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Diseases: Davisson > Obstructive Diseases > Flashcards

Obstructive Diseases Flashcards

1
Q

What is the primary impairment of of Obstructive diseases?

A

Exhalation

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2
Q

What greater effect does obstructive diseases have?

A

Ventilation (Co2) problems and increased deadspace

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3
Q

What are the obstructive diseases?

A

CFCBABE: Cystic fibrosis, chronic bronchitis, asthma, bronchiectasis, emphysema

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4
Q

What causes CF?

A

Genetic mutation to cystic fibrosis transmembrane conductance regulator (CFTR)

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5
Q

What ions does CF cause a disruption of movement in?

What do these ions do?

A

Na+ and Cl- ions across membrane.

Ion concentration is important for regulating the movement of fluids (mucus membranes). The faculty regulator is unable to allow Cl- to pass which in turn means Na+ cant pass. If ions cant pass then fluid (H2O) cant follow it.

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6
Q

What does the lack of Na+ and Cl- ions result in?

A

Dehydrated, viscous secretions with limited mobility. > risk obstruction and infection

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7
Q

Cystic fibrosis refers to the _____ of lung tissue.

A

Scarring

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8
Q

What three tracts does CF cause problems with?

A

Respiratory, digestive, reproductive

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9
Q

What abnormalities does CF cause with the Respiratory tract?

A

Impaired mucus clearance, inflammation, chronic productive cough

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10
Q

What problems does CF cause in the digestive tract?

A

Poor pancreatic function, low enzymes, malabsorption of nutrients, bowel obstruction, liver disease, pancreatitis, diabetes.

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11
Q

What problems does CF cause in the reproductive system?

A

Delayed puberty and reduced fertility

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12
Q

What is End Stage CF?

A

chronic/acute respiratory failure, pulmonary hypertension, cor pulmonale.

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13
Q

What are the four ways to test for CF?

A

Gold Standard Sweat Chloride Test, newborn screening, genetic testing, signs and sympts. to confirm diagnosis

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14
Q

How does the Gold Standard Sweat Chloride Test work to diagnose CF?

A

Uses sweat to test chloride. >60 mEq/L for positive diagnosis

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15
Q

How does the newborn screening work to test for CF?

A

It checks the trypsinogen in blood. Elevated levels suggest a positive CF test.

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16
Q

Signs and Sympt. of CF

A 
Increased HR, RR, BP, temp
Use of acces. muscles
Barrel chest, digital clubbing, cyanosis
Peripheral edema and venous distention
Decrease or increase in tactile fremitus
Low FVC1 , low FEV 1/ FVC ratio
Dim. breath sounds, crackles or wheezes
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17
Q

What are the CF treatments?

A 
Atrovent
Albuterol
ACT
Hypertonic saline
Dornase alfa
Tobramycin
Steriods
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18
Q

What is Bronchitis?

A

The swelling of the airways, which limits ability to move air and clear secretions

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19
Q

What is Bronchitis?

A

The swelling of the airways, which limits ability to move air and clear secretions

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20
Q

Bronchitis is caused by infection or irritation

A

Irritation = inflammation = increased mucus production

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21
Q

What is Bronchitis in the smaller airways (bronchioles) called?

A

Bronchiolitis

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22
Q

What are the two types of Bronchitis and what they do?

A

Acute: Anyone can develop. More common in winter months. People who are old, very young, and who have compromised immune systems, artificial airways or impaired secretions clearance

Chronic: Defined as a productive cough that is present for at least 3 months of the year, for 2 consecutive years. 3 months do not have to be all together.

23
Q

What anatomical changes does Bronchitis cause?

A

Chronic inflammation: mucosal edema, vasodialation, congestion = all lead to narrowed bronchi

Irritation: submucosal glands enlarge and goblet cells increase = more mucus

Cilliary function decrease = accumulation of mucus

24
Q

How do you diagnose Bronchitis for both acute and chronic?

A

Acute: productive cough, dyspnea/ access. muscle use, increase WOB/ WBC/ temp, wheezing and coarse crackles on auscultation, sputum may be discolored (green/yellow), CXR may show INFILTRATES in areas of secretion accumulation, decreased PEFR, PFT

Chronic: associated with COPD, peripheral edema, JVD, polycythemia, pulmonary hypertension, diffuse vascular markings on CXR (almost appear fibrotic), Co2 retention, possible hypoxemia

25
Q

What are the two groups of treatments for Bronchitis? And what do they include?

A

Pharmacological: bronchodilators, O2 therapy, steroids, antibiotics

ACT: cough, CPT, suctioning, chronic pulmonary rehab

26
Q

What is asthma?

A

The inflammation disease of the airway

27
Q

When is asthma commonly diagnosed?

A

When the person is a child, anyone can develop it though.

28
Q

What causes asthma attacks?

A

A trigger starts a cascade of inflammatory events (ex. allergens, infection, environment, etc)

29
Q

What are the different types of asthma, and what causes them?

A

Intrinsic: not resulting from allergens. Usually strong smells, cold/ hot air, anxiety, stress, reflux, humidity, smoke, other irritants.

Extrinsic: exposure to allergens. Dust, animal dander, pollen, grass clippings, foods, etc.

Exercise induced: sympts. associated with exercise

30
Q

What are the two responses of asthma, and what causes them?

