Respiratory Flashcards
Obstructive lung disease
+ examples
Airway obstruction that causes difficult expiration (dyspnoea) and requires accessory muscles
* Asthma, chronic bronchitis, emphesema
Asthma
- Chronic inflammatory disorder caused by exposure to irritants or allergens
- Type 1 hyersensitivity response caused by lymphocytes, IgE, mast cells and eosinophils
- Leads to bronchoconstriction, spasm, oedema, and mucus production
- Treat inflammation with relievers, preventors and controllers, avoid triggers
COPD
- Coexistance of chronic bronchitis and emphysema (sometimes asthma) that causes impaired airflow and mucous buildup
- Caused mainly by cigarette smoke
- Can cause hypoxaemic and hypercapnic resp failure
Chronic bronchitis
- Hypersecretion of thick mucous + SM hypertrophy = airway obstruction
Emphysema
- Descruction of alveolar septa and loss of elastic recoil = collapse and gas flow obstruction
- Air trapping causes increased chest expansive and workload
Acute bronchitis
Description, Tx
Infection of airways due to viral
Assessed with spirometry, sputum MC&S, CXR, ABG
Tuberculosis
- Lung infection caused by mycobacterium TB
- Inflammation causes isolates of bacteria in tubercles, and surrounding scar tissue
- Remain dormant until immune system breaks them down and causes active disease
Bronchiolitis
- Viral inflammation of bronchiolar airways in children
Croup
Description, PP, symptoms
- Acute inflammation of upper airways (larynx) in children caused by parainfluenza virus
- Swelling of trachea causes seal-like barking cough + rhinorrhoea, sore throat, low grade fever
Pertussis
- Bacteria bordatella pertussis that causes thick secretions, chornic cough and fits, spasms (whooping cough)
CF
- Autosomal recessive disease that causes thick secretions in lungs and GI
- Favours chronic bacterial infection (staph aureus), clogged airways and severe inflammation = lung damage
Pulmonary embolism & vascular disease
Pulmonary Vascular disease: embolism or HTN in pulmonary circulation
Embolism: occlusion of pulmonary vessel by thrombus, tissue or air, leading to vasoC, oedema, atalectasis, HTN, shock, death
Hypoxaemia
Description, causes
- Reduced oxygenation of arterial blood due to respiratory alterations
- Low air O2, hypoventillation, impaired perfusion, resp depression due to drugs
Hypercapnia
- Increased CO2 in the blood, caused by hypoventilation of alveoli
Causes
* respiratory centre depression (drugs)
* Medulla infection
* Thoracic abnormalities & neural issues
* Airway obstruction/obstructive diseases
Hypoxia
- Reduced oxygenation of cells in tissue, not necessarily respiratory (e.g. low BP, low Hb, cardiac output issues)
Dyspnoea
Description, causes
- Subjective sensation of uncomfortable breathing or SOB
Haemoptysis
D, causes
- Coughing up blood or bloody mucous
- Caused by infection or inflammation that damages bronchi (bronchiectasis, TB, cancer
Cyanosis
D, Causes
- Bluish discolouration of the skin and mucous membranes due to desaturated Hb, polycythaemia (too many RBC), peripheral vasoC
Minute volume
Minute volume: TV x RR
Average 700ml x 18/min = 12,600 ml/min or 12.5 L/min
* morphine overdose reduced tidal volume & RR therefore decreased minute volume
* Can cause reduce alveolar exchange, sats and hypoxia
Expectorants
Aid in the removal of sputum from bronchial passages by diluting or irritating mucuous membranes to stimulate cilia
Mucolytics
Help disintegrate mucus and reduce viscosity to facilitate removal
Acetylcystine
Asthma drugs
Types, examples, order of treatment
- Bronchodilator: relievers for SMrelaxation (B2 adrenoreceptors, SABA (salbutamol), xanthines, theophyllines, anticholinergics
- Controller: LABA (salmeterol)
- Preventers: reduce inflammation to prevent symptoms (inhaled corticosteroids, leukotriene-receptor antagonists)
SABA - SABA + CS - SABA + CS + LABA - all 3 + high dose CS
Cough suppressant
