Essentialsof)Human)...
Transcript of Essentialsof)Human)...
Copyright © 2016 by Elsevier Inc. All rights reserved. 1
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Essentials of Human Diseases and Conditions
6th edition
Margaret Schell FrazierJeanette Wist Drzymkowski
1
Copyright © 2016 by Elsevier Inc. All rights reserved. 2
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Chapter 9
Diseases and Conditions of the Respiratory System
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Learning Objectives Lesson 9.1: The Respiratory System
and Associated Conditions1. Explain the process of respiration.2. Discuss the causes and medical treatment for (a) the common cold, (b) sinusitis, and (c) pharyngitis.
3. Name the treatment of choice for nasal polyps.
4. Name some systemic disorders that might cause epistaxis.
5. Discuss the prognosis of cancer of the larynx.
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6. Define atelectasis and discuss some possible causes.
7. Compare the clinical pictures of (a) a patient with pulmonary embolism and (b) one with pneumonia.
8. List some health hazards of common molds.9. List some possible causes of pulmonary abscess.
Learning Objectives Lesson 9.1: The Respiratory System and Associated Conditions (Cont.)
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Orderly Function of the Respiratory System
Respiration made possible by ventilation and healthy lung tissue perfused by blood
Breathing is controlled by central nervous system
Pulmonary circulationØ Pulmonary arteries carry deoxygenated bloodØ Pulmonary capillaries for gas exchangeØ Pulmonary veins return oxygenated blood to heart
Lungs and kidneys maintain pH balance
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Respiration
External: Oxygen inhaled from the air is exchanged with carbon dioxide
Internal: The exchange of gases between the blood and tissue cells
Inhaled and exhaled air passes through the respiratory tract
Inspiration: Diaphragm contracts, causing air to be sucked into the lungs
Expiration: Diaphragm relaxes, forcing air out of the lungs
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Structure of the Respiratory System
From Patton KT, Thibodeau GA: The human body in health & disease, ed 6, Maryland Heights, MO, 2014, Elsevier.
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Inspiration and Expiration
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Symptoms of Respiratory Disorders
Include:Ø Chest painØ Dyspnea (difficulty breathing) and shortness of breath
Ø Hemoptysis (spitting up blood)Ø Dysphonia (hoarseness)Ø Chills and low- or high-grade feverØ WheezingØ Fatigue
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Common Cold
Can infect the nose and pharynx or larynx and various areas of lungs
Symptoms depend on which virus is responsibleØ Nasal congestion and discharge, sneezing, watering eyes, sore throat, hoarseness of the voice and coughing
Group of minor illnesses that can be caused by almost 200 different viruses
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Common Cold (Cont.)
An ordinary cold should clear up in 4 or 5 daysØ Antihistamines help dry up nasal secretions, diminish itchy or watery eyes, and decrease flare from allergic reactions
Ø Decongestants stimulate adrenergic receptors, induce vasoconstriction of blood vessels in the nose, throat, and sinuses
Ø Cough suppressants lessen cough
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Sinusitis
Frontal sinuses and the maxillary sinuses are most commonly involvedØ Headache, pain, drainage, and tenderness are symptoms
Caused by viral, fungal, or bacterial infections Treatment
Ø Saline and corticosteroid nasal spraysØ Broad-spectrum antibiotics and decongestantsØ Antihistamines and oral corticosteroids
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Sinusitis
From Damjanov I: Pathology for the health-related professions, ed 4, St Louis, 2011, Saunders/Elsevier.
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Pharyngitis
Often involves inflammation of the tonsils, uvula, and palate, and sore throat with dryness, a burning sensation, or the sensation of a lump
Most common cause is a viral infection Physical examination usually shows red, swollen mucous membranesØ Using lozenges, mouthwashes, salt water gargles, an ice collar, and antiinflammatory medications may help
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Nasopharyngeal Carcinoma
Classic clinical triad of symptoms is neck mass, nasal obstruction with epistaxis, and serous otitis media
People from southern China, areas around the Mediterranean Sea, Southeast Asia, and the Arctic are at risk
Surgery is usually not performed as treatmentØ Treated with radiation therapy with or without adjuvant chemotherapy
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Laryngitis
Inflammation of the larynx sometimes interferes with breathing;; main symptom is hoarseness
Caused by viral or bacterial infections, can be chronic or acute
Laryngoscopic examination reveals mildly or highly inflamed mucosa
TreatmentØ Voice rest and bed restØ Liberal fluid intakeØ Use of cough syrup
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Deviated Septum
Causes narrowing and obstruction of the air passage
May be of no consequence until aggravated by trauma to the nose
Congenital anomaly is usually the cause Treatment is not usually necessary unless compromise of the air passage is noted
The only possible prevention is avoiding trauma to the nose
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Deviated Septum (Cont.)
