Chronic Pulmonary (adults) Flashcards
restrictive lung disease
air can’t get IN, lungs won’t expand
(alveoli can’t, OR, other physical issues preventing proper lung expansion)
pulmonary fibrosis, interstitial lung disease, sarcoidosis (alveoli) Pickwickian syndrome, scoliosis (physical)
pickwickian syndrome
condition in some obese people in which poor breathing leads to lower oxygen and higher carbon dioxide levels in the blood; can involve sleep apnea
aka obesity hypoventilation syndrome
obstructive lung disease
air can’t get OUT, lungs won’t recoil
COPD, asthma, bronchiectasis, CF
pulmonary fibrosis is…
extensive, irreversible scarring
often exposure related; also drug related (amiodarone - antiarrhythmic medication used to treat ventricular tachycardia or ventricular fibrillation)
pulmonary fibrosis treatment
- poor options
- slow progression (corticosteroids, immunosuppressants)
- prevent infections
- lung transplant
asthma is…
obstructive process, airway inflammation, bronchoconstriction/spasm, stasis of secretions
asthma airway response looks like…
- hypersensitivity response from IgE
- bronchospasm
- hyperplasia of bronchioles
- capillary leak
- tissue edema, increased secretions (+ swollen airways = pneumonia because trapped)
asthma assessment findings
- dyspnea
- chest tightness
- cough, wheeze
- increased mucous production (and can’t cough it out)
- misc allergic presentations (rhinitis, skin rash (systemic inflammatory response), pruritis)
- accessory muscle breathing (abdomen breathing!)
- prolonged expiration
- barrel chest
pruritis
itchy skin
status asthmaticus
asthmatic episode unresponsive to usual therapy
- risk of cardiac/respiratory arrest
- absence of breathing => airway obstruction
REASSESSMENT IS KEY
chronic obstructive pulmonary disease is…
two conditions together!
- chronic bronchitis (chronic inflammation)
- emphysema (funky elasticity with bullae)
first indications that O2 is low
delirious, disoriented, mental status change
COPD risk factors
- tobacco smoke (first or second!)
- occupational, environmental exposure
- alpha 1 antitrypsin deficiency
- age, genetics
alpha 1-antitrypsin is…
protease inhibitor, regulates proteases present to break down inhaled pollutants, organisms
recessive gene; mutations increase risk for emphysema
chronic bronchitis
chronic inflammation (> 3 months continuously)
- vasodilation (more swollen tissue, more fluid leaks)
- mucosal edema
- congestion
- bronchospasm
airways so tight crud can’t get out
emphysema
loss of lung elasticity, alveolar hyperinflation, bullae
bullae (emphysema)
big dilated empty spaces in lung
alpha 1-antitrypsin deficiency
leads to excess protease and lung elastin destruction
COPD ramifications
- risk of respiratory infections
- pulmonary hypertension
- cor pulmonale
- cardiac dysrhythmias (pressure on heart from lungs causes this!)
COPD assessment findings
- barrel chest
- tripod breathing
- very cachetic population
- clubbing
effects of COPD
- chronic hypoexmia: PaO2 < 60
- chronic hypercarbia: PaCO2 > 45, HCO3 > 28, serum CO2 > 28
OPPOSITE drive to breathe! because patient always hypercapnic, body relies on O2 levels dropping to know when to breathe. CO2 increases faster than O2 drops.
NEVER WANT TO SEE O2 SAT OF 100% ON PATIENT OR THEY WILL NOT BREATHE
forced vital capacity (FVC)
total amount of moveable air in lungs
forced expiratory volume (FEV1)
air exhaled in one second
peak expiratory flow
fastest airflow rate reached at any time during exhalation.
quantifies breathing: amount, how hard, how fast
