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Pathophysiology > 23 Restrictive Pulmonary Disorders > Flashcards

23 Restrictive Pulmonary Disorders Flashcards

1
Q

obstructive vs restrictive pulmonary disorders

A

obstructive have problems w emptying their lungs

restrictive have problem opening/expanding their lungs

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2
Q

Restrictive Pulmonary Disorders

A
  • results fr DECREASED LUNG EXPANSION
  • alterations in lung parenchyma, pleura, chest wall, or neuromuscular function
  • –represent acute or chronic patterns of lung dysfunctions (not a single disease)
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3
Q

Restrictive Pulmonary Disorders

classifications

A

Pulmonary

Extrapulmonary

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4
Q

Restrictive Pulmonary Disorders

ABG

A

DECR PaO2
normal/DECR PaCO2
INCR pH (alkalosis)

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5
Q

Restrictive Pulmonary Disorders

PFT

A

DECR: VC, TLC, FRC, RV

FEV1/FVC: slight decrease in each but ratio is about normal

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6
Q

Atelectasis

A

complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid

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7
Q

Acute (Adult) Respiratory Distress Syndrome

[ARDS]

A
  • type of atelectatic disorder
  • damage to alveolar-capillary membrane
  • –causes widespread protein-rich alveolar infiltrates
  • occurs in assoc w other pathophysiologic processes
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8
Q

3 most important effects of AARDS

A

1 lung is filled w water + protein
2 decr in surfactant > collapse
3 fibrosis of lung > cannot expand
4 fibrosis of common membrane > cannot diffuse O2/CO2 thru blood vessels > low O2, high CO2

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9
Q

ARDS

etiology

A
  • mortality rt 30-63%
  • more than 150,000 cases/yr in US
  • assoc w decline in PaO2 that is REFRACTORY to supplemental O2 therapy
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10
Q

refractory

A
  • resistant to stimulus

- does not respond

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11
Q

ARDS

causes

A 
1 sepsis (>40%)
2 severe trauma
3 aspiration of gastric acid (>30%)
4 fat emboli syndrome
5 shock
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12
Q

ARDS

inflamation + fibrosis

A
  • increased permeability of the pulmonary vasculature
  • flooding of alveoli w proteinaceous fluid/protein-rich pulmonary edema
  • triggers the immune system to activate the complement system + initiate neutrophil sequestration in the lung
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13
Q

flooding of alveoli w proteinaceous fluid/protein-rich pulmonary edema

A

(hyaline membrane i.e. fibrosis)

  • diffuse, fluffy alveolar infiltrates
  • disruptions in O2 transport + utilization
  • —severe hypoxemia
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14
Q

lack of surfactant in ARDS

A

causes atelectasis + decrease in lung compliance

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15
Q

ARDS

clinical manifestation

A

-Hx of a precipitating event that has led to a low blood volume state [SHOCK state] + low BP 1-2 days prior to the onset of respiratory failure

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16
Q

ARDS

EARLY clinical manifestation

A
  • sudden marked respiratory distress (high vent rt)
  • slight increase in pulse rate
  • dyspnea
  • low PaO2
  • shallow, rapid breathing
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17
Q

ARDS

LATE clinical manifestation

A
  • FROTHY SECRETION (too much mucus + fluid)
  • CRACKLES, RHONCHI ON AUSCULTATION
  • tachycardia
  • tachypnea
  • hypotension
  • marked restlessness
  • use of accessory muscles: intercoastal + sternal retraction
  • cyanosis (severe)
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18
Q

ARDS

diagnosis

A 
1 Hypoxemia Refractory
2 ABG
3 Chest X-Ray
4 PFT
5 Open-lung biopsy shows
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19
Q

ARDS

Hypoxemia Refractory

A

hallmark diagnosis for ARDS

-hypoxemia refractory to increased levels of supplemental O2

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20
Q

ARDS

ABG

A
  • hypoxia
  • acidosis (bc retaining CO2)
  • hypercapnia
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21
Q

ARDS

chest x-ray

A

normal progression to DIFFUSE “WHITEOUT”

whiteout=filled w water

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22
Q

ARDS

PFT

A

DECR: FVC, lung vol, lung compliance

VA/Q mismatch w large right-to-left shunt

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23
Q

ARDS

open-lung biopsy

A
  • ateclasis
  • hyaline membranes
  • cellular debris
  • interstitial + alveolar edema
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24
Q

ARDS

treatment

A

1 Inhaled Nitric Oxide
2 Supplemental O2
3 ID + treat underlying cause
4 maintain fluid + electrolyte balance

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25
Q

most supportive treatments for ARDS

A

inhaled nitric oxide + supplemental O2

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26
Q

supplemental O2 ARDS

A
  • high-frequency jet ventilation [HFJV]
  • inverse ratio ventilation [IRV]
  • vol ventilator using pressure support
  • mechanical ventilation w positive end-expiratory pressure [PEEP]
  • –increases FRV and prevents alveolar collapse at end-expiration
  • –forces edema out of alveoli
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27
Q

increase of fluid administration can _____

A

produce or intensify pulmonary edema

28
Q

Infant Respiratory Distress Syndrome

IRDS

A

aka hyaline membrane disease

  • atelectatic disorder
  • syndrome of premature neonates
  • assoc w a1-antitrypsin deficiency
  • –atelectasis + decrease in lung compliance fr lack of surfactant
  • clinical S/S similar to ARDS
29
Q