From Monahan FD, Neighbors M: Medical-surgical nursing: foundations for clinical practice, ed 2, Philadelphia, 1998, Saunders.
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Nasal Polyps
Can become large enough to obstruct the airway or affect sense of smell
Polyps are caused by the overproduction of fluid in the cells of the mucous membrane
Surgical removal is the treatment of choice, but steroid injection directly into polyps may help
No specific preventive measures are known
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Nasal Polyps (Cont.)
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM,Philadelphia, 2000, Saunders.
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Anosmia
Ability to taste liquids and food also is impaired or lost
A chronic condition is the most common cause of anosmia Ø Intranasal swelling accompanying an upper respiratory condition causes temporary anosmia
Treatment is aimed at the causeØ Polyps are removedØ Allergic rhinitis is treated with a series of injections
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Epistaxis (Nosebleed)
Bleeding usually occurs from only one nostril with no explanation
Nosebleeds that persist for 10 minutes after constant pressure is applied require immediate emergency care
Common causes of epistaxis are colds and infections
Mild hemorrhage may be controlled by applying constant direct pressure
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Tumors of the Larynx
Benign or malignant growths on the larynx Dysphonia is usually the only symptom of a tumor on the larynx
Two types of benign tumors: Papillomas and polypsØ Caused by misuse or overuse of the vocal cords
Benign growths treated with correction of vocal strain and reflux management
If discovered early, malignant tumors may often be treated and cured with radiation
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Vocal Cord Polyp
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Laryngeal Cancer
Persistent hoarseness tends to occur early in the disease process and is the most common symptomØ Other symptoms may include dysphagia, hemoptysis, chronic cough, referred pain to the ear, and stridor
Major risk factors for development of laryngeal cancer are smoking and alcohol abuse
Quality of life issues are often incorporated into the treatment plan
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Hemoptysis
Sputum streaked or spotted with blood can be present with minor infections
Profuse bleeding is present in severe lung infections
Trauma, erosion of a vessel, calcification, or tumors can cause bronchial bleeding, as can inflammatory conditions
Source of bleeding is treated once locatedØ Ligation or surgical removal or repair of the involved vessels is indicated for severe bleeding
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Atelectasis
Follows incomplete expansion of lobules or segments of the lung, with partial or complete collapse;; dyspnea is another symptom
Caused by an obstruction in the bronchial treeØ Compression atelectasis results when a tumor exerts pressure on the lung and does not allow air to enter
Antibiotics, analgesics, surgical drainage of pleural effusion for treatment
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Atelectasis (Cont.)
From Gould B: Pathophysiology for the health professions, ed 3, Philadelphia, 2006, Saunders.
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Pulmonary Embolism
Size and location of the embolism and general physical condition of the patient determine consequences of interruption of blood supply
Most common symptom is sudden onset of dyspnea and chest pain
Emboli also may be composed of air, fat globules, a small piece of tissue, or a cluster of bacteria
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Pulmonary Embolism (Cont.)
Lung scans and CT angiography of the chest are used to image the pulmonary blood flow
Echocardiogram is also used to assess pulmonary artery pressure and right heart function
Primary treatment is aimed at preventing a potentially fatal episode and maintaining cardiopulmonary integrity and adequate ventilation and perfusion
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Pulmonary Embolism (Cont.)
From Kumar V, Cotran R, Robbins S: Robbins basic pathology, ed 8, Philadelphia, 2008, Saunders.
