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Nursing 2005: Clinical Pathophysiology > Nurs 2005: Pulmonary Disorders (Part 2) Obstructive and Vascular Disorders, Respiratory Failure > Flashcards

Nurs 2005: Pulmonary Disorders (Part 2) Obstructive and Vascular Disorders, Respiratory Failure Flashcards

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1
Q

Obstructive Disorders

A
  • obstruction d/t problem of getting air into lungs
  • inc TLC and inc residual air d/t trapped air
  • dec vital capacity
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2
Q

Obstructive Disorder Tyes:

  1. Asthma
    - def
A
  • chronic inflammatory disease
  • hyperresponsiveness of airways
  • bronchospasms
  • ranges from mild-severe
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3
Q

What triggers asthma attacks?

A
  1. allergies:
    - hypersensitivity to dust, pollen, animal dander,
  2. respiratory infections:
    - triggers asthma
  3. exercise:
    - d/t bronchospasms
  4. drug/food additives:
    - interfere w/prostaglandin mediators because irritates airways
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4
Q

What is the patho of asthma

A

Mast cells activated by allergens of irritants

  • ->histimine→ inflammation
  • -> hyperresponsiveness of airways.
  • Inflammatory process produces bronchial smooth muscles spasms
  • vascular congestion
  • inc vascular permeability and edema and thick mucus
  • Air gets trapped in lungs, hypoxemia develops, CO2 inc acidosis
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5
Q

What are the clinical manifestations of asthma?

A
  1. dyspnea with inc RR-
    - mostly happens at night
  2. inc resp effort
    - with prolonged expiration phase
  3. wheezing
    – can hear air move in and out
  4. chest constriction
    – d/t bronchiole spasm
  5. non-productive cough
    – d/t imflam
  6. inc HR
    - d/t heart is compensating
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6
Q

Status asthaticus

A
  • more severe and prolonged
  • resp failure
  • requires hospitalization
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7
Q

What type of diagnostic tests are done for asthma? What are the results?

A
  1. PFT
    - dec
  2. Blood gas- inc
  3. CXR
    - hyperinflation in airways
    - reversible inflam
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8
Q

What are the types of treatment for asthma?

A

Prevent:

  • eliminate cause
  • educate

Acute:

  • meds
    • dec bronchospasms and inflam w/ inhalers
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9
Q
  1. Chronic Obstructive Pulmonary Disease

- def

A
  • affect movement of air in and out of lung
    `
  • Inspiratory muscles strong enough but recoil not, so difficult to get air out. = takes longer
  • Exp > Insp.
  • Chronic bronchitis and/or emphysema
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10
Q

What is the etiology of COPD?

  • d/t
A
  • chronic irritation of lungs

d/t:

  • smoking (main cause)
  • chemical/toxin inhalants
  • recurrent infections
  • happens over time
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11
Q

What are the 2 conditions of COPD?

A

Emphysema and Chronic bronchitis

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12
Q

a. Emphysema

A
  1. hyperinflation of alveoli
    • d/t inc in compliance
  2. loss of lung elasticity
    • poor recoil = trapped air
  3. narrowing of small airways
    • harder to get air out
  4. destruction of alveolar and capillary walls
    • dec gas exchanges surface area
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13
Q

b. Chronic bronchitis

A
  • small and large airways.
  • Chronic inflammation of airways–> excessive mucous production
    • hard to clear from throat
  • thickening of bronchial walls–> blocks or narrows airways causing obstruction of
    airflow esp during expiration
  • results in air trapping.
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14
Q

What are the clinical manifestations of emphysema?

A

-SOB-
can compensate by pursed breath breathing

  • minimal cough
  • pink puffer
  • ok O2 levels d/t compensation (early on)
  • barrel chest (round chest) d/t hyperinflation of alveoli and flatten diaphragm
  • thin d/t altered nutrition
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15
Q

What are the clinical manifestations of chronic bronchitis?

A
  • cough
  • less SOB
  • normal to heavy wt
  • more spams and coughing when engaged in activity
  • blue bloater- lower O2 levels
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16
Q

What diagnostic tests are done for COPD? What are the results?

A
  1. chest x-ray – shows trapping of air
  2. PFT- dec vital capacity, inc residual vol
  3. blood gas analysis- low O2, CO2 inc (late stages)
17
Q

What is the treatment used for COPD?

A
  1. bronchodilators
  2. corticosteroids- anti-inflam and dec inflam in airway
  3. low flow oxygen
  4. antibiotics
  5. smoking cessation
  6. breathing exercises
  7. relaxation exercises
18
Q
  1. Acute Bronchitis
A
  • inflam of bronchi
  • d/t infection
  • similar to pneumonia
  • “acute” = can be treated/cured
19
Q

What are the clinical man of acute bronchitis?

