Pulmonary Patho Flashcards
obstructive:
increase resistance to (expiration or inhalation)
alveolar ___
alveolar ___ventilation
expiration
hyperinflation (air trap)
hypoventilation
Restrictive:
decrease lung or thoracic ___
compliance
What is the primary presentation of chronic bronchitis?
chronic productive cough
What is the primary presentation of emphysema?
SOB
What is the primary PFT increased with emphysema
increased RV and/or TLC
What is the primary problem with asthma?
reversible bronchospasm secondary to trigger with inflammatory response
What PFT is gonna be decreased with asthma?
FEV1/FVC
what is the primary pathophysiology of CF?
Genetic mutation of CFTR and increases viscosity of secretions across systems.
someone with CF is going to have (increased or decreased) DLCO?
decreased
what is the primary presentation in someone with idiopathic pulmonary fibrosis or other restrictive diseases?
decreased compliance and decreased lung volume secondary to lung tissue resistance.
What happens when there is increased goblet cells in CB?
hypersecretion of mucus in large airways –> progress to small airways –> obstuction
What kind of lung sounds in someone with CB? what is causing this?
course crackles when air pops mucus as it goes through
What is the pathophysiology of emphysema?
abnormal and permanent changes of alveoli distal to terminal bronchioles
What effects does emphysema have on the alveoli?
loss of gas exchange
Emphysema:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - diminished
tactile fremitus - decreased bc air
mediate percussion - hyperressonant bc air
COPD:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - crackles (course), low pitched wheeze
tactile fremitus - increased
mediate percussion - normal upper lobes, hyperresonant lower lobes
is someone with emphysema likely to have a cough?
no
What happens in emphysema when alveolar connective tissue gets damaged?
loss of support for airway causing it to narrow causing air to trap in lung, decreased elastic recoil
primary pathophysiology in asthma
reversible bronchospasm and inflammatory response in response to trigger
asthma: (during attack)
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - high pitch wheeze, possible decrease sounds
tactile fremitus - norm or dec in lower lobes from air trapping
mediate percussion - hyperresonance
asthma: (after attack)
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - maybe wheeze and crackles
tactile fremitus - normal or increase over secretions
mediate percussion - normal or diffuse scattered secretions
does someone with asthma have a cough after attack?
yes, with some secretions to clear
how is someones pulse ox and dyspnea after attack?
should be normal
What are the postural changes with air-trapping
elevated shoulder girdle
horizontal ribs increased A/P diameter
Flattened Diaphragm
when the diaphragm flattens there is __ abd pressure causing ___
increased abd pressure causing stress on pelvic floor leading to incontinence
when the diaphragm is flattened there is hypertrophy of ___
why?
accessor muscles
because it is harder to breath with a flat diaphragm
COPD muscle composiiton
decreased density of __ and __
type __ to type __
muscle __ and weakness
decreased __ metabolism of skeletal muscle
mitochondrial and capillary
I to II
atrophy
aerobic
bronchiectasis: ___ and abnormal __ of __
irreversible dilation of terminal bronchi
bronchiectasis:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - coarse crackles
tactile fremitus - increased over involvement
mediate percussion - dull over involvement
cough in bronchiectasis
very productive (copious) (possible hemoptysis)
frothy
mucus
pus
What is the result of the massive immune response in bronchiectasis
edema, ulceration, cratering or airways, and pus with surrounding tissue inflammation
primary pathophysiology in CF
genetic mutation of CFTR and increases viscosity of secretions across all systems
What happens with pancreatic insufficiency in CF
failure to thrive
CF:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - course crackles, low pitched wheeze
tactile fremitus - increased
mediate percussion - normal or hyperressonant from air trapping
does someone with CF have a cough
yes with cups of purulent secretions
people with CF have frequent infections, what is the most common bacteria
pseudamonous
What is complications that can happen later on with CF
enlarged heart, cor pulmonale, JVD, pulmonary HTN, clubbing
What MSK challenges with CF
possible developmental delays
osteoporosis
what is the best options for instruments for someone with CF
flute, trumpet, trombone
whats the most valuable measure in someone with asthma
peak flow meter
how does CF effect the reproductive system?