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Pneumonia
The inflammation may be either unilateral or bilateral and involve all or only a portion of an infected lung
Aspiration pneumonia results from aspiration of liquids or other material into the tracheobronchial tree
Pneumonia usually is caused by viral or bacterial infections
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Treatment Options for Pneumonia
Include:Ø Organism-specific antibiotics are prescribed for bacterial pneumonia
Ø Penicillin is the drug of choice for a pneumococcal pneumonia
Ø Mycoplasma infections may be treated with broad-spectrum antibiotics
Ø Fungal infections require the use of various antifungal medications, whereas viral infections are treated with specific antiviral agents
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Appearance of Pneumonia
From Long BW, Frank ED, Ehrlich RA: Radiography essentials for limited practice, ed 4, St Louis, 2013, Elsevier.
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Health Hazards of Common Molds
Toxic mold inside homes can cause allergic symptoms or unique/rare health conditions
CDC information Ø Molds grow naturally in both the indoor and outdoor environments
Ø Mold exposure does not always present a health problem
Ø In most cases, mold can be removed by a thorough cleaning with commercial products
Ø All molds should be treated the same
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Pulmonary Abscess
Main symptoms are alternating chills and fever
CausesØ Often a complication of pneumonia caused by bacteria
Ø Aspiration of food, foreign object, bronchial stenosis, or neoplasms
Ø Septic embolism is carried to lung via pulmonary circulation
Treatment of abscess is the use of antibiotics for a fairly long duration
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Pulmonary Abscess (Cont.)
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Learning Objectives Lesson 9.2: Other Conditions of the Respiratory System
10. Compare Legionnaires’ disease with Pontiac fever.
11. Explain who is at greatest risk for (a) respiratory syncytial virus (RSV) pneumonia and (b) histoplasmosis.
12. List the groups recommended to receive prophylactic use of influenza vaccines.
13. Recall what the acronym COPD stands for.14. Contrast the pathologic course of acute bronchitis with that of chronic bronchitis.
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15. Compare the pathology involved in bronchiectasis with that of pulmonary emphysema.
16. Name and describe three causes of pneumoconiosis.
17. Describe the presenting symptoms of pleurisy.18. Explain the difference between pneumothorax and hemothorax.
19. Describe the cause of the instability of the chest wall in a patient with flail chest.
Learning Objectives Lesson 9.2: Other Conditions
of the Respiratory System (Cont.)
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20. Discuss contributing factors to, and concern about, the rising prevalence of pulmonary tuberculosis (TB).
21. Describe the clinical course of infectious mononucleosis.
22. Explain the pathologic changes of the lungs in adult respiratory distress syndrome (ARDS).
23. Explain what determines the prognosis of sarcoidosis.
Learning Objectives Lesson 9.2: Other Conditions
of the Respiratory System (Cont.)
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24. Name the leading cause of cancer deaths worldwide for both men and women.
25. Explain the possible health consequences of smoking tobacco.
Learning Objectives Lesson 9.2: Other Conditions
of the Respiratory System (Cont.)
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Legionellosis (Legionnaires’ Disease and Pontiac Fever)
Legionnaires’ disease is more severe;; the milder form is Pontiac fever Ø Legionnaires’ produces severe pneumonia-like symptoms
Ø Symptoms of Pontiac fever include a high fever and muscle aches
Both disorders are caused by L. pneumophila Antibiotic therapy is initiated before diagnosis is made
Pontiac fever usually resolves itself
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Respiratory Syncytial Virus (RSV) Pneumonia
RSV causes cold-like symptoms, including nasal congestion, otitis media, and coughing
Respiratory syncytial virus is the causative agent of RSV pneumoniaØ Greatest occurrence of these annual epidemic infections is during the winter months
Antipyretics are prescribed for fever, and antibiotics are given for otitis media
Inhalation of 3% hypertonic saline is used to treat RSV
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Histoplasmosis
Many patients with histoplasmosis are asymptomatic at onsetØ As the fungus disseminates, patient reports dyspnea and loss of energy to the point of incapacitation
Histoplasmosis is caused by the fungus H. capsulatum, which is carried by dust and is inhaled
Antifungal drugs itraconazole, fluconazole, and amphotericin B, are used to treat more severe or progressive disease
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Influenza
Characterized by inflammation of respiratory tract mucous membranes, a severe protracted cough, fever, headache, and sore throat
Transmission is from person to person by inhalation of the virus in airborne mucus discharge
Known viruses that cause influenza are designated as orthomyxovirus types A, B, and C
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Influenza (Cont.)
