Resitrtive pulmonary disorders: Flashcards
1
Q
what would the pulmonary lung tests look like for restrictive disorders?
A
- normal FEV1: FVC ratio
- normal PEFR
2
Q
what is the pathophysiology of restrictive pulmonary disorders?
A
- they are a result from decreased lung expansion
- decreased lung expansion due to lung tissue, pleura, chest wall or neuromuscular function damage
3
Q
what are the two types (classifications) of restrictive pulmonary disorders?
A
- intra - pulmonary diseases: diseases of the lung tissue (parenchyma)
- ex: pulmonary fibrosis ARDS, pneumonia
- extra - pulmonary diseases: plural space disorders
- ex: Pneumothorax, pleural effusion,
neuromuscular/chest wall disorders
- ex: Pneumothorax, pleural effusion,
4
Q
what ABG’s are affected with restricted lung diseases?
A
- decreased paO2
- normal or decreased paCO2
- increased pH, risk of alkalosis
5
Q
what is atelectasis?
A
- complete or partial collapse of a lung or lobe of a lung
- alveoli within becomes deflated
6
Q
what are risk factors for atelectasis
A
- typical complications after surgery
- general aesthesia changes breathing pattern
- prolonged bed rest with few position changes meaning decreased lung expansion (can put pt at risk for pneumonia)
7
Q
how to decrease risk of atelectasis?
A
- incentive spirometer
- deep breathing exercise
- deep breath and cough important to prevent atelectasis = goal = stretch lungs
8
Q
what is a pneumothorax?
A
- air in the plural cavity that does not let lung expand
- accumulation of air in the pleural space
9
Q
what is a primary pneumothorax? & what are the risk factors?
A
- spontaneous rupture (of a bleb) that releases air in the pleural space that restricts breathing
- occurs in tall, thin, men 20 - 40 yrs
- no underlying disease
- cig smoking increases risk (or vape)
- air enters the pleural space, long collapses & ribs spring out
10
Q
what is a secondary pneumothorax?
A
- results of complications from an underlying lung problem
- may be due to rupture of cyst, bleb, or trauma
11
Q
if the trauma of a pneumothorax is super impactful what can a important clinical manifestation be?
A
- can shift the rest of our upper raspatory anatomy over (would be the opposite side effected)
- ex: shifting of trachea
12
Q
what are the clinical manifestations of a pneumothorax?
A
- severe tachycardia
- decreased or absent breath sounds on affected side
- hypotension (bc vena cava gets compressed decreasing pre load & BP)
- tracheal shift to opposite side
- JVD
- hyperresonance
- sudden chest pain on affected side (onset)
- dyspnea (onset)
13
Q
what’s the difference between small & tension pneumothoraxes?
A
- small (>20%) are usually undetectable on physical exams
- tension & large pneumothorax are emergency situation
14
Q
what is a tension pneumothorax?
A
- medical emergency
- results from penetrating or non-penetrating injury
- may also be due to another disease
- results from buildup of air under pressure in the pleural space
- air enters pleural space during inspiration but cannot escape during expiration
- lung on ipsilateral same side collapses and forces mediastinum toward contralateral (opposite) side
- decreases venous return and cardiac output
15
Q
what are the 5 types of pleural effusions?
A
- transudates (edema)
- exudate (infections)
- empyema (pus or fluid due to infection in the pleural space
- Hemothorax (blood)
- lymphatic
15
Q
what is a pleural effusion
A
- pathologic collection of fluid or pus in pleural cavity as result of another disease process
16
Q
what is transudate plural effusion
A
- not thick fluid
- low in protein
- edema like fluid
- associate w/ severe heart failure or other edematous stress
17
Q
what is exudate pleural effusion?
A
- infections thick fluid
- high in protein
18
Q
what are the causes of exudate pleural effusion
A
- malignancies, infections, pulmonary embolism, sarcoidosis,
post myocardial infarction syndrome, pancreatic disease
19
Q
what is an empyema pleural effusion?
A
- pus or fluid due to infection in the pleural space
20
Q
what is a hemothorax plural effusion?
A
- blood or presence of blood in the pleural cavity
- result of chest trauma
- contains blood pleural fluid: hemorrhagi
21
Q
what is a lymphatic pleural effusion?