Occupational Lung Disease

A
  • lung parenchyma disorder
  • results fr inhalation of toxic gases or foreign particles
  • pollutant interfere + paralyze cilia
  • interference w ciliary action
  • alveolar macrophage secrete lysosomes to control foreign particle activity
  • enzymes damage alveolar walls causing deposition of fibrous materials
30
Q

interference w ciliary action leads to____

A

impaired clearance effect

inability to be removed

31
Q

Occupational Lung Diseases

types

A

1 Pneumoconiosis
2 Anthracosis
3 Silicosis
4 Asbestosis

32
Q

cilia vs mucus

A

cilia catches med-lrg sized particles

mucus catches smaller sized

33
Q

Pneumoconiosis

A

caused by inhalation of inorganic dust particles

34
Q

Anthracosis

A

coal miner or black lung

35
Q

Silicosis

A

silica inhalation

36
Q

Asbestosis

A

asbestos inhalation

37
Q

Occupational Lung Diseases

clinical manifestation

A 
1 progressive productive cough
2 dyspnea w exercise
3 chronic hypocemia
4 cor pulmonale
5 respiratory failure
38
Q

what are the LATE clinical manifestations of Occupational Lung Diseases

A

1 chronic hypoxemia
2 cor pulmonale
3 respiratory failure

39
Q

Occupational Lung Diseases

diagnoses

A

1 Chest X ray
2 PFT
3 ABG

40
Q

Occupational Lung Diseases

chest x ray

A

produce 1 of 3 radiographic findings:

nodular, reticular, or linear

41
Q

Pneumothorax

A

-pleural space disorder
-accumulation of AIR in pleural space
—-if air is in, lung has more resistance to push out
—-lung can collapse due to pressure/resistance
2 types: primary + secondary

42
Q

Primary Pneumothorax

A
  • spontaneous
  • occurs in tall thin men 20-40 yrs old
  • no underlying disease factors
  • cig smoking incr risk
43
Q

Secondary Pneumothorax

A

-results of complication fr preexisting pulmonary disease

44
Q

Tension Pneumothorax

A
  • traumatic origin
  • results fr penetrating or nonpenetrating injury
  • may also be fr iatrogenic causes
  • medical emergency
45
Q

Pneumothorax

clinical manifestations

A

1 small pneumothoraces (<20%) are usually NOT detectable on phys exam
2 tachycardia (bc lung collapse, decr O2, SNS)
3 DECR or ABSENT BREATH SOUNDS on affected side
4 hyperresonance
5 Sudden chest pain on affected side
6 dyspnea
7 TENSION + LARGE SPONTANEOUS PNEUMOTHORAX

46
Q

tension + large spontaneous pneumothorax

A

-clinical manifestation of pneumothorax that is an emergency situation
1 severe tachycardia
2 hypotension - shock
3 tracheal shift to contralateral (opp side)
4 neck vein distension
5 hyperresonance
6 subcutaneous emphysema

47
Q

tracheal shift to contralateral side

A

leads to low blood pressure

48
Q

Pneumothorax

diagnosis

A

1 ABG
2 ECG
3 Chest X ray

49
Q

Pneumothorax

ABG

A

decr PaO2 acute respiratory alkalosis due to tachypenia

50
Q

Pneumothorax

chest x ray

A
  • expiratory films show better demarcation of pleural line than inspiration
  • depression of HEMIDIAPHRAGM on side of pneumothorax
51
Q

Pneumothorax treatment is based on…

A

severity of problem + cause of leak

52
Q

treatment for lung collapse of <15-25%

A

patient may or may not be hospitallized

-treat symptomatically + monitor closely

53
Q

treatment for lung collapse of >15-25%

A

chest tube placement w H2O seal + suction

-oxygen

54
Q

Pleural Effusion

A
  • type of pleural space disorder

- pathologic collection of FLUID or pus in pleural cavity as result of another disease process

55
Q

how much serous fluid is normally contained in pleural space?

A

5-15mL

  • constant mvmt of pleural fluid dr parietal pleural capillaries to pleural space
  • reabsorbed into parietal lymphatics
56
Q

5 major types of Pleural Effusion

A 
1 Transudates
2 Exudates
3 Emphysema due to infection in pleural space
4 Hemothorax
5 Chylothorax or lymphatic
57
Q

Transudates

A
  • type of pleural effusion

- LOW in protein (ratio

58
Q

Exudates

A
  • type of pleural effusion
  • HIGH in protein (>.5mg/dl)
    cause: malignancies, infection, pulmonary embolism, sarcoidosis, postmyocardial infarction syndrome, pancreatic disease
59
Q

Emphysema due to infection inpleural space

A

HIGH protein exudative effusion

60
Q

Hemothorax

A

hemorrhagic shock

  • presence of blood in pleural space
  • results of chest trauma
  • contains blood + pleural fluid
61
Q

Chylothorax or lymphatic

A

exudative process that dvlps fr trauma

62
Q

Pleural Effusion

clinical manifestations

A

-PLEURITIC PAIN (wharp, worsens w inspiration)
-ABSENCE OF BREATH SOUNDS
-CONTRALATERAL TRACHEAL SHIFT
-vary on cause + size of effusion
-may be asymptomatic w <300ml of fluid
-dyspnea
-decr chest wall mmt
-dry cough
-dullness to percussion
decr tactile fremitus over affected area

63
Q

contralateral tracheal shift is a sign of

A

massive effusion

64
Q

Pleural effusion

A

diagnosis
chest x ray: signs of CHF

CT or ultrasonographic test

65
Q

fluffy alveoli is a characteristic of

A

ARDS

66
Q

tracheal shift

A

opp side: pneumothorax

contralateral: pleural effusion

67
Q

sharp pleuritic pain that worsens during inhalation

A

pleural effusion

Pathophysiology (32 decks)

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