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Cardiovascular System Diseases and Disorders 167
Fill in the Blanks
13. In order for an individual to have a blood pressure, one needs a heart, a vessel, and ________________ .
14. Risk factors known to cause primary hypertension include heredity, obesity, stress, Type A personality, and
.
15. An aneurysm is a weakening of the wall of a/an ______________.
16. Angina pectoralis is commonly called _____________ .
17. The leading cause of death in the United States is ______________.
18. Arrhythmias are abnormalities in the heart’s ______________.
19. Inflammation of the heart is _____________.
20. Cardiomyopathy is defined as __________________________________ .
21. A red cord-like hardening usually found in the arm or leg that extends toward the heart is called __________________ .
22. An abnormal loss of blood is called a/an _____________ .
23. Coronary arteries are located in the _____________ .
24. A symptom of peripheral vascular disease is intermittent claudication in the ________________ .
25. Extremely low blood pressure is called _____________.
True or False
26. T F Arteriosclerosis, hardening of the arteries, and atherosclerosis are often used interchangeably.
27. T F Coronary artery disease often leads to myocardial infarction.
28. T F Phlebitis is often caused by flea bites.
29. T F DVT primarily occurs in the coronary arteries of the heart.
30. T F Bed rest is a common treatment for DVT.
31. T F Prolonged sitting and obesity increase the risk of developing varicose veins.
32. T F A major pulse point is directly behind the ear.
33. T F Symptoms of vascular system disease include edema, pain, and cyanosis.
34. T F Ischemia may lead to cyanosis.
35. T F The lumen of a blood vessel helps determine blood pressure.
36. T F Urinary kidneys play a vital role in blood pressure.
37. T F Atherosclerosis can affect all arteries in the body.
38. T F One is more likely to die of cancer than heart disease.
39. T F Women may have a myocardial infarction without the classic symptom of chest pain.
40. T F A primary way to prevent an MI is to quit smoking.
41. T F Shock may be caused by hemorrhage.
168 Chapter 8
Case Studies
■ Mr. Winston is a 72-year-old who has been diagnosed with CHF. He is a middle-class gentleman with a
fairly broad educational background. He is a college graduate who has managed a business for 30 years. He
asks you to explain his condition to him and his wife. How would you explain CHF to them? In addition, he
wants to know why he is so short of breath at times, why he has edema in his ankles in the evenings, and why
the physician ordered a low-sodium diet? How would you answer those questions?
■ Mrs. Marconi is a 68-year-old retired woman who volunteers three days per week at the hospital. A group of
nursing students from the local college were holding a health fair and invited her to participate. One station was
set up to check the ABI on the participants. Mrs. Marconi asked the students to explain what an ABI is and why
she needs this test. How would you answer this question? Describe how the test is done. When should someone
be referred for further testing after having the ABI checked?
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9
Respiratory
System Diseases
and Disorders
Key Terms
Analgesics (p. 176)
Antipyretics (p. 176)
Apnea (p. 172)
Arterial blood gases
(p. 173)
Atelectasis (p. 183)
Bronchiectasis (p. 182)
Bronchoscopy (p. 173)
Clubbing (p. 172)
Cyanosis (p. 172)
Dyspnea (p. 172)
Hemoptysis (p. 172)
Hypoxemia (p. 172)
Hypoxia (p. 182)
Orthopnea (p. 172)
Pharyngitis (p. 177)
Productive cough
(p. 172)
Rales (p. 173)
Rhinorrhea (p. 176)
Rhonchi (p. 173)
Sputum (p. 172)
Tachypnea (p. 173)
Thoracentesis (p. 190)
Wheezing (p. 172)
Learning Objectives
Upon completion of the chapter, the learner should be able to:
1. Define the terminology common to the respiratory
system and the disorders of the system.
2. Discuss the basic anatomy and physiology of the
respiratory system.
3. Identify the important signs and symptoms associated
with common respiratory system disorders.
4. Describe the common diagnostics used to determine
type and cause of the respiratory system disorders.
Overview
5. Identify the common disorders of the respiratory
system.
6. Describe the typical course and management of
the common respiratory system disorders.
7. Describe the effects of aging on the respiratory
system and the common disorders associated with
aging of the system.
