Chronic Obstructive/Restrictive Diseases Flashcards
Disease state characterized by airflow limitation that is not fully reversible. Usually progressive and associated with abnormal inflammatory response of the lungs to noxious particles or gases
COPD
- Cough/sputum production/hemoptysis
- Dyspnea on exertion
- Breath sounds decreased with adventitious sounds
- Increased RR
- Weight loss/anorexia
- Increased AP diameter of chest wall
- Clubbing
- Cyanosis
- Postures to structurally elevate shoulder girdle
COPD
COPD CXR shows?
ABGs show?
PFT shows? ____ FEV1, ___FVC, ___FRC and RV, ____ FEV1/FVC
- CXR showing hyperinflation, flattened diaphragm, hyperluceny
- Hypoxemia, hypercapnea
- Decreased, decreased, increased, decreased
Increased reactivity of trachea and bronchi to various stimuli (allergens, exercise, cold); reversible in nature; manifests by widespread narrowing of airways due to inflammation, smooth muscle constriction, increased secretions
Asthma
- Wheezing, possible crackles, decreased breath sounds
- Dyspnea
- Increased secretions of variable amounts
- Anxiety
- Increased accessory muscle use
- Tachycardia
- Tachypnea
- Hypoxemia
- Hypocapnea
- Cyanosis
- PFTs show impaired flow rates
- CXR: hyperlucency and flattened diaphragms during exacerbation
Asthma
Why does asthma have hypocapnea?
Responding to hypoxemia, increased RR and FEV1. This decreases PaCO2. With severe a/w constriction, increase in FEV1 cannot occur and hypercapnea results.
Genetically inherited disease with thickening of secretions of all EXOCRINE glands, leading to obstruction
Cystic fibrosis
3 clinical signs of CF
- Meconium ileus
- Frequent respiratory infections (especially staphylococcus aureus and pseudomonas aeruginosa)
- Inability to gain weight despite adequate calorie intake
How is CF dx?
Postnatally by blood test indicating TRYPSINOGEN, or later by positive sweat electrolyte test
With exacerbation:
- Onset of symptoms usually in early childhood
- Dyspnea
- Productive cough
- Hypoxemia, hypercapnea
- Clubbing
- Cyanosis
- Use of accessory muscles for ventilation
- Tachypnea
- Crackles, wheezes, decreased breath sounds
- Abnormal PFTs show obstructive/restrictive/both
- CXR: increased markings, findings of bronchiectasis/pneumonitis
CF
chronic congenital or acquired disease characterized by abnormal dilation of bronchi and excessive sputum production
Bronchiectasis
- Cough and expectoration of large amounts of MUCOPURULENT secretions
- Frequent secondary infections
- Hemoptysis
- Crackles, decreased breath sounds
- Cyanosis
- Clubbing
- Hypoxemia
- Dyspnea
- CXR: increased bronchial markings with interstitial changes
bronchiectasis
formerly known as hyaline membrane disease, alveolar collapse in premature infant resulting from lung immaturity, inadequate level of pulmonary surfactant
Respiratory distress syndrome (RDS)
- Respiratory distress
- Crackles
- Tachypnea
- Hypoxemia
- Cyanosis
- Accessory muscle use
- Expiratory grunting, flaring nares
- CXR: classic granular pattern (“ground glass”) caused by distended terminal airways and alveolar collapse
RDS
Obstructive pulmonary disease, often sequela of premature infants with respiratory distress syndrome; results from high pressures of mechanical ventilation, high fractions of FiO2, and/or infection. Lungs show areas of pulmonary immaturity and dysfunction due to hyperinflation.
Bronchopulmonary dysplasia
- Hypoxemia, hypercapnea
- Crackles, wheezing, decreased breath sounds
- Increased bronchial secretions
- Hyperinflation
- Frequent lower respiratory infections
- Delayed growth and development
- Cor pulmonale
- CXR shows hyperinflation, low diaphragm, atelectasis, and/or cystic changes
Bronchopulmonary dysplasia
How are chronic restrictive diseases categorized?
By difficulty expanding lungs, causing reduction in lung volumes
What are the 3 categories of restrictive disease?
- Alterations in lung parenchyma and pleura
- Alterations in chest wall
- Alterations in NM apparatus
Restrictive: Fibrotic changes within pulmonary ___ or ___ due to idiopathic pulmonary fibrosis, asbestosis, radiation pneumonitis, or oxygen toxicity
Pleura
Parenchyma
- Dyspnea
- Hypoxemia, hypOcapnea (hypERcapnea appears with severity)
- Crackles
- Clubbing
- Cyanosis
Restrictive disease due to alterations in lung pleura/parenchyma
Restrictive: alterations in chest wall lead to restricted motions of __ __. Diseases/disorders that lead to this include: (6)
Bony thorax
- Ankylosis spondylitis
- Arthrogryposis
- Arthritis
- Scoliosis
- Pectus excavatum
- Integ changes of chest wall (scleroderma, thoracic burns)
- Shallow, rapid breathing
- Dyspnea
- Hypoxemia, hypocapnea
- Cyanosis
- Crackles
- Decreased cough effectiveness
Restrictive disease due to alterations in chest wall
CXR for restrictive disease due to alterations in chest wall may show:
Decreased lung volumes, atelectasis
Restrictive disease due to alterations in NM apparatus: decreased muscular strength and inability to expand rib cage seen in diseases such as: (5)
MS, muscular dystrophy, PD, SCI, CVA
