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Chapter30.pptx

Chapter 30: Respiratory Tract Infections, Neoplasms, and Childhood Disorders

Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Areas Involved in Respiratory Tract Infections

Upper respiratory tract

Nose, oropharynx, and larynx

Lower respiratory tract

Lower airways and lungs

Upper and lower airways

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2

Common Respiratory Infections

Common cold

Influenza

Pneumonia

Tuberculosis

Fungal infections of the lung

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3

Factors Affecting the Signs and Symptoms of Respiratory Tract Infections

The function of the structure involved

The severity of the infectious process

The person’s age and general health status

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Transmission of Common Cold

Viral infection of the upper respiratory tract

Rhinoviruses, parainfluenza viruses, respiratory syncytial virus, corona viruses, and adenoviruses

Fingers are the greatest source of spread.

Cough, sneeze

The nasal mucosa and conjunctival surface of the eyes are the most common portals of entry of the virus.

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Question #1

The most common port of entry for cold viruses is _______.

inhalation

small cuts

food

conjunctival surface of the eyes

fingers

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Answer to Question #1

D. conjunctival surface of the eyes

Rationale: Conjunctival surface of the eyes and the nasal mucosa are the most common ports of entry for cold viruses.

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Rhinitis and Sinusitis

Rhinitis

Inflammation of the nasal mucosa

Sinusitis

Inflammation of the paranasal sinuses

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Types of Sinuses #1

Paranasal sinuses

Air cells connected by narrow openings or ostia with the superior, middle, and inferior nasal turbinates of the nasal cavity

Maxillary sinus

Inferior to the bony orbit and superior to the hard palate

Its opening is located superiorly and medially in the sinus, a location that impedes drainage.

Frontal sinuses

Open into the middle meatus of the nasal cavity

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Types of Sinuses #2

Sphenoid sinus

Just anterior to the pituitary fossa behind the posterior ethmoid sinuses

Its paired openings drain into the sphenoethmoidal recess at the top of the nasal cavity.

Ethmoid sinuses

Comprise 3 to 15 air cells on each side, with each maintaining a separate path to the nasal chamber

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Classifications of Rhinosinusitis

Acute rhinosinusitis

May be of viral, bacterial, or mixed viral–bacterial origin

May last from 5 to 7 days up to 4 weeks

Subacute rhinosinusitis

Lasts from 4 weeks to less than 12 weeks

Chronic rhinosinusitis

Lasts beyond 12 weeks

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Allergic Rhinosinusitis

Occurrence

Occurs in conjunction with allergic rhinitis

Mucosal changes are the same as allergic rhinitis.

Symptoms

Nasal stuffiness, itching and burning of the nose, frequent bouts of sneezing, recurrent frontal headache, watery nasal discharge

Treatment

Oral antihistamines, nasal decongestants, and intranasal cromolyn

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Types of Influenza Viruses

Type A

Most common type

Can infect multiple species

Causes the most severe disease

Further divided into subtypes based on two surface antigens: hemagglutinin (H) and neuraminidase (N)

Type B

Has not been categorized into subtypes

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13

Antiviral Drugs

Amantadine

Rimantadine

Zanamivir

Oseltamivir

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Types of Influenza Vaccinations

Trivalent inactivated influenza vaccine (TIIV)

Developed in the 1940s

Administered by injection

Live, attenuated influenza vaccine (LAIV)

Approved for use in 2003

Administered intranasally

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Pneumonia

Definition

Respiratory disorders involving inflammation of the lung structures (alveoli and bronchioles)

Causes

Infectious agents: such as bacteria and viruses

Noninfectious agents: such as gastric secretions aspirated into the lungs

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Factors Facilitating Development of Pneumonia

An exceedingly virulent organism

A large inoculum

Impaired host defenses

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Classifications of Pneumonias

According to the source of infection

Community-acquired

Hospital-acquired

According to the immune status of the host

Pneumonia in the immunocompromised person

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Tuberculosis

Caused by the mycobacterium, M. Tuberculosis

Outer waxy capsule that makes them more resistant to destruction

Infect practically any organ of the body, the lungs are most frequently involved

Macrophage-directed attack, resulting in parenchymal destruction

Cell-mediated immune response

Confers resistance to the organism

Development of tissue hypersensitivity

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Forms of Tuberculosis

M. tuberculosis hominis (human tuberculosis)

Airborne infection spread by minute droplet nuclei harbored in the respiratory secretions of persons with active tuberculosis

Living under crowded and confined conditions increases the risk for spread of the disease

Bovine tuberculosis

Acquired by drinking milk from infected cows; initially affects the gastrointestinal tract

Has been virtually eradicated in North America and other developed countries

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Positive Tuberculin Skin Test

Results from a cell-mediated immune response

Implies that a person has been infected with M. tuberculosis and has mounted a cell-mediated immune response

Does not mean the person has active tuberculosis

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21

Laboratory Tests to Diagnose Histoplasmosis

Cultures

Fungal stain

Antigen detection

Serologic tests for antibodies

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Classification and spread of Fungi

Yeasts

Are round and grow by budding

Molds

Form tubular structures called hyphae

Grow by branching and forming spores

Dimorphic Fungi

Grow as yeasts at body temperatures and as molds at room temperatures

Mechanisms of Fungal Spread

Inhalation of spores

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23

Lung Cancer

Causative factors

Smoking

Asbestos

Familial predisposition

Primary lung tumors (95%) versus bronchial, glandular, lymphoma

Secondary via metastasis

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Categories of Bronchogenic Carcinomas

Squamous cell lung carcinoma (25% to 40%)

Closely related to smoking

Adenocarcinoma (20% to 40%)

Most common in North America

Small cell carcinoma (20% to 25%)

Small round to oval cells, highly malignant

Large cell carcinoma (10% to 15%)

Large polygonal cells, spread early in development

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Question #2

The lungs are a common sight for secondary tumor development. Why?

Due to the highly vascular nature and small capillaries

Due to the fragility of the cells

Due to the rapid replication of type I alveolar cells

Due to dumb luck

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Answer to Question #2

A. Due to the highly vascular nature and small capillaries

Rationale: Due to the highly vascular nature and small capillaries

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Categories of the Manifestations of Lung Cancer

Those due to involvement of the lung and adjacent structures

The effects of local spread and metastasis

The nonmetastatic paraneoplastic manifestations involving endocrine, neurologic, and connective tissue function

Nonspecific symptoms such as anorexia and weight loss

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Question #3

Which of the following involves infection of the entire respiratory track?

Common cold

Pneumonia

Tuberculosis

Cancer

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Answer to Question #3

B. Pneumonia

Rationale: Pneumonia can involve all respiratory tissues, and due to its virulence, is a major health risk.

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Stages of Lung Development

Embryonic period

Pseudoglandular period

Canalicular period

Saccular period

Alveolar period

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Respiratory Disorders in the Neonate

Respiratory distress syndrome

Bronchopulmonary dysplasia

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Respiratory Disorders in Children

Upper airway infections

Viral croup

Spasmodic croup

Epiglottis

Lower airway infections

Acute bronchiolitis

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Impending Respiratory Failure in Infants and Children

Rapid breathing

Exaggerated use of the accessory muscles

Retractions

Nasal flaring

Grunting during expiration

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