Acute uncomplicated influenza with recovery is the most frequently encountered
Influenza outbreaks may be sporadic or epidemic
Transmission is from person to person by inhalation of the virus in airborne mucus discharge
Bed rest, increased fluid intake, a light diet, and use of antipyretic and analgesic drugs are helpful
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H1N1 (Swine Flu)
Novel influenza A (H1N1) virus is a highly unusual mix of swine, bird, and human flu viruses
Contagious and spread from human to human Can range from mild to severe Symptoms of H1N1 in people are similar to the symptoms of regular human flu
H1N1 susceptible to oseltamivir (Tamiflu) and zanamivir (Relenza)
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Chronic Obstructive Pulmonary Disease (COPD)
Describes a condition of slow and irreversible progressive airway obstruction
COPD encompasses:Ø Chronic bronchitisØ BronchiectasisØ AsthmaØ EmphysemaØ Cystic fibrosisØ Pneumoconiosis
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Acute and Chronic Bronchitis
Acute: Deep, persistent, productive cough is the main symptom
Chronic: Inflammation persists and becomes worse for at least 3 months of the year for 2 years
Acute bronchitis is part of a general URIØ Begins after a common cold or other viral infections
The same bacteria known to cause pneumonia may be responsible for chronic bronchitis
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Treatment of Bronchitis
Because acute bronchitis usually is caused by a viral infection, no specific treatment is prescribed, except measures that will relieve symptoms
Treatment of chronic bronchitis is based on the stage of the diseaseØ Low-flow oxygen therapy may be administered as needed for hypoxemia
Ø Postural drainage and percussion are techniques used to help loosen and expectorate thick mucus
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Chronic Obstructive Pulmonary Disease (COPD) (Cont.)
Bronchiectasis: Permanent, irreversible dilation or distortion of one or more bronchi, resulting from destruction of muscular and elastic portions of bronchial walls
Pulmonary emphysema: Chronic obstructive pulmonary disorder characterized by destructive changes in alveolar walls and irreversible enlargement of alveolar air spaces
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Bronchiectasis
Usually bilateral and involves the lower lobes of the lungs
Chronic cough producing large quantities of sputum is the main symptom
May be caused by repeated damage to the bronchial wall caused by recurrent airway infections
Antibiotics and bronchodilators are prescribed;; postural drainage is encouraged
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Bronchiectasis (Cont.)
From Cotran R, et al: Robbins pathologic basis of disease, ed 6, Philadelphia, 1999, Saunders.
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Pulmonary Emphysema
Pulmonary emphysema interferes with both the breathing process and gas exchange in the lungsØ Alveoli become enlarged, which precipitates destruction of the alveolar walls and damage to the adjacent capillary walls
Long-term cigarette smoking appears to be a contributing factor
Drug therapy: 2-Adrenergic sympathomimetic drugs alone in combination with corticosteroids
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Emphysema
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Pneumoconiosis
Refers to a number of occupational diseases that cause progressive, chronic inflammation, fibrosis, and infection in the lungs
The onset of symptoms can be insidious, with dyspnea on exertion being the first
Usually takes at least 10 years of continual daily exposure to develop
Anthracosis: Also known as black lung or coal miner’s lung
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Pneumoconiosis (Cont.)
From Damjanov I, Linder J: Pathology: a color atlas, St Louis, 1999, Mosby.
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Pneumoconiosis (Cont.)
Silicosis: Affects workers who are stone masons or metal grinders or who work in quarries
Treatment is directed toward relieving symptoms and includes:Ø Administration of bronchodilatorsØ Oxygen therapyØ Chest physical therapy to help remove secretionsØ The use of short-term corticosteroid drugs
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Pleurisy (Pleuritis)
SymptomsØ Sharp, needle-like pain that increases with inspiration and coughing
Ø May also experience fever, chills, and shallow breathing
Pleurisy is usually secondary to other diseases or infectionsØ Two types: Wet and dry
Antibiotic therapy and analgesics to control the pain may be given
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Pleurisy (Pleuritis) (Cont.)
