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Pathophysiology Taylor > Exam # 2: Obstructive Lung Disease > Flashcards

Exam # 2: Obstructive Lung Disease Flashcards

1
Q

What is Cystic Fibrosis, How is it caused, what is the patho?

A

Gentic: both mom and dad have genes
Autosomal recessive disorder
Mutation to CFTR gene: affects chloride ion transports in the cell membrane
Defects in the exocrine glands cause abnormally thick secretions- clog passages
Affects multiple systems, not just respiratory

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2
Q

What are the Signs and symptoms of CF (Cystic Fibrosis)?

A
  • Chronic cough
  • Ronchi, lung sound
  • Hypoxia
  • Frequent respiratory infection: early onset in kids
  • Exercise intolerance
  • Failure Meet normal growth milestones
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3
Q

What is the patho of CF?

A

-Affects the mucus secreting glands resulting in respiratory, GI tract, and reproductive tracts having thickened secretions
- Tihick, sticker mucus obstructing airflow in bronchioles in small bonchi
- Increase infection cause such as Psudomnas, Staphylcoccus
- Permanent bronchiectasis and emphysematous changes results from fibrosis and obstruction
- Respiratory failure develops and is most common cause of death

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4
Q

How does CF affect the GI system?

A

Blocks pancreatic diets and decreases the digestive enzymes causing malabsorption and malnutrition

If sever enough it can start destroying pancreatic tissue resulting in diabetes

Obstruction of bile dicts which cannot absorb fats and fat soluble vital means

Severe enough it can cause biliary cirrhosis

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5
Q

What are signs and symptoms CF has affected the GI System?

A

Meconum ileus newborns- often FIRST sign of CG
Signs of malabsorption - Can not gain weight
Steatorrhea, bulky, fat, foul stools

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6
Q

How does CF affect the reproductive tract?

A

Sterility or infertility- particularly in males

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7
Q

What does CF do to the sweat glands?

A

Hot weather and or strays exercise leads to excessive loss of electrolytes
Salty skin

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8
Q

Testing for CF

A

Genetic Testing
Sweat test: typically used for babies, taste salty

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9
Q

What are the main treatments for CF? X7

A

Replacement therapy for pancreatic enzymes (pancrelipase) with every meal and snack!!!! ESSENTIAL— Digest

Well balanced diet: High protein, vitamin supplements, increased daily intake

Chest physiotherapy: postural drainage, percussion, coughing techniques, vest, pt, change in positions

Bronchodilators and humidifiers to promote drainage

Regular moderate aerobic exercises

Immediate aggressive Treatment for infection is required: put on a broad spectrum antibiotic until we figure out specifics bacteria for a better antibiotic

Oxygen Supplementation

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10
Q

Lung Cancer Pathology

A

90% of cases are related to smoking
Primary is when the cancer starts, Secondary the tumor has metasized

Patho:
1. Metaplasia first- change in tissue secondary to smoking or chronic irritation,,, reversible if irritation stops
2. Loss of normal protective ciliated, pseudostratified epithelium
3. Various chemicals in cigarette smoke are carcinogenic and acts as initiators and promoters
4. Dysplasia or carcinoma in situ develops

  • Cylia cleans the lungs
    1. Metaplasia
    2. Dysplasia
    3. Neoplasia
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11
Q

What are the early signs and symptoms of lung cancer?

A

Insidious onset
Persistent productive cough, wheeze, dyspnea
Hemoptysis (coughing up blood)
Shortness of breath

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12
Q

What are signs and symptoms of lung cancer?
Symptoms are according to location of area it has spread to, can spread to anywhere

A

Obstruction of airflow by tumor growth— abnormal breath sounds, dyspnea

Inflammation— cough and predisposition to secondary infections

Pleural effusion, hempthorax, pneumothorax seen in tumors on the lung periphery- inflammation and erosion of the pleural membrane

Paraneoplastic syndrome (bronchogenic carcinoma): Tumor cell secretes hormones or hormone like substances— sometimes

Systemic Effects: fatigue, anorexia, weight loss

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13
Q

What are the treatments and test used for lung cancer?

A

Test:
CT Scan and MRU
Bronchoscope
Biopsy and mediastiniscopy
Treatment:
Surgical resection or lobectomy
Chemo and Rediation
Photodynamic therapy

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14
Q

What is aspiration?

