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Cardiopulmonary Exam II > Pulmonary Diseases > Flashcards

Pulmonary Diseases Flashcards

1
Q

What are the 5 classifications of pulmonary disease?

A
  1. Obstructive
  2. Restrictive
  3. Infectious
  4. Vascular
  5. Pleural
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2
Q

Give a pulmonary disease example for each of the pulmonary disease classifications.

A
  1. Obstructive - COPD
  2. Restrictive - pulmonary fibrosis, ARDS, bronchopulmonary dysplagia
  3. Infectious - empyema, pneumonia, TB
  4. Vascular - pulmonary emboli, pulmonary HTN, pulmonary edema
  5. Pleural - pneumothorax, pleural effusion
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3
Q

What is COPD?

A

Generic term for group of diseases that trap air in the lungs; associated with abnormal inflammatory response of the lungs to noxious particles/gases

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4
Q

What is the #1 risk factor of COPD?

A

Smoking cigarettes (80-90% of COPD cases)

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5
Q

Other COPD questions:

  1. Is COPD preventable?
  2. What is the death rate associated with COPD?
  3. Where does it rank as a cause for disability?
  4. Is the death rate associated with COPD rising or falling?
A
  1. Preventable/treatable but not fully reversible
  2. 3rd leading cause of death in US; 6th Worldwide
  3. 2nd leading cause of disability
  4. Rising
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6
Q

What are the 2 major categories of COPD?

A

Septic and Non-septic

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7
Q

Give 4 examples of non-septic COPD.

A
  1. Emphysema
  2. alpha-1 antitrypsin deficiency
  3. Bronchiolitis obliterans
  4. Asthma
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8
Q

Give 3 examples of septic COPD.

A
  1. Cystic fibrosis
  2. Chronic Bronchitis
  3. Bronchiectasis
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9
Q

What is the difference between septic and non-septic COPD and why is it important to know which you are dealing with?

A

Septic COPD produces a large volume of sputum, chronic cough, colonization of bacteria, & fungus associated with chronic infections.
Important because septic COPD will require bronchial hygiene as PRIMARY PT goal

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10
Q

What is the mechanism of COPD?

A

Inflammatory mediators (released by mast celss, eosinophils, & T lymohocytes) act on cells in the airway, leading to contraction of smooth ms, oedema due to plasma leakage, and mucus plugging

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11
Q

What happens with Residual Lung Volume in COPD pt.’s?

A

Pt.’s can’t get the air out of their lungs so residual volume INCREASES

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12
Q

What happens with Residual Lung Volume in Restrictive disease pt.’s?

A

Residual volume is far LESS than normal

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13
Q

What is residual volume?

A

The air left in the lungs after you breathe all your air out

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14
Q

What are the two main diseases that make up COPD?

A
  1. Emphysema
  2. Chronic Bronchitis
    * includes small airways disease & parenchymal disease*
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15
Q

What is the clinical dx of chronic bronchitis?

A

Cough & sputum production for >/= 3 months for >/= 2 years

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16
Q

What is the pathologic dx of emphysema?

A

Destruction of gas exchanging surface of lung (alveoli & capillaries)

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17
Q

What are 5 characteristics of Non-septic obstructive disease?

A
  1. Hyperinflation of lungs
  2. Barrel chest deformity
  3. Excessive accessory ms. use
  4. Increased lung compliance
  5. Larger lung volume with trapped air (due to premature airway closure)
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18
Q

What do the ABG’s of non-septic obstructive disease show?

A

Hypoxia with or without hypercapnia (increased CO2)

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19
Q

What does the Pulmonary Functional Test (PFT) reveal with non-septic obstructive disease?

A 
Increased...
1. TLC
2. IRC
3. RV
Decreased...
1. FVC
2. FEV1
3. CO diffusion capacity
4. FEV1/FVC ratio
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20
Q

What are the secondary sequelae (problems) from medication & limited activity related to non-septic Obstructive diseases?

