Medical Issues Ch. Pulmonary System and Conditions Flashcards
pulmonary system functions
extracts oxygen from the air
exchanges oxygen with carbon dioxide in the blood
prevalence of pulmonary pathology
second most frequent cause of disability
fifth leading cause of death among adults
14-15 million people suffer from asthma
inspiration A/P
active movement
contraction of diaphragm and external intercostals
expiration A/P
passive movement
relaxation of inspiring muscles
accessory breathing
the use of muscles other than the respiration muscles to breathe
respiration
gas exchange
ventilation
movement of air in and out of the lungs
ventilation control
medulla oblongata -senses pH changes in the blood receptors -baroreceptors -chemoreceptors nervous system -phrenic nerve --C3-C5 nerve root
effects of exercise on respiratory system
increased blood to the lungs
increased oxygen demand to muscles
increased carbon dioxide produced by muscles
increase in ventilation
S/S of pulmonary disease
dyspnea cough cyanosis abnormal breathing patterns thorax pain
types of coughs
dry cough -allergic irritant purulent sputum (pus) -lower respiratory infection hemoptysis -lung damage (referral)
thorax pain types
tracheobronchial -occurs over trachea diaphragm -can refer to shoulder -less commonly the neck, ribs pleurisy -results from inflammation of parietal pleura
medical history and physical exam
family and personal history symptoms inspection palpation percussion auscultation respiration rate and depth HR BP Peak Flow Meter
family and personal history questions
smoking
inspection
deformities
- pes excavatum
- -concave
- pes carinatum
- -convex
palpation
palpate ribs
percussion
lungs should be resonant
peak flow meter
establish a baseline for your patient test patient upon suspicion of bronchospasm -green zone: 80-100% of baseline -yellow zone: 50-80% of personal best --medication is necessary -red zone: below 50% --call 911
pulmonary pathology sources
environmental influences
trauma
genetic factors
immune response
pulmonary pathology disease classification
obstructive
-limits airflow
restrictive
-limits lung expansion
flail chest injury
multiple fractures that result in displacement of the ribs
can also sprain the joint between the rib and cartilage
pneumothorax
collaped lung (air in the pleural space) commonly caused by trauma S/S -pain -trouble breathing -would hear hyper-resonance during percussion Tx -referral
hemothorax
blood in the pleural space S/S -similar to pneumothorax -coughing up blood (frothy) -percussion and auscultation differences Tx -referral
asthma
produces -bronchial spasms -chronic bronchial inflammation -bronchial edema symptoms -chest constriction -fatigue -anxiety clinical signs: symptoms worsen at night
asthma cont.
onset -begins early, genetic predisposition to severe allergic responses causes -allergens -infection -cold/dry air -emotional states -exercise Tx -patient education is important -limit inflammation (corticostaroids) -treat bronchospasms (short and long acting beta-2 agonist) -control symptoms -prevent exacerbation by controlling known triggers
management of an acute asthma attack
seated position take deep breaths exhale through pursed lips (whistle) tell them to remain calm administer inhaler ER is all else fails
asthma can cause
pneumothorax
acute right heart failure
hypoxia
exercise induced bronchospasm
exercise-induced asthma
more common than asthma
-15% of the population
-90% of people with asthma
-35-40% of people with allergies
occurs 5-10 minutes into exercise, worsens with activity
spontaneous recovery occurs 30-60 minutes after stopping exercise
exercise induced bronchospasm
- triggers
- S/S
triggers -cold, dry air -allergens -pollutions -infection S/S -unusual dyspnea -central chest pain during exercise -coughing
Acute EIB management
similar to an asthma attack
remove from exercise
reassure
assess and monitor
when to refer w/ EIB
cyanosis
syncope
symptoms >60 minutes
short acting Beta-2 agonists
albuterol (proventil, ventolin)
bronchodilators
can also prevent the tightening of the muscle around the airways caused by asthma triggers
Beta-2 agonist how to use
inhaled
nebulizer or MDI
take 2 puffs from a MDI 2-3 minutes apart, not more often than every 4 hours apart
can take up to 30 minutes for effects to occur
athlete may need to get on field earlier than most to warm up
side effects
-jittery
inhaled corticosteroids
most common for chronic asthma sufferers will only fix the problem of inflammation, not bronchoconstriction comes in inhaled and oral forms -inhaled for more chronic -oral for acute exacerbation other names -Vanceril DS -Flovent -Axmacort
long acting Beta-2 agonist
not to be a substitute for corticosteroids
used in addition to corticosteroids
effects can diminish after even a month of use
other names
-Serevent
-Foradil
great for multi-sport or for young kids who play all day long
exercise induced anaphylaxis
breathing disorder + chronic use of NSAIDs produces an abnormal immune response S/S -flushing -urticaria -cough, croup (deep "honking" cough) -stridor --harsh wheezing sound -hypotension & tachycardia (shock)
EIA treatment
administer Epipen
call 911
acute bronchitis
caused by infection or irritant that produces an inflammatory response -most commonly viral early S/S -fever -nonproductive cough -sore throat -chest pain progresses to -productive cough -wheezing treatment -cough suppressants -rest -hydration
chronic bronchitis
caused by prolonged or repeated exposure to irritants
inflammation of the bronchial mucous membranes
S/S
-wheezing
-dyspnea
-cough that is more productive in the mornings and evenings
symptoms present from 3 months - 2 years
treatment
-avoid irritants
pneumonia
every year more than 60,000 Americans die of pneumonia
infection and inflammation in the lungs
recognition and early treatment is the best option
pleurisy
inflammation of the pleura
may develop secondary to other infections
fluid can accumulate at the site of the inflammation
can cause coughing, dyspnea, tachypnea, cyanosis, and retractions
diagnosis
-auscultation
-pain at one site with laughing, coughing
pleurisy
-doctor may order
chest X-ray CBC chest CT or ultrasound thoracentesis important to look for underlying pathology
influenza
the "Flu" viral S/S -high fever -headache/body aches -cough -chest pain -shortness of breath -fatigue -loss of appetite -nasal congestion -sore throat refer when -close contact with other person's diagnosed influenza -symptomatic diagnosis -clinincal grounds mainly -antigen testing -CBC's -sputum cultures -fever is generally the hallmark
upper respiratory infections
rhinovirus
very easily spread through cough or sneeze
mild symptoms very similar to influenza but don’t last as long
secondary bacterial infection can happen
7-10 day duration
tuberculosis
highly contagious bacterial infection -mycobacterium tuberculosis airborne droplets cause infection immunocompromised people are more likely to get active TB S/S -fatigue -fever -weight loss -cough -hemoptysis -shortness of breath/wheezing diagnosis -skin test -symptomatic -positive radiograph
pulmonary obstructive disorders (COPD)
Chronic obstructive pulmonary disease is a classification of diseases involving partially blocked airways
-asthma
-bronchitis
-emphysema
-cystic fibrosis
decreased vital capacity, increased CO2, decreased O2, thus disrupting the diffusion gradient across the alveoli
emphysema
complication of chronic pulmonary disease + prolonged smoking
causes destruction of alveolar walls, capillaries, and lung elasticity
S/S
-SOB
-increased exhalation effort
-infection
-Cor pulmonale (right sided heart failure)
irreversible, poor prognosis
