Pulmonary Flashcards
Portions of Respiratory System?
Upper airway- nasal cavities, sinuses, pharynx, tonsils, larynx
Lower airway- conducting A/W (tranches, bronchi, non-respiratory bronchioles)
Terminal Alveoli- respiratory bronchioles, alveolar ducts, alveolar sacs
How many generations of Airways are there?
26
- 1st 16 are conducting
- next are transitional
- the 24th generation is the final respiratory zone consisting of alveoli
Split in Trachea?
Bifurcated Angle of Lewis
Which lung is bigger?
Right–left has heart resting on it
Dyspnea
Shortness of breath, but what patient is perceiving
Orthopnea
Inability to sleep flat; sign on pulmonary and cardiac disease (30 degrees of head elevation is best)
Pleuritic Pain
Pain with breathing around the lung tissue
Cyanosis
Blue–not enough oxygen
Clubbing
Swollen–ends of fingers on pads
Tachypnea
Fast respiratory rate
Abnormal Chest Wall Shape
Pigeon Breast, bad scoliosis, etc.
Interferes with breathing and exercise tolerance
Hemoptysis
Coughing up blood
DOE
Dyspnea on exertion
Parietal vs. Visceral Pleura?
Parietal is sensitive to pain while visceral is not
Parietal Pleura
Outermost of the pleural membranes
Visceral Pleura
thin serous membrane tissue layer that sticks to the lung surface
Hypoxemia
Deficient oxygenation of arterial blood; can lead to hypoxia
Signs and Symptoms of Hypoxemia?
PaO2:
80-100 = Normal
60-80 = Tachycardia, DOE, possible onset of respiratory distress
50-60 = malaise, light headed news, nausea, impaired judgement
This is emergency!
Below 90 for pulse oximetry is already about 60-80 for PaO2
Pulmonary Edema
Fluid in tissues and air spaces of the lung
Most commonly caused by heart disease, especially LVF
Pneumonia
Inflammation affecting parenchyma of the lungs
-Dx with sputum cultures, chest percussion, urine test
Tx- antibiotics, chest PT, rest, fluids
-risk factors= bronchitis, smoking, chemo, COPD…
-Signs= pleuritic chest pain,productive cough, rust or green sputum, Dyspnea…
Either lobar or Bronchopneumonia
Recovery from Pneumonia
Consolidation- fluid displaces some of the air so get SOB
Red Hepatization- blood leaks into air leaks
Gray Hepatization- breakdown of accumulated RBC
Resolution- can see dis colored or bloody sputum; infection clearing
Pneunocystis Carinii Pneumonia (PCP)
Parasitic infection seen in AIDs, it is the first indicator of conversion from HIC to AIDS; also seen in the immunosuppressed
Signs= impaired gas exchange, fever, Dyspnea, tachypnea, weight loss Tx= Universal Precautions, breathing exercises, energy conservation
Tuberculosis- Primary Infection
Involves middle or lower lung area and spreads to bronchopulmonary lymph nodes and then travels to blood stream
Mycrobacterium TB
Characterized by granulomas, caseous necrosis, cavity formation
Tuberculosis
Infectious inflammatory systemic disease; affects lungs and may disseminate to involve lymph nodes and other organs
Risk factors= elderly, poor health, HIV, inadequate ventilation
Signs= appear late, night sweats, productive cough, fatigue, lung atelectasis, pulmonary infections weight loss
Etiology= inhalation of infected airborne particles
Dx= skin test, chest X-ray, culture of sputum, bronchoscopy
Ex= combo of drugs (rifampin and isoniazid), prevent transmission
Acute Bronchitis
Inflammation of the trachea and bronchi
Results from chemicals, viral infections
Signs of Acute Bronchitis
Cough, chest pain, constitutional symptoms
Lasts about 1-3 weeks
COPD
Refers to a number of disorders; chronic obstructive pulmonary disease–trouble getting air out so cannot really get it in
Diagnosis of COPD
Blood gas analysis, sputum culture, skin testing, X-ray, PFTs
COPD Goal?