A
  1. Type I & II ms. atrophy & weakness
  2. Osteopnia & osteoporosis
  3. R-sided heart failure development
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21
Q

What is the 2nd most prevalent COPD disease? Is it septic or non-septic?

A

Emphysema; non-septic

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22
Q

What is the most prevalent COPD disease? Is it septic or non-septic?

A

Asthma; Non-septic

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23
Q

What is emphysema?

A

Abnormal, non-reversible, airway dilation distal to terminal bronchioles causing premature airway closure and air trapping (bullae)

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24
Q

What pressures decrease as a result of emphysema and what does it result in?

A

Driving & intraluminal pressures decrease leading to impaired expiratory airflow & patent airway during inspiration

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25
Q

What happens to the inspiratory muscles as a result of emphysema?

A
  1. Shorten
  2. Have decreased sarcomeres
  3. Hypertrophy
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26
Q

What happens to the residual volume, acini, and lung size as a result of emphysema?

A
  1. Increased lung volume
  2. Acini destruction
  3. Hyperinflation
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27
Q

Explain the Protease-Antiprotease Hypothesis of Emphysema.

A
  1. Elastase (an enzyme) is normally inactivated by alpha-1-antitrypsin
  2. Smoking upsets balance between the these 2 enzymatic processes resulting in…
  3. Emphysema (the destruction of CT matrix of alveolar walls by elastase)
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28
Q

What are 4 signs & symptoms of Emphysema?

A
  1. Cough & Phlegm
  2. Dyspnea on exertion
  3. Increased AP diameter on CXR (barrel chest)
  4. Increased rib angle
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29
Q

On ascultation, what would a PT hear if a pt. has Emphysema?

A
  1. Decreased distant breath sounds
  2. Prolonged expiration
  3. Wheezing/ronchi (due to secretions)
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30
Q

What ‘advanced diseases’ are a potential result of Emphysema? (There’s a lot!)

A
  1. Cachexia
  2. R-sided heart failure
  3. Peripheral pitting edema
  4. Weight gain
  5. JVD (jugular vein distension)
  6. Decreased appetite
  7. RUQ discomfort
  8. Ventricular gallop
  9. S3 heart sound
  10. osteoporosis
  11. depression (from studying for this exam)
  12. CVD
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31
Q

List 3 types of medications used in Emphysema medication management.

A
  1. Smoking cessation drugs
  2. Bronchodilators
  3. Methylxanthines
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32
Q

What are 3 types of Bronchodilators?

A
  1. Anticholinergics
  2. B2-antagonists
  3. Inhaled corticosteroids
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33
Q

What is the purpose of Methylxanthines?

A

To improve respiratory ms. strength & endurance

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34
Q

What should a pt. take during emphysema exacerbations?

A
  1. Inhaled systemic corticosteroids to relieve SOB

2. Antibiotics for bacterial infection

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35
Q

Name 8 treatments for emphysema.

A
  1. Smoking cessation
  2. supplemental O2 (low flow via nasal canulae)
  3. BiPAP to decrease work of breathing
  4. Mucus clearance device
  5. AAT replacement (alpha-1-antitrypsin)
  6. Pulmonary rehab
  7. Influenza and Pneumococcal vaccine
  8. Surgery
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36
Q

What are the 3 types of Emphysema surgeries a pt. can undergo?

A
  1. Bullectomy - taking out areas of dead space in lungs
  2. LVRS (lung volume reduction surgery) - taking out a piece of lung that doesn’t function anymore
  3. Transplant
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37
Q

What is the only proven way to increase survival for a pt. with emphysema?

A

Therapy! (YAY Us!)

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38
Q

Explain the mechanism behind Alpha-1 Antitrypsin deficiency.

A

A1 Antitrypsin coats the lungs, protecting them from neutrophil elastase. With a deficiency, the lungs lack alpha-1 coating, leaving them open to damage by neutrophil elastase. The A1- antitrypsin gets trapped in the liver causing liver damage while the uninhibited elastase causes lung damage. No bueno!

