Cardiopulmonary Pathologies

Question 1

Pleural Effusion Overview

Answer 1

• Gradual, insidious onset
• Pleural cavity has increased fluid when it shouldn’t, causing a restrictive lung condition because lungs cannot inflate like they should
• Affects older adults with underlying conditions
• Chest x-ray shows fluid accumulation
• Thoracentesis for fluid analysis (to look for infection)

Question 2

Pleural Effusion Clinical Presentation

Answer 2

• SOB / dyspnea
• Pleuritic chest pain (knife like)
• Dry cough (bc fluid is not in lungs, it is in pleural cavity around lungs, so postural drainage would not work)
• Diminished or absent breath sounds
• Dullness to percussion (bc fluid is there when there should be air)

Question 3

Pneumonia Overview

Answer 3

• Inflammation of alveoli that progresses to an infection (the air sacs become filled with fluid or pus)
• Gradual, insidious onset
• Affects all ages, but more severe in elderly individuals with underlying health conditions
• Chest x-ray shows areas of consolidation
• Sputum culture to identify causative organism
• Increased WBC count (normal is 4,500-11,000 microliters)

Question 4

Pneumonia Clinical Presentation

Answer 4

• Wet productive cough (fluid and infection IN lungs)
• Fever, chills
• Difficulty breathing / dyspnea
• Chest pain
• Crackles (rales) on lung auscultation because of the fluid
• Dullness to percussion
• Bronchial breath sounds over areas of consolidation (bronchial breath sounds - harsh, loud, high pitched sounds)

Question 5

Atelectasis Overview

Answer 5

• Gradual, non-traumatic onset
• Common in post-op pts, pts with lung disease, and older adults
• Chest x-ray shows collapsed lung
• Mediastinal shift TOWARDS collapse
• Bronchoscopy may be used if an obstruction is suspected (camera goes into trachea to look for obstruction)

Question 6

Atelectasis Clinical Presentation

Answer 6

• SOB
• Dry cough
• Low O2 sat (hypoxemia)
• Decreased breath sounds
• Dullness to percussion

Question 7

Pneumothorax Overview

Answer 7

• Sudden, traumatic onset
• More common in young males with primary spontaneous pneumothorax and older adults with secondary pneumothorax from COPD or lung disease
• Chest x-ray shows air in pleural space
• Mediastinal shift AWAY from collapse

Question 8

Pneumothorax Clinical Presentation

Answer 8

• Sudden, sharp chest pain
• SOB
• Dry cough
• Absent breath sounds
• Dull percussion over collapsed lung
• Hyperresonance on percussion over empty airspace

Question 9

Asthma Overview

Answer 9

• Gradual onset (the exam can say exacerbation which would be sudden)
• Can affect all ages but often begins in childhood
• Spirometry will show decrease in FEV1/FVC ratio which is indicative of an obstructive disease

Question 10

Asthma Clinical Presentation

Answer 10

• Wheezing
• Chest tightness
• Dyspnea
• Increased RR (normal is 12-20)
• Coughing (especially at night)
• Hyperresonance due to air trapping
• Breath sounds (diffuse wheezes, often louder during expiration)
• Usually non-productive but may become productive in exacerbations

Question 11

Hemothorax Overview

Answer 11

• Blood collects in pleural space (without treatment, blood can continue to accumulate and put a lot of pressure on outside of lungs that they cannot fully inflate)
• Chest injury, trauma, surgery, or another condition can cause blood to enter pleural space and mix with pleural fluid

Question 12

Hemothorax Causes

Answer 12

• Blood clotting disorder
• Lung cancer
• Pulmonary infarction (lung tissue death)
• Thoracic chest surgery or heart surgery
• Blood vessel damage during central venous catheter placement
• Ehlers-danlos syndrome
• Tuberculosis

Question 13

Hemothorax Symptoms

Answer 13

• SOB / dyspnea
• Hyperventilation
• Rapid HR
• Chest pain
• Hypotension
• Restlessness
• Anxiety
• Fever
• Severe causes can cause death

Question 14

Hemothorax Complications

Answer 14

• Respiratory failure
• Hypovolemic shock
• Emphysema
• Scarring in your pleural tissue other than lung tissue

Question 15

Hemothorax Diagnosis

Answer 15

• Auscultation
• Chest x-ray
• CT scan
• Thoracentesis

Question 16

Hemothorax Medical Management

Answer 16

• Depending on the severity of the hemothorax, they will either insert a thin needle (thoracentesis) or chest tube (thoracotomy) between your ribs to remove blood from your pleural space
• If blood continues to fill your pleural space even with drainage, a surgeon will make an incision in pt’s chest to access your affected lung and treat the cause (thoracotomy)
• Pt may need blood transfusion if they lose a lot of blood