T
he respiratory system includes the chest, lungs, and internal airway structures. To maintain life, the indi
vidual must breathe and have a continuous exchange of oxygen for carbon dioxide. Breathing and the
exchange of gases that takes place within the system are complex processes involving the respiratory system as
well as the neurologic and circulatory systems. Diseases of the respiratory system include some of the most well
known disorders such as the common cold, pneumonia, and influenza. Public health officials are worried about
new strains of influenza becoming widespread. Respiratory diseases affect all ages, but older people are the
most susceptible to both chronic and acute disorders of the system. ■
169
170 Chapter 9
Anatomy and Physiology
The respiratory system consists of the chest (thorax),
lungs, and conducting airways. The chest, or thorax, is
the structure that houses the lungs and the mediasti
num (heart and major vessels). The respiratory system
structures in the thorax include the lungs, 12 pairs of
ribs, part of the vertebral column, and the sternum. The
diaphragm, a large muscle of respiration, separates the
thorax from the abdomen (Figure 9-1). The lungs are
two spongy organs divided into three lobes in the right
lung and two lobes in the left lung. They lie in the pleu
ral cavity, which is lined with a membrane called the
pleura, in the thorax. The lungs are also covered with a
second membrane or pleura. Between the two pleural
membranes is a lubricating liquid that prevents friction
as the process of breathing and lung expansion occurs.
Consider This...
If you were to roll the human lung tissue out
flat, it would cover an average tennis court.
Usually, the airways of the respiratory system are
divided into two parts. The upper respiratory system
includes the nose (nasal cavities), mouth, sinuses, phar
ynx, and larynx. The lower respiratory system includes
the trachea, bronchi, and bronchioles. The alveoli,
grape-like clusters of air sacs that are surrounded by
capillaries (Figure 9-2), are found at the distal end of the
terminal bronchioles. This is where the oxygen-carbon
dioxide gas exchange in the lungs occurs.
The mechanism of ventilation, the movement of air
into and out of the respiratory system, and gas exchange
is a complex process that requires both inhalation and
exhalation to occur. Ventilation is controlled by chemo-
sensory receptors in spinal fluid and by arterial carbon
dioxide tension and oxygen deficiency in the carotid
and aortic arteries. As the receptors detect increases or
decreases in carbon dioxide, oxygen, or both, ventila
tion is increased or decreased as needed to meet body
requirements. Because the respiratory control center is
located in the medulla of the brain, this process can be
altered by respiratory or neurologic disease.
The exchange of gases occurs both in the lungs and
throughout the body at the tissue level. In the lungs, car
bon dioxide is released from the capillary beds into the
Diaphragm
Upper lobe
right lung
Middle lobe
right lung
Lower lobe
right lung
Sternocleidomastoid muscle
Apex of lung
Sternum
Base of
lung
Lower lobe
left lung
Upper lobe
left lung
Figure 9-1 The respiratory system.
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Respiratory System Diseases and Disorders 171
Mouth
Larynx
Right lung
Bronchus
Pulmonary vein
Nasal
cavity
Cut edge of
diaphragm
Cut edge of
parietal pleura
Bronchial
artery
Lower
respiratory
system
Pulmonary artery
Alveoli
Upper
respiratory
system
Sinuses
Bronchiole
Bronchiole
Pulmonary
arteriole
Pulmonary
venule
Pharynx
Epiglottis
Trachea
Figure 9-2 Airway divisions and terminal bronchiole/alveoli.
alveolar spaces by the process of diffusion. In the same
way, oxygen moves from the air spaces into the capillaries
for transport to the tissues. This process is reversed at the
tissue level throughout the body, where oxygen moves
from the bloodstream into the tissues, and carbon diox
ide moves from the tissues into the blood for transport to
the lungs and removal from the body (Figure 9-3).
Common Signs and Symptoms
There are many common signs and symptoms of respi
ratory disease, ranging from mild (the common cold)
to severe (pneumonia). Dyspnea, orthopnea, apnea,
wheezing, sneezing, coughing, and nasal discharge are
some of the most common symptoms.
Healthy Highlight
Why Do I Sneeze?
S
ome people sneeze frequently and others sneeze very rarely. But, why does anyone
sneeze? Sneezing is rarely a sign of a serious problem but is actually therapeutic. It
is a protective mechanism that starts in the nerves. The body uses sneezing to get rid
of nasal irritants such as bacteria and viruses, and to keep the immune system healthy.
This happens more frequently in individuals who have allergies, especially those with
seasonal type allergies to irritants in the air. Other causes include the common cold,
inhaled nasal medications, bright lights, exercise, sunlight, and dust. Certain aerosols
such as cleaning products or hair sprays may also be the catalyst to a sneezing episode.
The best way to avoid sneezing is to avoid the common irritants to the nasal cavity. If
you have heard that your heart skips a beat or stops when you sneeze, that is an old
myth. One interesting fact is that you do not sneeze in your sleep.
