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Cardiopulmonary > Pulmonary Pathophysiology Part 1 > Flashcards

Pulmonary Pathophysiology Part 1 Flashcards

1
Q

How does COPD affect the lungs

A
  • Airways and air sacs lose their elastic quality
  • Walls b/w many of the air sacs are destroyed
  • Airway walls become thick & airways are narrowed by inflammation
  • Airways make more mucus than usual, which can also clog them
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2
Q

Common signs and symptoms of COPD

A
  • Constant coughing (may be called “smoker’s cough”)
  • Shortness of breath while doing everyday activities
  • Inability to breathe easily or take a deep breath
  • Excess mucus production (coughed up as sputum)
  • Wheezing
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3
Q

How to diagnose COPD

A
  • Spirometry is the primary test
  • Pulmonary function test (PFT): used to classify b/w obstructive vs restrictive
  • Lung diffusion capacity test
  • Chest x-ray
  • Chest CT
  • SaO2 of blood
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4
Q

Warning signs of a COPD exacerbation

A
  • Fever
  • Increased shortness of breath, wheezing, or coughing
  • Change in mucus (color, thickness, or amount)
  • Using your rescue inhaler more than usual
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5
Q

What are the top 3 most common treatments for COPD

A
  • Short acting bronchodilators: quick relief of sx; widen your airways & relaxes the muscles in your lungs
  • Long acting bronchodilators: used to relax the muscles around your airways over time & help you breathe easier; not used for quick relief of sx
  • Inhaled corticosteroids: work to reduce inflammation in the lungs over time & must be taken daily
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6
Q

Tips for quitting smoking

A
  • Keep your mouth busy
  • Keep your hands busy
  • Tell people you are quitting
  • Distract yourself
  • Understand the urge: replace the urge thoughts with positive ones
  • When you feel irritable or restless take a few deep breaths & remind yourself why you’re quitting
  • If having trouble sleeping make a sleep schedule & keep your bedroom quiet & dark
  • If worried about gaining weight: snack smart & stay active
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7
Q

Describe the differences between obstructive and restrictive dysfunction

A
  • Obstructive: If the flow of air on exhale is impeded, the defect is obstructive
  • Restrictive: If the volume of air or gas inhaled is reduced, the defect is restrictive
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8
Q

What is mixed impairment

A
  • Diseases and conditions that result in both obstructive and restrictive lung impairment
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9
Q

Pathophysiology of restrictive lung disease (RLD) is related to three factors

A
  • Decreased compliance of both the lung & the chest wall
  • Decreased lung volumes & capacities
  • Increased work of breathing
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10
Q

Airflow obstruction can be related to

A
  • Retained secretions
  • Inflammation of mucosal lining of airway walls
  • Bronchial constriction related to increased tone or spasm of bronchial smooth muscle
  • Weakened structural support of the airway walls
  • Alveolar sac destruction & alveolar sac overinflation with surfactant destruction
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11
Q

What are the 2 primary causes of COPD

A
  • Inhalation factors (smoking, air pollution, chemicals)
  • Genetics
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12
Q

COPD reduces airflow out of the air sacs & results in ________________ and ________________

A
  • Hyperinflation
  • Poor gas exchange
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13
Q

Signs of lung hyperinflation associated with COPD

A
  • Elevation of shoulder girdle
  • Horizontal ribs
  • Barrel-shaped thorax
  • Low, flattened diaphragms
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14
Q

Respiratory failure is defined as a PaO2 <60 mmHg describe type I vs type II

A
  • Type I: PaCO2 <45 mmHg; PaO2 is low (hypoxemia); V/Q mismatch
  • Type II: PaCO2 >45 mmHg (hypercarbia/hypercapnia); PaO2 <60 mmHg (hypoxemia); lungs are not well ventilated
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15
Q

Symptoms of hypercapnia (PaCO2 >45 mmHg)

A
  • HA
  • SOB
  • Seizures
  • Persistent tiredness of sluggishness during the day
  • Neurological symptoms: disorientation, confusion, altered mental status, depression
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16
Q

Symptoms associated with obstructive lung diseases

A
  • Dyspnea on exertion especially during functional activities
  • Possible increased anxiety
  • Secretion production & cough
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17
Q

Physical changes associated with obstructive lung diseases

A
  • Exhalation becomes forced instead of passive
  • Stress on the pelvic floor can manifest as urinary incontinence
  • Reduction in aerobic metabolism & poor muscle endurance
  • Recruitment of accessory muscles during inhale can lead to postural deviations (hypertrophy/shortening of muscle)
  • Exercise/activity tolerance reduced
18
Q

Psychologic impairments associated with obstructive lung diseases

A
  • Reduced activity tolerance
  • Anxiety & depression
  • Cognitive impairment
19
Q

What 2 spirometry measures can be followed after PFT to assess progression of COPD

A
  • Forced expiratory volume in 1 second (FEV1)
  • Forced vital capacity (FVC)
20
Q

Describe a normal, low, or high spirometry

A
  • Normal: FEV1/FVC ratio >75%
  • FEV1/FVC decreases as disease severity increases
  • FEV1 and FEV1/FVC <70% indicates obstructive lung disease
21
Q

