Respiratory 2 Flashcards
Asthma
Defined as: chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyperresponsiveness, constriction of the airways and variable airflow obstruction that is reversible
Risk factors? Genetics play a heavy role & hygiene hypothesis
Other risk factors:
Age of onset of disease
Levels of allergen exposure
Urban residence
Exposure to indoor and outdoor air pollution
Tobacco smoke
Recurrent respiratory tract viral infections
GERD
Obesity
Combination of innate and adaptive immunity responding to a allergen or irritant.
Early stage:
Exposure causes activation of dendritic cells causing release of inflammatory cytokines and interleukins that activate B cells (plasma cells) and eosinophils
Plasma cells produce IgE and bind to mast cells which causes degranulation of mast cells causing a couple of responses (look at the chart), generally releasing inflammatory mediators
Histamine, ILs, prostaglandins, etc.
**eosinophils cause direct damage to tissue and contribute to increased bronchial hyperresponsiveness, this also causes airway scarring. Once the damage is irreversible this is known as AIRWAY REMODELING.
Late asthmatic response begins 4-8 hrs after the early response.
The early immune response causes a delayed release of inflammatory mediators
Causing more bronchospasm, edema and mucus secretion with obstruction to airflow
During an attack:
Chest constriction
Expiratory wheezes
Dyspnea
Nonproductive coughing
Prolonged expiration
Tachycardia
Tachypnea
During SEVERE attack:
Accessory muscles use increases
Inspiratory and expiratory wheezes
Pulsus paradoxus
Decreases oxygen saturation
Complication:
STATUS ASTHMATICUS – may have silent chest at this point
Showing respiratory failure = mechanical ventilation
Acute attack -> oxygen + inhaled beta-agonists + oral corticosteroids
Avoiding allergens and irritants
FOR PARAMEDICS – bronchoconstriction directive
Emphysema
S/S
dyspnea
minimal cough
tachypnea
decreased breath sounds
pink skin and pursed lip breathing
cachexia
Hyperinflation / barrel chest
skinny due to work of breathing
pneumo due to bullae
Defined as: the abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis
Cause: changes in lung tissues, specifically the elastic recoil of lung tissue, from damage from inflammation and mucous presence from exposure to cigarette smoking or pollution
Patho: inherited alpha1-antitrypsin deficiency and infiltration of inflammatory cells and release of cytokines can cause increased protease activity with breakdown of elastin in connective tissue of lungs which destroys alveolar septa and loss of elastic recoil of bronchial walls leading to clinical presentations
Pulmonary Embolism
risk factors:
smoking
age
blood clotting disorder
cardiovascular diseases like heart failure, a fib
obesity
cancer
hormonal factors
surgery
dvt hx
prolonged immobility
CM:
SOB
Chest pain localized
rapid or ireg HR
cyanosis
Cough
Peripheral Edema
Fainting or lightheadedness
anxiety / insomnia
Respiratory distress syndrome of newborn
Typically presents in premature infants and is a significant cause of neonatal morbidity and mortality (29-30 weeks)
Death rates have declined due to antenatal steroid therapy and postnatal surfactant therapy
Cause: surfactant deficiency, leading to atelectasis
Clinically presents with: tachypnea (>60), expiratory grunting, intercostal and subcostal retractions, nasal flaring, and cyanosis
Preventative: corticosteroids
Treatments after birth: mechanical ventilation, nebulized or CPAPed with exogenous surfactant
Risk factors:
Premature birth/low birth weight (30weeks)
Male gender
Cesarean delivery without labor
Diabetic mother
Perinatal asphyxia
Increased pulmonary vascular resistance can cause a right-to-left shunt of blood through the ductus arteriosus and foramen ovale.
Metabolic acidosis can result from the hypoxia and hypoxemia.
Cystic Fibrosis
Autosomal recessive inherited disease (CF gene is on chromosome 7) that results from defective epithelial chloride transport
Affects the lungs, digestive tract and reproductive organs
Treatment: promotion of mucus clearance – chest therapy, mechanical devices, bronchodilators, aerosolized dornase alfa and hypertonic saline to liquefy mucus, antibiotics if needed, lung transplantation
Bacterio: staphylococcus aureus, haemophilus influenzae
Clinical manifestations:
Persistent cough or wheeze
Excessive sputum production
Recurrent or severe pneumonia
Chronic sinusitis
Barrel chest
Digital clubbing
Nasal polyps
Could be at risk for bronchial artery erosion, pulmonary hypertension and cor pulmonale.
SIDS
Sudden death of an infant under 1 year of age which remains unexplained.
Most frequent at 2-4 months old
Risk factors:
prone and side-lying sleeping positions,
sleeping on soft bedding,
overheated sleeping environment,
lower socioeconomic status,
mothers younger than 20,
lower birth weight or growth restricted infants,
male infants,
preterm delivery,
multiple gestations,
sibling who died of SIDS,
smoking during pregnancy,
exposure to tobacco smoke,
lack of prenatal care,
illicit drug use or binge-drinking,
larger family size
Bronchiolitis
Common viral respiratory tract infection (RSV – respiratory syncytial virus)
Infants and young toddlers
Patho:
Virus causes necrosis of bronchial epithelium and destruction
of ciliated epithelial cells, leading to a inflammatory response
Inflammation in the bronchioles causes air trapping,
hyperinflation and increased FRC —> hypercapnia and
increased WOB
Prognosis: typically, the affected will make a full recovery but premature or those with bronchopulmonary dysplasia or heart disease struggle to recover
Complications: increased risk for asthma
Treatment: palivizumab(antibiotic) and other supportive treatments
Clinical manifestations:
Rhinorrhea
Tight cough
Decreased appetite
Lethargy
Fever
Tachypnea
Respiratory distress
Wheezing, rales, ronchi
Severe apnea
Conjunctivitis
Otitis media
Epiglottis
Cause: Haemophilus influenzae Type B
More common in adults now, but was very common in children 2-7 years
Patho: inflammation in the posterior tongue base, covering the laryngeal inlet during swallowing and can cause life threatening upper airway obstruction
Clinically: high fever, irritability, sore throat, inspiratory stridor, severe respiratory distress, drooling, absence of cough, preference to sit (sniffing position), dysphagia, high fever; toxic appearance; muffled voice; drooling; dyspnea; sits erect & quietly
Complications: pneumonia, cervical lymph node inflammation, otitis, meningitis, septic arthritis
DO NOT AGITATE, avoid laryngospasms
Croup
age 6months 12 years
Types: acute laryngotracheobronchitis vs. acute tracheitis
Typically caused by parainfluenza (virus)a
Characterized as an infection causing obstruction of the upper airways
Subglottic inflammation and edema from infection, leading
to upper airway obstruction, increased resistance to airflow,
increased intrathoracic negative pressure and then collapse
of upper airway leading to respiratory failure
Most common in winter months
Clinically: rhinorrhea, sore throat, fever, hoarse voice, barking cough, inspiratory stridor
SEVERE WHEN ++WOB
As we know for treatment
Dexamethasone and Epi
Oxygen
Pneumonia
Cause by: a virus, otherwise sometimes bacteria
Spread: direct contact, droplet transmission, or aerosol exposure
Treatment: supplemental oxygen, assisted ventilations, antibiotics (if bacterial), preventatively children should be receiving vaccines against influenza and pneumococcus
