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The Power is in Your Hands
http://www.handsonlineeducation.com/Classes/APATH7/apath7entry.htm[3/20/18, 1:14:00 PM]
Main Menu
Respiratory System
Introduction__________
Infectious RespiratoryDisorders
Chronic ObstructivePulmonary Diseases
OtherRespiratoryDisorders
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Respiratory System
Copyright 2009 Walters Kluwers Health l Lippincott Williams & Wilkins
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Respiratory SystemEasiest way to discuss structure of the Respiratory System is to follow aparticle of air through it.
Bronchi
Asymmetrical with right bronchus being bigger, wider andstraighter. Right bronchus leads to three lobes; Leftbronchus is smaller and curves into two lobes. (If a foreignobject is inhales it almost always follows the path of leastresistance to the right side.)
Alveoli
Next section of tubing is bronchioles which subdivide 23 timesto end in microscopic alveoli: grape shaped clusters are liketiny balloons surrounded by blood capillaries. Gaseousexchange occurs between alveoli and capillaries.
Lobes
Have separate segments called lobules lined with mucousmembrane which traps pathogens and other particles.
Smooth tissue lines all of the tubes
Take a Deep Breath
l
Air drawn in the Noseencounters Mucous
Membranes
l
Air enters the Pharynx,
l
then Larynx,
l
then Trachea
l
and then Bronchi
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FunctionAir cycles through the lungs 12-20 times per minutes.
Fresh air contains about 21% oxygen
_______________
Exhaled air contains about 16% oxygen
_______________
Enough surface area in lungs that only 5% of resting energy isneeded to supply the whole body with adequate oxygen
Lungs have no muscletissue to make them fillup or empty; they are
limp-walled sacs. Theyare stretched by pulling
on thorax walls and snapback to original shape on
exhale.
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Infectious Respiratory System Conditions
Acute Bronchitis
Common cold
Influenza
Pneumonia
Sinusitis
Tuberculosis
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Acute Bronchitis
Self-limiting inflammation of bronchial tree; Usually acomplication of cold or flu; Distinguished from chronicbronchitis
Etiology
Irritated bronchi get inflamed: tubes swell, cilia aredamaged, mucus producedLeads to coughing, wheezingMost are complications of cold or flu:Virus can attack bronchial mucosa or bacteria can takeadvantage of a good growth mediumSelf-limiting: lasts about 10 days, then heals (notchronic bronchitis)
Demographics
12 million cases/year 3 million doctor visits
Smokers, workers in pollutedenvironments at risk ; Also, elderly, heartproblems, immunosuppressed
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more Acute Bronchitis
Signs and Symptoms Diagnosis Treatment Massage
Persistent coughStarts dry, becomesproductiveWheezing, congestion,headache, fever,muscle aches, chestpain, fatigueIf fever goes over101ºF (38.3ºC) or ifmucus becomes thickand opaque,pneumonia is possible
Usually clearCan look like sinusitis,pneumonia, asthma
Rest, fluids, warmhumid airAntibiotics only ifidentified as bacterialinfectionBronchodilators/coughsuppressants maysuppress symptoms;don’t speed healing
Circulatory massagecontraindicated foracute infectionMay be appropriateduring recovery
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Common Cold
200 viruses that attack upper respiratory system ; Also calledupper respiratory tract infection (URTI)
Etiology
Rhinoviruses (110 subtypes)CoronavirusesAdenovirusesRespiratory syncytial viruses
___________________________Viruses enter nose: good growth mediumAccess cells in lymphoid tissue of adenoidsIncubation is short: 12 hoursImmune system attacks infected cells; causes mostsymptoms
Does being cold cause cold? Maybe
Demographics
An estimated 1 billion infections/year inthe United States
Children most at risk: 6–10/yearAdults: 2–4/yearElderly: <2/year
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more Common Cold
Signs and Symptoms Prevention Treatment Massage
Runny nose, sneezing,sore throat, drycoughing, headache,mild fever
Less than 2weeks
Bacterial infections ofear, larynx, sinusesMay go to lungs:bronchitis, pneumonia
Especially iflungs arecompromised,e.g., chronicobstructivepulmonarydisease(COPD)
Virus can be airborneor picked up by handfrom contaminatedsurfacesPrevent spread bywashing hands,disposing of tissues,staying home whensick
No antibiotics!Rest, fluids, humidifierOver-the-counter(OTC) drugs canreduce symptoms,may increasecommunicabilityVitamin C, Echinacea,lysine, zinc, licoriceroot, hydrotherapy
Safest aftersymptoms havepeakedMay be more severe ifmassage occurs earlyin infectionMay exacerbatesymptoms for a day orso if massage occursduring healing—getpermission!
