Obstructive Diseases Flashcards
COPD, Bronchiectasis, Sleep Disorders
Primary Assessment of COPD
- Past medical history
- Shortness of breath
- Cough
- Appearance of the chest
- Respiratory Pattern
- Color
- Appearance of the nail beds
- Diagnostic chest percussion
- Breath sounds
Secondary Assessment of COPD
- CXR
- Arterial Blood Gas
- Pulmonary Function
- CBC
- Sputum
Appearance of CXR - Emphysema
- Translucent (dark) lung fields
- Depressed or flattened diaphragms
- Long and narrow heart
- Increased retrosternal air space
- Possibly hypertrophy of the right ventricle
Cough - Emphysema
Less common, mucoid secretions
Respiratory Pattern - Emphysema
Dyspnea, pursed-lip breathing, accessory muscle use, especially during exacerbations
Breath Sounds - Emphysema
Diminished breath sounds, prolonged expiration
Diagnostic Chest Percussion - Emphysema
Hyperresonant / tympanic note
Appearance of chest - Emphysema
- Barrel chest
- Increased A-P diameter
- Hoover’s sign
Pulmonary Function Findings - Emphysema
- Decreased flow rates
- Decreased DLco
CBC - Emphysema
Increased RBC, Hb, HCT in late stages
Sputum - Emphysema
Normal
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”
Emphysema
A chronic productive cough for 3 months in each year for 2 years in a row
Type B COPD “Blue Bloater”
Chronic Bronchitis
Appearance of CXR - Chronic Bronchitis
- Translucent (dark) lung fields
- Depressed or flattened diaphragms
- Possibly hypertrophy of right ventricles
Pulmonary Function - Chronic Bronchitis
- Decreased flow rates
- Normal DLco
CBC - Chronic Bronchitis
Increased RBC, Hb, HCT in early and late stages
Sputum - Chronic Bronchitis
Often shows: Streptoccus pneumonia, Haemophilus influenzae, Moraxella catarrhalis
Cough - Chronic Bronchitis
Productive, copious amounts, purulent secretions
Appearance of chest - Chronic Bronchitis
Occasionally barrel chest
Respiratory Pattern - Chronic Bronchitis
Use of accessory muscles less common
Breath Sounds - Chronic Bronchitis
Rhonchi, crackles, wheezes
Treatment - COPD
- 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
COPD - Pulmonary rehabilitation education program includes
- Nutritional management
- Avoiding infection
- Methods to aid secretion clearance
- Home oxygen and aerosol therapy
- Appropriate use of meds
Primary assessment - Bronchiectasis
- Past medical history
- Shortness of breath
- Cough
- Appearance of chest
- Respiratory pattern
- Color
- Appearance of nail beds
- Diagnostic chest percussion
- Breath sounds
Secondary Assessment - Bronchiectasis
- CXR
- ABG
- Pulmonary Function
- CBC
- Sputum
- Special Diagnostic tests
Cough - Bronchiectasis
Productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum, may be blood streaked
Breath Sounds - Bronchiectasis
Wheezing, diminished breath sounds
Appearance of chest - Bronchiectasis
Barrel chest, increased A-P diameter
CXR - Bronchiectasis
- Hyperlucent lung fields
- Depressed or flattened diaphragm
- Enlarged or elongated heart
PFT - Bronchiectasis
Decreased flow rates
CBC - Bronchiectasis
Increase RBC, Hb, HCT
Sputum - Bronchiectasis
May indicate infection
Special Diagnostic Tests - Bronchiectasis
CT scan - increased bronchial wall opacity. Characteristic appearance of end-on signet ring opacity
Treatment Management - Bronchiectasis
- Bronchopulmonary hygiene
- O2 for Hypoxemia
- Antibiotics for infection
- Aersolized medication
- Surgical resection of involved segments if necessary
Caused by failure of the respiratory center of the brain to send signals to the respiratory muscles
Central Sleep Apnea
Caused by anatomic obstruction of the upper airway in the presence of continued ventilatory effort
Obstructive Sleep Apnea
ABG - Sleep disorder
Chronic ventilatory failure with hypoxemia (severe sleep apnea)
CXR - Sleep disorder
May be normal or demonstrate right and/or left sided heart failure
Special Tests - Sleep disorder
Polysomnography results - Central Apnea
Both nasal flow and respiratory effort decrease then desaturation
Special Tests - Sleep disorder
Polysomnography results - Obstructive Apnea
Nasal flow decreases with increase in respiratory effort then desaturation
PFT - Sleep disorder
Decreased volumes if obese
Treatment and Management - Central Sleep Apnea
NPPV
Treatment and Management - Obstructive Sleep Apnea
- Nasal CPAP
- Weight loss
- Sleep posture
- O2 therapy for hypoxemia
- Surgery (trach)
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
