Classification of Respiratory Disease Flashcards
Diseases
Deviation from or interruption of normal structure/function of any body part, organ, or system
Deviation from homeostasis
Manifested through a characteristic set of signs and symptoms whose ethology, pathology, and prognosis may be known or unknown
Disorder
A derangement or abnormality of a function
Morbid physical or mental state
Something that results from a disease
Acute
Illness that appear quickly and can be serious or life threatening
After the illness ends the patients should return to normal
Chronic
Illness of a long duration
Describes a disease that has a slow prognosis
Classification Between Obstructive and Restrictive Diseases
Based on history, clinical manifestation, and pulmonary function studies
Obstructive Lung Diseases
Obstructive lung disease is a disease that is characterized by the patient decreased ability to fully exhale
Increase airway resistance is the major contributing factor in the obstructive disease process
Reasons: Mucus plug where air cant get out, Airway collapse because walls have loss elastic quality and air is stuck in there
Ex. COPD, asthma
RESTRICTIVE LUNG DISEASE
Restrictive lung disease is a disease that is characterized by a loss of lung volume
Decreased pulmonary compliance major contributing factors in restrictive processes
There is something wrong with the structure of the lung making them stiff and hard
So there is a lot of area that will not expand and is not wasted space that could have had oxygen but now is not usable making the whole system less efficient
Ex. Fibrosis (too much scare tissue), chest wall diseases (muscular diseases), problems in tissue of lungs
Upper Airway
nasal cavity, oral cavity, pharynx, and larynx
Etiology of Upper Airway Obstruction
All of these obstructions can be partial or complete/full-Pt. status will reflect if it is a partial or full obstruction
Causes/Etiology are divided into three major categories
1) Intraluminal Obstruction
2) Intramural Obstructions
3) Extramural Obstruction
Intraluminal Obstruction
Something inside of the airway lumen that is blocking/narrowing the airway
Ex. Foreign bodies, secretions
Intramural Obstructions
Lesion inside bronchial wall, swelling
Ex. Neoplasms
Extramural Obstruction
External pressure causing airway narrowing
Ex. Enlarged lymph nodes, carcinoma, and lymphoma
Pathologies of Upper Airway Obstruction
Rhinitis
Croup
Epiglottitis
Obstructive Sleep Apnea
Laryngeal paralysis
Tracheal stenosis-often occurred when we are extubating after a long time
Foreign Body Tetanus (Lockjaw)- bacterial infection that involves jaw and neck
A soft tissue obstruction (tongue blocking airway) is the most common type of upper airway obstruction
Signs of Upper Airway Obstruction
- Hot Potatoe Voice
- Difficulty Swallowing Secretions-Drooling
- Dyspnea
- Stridor-Mean obstruction immenient
Lower Airway
bronchi, bronchioles, and alveoli
Causes of Lower Airway Obstruction
Emphysema
Chronic Bronchitis
Asthma
Cystic Fibrosis
Bronchiectasis
Bronchiolitis
Bronchial compression (tumor)
Endobronchial tumors
Foreign Body
Mucous plugging
Conditions that lead to a decrease in compliance
Lung compression (e.g., secondary to a pneumothorax or pleural effusion)
Atelectasis (e.g., secondary to a pneumothorax, flail chest, or mucus plugging)
Consolidation (e.g., pneumonia)
Calcification (e.g., tuberculosis, asbestosis)
Fibrosis (e.g., pneumoconiosis, chronic interstitial lung diseases such as sarcoidosis)
Bronchogenic tumor (e.g., squamous cell carcinoma)
Cavitations (e.g., tuberculosis, lung abscess)
Intrapulmonary Causes
Includes interstitial disorders and alveolar disorders
Interstitial disorders
Disorder of the lung tissue itself that results in a decrease in compliance of the lung tissue Eg. Idiopathic pulmonary fibrosis (scarring/remodeling around the lungs), increase A/C membrane, atelectasis, surfactant dysfunction
Alveolar Disorders
Occurs in the alveolar space, when the alveolar space is “full” of substances other than air Ex. Pneumonia, CHF, Alpha 1 antitrypsin disorder, pulmonary edema
Extrapulmonary Disorders
Includes pleural, skeletal/thoracic
Extrapulmonary Pleural Disorders
