Diseases of the Respiratory System Flashcards
What are some common causes of respiratory failure?
Airway obstruction (e.g. BOAS) Ruptured diaphragm Pulmonary oedema / haemorrhage Pneumo/haemo/pyo/chylothorax Neoplasia Infection Toxic (e.g. paraquat intoxication)
What are the general signs of respiratory failure?
Cyanosis Distress Inspiratory dyspnoea (stertor/stridor) Expiratory dyspnoea (wheeze/crackles) Dyspnoea/tachypnoea/orthopnoea Tachycardia Weak pulses Collapse Unconsciousness
How can we administer oxygen to conscious and unconscious patients?
Conscious = flow-by / nasal catheter / face mask / oxygen tent / oxygen cage / incubator (may require sedation) Unconscious = ET intubation
What nursing considerations should be have for respiratory disease patients?
Observe/monitor (deterioration) Medication Care of drains/recumbent patient Change in environment/exercise Inhalation therapies Feeding Barrier nursing
What are the signs of URT diseases?
Nasal discharge (unilateral/bilateral, appearance) Sneezing Reverse sneezing Stertor/stridor Other - systemic / CNS signs
How do we carry out a physical examination on an URT disease patient?
Listen for noises Nasal discharge Facial deformity/pain Nasal planum depigmentation Assess airflow bilaterally Assess regional lymph nodes Retropulsion of the eyeballs/exophthalmia Dental / ophthalmic disease?
What investigations can we carry out in conscious URT disease patients?
Routine bloods
Tests for bleeding disorders (platelet count/coagulation factors)
Serology for fungal disease
Viral testing in cats (PCR/ELISA)
What investigations can be carried out in URT disease patients under GA?
Full oral examination
Dental probing
Nasopharyngeal swab in cats
What imaging can we use in URT disease patients?
X-rays (intra-oral nasal views)
CT scan of head
How do we carry out endoscopy in URT disease patients?
Start with retrograde view of nasopharynx
Anterograde rhinoscopy
Nasal flush
Nasal biopsy (histopathology + culture)
What nursing considerations should we have post-rhinoscopy?
Requires GA Painful Can bleed a lot (ice packs on nose, intranasal adrenaline) Be prepared Biopsies often required Consider topical local agent
What nursing care can we provide for nasal disease patients?
Must treat dyspnoea first Try to stop haemorrhage Must remove any foreign object Monitor food/fluid intake Correct and adequate nutrition Removal of dried nasal discharges Grooming Decongestant therapy Isolation for infectious patients
Describe aspergillosis in cats and dogs.
Cats = sino-orbital aspergillosis - brachycephalics predisposed Dogs = sino-nasal aspergillosis - meso/dolichocephalics predisposed
What are the clinical signs of aspergillosis?
Commonly: mucopurulent nasal discharge/epistaxis (unilateral or bilateral), sneezing, nasal pain, nasal depigmentation
Uncommonly: stertor, facial deformity, CNS signs
How can we diagnose aspergillosis?
Serology PCR Imaging (radiography, MRI) Rhinoscopy (plaque identification) Cytology Histopathology Fungal culture
How can we treat aspergillosis?
Mechanical debridement endoscopically - may require trephination to access frontal sinuses
Topical antifungal (clotrimazole) - questionable use if not intact cribriform plate
Oral itraconazole - not generally effective
Often requires referral
Describe tracheal collapse.
Seen in small/toy breeds
Most commonly occurs at thoracic inlet
Unknown aetiology - obesity seems to predispose
Goose-honking cough
Diagnosis = physical examination, X-ray/fluoroscopy to assess tracheal positioning
What nursing considerations should we have for tracheal collapse patients?
Sedation (butorphanol)
Medication - anti-tussive, corticosteroids, bronchodilators
Cage rest, exercise restriction
Harness (no collars)
Oxygen therapy
Long-term = weight loss +/- surgery (stent)
What are the two types of cough receptors?
Mechanical receptors - mucus, foreign body etc.
Chemical receptors - acid, heat etc.
What are the harmful effects of a cough?
Exacerbate airway inflammation/irritation Emphysema Pneumothorax Weakness/exhaustion Dissemination of infections
What are the clinical signs of Lower Respiratory Tract (LRT) disease?