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Pneumothorax
Symptoms Ø Severe shortness of breathØ Sudden, sharp chest painØ Falling blood pressure and rapid, weak pulse
Pneumothorax can be spontaneous or traumaticØ Spontaneous pneumothorax occurs when an opening is present on the surface of a lung
Ø Traumatic pneumothorax occurs when the integrity of the pleural cavity is breached
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Treatment of Pneumothorax
Patient is more comfortable in a Fowler or a semi-Fowler position and may require oxygen
An occlusive dressing is placed over any sucking wound to seal the portal of entry and to prevent additional air from entering the chest cavity
A thoracostomy is performed to withdraw air from the cavity
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Pneumothorax and Hemothorax
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Hemothorax
Signs of hemorrhage include pale and clammy skin, a weak and thready pulse, and falling blood pressure
Blood enters the pleural space, which causes the lung to collapse
Treatment: Lung must be reexpanded, usually by thoracostomy with closed drainage to evacuate the blood
The prognosis for a hemothorax is guarded
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Flail Chest
The patient with flail chest experiences severe pain and dyspnea and is cyanotic and extremely anxious
Direct trauma to the chest wall that fractures three or more adjacent ribs is the cause of flail chest
First responder emergency care employs measures to stabilize the chest wall until surgical repair is possible
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Flail Chest (Cont.)
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Pulmonary Tuberculosis (TB)
Acquired by inhaling a dried droplet nucleus that contains the tubercle bacillus
With primary TB, patient is asymptomatic The tubercle bacillus M. tuberculosis causes TB and is spread by droplet nucleiØ As the body’s defense mechanisms respond to the bacterial invasion, antigens are produced, which cause necrosis, followed by fibrosis and calcification of the affected tissue
Treatment dependent on whether TB is latent or active
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Tuberculosis (TB)
From Kumar V, Cotran R, Robbins S: Robbins basic pathology, ed 8, Philadelphia, 2008, Saunders.
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Infectious Mononucleosis: Epstein-Barr Virus (EBV) Infection
SymptomsØ Lymphadenopathy Ø Fever that typically peaks in afternoonØ Listlessness, malaise, chills, anorexiaØ Sore throat, fever, headache, fatigue, cervical and generalized lymphadenopathy
Mononucleosis is caused by the EBV, a herpesvirus
Acute treatment: Force bed rest and fluid intake
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Tonsils Infected by Mononucleosis
From Sigler B: Ear, nose, and throat disorders—Mosby's clinical nursing series, St Louis, 1994, Mosby.
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Adult Respiratory Distress Syndrome (ARDS)
SymptomsØ Sudden, severe dyspnea with rapid, shallow respirations
Ø Inspiratory intercostals and suprasternal retractions along with cyanosis or mottled skin
Ø Rales, rhonchi, and wheezes may also be present ARDS is considered secondary to some agent that precipitates increased capillary permeability in the lungs, pulmonary edema, and respiratory failure
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Adult Respiratory Distress Syndrome (ARDS) (Cont.)
Alveoli fill within 12 to 48 hours of injury, and then tend to collapse at end of expiration, leaving less pulmonary tissue for gas exchangeØ Low pulmonary compliance, pulmonary hypertension, decreased functional residual capacity, and hypoxemia result
The patient receives supportive care onlyØ Efforts are made to correct the underlying cause of ARDS
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Sarcoidosis
Patients may have no complaints or mild to severe symptoms, depending on the site of the lesions and the degree of involvement
The exact cause is not certainØ The disorder is thought to be a malfunction of the immune system or caused by a virus
Sarcoidosis abates spontaneously Corticosteroid therapy, such as prednisone, helps to relieve severe symptoms
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Lung Cancer
Leading cause of cancer death worldwide in both men and women, 30% of all cancer deaths
The most common symptom is cough with or without sputum production
Other symptoms may include dyspnea, hemoptysis, chest pain, and weight loss
Two main types by histology: Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC)
The primary risk factor for development of lung cancer is cigarette smoking
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Lung Carcinomas
From Damjanov I: Pathology for the health-related professions, ed 4, St Louis, 2011, Saunders.
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Diagnosis and Treatment of Lung Cancer
Many patients are symptomatic at the time of diagnosis, some may be diagnosed following a chest radiograph Ø Testing is also done to look for specific biomarkers that may affect treatment choice, such as gene mutations in epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase
Treatment decisions are based on the type of tumor and the stage of the tumor
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Prognosis and Prevention of Lung Cancer
Prognosis for patients with lung cancer is generally poorØ Five-year survival rate for all stages and types of lung cancer combined is 15%
Ø Prevention• Cessation of smoking• Avoidance of exposure to secondhand smoke