveoli and interstitial tis- C. lung NOTsues. FOR This SALE accumulation OR DISTRIBUTION of fluid reduces diffused D. NOTcolon 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 & Bartlettinhalation Learning, of toxic LLC gases. Of these factors, heart© Jones &C. Bartlett bronchiectasis Learning, LLC NOT FOR SALE diseaseOR DISTRIBUTION is the most common cause of pulmonaryNOT FOR D.SALE atelectasis OR DISTRIBUTION 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 produce venous© Jones stasis, &increased Bartlett coagulation Learning, LLC C. atresia © Jones & Bartlett Learning, LLC ability, or changesNOT inFOR the wallsSALE of bloodOR DISTRIBUTION vessels. D. gangrene NOT FOR SALE OR DISTRIBUTION Pathological changes that can cause pulmo- 4. 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 © Jonesfactors & include Bartlett pregnancy, Learning, sepsis, LLC congestive C. ©bronchiectasis Jones & Bartlett Learning, LLC NOTheart FOR failure, SALE and ORtumors. DISTRIBUTION D. NOTpneumothorax FOR SALE OR DISTRIBUTION 5. When the heart is pumping inadequately to meet CRITICAL THINKING QUESTIONS the needs of the body, the condition is called 1. Explain why there is an extensive network of cap- A. cor pulmonal B. congestive heart failure © Jones & Bartlettillaries Learning, in skeletal musclesLLC and in the liver. © Jones & Bartlett Learning, LLC 2. Explain why an embolus may cause a larger C. arrhythmia NOT FOR SALE infarcOR DISTRIBUTIONtion than an atheroma with a thrombus. NOT FOR D.SALE myocardial OR DISTRIBUTION infarction

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6. An abnormally slow heart rate is known as 12. Which of the following is the most common © Jones & BartlettA. bradycardiaLearning, LLC © Jones &caus Bartlette of emphysema? Learning, LLC NOT FOR SALE B.OR tachycardia DISTRIBUTION NOT FOR A.SALE bronchogenic OR DISTRIBUTION cancer C. heart block B. pneumothorax D. ventricular fibrillation C. pulmonary edema 7. Stasis of blood flow from immobility, injury D. smoking cigarettes 13. to a vessel, or© predispositionJones & Bartlett to clot Learning,formation LLC Which of the following© Jonescardiovascular & Bartlett disorders Learning, LLC increases the risk of is the leading cause of death in the United States? A. pulmonaryNOT embolism FOR SALE OR DISTRIBUTIONA. myocardial infarctionNOT FOR SALE OR DISTRIBUTION B. emphysema B. hypertension C. pneumothorax C. stroke D. chronic obstructive pulmonary disease D. angina pectoris 8. 14. © JonesWhich of& theBartlett following Learning, is an occupational LLC disease Which© Jonesof the following & Bartlett is the Learning, cause of primary LLC that causes progressive, chronic inflammation pulmonary hypertension? NOTand FOR infection SALE in theOR lungs DISTRIBUTION due to inhalation of A. hypoxemiaNOT FOR SALE OR DISTRIBUTION inorganic dust? B. pulmonary embolism A. emphysema C. pneumonia B. pneumothorax D. unknown C. 15. © Jones & Bartlett pneumoconiosisLearning, LLC © Jones &Tuberculosis Bartlett Learning, primarily affects LLC the D. bronchiectasis A. brain NOT FOR SALE9. FluidOR DISTRIBUTIONshift into the extravascular spaces of theNOT FOR B.SALE liver OR DISTRIBUTION lungs with accompanying dyspnea and coughing C. kidneys is indicative of D. lungs A. myocardial infarction B. pulmonary© edemaJones & Bartlett Learning, LLCCASE STUDY © Jones & Bartlett Learning, LLC C. angina pectoris A 52-year-old man who worked for 15 years in the nuclear D. pneumothoraxNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION power industry began to have symptoms of lung prob- 10. 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 © Jones & Bartlett Learning, LLC pulmonary ©function Jones tests & revealedBartlett impaired Learning, breathing. LLC B. atelectasis 1. What is the probable diagnosis of his condition? NOTC. FOR bronchiectasis SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 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 & BartlettB. heartLearning, failure LLC © Jones & Bartlett Learning, LLC NOT FOR SALE C.OR hypertension DISTRIBUTION NOT FOR SALE OR DISTRIBUTION D. asthma

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