Cough Tachypnoea / dyspnoea Exercise intolerance Weakness Cyanosis Syncope
How do we carry out a physical examination on a LRT disease patient?
Assess patient from a distance - oxygen/sedation needed?
Observe posture, rate + rhythm (inspiratory vs expiratory effort, shallow vs laboured)
Listen - URT noise (stertor/stridor), wheezing
Thoracic auscultation (crackles, wheezes, heart rate + rhythm, murmur?)
What investigations can we carry out on LRT disease patients?
Clinical pathology
Assessment of oxygenation (SpO2/PaO2)
Laryngeal examination (structure / function)
Imaging (radiography, CT scan, ultrasound)
Assessment of pleural space disease
What further investigations are available to LRT disease patients?
Bronchoscopy - collection of bronchoalveolar lavage (BAL)
BALs - cytology, bacterial culture, PCR
Removal of foreign body
What equipment do we need for a bronchoscopy?
Endoscope Sterile saline Collection pots Mouth gag? Urinary catheter Syringes Emergency box/induction agent
What nursing considerations should we have for bronchoscopy patients?
Requires several people
Needs to be quick
Coupage required
Monitor patient very carefully until fully recovered
Things can go wrong very quickly - pneumothorax
Easy access to emergency drugs/oxygen +/- thoracocentesis
Describe Canine Chronic Bronchitis.
Chronic bronchial inflammation with over-secretion of mucus
Common in middle-aged to older dogs
Often concurrent morbidities (tracheal/bronchial collapse, mitral valve disease, pulmonary hypotension)
What are the initial predisposing factors for Canine Chronic Bronchitis?
Kennel cough
Irritants/allergens
Parasites
What is the pathophysiology of Canine Chronic Bronchitis?
Smaller airways become obstructed by mucus
Alteration of mucociliary escalator
Inflammation of lower airways - narrowing
Define bronchomalacia and bronchiectasis.
Bronchomalacia = weakened cartilage Bronchiectasis = end-stage bronchial change
What are the clinical signs of Canine Chronic Bronchitis?
Chronic cough > 2 months (productive) \+/- dyspnoea/tachypnoea \+/- gagging/retching \+/- pyrexia if concurrent pneumonia Wheezes +/- crackles on auscultation
What investigations can we carry out for Canine Chronic Bronchitis?
X-rays/CT scan - bronchial pattern, possible interstitial pattern
Bronchoscopy - bronchoalveolar lavage
How do we treat Canine Chronic Bronchitis?
Management - weight control, harness, avoid smoke/dust/airway irritants
Medication - glucocorticoids, bronchodilators, antibiotics?, anti-tussives?, mucolytics?
Inhaled therapy - once stabilised, for corticosteroids and bronchodilators
How do we deliver antibiotic therapy to suspected Canine Chronic Bronchitis patients?
Depending on BAL result and severity of signs
First line = doxycycline (broad spectrum), empirical treatment for 7-10 days, interpretation in light of BAL culture and clinical response
What is the prognosis for Canine Chronic Bronchitis?
Chronic and progressive condition
Can live for years if well managed
Worse if bronchiectasis or bacterial pneumonia
Possible concurrent mitral valve disease and/or pulmonary hypertension
Describe Canine Infectious Tracheobronchitis.
Also known as ‘kennel cough’
A complex of several viruses, bacteria and other microorganisms may be the cause
Most cases resolve within 14-21 days
Highly contagious!
What nursing considerations should we have for suspected Canine Infectious Tracheobronchitis patients?
Highly contagious - keep away from other animals!
Antibiotic/anti-inflammatory treatment
Cough suppressants may be used
Client education - use of vaccine protocols
Describe Feline lower airway disease.
Spectrum - Feline asthma and Feline bronchitis
Chronic bronchial inflammation with mucus hypersecretion
Young/middle-aged cats
Bronchoconstriction - essential difference to dogs
What are the predisposing factors to Feline lower airway disease?
Bacteria
Virus
Parasites
Irritants/allergens
What is the pathophysiology of Feline lower airway disease?
