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CardioPulm Lecture 8 - Pulmonary Risk Factors and Disease > Pulmonary Disease - BPD and CF > Flashcards

Pulmonary Disease - BPD and CF Flashcards

1
Q

What is Obstructive Pulmonary Disease

and what could it ultimately affect

A

Respiratory tract diseases that produce an
obstruction
to air flow

which can ultimately affect the mechanical function and gas exchange of the lungs

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2
Q

Obstructive Pulmonary Disease risk factors (6)

A 
Age: (Prematurity, Elderly)
Immunocompromised
Environmental Factors
Smoking
Genetics
Restricted Thoracic Movement
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3
Q

The effects of smoking on the lungs

A

Produces a low level chronic inflammation in the lungs

Increased phagocytes, neutrophils, and alveolar macrophages all contribute to the breakdown of elastin in the alveoli

Destroys the action of cilia

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4
Q

What is Hypoxia

A

Hypoxia is inadequate oxygenation

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5
Q

Hypoxia can result from

A

Pulmonary Disease with impaired diffusion
V-Q mismatching: shunting
Inadequate O2 transport
Inadequate tissue oxygenation

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6
Q

Some causes of hypoventilation (5)

A

Respiratory center depression

Neural conduction interference

Respiratory muscle disease

Restriction of the thorax

Restriction of lung excursion

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7
Q

Some causes of Hyperventilation (8)

A

Anxiety

Lesion of CNS

Medications/ Hormones

Increased Metabolism

Hypoxia/ CO2 retention (short term)

Acidosis

Hypotension - drop in BP

Pain

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8
Q

BPD stands for

A

Bronchopulmonary Dysplasia

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9
Q

What is Bronchopulmonary Dysplasia

A

Chronic lung disease of early infancy

Presentation:
O2 dependency beyond 1 mos., and vent support

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10
Q

Infants at risk for BPD include those with:

A

Bronchopulmonary Dysplasia

Prematurity
Meconium aspiration
Persistent fetal circulation (PDA and PFO)

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11
Q

BRONCHOPULMONARY DYSPLASIA occurs in some respiratory distress syndrome infants who require (aka)

A

PROLONGED VENTILATION

AKA Pulmonary Fibroplasia and ventilator lung

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12
Q

BRONCHOPULMONARY DYSPLASIA occurs more in babies who are (2)

A

LBW (low birth weight)

and who rec’d high flow O2 for 5 d or longer

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13
Q

Effects of BPD on babies

A

Bronchopulmonary Dysplasia

Many infants recover and improve over time however severe BPD correlates highly with developmental delays

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14
Q

4 stages of BPD pathology

A

Stage 1: Hyaline membrane disease caused by decreased surfactant (will not have all your surfactant until 32 weeks)

Stage 2: Tissue granulation (breakdown of tissue), obliterating bronchitis

Stage 3: Emphysematous changes (distended terminal airways and open alveoli ->hyperinflation)

Stage 4: Subepithelial fibrosis (scarring), right ventricular hypertrophy (corpulmonaly)

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15
Q

BPD can cause injury by

A

Barotrauma (injury caused by pressure)

O2 Toxicity (cellular tissue damage occurs from excessive oxygen levels in the blood)

Pulmonary interstitial edema

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16
Q

BPD: Clinical Features

how will infants present?

A

Infants will present with:
Tachypnea
Cyanosis
Bronchiolitis or Pneumonia

May require a tracheostomy

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17
Q

Why is it important to know if a person has BPD in their medical history

A

If in persons history - might have decreased reserves and dec. endurance and also correlated with delayed developmental milestones

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18
Q

How does someone get CF

A

Autosomal recessive trait

Abnormal Gene- affects the transmembrane conductance regulator (CFTR) protein

19
Q

Normal Pancreatic Function

A

Pancreas secretes enzymes which aid in the digestion of fats and proteins

Normal mucous bathes and protects internal surfaces, transports chemicals between organs through small ducts

Flows easily, carrying bacteria, dirt and waste

20
Q

How does CF affect pancreatic function

A

changes cell permeability to salt causing an electrolyte abnormality

21
Q

Which tissues have CFTR and what does that mean for CF

A

CFTR is present in the respiratory tissue, GI tracts, as well as the sweat glands, and reproductive system

CF affects more than the lungs

22
Q

Which organs most affected with CF

A 
lungs
pancreas
reproductive system
sinuses
sweat  glands
23
Q

Accumulation of hyper viscous secretions in pts with CF leads to

A

progressive obstruction of mucous secreting exocrine glands, preventing delivery to target organs

24
Q

Cystic Fibrosis Impairments

A

1) Dysfunctional Cl channel epithelial function causes abnormal concentrations of Na and Cl
2) Blocked exocrine gland function
3) Increased susceptibility to chronic endobronchial colonization