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Influenza
Viral infection of respiratory tract: different from viruses thatcause colds
Etiology
Virus gains access (airborne or via hands)Invade mucus-producing cells in respiratory tractImmune system kills infected cells, making mostsymptomsIncubation 2–3 days; communicable before symptomsappearPeak of communicability about day 4; continues throughrecovery
____________________________Type A: most virulent, associated with epidemics,pandemicsType B, C: stable, less severeType A infects other animals (birds, pigs, etc); mutateseasily
Demographics
5–20% population has flu 1/year
Children more at risk thanadults
For young, elderly,immunocompromised, can be dangerous
200,000 hospitalizations36,000 deaths/year
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more Influenza
Signs and Symptoms Complications Treatment Massage
Looks like a bad cold
Respiratoryirritation,high fever 3or moredaysMuscle,joint pain
May last 2 weeksNo such thing asstomach flu
Acute bronchitis,pneumonia
No antibioticsRest, liquidsOTC drugs may controlsymptoms, don’tshorten durationAntiviral medications
Amantadine,rimantadine,Tamiflu,Relenza
Flu vaccine: madeseveral months aheadto predict active virus;must be updated yearly
Circulatory work iscontraindicated whileacuteMay exacerbatesymptoms duringrecovery: askpermission!May be contagiousduring recovery
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Pneumonia
Inflammation of the lungs, usually due to an infectious agent
Etiology
Alveoli fill with pus, mucus, other fluidDiffusion of gases is impossible; person drownsMay affect pleura: pleurisy is scarring of pleural layersInfection of pleural fluid: empyema
CausesMay be more than one at a time Viruses
About half of casesFlu, syncytial viruses most commonShort-lived, not serious for most
Bacteria
Staphylococci or streptococci get fromthroat to lungs; toxins initiate inflammatoryresponseCould also be tuberculosis, legionellaEdema in alveoliResponsive to antibiotics
Mycoplasma
Smallest living infectious agentsTiny bacteria: responsive to antibioticsWalking pneumonia
Fungi
Several species are endemic to certainareasPCP: Pneumocystis carinii pneumonia inimmunosuppressed people
DemographicsOpportunistic infection: takes advantageof weak immune system
Combines with flu to benumber 7 cause of death inthe United States3 million to 5 millioncases/year, 500,000+hospitalizations, 60,000deaths
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Forms of pneumoniaPrimary pneumonia: rare attack directly on lungs Secondary pneumonia: more common, complication ofother problems; may be classified by location Bronchopneumonia: patchy pattern all over the lungs Lobar pneumonia: Restricted to one lobe; may spreadto whole lung Double pneumonia: affects both lungs
Source of the infectious agentCommunity acquired pneumoniaNosocomial, or hospital-acquired, pneumonia
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more Pneumonia
Signs andSymptoms Diagnosis Treatment Massage
Vary with agent,virulence, health ofpatientCoughing, high fever,chills, sweating,delirium, chest pain,cyanosis, thicksputum, shortness ofbreath, muscle aches,pleurisySudden or gradualonset; looks like flu butgets progressivelyworse
Clinical examinationand description ofsymptomsViral, bacterial oftenhave fast onsetMycobacterium hasslower onset, lesssevere symptomsRadiography,computed tomography(CT), arterial blood gasstudy
Depends on type
Antibioticsfor bacteria,mycoplasma
Humidifier, fluids, rest,oxygenSurgery to drain pleuralspace if necessary
PreventionFlu vaccinePneumovax forpneumococcus
PrognosisUsually reversible iftreatedUntreated: 30%mortality rate; maycomplicate tomeningitis, respiratoryfailure, blood poisoningFibrosis, scar tissuemay accumulate
Raises riskof futureinfections
Contraindicated forcirculatory massagewhile acutePost acute stage canbenefit frompercussive massageon back, chest
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Sinusitis
Inflammation of mucous membranes in nose,sinuses ; Can be from infection or allergies
Etiology
Cilia in sinuses break down in response toinfection, pollutants