Type I hypersensitivity (IgE mediated) - histamine and serotonin production by mast cells
Smooth muscle contraction - bronchoconstriction
Oedema and eosinophilic inflammation of lower airways
Mucus hypersecretion
Obstruction of bronchus
What are the clinical signs of Feline lower airway disease?
Wide spectrum - asymptomatic to asthmatic crisis
Cough
Dyspnoea/tachypnoea (open mouth breathing)
Cyanosis
Thoracic auscultation - wheezes (+ crackles if emphysema) (+ dull lung sounds if pneumothorax)
What investigations can we carry out on Feline lower airway disease patients?
Chest X-rays/CT scan - bronchial/interstitial/alveolar pattern, overinflated lungs, pneumothorax (or none)
Bronchoscopy - bronchoalveolar lavage (cytology, PCR, parasitology, bacterial culture)
What nursing considerations should we have for treating emergency Feline lower airway disease patients?
Stress-free Oxygen Bronchodilators Corticosteroids Sedation (butorphanol)
How can we treat Feline lower airway disease?
Management - dust-free litter, no smoking, limit aerosols
Medication - glucocorticoids, bronchodilators, doxycycline?, fenbendazole (parasitic infection)
Inhaled therapy - corticosteroids and bronchodilators once stabilised
What is the prognosis for Feline lower airway disease?
Variable
Chronic = good if treated appropriately
Acute = can be fatal, prompt management is essential
What are the clinical signs of Angiostrongylus vasorum infection?
Wide range - mild to fatal
Chronic cough, acute dyspnoea, severe pulmonary hypertension, syncope
Increased bleeding tendency
Neurologic signs - CNS haemorrhage
What investigations can we carry out in A. vasorum infected patients?
Chest X-rays/CT scan - patchy bronchial, interstitial and alveolar patterns, peripheral distribution, no vascular changes
How do we diagnose A. vasorum infection?
Angio Detect (patient-side blood test) - antigen detection PCR (diagnosis and speciation) Faecal smear Baermann faecal examination Empirical treatment
How do we treat A. vasorum infection?
Moxidectin - 2 doses 30 days apart
Fenbendazole - 25-50mg/kg PO SID for 10-20 days
Post treatment reaction (dyspnoea, ascites, sudden death)
What is the prognosis for A. vasorum infected patients?
Depends on severity of clinical signs.
Describe bacterial pneumonia.
Often mixed flora (aerobic/anaerobic bacteria)
Inhaled bacteria/haematogenous spread
Unilobar/multilobar
Acute/chronic
Associated with abscess, pleural effusion or pneumothorax
What are the predispositions for bacterial pneumonia?
Chronic bronchitis Bronchiectasis Immunosuppression Foreign body Aspiration - bacterial pneumonia/chemical pneumonitis
What are the clinical signs of bacterial pneumonia?
Cough (soft + productive), mixed dyspnoea, tachypnoea, crackles and/or wheezes on auscultation
Pyrexia, lethargy, inappetence
What investigations can we carry out on bacterial pneumonia patients?
Haematology
C reactive protein
SpO2 / PaO2
Chest X-rays/CT scan - alveolar pattern with ventral distribution, haematogenous spread = dorso-caudal distribution, interstitial pattern
How do we treat bacterial pneumonia with antibiotics?
If possible, wait for culture result
Empirical treatment = doxycycline
No antibiotics for aspiration pneumonia - chemical pneumonitis
Duration = 10-14 days then reassessment
What nursing considerations should we have for bacterial pneumonia patients?
Oxygen supplementation if hypoxic
Fluid therapy - dehydration impairs mucociliary defences
Nebulisation - increased mucus fluidity
Bronchodilators?
Mucolytics?
Consider treatment for predisposing factors
What is the prognosis for bacterial pneumonia patients?
Depends on severity of clinical signs
Pneumothorax and abscessation may require lung lobectomy
What is the pathophysiology of pleural space disease?
Pleural effusion = restrictive defect
Gradual collapse of lungs and increased intrathoracic pressure, becoming positive
‘Trapped lung’ secondary to active inflammation/pneumothorax
What happens if a pleural space disease is left untreated?
