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final review > Classification of Respiratory Disease > Flashcards

Classification of Respiratory Disease Flashcards

1
Q

Diseases

A

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

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2
Q

Disorder

A

A derangement or abnormality of a function

Morbid physical or mental state

Something that results from a disease

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3
Q

Acute

A

Illness that appear quickly and can be serious or life threatening

After the illness ends the patients should return to normal

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4
Q

Chronic

A

Illness of a long duration

Describes a disease that has a slow prognosis

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5
Q

Classification Between Obstructive and Restrictive Diseases

A

Based on history, clinical manifestation, and pulmonary function studies

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6
Q

Obstructive Lung Diseases

A

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

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7
Q

RESTRICTIVE LUNG DISEASE

A

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

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8
Q

Upper Airway

A

nasal cavity, oral cavity, pharynx, and larynx

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9
Q

Etiology of Upper Airway Obstruction

A

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

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10
Q

Intraluminal Obstruction

A

Something inside of the airway lumen that is blocking/narrowing the airway

Ex. Foreign bodies, secretions

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11
Q

Intramural Obstructions

A

Lesion inside bronchial wall, swelling

Ex. Neoplasms

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12
Q

Extramural Obstruction

A

External pressure causing airway narrowing

Ex. Enlarged lymph nodes, carcinoma, and lymphoma

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13
Q

Pathologies of Upper Airway Obstruction

A

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

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14
Q

Signs of Upper Airway Obstruction

A
  1. Hot Potatoe Voice
  2. Difficulty Swallowing Secretions-Drooling
  3. Dyspnea
  4. Stridor-Mean obstruction immenient
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15
Q

Lower Airway

A

bronchi, bronchioles, and alveoli

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16
Q

Causes of Lower Airway Obstruction

A

Emphysema

Chronic Bronchitis

Asthma

Cystic Fibrosis

Bronchiectasis

Bronchiolitis

Bronchial compression (tumor)

Endobronchial tumors

Foreign Body

Mucous plugging

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17
Q

Conditions that lead to a decrease in compliance

A

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)

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18
Q

Intrapulmonary Causes

A

Includes interstitial disorders and alveolar disorders

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19
Q

Interstitial disorders

A

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

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20
Q

Alveolar Disorders

A

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

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21
Q

Extrapulmonary Disorders

A

Includes pleural, skeletal/thoracic

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22
Q

Extrapulmonary Pleural Disorders

A

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

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23
Q

Extrapulmonary Skeletal/Thoracic

A

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

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24
Q

Extrapulmonary-Neuromuscular

A

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

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25
Q

Neurological Disorders

A

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

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26
Q

Obstructive Pulmonary Disorder Clinical Manifestation

A

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

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27
Q

Restrictive Pulmonary Disorder Clinical Manifestation

A

Dyspnea on exertion Non productive cough Hypo-resonant or normal percussion notes Fine bilateral inspiratory crackles Rapid shallow breathing

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28
Q

PULMONARY DIFFUSION CAPACITY

A

Decreased DLCO is a hallmark finding in emphysema

Decreased if combined with moderate to severe atelectasis, consolidation, A/C membrane thickness increases

29
Q

Types of Obstructive Lung Diseases

A

Chronic Bronchitis Emphysema Asthma Bronchiectasis Cystic Fibrosis

30
Q

Type I Respiratory Failure

A

Oxygenation Failure “a more specific term indicating an arterial oxygen tension of less than 60 mmHg despite an FiO2 of 0.50 or higher.”

31
Q

Type 2 Respiratory Failure

A

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.”

32
Q

5 Signs of Hypoxemia

A

Decreased Inspired O2

Decrease Alveolar Ventilation

Increased Dead Space

Increased Shunt

Decreased Diffusion Across AC Membrane

33
Q

Signs of Cyanosis

A

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%

34
Q

Decreased Alveolar Ventilation

A

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

35
Q

Increased Dead Space

A

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

36
Q

Increase Alveolar Shunt

A

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

37
Q

Decreased Diffusion

A

Increase in tissue distance or a shorten time for pulmonary gas exchange Fibrosis, 3rd spacing

38
Q

Hypoxemia vs. Hypoxia

A

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

39
Q

Hypoxemia

A

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.

40
Q

Type 1 Acute Oxygenation Failure Clinical Manifestations

A

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

41
Q

Type 2-Impending Ventilatory Failure

A

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

42
Q

Type 2 Acute Ventilatory Failure

A

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

43
Q

Type 2 Chronic Ventilatory Failure

A

Normal pH with elevated PaCO2 and HCO3

44
Q

Obstructive Pulmonary Disorder Clinical Manifestation

A

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

45
Q

Restrictive Pulmonary Disorder Clinical Manifestation

A

Dyspnea on exertion Non productive cough Hypo-resonant or normal percussion notes Fine bilateral inspiratory crackles Rapid shallow breathing

46
Q

PULMONARY DIFFUSION CAPACITY

A

Decreased DLCO is a hallmark finding in emphysema

Decreased if combined with moderate to severe atelectasis, consolidation, A/C membrane thickness increases

47
Q

Types of Obstructive Lung Diseases

A

Chronic Bronchitis Emphysema Asthma Bronchiectasis Cystic Fibrosis

48
Q

Type I Respiratory Failure

A

Oxygenation Failure “a more specific term indicating an arterial oxygen tension of less than 60 mmHg despite an FiO2 of 0.50 or higher.”

49
Q

Type 2 Respiratory Failure

A

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.”

50
Q

5 Signs of Hypoxemia

A

Decreased Inspired O2

Decrease Alveolar Ventilation

Increased Dead Space

Increased Shunt

Decreased Diffusion Across AC Membrane

51
Q

Signs of Cyanosis

A

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%

52
Q

Decreased Alveolar Ventilation

A

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

53
Q

Increased Dead Space

A

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

54
Q

Increase Alveolar Shunt

A

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

55
Q

Type 2 Chronic Ventilatory Failure

A

Normal pH with elevated PaCO2 and HCO3

56
Q

Type 2 Acute Ventilatory Failure

A

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

57
Q

Type 2-Impending Ventilatory Failure

A

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

58
Q

Type 1 Acute Oxygenation Failure Clinical Manifestations

A

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

59
Q

Hypoxemia

A

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.

60
Q

Hypoxemia vs. Hypoxia

A

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

61
Q

Decreased Diffusion

A

Increase in tissue distance or a shorten time for pulmonary gas exchange Fibrosis, 3rd spacing

62
Q

Neurological Disorders

A

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

63
Q

Extrapulmonary-Neuromuscular

A

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

64
Q

Extrapulmonary Skeletal/Thoracic

A

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

65
Q

Extrapulmonary Pleural Disorders

A

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

66
Q

Extrapulmonary Disorders

A

Includes pleural, skeletal/thoracic

67
Q

There are different categories of things that can go wrong in the lungs

A
  • Oxygen not coming in
  • CO2 not escaping
  • Problem in the exchange process between air sac and blood supply
  • Something wrong with the blood supply
68
Q

Problem with Exchange in Alveoli (Ventilation Problems)

A
  • 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
69
Q

Perfusion Problems

A
  • 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

final review (27 decks)

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