HLTH 2501: expansion disorders Flashcards
atelectasis
is a collapse of a lung or part of a lung or non aeration; resulting in decreased gas exchange and hypoxia
what happens to the alveoli when they become airless?
they shrivel up as the natural elasticity of the tissue dominates
what exchange of gas is impacted more in atelectasis
O2; CO2 can diffuse easier
what are complications of atelectasis?
necrosis, infection, and permanent lung damage
types of atelectasis mechanisms
obstructive, compression, increased surface tension, fibrotic tissue, and postoperative
obstructive atelectasis
aka resorption; occurs when total obstruction of the airway because of mucus or tumor leads to diffusion into the tissue of air distal to the obstruction
compression atelectasis
results when a mass such as a tumor exerts pressure on a part of the lung and prevents air from entering; this causes the pressure in the pleural cavity to expand, destroying the adhesion
increased surface tension atelectasis
occurs in the alveoli with pulmonary edema or respiratory distress syndrome, preventing expansion
fibrotic tissue atelectasis
when fibrotic tissue in the lungs or pleura restricts expansion, leading to collapse; aka contraction atelectasis
postoperative atelectasis
commonly occurs 24-72 hours after surgery (commonly abdominal) and includes restricted ventilation, slow shallow respirations, and increased secretions
small areas of atelectasis
are asymptomatic
large areas of atelectasis
cause dyspnea, increased heart and respiratory rates, chest pain, and abnormal or asymmetric chest expansion
treatment for atelectasis after a surgery
deep breathing exercises, changing body positions, and forced coughin
treatment for atelectasis caused by external pressure
removal or fluid, tissue, or tumor causing the pressure
treatment for atelectasis caused by blockage
chest clapping or percussion, postural drainage, and medications to open airways and loosen mucus
pleural effusion
is the presence of excessive fluid in the pleural cavity (more than normal)
pleurisy
is a condition in which the pleural membranes are inflamed, swollen, and rough, often in associated with lobar pneumonia; can precede or follow pleural effusion
effects of fluid in the pleural cavity
can prevent expansion of the lung and leads to atelectasis
different types of fluid that may be collected in the pleural cavity?
exudative effusions, transeduates (hydrothrax), and hemothorax
exudative effusions
are a response to inflammation in which increased capillary permeability allows fluid containing proteins and WBCs to leak into the pleural cavity
transudate effusions
aka hydrothorax; are watery effusions that result from increased hydrostatic pressure or decreased osmotic pressure; often is associated with liver or kidney disease
hemothorax effusion
blood in the pleural cavity and is often the result of trauma, cancer, or surgery
signs of pleural effusion
dyspnea, chest pain, increased respiratory and heart trates, absence of breath sounds, tracheal deviation, and hypotension
what indicates a massive effusion?
tracheal deviation and hypotension; this interferes with both respiratory and cardiovascular function
signs of pleurisy
cylic pleuritic pain and a friction rub
treatment for pleural effusion
removing the underlying cause, chest drainage tubes, and thoracocentesis (needle aspiration)
name for needle aspiration
thoracocentesis
pneumothorax
refers to air in the pleural cavity, causing the pleural membranes to separate and for lung expansion to be difficult, leading to atelectasis
hydropneumothorax
when more fluid than air is present in the pleural cavity, but both are; can be caused by tumor or trauma
what can diagnose and determine pneumothorax?
chest X-rays
3 types of pneumothorax
closed, open, and tension
closed pneumothorax
occurs when air can enter the pleural cavity through an opening directly from the internal airways; no opening in the chest wall; can be simple or caused by another disease
simple pneumothorax
occurs when a tear on the surface of the lung allows air to escape from inside the lung through a bronchus and the visceral pleura, into the pleural cavity
result of a simple pneumothorax
as the lung tissue collapses, it seals off the leak
secondary pneumothorax
is associated with an underlying respiratory disease resulting from rupture of an emphysematous bleb on the surface of the lung or erosion by a tumor; lets air pass into the pleural cavity
open pneumothorax
refers to atmospheric air entering the pleural cavity through an opening in the chest wall; can result from trauma or surgery
sucking wound
is used to describe a large opening in the chest wall, in which the sound of air moving in and out makes a typical sucking sound
result of open pneumothorax
causes immediate atelectasis on the affected side; the mediastinum also pushes against the unaffected lung, limiting its expansion
what is the most serious form of pneumothorax
tension pneumothorax
tension pneumothorax
results from an opening through the chest and parietal pleura, or from a tear in the lung tissue and visceral pleura (closed); as a result a one-way valve effect is created, trapping air in the cavity
results of tension pneumothorax
atelectasis, mediastinal contents push against the other lung, serve hypoxia, and respiratory distress
signs of pneumothorax
atelectasis, dyspnea, cough, chest pain, reduced breath sounds over the area, unequal chest expansion, hypoxia (activates a sympathetic response) and hypotension (due to interference with venous return)
flail chest
results from fractures of the thorax; there is often also some edema and bleeding; atelectasis is not a direct result but may occur is a broken rib punctured the pleura
common causes of chest injuries
car accidents and falls
paradoxical movement from flail chest
occurs when chest wall rigidity is lost, causing opposite movement during inspiration and expiration
what occurs during inspiration and chest flail
the flail or broken section of the ribs moves inward instead of outward and this inward movements prevents expansion; the adjacent lung tissue is compressed, causing air to come out and into the other lung
what occurs during expiration and flail chest?