Source: WebMD Davidson (2020)
Airways of respiratory
tree (ventilation)
Alveoli
O
CO2
External respiration (gas exchange between air in
alveoli and blood in pulmonary capillaries)
Blood in I
pulmonary capillaries
Tissue cells
Blood flow
CO
2
Blood flow
O
Blood in
systemic capillaries
- Internal
. respiration
(gas exchange
between tissue
cells
and blood in
systemic
capillaries)
Figure 9-3 Gas exchange in the lungs and tissues.
Dyspnea (DISP-nee-ah; dys = difficulty, pnea =
breathing) is a common sign of respiratory disease. It can
be in the form of orthopnea (or-THOP-nee-ah; ortho =
straight, pnea = breathing), in which an individual has
difficulty breathing in a lying position or is able to breathe
with less difficulty when standing or sitting straight up.
Apnea (ap-NEE-ah; a = without, pnea = breathing) for
an extended length of time is a life-threatening emer
gency. Dyspnea caused by a partial obstruction of the air
ways will produce wheezing. Severe dyspnea can lead to
hypoxemia (high-POX-SEE-me-ah; hypo = not enough,
ox = oxygen, emia = blood), low blood oxygen level. A
common sign of hypoxemia is cyanosis (SIGH-ah-NO-
sis; cyano = blue, osis = condition), a blue color often
observed in the nail beds and lips.
Coughing is another common symptom, caused
by irritation of the airways or a buildup of fluid in
the lung tissue. Sputum (SPYOU-tum) is fluid or
secretions coughed up from the lungs, not to be con
fused with saliva or spit from the digestive system. A
productive cough is one in which sputum or excessive
mucus is brought up and expelled. Coughing up blood
is called hemoptysis (he-MOP-tih-sis; hemo = blood,
ptysis = saliva) and can be a sign of serious respiratory
disease.
Nasal discharge is frequently present in infections,
inflammation, and allergic respiratory reactions. It is
the most frequent symptom of the common cold, but it
is also present in other respiratory disorders and can be
a serious symptom of a chronic problem.
Hiccoughs, commonly called hiccups, are the result
of a sudden spasm of the diaphragm. They commonly
occur after eating or drinking and can be stopped by
a variety of techniques, including holding the breath
and drinking water through a straw. Hiccoughs might
accompany disease and, in such an instance, are more
difficult to eliminate.
Chronic respiratory conditions often lead to
abnormal, permanent signs such as clubbing and a
barrel-chested appearance. Clubbing is a condition of
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Respiratory System Diseases and Disorders 173
Figure 9-4 Clubbing.
unknown pathogenesis, but it usually is related to poor
distal circulation and oxygenation. It affects the distal
portion of the fingers and is characterized by soft tis
sue enlargement and an abnormal curvature of the nail
(Figure 9-4). A barrel chest appears because the indi
vidual uses accessory chest muscles over a long period
of time in an effort to improve breathing.
Diagnostic Tests
A physical examination including auscultation (listen
ing to the chest with a stethoscope) should be com
pleted to assess for abnormal breathing quality and
rate. Tachypnea (TACK-ihp-NEE-ah; tachy = rapid,
pnea = breathing), or rapid breathing, and abnormal
breath sounds, including wheezes, rales, and rhonchi,
are common with respiratory diseases. Rales are abnor
mal musical sounds heard on inspiration and are often
called crackles. Rhonchi are dry rattling sounds in the
bronchi due to obstruction of the airways.
A chest roentgenogram (X-ray) is a major diagnos
tic tool used to diagnose lung diseases such as tumors,
tuberculosis, abscesses, and pneumonia. Sputum cul
tures are effective in determination of infectious dis
ease. A tissue biopsy can be obtained as a definitive test
for lung disease. Tissue biopsy is often obtained during
a bronchoscopy (brong-KOS-koh-pee; broncho =
bronchus or lung passageways, oscopy = procedure to
look into the bronchus) (Figure 9-5). Lung tissue can
be biopsied by using a fine-needle technique.
The best indicator of lung function is measurement
of the amounts of carbon dioxide (waste) and oxygen
in the blood. These measurements are done on arterial
blood and are called arterial blood gases (ABGs). Nor
mal arterial blood gases should be high in oxygen and
low in carbon dioxide. Parameters for normal ABGs
are oxygen (PaO
2
) 80-100 mm Hg and carbon dioxide
(PaCO
2
) 35-45 mm Hg. The reverse of these readings is
indicative of poor pulmonary function. Another import
ant ABG is oxygen saturation (O
2
Sat) with normal levels
of 95-100%. O
2
saturation is often measured with a
simple oximeter that measures pulse and O
2
saturation.