A
- exudative process that develops from truma
22
Q
plural effusion clinical manifestations
A
- very depending on cause & size of effusion
- asymptomatic with < 300 ml of fluid in plural cavity - dyspnea
- decreased chest wall movement (one size normal other not)
- pleuritic pain (sharp, worsens w/ inspiration)
- dry cough (!!)
- absence of breath sounds (emergency)
- contralateral tracheal shift (massive effusion)
23
Q
what is the def of pneumonia
A
- inflammatory reaction in the alveoli and interstitium caused by infectious agent
24
what are the 3 causes of pneumonia?
1. aspiration of oropharyngeal secretions composed of normal bacteria flora (or gastric)
2. inhalation of contaminants (common cold)
3. contamination from the systemic circulation (another infection that has gone to lung tissue)
25
what are the 5 different types of pneumonia
1. community acquired = cold turned into pneumonia
2. nosocomial = hospital aquried
3. bacterial = bacteria, productive cough
4. atypical
5. viral = non productive cough
26
How does a pt get phumonia?
- acquired when normal pulmonary defense mechanisms are compromised
- organisms get into lung, multiply & trigger pulmonary inflammation
27
what are the clinical manifestations for bacterial pneumonia?
- crackles & bronchial breath sounds over affected lung tissue
- chills & fever
- cough, purulent sputum
- aveolar exudate
28
what are the clinical manifestations for viral pneumonia?
- fever
- non productive dry cough (!!)
- hoarseness
- wheezing
29
what is acute respiratory failure?
- emergency bc there is no 02 coming in, only CO2 out causing a severe gas exchange
- LESS THAN 60 paO2 or LESS THAN 50 paCO2 and PH LESS THAN 7.3
30
what are the 3 categories of acute respiratory failure
1. failure of respiration or oxygenation leading to hypoxemia & low or normal co2 levels (restrictive)
2. failure of ventilation leading to hypercapnia (obstructive)
3. combo of respiratory & ventilatory failure
31
what are the C.M of respiratory failure?
hypoxemia, hypercapnea, headache, dyspnea,
confusion, ↓ LOC, agitation, dizziness, restlessness
* Early: rapid, shallow breathing
- Late: cyanosis, nasal flaring, retractions
32
how is raspatory failure diagnosed & treated?
- diagnosed: blood gases, CXR, CBC, electrolyte
- TX: maintain airway, mechanical ventilation to keep O2 sat
- >90%, treat underlying problem
33
what is PNUEMOCONIOSIS: OCCUPATIONAL LUNG DISEASE
- due to inhalation of toxic gases or foreign particles
- more exposure more consequences
- treatment: preventative, use masks
- is apart of fibrotic lung disorders
34
what are symptoms of pulmonary edema?
- weight loss (bc pt can't breathe)
- bibasilar crackles (@ base of lung)
- coughing up blood or bloody sputim
- orthopnea
- Feeling of "air hunger" or "drowning" (called "paroxysmal nocturnal dyspnea" if it causes you to wake up and try to catch your breath.
34
what is acute respiratory disress syndrome (ARDS)
- damage to alveolar capillary membrane
- pt normally on vent to push out infection & gunk
- associated w/ decline in paO2 that is refractory (not responsive) to o2 therapy
- 30 - 63% mortality rate
34
what are the causes of ARDs?
- Sepsis (>40%)
* Shock (full system infection)
* Aspiration of gastric acid (>30%)
* Severe trauma
* Emboli
35
what are the C.M of ARDs?
- Sudden marked respiratory distress
- tachypnea &cardia
* Hypotension
* Marked restlessness
* Frothy secretions
* Crackles
, rhonchi on auscultation
* Use of accessory muscles
* Intercostal and sternal retractions
36
what is the treatment for ARDs?
- - PEEP = forces air out of alveoli (Mechanical ventilation with positive end-expiratory pressure)
- mostly supportive = increase tissue O2 till inflammation resolves
- treat underlying cause
- maintain fluid & electrolyte balance (not too much fluids or can give pulm edema)
- o2 therapy (goal = keep paC02 over 60