CausesNoninfectious sinusitis: allergic rhinitis:sinuses are inflamed without infection; mayincrease risk of infectionInfectious sinusitis:Acute (complication of viral infection, lasts6–8 weeks)Chronic (less severe, longer-lastingsymptoms)
Infectious agentsViruses and bacteria: cold, flu,Streptococcus pneumoniae,Haemophilus influenzae, bacteriafreed by dental workFungi and bacteria: Colonies offungi may create growth mediumfor bacteria as well
Other causes of infectious sinusitis
Structural problems: Deviatedseptum, nasal polypsEnvironmental irritants: cigarettesmoke, indoor and outdoorpollutants, cocaine, other irritantsOther conditions: severe cavities,asthma
Demographics37 million infections/year in the United States
Copyright 2009 Walters Kluwers Health l Lippincott Williams & Wilkins
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more Sinusitis
Signs and Symptoms Treatment Massage
Depends on causeSevere headache, worse withbending overLocal pain, edemaFever, chills with acuteinfectionSore throat, coughing(postnasal drip)Mucus clear with allergies;streaked or opaque withinfection
Humid air, fluids, saline wash ofsinusesDrugs: antibiotics for bacterialinfection; short-termdecongestants; steroid spraySurgery to correct structuralanomalies
Indicated for allergies if client iscomfortable on table (mayrequire some adjustment inposition or duration)Circulatory massage iscontraindicated for acute,untreated infection
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Tuberculosis
Tubercle = bump ; TB is a bacterial infection leading topus-filled bumps in lungs and other areas
Etiology
Airborne bacterium: Mycobacterium tuberculosisSpore gives it environmental resistanceUsually takes prolonged, repeated exposure tospread; can go more quickly
ProgressionTwo phases
Primary phase
Inhaled bacteria travel to alveoli, engulfed bymacrophages (doesn’t work)Set up small colonyBody builds protective wall around them: tubercleThis is exposure—not active disease; stays stablefor 90%
Secondary phase
Bacteria escape capsule and spread through lungto other tissuesScarring, pleurisyHappens to about 10% of infected, usually withinfirst yearInside large capsules tissue is infected, dead
Risk Factors
Long-term exposure to a person with activediseaseTravelers to areas with high infection ratesMost likely to → active infection if poor, unhealthy,drug user, alcoholic, HIV+
HIV and tuberculosis
DemographicsWorldwide:
2 billion people exposed8 million new infections/year9 million develop infection in activeform2 million to 3 million deaths/year:>AIDS + malaria + all tropicaldiseases combined
United States
10 million to 15 million exposed14,000 in active formMostly in poor, indigent, limitedaccess to health care
Copyright 2009 Walters Kluwers Health l Lippincott Williams & Wilkins
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Coinfection with HIV and TB increases risk of TBbecoming activeHIV+ can interfere with accurate diagnosisWorldwide one-third who are HIV+ are also TB+
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more Tuberculosis
Signs and Symptoms Diagnosis Treatment Massage
Primary phase: may besilent or look like mildfluActive phase: fever,sweating, weight loss,exhaustion, chest pain,shortness of breath
Cough withphlegm thatmaybecomebloodyOtherorgans:bone pain,hematuria,CNSsymptoms
Within weeks ofexposure a skin test ispositive
Coinfectionwith HIVcan altertestVaccinationwith bacilleCalmette-Guérin(BCG) canalter test
Harder to catch activeinfection: looks likecold, flu, pneumonia,fungal infections oflungs
Previously: sanatoriaNow: antibiotics (INH =isoniazid)
6–12months,severalsideeffects,especiallywith alcohol
Low compliance leadsto drug-resistant TB
Drug-Resistant TBMDR-TB$250,000 to treat; 18–24 months ofmedications; samemortality as untreatedregular TB; spreads asMDR-TBWorldwide: 1% haveMDR-TB; 47 statesand DC in the UnitedStatesXDR-TBVirtually no treatmentworks74 deaths in the UnitedStates since 1993Most common in theformer Soviet Union,Asia, in HIV+ in SouthAfrica
Safe if infection islatent2 weeks of antibiotictreatment cutscommunicability risk tonear 0Contraindicated withactive infection
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Chronic Obstructive Pulmonary Diseases
Asthma
Chronic bronchitis
Emphysema
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Asthma