Pulmonary function tests (PFTs) are a group of
tests that measure volume and flow of air by using a
spirometer. These tests are valuable in the diagnosis of a
respiratory problem. PFTs can also be performed before
and after bronchodilation treatment to measure treat
ment effectiveness. PFTs are measured against a norm
for the individual’s age, height, and sex. Patients are
often encouraged to use a simple model of a spirometer
(Figure 9-6) to maintain and improve lung function.
Genetic testing may be done since there is a hered
itary risk factor for chronic obstructive pulmonary dis
ease (COPD). The blood test is checking for the alpha-1
antitrypsis (AAT) level. AAT helps protect the lungs
from excessive irritation that might occur from pollu
tion or smoking.
Common Diseases of the
Respiratory System
Diseases of the respiratory system range from simple to
very serious. The symptoms of the various disorders are
often similar in the early stages, with most conditions
Chapter 9
Figure 9-6 Spirometer: simple, for single patient use.
other communicable respiratory diseases have been
common for centuries, epidemics in the United States
have not been as devastating as they were historically.
Now public health officials are seeing new strains of
respiratory viruses emerge and the threat of an epi
demic is cause for concern.
Diseases of the Upper Respiratory Tract
Upper respiratory tract illnesses are mostly viral infec
tions. They are usually acute illnesses that are not life
threatening. Respiratory infections account for approx
imately 55% of all infections requiring hospitalization
(Figure 9-7). These illnesses may often be prevented
with good handwashing. The most common upper
respiratory tract illness is the common cold.
manifesting in shortness of breath and coughing,
wheezing, or both, although some disorders might not
present symptoms until late in the disease development.
Smoking is the number one risk behavior for develop
ing chronic respiratory disease. Although influenza and
Consider This...
5
Humans breathe mostly through one nostril
at a time.
Pharmacology
Highlight
Common Drugs for Respiratory Disorders
Category Examples of Medications
Anticholergics
Drugs that are used to inhibit Atropine, benztropine, cyclopentolate, or
cholinergic nerve reflexes fesoterodine
(most commonly used in the
treatment of COPD)
Antihistamines
Drugs used for treatment/ Carbinoxamine or levocabastine (prescription
prevention of allergies drugs); fexofenadine, cetirizine, or loratadine
(over-the-counter drugs)
Antibiotics
Drugs used to prevent or Ampicillin, amoxicillin, ciprofloxacin, doxycycline,
stop bacterial infections erythromycin, penicillin, or tetracycline
Antivirals
Drugs used to stop the action Acyclovir, imiquimod, or cidofovir
of a virus Remdesivir has been approved to treat COVID-19 in
adults and children age 12 and older. Baricitinib has also
been approved in combination with remdesivir for the
treatment of suspected or laboratory proven cases in
adults and pediatric patient (two years of age or older)
who are hospitalized and on oxygen or mechanical
ventilation. (Additional medications are being
developed and may be approved very soon. Research on
new drugs to treat Covid variants is ongoing.)
(continued )
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Respiratory System Diseases and Disorders 175
Common Drugs for Respiratory Disorders (continued)
Category Examples of Medications
Antineoplastics
Drugs used to treat cancer
Alkylating agents
Antimetabolites
Antitumor antibiotics
Hormones/antihormones
Other substances
Chlorambucil, cyclophosphamide, or lomustine
5-Flourauracil, mercaptopurine, or methotrexate
Mitomycin or streptozocin
Androgens, estrogens, flutamide, or tamoxifen
Bevacizumab, carboplatin, cisplatin, erlotinib,
Etoposide, gefitinib, L-asparaginase, paclitaxel,
pembrolizumab, pemetrexed, or vincristine
Bronchodilators
Drugs used to open or Albuterol, aclidinium, formoterol, or ipratropium
relax airways
Cough Suppressants
Drugs used to stop the Butorphenol, codeine, or dextromethorphan
cough reflex
Expectorants
Drugs used to make Guaifenesin, carbocysteine, or potassium iodide
coughs more productive
Decongestants
Drugs used to relieve nasal Oxymetozoline, phenylephrine, or pseudoephedrine
congestion
Mucolytics
Drugs used to breakdown Carbocisteine, dembrexine, erdosteine, or guaifenesin
mucus to make it easier to
cough up
Source: US. Food and Drug Administration (2020)
Upper Respiratory Infection (URI)
■ Description. URI is a broad term referring to several
infectious diseases of the upper respiratory tract. These
infections are the most common cause for lost days of
work for adults (Figure 9-7).
