Pulmonary Patho Flashcards
How common is asthma in children?
Leading cause of acute and chronic illness in children and most frequent admitting diagnosis
What is asthma?
Reversible obstructive airway disease
What are the 3 mechanisms of asthma?
- Bronchospasms (obstruction)
- Inflammation and edema (mucus)
- Reactivity to variety of stimuli
High risk populations for asthma
- African Americans and Hispanics
- Live in inner city
- Premature, low birth weight
- Family history
- Allergies
- Eczema
- Low SES
Intrinsic/Non-Allergic Asthma
- Usually adult onset
- No history of allergies
- Respiratory infection/psychological
Extrinsic/Allergic Asthma
- More in peds
- Triggers: pollen, dust, dust mites, cockroach droppings, drugs, chemicals, foods, MSG
Exercise induced asthma
- Don’t have asthma attack until you exercise
Status asthmaticus
- Cannot stop asthma attack
- Ongoing and life-threatening
Asthma Pathophysiology: early response
INFLAMMATORY
- Allergen binds to IgE on mast cells
- Mast cells degranulate
- Mediators released: histamine, leukotrienes, prostaglandins, TNF, IL-1
- Vasodilation, increased permeability, bronchospasm and edema and mucus secretion
- Ach: released and leads to smooth muscle constriction and adds extra mucus
Asthma Patho: late response
- 4-8 hours later
- Continued recruitment of inflammatory process
- Synthesize leukotrienes: prolong smooth muscle contraction
- Eosinophils: direct tissue injury impaired mucociliary function
- Accumulation of mucus and cellular debris form plug in airways
Asthma Chronic changes
- Airway remodeling: changes to bronchial wall due to chronic inflammation
- Basement membrane thickens and results in smaller airway
- More mucus glands
- Smooth muscle hypertrophy
Most common asthma clinical manifestations
- Wheezing (vibrations through narrow airways)
- Cough: often at night
- Feelings of chest tightness
- Sputum
- Tachycardia = hypoxemia
- Tachypnea
Severe clinical manifestations
- Cyanosis
- Retractions, nasal flaring
- Decreased breath sounds
- Agitation
- Cannot speak in complete sentences
- Pulsus paradoxus: decrease in systolic during inspiration
Asthma diagnosis
- History and physical
- Pulmonary function tests: measuring obstruction
Asthma treatment
- Asthma action plan
- Manage allergens: patient education
- Use peak flow meter to guide treatment at home
- Pharm: maintenance
What is bronchiolitis?
- Inflammation of bronchioles: lower resp tract, usually secondary to infectious agents
- Related to RSV, influenza, bacteria
- Seasonal: november to april
Bronchiolitis Patho
- Viral attack leads to necrosis of bronchial epithelium
- Mucus production and obstruction
- Chemical mediators released
- Fibrin plugs
Bronchiolitis changes to breathing mechanisms
- Air trapping = hyperinflation
- Decreased compliance = atelectasis (collapsing of airways)
- Increased work of breathing
Bronchiolitis Clinical manifestations
- Rhinorrhea and tight cough
- Decreased appetite, lethargy, fever
- Tachypnea and respiratory distress (retractions)
- Abnormal breath sounds: wheezing, rhonchi
- Xray, hyper-expanded lungs, infiltrates, atelectasis
Bronchiolitis Evaluation
- History and physical
- Chest x-ray
- Nasal washing: specimen taken from nose to test for RSV
Bronchiolitis Treatment
- Supplemental oxygen
- Increased hydration
- Inhaled hypertonic saline: YES bronchodilators, steroids not as much
What is a pulmonary embolus
- Undissolved detached material that occludes blood vessels of the pulmonary vasculature
- 90% originate from DVT but could also be fat, air, amniotic fluid
- Virchow’s Triad: vessel wall injury, circulatory stasis, hyper coagulable conditions
- Impact depends on size, area of circulatory impairment, health status of patient
Patho of PE
- Virchow’s triad leads to thrombus
- Thrombus dislocates and travels to lungs
- Leads to hypoxic vasoconstriction, decreased surfactant, atelectasis, edema
Clinical manifestations of PE
- Restlessness, apprehension, anxiety
- Dyspnea
- Chest pain
- Tachycardia, tachypnea
- Hemoptysis (maybe)
- Progress to heart failure, shock, resp arrest
Diagnosis of PE
- History and physical: evidence of DVT, pulse ox, Virchow’s triad
- Chest xray
- ABG: oxygenation, will see low PaO2, low PCO2, high pH
- Elevated D-dimer
- CT
Treatment of PE
- Prevention: ROM
- Resp support
- Thrombolytic therapy and heparin
