Ch. 13 and 14 Flashcards
ATS guidelines for COPD is a
preventable and treatable disease, characterized as airflow limitation
COPD is primarily caused by
cigarette smoke
Chronic productive cough for 3 months and 2 successive years
chronic bronchitis
permanent enlargement of the air sacs distal to the terminal bronchioles w. destruction of bronchial walls
emphysema
The conducting airway are the primary structures that under go change in
chronic bronchitis
As a result _________ inflammation, the __________ walls are narrowed by vasodilation, congestion and mucosal edema
chronic; bronchial
Major pathologic associated w/ chronic bronchitis (5)
- thickening of the walls
- excessive mucous production
- partial of total mucous plugging
- smooth muscle constriction
- air trapping hyperinflation
The weakening and permanent enlargement of the air sacs distal to the terminal bronchioles
emphysema
Major pathologic associated w emphysema
- permananet enlargement and destruction of the air spaces
- destruction of AC membrane
- Weakening of the distal, primarily respiratory bronchioles
- air trapping and hyperinflation
2 types of emphysema
- panacinar (panlobular) emphysema
- centriacinar (centrilobular) emphysema
Most common, emphysema chronic bronchitis, cigarette smoke
centrilobular
Less common, more severe, genetic factor Alpha- anti trypsin deficiency
panlobular
Chronic bronchitis, abnormal weakening and enlargement of the Respiratory bronchioles and alveoli in the proximal portion of the acinus
centrilobular emphysema
Abnormal weakening and enlargement of all air spaces distal to the terminal bronchioles
panlobular
How many people in the US have chronic bronchitis, emphysema or both?
10- million
Risk factors include (4)
- genetic factors
- age/ gender
- lung growth/ development
- exposure to particles
Diagnosis should be considered at what age, and with pts who experience these symptoms
40; dyspnea, chronic cough, sputum production, history of exposure risk factors
3 main spirometry test are to measure the severity of airflow limitation w/ suspected COPD
- FVC
- FEV1
- FEV1/FVC ratio
What the primary goals of a COPD assessment (3)
- Establish the degree of airflow limitation
- Determine the effect of COPD on pt’s health
- Ascertain the risk for future events( exacerbation of hospitalizations)
GOLD recommended the assessment of the features independently (4 ASEC)
- Airway limitation
- Symptoms
- Exacerbation risks
- Comorbidities
GOLD 1 = MILD=
FEV1 Greater than or equal to 80% predicated
GOLD 2= MODERATE =
FEV1 50% - 79% predicted
GOLD 3 = SEVERE=
FEV1 30%-49% predicated
GOLD 4 = VERY SEVERE =
FEV1 Less than or equal to 29% or less than predicated
Characteristics of Emphysema (pink puffers)
- barrel chest
- dyspnea
- reddish skin
- decreased breath sounds
- hyper resonance
- accessory muscle used
- diminished respiratory drive
Characteristics of Chronic Bronchitis (blue bloaters)
- digital clubbing
- hypercapnic state
- cyanosis
- peripheral edema
- polycythemia
- cor pulmonale
wheezes, crackles, rhonchi
The heart appears long in narrow as a result being drawn downward by the descending diaphragm in which disease process
emphysema
Translucent (dark) lung fields at the bases, depressed diaphragms and long and narrow heart appears in which disease process
chronic bronchitis
In the PFT’s all of the tests are
decreased
Mild to moderate stages 1 and 2 (Acute alveolar hypoventilation w/ hypoxemia)
pH is…… paco2 is…… hco3- is …… pao2 is…. sao2 is…..
pH increased
paco2 decreased
hco3- decreased
pao2 decreased
sao2 decreased
Severe stages 3 and 4 (Chronic vent failure w/ hypoxemia)
pH is…… paco2 is…… hco3- is …… pao2 is…. sao2 is…..
pH normal
paco2 increased
hco3- increased
pao2 decreased
sao2 decreased
lung volume and capacity findings: CB and emphysema
vT is or normal;
IRV is normal or;
RV is normal or;
VC is;
IC is normal or;
FRC is;
TLC is normal or;
RV/TLC is normal or
Increased
Decreased
Increased
Decreased
Decreased
Increased
Increased
Increased
Chronic airway inflammation, history of respiratory symptoms like wheezing, SOB, chest tightening and cough
Asthma
Asthma is also described as heterogenous disease that commonly has a set of observable characteristics that result from the interaction of the pt’s genotype w/ environment called
asthma phenotype
The more common asthma phenotypes include
- allergic or atopic asthma
- nonallergic asthma
- late onset asthma
- asthma w/ fixed airflow limitation
- asthma w/ obesity
Most easily to identify , typically appears in childhood
allergic or atopic asthma
seen in some adults who do not have allergies
nonallergic asthma
develop asthma for the first time in adult life (especially in women)
late onset asthma
long history of asthma develop a fixed airflow limitation caused by airway wall remodeling
asthma w/ fixed airflow limitation
BMI greater that 30 , asthma is difficult to control
asthma w/ obesity
NAEPP guidelines under 4 components (APCT)
- Assessment and monitoring
- Pt education
- Control factors contributing to asthma severity
- treatment medications
Asthma is described as lung disorder characterized by (3)
- Reversible bronchial smooth muscle constriction
- Airway Inflammation
- Increased airway responsive to an assortment
Pathologic changes during an asthma attack (6)
- Smooth muscle constriction of bronchial airways (bronchospasm) (wheezing breath sound typically reversable)
- Excessive production of thick, whitish bronchial secretions
- Mucous plugging
- Hyperinflation of the alveoli (air trapping)
- In severe cases atelectasis caused by mucous plugging
- Bronchial wall inflammation leading to fibrosis (in severe cases, caused by remodeling)
How many adults and children suffer from asthma in the US
18.4 million(7.6%) and 6.2 million (8.4%)
total 25 million
how many people suffer from asthma worldwide
235 million
Risk factors for asthma (3)
- genetics
- obesity
- sex
What are GINA 2 guidelines to help clinical diagnosis of asthma
- history of variable Respiratory symptoms
- the evidence of variable expiratory airflow limitation
what test helps to induce asthma attacks
bronchial provocation test (methacoline challenge)
Allergy test measures the level of specific _____ via RAST (eosinophils)
IgE
Measures fractional concentration of exhaled nitric oxide (FeNO)
Exhaled Nitric Oxide
Chest assessment findings during asthma attacks (6)
- Expiratory prolonged (I/E >1:3)
- decreased tactile and vocal fremitus
- Hypersonanate percussion note (b/c of air)
- diminished breath sounds
- wheezing (bronchospasm)
- crackles
PFT Moderate to Severe Asthma episode
ALL PFT’s are decreased
Lung volumes and capacity
GINA long term goals for asthma are (2)
- symptom control
- risk reduction of future exacerbation (removal of potential risk factors)
Used for regular maintenance treatment
Controller medications
Used for as needed relief of asthma symptoms
Reliever (rescue) medications
Pt continues to have symptoms despite optimized treatment. Possibly adding on corticosteroids
Add- on therapies for pts w/ severe asthma
In obesity, GERD, anxiety and depression, food allergy and anaphylaxis asthma is
difficult to treat
Aerosolized Medication protocol for asthma
- Bronchodilators
- LABA’S
- ICS
Treat hypoxemia to decrease WOB, what protocol would you use?
Oxygen Therapy protocol
Excessive mucous production and secretions, PEP therapy or Acapella may be used to mobilize secretions. What protocol would be used
Airway clearance therapy
When a pt is status asthmatics (will not respond to therapy) and continue MV may be required what protocol may be used
Mechanical Ventilation Protocol
