Final: Ch 23 CF, Restrictive Lung Disease, Pulmonary Embolism, PA HTN, ARDS, RF Flashcards
genetics of cystic fibrosis
autosomal recessive mutation
mutated CF transmembrane regulator channel (Cl-)
impacts of CF on sweat glands and airways
sweat glands: CFTR doesn’t reabsorb secreted Cl-, so very salty sweat
airways: CFTR doesn’t allow Cl- to enter airways, causing lower water content of sputum
respiratory and pancreatic symptoms of CF
respiratory: viscous sputum, chronic bronchitis, respiratory infections
pancreatic: may include exocrine pancreatic insufficiency
diagnosis of CF
sweat test: conductivity and chem analysis
genetic test for CFTR mutation
treatment of CF
postural drainage to clear secretions
antibiotics for infection
deoxytibonuclease breaks down DNA in sputum
oral replacement of pancreatic enzymes
interstitial (restrictive) lung disease causes
inflammation and fibrotic changes to lung tissue
environmental, drugs, immune
alveolar macrophages secrete TGF and fibroblast GF
fibrosis results
symptoms of interstitial (restrictive) lung disease
lower lung volumes and diffusion capacity
dyspnea, tachypnea, cyanosis
low FVC and TLC
normal or even high FEV1/FVC
diagnosis and treatment of interstitial (restrictive) lung disease
Dx: CXR, biopsy
Rx: steroids for inflammation
idiopathic pulmonary fibrosis
unknown cause, smoking risk factor
CXR: patchy infiltrates
survival 3-5 yrs
sarcoidosis
systemic disorder
granulomas form in lung, nodes, or other organs
genetic or environmental
symptoms of sarcoidosis
SOB
non-productive cough
chest pain
weight loss
fatigue
Dx/Rx of sarcoidosis
Dx: H&P, CXR
Rx: remove cause, steroids
pulmonary embolism
any blood-borne substance that lodges in the PA
ex. fat, amniotic fluid, air
most common cause of pulmonary embolism
emboli from DVT of legs
risk factors for DVT
venous stasis - immobilization
trauma
smoking
BCP
symptoms of pulmonary embolism
chest pain
dyspnea
bloody sputum
tachycardia, tachypnea
can cause cardiovascular collapse
Dx of pulmonary embolism
lung scans, CT, angiography
high D-diamer (fibrin degeneration product) indicates clotting
Rx of pulmonary embolism
prevent DVT (anticoagulant therapy)
vena cava plication: insertion of filter in vena cava to catch clots
intermittent pneumatic compression boot
normal pulmonary artery pressure is, and what causes elevations
28/8 (15 mean)
high resistance, blood flow, LAP
2 types of PA HTN
primary
secondary
primary PA HTN
rare, but progressive and deadly
triggers: HIV, autoimmune, hypoxia
familial is autosomal dominant mutation of TGF-beta receptor (SMC proliferation)
secondary PA HTN
secondary to another disease
high pulmonary venous pressure (mitral stenosis, Lt HF)
high pulmonary blood flow (ASD, VSD, PDA)
high resistance (PE, hypoxic pulmonary vasoconstriction)
symptoms of 2ndary PA HTN
dyspnea
peripheral edema
fatigue
Rt HF
Dx/Rx of 2ndary PA HTN
Dx: CXR, echo, Rt heart cath
Rx: vasodilators
Dx/Rx of primary PA HTN
Dx: pulmonary HTN without another cause
Rx: O2, Ca channel blockers, prostacyclin
Cor Pulmonale
Rt HF from lung disease
PA HTN –> RV hypertrophy –> failure
Rx: treat lung disease, give O2
ARDS
highly fatal
common pathway from a range of lung problems
pathologic changes of ARDS
alveolar-capillary memb. disrupted
proteins, fluid, and WBC enter interstitium & alveoli to cause hypoxia
surfactant inactivated (hypoxia, alveolar collapse)
Rx: of ARDS
supportive
give O2
use PEEP
respiratory failure
failure of lungs to deliver O2, or to remove CO2 from blood
causes of respiratory failure
impaired:
ventilation
diffusion
V/Q matcing
hypoxemic respiratory failure
V/Q mismatch seen in COPD
severe hypoxia when low V/Q areas exist
impaired diffusion: thickening of respiratory memb.
O2 therapy
hypercapnia/hypoxemic respiratory failure
hypoventilation decreases minute alveolar ventilation
central (drug OD, head injury), peripheral (Gullian-Barre), mucsular distrophy
produces hypercapnea but not hypoxia until severe
symptoms of respiratory failure
hypoxia: cyanosis, seizures
polycythemia: when chronic hypoxia
hypercapnea: air hunger and headache
Dx of respiratory failure
ABG
pulse oximeter
PA catheter for MV O2
treatment of respiratory failure
O2 therapy
positive pressure mechanical ventilation
intubation of trachea
mask methods?
CXR of pleural effusion vs pneumothorax
PE: white out on affected side
Pneumothorax: blackout on affected side
Why does incentive spirometer work for atelectasis
Produces negative intrapleural pressure to pull open collapsed alveoli
PA HTN produces rt or lt HF?
Rt HF
Distinguish obstructive from restrictive lung disease
Obstructive has a low FEV1/FVC
restrictive has a normal to high FEV1/FVC