absence of vas deferens (infertile)
women have issues but usually can have children
Restrictive lung dysfunction:
___ compliance of lung and thorax
___ lung volumes
___ work of breathing
deceased
deceased
increased
Intrapulmonary restrictive lung function
decreased lung compliance from lung tissue resistance
extra pulmonary restrictive lung dysfunction
conditions that change lung and thoracic cage compliance
pulmonary edema, pulmonary fibrosis, ARDS, sarcoidosis, asbestosis are example of what
intrapulmonary restrictive lung dysfunction
scarring from burn, surgical pain, rib fx, scoliosis, obesity, SLE, RA, ankylosing spondylitis are examples of what
extra pulmonary restrictive lung dysfunction
extra-pulmonary RLD:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - decreased/diminished
tactile fremitus - normal
mediate percussion - normal
how is the pulse ox and dyspnea of someone with extra pulmonary RLD
yes dyspnea/SOB
pulse ox may be normal or decreased
intrapulmonary RLD:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - diminished, fine crackles
tactile fremitus - normal but depends on condition
mediate percussion - dullness with ARDS and pulmonary edema but normal with pulmonary fibrosis (clubbing) disorders
how does NM disorders effect respiratory muscles
may be weak from lack of innervation, progressive muscle disorder
muscle tone changes (high or low)
chest excursion:
NM:
intrapulmonary:
extra pulmonary:
NM: decreased due to tone or weakness
intrapulmonary: decreased
extra pulmonary: symmetrical or asymmetrical decrease
NM RLD:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - diminished (symmetrical or asymmetrical
tactile fremitus - normal
mediate percussion - normal
how does a NM disorder effect cough
diminished from weakness or decreased vital capacity
What is atelectasis?
large areas of alevoli that are unable to inflate resulting in lung tissue collapse
What is resorptive atelectasis
obstruction due to tumor, mucus, or foreign body, alveoli distal to obstruction do not expand
What is passive atelectasis?
loss of volume due to low Tidal Volume, weak diaphragm, post-op, muscle dystropothy, meds
What is adhesive atelectasis?
due to surfactant deficiency
alveolar walls adhere making it difficult to inflate
what kind of atelectasis would result from ARDS?
adhesive atelectasis
what is compressive atelectasis?
compression from space occupying lesion, pleural effusion
what is cicatrization atelectasis?
decrease compliance due to fibrosis
atelectasis:
Lung sounds -
tactile fremitus -
mediate percussion -
lung sounds - bronchial breath sounds
tactile frem - normal or decreased due to lack of sections
mediate percussion - dull over area
What MSK issue can come with atelectasis?
tracheal deviation toward side of lesion (ipsilateral)
What is pnemonia?
acute infection with inflammation of lung parenchyma causing secretions not getting out
What are the 4 types of pneumonia? which is most common
hospital acquired
health-care associated
community acquired - most common
ventilator acquired
what are s/s of bacterial pneumonia
high fever, chills, SOB, cough, leukocytosis
What is the complication of viral pneumonia?
destroys mucociliary function
can lead to ARDS
What is the chest excursion in someone with pnemonia?
diminished in area of consolidation
pneumonia:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - bronchial and bronchovesicular in abnormal locations, crackles and egophany, bronchophony, and whispered pectoriloquy
tactile fremitus - increased over consolidation
mediate percussion - dull over areas of consolidation
what is the cough like in someone with pneumonia?
cough with or without secretions, may or may not be productive
What is the pathophysiology of pulmonary edema
cariogenic - L sided heart failure
noncardiogenic causes
What is the L side of the heart doing to cause pulmonary edema
LV pump fails causing blood to back up into the pulmonary venous system
What is the backwards flow with pulmonary edema
LA
pulm veins
pulm capillaries
interstitial space
*Interstitial fluid pushed into alveoli by reverse pressure gradient
“Congested”HF
What happens to alveoli with pulmonary edema
alveolar hypoventilation likely leading to atelectasis
if pressure is high enough it can push fluid into pleural cavity
What is pleural effusion?
between what cavities?
abnormal amount of fluid in the pleural space between visceral and parietal pleura
trasudate vs exudate
transudate: low protein content and due to changes in hydrostatic pressure in pleural capillaries
exudate: high protein content and due to changed in pleural permiability
What are some causes for pleural effusion?