25
Q

What is endobronchial colonization

A

infections in the lungs over and over again, pneumonia is a destructive process leads to decrease in function

26
Q

Pancreatic Dysfunction

and CF

A

Viscous secretions begin to obstruct pancreas in utero with periductal inflammation and fibrosis

Maldigestion of protein = greasy, bulky, foul
smelling stools
*stool is a confirmatory test

27
Q

Pulmonary Dysfunction

and CF

A

Obstruction of small airways

Air trapping and atelectasis

Progressive airway obstruction

Decreased gas exchange

Opportunistic bacteria, inflammation, bronchiectasis, and irreversible airway damage

28
Q

Patient presentation with CF

A 
Patients are likely to present with:	
Persistent Cough
Recurrent Pneumonia
Excessive Appetite
Poor Weight Gain
Salty Skin/Sweat
Bulky Foul Smelling  Stools
Infertility
Nasal Polyps
Chronic Wheeze
Glucose Intolerance
Tachypnea
Cyanosis/Digital Clubbing
Exertional Dyspnea
Pneumothorax
Hemoptysis 
Right Sided Heart Failure (lungs do not work)
29
Q

Why does a person with CF have poor weight gain

A

lack of digestion

30
Q

Associated Medical Complications with CF

A

↑ Incidence of DM, Intestinal Obstruction, Hepatobiliary involvement, Recurrent Pancreatitis

Obstruction of the vas deferens
(98% infertility in males, ↓ fertility in females)

Sinusitis (Persistent HA)

Pneumothorax 2º rupture of bronchiectatic cysts or subpleural blebs, Clubbing, Anorexia, Malnutrition

31
Q

*Medical Tests for Diagnosis of CF

A

Sweat Test

Nasal PD (Potential difference)

Stool Analysis

32
Q

Can CXR diagnose CF

A

Findings are negative early on in the disease process

Later, X-rays demonstrate streaky, white bands across the lung fields

Pneumonia, bronchiectasis, atelectasis, pneumothorax

33
Q

What will a CXR of later stages of CF look like

A

Streaky

White bands

34
Q

What problems would a PFT show for a person with CF

A

Obstructive Components: -Air trapping
Increased RV and FRC
Increased PaCO2

Restrictive Components: Restricted air flow
Decreased TLC and VC

35
Q

CF chest pt assessment will show

A

Auscultation - Rales/sonorous wheezes

Increased A/P diameter (Barrel Chest)

Chronic, productive cough

Accessory muscle use

36
Q

CF chest PT treatment

A

Postural Drainage (no trendelenburg)

FET (forced expiration technique) (huffing) as effective as 2-3 CPT treatments/day

ACB (Active cycle breathing) uses FET in conjunction with thoracic exp. exercises

AD (Autogenic draining)(uses segmental breathing)

Trunk Mobility/Postural Education

Exercise encouragement

37
Q

Aduct tools to increase exercise tolerance and secretion clearance in pts with CF

A

IPV Intrapulmonary Percussive Ventilator
machine that delivers small bursts of air to help clear mucus

PEP (positive expiratory pressure)/flutter

Aerobika- oscillating positive expiratory pressure device

Inflatable therapy vest

Mucolytics (thins secretions)

38
Q

Any PT program for CF should advocate regular exercise, the benefits of which include:

A

👍 ↑ sputum clearance
👍 ↑ aerobic fitness
👍 psychological benefits

39
Q

CF Nutrition

A

Balanced diet - high calorie

Enzyme supplementation for fat and protein digestion

May require supplemental nutrition at night by NG or IV (hydration essential for adequate expectoration of secretions)

40
Q

CF Pharmacology

A

Abx - for recurrent infections

Nebulizers

Mucus thinners

CFTR Modulation Therapies

Steroids to dec. inflammation

41
Q

Lung transplant and CF

A

Must be done bilaterally

Severe pulmonary disease with marked hypoxemia

Increase in the frequency of hospitalizations

Increased antibiotic resistance

No other significant vital organ disease

History of medical compliance

Acceptable psychological profile

42
Q

Complications and things to keep in mind with lung transplants

A

Complicated by fact many recipients are adolescents

May tend to skip follow up rx in order to fit in better with peers

cystic fibrosis is still all in the body even though lungs do not have gene

43
Q

Lung Transplant P/O

A

Immunological suppression post op

Risk of rejection

Pts may be colonized with infectious agents (esp in sinuses) that can infect new lungs

Unique challenges (only organ transplant that comes into contact with the outside world)

CardioPulm Lecture 8 - Pulmonary Risk Factors and Disease (4 decks)

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