Pathological disorder of the pleural membrane, and lung expansion will be restricted as there is something occupying the pleural space Pleurisy- Exudate on pleural surface which will increase friction (painful) Ex. Pneumonia, infection, and neoplasms, Pneumothorax, pleural effusion, hemothorax (blood in pleural space, and emphysema
Extrapulmonary Skeletal/Thoracic
Chest Trauma-Single, multiple rib fractures (splinting), Flail chest, Fracture of sternum, Hemothorax/pneumothorax Obesity-Decreased ability to move high mass tissue Deformities of the spine-Structural changes of muscles or bones, Scoliosis, kyphosis, kyphoscoliosis Deformities of Chest Cage-Reduced compliance of chest cage, Pectus excavatum/carinatum, ankylosing spondylitis
Extrapulmonary-Neuromuscular
Interference of nerve transmission or decrease respiratory muscle function-Diaphragm Inability to generate normal respiratory pressures-Decreases TLC, increase RV, and normal FRC Normal lung/chest wall compliance-If you don’t inhale it you cant exhale it
Neurological Disorders
Spinal Cord Transection
Trauma Amyotrophic Lateral Sclerosis
Progressive muscle wasting
Guillian-Barre Syndrome-Grounded to brain ascending paralysis
Myasthenia Gravis-Destruction of myelin sheath
Muscular Dystrophy-Progressive weakness and loss of skeletal muscle
Obstructive Pulmonary Disorder Clinical Manifestation
Dyspnea on exertion Cough - productive Hyper-resonant percussion notes-Sounds like you are beating on a drum due to air trapping Wheezing Diminished breath sounds Diminished heart sounds Prolonged expiration
Restrictive Pulmonary Disorder Clinical Manifestation
Dyspnea on exertion Non productive cough Hypo-resonant or normal percussion notes Fine bilateral inspiratory crackles Rapid shallow breathing
PULMONARY DIFFUSION CAPACITY
Decreased DLCO is a hallmark finding in emphysema
Decreased if combined with moderate to severe atelectasis, consolidation, A/C membrane thickness increases
Types of Obstructive Lung Diseases
Chronic Bronchitis Emphysema Asthma Bronchiectasis Cystic Fibrosis
Type I Respiratory Failure
Oxygenation Failure “a more specific term indicating an arterial oxygen tension of less than 60 mmHg despite an FiO2 of 0.50 or higher.”
Type 2 Respiratory Failure
Ventilation Failure “an inadequate ventilation between the lungs and atmosphere that results in an inappropriate elevation of arterial carbon dioxide tension of greater than 45 mmHG in the arterial blood.”
5 Signs of Hypoxemia
Decreased Inspired O2
Decrease Alveolar Ventilation
Increased Dead Space
Increased Shunt
Decreased Diffusion Across AC Membrane
Signs of Cyanosis
Pale cold skin and inside of lip looks blue
Technically is evident when hemo 5g/dL, detected when O2 sats are even 75% (40 mmHg) but depending on hemoglobin, skin pigmenttion, etc can even see it at 85%
Decreased Alveolar Ventilation
Decrease in RR and/or VT (RRx Vt=MV)
Drug overdose, any disease with decrease compliance, neuromuscular diseases, airway obstruction (sleep apnea), foreign body obstruction (full or partial) Need to treat the underlying cause
Increased Dead Space
V/Q Mismatch-Most common cause of hypoxemia
When you are using high pressure in non compliant lung you will see a decrease in venous return as there is a increase in deadspace ventilation
Increase Alveolar Shunt
V/Q Mismatch-Most common cause of hypoxemia Due to a pathology when some alveoli are not getting air to them other well ventilated alveoli can help When alveoli are perfused but not ventilated When we are intubated and we have a right main stem intubation the whole left side is well perfused but not ventilated which causes a huge alveolar shunt and in turn and increase V/Q mismatch Atelectasis, pulmonary edema, pneumonia, mucus plugging
Decreased Diffusion
Increase in tissue distance or a shorten time for pulmonary gas exchange Fibrosis, 3rd spacing
Hypoxemia vs. Hypoxia
Hypoxemia=PaO2 > 60 mmHg
Hypoxia= Decreased tissue oxygenation
Hemoglobin related problems (anemic, decreased tissue perfusion) and Carbon monoxide or cyanide poisoning will lower blood oxygen and can lead to hypoxia but not hypoxemia because the PaO2 remains normal The truck are still full there just isn’t enough trucks
Hypoxemia
Mild PO2-60-79
Moderate PO2-40-59
Severe PO2-Under 40
Can lead to cerebral and/or cardiac hypoxia!!
