ANSWER
Any disease or disorder of the airways and lungs that affects human respiration is a respiratory disease.

Respiratory system diseases can affect any of the structures and organs involved in breathing, including the nasal cavities, pharynx (or throat), larynx, trachea (or windpipe), bronchi and bronchioles, lung tissues, and respiratory muscles of the chest cage.

emphysema \emphysema
Because the respiratory tract is exposed to the environment, it may be affected by inhaled organisms, dust, or gases; (2) it has an extensive network of capillaries through which the entire output of the heart must pass, diseases that affect the small blood vessels are likely to affect the lung, and (3) it may be the site of “sensitivity” or allergic phenomena.

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asthma \asthma
This article discusses the signs and symptoms of respiratory disease, the natural defences of the human respiratory system, methods for detecting respiratory disease, and the various respiratory diseases. See the human respiratory system for more information on the anatomy of the human respiratory system and the process of respiration.

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Symptoms and signs
Examine the effects of smoking on lung tissue and different stages of respiratory disease.
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Lung disease symptoms are few and far between. Cough is a significant symptom of any disease that affects the bronchial tree. A sputum-producing cough is the most common manifestation of inflammatory or malignant diseases of the central airways, such as bronchitis. The mucous glands lining the bronchi enlarge greatly in severe bronchitis, and 30 to 60 ml of sputum is commonly produced in 24 hours, particularly in the first two hours after awakening in the morning. An irritative cough without sputum may be caused by the spread of malignant disease from nearby organs to the bronchial tree. The presence of blood in the sputum (hemoptysis) is a severe symptom that should never be ignored. Although it could simply be an exacerbation of an existing infection, it could also indicate inflammation, capillary damage, or the presence of a tumour. Hemoptysis is a classic symptom of pulmonary tuberculosis.

Dyspnea, or shortness of breath, is the second most common symptom of lung disease. This complex sensation can occur suddenly, such as when a foreign body is inhaled into the trachea or when a severe asthma attack begins. More often than not, the onset is gradual and insidious. The difficulty in completing a task, such as walking up a flight of stairs, playing golf, or walking uphill, gradually increases. Shortness of breath can vary in severity, but it is always present in diseases like emphysema (see below Pulmonary emphysema), which causes irreversible lung damage. It can become so severe that the victim becomes immobile, and tasks like dressing become difficult. Severe fibrosis of the lung, whether caused by occupational lung disease or an unidentified antecedent condition, can cause severe and unremitting dyspnea. Dyspnea is also an early symptom of lung congestion caused by impaired left ventricle function in the heart. When this happens, the lung capillaries become engorged, and fluid may accumulate in tiny alveoli and airways if the right ventricle, which pumps blood through the lungs, is functioning normally. Dyspnea is the most common symptom that prompts a patient to seek medical attention. Still, the absence of the sign does not rule out severe lung disease because, for example, a small lung cancer not obstructing an airway does not cause shortness of breath.

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Chest pain can be an early symptom of lung disease. Still, it is most often associated with a pneumonia attack caused by an inflammation of the pleura that occurs after the pneumonic process begins. When taking a deep breath, pain associated with pleural inflammation is typically felt. When fluid accumulates in the pleural space, a condition known as pleural effusion, the pain goes away. Acute pleurisy with pain may indicate a pulmonary vessel blockage, resulting in acute congestion of the affected part. Pleurisy can be caused by pulmonary embolism, the occlusion of a pulmonary artery by a fat deposit or a blood clot that has become dislodged from another location in the body. A blood vessel suddenly blocked injures the lung tissue to which it typically delivers blood.
Furthermore, severe chest pain may result from the spread of malignant disease to the pleura or from a tumour that arises from the pleura, as in mesothelioma. Severe and intractable pain caused by such conditions may necessitate surgery to cut the nerves supplying the affected segment. Fortunately, such intense pain is uncommon.