A

Passage of food, fluid, eyes is, other foreign material into trachea and lungs

Complications in an individual of any age when swallowing or gag reflex is depressed…. After anesthesia or stroke

Laying down eating and drinking clean lead to this

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15
Q

Clinical Manifestations of aspiration

A

Cough, choking, strider, hoarseness, tachycardia, tachypnea , respiratory distress, loss of voice if total obstruction

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16
Q

Aspiration Complications X4

A

Aspiration Pneumonia: Inflammation gas diffusion is impaired

Respiratory Distress Syndrome: May develop if inflammation is widespread

Pulmonary Abscess: May develop if microbes are in aspirate

Systemic Effects: When aspirated materials are absorbed into the blood

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17
Q

Treatment for Aspiration

A

Prevention is key!!!!!
Will ONLY NEED antibiotic therapy if aspiration pneumonia develops

Emergency Treatment
1. Hamlisch maneuver
2. Infant: Back blows, sweep only if you can get the object

Trach pt. Only until you can get them into the OR

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18
Q

Sleep Apnea Potential Complications

A

Chronic hypoxia and fatigue: b/c you can not get into a true deep sleep
Diabetes 2
Pulmonary hypertension -> High blood pressure in lungs-> vessels in between heart and lungs

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19
Q

Treatment of Sleep Apnea

A

Sleep Hygine
Continuous positive airway pump CPAP
Oral appliances that reduce collapse of pharyngeal tissue: fancy mouth guard, only for very mild cases

This can also cause low Oxygen during the day

Te CPAP is constant pressure to prevent the airway from closure, use distilled water to prevent bacteria which can lead to a lung infection

CPAP is a one way valve and automatic
BIPAP: 2 levels to it breathing in and out
= both very effective

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20
Q

Asthma Triggers

A

Hypersensitive airway or hyperresponsive airways
Often family or personal history of allergic conditions such as eczema, allergic rhinitis, hay fever
Triggers:
Respiratory Infection
Stress
Weather Change
Inhalation air irritants
Exercise

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21
Q

What is the Patho of asthma?

A

Changes of bronchi and bronchioles
1. Inflammation of the mucosa
2. Bronchoconstrictionc caused by contraction of smooth muscle
3. Increased section of thick mucus in airway

Changes create obstructed airways, partially or fully

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22
Q

What are signs and symptoms of asthma?

A

Cough, marked dyspnea, chest tightness, wheezing (air sneaking into the airway), Rapid and labored breathing, thick or sticky mucus, tachycardia (heart picking up the slack), hypoxia

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23
Q

What is happening in the Respiratory system while having asthma attacks?

A
  1. Respiratory Alkalosis: Initially caused by hyperventilation. Blowing off all CO2= Hyperventilation
  2. Later- Respiratory acidosis: Caused by air trapping
  3. Sever Respiratory Distress: Hypoventalation leads to hypoxia and respiratory acidosis, Can not reverse it, Less and less responsive
  4. Respiratory failure: Indicating y decreasing responsiveness and cyanosis
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24
Q

What is Status Asthmatics

A

Persuistent severe attack of asthma
Does not respond to usual therapy
Medical emergency
May be fatal because of severe hypoxia and acidosis

REMEMBER VIDEO WATCHED IN CLASS

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25
Q

What is the general treatment to avoid status asthmaticus?

A

Skin test
Avoidance of triggering factors
Swimming, walking

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26
Q

What is measures for acute attacks of status asthmaticus?

A

Inhalers
COntrolled breathing
Bronchodilators:
Albuterol: short acting
Ipratropium: anticholinergic= smooth muscle relaxer
Oral Glucocorticoids (Predizone)= decrease inflammation
Nebulizers
Steroids

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27
Q

What is maintance therapy for chronic asthma?

A

Daily inhalers meant to decrease frequency of asthma attacks

Use of maintaince inhalers or drugs
1. LABA: long acting bronchodilators
2. ICS: Inhaled corticosteroids
3. LAMA: Long acting anti muscarinic

Neither is effective for acute attacks

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28
Q

What are the different types of COPD

A
  1. Emphysema
  2. Chronic Bronchitis
  3. Bronchiectasis

Mainly focusing of emphysema and chronic bronchitis

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29
Q

What is COPD and how is it diagnosised?