Tissue oxygenation may be preserved by increasing cardiac output.
Most Common cause is V/Q mismatch.
Type 1 Acute Oxygenation Failure Clinical Manifestations
Central cyanosis Abnormal vital signs Increased HR, RR, BP Confusion, Agitation, slowness to respond-Less O2 going to the brain Abnormal cardiac rhythms-PVCs Cor Pulmonale-Right sided heart failure due to the fact that there is pulmonary hypertension Hepatomegaly Pitting peripheral edema JVD Polycythemia Increased RBCs, hematocrit, Hb
Type 2-Impending Ventilatory Failure
Demand for CO2 elimination exceeds capacity to do so. Signs and Symptoms Abdominal Paradox (see saw breathing) Diaphragmatic fatigue Tachypnea with normal PaCO2 and normal pH
Type 2 Acute Ventilatory Failure
pH lower than 7.35
PaCO2 higher than 45 mmHg or PaCO2 higher than baseline
Few clinical signs indicate ↑PaCO2 Headache Diminished alertness Warm, flushed skin Bounding peripheral pulses Hypoxemia often concurrent
Type 2 Chronic Ventilatory Failure
Normal pH with elevated PaCO2 and HCO3
Obstructive Pulmonary Disorder Clinical Manifestation
Dyspnea on exertion Cough - productive Hyper-resonant percussion notes-Sounds like you are beating on a drum due to air trapping Wheezing Diminished breath sounds Diminished heart sounds Prolonged expiration
Restrictive Pulmonary Disorder Clinical Manifestation
Dyspnea on exertion Non productive cough Hypo-resonant or normal percussion notes Fine bilateral inspiratory crackles Rapid shallow breathing
PULMONARY DIFFUSION CAPACITY
Decreased DLCO is a hallmark finding in emphysema
Decreased if combined with moderate to severe atelectasis, consolidation, A/C membrane thickness increases
Types of Obstructive Lung Diseases
Chronic Bronchitis Emphysema Asthma Bronchiectasis Cystic Fibrosis
Type I Respiratory Failure
Oxygenation Failure “a more specific term indicating an arterial oxygen tension of less than 60 mmHg despite an FiO2 of 0.50 or higher.”
Type 2 Respiratory Failure
Ventilation Failure “an inadequate ventilation between the lungs and atmosphere that results in an inappropriate elevation of arterial carbon dioxide tension of greater than 45 mmHG in the arterial blood.”
5 Signs of Hypoxemia
Decreased Inspired O2
Decrease Alveolar Ventilation
Increased Dead Space
Increased Shunt
Decreased Diffusion Across AC Membrane
Signs of Cyanosis
Pale cold skin and inside of lip looks blue
Technically is evident when hemo 5g/dL, detected when O2 sats are even 75% (40 mmHg) but depending on hemoglobin, skin pigmenttion, etc can even see it at 85%
Decreased Alveolar Ventilation
Decrease in RR and/or VT (RRx Vt=MV)
Drug overdose, any disease with decrease compliance, neuromuscular diseases, airway obstruction (sleep apnea), foreign body obstruction (full or partial) Need to treat the underlying cause
Increased Dead Space
V/Q Mismatch-Most common cause of hypoxemia
When you are using high pressure in non compliant lung you will see a decrease in venous return as there is a increase in deadspace ventilation
Increase Alveolar Shunt
V/Q Mismatch-Most common cause of hypoxemia Due to a pathology when some alveoli are not getting air to them other well ventilated alveoli can help When alveoli are perfused but not ventilated When we are intubated and we have a right main stem intubation the whole left side is well perfused but not ventilated which causes a huge alveolar shunt and in turn and increase V/Q mismatch Atelectasis, pulmonary edema, pneumonia, mucus plugging
Type 2 Chronic Ventilatory Failure
Normal pH with elevated PaCO2 and HCO3
Type 2 Acute Ventilatory Failure
pH lower than 7.35
PaCO2 higher than 45 mmHg or PaCO2 higher than baseline