Antitussive opioid that inhibits sensory receptors responsible for non-productive coughs
Pneumonia
+ mechanisms of organism spread, extrinsic and intrinsic factors
Infection of the lung parenchyma
* Aspiration from nasopharyn or oropharynx
* Inhalation of microbes in air
* Haematogenous spread from primary infection
Extrinsic: exposure to causative agent or irritant (infection)
Intrinsic: loss of airway reflexes (sedation, intoxication, ETT, neurological), immune impairment, defence mechanism dysfunction - COPD)
Natural respiratory defence
- Warmth & humidity
- Cough reflex
- Mucociliary clearance
- Macrophages in surfactant
- Ventilation
Pneumonia risk factors
- Elderly
- Pollution & smoking
- Chronic diseases
- Immunosuppression (neutropenia)
- URTI & co-infection with influenza
- Lung pathologies
- CNS depressants/impairment that predispose aspiration
Classifications of pneumonia
4 types + organism
- Community aquired (strep pneumoniae)
- Medical-care associated (hospital, ventilator, healthcare) (e. coli)
- Aspiration pneumonia (material triggers an inflam response & usually bac inf)
- Opportunistic (pathogens are usually those that dont cause disease)
NB: put 4 organisms in exam notes
Pathophysiology of pneumonia
- Organism trigger inflammatory response, causing hyperaemia & vascular permeability
- Neutrophils and oedema fill alveoli, impaired ventilation/perfusion mismatch & mucus production disrupts O2 causing hypoxia, worsened by mucus production = consolidation
- Strep pneumonia produces pneumolysin that is toxic to epi and endo & decreases clearance
PP - patterns of involvement in pneumonia
Lobular pneumonia: classical of one or more lobes by pneumococci. Inflammation if intra-alveoli exudate & consolidation that eventually spreads to bronchioles
Bronchopneumonia: involved bronchi, bronchioles and alveoli where consolidation is from suppurative, leukocyte filled exudate that fills bronchi first then other spaces (staph aureus)
PP - stages of lobular pneumonia
- Congestion: vascular engorgement, intraalveolar fluid, bacteria. Lung is heavy and red
- Red hepatization: massive exudate (RBC, leukocytes, fibrin fill alveoli). Lung is red, firm, airless
- Grey hepatization: disintegration of RBC, lots of fibrin exudate
- Resolution: enzymatic digestion of consolidation that is ingested by macrophages and coughed up
Pneumonia Manifestations
Depends on type of organism
- Cough (green/yellow sputum), dyspnoea, tachypnoea, chest pain
- Fever, shakes
- Low O2
- Accessory muscles
- Cognitive change due to hypoxia in elderly patients
- Auscultated crackles, fremitus, adventitious breath sounds
Diagnostic studies in pneumonia
- History & physical
- CXR
- Sputum analysis
- FBC: leukocytosis, blood cultures
- ABGs
- Thoracentesis/bronchoscopy (fluid samples)
Pneumonia complications
- Fibrosis & scarring of parenchyma
- Pleurisy: inflammation of pleura
- Pleural efflusion
- Atelectasis : collapsed lung caused by airway blockage
- Pneumothorax: traumatic (penetration) or tension (air in pleural space)
- Bactereamia, sepsis, meningitis, pericarditis
- Resp failure
Pneumonia management
- Pneumococcal vax
- Supportive: O2, analgesia, antipyretics
- Antivirals
- IV AB therapy (then oral) based on likely organism, risk factors for MDR, and local AB resistance patterns, minimum 5 days
- Hydration, nutritional support, ambulation & side lying, breathing exercises (Identify at risk patients, health habits)
Nursing assessment
- Health history (resp, immunity, allergen exp), meds (ABs, immunosupp), surgery, nutrition, activity/exercise
- O2 sats
Focussed assessment:
* General: fever, lethargy
* Resp: tachypnoea, assumetry, accessory muscle, crackles, fullness, sputum
* CV: tachycardia, confusion, hypoxia
Nursing goals/evaluation
- Effective RR, rhythm, depth
- Clear auscultation
- Pain management
- SpO2 > 95
- No adventitious breath sounds
- Clear sputum