the unstable flail section is pushed outward, airflow may be altered and air from the unaffected lung moves across into the affected lung
mediastinal flutter
occurs when the flail section is large and the mediastinum is pushed to and fro
how is cardiac output reduced during flail chest?
the pressure changes interfere with venous return to the heart, thus reducing CO and O2 supply to cells
IRDS acronym
infant respiratory distress syndrome
another names for IRDS
neonatal respiratory distress syndrome or hyaline membrane disease
normal fetal lung development
during the third trimester, alveolar SA and lung vascularity increase and surfactant in produced
IRDS
occurs when in utero stress affects the maturation of lung tissue; the result is alveoli are difficult to inflate and inadequate blood is supplied to lung tissue; this further results in diffuse atelectasis and the formation of the hyaline membrane
hyaline membrane in IRDS
poor lung perfusion and a lack of surfactant lead to increased alveolar capillary permeability, with fluid and protein (fibrin) leaking into the interstitial area and alveoli, forming this membrane
result of hyaline membrane is IRDS
impairs lung expansion and decrease O2 diffusion; this further results in brain damage due to hypoxia
cycle in IRDS
a cycle develops because of acidosis and the strenuous muscle activity needed to breathe; this leads to anaerobic metabolism and increased lactic acid; this causes pulmonary vasoconstriction, impairing cell metabolism and reducing the synthesis and secretion of surfactant
IRDS causes
premature birth, male children, C-section, and those born to diabetic mothers
signs of IRDS at birth
respiratory difficulty, nasal flaring, subcostal and intercostal retractions, rales, low body temp, and marked chest retractions
later signs of IRDS
respirations become rapid and shallow, frothy sputum, expiratory grunt, blood pressure falls, cyanosis, peripheral edema, signs of hypoxemia, decreased responsiveness, and irregular respirations with periods of apnea
testing for IRDS
ABG analysis and chest-X rays
treatment for IRDS
glucocorticoids given in mothers in premature labor, synthetic surfactant (colfosceril), CPAP ventilation, and nitrous oxide
dangers of high concentrations of O2 for IRDS
can cause pulmonary damage (bronchodysplasia) and retrolental fibroplasia; this can cause damage to the retina and eye
ARDS acronym
adult respiratory distress syndrome
ARDS other names
aka shock lung, wet lung, stiff lung, and postperfusion lung
ARDS precipitating causes
usually precipitated by sepsis, prolonged shock, burns, aspiration, and smoke inhalation
ARDS
is a restrictive lung disorder that results from injury to the alveolar wall and leads to an inflammation response (release of mediators, increased permeability, increased fluid and proteins); damage to lung tissue may result from neutrophils releasing proteases and other mediators
what cells are damaged in ARDS
surfactant producing cells
what is the result of ARDS?
decreased diffusion of O2, reduced blood flow to the lungs, difficulty expanding the lungs, and diffuse atelectasis; tidal volume and vital capacity are also reduced
how does the tissue of the lungs change in ARDS?
hyaline membranes form from protein-rich fluid in the alveoli, platelet aggregation and microthrombi form in the pulmonary circulation which causes stiffness, necrosis, and fibrosis
potential complications of ARDS
CHF and pneumonia
cause of ARDS
ischemic damage to the lung tissue via inhalation of toxic chemicals or smoke, excessive O2 concentration in inspired air, severe viral infections, toxins gram-negative bacteria, fat emboli, explosions, aspirations of acidic gastric contents or lung cancer
early signs of ARDS
dyspnea, restlessness, rapid, slow respirations, increased HR, decreased in O2 partial pressure, rales, productive cough, frothy sputum, cyanosis, confusion, and metabolic/respiratory acidosis
treatment for ARDS
O2 therapy and manual ventilation
acute respiratory failure
can be the result of many pulmonary disorders and is when O2 partial pressure is less than 50 mm Hg or CO2 partial pressure is greater than 50 mm Hg
normal O2 and CO2 partial pressure values
O2 is 80-100 mm Hg and CO2 35-45 mm Hg for
what system is mainly affected from acute respiratory failure
CNS, including the respiratory centre
respiratory insufficiency
is an interim state when blood gases are abnormal but cell function continues
primary problem causing acute respiratory failure
vasoconstriction that results from low O2 levels or acidosis
respiratory arrest
refers to cessation of respiratory activity and is quickly followed by cardiac arrest
causes of acute respiratory failure
often from acute or chronic disorders (or combinations), including neuromuscular disorders
example of a chronic disorders leading to acute respiratory failure
emphysema
example of a combination of chronic and acute disorders causing acute respiratory failure
early stage of emphysema and then is complicated by pneumonia or pneumothorax
examples of an acute respiratory disorder causing acute respiratory failure
chest trauma, pulmonary embolism, or acute asthma
examples of neuromuscular diseases that may cause acute respiratory failure
myasthenia gravis, ALS, and muscular dystrophy
signs of acute respiratory failure
rapid, shallow and labored respirations, hypoxia and hypercapnia, headache, tachycardia, lethargy and confusion