Several other symptoms of lung disease, in addition to coughing, dyspnea, and chest pain, may be present. There may be wheezing in the chest. This is caused by airway narrowing, which occurs in asthma. Some lung diseases are associated with “clubbing” of the fingertips (and, in rare cases, the toes). Clubbing may be a symptom of bronchiectasis (chronic inflammation and dilation of the significant airways), diffuse lung fibrosis caused by any cause, or lung cancer. In the case of lung cancer, this unusual symptom may disappear after the tumour is surgically removed. The first symptom of some lung diseases may be swelling of the lymph nodes that drain the affected area, particularly the tiny nodes above the collarbone in the neck; enlargement of the lymph nodes in these areas should always raise the possibility of intrathoracic disease. Lung cancer presenting symptoms are frequently caused by metastasis, or the tumour spread to other organs or tissues. Thus, a hip fracture from bone metastases, cerebral signs from intracranial metastases, or jaundice from liver involvement may all be the first signs of primary lung cancer, as may sensory changes in the legs, as these tumours may also present with peripheral neuropathy.

Many lung diseases are known to have a generally debilitating effect. As the first sign of active lung tuberculosis or lung cancer, a person may be aware of only a general feeling of malaise, unusual fatigue, or seemingly minor symptoms. Loss of appetite and weight, a lack of physical activity, general psychological depression, and some symptoms that appear unrelated to the lung, such as mild indigestion or headaches, may all be signs of lung disease. Not infrequently, the patient may experience symptoms similar to those experienced when recovering from an influenza attack. Because the symptoms of lung disease are variable and nonspecific, a physical and radiographic examination of the chest is an integral part of evaluating people who have these complaints.

Respiratory system safeguards
Because it is exposed to the outside environment, the respiratory tract has a complex but comprehensive defence against inhaled material. Large debris particles are filtered out by cilia and mucus secreted by the mucous membrane lining the nasal cavity as air passes through the nose. The air then passes through the pharynx, the final portion of the upper airway, the larynx, the beginning of the lower airways, and into the trachea. The air is further filtered through the trachea’s cilia and sticky mucus. Furthermore, lymphatic vessels in the tracheal wall transport immune system cells such as lymphocytes and macrophages that act to trap and destroy foreign particles. Muscle bands surrounding the tracheal cartilage are essential in narrowing the airway during coughing, providing a powerful defence mechanism that allows sputum and other substances to be quickly expelled from the respiratory tract.

Cilia in the bronchial tree beat in unison, moving substances up and out of the airways. A thin layer of fluid covers the cilia in the bronchioles and small bronchi, which thickens and becomes layered with mucus as the small bronchi converge into the large bronchi. Foreign particles are transported through the fluid and mucus layers when the cilia beat. The mucociliary escalator transports debris to the pharynx, where the fluid and mucus are swallowed, and the waste is eliminated by the digestive system.

In the smaller branches of the airways, macrophages serve as the first line of defence. These cells, which are found in the lungs’ alveoli, ingest and destroy bacteria and viruses and remove small particles. They also secrete chemicals that attract other immune cells, such as white blood cells, to the site, triggering an inflammatory response in the lung. Particles picked up by macrophages are carried into the lung’s lymphatic system and stored in lymph nodes in the lung and mediastinum (the region between the lungs). Soluble particles are removed from the bloodstream and excreted by the kidneys.

Investigation methods
A physical examination of the chest is still necessary because it can reveal the presence of an area of inflammation, a pleural effusion, or an airway obstruction. Physical inspection and palpation for masses, tender spots, and abnormal breathing patterns; percussion to determine the resonance of the underlying lung; and auscultation (listening) with a stethoscope to determine pitch and loudness of breath sounds are all methods of examination. The sounds picked up by a stethoscope can reveal problems with the airways, lung tissue, or pleural space. Sputum examination for bacteria allows for identifying many infectious organisms and administering specific treatment; sputum examination for malignant cells is occasionally helpful.

The computed tomography technique has dramatically improved the traditional radiological examination of the chest (CT). This method creates a complete picture of the lungs using X-rays to create two-dimensional images combined into a single image by a computer. While computed tomography has a much higher resolution than most other visualization techniques, lung ventilation and perfusion scanning can also help detect lung abnormalities. A radioactive tracer molecule is either inhaled in the case of ventilation scanning or injected in the case of perfusion scanning in these techniques. The ventilation scan visualizes gas exchange in the bronchi and trachea, while the perfusion scan visualizes blood vessels in the lungs. The combined ventilation and perfusion scanning results are critical for detecting pulmonary emboli that cause focal occlusion of pulmonary blood vessels.

