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Clinical Simulation > Obstructive Diseases > Flashcards

Obstructive Diseases Flashcards

COPD, Bronchiectasis, Sleep Disorders

1
Q

Primary Assessment of COPD

A
  • Past medical history
  • Shortness of breath
  • Cough
  • Appearance of the chest
  • Respiratory Pattern
  • Color
  • Appearance of the nail beds
  • Diagnostic chest percussion
  • Breath sounds
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2
Q

Secondary Assessment of COPD

A
  • CXR
  • Arterial Blood Gas
  • Pulmonary Function
  • CBC
  • Sputum
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3
Q

Appearance of CXR - Emphysema

A
  • Translucent (dark) lung fields
  • Depressed or flattened diaphragms
  • Long and narrow heart
  • Increased retrosternal air space
  • Possibly hypertrophy of the right ventricle
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4
Q

Cough - Emphysema

A

Less common, mucoid secretions

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5
Q

Respiratory Pattern - Emphysema

A

Dyspnea, pursed-lip breathing, accessory muscle use, especially during exacerbations

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6
Q

Breath Sounds - Emphysema

A

Diminished breath sounds, prolonged expiration

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7
Q

Diagnostic Chest Percussion - Emphysema

A

Hyperresonant / tympanic note

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8
Q

Appearance of chest - Emphysema

A
  • Barrel chest
  • Increased A-P diameter
  • Hoover’s sign
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9
Q

Pulmonary Function Findings - Emphysema

A
  • Decreased flow rates

- Decreased DLco

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10
Q

CBC - Emphysema

A

Increased RBC, Hb, HCT in late stages

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11
Q

Sputum - Emphysema

A

Normal

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12
Q

The presence of permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis

Cigarette smoking >80% of all cases
Genetic predisposition
Occupational exposure
Atmospheric pollutants

“Pink Puffer”

A

Emphysema

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13
Q

A chronic productive cough for 3 months in each year for 2 years in a row

Type B COPD “Blue Bloater”

A

Chronic Bronchitis

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14
Q

Appearance of CXR - Chronic Bronchitis

A
  • Translucent (dark) lung fields
  • Depressed or flattened diaphragms
  • Possibly hypertrophy of right ventricles
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15
Q

Pulmonary Function - Chronic Bronchitis

A
  • Decreased flow rates

- Normal DLco

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16
Q

CBC - Chronic Bronchitis

A

Increased RBC, Hb, HCT in early and late stages

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17
Q

Sputum - Chronic Bronchitis

A

Often shows: Streptoccus pneumonia, Haemophilus influenzae, Moraxella catarrhalis

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18
Q

Cough - Chronic Bronchitis

A

Productive, copious amounts, purulent secretions

19
Q

Appearance of chest - Chronic Bronchitis

A

Occasionally barrel chest

20
Q

Respiratory Pattern - Chronic Bronchitis

A

Use of accessory muscles less common

21
Q

Breath Sounds - Chronic Bronchitis

A

Rhonchi, crackles, wheezes

22
Q

Treatment - COPD

A
  1. Low flow O2 therapy
    - Nasal cannula 1-2 LPM / 24%-28% air entrainment mask
  • Bronchodilators (SABA, LABA, anticholinergics
  • Inhaled corticosteroids
  • Antibiotics if indicated by sputum culture
  • Bronchial hygiene
  • Smoking cessation program, nicotine replacement therapy
  • NPPV for acute exacerbation of ventilatory failure
  • Pulmonary rehabilitation education program
  • Annual flu vaccines
23
Q

COPD - Pulmonary rehabilitation education program includes

A
  • Nutritional management
  • Avoiding infection
  • Methods to aid secretion clearance
  • Home oxygen and aerosol therapy
  • Appropriate use of meds
24
Q

Primary assessment - Bronchiectasis

A
  • Past medical history
  • Shortness of breath
  • Cough
  • Appearance of chest
  • Respiratory pattern
  • Color
  • Appearance of nail beds
  • Diagnostic chest percussion
  • Breath sounds
25
Q

Secondary Assessment - Bronchiectasis

A
  • CXR
  • ABG
  • Pulmonary Function
  • CBC
  • Sputum
  • Special Diagnostic tests
26
Q

Cough - Bronchiectasis

A

Productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum, may be blood streaked

27
Q

Breath Sounds - Bronchiectasis

A

Wheezing, diminished breath sounds

28
Q

Appearance of chest - Bronchiectasis

A

Barrel chest, increased A-P diameter

29
Q

CXR - Bronchiectasis

A
  • Hyperlucent lung fields
  • Depressed or flattened diaphragm
  • Enlarged or elongated heart
30
Q

PFT - Bronchiectasis

A

Decreased flow rates

31
Q

CBC - Bronchiectasis

A

Increase RBC, Hb, HCT

32
Q

Sputum - Bronchiectasis

A

May indicate infection

33
Q

Special Diagnostic Tests - Bronchiectasis

A

CT scan - increased bronchial wall opacity. Characteristic appearance of end-on signet ring opacity

34
Q

Treatment Management - Bronchiectasis

A
  • Bronchopulmonary hygiene
  • O2 for Hypoxemia
  • Antibiotics for infection
  • Aersolized medication
  • Surgical resection of involved segments if necessary
35
Q

Caused by failure of the respiratory center of the brain to send signals to the respiratory muscles

A

Central Sleep Apnea

36
Q

Caused by anatomic obstruction of the upper airway in the presence of continued ventilatory effort

A

Obstructive Sleep Apnea

37
Q

ABG - Sleep disorder

A

Chronic ventilatory failure with hypoxemia (severe sleep apnea)

38
Q

CXR - Sleep disorder

A

May be normal or demonstrate right and/or left sided heart failure

39
Q

Special Tests - Sleep disorder

Polysomnography results - Central Apnea

A

Both nasal flow and respiratory effort decrease then desaturation

40
Q

Special Tests - Sleep disorder

Polysomnography results - Obstructive Apnea

A

Nasal flow decreases with increase in respiratory effort then desaturation

41
Q

PFT - Sleep disorder

A

Decreased volumes if obese

42
Q

Treatment and Management - Central Sleep Apnea

A

NPPV

43
Q

Treatment and Management - Obstructive Sleep Apnea

A
  • Nasal CPAP
  • Weight loss
  • Sleep posture
  • O2 therapy for hypoxemia
  • Surgery (trach)
44
Q

Chronic dilation and distortion of one or more bronchi as a result of excessive inflammation and destruction of bronchial walls, blood vessels, elastic tissue and smooth muscle. Can create an obstructive or restrictive pattern

A

Bronchiectasis

Clinical Simulation (7 decks)

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