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39
Q

What is the most common autosomal recessive genetic liver disease in children?

A

AAT Deficiency

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40
Q

What leads to early development of emphysema in the 3rd or 4th decade of life?

A

AAT Deficiency

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41
Q

List the millions of signs & symptoms of Bronchiolitis Obliterans. (There’s actually 8 - close enough)

A
  1. SOB with exertion
  2. Wheezing, crackles, ronchi
  3. Persistent cough
  4. Hypoventilation
  5. Hypercapnia (too much CO2)
  6. Intercostal retraction
  7. Tachynpnea (rapid breathing)
  8. Grunting (back pressure keeping airways open)
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42
Q

What would a CXR (chest x-ray) look like for a pt. with Bronchiolitis Obliterans?

A

Hyperinflation with patchy atelectasis

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43
Q

What is atelectasis?

A

Hardening of the alveoli causing alveoli to collapse, which in turn causes the area of lung to collase

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44
Q

What would a Pulmonary Functional Test (PFT) show for a pt. with Bronchiolitis Obliterans?

A
  1. Decreased FVC (forced vital capacity)
  2. Decreased FEV1 (forced expiratory volume)
  3. Increased RV (residual volume)
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45
Q

What would a CT scan show for a pt. with Bronchiolitis Obliterans?

A
  1. Mosaic perfusion
  2. Vascular attenuation (loss of strength)
  3. Central bronchiactasis (dilation of bronchial tree)
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46
Q

What are 5 ways to treat Bronchiolitis Obliterans?

A
  1. Prevention *****
  2. Supplemental O2
  3. Antivirals
  4. Corticosteroids
  5. Bronchodilators
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47
Q

What is asthma?

A
  1. Asthma is a chronic disease that involves reversible obstruction to airflow within the lungs
  2. Caused by airway inflammation & bronchial hyper-responsiveness
  3. between episodes, lung function is normal
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48
Q

What are the 10 risk factors associated with asthma?

A
  1. Maternal smoking
  2. 2nd hand smoke
  3. Family hx
  4. genetics
  5. Allergic hypersensitivity (atopy)
  6. Childhood asthma
  7. Occupational exposure (related to adult onset)
  8. Environmental exposure
  9. Gender (female > males)
  10. Early infection (RSV)
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49
Q
  1. What age group has the highest occurrence of asthma?
  2. What socio-economic level is most affected by asthma?
  3. Is the prevalence/death rate increasing or decreasing worldwide?
A
  1. Children!
  2. Lower!
  3. Increasing!
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50
Q

What are the signs & symptoms of asthma?

A
  1. Wheezing
  2. Dyspnea
  3. Chest pain/tightness at night
  4. Facial distress
  5. Non-productive cough
  6. Decreased breath sounds
  7. Cyanosis (lips/nail beds)
  8. Exhaustion
  9. Hypercapnia
  10. Pending respiratory failure
  11. Status Asthmaticus
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51
Q

What is Status Asthmaticus?

A

A sever attack this is refractory (non-compliant) to bronchodilators

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52
Q

What are the triggers/stimulants of asthma?

A
  1. Air Pollution**
  2. Medications**
  3. Indoor irritants
  4. Allergens
  5. Mold
  6. Dust Mites, rodents (gross), cockroaches (wicked gross), animal dander
  7. Respiratory infection
  8. Exertion and/or exercise
  9. Cold air
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53
Q

What does exercise induced asthma (EIA) result from?

A

Results from loss of H2O and heat from lower respiratory system (mouth breathing)

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54
Q

What does loss of heat during EIA cause?

A
  1. Hyperemia (increase in blood flow)
  2. Vascular engorgement
  3. Bronchial Edema (narrows bronchioles)
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55
Q

How long after exercise can bronchoconstriction present itself (in regard to EIA)?

