U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL FORT SAM HOUSTON, TEXAS 78234-6100 RESPIRATORY DISEASES AND DISORDERS SUBCOURSE MD0568 EDITION 200 DEVELOPMENT This subcourse is approved for resident and correspondence course instruction. It reflects the current thought of the Academy of Health Sciences and conforms to printed Department of the Army doctrine as closely as currently possible. Development and progress render such doctrine continuously subject to change. ADMINISTRATION Students who desire credit hours for this correspondence subcourse must enroll in the subcourse. Application for enrollment should be made at the Internet website: http://www.atrrs.army.mil. You can access the course catalog in the upper right corner. Enter School Code 555 for medical correspondence courses. Copy down the course number and title. To apply for enrollment, return to the main ATRRS screen and scroll down the right side for ATRRS Channels. Click on SELF DEVELOPMENT to open the application; then follow the on-screen instructions. For comments or questions regarding enrollment, student records, or examination shipments, contact the Nonresident Instruction Section at DSN 471-5877, commercial (210) 221-5877, toll-free 1-800-344-2380; fax: 210-221-4012 or DSN 471-4012, e-mail [email protected], or write to: NONRESIDENT INSTRUCTION SECTION AMEDDC&S ATTN: MCCS-HSN 2105 11TH STREET SUITE 4191 FORT SAM HOUSTON TX 78234-5064 Be sure your social security number is on all correspondence sent to the Academy of Health Sciences. CLARIFICATION OF TERMINOLOGY When used in this publication, words such as "he," "him," "his," and "men" 'are intended to include both the masculine and feminine genders, unless specifically stated otherwise or when obvious in context. USE OF PROPRIETARY NAMES The initial letters of the names of some products may be capitalized in this subcourse. Such names are proprietary names, that is, brand names or trademarks. Proprietary names have been used in this subcourse only to make it a more effective learning aid. The use of any name, proprietary or otherwise, should not be interpreted as endorsement, deprecation, or criticism of a product; nor should such use be considered to interpret the validity of proprietary rights in a name, whether it is registered or not. TABLE OF CONTENTS Lesson Paragraphs INTRODUCTION 1 ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM Section I. Structure and Function of the Respiratory Organs....1-1--1-5 Section II. Accessory Structures of the Respiratory System......1-6--1-9 Section III. Physiology of Respiration.........................................1-10--1-17 Exercises 2 PHYSICAL ASSESSMENT OF THE RESPIRATORY SYSTEM Section I. General Approach to Physical Assessment..............2-1--2-4 Section II. Steps of the Procedure.............................................2-5--2-8 Exercises 3 INFECTIOUS RESPIRATORY DISEASES Section I. Upper Respiratory Diseases....................................3-1--3-5 Section II. Upper Respiratory Diseases with Systemic Effects.....................................................................3-6--3-7 Section III. Lower Respiratory Diseases....................................3-8--3-10 Section IV. Other Causes of Pneumonia...................................3-11--3-15 Exercises 4 CHRONIC OBSTRUCTIVE PULMONARY DISEASES Section I. Asthma....................................................................4-1--4-4 Section II. Chronic Bronchitis...................................................4-5--4-7 Section III. Emphysema.............................................................4-8--4-10 Exercises 5 RESPIRATORY DISORDERS Section I. Hyperventilation Syndrome........ .............................5-1--5-3 Section II. Spontaneous Pneumothorax...................................5-4--5-7 Section III. Pulmonary Embolism...............................................5-8--5-12 Section IV. Inhaled Toxic Substances......... ..............................5-13--5-17 Exercises 6 TUBERCULOSIS...........................................................................6-1--6-11 Exercises MD0568 i CORRESPONDENCE COURSE OF THE U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL SUBCOURSE MD0568 RESPIRATORY DISEASES AND DISORDERS INTRODUCTION The respiratory tract has defense mechanisms that prevent most microorganisms and foreign objects from entering the lungs of a healthy person. Sometimes these defense mechanisms cannot resist invasion, and infection occurs. The person's defenses may be weakened, damaged, or the invading agent may be too strong for the person's body to resist. As a Medical NCO, it is extremely important that you become aware of the characteristics and treatments for respiratory problems that you may encounter. With the awareness of respiratory diseases and their general characteristics, you may be alert for signs and symptoms of such diseases in the soldiers in your care. Subcourse Components: The subcourse instructional material consists of six lessons as follows: Lesson 1, Anatomy and Physiology of the Respiratory System. Lesson 2, Physical Assessment of the Respiratory System. Lesson 3, Infectious Respiratory Diseases. Lesson 4. Chronic Obstructive Pulmonary Diseases. Lesson 5. Respiratory Disorders. Lesson 6. Tuberculosis. Here are some suggestions that may be helpful to you in completing this subcourse: --Read and study each lesson carefully. --Complete the subcourse lesson by lesson. After completing each lesson, work the exercises at the end of the lesson, marking your answers in this booklet. --After completing each set of lesson exercises, compare your answers with those on the solution sheet that follows the exercises. If you have answered