A

Group of chronic respiratory disorders that cause irreversible and progressive damage to lungs

Caused difficulty doing ADLS

May lead to right sided heart failure and or respiratory failure

Diagnosed via imaging and pulmonary function test (PFTs), hyperflation, damaged alveoli

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30
Q

LOOK AT POWERPOINT

A

SLIDE 60

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31
Q

What is Emphysema?

A

Destruction of alveolar walls and septae, leads to large, permanently inflated alveolar air space, sticks does not move

Causes:
Smoking, Nonsmokers, alpha 1 antitrypsin deficiency genetic component
Exposure to other air pollutants

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32
Q

What is the Patho of Emphysema?

A

Breakdown of alveolar walls resulting in:
Loss of surface area for gas exchange
Loss of pulmonary capillaries
Loss of elastic fibers
Altered Ventialtion perfusion ratio

Fibrosis: Scar tissue
Narrowed airways
Weakened walls
Interference with passive expiratory airflow

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33
Q

What is emphysema causing progressive difficulty breathing with expiration?

A

Air trapping and increased residual volume: air left overinflated lungs
Over inflation of lungs
Fixation of rinbs: increased anterior
Posterior diameter of thorax: BARREL CHEST -> Chronic hyperinflation of lungs = increase chest capacity

34
Q

What is advanced emphysema?

A

Loss of tissue
Adjacent damage alveoli coalesce forming large air spaces- dead space in the lungs
Hypercapnia becomes marked
Frequent infections

35
Q

What are the sings and symptoms of emphysema? Remember Pink Puffer

A

Purse lip breathing: puckered limped
Barrel Chest
Exertional Dyspnea
Oxygen is needed at some point, want to keep pt above 80%
Increase CO2 Retension
No cyanosis
Ineffective cough
Thin appearance
Leads to Right Side heart failure

36
Q

What is chronic bronchitis?

A

Inflammation, obstruction, recurrent infection, chronic cough
History of cigarette smoking or living in urban or industrial areas

37
Q

Patho of Chronic Bronchitis

A

Mucosa inflamed and swollen
Hypertrophic and hyperplasia of mucous glands -> too much mucus
Fibrosis and thickening of bronchial walls
Hypoxic
Sever dyspnea and fatigue

38
Q

What are the signs and symptoms of chronic bronchitis? Remember blue bloater

A

Airway flow problem
Dusty cyanotic skin tent
Recurrent cough and increase sputum production
Hypoxia
Hypercapnia -> increase pCO2
Respiratory acidosis
Increase Hbg and Respiratory rate Increase incidence in smokers

39
Q

What are the treatments for COPD? Remember does not go away

A

Cessation smoking and reeducation of exposure to irritants
Prompt treatment of infections
Stay up to date on vaccines
Chest physiotherapy: postural drainage and percussion
Low flow Oxygen: 80% minimum, 92% is good
Nutritional supplements and adequate hydration
Pulmonary rehabilitation for ADLS
Breathing techniques: pursed lips breathing
Medications
1. Ecoectorants chronic bronchitis
2. Bronchodilators short and long acting

40
Q

What is Bronchiectasis?

A

Irreversible abnormal dial action of the medium sized bronchitis

Arises from recurrent inflammation and infection leading to obstruction of airways, weakening of muscle and elastic fibers in bronchial walls or both

Large amounts of fluid constantly collect in those areas and become infected with bacteria ex. Strep

Completely changes tissue

41
Q

What are the clinical manifestations of Bronchiectasis?

A

Chronic cough with copious amounts of sputum often purulent

Recurrent infections
Rakes
SOB
Weight loss
Fatigue

42
Q

What is the treatment for Bronchiectasis?

A

Antibiotics
Bronchodilators
Chest physiotherapy
Treatment of primary condition

43
Q

What is pulmonary edema?

A

Fluid collection in the alveoli and intestinal area
Can result from primary conditions such as heart failure
Reduces amount of oxygen diffusing into blood and interferes with lung expansion (O2 does not like to swim far)

44
Q

Signs of mild pulmonary edema

A

Cough
orthopnea: can not lay down flay because they are drowning in sec reactions
Rales from mucus

45
Q

Signs of pulmonary edema with increased congestion, worsening edema

A

Hemoptysis
Frothy sputum often pink or blood tinged
Worksing dyspnea
Hypoxemia
Cyanosis develops in the late stage

46
Q

What is the treatment of Pulmonary Edema?

