Pulmonary Conditions Flashcards

1
Q

Flail chest

A

Segment of rib cage breaks from the rest of the chest wall (>3 ribs break on >2 places)

Caused by trauma; it is a life-threatening emergency

Characteristic:
Paradoxical breathing: inspiration = inward; expiration = outward (“flails”)

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2
Q

Pneumothorax

A

Air in the thoracic cavity or chest wall; causes lung/s to collapse

S/S: Dyspnea, chest ache and tightness, cyanosis, tachycardia, apnea on collapsed lung

Types of pneumothorax:
1. Traumatic (GSW)

  1. Spontaneous: lung collapses for no apparent reason; primary risk factors: <30 y/o, thin, male, smoker, abrupt changes to atmospheric pressure; secondary risk factors (diseased lung tissue): COPD, asthma, CF, interstitial/inflammatory lung disease
  2. Tension: a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure; displaces mediastinal structures and compromises cardiopulmonary function (decreases preload, and BP)
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3
Q

Pleural effusion

A

Build-up of excess fluid in the pleural space

Empyema: collection of pus in pleuritic space d/t infection (exudative)

S/S: Dyspnea, excessive cough, pain on inspiration, fever, difficulty taking deep breaths

Types of effusion:
1. Transudative: non-inflammatory; fluid is clear, low-protein, and absent of cells; typically due to salt and fluid retention/increased venous pressure; causes: CHF, cirrhosis, nephrotic syndrome, peritoneal dialysis

  1. Exudative: inflammatory; fluid is cloudy, thick, high-protein, cells are present, and contain blood, bacteria and WBCs; causes: infection, malignancy, connective tissue disease, inflammatory disorders, CABG, PE
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4
Q

Bronchiectasis

A

A condition where the bronchial tubes of the lungs are permanently damaged, widened, and thickened from frequent infection and blockage (inflammation)

Damaged airway and cilia allow bacteria and mucus to build-up and pool in lungs; this can lead to RF and atelectasis if left untreated

Risk factors: Progressive lung diseases (CF), measles, pertussis (whooping cough), TB, fungal infection, immunodeficiencies, connective tissue diseases, environmental, idiopathic

S/S: Dyspnea, excessive cough, increased sputum production, wheezing, chest pain, clubbing, hemoptysis, fatigue, FTT

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5
Q

Bronchiolitis

A

Inflammation and congestion of the small airway (bronchioles) of the lung; may lead to alveolar destruction

Commonly caused by viral infections among young children and infants

S/S: Tachypnea, accessory muscle use, low-grade fever, dry cough, hyper-inflated chest

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6
Q

Epiglottitis

A

Inflammation of the epiglottis

Commonly caused by H. influenza and other bacteria among unvaccinated children 2-8 y/o. and adults

S/S: Sore throat, dysphagia, drooling, changes in voice, dyspnea, inspiratory stridor

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7
Q

Atelectasis

A

A complete or partial collapse of the entire lung or lobe that can lead to hypoxia, pneumonia, and/or RF

Causes:

  1. Reduced alveolar ventilation (deflation)
  2. Air and/or fluid trapped inside alveoli

Risk factors: Bed confinement/immobility, infection, disease, FB, surgery

S/S: Dyspnea, tachycardia, cough, pain, cyanosis, wheezing; treated with incentive spirometer

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8
Q

Interstitial lung disease

A

Lung disorders (CF, sarcoidosis) that cause progressive scarring of lung tissue (pulmonary fibrosis); characterized by inflammation and scarring on supporting tissue

Results in decreased gas exchange; it is commonly fatal and often untreatable (3-5 yr. life expectancy post-diagnosis)

S/S: Dry cough, dyspnea, weight loss, clubbing, enlarged heart, fatigue

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9
Q

Sarcoidosis

A

Autoimmune inflammatory disease that affects multiple organs, but mostly the lungs and lymph nodes (type IV cell-mediated hypersensitivity)

Chronic inflammation results in deposition of immune cells, granuloma development, and scarring that can lead to pulmonary fibrosis and pulmonary HTN