Improve PaO2 and decrease CO2 retention, prevent respiratory infections
Treatment for COPD
Pharmacology managements, pulmonary hygiene, bullectomy, chest PT; low-level walking!
Chronic Obstructive Bronchitis
Productive cough lasting 3 months, for 2 consecutive years with a decreased FEV1/FVC
Chronic Obstructive Bronchitis Signs
Cough with mucus, cyanosis, prolonged expiration, recurrent infection, SOB, Hypoxemia, retention of CO2, accessory breathing muscles, hypertrophy of mucus producing cells, air trapping
-forced expiration tends to produce collapse of tissue
Emphysema
3 types:
Centrilobular, panlobular, and paraseptal–> all produce destruction of airways
Obstruction results from changes in lung tissue (not mucus)
Emphysema Signs
Dyspnea, tachypnea with prolonged expiration, wasting appearance, leaning forward with arms braced on knees to assist breathing
Asthma
Inflammation of airways causing bronchospasm with SOB and wheezing; release of inflammatory mediators produces bronchial smooth muscle spasm, vascular congestion, edema, increased mucus productions, and impaired much ciliary function–eosinophilia infiltration
-there is an airway spasm, trapping of air, a ventilation/perfusion mismatch, and Hypoxemia
Asthma Signs
Begins with sensation of chest constriction, inspirations and expiration wheezing, non-productive coughing, tachycardia, tachypnea, later cough becomes productive with nasal flaring and cyanosis of lips
-status asthmaticus–over 24 hours, very serious attack!
Asthma Diagnosis
PFTs, ABGs, pulse oximetry, will occur in families (possible genetic component)
Asthma Treatment
Bronchodilators, steroids, leukotriene inhibitors
Exercise induced- use inhaler 20-30 min prior to exercise
Intrinsic Asthma
No allergic, adult onset (over 40), secondary to chronic infections
Extrinsic Asthma
Allergic asthma (often seen in kids)
Bronchiectasis
Progressive form of obstructive lung disease characterized by irreversible destruction and dilation of airways associated with chronic bacterial infections
Chronic dilation of bronchi/bronchioles with wet secretions plug airways and cause more purple to mucus causing bronchospasm, destruction of bronchial walls occur with fibrosis that further obstructs lumen
Pockets of pus/infection–> can burst!!!
Bronchiectasis Signs
Persistent coughing, increased amounts of sputum, anemia, fever, may have hemoptysis, weight loss, weakness
Bronchiectasis Treatment
Chest PT, bronchodilators, antibiotics
Bronchiolitis
Severe inflammation of the lower airways caused by viral infection; children under 2 yrs most commonly affected
Bronchiolitis Characterized By:
Bronchioles muscle swelling and filling with mucus, hyperinflation, obstruction, cough respiration distress, cyanosis
Sleep Apnea
Episodes of cessation of breathing occurring at transition from BREM to REM repeated awakenings
-once you start to go into REM sleep, PaO2 begins to drop
More than 5 cessation so for at least 10 seconds per hour
Sleep Apnea Risk Factors
Narrowed upper airways, obesity, adenoid, uvula, and tonsil hypertrophy, smoking
Sleep Apnea Signs
Snoring, breath cessation, thrashing movement of extremities, daytime sleepiness, headaches, personality changes
Sleep Apnea Treatment
Weight loss, CPAP (positive pressure keeps alveoli open so you get better gas exchange)
Restrictive Lung Diseases
Limits lung expansion–cannot get air into the lungs
Chronic hyperventilation, exertional Dyspnea and later at rest, respiratory muscle fatigue leading to decreased alveolar ventilation and CO2 retention, Hypoxemia
Restrictive Lung Disease Causes
Weakness from neuromuscular disease, interstitial lung diseases
Systemic Sclerosis Lung Disease
Scleroderma-autoimmune disease of connective tissue with excessive collagen deposition in skin and internal organs
Skin changes verbally precede visceral alterations
-about half will develop interstitial lung disease
Systemic Sclerosis Lung Disease Treatment
Low-dose prednisone
Sarcoidosis
Systemic disease of unknown cause, granulomas throughout body, collection of macrophages surrounded by lymphocytes taking nodular form