CHF, pneumonia, neoplasm, post-op
pleural effusion:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - diminished
tactile fremitus - decreased
mediate percussion - dull
Pleural effusion may cause tracheal deviation to what side?
the contralateral side
what is the chest excursion of pleural effusion?
decreased because physical barrier compressing it
What is an open pneumothorax?
air moves in and out through opening in chest wall
what are the 2 kinds of closed pneumothorax?
tension: air in pleural space but cannot exit
spontaneous: without precipitating event, with underlying pulmonary pathology
What kind of pneumothorax is life threatening emergency
tension pneumothorax
in an open pneumothorax, whats happening with pressure?
patient cannot maintain negative pleural space pressure
in open pneumothorax lung volume (increase or decrease)
decrease
pneumothorax:
Lung sounds -
tactile fremitus -
mediate percussion -
Lung sounds - absent
tactile fremitus - decreased from air barrier
mediate percussion - hyperressonant
a pneumothorax may cause tracheal deviation to what side?
tension: contralateral
chest excursion and cough in pneumothorax
decreased chest excursion in area of pneumothorax
no cough
What is idiopathic pulmonary fibrosis
chronic progressive irreversible lung disease occurring in older adults
inflammation, fibrosis, scarring
idiopathic pulmonary fibrosis leads to
hypoventilation of alveoli and atelectasis with steady decline in lung function with some exacerbations
What is the threshold values for vent:
FVC
MIP
MEP
FVC < 20
MIP < 30
MEP <40
What are the functional levels of COPD: 0, 1, 2, 3&4
0: no symptoms, at risk
1: chronic cough and spututum, SOB with some work
2: SOB that limits exertion, breathless after few minutes (100m on level ground)
3&4: too breathless to leave house or breathless with dressing
MRC levels to Functional levels
Stage 1: MRC 2
stage 2: MRC 3-4
stage 2&4: MRC 5
what is staticus asthmaticus
emergency!!
attack with meds not working, may need vent
I:E ration in obstructive and restrictive
O - 1:3 longer expiration, with tachypnea 1:1 bc air trapping
R - 1:1
(Restrictive)normal TLC:
mild:
mod:
severe:
norm: >80%
mild: 70-75%
mod: 50-69%
severe: <50
How does the flow volume loop shift with O and R
O: shift to left
R: shifts to right
what re the 2 kinds of mechanical vent?
Assist control: machine doing most of work, pt breaths and vent will compensate
SIMV: if pt breaths vent will not compensate
What are the qualifications to evaluation someones hypoxemia with this scale
mild
mod
severe
<60 years old and on room air (21%)
mild: 60-80
mod: 60-40
severe: <40
What is the absolute PaO2 that the pt needs supplental O2
<55 PaO2
Whats the rule with PaO2 and Spo2
add 30
PaO2 60mmhg…….SpO2 90%
whats the relationship between FI02 and PaO2
PaO2 should be 5x FIO2
what is the ratio that is an indicator of hypoxemia
PaO2/FIO2 ratio
What is the norm PaO2/FIO2 ratio? what is that indicator for mechanical vent
400-500 –> norm
200-300 –> VENT
s/s of SP02 in 80-90
restlesness, light headed, incoordination, virgo, nausea
s/s SPO2 60 - 82
marked confusion, dysrhythmias, labored respiration
s/s SPO2 48 - 60
cartiac arrest, dec renal BF, dec UO, lactic acidosis
What our primary and secondary drive to breath
- CO2
- O2
what is hypoxic drive
what is impaired in COPD?
PaO2 drops and chemoreceptors notice (back up)
CO2 receptors desensitized in COPD so the primary drive isnt working
What is BNP and what does it tell us?
that the pt has heart failure and how bad it is
What is normal, mild, marked, and bad BNP values
Normal is <100
Over 300 → mild
Over 600 → marked
Over 900 → bad
what is heart failure?
Unable to pump efficiently to provide oxygen and nutrients to body due to workload
what are some red flags in HF?
Red flags: weight gain (2-3 lb in a day, 5-6lb in a week), SOB, dyspnea on exertion or rest
in ICU change in muscle fibers within__ hours, loss of bone mineral density, ALI, frailty
18 to 69
Fried Fraility index: Every 1 point increase equals __ risk of dying in next __ months related to neuromuscular weakness
3x
6
with ICU weakness what are some muscle groups that get weak?
Trunk
Symmetrical limbs
Diaphragm