Restrictive lung disease

Risk factors: >55 yrs. old, occupation, mold exposure, FHX, African or Scandinavian descent, female

S/S: Fatigue, fever, pain, swollen joints, cough, dyspnea, skin lesions

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10
Q

Pulmonary edema

A

Excess fluid in the lungs

Causes: (1) Excess filtration or (2) disruption in the reabsorption of net filtrate

Types of pulmonary edema:
1. Cardiogenic: caused by increased pressures in the heart (usually a result of LHF)

  1. Non-cardiogenic: NOT caused by increased pressures in the heart; caused by (1) increased filtrate d/t injury, inflammation, obstruction, high altitude, CA, toxins OR (2) lymph blockage that prevents net filtrate reabsorption

S/S: DOE, orthopnea, wheezing, feeling of suffocating/drowning, anxiety, restlessness, “wet” cough, chest pain, fatigue, frothy sputum, diaphoresis

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11
Q

Pulmonary embolism

A

Detached clot that lodges in pulmonary vasculature

S/S: Tachypnea, dyspnea, chest pain, increased dead space, hypoxemia, pulmonary infarction and HTN, decreased CO, systemic hypotension, shock

Virchow’s Triad:
1. Circulatory stasis (atrial fibrillation, HF, immobility, paralysis)

  1. Vascular (endothelial) wall injury (trauma, venipuncture, atherosclerosis)
  2. Hyper-coagulable state (CA, trauma, sepsis, infection, HRT/ERT, female contraceptives)
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12
Q

Pneumonia

A

Viral, bacterial or fungal infection of the lungs that causes purulent fluid build-up in alveoli

Locations:

  1. Lobar: one or more WHOLE sections of lungs
  2. Bronchial: PATCHES throughout both lungs

Risk factors: >65 and <2 yr. olds, existing lung disease, smoking, unvaccinated

S/S: Cyanosis, productive cough (green/yellow, hemoptysis), fever, diaphoresis, chills, fatigue, tachypnea, dyspnea, tachycardia, chest pain

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13
Q

Tuberculosis

A

An airborne-transmitted disease caused by Mycobacterium tuberculosis that infects the lungs; 10% infected develop active disease

Chronic granuloma inflammation undergo tubercle formation that are filled with caseous necrosis (to isolate TB bacteria)

Differentiated by placing under blanket of non-tuberculosis Mycobacterium; Dx: TB skin, CXR, sputum analysis

Risk factors: recent exposure, living/visiting countries with high TB rates, <5 yrs. old with pos. TB test, immunodeficiency, housing insecurity, IV drug users, s/p organ transplant, health care workers, diabetes

S/S: Progressive fatigue, malaise, anorexia, weight loss, productive cough with sputum, night sweats, hemoptysis, pleuritic chest pain, low-grade fever

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14
Q

Acute Respiratory Distress (ARDS) and Acute Lung Injury (ALI)

A

A spectrum of lung diseases characterized by an acute, severe inflammatory process causing diffuse alveolar damage and resulting in a variable degree of V/Q mismatch, severe hypoxemia, and poor lung compliance

High mortality rate (>35%) d/t sepsis and RF

Causes:

  1. Direct lung injury: trauma
  2. Indirect lung injury: infection (pneumonia, inhalation of harmful substances, sepsis, shock, drug overdose, severe bleeding)

First symptoms: increased RR and hypoxemia; treatment: mechanical ventilation (maintain arterial PaO2 >60 mmHg and O2 sat. >90%)

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15
Q

Common diagnostics

A

CXR

Chest CT

Ultrasound (fluids)

Spirometry (lung function)

Sputum culture

Bronchial alveolar lavage

ABG

O2 sat.

Other labs: CBC, CMP

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16
Q

Arterial Blood Gas (ABG)

A

Measures:

  1. pH = 7.35-7.45
  2. PaO2 = 75-100 mmHg
  3. PaCO2 = 35-45 mmHg
  4. HCO3 = 22-26 mEq/L
  5. O2 sat. = 94-100%