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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
What is the general treatment to avoid status asthmaticus?
Skin test Avoidance of triggering factors Swimming, walking
26
What is measures for acute attacks of status asthmaticus?
Inhalers COntrolled breathing Bronchodilators: Albuterol: short acting Ipratropium: anticholinergic= smooth muscle relaxer Oral Glucocorticoids (Predizone)= decrease inflammation Nebulizers Steroids
27
What is maintance therapy for chronic asthma?
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
28
What are the different types of COPD
1. Emphysema 2. Chronic Bronchitis 3. Bronchiectasis Mainly focusing of emphysema and chronic bronchitis
29
What is COPD and how is it diagnosised?
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
30
LOOK AT POWERPOINT
SLIDE 60
31
What is Emphysema?
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
32
What is the Patho of Emphysema?
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
33
What is emphysema causing progressive difficulty breathing with expiration?
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
What is advanced emphysema?
Loss of tissue Adjacent damage alveoli coalesce forming large air spaces- dead space in the lungs Hypercapnia becomes marked Frequent infections
35
What are the sings and symptoms of emphysema? Remember Pink Puffer
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
What is chronic bronchitis?
Inflammation, obstruction, recurrent infection, chronic cough History of cigarette smoking or living in urban or industrial areas
37
Patho of Chronic Bronchitis
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
What are the signs and symptoms of chronic bronchitis? Remember blue bloater
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
What are the treatments for COPD? Remember does not go away
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
What is Bronchiectasis?
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
What are the clinical manifestations of Bronchiectasis?
Chronic cough with copious amounts of sputum often purulent Recurrent infections Rakes SOB Weight loss Fatigue
42
What is the treatment for Bronchiectasis?
Antibiotics Bronchodilators Chest physiotherapy Treatment of primary condition
43
What is pulmonary edema?
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
Signs of mild pulmonary edema
Cough orthopnea: can not lay down flay because they are drowning in sec reactions Rales from mucus
45
Signs of pulmonary edema with increased congestion, worsening edema
Hemoptysis Frothy sputum often pink or blood tinged Worksing dyspnea Hypoxemia Cyanosis develops in the late stage
46
What is the treatment of Pulmonary Edema?
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
What is Pulmonary emolism (PE)?
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
What are risk factors for pe’S?
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
What are the diagnosis for PE’s?
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
S/s of of a small PE
Transient chest pain Cough Dyspnea may occur
51
S/s of a large PE
Chest pain Tachypnea Dyspnea develops suddenly Hemoptysis and fever Hypoxia stimulates response, with anxiety restlessness and pallor, and teach cardio
52
S/s of a massive PE
Severe crushing chest pain Low blood pressure Rapid weak pulse Loss of consciousness Shock
53
What are prevention measures for a PE?
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
What is the treatment for PE?
Oxygen, Extra Heparin or streptokinase, to prevent more clots Anticoagulants Mechanical ventilation Embolectomy: go in and fish clot out
55
What is atelectasis?
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
What are mechanisms that can result in atelectasis?
- 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
What are clinical manifestation of atelectasis?
Smaller areas are asymptomatic Large areas: -Dyspnea -Increased heart and respiratory rate -Chest Pain - Asymmetric chest expansion on X-ray
58
Treatments results for surgery: atelectasis?
Deep breathing exercises Changing body positions Forced cough TCDB: Turn- cough- deep breath
59
Treatment for atelectasis caused by external pressure
Removal of fluids, tissue or tumor, causing the pressure on the lungs
60
Treatment for atelectasis caused by blockage
Chest clapping or percussion Postural drainage Medications to open airways and loosen mucus
61
What is a pleural effusion?
Presences of excessive fluid in the pleural cavity Causes increased pressure in pleural cavort Separation of pleural membranes Lung cannot fully expand
62
What is the Pleural Effusion Etiology? 1-4
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
What are s/s of pleural effusions
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
What are the three types of a pneumothorax?
Closed, Open, and Tension
65
How is a closed pneumothorax caused?
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
How is an open pneumothorax caused?
Hole in pleural membrane/ chest wall Trauma Air in pleural space
67
How is a tension pneumothorax caused?
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
What is a simple or spontaneous pphyyemothorax?
Tear on the surface of the lung, severity
69
What is a secondary pneumothorax?
Associated with underlying respiratory disease Rupture of an emphysematous blew on lung surface or erosion by a tumor of tubercular cavitation
70
What are s/s of a pneumothorax?
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
What is flail chest?
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
What happens to flail chest during expiration?
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
Emergency treatment for pneumothorax 1-4
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
What is infant respiratory distress syndrome? IRDS
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
Signs and Symptoms of IRDS
Retractions, nasal flaring, respirations rapid and shallow >60 per min Frothy sputum and expiratory grunt
76
Treatment if IRDS
Glucocorticoids for women in premature labor Synthetic surfactant for high risk neonate, through eat tube O2 Therapy Supportive care Steroids
77
Adult respiratory distress syndrome
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
Patho of ARDS
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
S/S of ards
Restlessness, Combination of respiratory and metabolic acidosis, Confusion, decreased levels of consciousness, lethargy, cardiac arrhythmia, shock
80
Treatment for ards
Treat underlying cause, supportive respiratory therapy: intubation, positive end expiratory pressure PEEP, Fluids, prone position, paralysis
81
What is acute respiratory failure
Results from chronic disease, COPD Trauma Neuromuscular diseases
82
S/S of acute respiratory disease and treatment
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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