A

Treat the cause
Can be reversible
Supportive Oxygen care— supplemental O2
Position upright to give more room to expand
Diuretics: get rid of excessive flood
TREAT CHF (Congested heart failure) first
Some may require positive pressure mechanical ventilation to keep alveoli open

47
Q

What is Pulmonary emolism (PE)?

A

Blood clot or mass that obstructs pulmonary artery or any of its branches
Effects of embolus depends on material size and location:
-Smaller pulmonary embolus might be silent unless they involve a large area of the lung
-Large embolus may cause sudden death

90% of PE’s originate from deep vein thromboses in legs and are preventable

48
Q

What are risk factors for pe’S?

A

Immobility
Trauma or surgery to the legs
Child Birth
Congestive heart failure
Dehydration: less volume going through
Increased coagulablity of the blood: different clotting
Cancer: trigger

49
Q

What are the diagnosis for PE’s?

A

D Dimmer lab
Radio pop graphs, lung scan, mru, pulmonary angiography (Cath lab)

VQ SCAN is main= ventilation vs perfection, which is lack of perfusion in lungs

50
Q

S/s of of a small PE

A

Transient chest pain
Cough
Dyspnea may occur

51
Q

S/s of a large PE

A

Chest pain
Tachypnea
Dyspnea develops suddenly
Hemoptysis and fever
Hypoxia stimulates response, with anxiety restlessness and pallor, and teach cardio

52
Q

S/s of a massive PE

A

Severe crushing chest pain
Low blood pressure
Rapid weak pulse
Loss of consciousness
Shock

53
Q

What are prevention measures for a PE?

A

Educate prior to surgery
Antiemebolic stocks, Ted hose
Early ambulation
ROM Exercisee if bedbound
SCDs
Use of anticoagulant prophylaxis (heparin or lovenox) before for prevention

54
Q

What is the treatment for PE?

A

Oxygen, Extra
Heparin or streptokinase, to prevent more clots
Anticoagulants
Mechanical ventilation
Embolectomy: go in and fish clot out

55
Q

What is atelectasis?

A

Collapse or part of the lung not getting air into alveoli= no gas exchange
Ex. Puss

Non-aeration or collapse of part of a lung
Alveoli becomes airless -> decreased gas exchange and hypoxia

56
Q

What are mechanisms that can result in atelectasis?

A
  • Obstruction: resorption atelectasis- caused by total obstruction of airway
  • Compression: atelectasis- mass or tumor experts pressure on part of the lung
  • Increased surface tension in alveoli: prevents expansion of lung
  • Fibrotic tissue: in lungs or pleura- May restrict expansion and lead to collapse
    -Postoperative: atelectasis- can cue after surgery
57
Q

What are clinical manifestation of atelectasis?

A

Smaller areas are asymptomatic
Large areas:
-Dyspnea
-Increased heart and respiratory rate
-Chest Pain
- Asymmetric chest expansion on X-ray

58
Q

Treatments results for surgery: atelectasis?

A

Deep breathing exercises
Changing body positions
Forced cough
TCDB: Turn- cough- deep breath

59
Q

Treatment for atelectasis caused by external pressure

A

Removal of fluids, tissue or tumor, causing the pressure on the lungs

60
Q

Treatment for atelectasis caused by blockage

A

Chest clapping or percussion
Postural drainage
Medications to open airways and loosen mucus

61
Q

What is a pleural effusion?

A

Presences of excessive fluid in the pleural cavity
Causes increased pressure in pleural cavort
Separation of pleural membranes
Lung cannot fully expand

62
Q

What is the Pleural Effusion Etiology? 1-4

A

Do not get caught up on the following 2:
1. Exudative effusion: Fluid with protein and WBCs, Response to inflammation: tumor
2. Transudate effusion: water effusion, hydro thorax, kidneys/liver, results of increased hydrostatic pressure or decrease osmotic pressure in blood vessels
3. Hemothorax: blood, traumatic injury, cancer, surgery
4. Pus, inflection, Pneumonia

63
Q

What are s/s of pleural effusions

A

Analyze fluid to confirm cause
Remove underlying cause to treat respiratory impairment
Chest drainage, Torrance tests to remove fluid and relieve pressure
Chest tube placement

64
Q

What are the three types of a pneumothorax?