Sympathetic/parasympathetic swing in bronchioles ; Triggered by irritant, stress ; Sometimes classifiedas COPD; doesn’t usually cause irreversible lungdamage
Etiology
Hyperreactive bronchioles
Chronic inflammation, waiting fortriggerDilation (sympathetic) followed byconstriction (parasympathetic)Membranes swell, secreteexcessive mucus
Breathing, especially exhalation, becomeslaboredTriggers: pet allergens, cockroach waste,cigarette smoke, dust mites, viral infections,breathing cold dry air, exercise
Mild, intermittent asthmaEpisodes < twice/week; little impact on activity
Mild, persistent asthma>Once/week; up to 1/day; impacts activity
Moderate, persistent asthma
At least 1/day, plus nighttime episodes1+/week
Severe, persistent asthmaEpisodes most days and nights; activityseverely limited
Demographics20 million in United States; 9 million < 18 years old12.7 million doctor visits; 2 million emergencydepartment visits, 5,000 deaths/yearStatistics continue to climb; up 160% between 1980-1994Highest among African Americans
Copyright 2009 Walters Kluwers Health l Lippincott Williams & Wilkins
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more Asthma
Signs and Symptoms Diagnosis Treatment Massage
Dyspnea, wheezing,coughingHardest to expel airBronchial asthma: tightbronchioles withexcess mucusExercise induced: withexertionSilent: no transition,just sudden shortnessof breathCough variant:coughing is onlysymptomDuring episode: panicsymptoms, cyanosis
Rule out other lungdisordersSpirometry
Manage exposure tostimuliRecognize warningsigns of attackShort term: beta-agonist inhalersLong term: inhaled ororal steroidsAllergy shots
Contraindicated duringepisode; otherwise canbe helpful for breathingefficiencyBe careful abouttriggers in massagesetting: essential oils,hyperallergenic oil,perfume, etc.
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Chronic Bronchitis
Part of COPD ; Long-term irritation of the bronchi andbronchioles, with or without infection ; Progressive andirreversible ; Precursor to emphysema
Etiology
Long-term irritation to bronchial tubes
Inflammation: destruction of cilia, elastin andovergrowth of mucus-producing cells
Increased resistance to air movement in lungsDamage becomes permanentWith increasing resistanceHeart works harderRed blood cell production increases (blood becomesthicker)Acidosis → vasoconstriction in pulmonary arteriesRight-sided heart failure, edema in extremities
Demographics9 million people in the United States
Men > womenWhites > other groups
Leading risk factor is smoking
Others: occupational irritants,air pollution, history ofrespiratory infections
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more Chronic Bronchitis
Signs and Symptoms Diagnosis Treatment Massage
Slow onsetCough followsrespiratory infection,lingers
Producesthick, clearsputum forweeks to 3monthsRepeatsseveraltimes within2 years
Frequent throatclearingShortness of breathgets worseVulnerable torespiratory infections,pneumoniaCyanosis
ComplicationsHigh risk of infection,heart failure
Patient history,examination,pulmonary functiontestsChest radiography, CTto rule out otherdamage
Aggressively treatinfectionsVaccinate for flu,pneumococcusLimit progression ofdamage, quit smoking,avoid polluted airBronchodilators withanti-inflammatories forbest function
May be indicated ifcirculatory system isstrongClients in advancedstage may not toleratelaying flat, strongchallenges tocirculatory systemAdjust for positioning
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Emphysema
Part of COPD ; Blown up, inflated
Etiology
Normal exhalation is passive: elastin in alveoliand bronchioles pulls lungs back to neutral300 million alveoli in lungs, each with capillarybed for gaseous exchange, coated with alpha-1antitrypsin (AAT)With chronic exposure to irritants
AAT doesn’t work to protect alveoliElastin degenerates; lungs don’treboundAlveoli fuse into bullaeReduces surface area for gasexchangeMore effort to breathe, to exhaleRespiration rate slows → acidosis,high carbon dioxide, spasm ofpulmonary arteriesRight-sided heart failure: can’t pumpadequate blood through resistantpulmonary circuitRespiratory/circulatory collapse
Demographics3.6 million people in the United States
Most have smoked 20/day, 20years+
Other irritants: coal dust, quarries, grain dust,etc.
