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NURS 2500 > CLASS 17 - Respiratory Disorders / Lower Airway Disorders > Flashcards

CLASS 17 - Respiratory Disorders / Lower Airway Disorders Flashcards

1
Q

Define Atelectasis

A

Lung collapse / incomplete expansion of the lung or a portion of the lung

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2
Q

Whar are the 3 potential causes of atelectasis?

A

AIRWAY OBSTRUCTION
ex - aspiration or mucus, cystic fibrosis, emphysema, chronic bronchitis

LUNG COMPRESSION
ex - tumor, mass, air or fluid

INCREASED ALVEOLAR SURFACE TENSION
- ex decreased surfactant in IRDS or ARDS

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3
Q

What is Compression Atelectasis?

A

Compression Atelectasis occurs when the pleural cavity is filled/partially filled with:

  • fluid (called pleural effusion)
  • tumor mass
  • blood (trauma, cancer or surgery) (ie hemothorax)
  • air (pneumothorax)

As a result of this, the lung is partially compressed.

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4
Q

Define pneumothorax.

Describe how this occurs in terms of pessure in the pleural cavity.

A

Pneumothorax is caused by air (or another gas) in the pleural cavity, which results in lung collapse.

There is normally negative pressure in the pleural cavity. This helps keep the lungs open and causes the lungs to expand w the thoracic cavity during expansion.

If air enters the peural cavity and equalizes the pressure, compression atelectasis occurs and the lung will collapse immediately

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5
Q

What are the 3 types of pneumothorax?

A
  1. CLOSED / SIMPLE / SPONTANEOUS PNEUMOTHORAX
  2. OPEN PNEUMOTHORAX / SUCKING CHEST WOUND
  3. TENSION PNEUMOTHORAX
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6
Q

Define Closed / Simple / Spontaneous Pneumothorax.

What causes it? What causes secondary pneumothorax?

A

Closed / Simple / Spontaneous Pneumothorax occurs when air enters the pleural cavity directly from the airways.

This type of pneumothorax is idiopathic and caused by a tear or rupture on the surface of a lung that allows air to reach the cavity through a bronchus.

Secondary pneumothorax is caused by rupture of an emphysematous bleb, erosion of a tumour, or cavitation through the visceral pleura.

The involved area of lung collapses by recoil, and the leak seals with collapse.

The mediastinum shifts toward the affected lung because the pleura vacuum is partially preserved.

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7
Q

A patient is seen in the ER after a skiing incident. He sustained chest injuries from the impact of falling into trees. He reports pain over his right chest. His breathing is laboured and his chest movements over his right ribs are normal. There is a penetrating wound over the right lateral chest and a sucking sound is heard with inspiration.

What might be the problem with this patient?

A

Patient has open pneumothorax.

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8
Q

Define Open Pneumothorax.

What do the mediastinum + trachea do during inspriation + expiration?

What is a sucking wound?

A

Open pneumothorax occurs when air enters the pleurla cavity through an opening in the chest (from surgery, traumatic wound) which causes immediate atelectasis.

During inspiration, the mediastinum + trachea shift toward the unaffected side which limits chest expansion. The mediastinum + trachea shift toward the affected side during expiration, which impairs venous return of the heart.

A sucking wound describes a large opening in the chest wall in which the sound of air moving in and out makes a sucking sound.

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9
Q

What is Flail Chest?

A

Flail Chest occurs when you have multiple rib fractures resulting in the instability of the chest wall. Results in a section of rib that is discontinuous from the rest of the thoracic cage because it’s not tethered down.

This will result in paradoxical mvmt of the chest wall during the respiratory cycle. The broken section of rib will suck up against the lung rather than expand during inspiration.

Directly impairs ventilation and is associated with pulmonary contusion.

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10
Q

What is Tension Pneumothorax? Is this type of pneumothorax open or closed?

A

Tension pneumothorax is the most serious form of pneumothorax. It can be open or closed.

Tension pneumothorax is characterized by the one-way movement of air caused by a flap of damaged tissue that allows air to move into the pleural cavity during inspiration, but seals off the opening during expiration. With each breath, more air is added to the pleural cavity.

This increases the pressure in the pleural caity, which leads to widespread compression atelectasis. The pressure pushes on the mediastinum and displaces the heart while compressing the vena cava and unaffected lung. This results in decreased venous return and gas exchange.
Eventually will result in tracheal deviation as well.
Severe hypoxia and respiratory distress develop quickly.

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11
Q

What are the 7 Clinical Manifestations of Pneumothorax?

A
  1. Hypoxemia
  2. Tachycardia, anxiety, pallor
  3. Atelectasis
  4. Dyspnea, cough, chest pain
  5. Decreased breath sounds on affected side
  6. Unequal lung expansion and mediastinum shift
  7. Hypotension and shock caused by decreased venous return in tension pneumothorax
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12
Q

When is chest tube drainage indicated?

A

To remove fluid, and to remove air.

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13
Q

Describe the basic mechanism of a suction unit.

A

Uses an underwater one way seal to allow air and fuid to be drained. Gentle suction is most often applied. A collection chamber lets us measure the output.

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14
Q

Pumonary Edema + Pulmonary Embolism are examples of which type of lung disorders?

A

Vascular Lung Disorders.

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15
Q

What is pulmonary edema?

A

Abnormal accumulation of fluid in the alveoli and the interstitial spaces of the lungs.

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16
Q

What is a pulmonay embolism?

Which lobes of the lungs are most commonly effected?

What are the main causes of pulmonary embolism?

A

Blockage of pulmonary arteries by a thrombus, fat or air embolus,or tumour tissue.