**lungs and lymph nodes commonly affected!
Sarcoidosis Signs
Dyspnea, dry cough, fever, skin lesions
Sarcoidosis Diagnosis
Chest X-ray
Sarcoidosis Treatment
Steroids, may also come to PT for stiff joints and to increase aerobic endurance
Pulmonary Fibrosis
Excessive fibrous tissue in lung that replace normal tissue due to chronic inflammation; also know as interstitial lung disease
Pulmonary Fibrosis Causes
Healing scar tissue after TB, systemic sclerosis, ARDS, or inhalation of toxic substances
About 2/3 are idiopathic
Pulmonary Fibrosis Treatment
Corticosteroids
Pulmonary Fibrosis Prognosis
Poor; everything becomes stiff
Chest Wall Disease
Range from superficial wounds to tension pneumothorax (air enters lungs because of trauma and prevents you from getting air out
Chest Wall Disease- Flail Chest
Multiple rib fractures or fracture of the sternum which may cause paradoxical movement of the chest
2 or more fractures of adjacent ribs on the same side
Chest Wall Disease Treatment
Pain meds, mechanical ventilation
Pneumoconiosis
Group of disorders resulting from inhalation of industrial substances (iron, coal dust, asbestos, silica, talc, beryllium)
Exposure over 10 years
Smaller the dust particles, the more dangerous
Fibers are indestructible and produce inflammatory process that results in excess fibrosis
Pneumoconiosis Signs
Progressive Dyspnea, chest pain, chronic cough, expectoration of mucus
Smoke Inhalation
Produces mucosal injury via hot gases, asphyxia as O2 is consumed by fire; deficient supply of O2 to blood
Thermal injury in upper airway produces edema and obstruction
Cystic Fibrosis
Inherited disease of exocrine glands; affects hepatic, digestive, male reproductive system, and respiratory system
Altered chloride and sodium channels
Dehydration with increased viscosity of secretions
Progresses from mucus plugging of small airways to bronchitis, to bronchi ecstasies, pneumonia, and fibrosis–>later involves all bronchi
Cystic Fibrosis- Pancreas
Thick secretion blocks ducts, preventing enzymes from reaching the duodenum; results in fatty stools
Me odium ileum at birth, prolapse of rectum, risk of impacting
Cystic Fibrosis- Pulmonary
Chronic cough and sputum production, increased risk of infection, reduced oxygen CO2 exchange, acidosis
Cystic Fibrosis Dagnosis
Sweat test/stool fat measurements, pancreatic elastase-1
Cystic Fibrosis Treatment
Antibiotics, drugs to thin secretions, adequate hydration, nutritional support, pancreatic enzymes, mucous tics, CPT, exercise
Atelectasis
Lung collapse
Alveolars close, air is sucked out, alveoli collapse
Obstructive Absorptive Type Atelectasis
Collapse resulting from removal of air from obstructed or hypoventilated alveoli
Compressive Type Atelectasis
Due to air, blood, or fluid filling the pleural space
Atelectasis Signs
Dyspnea, tachypnea, cyanosis, fever, decreased BP, shock
Atelectasis Diagnosis
via X-ray
Atelectasis Treatment
Remove cause, auctioning or bronchoscopy, prevention especially in post surgical patients, breathing exercises, percussion/vibration
**deep breathing and coughing best thing to do after surgery
Pulmonary Edema
Fluid in the lungs which leak into interstitial tissue and in alveoli
Pulmonary Edema Causes
Left ventricular failure, acute HBP, mitral valve disease
Non-cardiac causes: liver disorders and kidney disorders in which there is sodium and water retention
Increased capillary permeability, decreased albumin, and increased lymphatic obstruction
Pulmonary Edema Signs
Persistent cough, Dyspnea, diaphoresis, intolerance to exercise
As fluid increases, these sing scan become more pronounced!
