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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
Secondary Assessment - Bronchiectasis
- CXR - ABG - Pulmonary Function - CBC - Sputum - Special Diagnostic tests
26
Cough - Bronchiectasis
Productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum, may be blood streaked
27
Breath Sounds - Bronchiectasis
Wheezing, diminished breath sounds
28
Appearance of chest - Bronchiectasis
Barrel chest, increased A-P diameter
29
CXR - Bronchiectasis
- Hyperlucent lung fields - Depressed or flattened diaphragm - Enlarged or elongated heart
30
PFT - Bronchiectasis
Decreased flow rates
31
CBC - Bronchiectasis
Increase RBC, Hb, HCT
32
Sputum - Bronchiectasis
May indicate infection
33
Special Diagnostic Tests - Bronchiectasis
CT scan - increased bronchial wall opacity. Characteristic appearance of end-on signet ring opacity
34
Treatment Management - Bronchiectasis
- Bronchopulmonary hygiene - O2 for Hypoxemia - Antibiotics for infection - Aersolized medication - Surgical resection of involved segments if necessary
35
Caused by failure of the respiratory center of the brain to send signals to the respiratory muscles
Central Sleep Apnea
36
Caused by anatomic obstruction of the upper airway in the presence of continued ventilatory effort
Obstructive Sleep Apnea
37
ABG - Sleep disorder
Chronic ventilatory failure with hypoxemia (severe sleep apnea)
38
CXR - Sleep disorder
May be normal or demonstrate right and/or left sided heart failure
39
Special Tests - Sleep disorder Polysomnography results - Central Apnea
Both nasal flow and respiratory effort decrease then desaturation
40
Special Tests - Sleep disorder Polysomnography results - Obstructive Apnea
Nasal flow decreases with increase in respiratory effort then desaturation
41
PFT - Sleep disorder
Decreased volumes if obese
42
Treatment and Management - Central Sleep Apnea
NPPV
43
Treatment and Management - Obstructive Sleep Apnea
- Nasal CPAP - Weight loss - Sleep posture - O2 therapy for hypoxemia - Surgery (trach)
44
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
Bronchiectasis

Clinical Simulation (7 decks)

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