A

6-8 hrs

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56
Q

How is EIA diagnosed in Children? In adults?

A
  1. Hx of symptoms in children

2. Adults: FEV1>15% following use of bronchodilator and/or 15% drop in peak expiratory flow following exercise

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57
Q

What factors determine the severity of EIA?

A
  1. Minute ventilation during exercise
  2. temperature
  3. humidity of air
  4. baseline airway reactivity
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58
Q

What is the process of EIA?

A

Trigger -> Inflammatory process -> bronchorestriction & airway obstruction

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59
Q

Why would a pt. use B Adrenergic Agonist as an asthma medication?

A

To increase smooth ms. relation resulting in bronchodilation & inhibits release of mediators

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60
Q

Why would a pt. use Cromolyn as an asthma medication?

A

To prevent an attack - this is NOT a rescue drug

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61
Q

Why would a pt. use Leukotriene Modifiers as an asthma medication?

A

To block pro-inflammatory mediators that promote smooth ms. contraction, vascular leakage, mucous secretion, & airway hyperacticity

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62
Q

Why would a pt. use Immunosuppressive Meds as an asthma medication?

A

Used in chronic, severe asthma cases

63
Q

Are antibiotics usually indicated for asthma tx?

A

Psh, No!

64
Q

How can EIA be reduced?

A

By medication & warming up 45-60 minutes prior to exercise (30 sec bouts with 2 min rest periods)

65
Q

What is the goal of asthma tx and management?

A

Prevention first & minimizing exacerbation second!

66
Q

Routine exercise programs have been shown to impact 3 factors. What are they?

A
  1. increase minute ventilation
  2. increase O2 consumption
  3. decrease blood lactate
67
Q

Name 3 other treatments and/or management schemes for asthma.

A
  1. Environmental control meausures
  2. Pharmacologic therapy
  3. pt. educatioin
68
Q

What are 4 general signs of Septic Obstructive Diseases (Chronic bronchitis, cystic fibrosis, bronchiectasis)?

A
  1. Purulent sputum production & high incidence of pulmonary infection
  2. Productive cough with excessive secretion
  3. Pulmonary HTN
  4. High pressure & narrowing of vessels causing Cor Pulmonale (R heart enlargement & failure)
69
Q

What does the a pulmonary functional test reveal in a pt. with Septic obstructive disease?

A
  1. Decrease in expiratory effort
  2. Increased TLC
  3. Hypercapnia (leading to HTN & Cor Pulmonale)
70
Q

What is the number 1 risk factor associated with Chronic Bronchitis?

A

SMOKING! (leads to inflammation & airway destruction)

71
Q

What leads to excess airway mucus in Chronic Bronchitis?

A

Increased size & number of bronchial mucous glands

72
Q

What causes airway walls to thicken in Chronic Bronchitis?

A
  1. Increased glands

2. Airway inflammation

73
Q

What leads to decreased mucociliary clearance in Chronic Bronchitis?

A

Structural and functional effects on cilia

74
Q

With Chronic Bronchitis, the airways are small (less than 2mm). What develops as a result?

A
  1. Narrowing
  2. Inflammation
  3. Firbosis
75
Q

List the 6 types of Chronic Bronchitis Meds.

A
  1. Short acting Beta-agonists
  2. Long acting Bronchodialtors
  3. Inhaled corticosteroids
  4. Smoking cessation drugs
  5. Expectorants & mucolytics
  6. Anti-protease treatment
76
Q

What are 6 ways to treat Chronic Bronchitis?

A
  1. Supplemental O2
  2. Bronchial hygiene
  3. Pulmonary Rehab
  4. Early mobilization
  5. Smoking cessation
  6. Influenza & Pneumococcal Vaccines
77
Q

What are the characteristics of the Pink Puffers (Type A Pathophysiology)?

