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PHTH554 - Cardiology > Lecture 9 - Acute respiratory conditions > Flashcards

Lecture 9 - Acute respiratory conditions Flashcards

1
Q

What is atelectasis?

A

Loss of lung volume due to collapse of lung tissue (alveoli)

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2
Q

What are the 2 causes of atelectasis ?

A

Compression atelectasis: Physical compression of lung tissue

Resorption atelectasis: Complete obstruction of an airway

Passive atelectasis: Inadequate inspiratory volume

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3
Q

Example of compression atelectasis

A

ex: pleural effusion, pneumothorax or other space-occupying lesion

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4
Q

examples of resoprtion atelectasis

A

ex: secretions, mucus plug, tumor

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5
Q

example of passive atelectasis (5)?

A

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

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6
Q

What impact have atelectasis on:
compliance
work of breathing

A

dec lung compliance

inc work of breathing

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7
Q

What causes a localized atelectasis

A
  • > hypoxic vasoconstriction usually limits V/Q mismatching

- >relatively normal gas exchange maintained

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8
Q

What causes an extensive atelectasis?

A

Incr pulmonary arterial pressure overrides the vasoconstriction

intrapulmonary shunt (i.e., blood flows past nonventilated alveoli)

decrgas exchange

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9
Q

symptoms of work of breathing?

A

nasal flaring, grunting

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10
Q

what are the s/s of atel

- resp & vitals

A

± 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

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11
Q

What are the findings in auscultation?

A

Decreased or absent breath sounds over the area

End-inspiratory crackles at involved site

If lobar collapse, absent or bronchial breath sounds

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12
Q

What are the results in PaO2 and SpO2, what does it lead to?

A

↓ PaO2 and SpO2

- Lung units perfused but not ventilated – “SHUNT”

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13
Q

what are the findings on x-rays concerning atelectasis&

A

Increased lung opacity, tracheal and mediastinal shift (toward ateleactasis), and diaphragm elevation on CXR

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14
Q

what are the med tx for atelectasis?

A

Prevention (e.g., airway clearance techniques, breathing exercises, mobilization)

Identification and reversal of the underlying cause

Supplemental O2

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15
Q

What are the physio tx for atelctasis?

A

Deep breathing with end-inspiratory hold, incentive spirometry

Airway clearance techniques

Positioning and mobilization

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16
Q

What is a pneumonia?

A

Inflammation of the lung parenchyma as a result of infection

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17
Q

What are the cases of pneumonia (4)?

A

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

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18
Q

what conditions are increasing the risk of pneumonia (6)?

A

Impaired airway defense mechanisms
cigarette smoking,
upper respiratory infection
dehydration

Chronic obstructive lung disease

Hospitalization

Debilitation

Dysphagia

Compromised immune status

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19
Q

What are the 3 anatomical classification of pneumonia?

A

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

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20
Q

What are the etiological classification of pneumonia?

A

Viral
Bacterial
Fungal
Parasitic

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21
Q

What can be the origin of pathogen in pnemonia (diff names of pneumonia)?

A

Community-acquired pneumonia

Hospital-acquired (nosocomial) pneumonia
- Ventilator-associated pneumonia (VAP)

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22
Q

What are the s/s of viral pneumonia?

  • vit signs
  • resp
  • body functions
  • WBC count
A 
Fever
Dyspnea
Tachypnea
Tachycardia
Loss of appetite
Myalgia
Persistent non-productive cough
Normal white blood cell count
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23
Q

What are the findings in auscultation of a viral pneumonia?

A

Normal breath sounds throughout both lungs with scattered inspiratory crackles.

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24
Q

What are the med tx for viral pneumonia?

A 
Rest
Salicylates
Antiviral meds: Acyclovir, Amantadine, Tamiflu 
↑ Hydration
Vaccination (prevention)
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25
Q

What are the common etiology of bact pneumonia?

A

Gram positive bacteria:
- Pneumococcal
Staphlococcal
Streptococcal pyogenes

 Gram negative bacteria:
- Hemophilus influenza 
- Escherichia coli
Pseudomonas aeruginosa
Enterobacter
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26
Q

What are the s/s of bacterial pneumo?

A 
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
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27
Q

What are the auscultation findings with bact pneumo?

A

Bronchial breath sounds (consolidation); crackles, reduced breath sounds

28
Q

What are the percussion findings with bact pneumo?

A

Dullness to mediate percussion

29
Q

What are the PaO2 and PaCO2 findings with bact pneumo?

A

↓PaO2, PaCO2 may be ↓

30
Q

What are the x-rays findings with bact pneumo?