A
  • productive cough
  • fever, chills d/t infection
  • malaise, weakeness
  • chest pain d/t coughing
20
Q

What diagnostic test are used for acute bronchitis?

A
  • chest xray
    • see open/inflammed airways
    • can hear good airflow in lungs
21
Q

What type of treatment is used for acute bronchitis?

A
  • antibiotics
  • rest
  • fluids
  • humidifier to dec inflam
22
Q

Pulmonary Vascular disorder

  • def
  • d/t
A
  • occlusion (blocked) of protion of pul vasc bed by embolus
    • blood clot, air, bacteria, trauma, fat
  • d/t:
    • deep vein thrombosis
    • heart arrhythmia = afib
23
Q

What is the patho of pulmonary vasc disorder

A
  • emboli go to lungs = lodged in narrow part of circ system
  • cause ventilation/perfusion mismatch (VQ mismatch)
    • air in lungs and match it w/ perfusion
24
Q

What are the risk factors for pulmonary vasc disorder

A
  • immobile people = pooling of blood
  • varicose veins = effect blood flow to heart = pooling of blood
  • oral contraceptive = blood clots
  • diabetes = emboli/blood clots developing
25
Q

What are the clinical man of pulmoary vasc disorders?

A
  • depends where the emboli occur:
  • lower lobes = less pain
  • major lobes = more pain
  • inc RR and HR
  • dyspnea
  • anxiety
  • pain d/t inc breathing
  • infarction:
    • fever
    • hemoptysis = blood in sputum
    • pleural effusion
  • occlusion
    • shock
    • dec BP
    • pul HTN
26
Q

What diagnostic tests are done for Pul vasc disorder?

A
  • prevention of DVT
    • elevate leg
    • ROM
  • acute
    • anticoagulants if immobile to dec clots
    • fibrinolytics = breaks clots if given 6hrs of detection
27
Q

Pulmonary HTN

A
  • high BP in pul arteries
  • normally low pressure = 25/10 = gas exchange
  • pul HTN d/t inc workload of right ventricle
28
Q

What is the patho of pul htn?

A
  1. inc left ventricle filling pressure
    - d/t mitral disease
  2. inc blood flow through pulm circulation- d/t congenital heart disease
  3. obstruction of pulmonary bed or destruction of alveolar walls-
    d/t pul embolism

4 inc vasoconstriction of vascular bed
- d/t low O2 levels

  1. primary pulmonary HTN
    - unknown development
29
Q

What are the clinical man of pul htn?

A
  • fatigue
  • chest discomfort
  • inc RR d/t compensation
  • dyspnea d/t diff breathing and lack of O2
30
Q

What are the diagnostic tests done for pul htn?

A
  • chest xray
  • shows enlarged pul arteries and L side heart
  • echocardiogram
  • R side enlarged heart
31
Q

What are the treatment options for pul htn?

A
  • primary:
    • pul vasodilators (Viagra)
    • lung transplant
  • secondary:
    • oxygen
    • diurectics
    • inotropics
32
Q

Cor pulmonale

A
  • enlargement of R ventrivle d/t pul HTN

- d/t disease of lungs, chest wall, or pul circulation

33
Q

What are the clinical manifestations

A
  • SOB
  • productive cough
  • peripheral edema
    • d/t poor blood flow
  • chest pain
  • fatigue
34
Q

What type of treatment is used for cor pulmonale

A
  • treat cause

- same treatment as pul htn

35
Q

Acute resp failure (ARF)

A
  • PaO2 50 mmHg

- alveolar can’t produce enough O2 for the body

36
Q

What is ARF caused by?

A
  1. . Hypoventilation: tidal volumes dec, CO2 levels inc, O2 levels dec.
    - d/t not breathing enough
     a. CNS depression (muscular problem)- narcotic use = anesthesia 
 b. injury to nervous system itself- head, spinal cord trauma
 c. neuromuscular disease
  2. Impaired Diffusion:
    - impairment or difference between O2 pressure in alveoli and pulmonary capillary bed.
  • impairs gas exchange

Cause:
a. thicken blood-gas membrane (x)

	b.  reduced pulmonary capillary blood flow- destruction of alveolar walls
  1. Mismatching of Ventilation/Perfusion (V/Q):
    a. adequate ventilation but poor perfusion – pul emboli
    b. poor ventilation but adequate perfusion – COPD, pneumonia
37
Q

What are the clinical man of ARF

A
  • r/t accum of CO2
  • dec O2 in blood

S/S of hypoxemia and hypercapnia

38
Q

What type of treatment is used for ARF?

A
  • treat cause

- resp support = mechanical ventilation

Nursing 2005: Clinical Pathophysiology (9 decks)

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