A

Closed, Open, and Tension

65
Q

How is a closed pneumothorax caused?

A

No external hole in body, just a hole in the lying
Air in pleural space

Atmospheric pressure air enters the plural cavity though an opening in the chest wall
Sucking wound
Large opening in chest wall

66
Q

How is an open pneumothorax caused?

A

Hole in pleural membrane/ chest wall
Trauma
Air in pleural space

67
Q

How is a tension pneumothorax caused?

A

Build up air, can not escape and shifts the trachea
Pushed on the heart
Air in pleural space increasing and unable to escape

Most serious form
Results of an opening through chest wall and partial pleura or form a tear in the lung tissue and visceral pleura
Think one way valve
Air enters into pleural cavity on insipiration but hole closes on expiration
Trapping air leads to increased pleural pressure and atelectasis

68
Q

What is a simple or spontaneous pphyyemothorax?

A

Tear on the surface of the lung, severity

69
Q

What is a secondary pneumothorax?

A

Associated with underlying respiratory disease
Rupture of an emphysematous blew on lung surface or erosion by a tumor of tubercular cavitation

70
Q

What are s/s of a pneumothorax?

A

Atelectasis: does not sound the same: area where you do not hear breath sounds
Breath sounds are reduced or absent
Unequal chest expansion
Mediastinal shift

71
Q

What is flail chest?

A

Results from fracture of ribs (MVA, Falls) which allow ribs to move independently during respiration
During inspiration:
- Flair or broken section move inward rather than outward
- Inward movement prevents expansion of affected lung
- Large flail section can compress adjacent lung tissue

72
Q

What happens to flail chest during expiration?

A

Unstable fail section pushes outward by increased inter thoracic pressure
Paradoxical movement of ribs alter airflow during expiration
Air from unaffected lung moves across to affected lung
Hypoxia results from limited expansion and decrease inspiratory volume

73
Q

Emergency treatment for pneumothorax 1-4

A
  1. Hospital
  2. Cover with occlusive dressing to prevent air from moving in and out
  3. Do not remove any penetrating objects
  4. If possible, tension pneumothorax should be converted to an open thorax, by removing loose tissue or enlarging the opening.
74
Q

What is infant respiratory distress syndrome? IRDS

A

Usually related to premature births
Lack of surfactant in alveoli
Poorly developed alveoli are difficult to inflate
- diffuse atelectasis results
- decrease pulmonary blood flow -> pulmonary vasoconstriction -> severe hypoxia
Poor lung perfusion and lack of surfactant

75
Q

Signs and Symptoms of IRDS

A

Retractions, nasal flaring, respirations rapid and shallow >60 per min
Frothy sputum and expiratory grunt

76
Q

Treatment if IRDS

A

Glucocorticoids for women in premature labor
Synthetic surfactant for high risk neonate, through eat tube
O2 Therapy
Supportive care
Steroids

77
Q

Adult respiratory distress syndrome

A

Caused by multi duet of predisposing conditions
Systemic sepsis, prolonged shock and burns, aspiration, smoke inhalation
Inhalation of toxic chemicals, excessive oxygen concentration in inspired air, severe viral infections
Occurs 1-2 days after the precipitating event
Often associated with multiple organ dysfunctions or failures

78
Q

Patho of ARDS

A

Results from injury to the alveolar walls and capillary membranes
Causes the release of chemical mediators
-Increase permeability of alveolar capillary membranes
-Increased fluid and protein in interstitial area and alveoli
-Damage to surfactant producing cells
-Diffuse necrosis and fibrosis if pt survives, outcome very low

79
Q

S/S of ards

A

Restlessness, Combination of respiratory and metabolic acidosis, Confusion, decreased levels of consciousness, lethargy, cardiac arrhythmia, shock

80
Q

Treatment for ards

A

Treat underlying cause, supportive respiratory therapy: intubation, positive end expiratory pressure PEEP, Fluids, prone position, paralysis

81
Q

What is acute respiratory failure

A

Results from chronic disease, COPD Trauma Neuromuscular diseases

82
Q

S/S of acute respiratory disease and treatment

A

Hypoxia, Hypercapnia, headache, confusion= due to lack of O2 to the brain, neuro manifestations

Primary problem must be resolved

Pathophysiology Taylor (5 decks)

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