PM Asthma, atelectasis, pleural effusion Flashcards
what is chronic about asthma
chronic inflm of the airway
the airways is hyper-responsive
there are recurrent, reversible bronchospasm
(it is chronic but it has episodes)
what is reversible about asthma
asthma has reversible episodes of airway obstruction that is due to
- inflm
- muscle hyperactivity (of the airway->spasm)
asthma is?? also? other than reverisble episodes of a/w obstr and chronic inflm of the a/w
other allergic disorders
et of asthma
- complex trait
- genetic and enviro factors
- hypersensitivity to stimuli (these are triggers)
- allergens
- a/w irritants
- exercise
- strong odours
- cold air
fig 29.6
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fig 29.6
f
fi
fig 29.6
f
differences in time of early vs late phase in relation to timing
early phase peaks in 5min
late phase is more progressive and can last months
why does the late phase last so long
there is a cyclic inflm that attracts more inflm cells etc.
does the early or late phase have mucus
late
what is necessary for the acute phase response to occur
prior sensitization to allergen (TYpe 1 hypersensitivyt0
what happens acute phase after subseq exposure
allergen binds to IgE coated mast cells->mediator release->inflm
- intercellular junction open->allergens enter submucosa
- inc permb and increased mucus secretion->edema of the airways
- PNS stimulated to bronchospasm
- dyspnea and wheezing
- a/w constriction (compensatory)
is the bronchospasm from PNS beneficial in the acute phase of asthma
no
how long does acute phase last
what could alter this
up to 1hr (unless they take their meds to stop/prevent it
how is the a/w constriction compensatory that occurs in acute phase response
eg in inhale smoke or irritant the a/w contricts to limit amount of irritant that gets in. the a/w constriction will further irritate the asthma)
why does wheezing sound the way it does
blowing through a narrow tube
what occurs in the late phase response of asthma
peak
what type of mnfts do you see
peaks in 4-8hrs
mnfts (dyspnea, wheezing, edema of a/w, a/w constriction persist)
what occurs in the late phase response of asthma
self sustaining cycle of exacerbation
can last days to weeks
-there is influx of inflm cells (basophils, eosinophils etc)
-epithelial damage
-dec mucociliary fx
-hyperresponsive a/w
-respond to new triggers (eg cold air)
-freq and severe episodeswhy is the a/w hyperresponsive in late phase of asthma
d/t inflm change
do recurrent attacks get better o worse
they get worse d/t cumulative damage
there are EPISODES they are NOT periods of exacerbation and remission
which receptors cause broncho contriction and dilation
alpha adrenergic receptors cause bronchoconstriction
beta adrenergic receptors cause bronchodilation
what mediates the broncho/contr/dilation
cAMP (a second messenger)
what might be lacking in asthma
a lack of beta receptor stimulation in asthma??
mnfts of asthma
-dyspnea
-wheezing
-immobilization
-bronchospasm
-coughing
-inc resp effort
-ventilatory compromise–alt resp status and ABGs (youll see hypoxemia, changes in pH, acidosis, hypercapnia
DWIB VIC the dweeb who lives in Vic
dx of asthma
what are they trying to separate it from?
(they are trying to separate it from respiratory tract infection)
hx, px
labs
pulm fx tests (these will show alt resp status)
inhalation challenge tests (we need alllergen because it is a T1H. this is like an allergy test. IF hyperresponsive they have asthma
tx of asthma
control w preventative meds
what are preventative measures for asthma
avoid allergens and irritants
no smoking
durgs for asthma
at what level is it usually enough?
steps 1-4
step 1: inhaled short acting (beta) bronchodilators PRN
step 2: add inhaled steroids (these first two steps are generally enough for eveyrone)
step 3 add lng acting bronchodilator to the steroid
step 4: short course oral steroid
ass 3rd drug-leukotriene receptor antagonist or theophylline
fx of leukotriene receptor antagonist
(blocks inflm and Type 1 H)
theophylline fx
bronchodilator w anti inflm effects
what are the disorders of lung inflation?
atelectasis
, pleural effusion. maybe more?
what is atelectasis
collapse of part of lung->impedes filling (this is usually only a small part of the lung, surfactant prevents the sides from sticking together)
-affected part is non functional
types of atelectasis
obstructive resporptive
compression atelectasis
contraction atelectasis
obstr/resorptive atelectasis
-a/w obstr eg by mucus)->air trapped (distal to obstr)->absorbed into capillaries->lung collapse
compression atelectasis
external pressure on lungs eg by tumor
contraction atelectasis
scar tissue contraction ->lung collapse
mnfts of atelectasis
- dyspnea
- tachypnea (to get more O2)
- dec chest expansion
- tachycardia (compensatory)
is atelectasis reversible
if not in place too long you can fix it
dx of atelectasis
px
CXR
CT
bronchoscopy
fig 29.4
r
tx of atelectasis
cuase
pleural effusion aka
hydrothorax
what is pleural effusion
fluid accum in pleural space (betweent he pleural membranes)
- d/t abn seepage and or drainage
- exudate: inflm fluid, inc protein content
- transudate: non inflm fluid, dec protein content
pleural effusion of lymph aka
chylothorax
pleural effusion of blood aka
-hemothorax: blood
pleural effusion of pus
-empyema: purulent
et of pleural effuson
usually CHF (L sided is lung and R sided is rest of body)
-infection
CA (tumor in pulm system)
pulmonary infarction. (infarction->dec blood flow->inc push pressure->hydrothorax)
dx of pleural effusion
xray (might not give enough info)
US
CT
tx of pleural effusion
cause
-thoracentesis and fluid analysis
chest tube (this and thoracentesis wont work if the pus solidifies or blood coagulates. youd have to do sx)
can pleural effusion be deadly
yes with large volume
what is given to some palliative care pts and repeticie cases
sclerosing agents that causes the lungs to stick together and fluid cant get in
What causes the airway obstruction that reversible?
Inflation and muscle hyperactivity(muscle spasm)
What causes the chronic inflammation of the airway in asthma
The airway is hyper responsive
There is recurrent reversible bronchi spasm (recurrent due to triggers)