Most commonly affects the lower lobes.

Most from DVT in legs, above the knee

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17
Q

What are the 3 ways in which we can treat a pulmonary embolism?

A

anticoagulants

thrombolytics

embolectomy

18
Q

what are the risk factors for a pulmonary embolism?

A
  • immobility
  • recent surgery
  • history of DVT
  • malignancy
  • obesity
  • oral contraceptives
  • hormone therapy
  • smoking
  • prolonged air travel
  • heart failure
  • pregnancy
  • clotting disorders
19
Q

What are the 2 common risk situations for pulmonary edema?

A

over-hydration with IV fluids

  • left-sided heart failure
20
Q

How does a pulmonary emolism occur?

A
  • a blood clot forms in a vein and breaks free from the vessel wall.
  • the embolus travels through the bloodstream and heart into the vessels of the lung
  • embolism obstructs a vessel in the lung and deprives the tissue of blood
21
Q

What are the non-specific manifestations of a pulmonary embolism?

A

Classic triad is dyspnea, chest pain, and hemoptysis (coughing up blood)

hypoxemia

22
Q

What are the clinical manifestations of a massive pulmonary embolism?

A 
Decreased BP
Pallor
Severe dyspnea and hypoxemia
Cough
crackles
fever
altered mentation
tachycardia
Pleural friction rub
pulmonary hypertension
23
Q

What diagnostic studies would be performed to identify a pumonary embolism?

A
  • spiral ct scan w IV contrast media
  • VQ scan
  • pulmonary angiography
  • D dimer
  • ABG
24
Q

What are the ways in which we can treat a pulmonary embolism?

A
  • supplemental oxygen, possible intubation
  • anticoagulants or fibrinolytics
  • limit activity
  • provide opioids for pain
25
Q

What assessment findings would be found for pneumothorax?

A
  • Dyspnea, chest pain
  • Tachypnea
  • Air hunger and decreased o2sat
  • Tracheal shift
  • Absent breath sounds
  • Hyper-resonance
26
Q

What assessment findings would be found for tension pneumothorax?

A
  • respiratory distress
  • mediastinal shift to unaffected side
  • decreased venous return
  • tachycardia
  • hypotension
  • hemodynamic instability
27
Q

What assessment findings would be found on assessment for a pulmonary embolism?

A
  • Dyspnea, chest pain
  • Productive cough, hemoptysis
  • decreased O2 sat (pao2 70 and paco2 30)
  • crackles on auscultation, pleural rub
  • tachycardia, hypotension
  • mild fever
28
Q

What hemodynamic changes occur in tension pneumothorax?

A
  • hemodynamic instability due to impaired cardiac filling and reduced venous return
  • hypoxemia
29
Q

Define Blunt Trauma in terms of the cause of these injuries and the type of injuries that fall under this category.

A

Blunt Trauma injuries occur when the body is struck by a blunt object such as a steering wheel. External injury may appear to be minor but can cause severe, life-threatening injuries such as a ruptured spleen.

These types of injuries include rib fractures, flail chest, pneumothorax, pulmonary contusion, and great vessel tears

30
Q

Define penetrating trauma in terms of the cause of these injuries and the types of injuries that fall under this category.

A

Occurs when a foreign body impales body tissues, such as a gunshot or stab wound to the chest.

These types of injury include open pneumothorax, tension pneumothorax, esophageal damage, tracheal tear, great vessel tears

31
Q

Describe hemopneumothorax

A

Accumulation of blood in the intrapleural space.

Causes include chest trauma, lung cancer, complications of anticoagulant therapy, pulmonary embolism, and tearing of pleural adhesions.

32
Q

what is tracheal deviation?

A

Tracheal deviation occurs when the trachea is pushed to one side.

This is a sign of open pneumothorax or tension pneumothorax. .

33
Q

What happens in paradoxical respiration?

A

In flail chest, the flail area moves paradoxically to the intact portion of the chest wall. It will suck in during inspiration rather than expand, and bulge out during expiration.

34
Q

What is the impact of flail chest on the venilation/perfusion ratio?

A

It will decrease it.

Prevents adequate ventilation of the lungs and leads to hypoxemia.

35
Q

What are the 2 purposes of chest tube drainage?

A

Removal of air or fluid/blood.

36
Q

Where is a chest tube inserted when the purpose is to remove air?

A

To remove air, the chest tube is inserted anteriorly into the second intercostal space.

37
Q

Where is a chest tube inserted when the purpose is to remove fluid or blood?

A

To remove fluid or blood, the chest tube is inserted posteriorly through the 8th or 9th intercostal space.

38
Q

What is tidalling?

A

Tidaling is the rise and fall of fluid in the water seal tube chamber, which is a direct reflection of the degree of lung re-expansion. Tidaling decreases as the lung re-expands. In order to observe tidaling when suction is used, suction may be temporarily disconnected.

39
Q

What is the difference between interstitial and alveolar edema?

A

Interstitial edema occurs when fluid leaves the pulmonary capillaries and enters the interstitial space.

Alveolar edema occurs when the fluid continues to leak from the pulmonary capillaries (instead of being taken care of by the lymphatic system) and enters the alveoli.

40
Q

What are the 2 most common causes of Pulmonary edema?

A

Left sided heart failure

Overhydration w IV fluid

41
Q

What are the ABG values in Pulmonary embolism?

A

Partial pressure of Oxygen decreases due to inadequate oxygenation.

pH remains normal, but prolonged hypoventilation can result in respiratory alkalosis.

42
Q

What primary complication results from hypoxemia?

A

Pulmonary infarction (or the death of lung tissue)

NURS 2500 (22 decks)

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