Lecture 9 - Acute respiratory conditions Flashcards
What is atelectasis?
Loss of lung volume due to collapse of lung tissue (alveoli)
What are the 2 causes of atelectasis ?
Compression atelectasis: Physical compression of lung tissue
Resorption atelectasis: Complete obstruction of an airway
Passive atelectasis: Inadequate inspiratory volume
Example of compression atelectasis
ex: pleural effusion, pneumothorax or other space-occupying lesion
examples of resoprtion atelectasis
ex: secretions, mucus plug, tumor
example of passive atelectasis (5)?
neurologic conditions resulting in inspiratory muscle weakness
musculoskeletal conditions that hinder lung expansion
post-anesthetic effects
splinting due to pain
upper abdominal, thoracic surgery, trauma
What impact have atelectasis on:
compliance
work of breathing
dec lung compliance
inc work of breathing
What causes a localized atelectasis
- > hypoxic vasoconstriction usually limits V/Q mismatching
- >relatively normal gas exchange maintained
What causes an extensive atelectasis?
Incr pulmonary arterial pressure overrides the vasoconstriction
intrapulmonary shunt (i.e., blood flows past nonventilated alveoli)
decrgas exchange
symptoms of work of breathing?
nasal flaring, grunting
what are the s/s of atel
- resp & vitals
± Fever
Tachypnea
Dyspnea
If extensive atelectasis – tracheal shift towards affected side with diaphragm elevation
± Wet or dry cough, sputum can range in color depending on reason for atelectasis
What are the findings in auscultation?
Decreased or absent breath sounds over the area
End-inspiratory crackles at involved site
If lobar collapse, absent or bronchial breath sounds
What are the results in PaO2 and SpO2, what does it lead to?
↓ PaO2 and SpO2
- Lung units perfused but not ventilated – “SHUNT”
what are the findings on x-rays concerning atelectasis&
Increased lung opacity, tracheal and mediastinal shift (toward ateleactasis), and diaphragm elevation on CXR
what are the med tx for atelectasis?
Prevention (e.g., airway clearance techniques, breathing exercises, mobilization)
Identification and reversal of the underlying cause
Supplemental O2
What are the physio tx for atelctasis?
Deep breathing with end-inspiratory hold, incentive spirometry
Airway clearance techniques
Positioning and mobilization
What is a pneumonia?
Inflammation of the lung parenchyma as a result of infection
What are the cases of pneumonia (4)?
Inhalation of airborne organism
Bacteria, viruses, mycoplasma, fungi
Hematogenous (circulation)
Occurs more in immuno-suppressed individuals
Infection from trauma or chest tube
Aspiration
Contaminated orophryngeal contents
what conditions are increasing the risk of pneumonia (6)?
Impaired airway defense mechanisms
cigarette smoking,
upper respiratory infection
dehydration
Chronic obstructive lung disease
Hospitalization
Debilitation
Dysphagia
Compromised immune status
What are the 3 anatomical classification of pneumonia?
Bronchopneumonia: spread and involvement along the bronchi and bronchioles.
Lobar pneumonia: localized to one or more lobes of a lung
Interstitial pneumonia (Primary atypical pneumonia): involves interstitial inflammation
What are the etiological classification of pneumonia?
Viral
Bacterial
Fungal
Parasitic
What can be the origin of pathogen in pnemonia (diff names of pneumonia)?
Community-acquired pneumonia
Hospital-acquired (nosocomial) pneumonia
- Ventilator-associated pneumonia (VAP)
What are the s/s of viral pneumonia?
- vit signs
- resp
- body functions
- WBC count
Fever Dyspnea Tachypnea Tachycardia Loss of appetite Myalgia Persistent non-productive cough Normal white blood cell count
What are the findings in auscultation of a viral pneumonia?
Normal breath sounds throughout both lungs with scattered inspiratory crackles.
What are the med tx for viral pneumonia?
Rest Salicylates Antiviral meds: Acyclovir, Amantadine, Tamiflu ↑ Hydration Vaccination (prevention)
What are the common etiology of bact pneumonia?
Gram positive bacteria:
- Pneumococcal
Staphlococcal
Streptococcal pyogenes
Gram negative bacteria: - Hemophilus influenza - Escherichia coli Pseudomonas aeruginosa Enterobacter
What are the s/s of bacterial pneumo?
Fever, possible shaking chills Dyspnea Tachypnea Tachycardia Fatigue, weakness, malaise Pleuritic chest pain over affected lung region Cough with or without expectoration ↓chest expansion of affected area
What are the auscultation findings with bact pneumo?
Bronchial breath sounds (consolidation); crackles, reduced breath sounds
What are the percussion findings with bact pneumo?
Dullness to mediate percussion
What are the PaO2 and PaCO2 findings with bact pneumo?
↓PaO2, PaCO2 may be ↓
What are the x-rays findings with bact pneumo?
CXR: Atelectasis, infiltrates, consolidation
Can you have a tracheal shift with bact.pneumo?
NO TRACHEAL SHIFT with a consolidation
What are med tx for bact.pneumo?
Antibiotic therapy
O2 therapy and mechanical ventilation in certain patients
Adequate hydration and nutrition
What are physio tx for bact.pneumo?
Poor gas exchange: Deep breathing, positioning (side-L opp side of pneumo)
Pain due to coughing or pleurisy: relaxation, supported cough
Secretion clearance techniques for patients producing more than 30 mL of secretions/day or who have impaired cough.
Reduced mobility: bed mobility ambulation
What is a lung abcess?
cavitated infected necrotic lesion within the parenchyma.
