2) Cardiopulm Pathologies Flashcards
Restrictive Diseases
Restricted inspiratory capacity bc lungs can’t fully expand
Obstructive Diseases
Decr airflow during expiration
Characteristics of Obstructive Diseases
- Decr elastic recoil
- Incr compliance
- Decr alveolar ventilation
- VQ mismatch
- DOE
- Hyperinflated Lungs
- Flattened diaphragm
- Enlarged R ventricle
Main diseases of COPD
- Emphysema
- Chronic bronchitis
- Asthma
- Bronchiectasis
Chronic Bronchitis
Cough producing sputum for at least 3 months of 2 consecutive yrs
Explain the patho of chronic bronchitis
- Goblet cell & mucus gland hyperplasia
- Decr # of cilia
- Ciliary dysfxn
What are the causes of chronic bronchitis?
- Long-term irritation of tracheobronchial tree (smoking)
- Pollution
- Infection
Why does smoking cause chronic bronchitis?
Smoking stims goblet cells & mucus glands to secrete mucus & inhibits ciliary action, which causes constriction in the tracheobronchial tree
Characteristics of pt’s w/chronic bronchitis
- Blue bloaters
- Stocky build
- Incr PaCO2
- Polycythemia
- Incr PAP
- R ventricular hypertrophy
Exacerbations of chronic bronchitis
- Incr purulent sputum
- VQ abn’s
- Hypoxemia
- Incr RR, work of breathing, & VO2 w/CO2 production
- Incr PAP
- R heart failure (look for edema in ankles & feet)
Emphysema
Hyperinflated alveoli so air can’t flow out during exhalation
*Leads to alveolar destruction w/enlarged air space in lungs
Sx’s of Emphysema
- Pink puffers bc of incr respiratory work
- Thin build
- I AP diameter of chest
- Accessory muscle use
- Seen leaning forwards w/hands on thighs
- Decr breath sounds
- Slight PaO2 abns
- Overinflatted lungs & flattened diaphragm
- SOB w/heart failure in the end
What causes emphysema?
Not sure but it tends to incr w/age, in smokers, & could be hereditary
What is used to consider the prognosis of chronic bronchitis & emphysema?
Pt’s age & inital FEV1
What are the most common causes of death for pt’s w/chronic bronchitis or emphysema?
- CHF
- Pneumonia
- PE
- Respiratory Failure
Asthma
Incr responsiveness of the trachea & bronchi to various stimuli so it narrows
What happens during an asthma attack?
- Bronchial smooth muscle spasm
- Lumen of AW becomes narrowed/occluded
- Mucosal inflammation
- Overproduction of mucus
Allergic/Extrinsic Asthma
Begins in pt’s <35y/o bc of allergies
Non-Allergic/Intrinsic Asthma
Begins in pt’s >35y/o bc of chronic AW obstruction w/bronchospasm & not from a specific trigger
Sx’s of asthma
- Incr RR w/accessory muscle use
- Prolonged expiration w/wheezing & ronchi
- Underproductive cough w/chest tightness
- Hyperinflated lungs w/small areas of atelectasis
- Decr PaO2 & incr PaCO2
- Nocturnal awakenings
Status Asthmaticus
Asthma attack that persists for hours so pt becomes exhausted from breathing
For a pt w/a restrictive disorder, what would you expect their PFT to look like?
Decr VC, IC, & TLC
Sx’s of restrictive disorders
- SOB
- Non-productive cough
- Emaciated appearance
Causes of restrictive disorders
- Maturational
- Pregnancy
- Pulmonary
- Cardiac
- Neuromuscular
- MSK
- Immunologic
- CT issues
- Nutritional/metabolic issues
- Traumatic
- Radiologic
- Pharmacologic
ARDS
Clinical syndrome characterized by severe hypoxemia & incr alveolar capillary membrane permeability
What is ARDS associated w/?
Multi-organ failure
Causes of ARDS
Acute Lung Trauma
- Fat emboli
- Heart-lung transplant
- Massive blood transfusion
- Aspiration
- Drugs
- Inhaled toxins
- Primary pneumonia
- Shock
Pulmonary Fibrosis
Chronic inflammation that causes fibrosis, destruction, & distortion of lung parenchyma
Sx’s of pulmonary fibrosis
- Rapid, shallow breathing
- Decr breath sounds
- Rales
- DOE progressing to DOR
- Cyanosis
- Hypoxemia
- Nonproductive cough
- Fatigue
- Digital clubbing
- Loss of appetite
- Weight loss
Atelectasis
Collapsed lung bc of collapsed alveoli
What is atelectasis associated w/?
Pathological & mechanical pulmonary abn’s caused by obstruction, insufficient surfactant production, & inadequate inspiratory volume
Atelectasis can only occur when?
When there’s blood flow to the affected alveoli that are trying to absorb gas
True or False: Atelectasis will decr lung compliance & incr work of breathing.
True
What are the effects of acute atelectasis?
- Profound dyspnea
- Hypoxemia
- Reduce/absent breath sounds
- Crackles
- Tracheal & mediastinal shift towards the affected side
Pneumonia
Inflammatory process of the lungs caused by respiratory infections leading to consolidation of alveoli as they fill w/exudate & cellular debris
Angina Pectoris
Chest pain bc of ischemia of the myocardium
What is the referred pain pattern of angina pectoris?
- Shoulders
- Between scaps
- UE’s
- Jaw
- Ear
- Teeth
- Neck
Describe the pain of angina pectoris
- Squeezing
- Pressure
- Tightness
- Crushing
- Burning
What are the 3 types of angina?
- Stable
- Unstable
- Prinz-Metal
Stable Angina
Occurs during physical activity
Describe the pain of stable angina
Substernal, non-radiating, lasting 5-15min
Tx for stable angina
Nitroglycerin
Unstable Angina
Occurs during low-level exercise & stress
What is unstable angina indicative of?
CAD progression
Prinz-Metal Angina
Occurs at rest, usually during waking
MI
Necrosis of a portion of the myocardium
Describe the pain of MI
Similar to angina, but it radiates, waxes, & wanes, & NTG doesn’t do anything
Transmural MI
Full wall thickness
Subendocardia (Non Q-wave) MI
Portion of the wall is involved & can extend to transmural
Uncomplicated MI
Small infarction w/no complications during recovery
Complicated MI
Pt’s may have one or a combo of dysrhythmia, heart failure, thrombosis, & damage to heart structures
What happens if an MI involves >40% of the L ventricle?
Cardiogenic shock & death
Sx’s of MI in women
- Nausea
- Fatigue
- Dizziness
- Pain from the waist up
- Pain when sleeping
True or False: Menopause & estrogen levels are risk factors for MI in women?
True
CHF
Syndrome where the heart is unable to sufficiently pump blood to supply the body’s needs
LV failure=
CHF
RV failure=
Cor pulmonale
Explain the patho of CHF
LV doesn’t pump effectively so blood backs up into the lungs
Explain the patho of cor pulmonale
RV fails to pump effectively so blood backs up into the R atrium & then the periphery
Can NSAID’s exacerbate heart failure?
Yes
