23 Restrictive Pulmonary Disorders Flashcards
obstructive vs restrictive pulmonary disorders
obstructive have problems w emptying their lungs
restrictive have problem opening/expanding their lungs
Restrictive Pulmonary Disorders
- 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)
Restrictive Pulmonary Disorders
classifications
Pulmonary
Extrapulmonary
Restrictive Pulmonary Disorders
ABG
DECR PaO2
normal/DECR PaCO2
INCR pH (alkalosis)
Restrictive Pulmonary Disorders
PFT
DECR: VC, TLC, FRC, RV
FEV1/FVC: slight decrease in each but ratio is about normal
Atelectasis
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
Acute (Adult) Respiratory Distress Syndrome
[ARDS]
- type of atelectatic disorder
- damage to alveolar-capillary membrane
- –causes widespread protein-rich alveolar infiltrates
- occurs in assoc w other pathophysiologic processes
3 most important effects of AARDS
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
ARDS
etiology
- mortality rt 30-63%
- more than 150,000 cases/yr in US
- assoc w decline in PaO2 that is REFRACTORY to supplemental O2 therapy
refractory
- resistant to stimulus
- does not respond
ARDS
causes
1 sepsis (>40%) 2 severe trauma 3 aspiration of gastric acid (>30%) 4 fat emboli syndrome 5 shock
ARDS
inflamation + fibrosis
- 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
flooding of alveoli w proteinaceous fluid/protein-rich pulmonary edema
(hyaline membrane i.e. fibrosis)
- diffuse, fluffy alveolar infiltrates
- disruptions in O2 transport + utilization
- —severe hypoxemia
lack of surfactant in ARDS
causes atelectasis + decrease in lung compliance
ARDS
clinical manifestation
-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
ARDS
EARLY clinical manifestation
- sudden marked respiratory distress (high vent rt)
- slight increase in pulse rate
- dyspnea
- low PaO2
- shallow, rapid breathing
ARDS
LATE clinical manifestation
- FROTHY SECRETION (too much mucus + fluid)
- CRACKLES, RHONCHI ON AUSCULTATION
- tachycardia
- tachypnea
- hypotension
- marked restlessness
- use of accessory muscles: intercoastal + sternal retraction
- cyanosis (severe)
ARDS
diagnosis
1 Hypoxemia Refractory 2 ABG 3 Chest X-Ray 4 PFT 5 Open-lung biopsy shows
ARDS
Hypoxemia Refractory
hallmark diagnosis for ARDS
-hypoxemia refractory to increased levels of supplemental O2
ARDS
ABG
- hypoxia
- acidosis (bc retaining CO2)
- hypercapnia
ARDS
chest x-ray
normal progression to DIFFUSE “WHITEOUT”
whiteout=filled w water
ARDS
PFT
DECR: FVC, lung vol, lung compliance
VA/Q mismatch w large right-to-left shunt
ARDS
open-lung biopsy
- ateclasis
- hyaline membranes
- cellular debris
- interstitial + alveolar edema
ARDS
treatment
1 Inhaled Nitric Oxide
2 Supplemental O2
3 ID + treat underlying cause
4 maintain fluid + electrolyte balance
most supportive treatments for ARDS
inhaled nitric oxide + supplemental O2
supplemental O2 ARDS
- 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
increase of fluid administration can _____
produce or intensify pulmonary edema
Infant Respiratory Distress Syndrome
IRDS
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
Occupational Lung Disease
- 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
interference w ciliary action leads to____
impaired clearance effect
inability to be removed
Occupational Lung Diseases
types
1 Pneumoconiosis
2 Anthracosis
3 Silicosis
4 Asbestosis
cilia vs mucus
cilia catches med-lrg sized particles
mucus catches smaller sized
Pneumoconiosis
caused by inhalation of inorganic dust particles
Anthracosis
coal miner or black lung
Silicosis
silica inhalation
Asbestosis
asbestos inhalation
Occupational Lung Diseases
clinical manifestation
1 progressive productive cough 2 dyspnea w exercise 3 chronic hypocemia 4 cor pulmonale 5 respiratory failure
what are the LATE clinical manifestations of Occupational Lung Diseases
1 chronic hypoxemia
2 cor pulmonale
3 respiratory failure
Occupational Lung Diseases
diagnoses
1 Chest X ray
2 PFT
3 ABG
Occupational Lung Diseases
chest x ray
produce 1 of 3 radiographic findings:
nodular, reticular, or linear
Pneumothorax
-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
Primary Pneumothorax
- spontaneous
- occurs in tall thin men 20-40 yrs old
- no underlying disease factors
- cig smoking incr risk
Secondary Pneumothorax
-results of complication fr preexisting pulmonary disease
Tension Pneumothorax
- traumatic origin
- results fr penetrating or nonpenetrating injury
- may also be fr iatrogenic causes
- medical emergency
Pneumothorax
clinical manifestations
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
tension + large spontaneous pneumothorax
-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
tracheal shift to contralateral side
leads to low blood pressure
Pneumothorax
diagnosis
1 ABG
2 ECG
3 Chest X ray
Pneumothorax
ABG
decr PaO2 acute respiratory alkalosis due to tachypenia
Pneumothorax
chest x ray
- expiratory films show better demarcation of pleural line than inspiration
- depression of HEMIDIAPHRAGM on side of pneumothorax
Pneumothorax treatment is based on…
severity of problem + cause of leak
treatment for lung collapse of <15-25%
patient may or may not be hospitallized
-treat symptomatically + monitor closely
treatment for lung collapse of >15-25%
chest tube placement w H2O seal + suction
-oxygen
Pleural Effusion
- type of pleural space disorder
- pathologic collection of FLUID or pus in pleural cavity as result of another disease process
how much serous fluid is normally contained in pleural space?
5-15mL
- constant mvmt of pleural fluid dr parietal pleural capillaries to pleural space
- reabsorbed into parietal lymphatics
5 major types of Pleural Effusion
1 Transudates 2 Exudates 3 Emphysema due to infection in pleural space 4 Hemothorax 5 Chylothorax or lymphatic
Transudates
- type of pleural effusion
- LOW in protein (ratio
Exudates
- type of pleural effusion
- HIGH in protein (>.5mg/dl)
cause: malignancies, infection, pulmonary embolism, sarcoidosis, postmyocardial infarction syndrome, pancreatic disease
Emphysema due to infection inpleural space
HIGH protein exudative effusion
Hemothorax
hemorrhagic shock
- presence of blood in pleural space
- results of chest trauma
- contains blood + pleural fluid
Chylothorax or lymphatic
exudative process that dvlps fr trauma
Pleural Effusion
clinical manifestations
-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
contralateral tracheal shift is a sign of
massive effusion
Pleural effusion
diagnosis
chest x ray: signs of CHF
CT or ultrasonographic test
fluffy alveoli is a characteristic of
ARDS
tracheal shift
opp side: pneumothorax
contralateral: pleural effusion
sharp pleuritic pain that worsens during inhalation
pleural effusion