Decreased cardiac output
Cardiac arrest
Especially for pneumothorax
What is the clinical presentation of a pleural space disease?
Tachypnoea
Restrictive dyspnoea (rapid + shallow breathing)
Paradoxical breathing
Pneumothorax
How does respiratory distress present in pleural space disease patients?
Body position / orthopnoea Mouth-breathing Tachypnoea/hyperpnoea Respiratory noise Cyanosis Restrictive dyspnoea
Describe the three types of dyspnoea.
Inspiratory = upper airway obstruction (increased inspiratory noises) Expiratory = dynamic lower airway obstruction (abnormal auscultation) Mixed = parenchymal disease, + restrictive pattern = pleural space disease
How do we diagnose a pleural space disease?
Chest radiographs if stable
Thoracic ultrasound
Thoracocentesis
Fluid analysis
What fluid analysis tubes do we need for pleural space disease?
1 EDTA tube for cytology
1 plain tube for culture
1 plain tube for biochemistry
What is a thoracocentesis?
Aspiration of air/fluid from the pleural cavity by inserting a needle/catheter/drain via a caudal rib space
How do we prep for a thoracocentesis?
Clipped and aseptic area of skin (usually at 8th rib)
Suitable needle - e.g. butterfly catheter
3 way tap
Extension set if needed
Sterile drapes, gloves, surgical spirit
Local anaesthetic agent
Measuring jug
Placement = cranial aspect of rib (caudal side has nerves/blood vessels)
How do we care for a thoracic (chest) drain?
Can be left to drain continuously or intermittently
Always use aseptic technique
Gloves/good hand hygiene/ sterile syringes/ports/alcohol wipes
Make sure patient is comfortable and calm
Dress with sterile dressing, stocking, Buster collar
Measure if able
Record on hospital notes
What are the four types of fluid that may be removed during thoracocentesis?
Pure transudate (protein-poor)
Modified transudate (protein-rich)
Exudate
Misc. - blood/chyle
Describe pure transudate.
Protein-poor
Clear fluid
Hypoalbuminaemia
Causes = liver failure, protein-losing enteropathy (PLE), protein-losing nephropathy (PLN)
Describe modified transudate.
Protein-rich
Yellow, blood-tinged fluid
Causes = congestive heart failure, pericardial disease, neoplasia, diaphragmatic rupture
Describe exudate.
Turbid fluid
Non-septic (neutrophils/macrophages/eosinophils/lymphocytes, no organisms) - causes = FIP, neoplasia, diaphragmatic hernia, lung lobe torsion, resolving pyothorax
Septic (pyothorax) (degenerate neutrophils, possible intra/extracellular bacteria) - causes = bite, foreign bodies, iatrogenic, parapneumonic
Describe chylothorax.
Milky appearance
Triglyceride in effusion higher than in plasma
Causes = idiopathic, cardiac disease (cats), cranial vena cava thrombosis/mass, heartworm disease, neoplasia
Describe haemothorax.
Hypovolaemia
Causes = anticoagulant rodenticide, coagulopathy, lung lobe torsion, trauma, neoplasia
What underlying diseases can we treat to treat pleural space disease?
Neoplasia Lung lobe torsion Diaphragmatic rupture Pyothorax Chylothorax
What are the causes of pneumothorax?
Traumatic
Spontaneous - blebs, bullae, chronic airway disease (asthma in cats)
Iatrogenic
How does a pneumothorax present?
No lung sounds audible
Hyper-resonant percussion
How do we diagnose a pneumothorax?
Radiography
Ultrasound
How do we treat a pneumothorax?
Rest
Thoracocentesis as required/chest drain
Oxygen therapy
May require continuous drainage/exploratory thoracotomy
What nursing considerations should we have for pneumothorax patients?
Delay diagnostics until stable STRESS = DEATH Obtain SpO2 if able (ideally >95%) Supplement oxygen Consider mild sedation/opioid e.g. butorphanol Thoracocentesis - prep Cover any chest wounds
What is the role of the vet nurse in caring for pleural space disease patients?
Oxygen therapy Observation + monitoring Medication + analgesia Care of wounds/chest drains Fluid therapy Shock treatment Recumbent patient care Feeding + exercise adjustments