A

Acute (early) response: “primary” exposure to trigger cause immediate hypersensitivity reactions (bronchospasm) narrowing the airway which limits airflow and increase WOB.
- usually subsides within 1 hr

Secondary (late) response: initial trigger causes bronchospasm, but also cascade of immune responses. Mast-cells in airway issue degranulate releasing their pro inflammatory chemical including proteases, histamine, and cytokines. These cause the airway to swell and also increase secretion production. Occurs in 50% of asthma patients.
- delayed, more severe than early response

31
Q

What are the five ways to diagnose asthma?

A

Exam

Decreased Peak Expiratory Flow Rate (PEFR): bedside spirometry and evaluate patient to place into “zone”.

CXR: usually normal or shows hyperinflation (from trapped air)

Labs: elevated IgE and esinophils, ABG in an acute attack (low PaCo2)

PFT: decreased FEV1, FEV1/ FVC ratio. Improvement of 12% and 200 ml after bronchodilator is evidence of reversibility.

32
Q

What does Status Asthmaticus mean?

A

Patient is not responding to treatment. (Refractory)

33
Q

What are the four main ways to treat an asthma attack?

A

Bronchodilators, steroids, mast cell stabilizers, and bronchial thermoplasty.

O2 therapy and heliox mechanical ventilation are last resort

34
Q

What are the NAEP guidelines for asthma management?

A

Objective measurements and monitoring lung function: PEFR, spirometry, zoning

Pharmacologic therapies: depending on severity

Environmental control: decrease triggers

Patient education: how to take meds, using PEFR, when to seek care, etc.

35
Q

What is bronchiectasis?

A

The abnormal, irreversible dilation of the bronchi, caused by chronic inflammation and permanent damage to tissue.

36
Q

What are the 3 patterns of bronchiectaisis?

A

Cylindrical: airway wall is regularly and uniformly dilated.

Varicose: irregular with alternating areas of constriction and dilation.

Cystic: progressive, distal, enlargement of the airways resulting in sac like dilations.

37
Q

Is bronchiectasis always secondary to something?

A

Yes. Typically chronic inflammatory or infectious diseases of lungs.

38
Q

What are the two types of Bronchiectasis?

A

Local and Diffuse

39
Q

What causes local bronchiectasis?

A

Foreign body, airway tumor, bronchial compression by surrounding lymph nodes.

40
Q

What causes diffuse bronchiectasis?

A

Cystic fibrosis: MOST COMMON, chronic bronchitis, alpha 1 anti-trypsin deficiency (AAT), rheumatoid arthritis, etc.

41
Q

How do you diagnose bronchiectasis?

A

CXR, bronchogram, CT scan, and PFT

42
Q

What would a CXR show if you had bronchiectasis?

A

“TRAM TRACKS”, cystic spaces, hyperinflation, ATX

43
Q

Signs and symptoms of bronchiectasis?

A

Copious, purulent secretions, and hemoptysis, productive cough.

Increased HR, RR, and access. muscle use.

Course crackles, wheezing breath sounds

Dull or hyper resonant percussion

Increased or decreased tactile and vocal fremitus

Dyspnea, mucus retention

History of infectious/ inflammation process of the lungs

44
Q

How to treat bronchiectasis?

A

Treat underlying disease

Disease prevention

Surgical lung resection

Respiratory therapy: bronchodilators, mucolytics, ACT, lung expansion, O2 therapy, inhaled corticosteroids, antibiotics, etc.

45
Q

In reference to bronchiectasis, what is dynamic airway collapse?

A

It is when the dilated airways loose the ability to keep themselves open and collapse during breathing cycle.

46
Q

What is emphysema?

A

Abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of the walls of the alveolar walls.

47
Q

What are the two types of emphysema? And who gets it?

A

Acquired: shown in cigarette smokers. 80-90% of COPD deaths result from cigarette smoking. Begins later in life.

Genetic: shown in people with Alpha 1 Anti-trypsin Deficiency. Seen in middle aged individuals. Begins sooner. Causes more severe version of emphysema.

48
Q

Destruction of the alveolar walls leads to the loss of what?

A

Surface area for gas exchange

49
Q

What is a “pink puffer”? What was disease process is it associated with?

A

Reddish complexion, pursed lip breathing, thin and barrel chested, access. muscle use, and increased HR.

Associated with emphysema

50
Q

How to diagnose emphysema?

A

Dyspnea, age 60-70 years, increased AP diameter, decreased PEFR (impaired flow)

ABG reveals hypoxemia and chronic hypercarbia in severe cases.

Access. muscle use, blood test for AAT deficiency, PFT

51
Q

How to treat emphysema?

A

Bronchodilators, sterioids, alpha 1 antitrypsin replacement therapy (AAT)

O2 therapy, non invasive ventilation (BiPAP, CPAP, Hi Flow)

Lobectomy, pulmonary rehab

52
Q

Asthma is apart of what overlap syndrome?

A

ACOS: asthma COPD overlap syndrome

53
Q

What does GOLD stand for?

A

Global Initiative for chronic Obstructive Lung Disease
- provides criteria for classifying stages of COPD severity
guidelines for pharmacologic therapy
identifies COPD patients at high risk for exacerbation and readmission

Diseases: Davisson (5 decks)

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