Nurs 2005: Pulmonary Disorders (Part 2) Obstructive and Vascular Disorders, Respiratory Failure Flashcards
Obstructive Disorders
- obstruction d/t problem of getting air into lungs
- inc TLC and inc residual air d/t trapped air
- dec vital capacity
Obstructive Disorder Tyes:
- Asthma
- def
- chronic inflammatory disease
- hyperresponsiveness of airways
- bronchospasms
- ranges from mild-severe
What triggers asthma attacks?
- allergies:
- hypersensitivity to dust, pollen, animal dander, - respiratory infections:
- triggers asthma - exercise:
- d/t bronchospasms - drug/food additives:
- interfere w/prostaglandin mediators because irritates airways
What is the patho of asthma
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
What are the clinical manifestations of asthma?
- dyspnea with inc RR-
- mostly happens at night - inc resp effort
- with prolonged expiration phase - wheezing
– can hear air move in and out - chest constriction
– d/t bronchiole spasm - non-productive cough
– d/t imflam - inc HR
- d/t heart is compensating
Status asthaticus
- more severe and prolonged
- resp failure
- requires hospitalization
What type of diagnostic tests are done for asthma? What are the results?
- PFT
- dec - Blood gas- inc
- CXR
- hyperinflation in airways
- reversible inflam
What are the types of treatment for asthma?
Prevent:
- eliminate cause
- educate
Acute:
- meds
- dec bronchospasms and inflam w/ inhalers
- Chronic Obstructive Pulmonary Disease
- def
- 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
What is the etiology of COPD?
- d/t
- chronic irritation of lungs
d/t:
- smoking (main cause)
- chemical/toxin inhalants
- recurrent infections
- happens over time
What are the 2 conditions of COPD?
Emphysema and Chronic bronchitis
a. Emphysema
- hyperinflation of alveoli
- d/t inc in compliance
- loss of lung elasticity
- poor recoil = trapped air
- narrowing of small airways
- harder to get air out
- destruction of alveolar and capillary walls
- dec gas exchanges surface area
b. Chronic bronchitis
- 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.
What are the clinical manifestations of emphysema?
-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
What are the clinical manifestations of chronic bronchitis?
- cough
- less SOB
- normal to heavy wt
- more spams and coughing when engaged in activity
- blue bloater- lower O2 levels
What diagnostic tests are done for COPD? What are the results?
- chest x-ray – shows trapping of air
- PFT- dec vital capacity, inc residual vol
- blood gas analysis- low O2, CO2 inc (late stages)
What is the treatment used for COPD?
- bronchodilators
- corticosteroids- anti-inflam and dec inflam in airway
- low flow oxygen
- antibiotics
- smoking cessation
- breathing exercises
- relaxation exercises
- Acute Bronchitis
- inflam of bronchi
- d/t infection
- similar to pneumonia
- “acute” = can be treated/cured
What are the clinical man of acute bronchitis?
- productive cough
- fever, chills d/t infection
- malaise, weakeness
- chest pain d/t coughing
What diagnostic test are used for acute bronchitis?
- chest xray
- see open/inflammed airways
- can hear good airflow in lungs
What type of treatment is used for acute bronchitis?
- antibiotics
- rest
- fluids
- humidifier to dec inflam
Pulmonary Vascular disorder
- def
- d/t
- occlusion (blocked) of protion of pul vasc bed by embolus
- blood clot, air, bacteria, trauma, fat
- d/t:
- deep vein thrombosis
- heart arrhythmia = afib
What is the patho of pulmonary vasc disorder
- 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
What are the risk factors for pulmonary vasc disorder
- immobile people = pooling of blood
- varicose veins = effect blood flow to heart = pooling of blood
- oral contraceptive = blood clots
- diabetes = emboli/blood clots developing
What are the clinical man of pulmoary vasc disorders?
- 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
What diagnostic tests are done for Pul vasc disorder?
- prevention of DVT
- elevate leg
- ROM
- acute
- anticoagulants if immobile to dec clots
- fibrinolytics = breaks clots if given 6hrs of detection
Pulmonary HTN
- high BP in pul arteries
- normally low pressure = 25/10 = gas exchange
- pul HTN d/t inc workload of right ventricle
What is the patho of pul htn?
- inc left ventricle filling pressure
- d/t mitral disease - inc blood flow through pulm circulation- d/t congenital heart disease
- obstruction of pulmonary bed or destruction of alveolar walls-
d/t pul embolism
4 inc vasoconstriction of vascular bed
- d/t low O2 levels
- primary pulmonary HTN
- unknown development
What are the clinical man of pul htn?
- fatigue
- chest discomfort
- inc RR d/t compensation
- dyspnea d/t diff breathing and lack of O2
What are the diagnostic tests done for pul htn?
- chest xray
- shows enlarged pul arteries and L side heart
- echocardiogram
- R side enlarged heart
What are the treatment options for pul htn?
- primary:
- pul vasodilators (Viagra)
- lung transplant
- secondary:
- oxygen
- diurectics
- inotropics
Cor pulmonale
- enlargement of R ventrivle d/t pul HTN
- d/t disease of lungs, chest wall, or pul circulation
What are the clinical manifestations
- SOB
- productive cough
- peripheral edema
- d/t poor blood flow
- chest pain
- fatigue
What type of treatment is used for cor pulmonale
- treat cause
- same treatment as pul htn
Acute resp failure (ARF)
- PaO2 50 mmHg
- alveolar can’t produce enough O2 for the body
What is ARF caused by?
- . Hypoventilation: tidal volumes dec, CO2 levels inc, O2 levels dec.
- d/t not breathing enougha. CNS depression (muscular problem)- narcotic use = anesthesia b. injury to nervous system itself- head, spinal cord trauma c. neuromuscular disease
- 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
- Mismatching of Ventilation/Perfusion (V/Q):
a. adequate ventilation but poor perfusion – pul emboli
b. poor ventilation but adequate perfusion – COPD, pneumonia
What are the clinical man of ARF
- r/t accum of CO2
- dec O2 in blood
S/S of hypoxemia and hypercapnia
What type of treatment is used for ARF?
- treat cause
- resp support = mechanical ventilation