■ Etiology. Most URIs (not to be confused with UTI,
urinary tract infection) are caused by viruses. The most
common is a group called rhinovirus.
■ Symptoms. Symptoms commonly include nasal con
gestion, runny nose, sore throat, ear pain or fullness,
sneezing, coughing, mild fever, headache, and general
ized aches. Symptoms usually resolve in 7-10 days.
■ Diagnosis. Diagnosis is usually made on the basis of
a history and physical examination revealing the com
mon signs and symptoms.
hospitalization.
176 Chapter 9
■ Treatment. General treatment for viral diseases
includes rest, drinking increased amounts of fluids, taking
antipyretics (anti = against, pyretic = fever), and analgesics
(an = without, algesic = pain). Antibiotics are not effective
with viral infections but might be needed for secondary
bacterial infection. The common cold is the most frequent
URI and often leads to secondary infectious diseases.
■ Prevention. Prevention is often difficult because viruses
are easily spread by droplet infection such as sneezing or
coughing. These microscopic droplets are then picked
up on the hands and carried to the membranes of the
respiratory tract by touching or wiping the eyes and nose.
The greatest preventive measure is regular handwashing.
Other preventive activities include avoiding crowds,
avoiding smoking, and maintaining general health.
Consider This...
It is impossible to sneeze with your eyes
open due to a defensive mechanism that
protects the eyes from bacteria and debris
that are spread with the sneeze.
Common Cold (Acute Rhinitis)
■ Description. The common cold is an acute inflamma
tion of the mucous membranes of the upper respiratory
tract. There are several hundred-virus strains that cause
a cold. Developing immunity to one strain does not pro
vide immunity to others.
■ Etiology. A cold is very contagious and is usually
passed from one individual to another through touch
and air droplets. Many individuals believe that getting
chilled or wet is the cause of a cold. In actuality, these
actions do not directly cause a cold; they merely lower
an individual’s resistance to invasion by a cold-causing
virus. Children, older people, and individuals in gen
erally poor health are at increased risk of contracting
a cold.
■ Symptoms. Most individuals are very familiar with
the symptoms of runny nose, or rhinorrhea (rye-nor-
REE-ah; rhino = nose, orrhea = run through), watery
eyes, stuffy head, sore throat, sneezing, and fever.
■ Diagnosis. Diagnosis is usually determined by
physical examination and presence of signs and
symptoms.
■ Treatment. Treatment involves basic comfort care,
including rest, drinking increased fluids, and taking
antipyretics and analgesics as prescribed.
■ Prevention. Good handwashing is the best preventive
measure against a cold.
Hay Fever (Allergic Rhinitis)
Allergic rhinitis is an inflammation of the mucous
membranes due to allergies. This sensitivity to an
allergen tends to run in families. Ragweed and grasses
are two common allergens. Hay fever was discussed
in detail in Chapter 5, “Immune System Diseases and
Disorders.”
Sinusitis
■ Description. Sinusitis is an inflammation of the
mucous membrane lining the sinuses. The sinuses are
air-filled cavities in the bony tissue of the head. The
membranes that line the nose extend into the sinuses.
■ Etiology. Acute rhinitis often leads to sinusitis. It is
also believed that blowing the nose too hard actually
spreads infection into the sinuses. As mucous mem
branes become swollen, the drainage system becomes
blocked. Mucus accumulates in the sinuses, causing
increased pressure and often leading to sinus head
aches, dizziness, and difficulty breathing. Other causes
of sinusitis include tooth infections, air pollution, and
nasal deformities.
■ Symptoms. Pain in the area of the affected sinus is
common. Headaches upon awakening are most com
mon with sinus involvement. Pain in the forehead area
can be related to frontal sinus inflammation. Other
symptoms include tiredness, a night cough, runny nose,
nasal congestion, and sore throat.
■ Diagnosis. Diagnosis is based on clinical history,
physical examination, computed tomography (CT) scan
or magnetic resonance imaging (MRI), and laboratory
tests to help identify the allergies.
■ Treatment. Treatment often includes antibiotics and
decongestants. Because sinusitis can lead to more seri
ous infections such as mastoiditis and encephalitis,
aggressive treatment is necessary.
■ Prevention. Sinusitis in many cases cannot be pre
vented, although there are measures that might reduce
frequency of attacks, such as use of a humidifier, avoid
ing cigarette smoke and other air pollutants, avoiding
alcohol because it causes nasal membranes to swell, and
avoiding swimming in chlorinated pools.
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