A
  1. Predominant emphysema
  2. Dyspnea as major symptom
  3. pt. is thin, wasted, NOT cyanotic
  4. Decreased PO2
  5. Normal or decreased PCO2
  6. Decreased elastic recoil & diffusing capacity
  7. Normal Hematocrit
  8. Infrequent Cor pulmonale
78
Q

What are the characteristics of the Blue Bloaters (Type B Pathophysiology)?

A
  1. Predominant bronchitis
  2. Cough & sputum as major symptom
  3. pt. is obese, cyanotic
  4. Super decreased PO2
  5. Normal or increased PCO2
  6. Normal elastic recoil & diffusing capacity
  7. Increased hematocrit
  8. Common Cor pulmonale
79
Q

What is an autosomal recessive trait that is the most common & lethal genetic disease in the US?

A

Cystic Fibrosis

80
Q

What organs are targeted in Cystic Fibrosis?

A
  1. Sinuses
  2. Lungs
  3. Pancreas
  4. Intestines
  5. Biliary tracts
  6. Vas deferens
  7. Uterine Cervix
  8. Sweat glands
81
Q

How does Cystic Fibrosis affect the lungs?

A
  1. Mucociliary clearance mechanism is hindered
  2. Secretions settle in lungs providing a medium for bacterial growth
  3. Cycle of inflammation, infection and tissue destruction occurs
82
Q

Why are secretions thicker and drier with Cystic Fibrosis?

A

Because of the defect in the chloride ion transfer; Na+ & Cl- transport is diturbed causing water to be pulled back into the cells

83
Q

What is the hallmark sign of Cystic Fibrosis?

A

The baby tastes “salty” (weird)

84
Q

What are the 17 signs and symptoms of Cystic Fibrosis? (Name 6 and we’ll call it even)

A
  1. Meconium ileus at birth
  2. Failure to thrive/ regain birth wt.
  3. Recurrent respiratory infections
  4. Chronic productive cough (hemoptysis)
  5. “Salty Kiss”
  6. Pancreatic insufficiency, pancreatitis, diabetes
  7. Nasal polyps
  8. GERD
  9. SOB w/ excessive inspiratory accessory ms. use
  10. inspiratory crackles & wheezing
  11. Clubbing of nails
  12. wt. loss
  13. decreased activity tolerance
  14. osteoporosis
  15. ms. wasting
  16. chronic low back pain
  17. developmental delays
85
Q

How is Cystic Fibrosis treated?

A
  1. Early detection/treatment for nutritional support
  2. aerobic & strengthening ex.
  3. energy conservation techniques
86
Q

How is life expectancy increased in a pt. with Cystic Fibrosis?

A
  1. Pancreatic enzyme replacement
  2. Vitamin supplements
  3. High caloric diets
  4. Airway clearance techniques
  5. antibiotic and antifungal tx
  6. mucolytic & bronchodilator meds
87
Q

What are some complications due to Cystic Fibrosis?

A
  1. respiratory failure
  2. cor pulmonalae
  3. severe hemoptysis (blood in sputum)
  4. spontaneous pneumothorax (lung collapse)
88
Q

What are the common medication classes for CF?

A
  1. Glucocorticoid steroids
  2. Bronchodilators
  3. Antibiotics
  4. Pancreatic enzymes
89
Q

What are the 2 key causes of Bronchiectasis?

A
  1. Intense chronic inflammation

2. Inadequate defense to minimize infection (causes tissue damage)

90
Q

What is Bronchiectasis?

A

Permanent dilation of bronchi due to destruction of muscular and elastic properties of lungs

91
Q

List 4 characteristics of Bronchiectasis.

A
  1. Thickening of bronchial walls
  2. Impairment of mucociliary blanket
  3. Hypersecretion of purulent sputum
  4. Associated with other pulmonary diseases (i.e. CF, emphysema)
92
Q

What is the gold standard for diagnosis of Bronchiectasis?

A

High resolution CT scan

93
Q

What are the signs & symptoms of Bronchiectasis?