an exercise incorrectly, check the reference cited after the answer on the solution sheet to determine why your response was not the correct one. MD0568 ii Credit Awarded: Upon successful completion of the examination for this subcourse, you will be awarded 12 credit hours. To receive credit hours, you must be officially enrolled and complete an examination furnished by the Nonresident Instruction Branch at Fort Sam Houston, Texas. You can enroll by going to the web site http://atrrs.army.mil and enrolling under "Self Development" (School Code 555). A listing of correspondence courses and subcourses available through the Nonresident Instruction Section is found in Chapter 4 of DA Pamphlet 350-59, Army Correspondence Course Program Catalog. The DA PAM is available at the following website: http://www.usapa.army.mil/pdffiles/p350-59.pdf. MD0568 iii LESSON ASSIGNMENT LESSON 1 Anatomy and Physiology of the Respiratory System. TEXT ASSIGNMENT Paragraphs 1-1 through 1-17. LESSON OBJECTIVES After completing this lesson, you should be able to: 1-1. Identify the structure and function of the respiratory organs. 1-2. Identify the accessory structures of the respiratory system. 1-3. Describe the physiology of respiration. 1-4. Describe factors in air capacity of the lungs. SUGGESTION After completing the assignment, complete the exercises at the end of this lesson. These exercises will help you to achieve the lesson objectives. MD0568 1-1 LESSON 1 ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM Section I. STRUCTURE AND FUNCTION OF THE RESPIRATORY ORGANS 1-1. INTRODUCTION a. Respiration. Respiration is the exchange of gases between the atmosphere and the cells of the body. It is a physiological process. There are two types of respiration: external respiration and internal respiration (figure 1-1). External respiration is the exchange of gases between the air in the lungs and blood. Internal respiration is the exchange of gases between the blood and the individual cells of the body. Figure 1-1. Respiration. b. Breathing. Breathing is the process that moves air into and out of the lungs. It is a mechanical process. There are two types of breathing in humans: costal (thoracic) breathing and diaphragmatic (abdominal) breathing (figure 1-2). In costal breathing, the major structure causing the movement of air is the rib cage. In diaphragmatic breathing, interaction between the diaphragm and the abdominal wall causes air to move into and out of the lungs. Figure 1-2. Breathing. MD0568 1-2 1-2. COMPONENTS AND SUBDIVISIONS OF THE HUMAN RESPIRATORY SYSTEM See figure 1-3 for an illustration of the human respiratory system. a. Components. The components of the human respiratory system consist of air passageways and two lungs. Air moves from the outside of the body into tiny sacs in the lungs called alveoli (pronounced al-VE-oh-lie). Figure 1-3. The human respiratory system. MD0568 1-3 b. Main Subdivisions. The main subdivisions of the respiratory system may be identified by their relationship to the voice box or larynx. Thus, the main subdivisions are as follows: SUBDIVISION FUNCTION SUPRALARYNGEAL STRUCTURES Cleanse, warm, moisten, and (su-prah-lah-RIN-je-al) test inflowing air. LARYNX (voice-box) Controls the volume of inflowing (LARE-inks) air; produces selected pitch (vibration frequency) in the moving column of air. INFRALARYNGEAL STRUCTURES Distributes air to the alveoli (in-frah-lah-RIN-je-al) of the lungs where actual respiration takes place. 1-3. SUPRALARYNGEAL STRUCTURES See figure 1-4. Figure 1-4. Supralaryngeal structures. MD0568 1-4 a. Nose. There is an external nose, the part projecting from the face, and an internal nose, the portion that is inside the skull. (1) External portion of the nose. A supporting framework of bone and cartilage covered with skin and lined with mucous membrane makes up the external nose. Nasal bones form the bridge of the nose and hold it in a fixed position. The rest of the external nose is flexible because it has a framework of pliable cartilage. The midline divider of the external nose is called the nasal septum. Two openings called the nostrils or external nares are on the underside of the external nose. These nostrils lead to paired spaces (vestibules). (2) Internal portion of the nose. Behind each vestibule of the external nose is a nasal chamber. The two chambers together form the internal nose. These chambers are separated by the nasal septum. (a) Mucoperiosteum. The walls of the nasal chambers are lined with a thick mucous-type membrane known as the mucoperiosteum. This lining is moist and full of blood vessels. As air is inhaled and passes over this lining, several changes happen to the inhaled air. Blood in the lining's blood vessels warms the air. The air picks up moisture from the lining. Dust sticks to the mucous of the lining resulting in relatively dust-free air. (b) Conchae. The lateral wall of each nasal chamber has three scroll- like extensions into the chamber, which help increase the surface area exposed to inflowing air. These scroll-like extensions are known as conchae. CONCHA = sea shell CONCHA (singular), Conchae (plural) pronounced KON-kah) (c) Olfactory epithelium (membrane). The olfactory epithelium is a membrane that lines the upper nasal chambers. The olfactory receptors (nerve endings responsible for the sense of smell) are located in this membrane. (d) Paranasal sinuses. Paranasal sinuses (figure 1-5) are air "cells" or cavities in the skull. They are connected with the nasal chambers and are lined with the same ciliated mucoperiosteum. These sinuses are extensions of the nasal chambers into the skull bones. For this reason, they are known as paranasal sinuses. MD0568 1-5