COPD is associated with larger TLV and RV as a result of

A
  • Air trapping
  • Lung hyperinflation
22
Q

Emphysema is a condition of the lung characterized by

A
  • Destruction of alveolar walls
  • Enlargement of airspaces distal to terminal bronchioles
23
Q

COPD is a combination disease caused by a mixture of

A
  • Parenchymal alveolar disease (emphysema)
  • Small airway disease (obstructive bronchiolitis)
24
Q

What are the 3 subtypes of emphysema

A
  • Centrilobular: proximal dilation of the respiratory bronchioles with alveolar ducts & sacs remaining normal
  • Panlobular: dilation of all respiratory airspaces in the acinus; occurs most frequently in the lung bases
  • Distal acinar: dilation of airspaces underneath the apical pleura
25
Q

Describe chronic bronchitis

A
  • Presence of chronic productive cough for 3mo in each of 2 successive yrs
  • Hypersecretion of mucus begins in larger airways and move to smaller
  • Leads to hypertrophy of submucosal glands
  • Degree of small airway involvement determines degree of disability
  • May develop cyanosis & pulmonary edema
26
Q

Physical exam findings for COPD

A
  • Auscultation of the lungs show prolongs expiratory phase
  • Pt may assume tripoding position
  • Chest x-ray changes noted late in disease progression
  • CT scan can help to detect the presence of bullae
27
Q

Medical management for COPD

A
  • Smoking cessation
  • Pharmacotherapy
  • Influenza vaccine (yearly) and pneumococcal vaccine (one time) to help prevent respiratory infections
  • Treatment of sleep disorders (e.g., sleep apnea)
  • Pulmonary rehabilitation, breathing retraining, and exercise training to improve exercise tolerance and reduce dyspnea and fatigue
28
Q

What is bronchiectasis

A
  • Bronchial tubes become widened, scarred, & swollen causing difficulty breathing
  • Cilia in airways become damaged making them unable to clear mucus from bronchial tubes
  • Mucus stuck in the airways can lead to infection
  • Progressive disease with no cure
29
Q

Symptoms of bronchiectasis

A
  • Cough & mucus production
  • Shortness of breath with activity
  • Frequent lung infections
  • Tiredness (fatigue)
  • Chest pain
29
Q

What are some causes of bronchiectasis

A
  • Severe lung infections: repeated infections
  • Lung injury: aspiration happening over a period of months to years leads to inflammation/damage of airways
  • Immune deficiencies
  • Inflammatory diseases: ulcerative colitis, Crohn’s disease, RA, Sjögren’s syndrome
  • Genetic disorders
30
Q

Key physical exam findings of bronchiectasis

A
  • Dx by presence of signet ring sign on chest CT
  • Classified as 3 types based on appearance of bronchial walls: cylindrical, varicose, & saccular
  • Blood gases become abnormal
  • Sputum testing
31
Q

What is the signet ring sign found on chest CT for bronchiectasis

A
  • Dilated bronchus is larger than the accompanying pulmonary artery
32
Q

warning signs of a bronchiectasis exacerbation

A
  • Change in color, thickness, odor, or amount of mucus
  • Increased coughing
  • Increased SOB
  • Increased tiredness that lasts more than one day
  • Low grade fever that doesn’t go away
  • Increased use of fast acting or rescue medications
  • If use O2 you may find that you need more O2 than usual
33
Q

Medical management for bronchiectasis

A
  • Goal is to reduce the number of exacerbations & improve QoL
  • Nebulized medication, bronchodilators if indicated
  • Increase hydration
  • Secretion clearance techniques
34
Q

What is cystic fibrosis

A
  • Multisystem disorder in children/young adults affecting every organ system with epithelial surfaces
  • Mucus stasis occurs in conducting airways
  • Prominent sx related to pulmonary, intestine, & pancreatic involvement
35
Q

Goals for medical management of cystic fibrosis

A
  • Controlling lung infection
  • Promoting mucus clearance
  • Improving nutritional status
36
Q

What is asthma

A
  • Chronic inflammatory disorder of the airways
  • Associated with increased hyperactivity to certain stimuli
  • Causes recurrent episodes of wheezing, dyspnea, chest tightness, & coughing
37
Q

A slow onset asthma exacerbation is characterized by

A
  • A slow, subacute worsening of the peak expiratory flow rate (PEFR) over days
38
Q

A sudden onset asthma exacerbation presents with

A
  • Severe deterioration within hrs
  • Often precipitated by sudden massive exposure to external triggers like allergens, food particles, & sulfites
39
Q

What is status asthmaticus

A
  • Medical emergency
  • Extreme form of asthma exacerbation characterized by hypoxemia, hypercarbia, & 2ndy respiratory failure
  • If not managed appropriately can lead to acute ventilatory failure & even mortality
40
Q

Key physical exam findings for asthma

A
  • Reversibility of airway obstruction following use of bronchodilator medications
  • Results of pulmonary function test (PFT) help classify severity
41
Q

What are the 4 treatment recommendations for asthma

A
  • Use objective measures of pulmonary function
  • Identify/eliminate factors that worsen symptoms
  • Provide pharmacologic therapy to reverse bronchoconstriction & prevent airway inflammation
  • Create therapeutic partnership b/w pt & care provider

Cardiopulmonary (18 decks)

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