A
  1. Persistent cough
  2. Copious secretions
  3. Hemoptysis (blood in sputum)
  4. Crackles
  5. High and low pitched ronchi
  6. Pleural rubs
  7. Fever & Fatigue
  8. Dyspnea
  9. Digital clubbing
94
Q

Prognosis of Bronchiectasis tx depends upon what?

A

The underlying disease!

95
Q

How is Bronchiectasis treated?

A
  1. Management of underlying cause
  2. Antibiotics, corticosteroids, & bronchodilators
  3. Nutritional support
  4. Supplemental O2
  5. Airway clearance/ bronchial hygiene
96
Q

Is total lung capacity (TLC) increased or decreased in Obstructive Diseases? Restrictive Diseases?

A
  1. Obstructive - Increased

2. Restrictive - Decreased

97
Q

What can cause pulmonary fibrosis (a restrictive lung disease)?

A
  1. Immune disorders
  2. Occupational exposure
  3. Genetic & hormonal abnormalities
  4. Complications of lung injuries
98
Q

What are the clinical manifestations of Restrictive Lung Disease?

A
  1. Hypoxemia w/ rapid desaturation on exercise
  2. Pulmonary HTN
  3. Cor Pulmonalae
99
Q

What are the PFT’s of Restrictive Lung Disease?

A
  1. Decreased FVC & FEV1
  2. Normal FEV1/FVC ratio
  3. Decreased VC & TLC
100
Q

What is interstitial lung disease (ILD)?

A

A group of lung diseases affecting the interstitium (tissue & space around the air sacs of the lungs); usually involves fibrosis

101
Q

ILD can be classified into 6 categories. What are they?

A
  1. Inhaled Substances
  2. Drug Induced
  3. CT disease
  4. Infection
  5. Idiopathic
  6. Malignancy
102
Q

What are the signs & symptoms of restrictive lung disease?

A
  1. Dry cough
  2. Gradual dyspnea with walking
  3. Crackles at lung base
  4. Clubbing
103
Q

How are restrictive pulmonary diseases treated?

A
  1. Treat underlying cause!
  2. Pulmonary Rehab
  3. O2
  4. Lung transplant
  5. N-acetylcysteine, IFN-gamma, etc.
104
Q

Name 3 diseases that are considered Infectious Pulmonary Diseases.

A
  1. Empyema
  2. Pneumonia
  3. Tuberculosis
105
Q

What is empyema?

A

Pus in the pleural space

106
Q

What is pneumonia?

A

An acute inflammation of the lungs where small bronchioles & alveoli become plugged with fibrotic exudate

107
Q

How are infectious pulmonary diseases classified?

A
  1. By infectious AGENT (bacterial, viral, fungal)

2. By ENVIRONMENT of infection (community, hospital, nursing home)

108
Q

What are the risk factors associated with Infectious pulmonary disease?

A
  1. Medical (i.e. age, trauma, surgery)
  2. Environmental (i.e. hospital admission, tracheal devices)
  3. Respiratory (i.e. mechanical ventilation)
109
Q

Aspiration is a contributing factor of IPD. Who is at increased risk of aspiration?

A

Pt.’s with…

  1. nasal or oral gastric tubes
  2. endotracheal tube
  3. head & neck trauma
  4. depressed mental status
110
Q

What are the clinical manifestations of IPD?

A
  1. Fever
  2. Productive cough with yellow-green or rust colored sputum
  3. Elevated WBC count
    • sputum culture
111
Q

How is IPD treated?

A
  1. Prevention (flu shots)
  2. care/cleaning of respiratory equipment
  3. hand washing
112
Q

How is IFP diagnosed?

A
  1. With chest x-ray showing consolidation (white, dense, fluid-filled lobe) for at least 48 hrs
  2. At least 2 clinical signs (dyspnea, fever, cough, leukocytosis, leukopenia)
113
Q

What are the risk factors associated with TB?