<5% have genetic problem: lackingalpha-1 antitrypsin
Copyright 2009 Walters Kluwers Health l Lippincott Williams & Wilkins
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Other Respiratory Disorders
Cystic Fibrosis
Lung Cancer
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Cystic Fibrosis
Autosomal recessive genetic disorder ;Causes production of thick, viscousexocrine secretions ; Respiratory tract anddigestive, integumentary, reproductivesystem
Etiology
Genetic mutations → transmembraneconductance regulator gene (CFTR) isaltered so that cell membranes can’tconduct chlorideLeads to thick, sticky secretions
Respiratory system:Mucus is thick, gluey, difficult todislodgeGrowth medium for infections; chronicinflammationAlso, growth of nasal polyps, chronicrhinitis
Digestive systemGastrointestinal (GI) tract andaccessory organsBabies may be born with intestinalobstruction: intestines don’t move wellPoor absorption → failure to thriveAbnormal production of bile →splenomegaly, gallstones, portalhypertensionAbnormal pancreatic secretions →pancreatitis, peptic ulcers
Integumentary systemThick, salty sweatRisk of heat stroke, salt depletion
DemographicsCF is the most common lethal inherited disease of whites
1:3,000 births in the United States12 million may have gene (many don’t know)30,000 people in the United States have CF
Life expectancy is improving: patients who make it throughchildhood make it to about 35
40% of patients > 18 years
Copyright 2009 Walters Kluwers Health l Lippincott Williams & Wilkins
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Reproductive systemMen usually sterile: epididymis can’tsecrete normally or incomplete vasdeferensWomen usually have normal reprotract, successful pregnancies
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more Cystic Fibrosis
Signs and Symptoms Diagnosis Treatment Massage
Vary, depending onsystemRespiratory symptomsare most common: dryor productive cough,dyspnea, wheezing,chest pain, cyanosis,clubbing of fingers
Skin test to analyze forabnormal sweatLook for defect inCFTR geneLook for changes inupper respiratory tract
ComplicationsRelated to the exocrinegland dysfunction ofthe affected system (Chronic intractablebacterial infection;bronchiectasis,resistance in thepulmonary circuit,pnuemothorax, risk ofright-sided heart failureCirrhosis, gallstones,duodenal ulcers,intestinal obstructionwith or without rectalprolapse, risk ofpancreatitis ordiabetes from adamaged pancreas,and vitamin andmineral deficienciesfrom poor absorptionHeat stroke, saltdepletionSterility in men
Minimize symptoms,complicationsBreak up congestion inlungs, breathingexercisesSupplement enzymes,vitaminsBronchodilators,mucolytics, antibioticsto fight infection, anti-inflammatoriesSurgery: lungtransplant
Guided by health,resilience of clientTherapy on lungs caninclude massage
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Lung Cancer
Growth of malignant cells in the lungs
Etiology
85–90% related to tobacco exposureOther factors: radon, asbestos, uranium, arsenic, airpollution, other carcinogensOrderly pattern of death and repair in epithelial cells oflungs is disruptedAbnormal cells accumulate in patchesLots of circulatory and lymph vessels allow cells totravel before a significant tumor forms
Mediastinal lymph nodes, liver, bone, skin,adrenal glands, brain
Types of lung cancerSmall cell lung cancer (SCLC):
Also called oat cell carcinoma15–25% of all lung cancersGrows fast, spreads quickly, usuallyinoperable
Non–small cell lung cancer
75–85% of all lung cancersIncludes squamous cell carcinoma,adenocarcinoma, large cell carcinoma,others (Fig. 7.7)Grow more slowly than SCLC, still hard todetect early
Other types of lung malignancies
Carcinoid tumors, adenoid cystic carcinoma,sarcomas, mesothelioma
Risk FactorsSmokingExposure to asbestos, coal miners, toxic chemicals
Demographics180,000 new diagnoses/year160,000 deaths/yearNumber 1 cause of death by cancer(more deaths from breast and colorectaland prostate cancers)
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15,000 deaths/year in people who never smoked
Exposure to other cigarette smoke, geneticpredisposition
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more Lung Cancer
Signs and Symptoms Diagnosis Treatment Massage
No early signsSmoker’s cough,bloodstained phlegm,chest pain, wheezing,and possibly shortnessof breathTumor may putpressure on otherstructures: brachialplexus, vena cavaesophagus, larynx,phrenic nerve
Radiography, CT, MRISputum analysis isinconsistentNo accurate,noninvasive earlydetection methodsUsually metastasizesbefore detection
Surgery, radiation,chemotherapyPhotodynamic therapymay become practical;other biologicaltherapies indevelopment
Useful to deal withchallenges of cancertreatment; respectlimitations of client andrisks associated withtreatment protocols
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