–> Cough may produce pink frothy sputum, wheezing occurs, respiration rate increases
Pulmonary Edema Diagnosis
Clinical presentation and chest X-ray
Pulmonary Edema Treatment
Meds, ventilation
ARDS (Adults Respiratory Distress Syndrome)
Result of injury to the lung by a variety of disorders- a collection of symptoms
ARDS Causes
Damage to capillary endothelial cells and alveolar epithelial cells which inactivated surfactant and allows fluids, proteins, and cells to leak from capillary
–leads to pulmonary edema and alveolar collapse, impairments of lung compliance (shuts lungs down)
ARDS Signs
Initially increased respiration rate then Dyspnea, hyperventilation, cyanosis
ARDS Diagnosis
Exam of ABGs and microbiological cultures, X-rays
ARDS Treatment
Treat underlying condition, ventilation
ARDS Prognosis
Unpredictable, pulmonary fibrosis may result, mortality rate is about 50-70%, if accompanied by sepsis it is 90%
Lung Cancer
Most frequent cause of cancer death in U.S., classified as small cell lung Cancer (20%) or non-small cell lung cancer (80%)
Four Main Types of Malignant Lung Tumors
SCLC- oat cell
NSCLC- squamous cell carcinoma, adenocarcinoma, large cell carcinoma
Small or non-small!
Small Cell Lung Cancer
Oat cells become so dense that there is almost no cytoplasm, compressed into an ovoid mass, located centrally near hilum
Rapid growth with early mets, secretes ACTH, early symptoms similar to those of smoking
Treat with chemo and radiation
Squamous Cell Cancer
Arise in central portion of lung near hilum, projecting in into bronchi, have a central cavity, stay local within thoracic cavity longer
Adenocarcinoma Lung Cancer
Moderate growth rate, arise in periphery, early mets
Large Cell Lung Cancer
Peripheral pulmonary tumors that cause sharp and significant pleural pain, early mets, poorest prognosis!
Lung Cancer Symptoms
Depends on location
Central tumors obstruct airflow
Peripheral tumors only produce pain when pleura is affected, may limit lung expansion
Tumors of apex- Pancoast’s tumors-invade brachial plexus
Lung Cancer Diagnosis
X-ray, CT, lung imaging fluorescence endoscope, bronchoscopy
Lung Cancer Treatment
Surgery with lymph node resection, radiation, and chemo
Surgery choice in NSCLC and chemo
Radiation in SCLC with chemo
Lung Cancer Paraneoplastic Syndromes
Effects of malignancy felt remotely-hyper alexia, osteoarthropathies, DVT
Pulmonary Embolism
Lodging of blood clot in a pulmonary artery, with subsequent obstruction of blood supply to lung parenchyma
Pulmonary Embolism Risk Factors
Blood stasis secondary to immobilization, endothelial injury secondary to hypercoagulable states (BCP), DVT, obesity, smoking, HTN, malignancy, fractures of hip or femur
Pulmonary Embolism Signs
Depends on size of PE
Humans sign, pleuritic chest pain, persistent cough, hemoptysis, diaphoresis, fever, tachypnea, sudden death
Pulmonary Embolism Prevention
LMW Heparin to prevent clot extension, thrombolytic therapy to lyse thromboemboli, greenfield filter in vena cava
Pulmonary Embolism PT
Avoid restrictive clothing, crossing legs, prolonged sitting, pillow under knees in supine, extreme flexion at hips
No massage to legs if DVT or PE has been diagnosed
Bed exercises for LEs, compression stockings, early ambulation, hydration
Pulmonary Hypertension
HBP in pulmonary arteries, with 5-10 mmHg above normal (15-18 mmHg)
Pulmonary Hypertension Causes
Primary: narrowing of pulmonary arterioles by hypertrophy of smooth muscle
Secondary: increases in volume or pressure of blood entering the pulmonary arteries
Pulmonary HTN Signs
Fatigue, tachypnea, cyanosis, Dyspnea
Pulmonary HTN Treatment
Oxygen for Hypoxemia, digitalis, diuretics
Poor prognosis without a heart-lung transplant