A
  1. HIV
  2. Substance abuse
  3. Cancer of head/neck
  4. Leukemia or Hodgkin’s
  5. Diabetes Mellitus
  6. Severe kidney disease
  7. Low body wt.
  8. Certain med tx (corticosteroids/organ transplants)
  9. Tx for Crohn’s & RA
  10. Silicosis (restrictive lung disease)
114
Q

How is TB transmitted?

A

By inhalation of small, dry droplet nuclei that become airborne from cough/sneeze of infected person; particles must reach alveoli

115
Q

Risk of TB infection depends upon what factors?

A
  1. Concentration of particles in the air
  2. Length of exposure
  3. Hosts’ immune system
116
Q

TB presents with nonspecific symptoms. Thus, what is the gold standard for dx’ing TB?

A

Smear & culture

117
Q

What are the general tx principles for TB?

A
  1. Appropriate regimen (i.e. pt. tolerance)

2. Close follow-up care (i.e. compliance)

118
Q

What is the tx regimen for TB?

A
  1. 4 drug regimen-induction (intensive phase)

2. 2 drug regimen-continuation phase

119
Q

Name 3 diseases associated with vascular pulmonary disease?

A
  1. Pulmonary Emboli
  2. Pulmonary HTN
  3. Pulmonary Edema
120
Q

What is the 3rd leading cause of cardiovascular death closely associated with DVT?

A

Pulmonary Embolism

121
Q

List the risk factors of PE.

A
  1. Immobilization
  2. surgery within 3 months
  3. stroke
  4. previous thromboembolism
  5. Chronic heart disease
  6. Acute MI
  7. CHF
  8. Cancer
  9. Over 40 yrs old
  10. Obese
  11. Lupus
  12. Major trauma
  13. Spinal cord injury
  14. Oral contraceptives
122
Q

What are the top 2 signs and symptoms of PE that account for 97% of all cases?

A
  1. Dyspnea
  2. Pleuritic chest pain
  3. Tachypnea
123
Q

What are some other s&s of PE?

A
  1. Hemoptysis
  2. Crackles
  3. Tachycardia
  4. Decreased breath sounds
  5. Abnormal lung sounds
124
Q

What is the gold standard for dx’ing PE?

A

Spiral CT angiography
Note: Clinical probability is still very important
Note: Color flow duplex imaging is used to detect a DVT

125
Q

How do you treat PE?

A
  1. PREVENTION
  2. Throbolysis
  3. Anticoagulation
  4. Surgical & catheter embolectomy
126
Q

What is Pulmonary HTN?

A

Mean pressure greater than 25 mmHg at rest, 30 mmHg during exercise (normal mean pressure in pulm. arterial system is less than 15 mmHg)

127
Q

What causes Pulmonary HTN?

A

Increase in pulmonary vascular resistance; can result in cor pulmonale

128
Q

What is the pathophysiology of Pulmonary HTN?

A
  1. pressure elevation creating RV overload and hypertrophy
  2. CO is not maintained during exercise (maintained at rest through compensated tachycardia & RVH)
  3. Continued overload results in RV failure leading to venous congestion & inadequate CO at rest
129
Q

List the clinical manifestations of pulmonary HTN.

A
  1. Dyspnea
  2. Fatigue, weakness
  3. exertional chest pain
  4. lightheadedness, syncope
  5. Palpitations
  6. Hemoptysis
  7. Cor pulmonale S&S (RV hypertrophy & dilation)
130
Q

How is pulmonary HTN dx’ed?

A
  1. Cardiac Catheterization gold standard
  2. PFT
  3. Echocardiogram
  4. Pumonary angiography
  5. V/Q & CT scans
131
Q

How is pulmonary HTN treated?

A
  1. Treat underlying cause
  2. Supplemental O2
  3. Meds (anticoagulants, diuretics, vasodilators)
  4. Lung transplant
132
Q

What is pulmonary edema?