What is the etiology of a lung abcess?
aspiration of a foreign body, cavitary TB, obstruction by a neoplasm, unresolved pneumonia, infection of an infarct, sepsis.
What are the s/s of a lung abcess? (5)
depends on size of abscess
- fever, malaise, cough with purulent foul sputum, hemoptysis.
What are the med tx of a lung abcess?
Treatment of the underlying cause
Antibiotic therapy
O2 therapy
Adequate hydration and nutrition
What is the physio tx of a lung abcess?
Deep breathing and positioning if poor gas exchange a problem.
Secretion clearance techniques for retained secretions or if lung abscess draining into the airway.
What is a pleural effusion?
collection of non-purulent fluid in the pleural space
What are the 2 pleural effusion?
Exudates: seen in infectious/inflammatory diseases
Transudates: elevated hydrostatic pressure in the pleural capillaries causing fluid to leave the vascular spaces
What differentiate the 2 pleural effusion?
Ex: high protein content (albumin) and increased inflammatory cells.
Trans: low in protein with no inflammatory cells
Give examples of the 2 pleural effusion condiditons
ex: bacterial or viral pneumonia, pulmonary infarction, malignant tumors, TB, postmyocardial infarction syndrome, acute pancreatitis, cancer of the pleura.
Trans: congestive heart failure, hepatic cirrhosis (dec albu), kidney failure
Pleural effusion s/s (small effusion) - 3?
Rapid or sudden onset of symptoms
Pleuritic chest pain with deep breathing and cough
± Fever, possible shaking chills night sweats
Pleural effusion s/s (large effusion) - 7?
Dyspnea
Mediastinal shift to unaffected side
↓ chest expansion on affected side, ↓ VC
Dry nonproductive cough (irritation)
Absent br. s./ bronchial breathing just above the effusion
Dull to flat over the effusion on mediate percussion
Pleural friction rub
What are the medical interventions for pleural effusion
Rx of underlying cause.
Resolution without intervention.
Thoracocentesis: needle aspiration
Thorascopy: rigid scope used to remove fluid or perform talc pleurodesis (recurrent malignant pleural effusion)
Fluid drained with chest tube (larger effusion)
Surgery to drain fluid and remove adhesions
What are the physio tx for pleural effusion?
Physio Rx: segmental and diaphragm breathing, mobility and arm ROM when chest tube inserted
What is a pleurisy?
inflammation of the pleura
T/F Pleurisy comes with pleural effusion
F
With or without a pleural effusion
In which conditions can we find a pleurisy?
Pneumonia (bacterial, viral), TB, pulmonary infarction connective tissue diseases, chest wall trauma, carcinoma, mesothelioma
What’s a fibrothorax?
Fibrous response of pleurisy leads to scarring and pleural adhesion = Fibrothorax
What are the s/s of a pleurisy?
Pain: dull and nonspecific/sharp and localized
Doorstop breathing
Pleural friction rub
Whats a pneumothorax?
Leakage of air into the pleural spac
Whats the 4 possible causes (mechanisms) of pneumothorax + examples?
Traumatic:
- automobile accident, gunshot, stabbing etc.
Iatrogenic:
- occurring with various cardiac and pulmonary surgeries and biopsies, mechanical ventilation, etc .
Artificial or induced:
- treatment of TB
Spontaneous:
- asthma, CF, pulmonary emphysema, malignancies, and infections.
The pneumothorax s/s will depend on what?
What happens with small?
Depends on the mechanism, severity/size
Small:
asymptomatic
What are s/s of large pneumothorax (4)?
sudden sharp pain and dyspnea
mediastinal shift to the opposite side.
diminished breath sounds
tympanic sound on mediate percussion
What are the tx for pneumothorax (4)?
Simple observation
Needle aspiration
Chest tube
Pleurodesis: a physical attempt to adhere the parietal and visceral pleura (to prevent recurrence).
What can happen with a tension penumothorax (4)?
Check-valve mechanisms permits air to enter but not exit the pleural space
Can compress the ipsilateral lung, mediastinum (heart and vessels) and contralateral lung
↓ cardiac output, hypotension, shock
LIFE-THREATENING!!! (stat chest tube)
Whats a hemothorax?
Hemorrhage into the pleura
Whats a chylothorax?
Traumatic rupture of the thoracic duct which causes lymphatic fluid to enter the pleural space.
Whats a empyema
Localized collection of pus in the pleural cavity
- i.e. effusion that has become infected.
- often accompanied by formation of fibrous adhesions
What are the tx for rib fx?
pain control - no other treatment if rib fractures do not damage the underlying tissue.
What is a flail chest and what are the repercussions?
segment of ribs due to multiple fractures of the rib and/or sternum.
Flail segment moves in the opposite direction of the rib cage on inspiration/expiration.
Restrictive defect: inefficient ventilation, impaired gas exchange.
What can happen with a lung contusion?
Hemorrhage into the lung parenchyma – can lead to hemoptysis.
Decreased lung compliance, ↓ V/Q matching - ↓ PaO2
May resolve in 3 days – risk for pneumonia, empyema and ARDS.
What are the s/s of a chest trauma (6)?
Chest wall pain - especially coughing and sneezing
Splinting
Rapid shallow breathing
Reduced breath sounds, crackles if have atelectasis
V/Q mismatching - ↓ PaO2 with incr PaCO2
Weak cough
What are the tx for chest trauma?
Pain control
Maintain oxygenation: supplemental O2, mechanical ventilation – severe flail chest
Breathing exercises – maintain/improve ventilation