A

CXR: Atelectasis, infiltrates, consolidation

31
Q

Can you have a tracheal shift with bact.pneumo?

A

NO TRACHEAL SHIFT with a consolidation

32
Q

What are med tx for bact.pneumo?

A

Antibiotic therapy
O2 therapy and mechanical ventilation in certain patients
Adequate hydration and nutrition

33
Q

What are physio tx for bact.pneumo?

A

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

34
Q

What is a lung abcess?

A

cavitated infected necrotic lesion within the parenchyma.

35
Q

What is the etiology of a lung abcess?

A 
aspiration of a foreign body, 
cavitary TB, 
obstruction by a neoplasm, 
unresolved pneumonia, 
infection of an infarct, 
sepsis.
36
Q

What are the s/s of a lung abcess? (5)

A

depends on size of abscess

- fever, malaise, cough with purulent foul sputum, hemoptysis.

37
Q

What are the med tx of a lung abcess?

A

Treatment of the underlying cause

Antibiotic therapy

O2 therapy

Adequate hydration and nutrition

38
Q

What is the physio tx of a lung abcess?

A

Deep breathing and positioning if poor gas exchange a problem.

Secretion clearance techniques for retained secretions or if lung abscess draining into the airway.

39
Q

What is a pleural effusion?

A

collection of non-purulent fluid in the pleural space

40
Q

What are the 2 pleural effusion?

A

Exudates: seen in infectious/inflammatory diseases

Transudates: elevated hydrostatic pressure in the pleural capillaries causing fluid to leave the vascular spaces

41
Q

What differentiate the 2 pleural effusion?

A

Ex: high protein content (albumin) and increased inflammatory cells.

Trans: low in protein with no inflammatory cells

42
Q

Give examples of the 2 pleural effusion condiditons

A

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

43
Q

Pleural effusion s/s (small effusion) - 3?

A

Rapid or sudden onset of symptoms

Pleuritic chest pain with deep breathing and cough

± Fever, possible shaking chills night sweats

44
Q

Pleural effusion s/s (large effusion) - 7?

A

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

45
Q

What are the medical interventions for pleural effusion

A

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

46
Q

What are the physio tx for pleural effusion?

A

Physio Rx: segmental and diaphragm breathing, mobility and arm ROM when chest tube inserted

47
Q

What is a pleurisy?

A

inflammation of the pleura

48
Q

T/F Pleurisy comes with pleural effusion

A

F

With or without a pleural effusion

49
Q

In which conditions can we find a pleurisy?

A

Pneumonia (bacterial, viral), TB, pulmonary infarction connective tissue diseases, chest wall trauma, carcinoma, mesothelioma

50
Q

What’s a fibrothorax?

A

Fibrous response of pleurisy leads to scarring and pleural adhesion = Fibrothorax

51
Q

What are the s/s of a pleurisy?

A

Pain: dull and nonspecific/sharp and localized
Doorstop breathing
Pleural friction rub

52
Q

Whats a pneumothorax?

A

Leakage of air into the pleural spac

53
Q

Whats the 4 possible causes (mechanisms) of pneumothorax + examples?

A

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.

54
Q

The pneumothorax s/s will depend on what?

What happens with small?

A

Depends on the mechanism, severity/size
Small:
asymptomatic

55
Q

What are s/s of large pneumothorax (4)?

A

sudden sharp pain and dyspnea

mediastinal shift to the opposite side.

diminished breath sounds

tympanic sound on mediate percussion

56
Q

What are the tx for pneumothorax (4)?

A

Simple observation

Needle aspiration

Chest tube

Pleurodesis: a physical attempt to adhere the parietal and visceral pleura (to prevent recurrence).

57
Q

What can happen with a tension penumothorax (4)?

A

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)

58
Q

Whats a hemothorax?

A

Hemorrhage into the pleura

59
Q

Whats a chylothorax?

A

Traumatic rupture of the thoracic duct which causes lymphatic fluid to enter the pleural space.

60
Q

Whats a empyema

A

Localized collection of pus in the pleural cavity

  • i.e. effusion that has become infected.
  • often accompanied by formation of fibrous adhesions
61
Q

What are the tx for rib fx?

A

pain control - no other treatment if rib fractures do not damage the underlying tissue.

62
Q

What is a flail chest and what are the repercussions?

A

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.

63
Q

What can happen with a lung contusion?

A

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.

64
Q

What are the s/s of a chest trauma (6)?

A

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

65
Q

What are the tx for chest trauma?

A

Pain control

Maintain oxygenation: supplemental O2, mechanical ventilation – severe flail chest

Breathing exercises – maintain/improve ventilation

PHTH554 - Cardiology (9 decks)

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