A

The accumulation of extravascular fluid in the interstitial and alveolar spaces in the lungs

133
Q

What are the 2 types of pulmonary edema?

A
  1. Increased pressure, hydrostatic or cardiogenic pulmonary edema (CAD)
  2. Increased permeability or non-cardiogenic pulmonary edema due to acute lung injury (ARDS)
134
Q

Describe cardiogenic pulmonary edema.

A
  1. when high pressure in L heart is reflected back to small vessels in the pulmonary system
  2. results in flooding of the pulmonary interstitial space & alveoli with low-protein fluid
135
Q

What are the S&S of pulmonary edema?

A
  1. Dyspnea, respiratory distress
  2. Orthopnea
  3. Pallor, cyanosis
  4. Diaphoresis
  5. Tachycardia
  6. Anxiety, agitation
  7. Diffuse crackles, wheezes
  8. pulmonary congestion on CXR
  9. S3 heart sounds
136
Q

How do you treat pulmonary edema?

A
  1. prompt dx
  2. treat underlying cause
  3. supplemental O2
  4. prevent & treat complications
137
Q

What are 3 types of pleural pulm. disease?

A
  1. pneumothorax
  2. hemothorax
  3. pleural effusion
138
Q

What is pleural disease?

A

disease involving air or fluid within the pleural space that may require drainage of the fluid

139
Q

What is mesothelioma?

A

A tumor of the pleura associated with asbestos exposure

140
Q

What is primary Pnemothorax? Secondary?

A
  1. Primary: spontaneous collapse, no underlying disease, tall thin young men
  2. Secondary - associated with underlying cause, esp. COPD
141
Q

What are blebs & bullae?

A

Imbalance of protease and anti-protease enzymes; increased # of neutrophils & macrophages create bullae; if blebs & bullae rupture, air will enter pleural space

142
Q

What are the 3 types of pneumothorax?

A
  1. Iatrogenic
  2. Traumatic
  3. Tension
143
Q

What is Iatrogenic Pneumothorax?

A

A result of complications from diagnostic or tx procedure

144
Q

What is traumatic pneumothorax?

A

Penetrating wound that allows air through the chest wall; the pleura fills with air or blood

145
Q

What is tension pneumothorax?

A

Potentially life threatening; air enters pleural space and cannot escape causing progressive lung collapse; Mediastinum to CONTRALATERAL side

146
Q

How do you treat pneumothorax/hemothorax?

A
  1. Needle or chest tube
  2. Chemical pleurodesis to adhere visceral pleura to parietal pleura (causes inflammation and scarring)
  3. Thoractomy to resect bullae
147
Q

What is pleural effusion?

A

Excessive collection of fluid between parietal and visceral pleurae

148
Q

What are the 2 types of pleural effusion?

A
  1. Transudate (results from increased hydrostatic pressure in capillaries due to CHF, PE, renal disease)
  2. Exudate (due to infection, malignancy, PE, infarct)
149
Q

When fluid is grossly purulent in pleural effusion, what is it considered?

A

Empyema

150
Q

Describe the pathophys of plueral effusion.

A
  1. excess fluid compresses lung tissue leading to atelectasis
  2. Atelectasis reduces alveolar ventilation and increases the work of breahing
  3. Lung expansion is restricted and mediastinum shifts AWAY from affected side
151
Q

What are the S&S of pleural effusion?

A
  1. dyspnea
  2. chest pain (esp. with deep breathing/ coughing)
  3. fever, chills, night sweat
  4. decreased/absent breath sounds over effusion (pleural rub)
  5. Dullness to percussion
152
Q

What are the common causes of pleural effusion?

A
  1. CHF
  2. Pneumonia
  3. Malignancy
153
Q

How do you treat pleural effusion?

A
  1. observe for natural reabsorption
  2. segmental expansion and diaphramatic breathing to prevent atelectasis
  3. increase mobilization
  4. thoracentesis (needle)

Cardiopulmonary Exam II (2 decks)

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