Few clinical signs indicate ↑PaCO2 Headache Diminished alertness Warm, flushed skin Bounding peripheral pulses Hypoxemia often concurrent
Type 2-Impending Ventilatory Failure
Demand for CO2 elimination exceeds capacity to do so. Signs and Symptoms Abdominal Paradox (see saw breathing) Diaphragmatic fatigue Tachypnea with normal PaCO2 and normal pH
Type 1 Acute Oxygenation Failure Clinical Manifestations
Central cyanosis Abnormal vital signs Increased HR, RR, BP Confusion, Agitation, slowness to respond-Less O2 going to the brain Abnormal cardiac rhythms-PVCs Cor Pulmonale-Right sided heart failure due to the fact that there is pulmonary hypertension Hepatomegaly Pitting peripheral edema JVD Polycythemia Increased RBCs, hematocrit, Hb
Hypoxemia
Mild PO2-60-79
Moderate PO2-40-59
Severe PO2-Under 40
Can lead to cerebral and/or cardiac hypoxia!!
Tissue oxygenation may be preserved by increasing cardiac output.
Most Common cause is V/Q mismatch.
Hypoxemia vs. Hypoxia
Hypoxemia=PaO2 > 60 mmHg
Hypoxia= Decreased tissue oxygenation
Hemoglobin related problems (anemic, decreased tissue perfusion) and Carbon monoxide or cyanide poisoning will lower blood oxygen and can lead to hypoxia but not hypoxemia because the PaO2 remains normal The truck are still full there just isn’t enough trucks
Decreased Diffusion
Increase in tissue distance or a shorten time for pulmonary gas exchange Fibrosis, 3rd spacing
Neurological Disorders
Spinal Cord Transection
Trauma Amyotrophic Lateral Sclerosis
Progressive muscle wasting
Guillian-Barre Syndrome-Grounded to brain ascending paralysis
Myasthenia Gravis-Destruction of myelin sheath
Muscular Dystrophy-Progressive weakness and loss of skeletal muscle
Extrapulmonary-Neuromuscular
Interference of nerve transmission or decrease respiratory muscle function-Diaphragm Inability to generate normal respiratory pressures-Decreases TLC, increase RV, and normal FRC Normal lung/chest wall compliance-If you don’t inhale it you cant exhale it
Extrapulmonary Skeletal/Thoracic
Chest Trauma-Single, multiple rib fractures (splinting), Flail chest, Fracture of sternum, Hemothorax/pneumothorax Obesity-Decreased ability to move high mass tissue Deformities of the spine-Structural changes of muscles or bones, Scoliosis, kyphosis, kyphoscoliosis Deformities of Chest Cage-Reduced compliance of chest cage, Pectus excavatum/carinatum, ankylosing spondylitis
Extrapulmonary Pleural Disorders
Pathological disorder of the pleural membrane, and lung expansion will be restricted as there is something occupying the pleural space Pleurisy- Exudate on pleural surface which will increase friction (painful) Ex. Pneumonia, infection, and neoplasms, Pneumothorax, pleural effusion, hemothorax (blood in pleural space, and emphysema
Extrapulmonary Disorders
Includes pleural, skeletal/thoracic
There are different categories of things that can go wrong in the lungs
- Oxygen not coming in
- CO2 not escaping
- Problem in the exchange process between air sac and blood supply
- Something wrong with the blood supply
Problem with Exchange in Alveoli (Ventilation Problems)
- A problem could be the air sac is filled with fluid because it is harder for air to diffuse through fluid rather than empty space so O2 and CO2 get stuck in the fluid
- Less O2 in blood and more CO2 in lungs because its stuck
- Ex. Pneumonia, edema
Perfusion Problems
- Clot in the blood supply around alveolus so it is limiting blood supply around alveolus
- No matter we how much O2 we have we don’t have blood to put it into
- Ex. Pulmonary embolus
- The severity of pulmonary embolus will depend on its location so if it is higher in the bronchus it is more severe
