Pulmonary disorders Flashcards
Obstructive diseases are manifested by what?
increased resistance to airflow
What are the three types of obstructive pulmonary diseases?
- Obstruction from conditions in the wall of the lumen
- Obstruction related to loss of lung parenchyma
- Obstruction of the airway lumen
What type of disease is asthma?
Obstruction from conditions in the wall of the lumen
What is the level of alveolar damage going from asthma, chronic bronchitis, to COPD?
Increases steadily
What is the level of reversibility going from asthma, chronic bronchitis, to COPD?
Decreases steadily
What is the level of sputum production going from asthma, chronic bronchitis, to COPD?
High in chronic bronchitis
Low for asthma and COPD
What is asthma?
Increased airway responsiveness to stimuli that partially or completely reversible bronchoconstriction
Allergic asthma presents when? Non allergic?
Allergic = peds Non-allergic = adulthood
What is the main difference between allergic and nonallergic asthma?
Can have allergen specific immunotherapy if know allergen
Allergen binding to the bronchial epithelium in allergic asthma activates what? What does this lead to (2)?
Inflammatory mediators,
leading to vasodilation, increased mucus production and loss of epithelium
What type of disease is Acute bronchitis?
Obstruction from conditions in the wall of the lumen
What type of disease is Chronic bronchitis?
Obstruction from conditions in the wall of the lumen
What type of obstructive disease is COPD?
Loss of lung parenchyma
What type of obstructive disease is bronchiectasis?
Obstruction of the airway lumen
What type of obstructive disease is Bronchiolitis?
Obstruction of the airway lumen
What type of obstructive disease is Cystic fibrosis?
Obstruction of the airway lumen
What type of obstructive disease is Acute tracheobronchial obstruction?
Obstruction of the airway lumen
What type of obstructive disease is epiglottitis?
Obstruction of the airway lumen
What type of obstructive disease is croup?
Obstruction of the airway lumen
Do you have a family or personal h/o allergies in allergic asthma? Nonallergic asthma?
Yes for allergic, no for nonallergic
What leads to the increase in mucus secretion/narrower bronchiolar diameter seen in asthma? (3)
- Loss of epithelial cells and their cilia
- Vasodilation/angiogenesis
- Bronchoconstriction
What happens to the submucosal layer of the bronchi in asthma? Smooth muscle?
Thickening and edema
Hyperplasia and hypertrophy
What is the HPI like in asthma?
SOB d/t temp changes, allergen exposure, exercise,
What are the vital like in asthma attack? (3)
- Tachypnea
- Tachycardia
- Pulsus paradoxus
What is pulsus paradoxus?
Inspiration produces a drop in the plus pressure (this is opposite of normal)
What causes pulsus paradoxus?
Increased afterload of the right heart, lowering stroke volume, and lowering left ventricular SV d/t pressure from the right side of the heart
What are the four major exam findings in asthma?
- Accessory musle use
- expiration > inspiration
- hyperinflated chest
- Wheezing
When, typically, is wheezing longer/louder in asthma, the inspiratory or expiratory phase?
Expiratory phase
What are the peak flow rates like in an asthma attack?
A decrease in airflow rates throughout the vital capacity is the cardinal pulmonary function
abnormality during an asthmatic episode.
What happens to the volumes of the lung in asthma?
lung volume measurements
demonstrate an increase in both total lung capacity and residual volume;
What are the therapeutic goals of treating asthma?
- ADLs w/o SOB
- Sleep w/o awakening
- Minimize rescue inhaler use
- Minimize care
When are bronchodilators used in asthma?
Acutely
What is the MOA of controller treatments for asthma?
block the effects or prevent the production of inflammatory mediators that are released by
inflammatory cells in the airway
What are the two receptors that we utilize to effect bronchodilation?
Beta 2 (excite)
M3 (inhibit)
What are restrictive lung diseases?
Decreased expansion of the lungs d/t alteration in thelung parenchyma
What are the four types of restrictive lung disorders?
- Lung parenchyma disorders
- Pleural space disorders
- Neuromuscular/chest wall abnormalities
- Infection/inflammation of the lungs
What are the two types of lung parenchyma disorders?
- Fibrotic interstitial lung disease
2. Atelectasis disorders (ARDS, IRDS)
What are the two types of pleural space disorders?
Pneumothorax
Pleural effusion
What is Adult Respiratory distress syndrome (ARDS)?
A severe respiratory distress condition characterized by damage to the alveolar-capillary
membrane
What are the three key pathological features of ARDS?
- noncardiogenic pulmonary edema
- Atelectasis d/t lack of surfactant
- Fibrosis
What are the two most common causes of ARDS?
- Sepsis
2. Aspiration of gastric acid
How do you diagnose ARDS?
Decrease in PaO2 that is refractory to supplemental O2 therapy
What causes noncardiogenic pulmonary edema?
Damage to the alveolar capillaries
What causes the severe hypoxemia seen in ARDS?
intrapulmonary shunting of blood
What causes the decreased lung compliance seen in ARDS?
Deposition of plasma protein
What are the findings seen on a CXR in ARDS?
White out
What is the treatment for ARDS?
Supportive
Cure cause of disease
PEEP
How does PEEP help ARDS?
Increases FRV
Forces edema out
How does atelectasis occur during high [c] oxygen administration?
Use of oxygen by body
What is High Frequency Jet Ventilation (HFJV??
small Vt is given at a high frequency, reducing
lung injury caused by ventilator
Why is inhaled NO given to ARDS patients?
Relaxation of the bronchioles