Although magnetic resonance imaging (MRI) has a limited role in lung examination due to its inability to image air-filled spaces, it helps image the heart and blood vessels within the thorax. PET scanning distinguishes malignant lung tissue and scar tissue on tissues such as lymph nodes. Flexible fibre-optic bronchoscopes inserted through the mouth into the upper airway are used to examine the larynx, trachea, and primary bronchi. Physicians can collect fluid and small tissue samples from the airways by feeding a surgical instrument through a particular bronchoscope channel. Tissue samples are examined for histological changes that indicate disease and cultured to determine the presence of harmful bacteria.

Various tests are available to determine lung function and the effects of disease on pulmonary function. Spirometry, which measures the rate and amount of air exhaled forcibly during total respiration, allows for the measurement of the lungs’ ventilation capacity and quantification of the degree of airflow obstruction. A peak flow meter, which is commonly used in field studies, can be used to measure ventilation capability. To calculate the volumes of gas in the lung, the distribution of ventilation within the lung, airflow resistance, the stiffness of the lung, or the pressure required to inflate it, and the rate of gas transfer across the lung, which is commonly measured by recording the rate of carbon monoxide absorption into the blood, more complex laboratory equipment is required (hemoglobin has a high affinity for carbon monoxide). Arterial blood gases and pH values are routinely measured in patients in intensive care units to determine the adequacy of oxygenation and ventilation. Workload, total ventilation, and gas exchange tests that compare before, during, and after exercise help assess functional impairment and disability.

Transplantation of the lungs
In 1963, scientists performed the first single-lung transplant, but the patient only lived for 18 days. Long-term survival was achieved with single-lung transplantation in 1983 and double-lung transplantation in 1986. Persons severely disabled by cystic fibrosis, emphysema, sarcoidosis, pulmonary fibrosis, or severe primary pulmonary hypertension were able to achieve nearly normal lung function several months after the procedure in the following decades. By the early 2000s, the median survival time for lung transplant patients had surpassed five years. However, the number of procedures performed each year was limited by a scarcity of donor lungs.

Bronchiolitis obliterans is the most common complication after lung transplantation. Many single or double lung transplant recipients develop bronchiolitis obliterans months or years after surgery. Despite the use of immunosuppressive drugs, this complication is thought to represent a gradual immunologic rejection of the transplanted tissue. Bronchiolitis obliterans, as well as the constant risk of severe infection caused by immunosuppressive drugs, can severely limit survival.
QUESTION
PRN1725 Section MHPA1A0Z Client-Centered Care IV (11 Weeks) – Fully on Campus – 2023 Winter Quarter

Module 04 Assignment – Respiratory Case Study
Module 04 Assignment – Respiratory Case Study
Module 04 Content
Competency: Select nursing interventions for clients with complex disorders.

Instructions:

Scenario: Anna is a 28-year-old female who was prescribed Bactrim DS for a Urinary Tract Infection. She took her first dose of medication yesterday. Anna has taken Bactrim DS in the past, but today, woke up with hives all over her legs and arms. She was also wheezing and could not catch her breath. Her roommate was very worried about her and decided to call 911. When EMS arrived, Anna was not able to talk and was in respiratory distress. Because Anna was in severe respiratory distress, EMS took the measure of securing her airway by inserting an endotracheal tube (ETT). Once Anna’s airway was securely managed, EMS then gave her a dose of Benadryl and Epinephrine prior to transporting her to the hospital. These medications will help decrease the manifestations of the allergic reaction. Anna remains ventilated and is admitted to the ICU for further care.

Answer the following questions related to this scenario:
Why are ventilated clients at risk for pneumonia? Explain your response.
What nursing interventions can be taken to prevent pneumonia? Explain the rationale for your response.
The patient most likely had an allergic reaction to the Bactrim DS that she was taking. Why did the reaction occur even though Anna has taken this medication before without any problems?
The patient has multiple intravenous lines. One of the intravenous IV sites is red and the patient winces in pain when the nurse palpates around the site. The site is slightly swollen. What complication does the nurse suspect? What action should the nurse take to prevent further complication at the compromised site?
The patient has a full recovery and is ready for discharge. What discharge instructions would you provide to the patient regarding future administration of Bactrim DS?
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