Respiratory Flashcards
What is Pneumonia?
Acute inflammation of lungs which some or all alveoli are filled with fluid or cells
What are the SS of pneumonia?
Cough up green sputum, dyspnea, tachypnea, pleuritic pain, fever
Percussion: Dull sound
Presentation:
(1) Typical= sudden onset of symptoms, bacterial infection most common, fever, sputum, physical sign of consolidation
(2) Atypical (aka ‘walking pneumonia’) = few Sx, little sputum, minimal chest signs
What are the types of Pneumonia?
1. Inhalation ▪ Bacterial ▪ Viral ▪ Fungal ▪ Toxic chemicals: smoke, dust, gas 2. Hematogenous ▪ Occurs more often in immunosuppressed people 3. Aspiration ▪ Common in patients with swallowing disorders ➢ Supine body position increases risk
What are risk factors for developing pneumonia?
exposure to infectious agent, aspiration, impaired consciousness, alcohol abuse, post surgery, very
old/young and/or immunosuppressed, most are preceded by an upper respiratory infection followed by sudden and sharp chest pain
What is the treatment plan for Pneumonia?
(1) Poor gas exchange: Deep breathing, positioning
(2) Pain in cough or pleuritis (support cough, relaxation)
(3) retained secretion (mobilize ASAP, coughing, huffing, active cycle of breathing, improve chest expansion)
(4) Decreased mobility (Bed exercises, mobilize to tolerance level, upright position as much as possible)
(5) Active infection (Antibacterials/antibiotics, antifungal (if fungal infection))
What are preventions for pneumonia?
- Vaccine.
- Treatment of influenza.
- Mobility (keep lungs clear of sputum).
- Prevent aspiration (HOB at 30).
- Universal precautions and overall health.
What is atelectasis?
Collapse of normally expanded and aerated lung tissue at any structural level involving all or part of the lung. Can be patchy, segmental or lobar distribution
Causes of Atelectasis
- Blockage of bronchus/bronchiole: Lung is prevented from expanding due to mucous or airway obstruction
- Compression which prevents alveoli from expanding due to pneumothorax, pleural effusion, space-occupying lesion (tumor)
- Post-anesthetic effects: Anaesthesia and prolonged recumbency, breathing at low lung
volumes - Poor ventilation: Due to paralysis, diaphragmatic disorders, hypoventilation
Signs of Atelectasis
- Possible dyspnea, tachypnea, cyanosis
- Chest X-Ray: shifting of lung structures toward collapse
- Percussion: Dull
- On Auscultation: Decreased breath sounds, fine crackles
Treatment for Atelectasis
Identify underlying cause:
o Suctioning/secretion removal techniques if due to secretions
o Chest tube if due to pneumo/hemo-thorax or extensive pleural effusion
• Positioning, mobility as tolerated and breathing exercises.
What is Acute Respiratory Distress syndrome (ARDS)
ARDS is not a single disease. It is a term given to the clinical manifestation of the common pathway of several indirect lung injuries. Other names may include adult respiratory disease syndrome, shock lung, wet lung or hyaline membrane disease.
• Acute respiratory failure with severe hypoxemia as a result of pulmonary or systemic problem.
• Lung injury characterized by increased permeability of alveolar capillary membrane.
• Leakage of fluid and blood into lung interstitium and alveoli - inflammatory reaction; alveolar edema and collapse.
• Can occur in adults and infants.
Risk factors for ARDS
- Severe trauma.
- Aspiration.
- Embolism.
- Indirect: happens after viral infection or pneumonia.
Treatment for ARDS
• Intubation and ventilator assistance.
Positive-end expiratory pressure (PEEP) to keep airways open
• Tackle underlying cause.
• Prone position.
• Secretion clearance if needed (manual or mechanical vibration).
Signs and Symptoms of ARDS
Key feature on X-ray = white out.
• Increased respiratory rate, shallow breathing, severe dyspnea, cyanosis, accessory
Why do you put someone with ARDS into prone?
The lung expands from the apex at the shoulder and goes down the rib 6 anteriorly, 8 medially and 10 posteriorly. There is more surface area available for gas exchange posteriorly. There are copious amounts of secretions in ARDS hence the white out. In supine, the posterior lung parenchyma (alveoli) are compressed by the abdominal content. When a patient with ARDS is placed prone, the posterior aspect of the lung is no longer subject to high pressure and posterior lung atelectasis decreases which increases V/Q marching and subsequent oxygenation
Why does Infant Respiratory Distress Syndrome happen?
Children have a lack of surfactant (helps lungs inflate with air and keeps the sacs from collapsing)
Risk for Infant respiratory distress syndrome? (IRDS)
prematurity, c-section, multiple babies, blue baby, stop breathing, grunts
What is the treatment for infant respiratory syndrome? (IRDS)
Deliver artificial surfactant
What is Lung Abscess?
Infection leading to necrosis of lung tissue and cavity formation
Signs of Symptoms for lung abcess
Purulent and foul smelling sputum
Cough
Fever
Chest pain
Treatment for lung abscess
Prolonged antibiotic use Drainage of abscess Deep breathing exercises Supplemental O2 if needed Mobility as tolerated Secretion removal if abscess if draining into airway
What is Tuberculosis?
Infection- mycobacterium tuberculosis
Inflammatory, systemic disease that affects lungs and may disseminate to involve kidneys, growth plates, meninges, avascular necrosis of hip joint, lymph nodes and other organs
How does Tuberculosis spread?
airborn droplets: when infected people sneeze, laugh, sing and cough
Signs and symptoms of TB
cough 3+ weeks weight loss fever night sweats fatigue bronchial breath sounds
How is TB detected?
Injected TB derivative into forearm: to determine of body’s immune response has been activated by TB before
+ve test: red/swollen site
Medical management of TB
There are 10 different drugs that have been approved to treat TB
Medication for 6-9 months
What are the Precautions for TB?
patient should have a PRIVATE, -ve pressure room
Patient should wear a surgical face mask when leaving the room
What is the PT treatment for TB?
Thorough Hx to be identify TB
Typically not treated in PT because medications are vital to curing TB
PT can provide percussions and postural drainage to clear secretions out of lung if needed
Self protection (N95, glove and gown)
What is Pneumothorax
Collapse of lung due to lung gathering in pleural space
Can be spontaneous due to lung disease or due to trauma
Signs and Symptoms of pneumothorax
Sudden chest pain and SOB
What is the percussion sound of a pneumothorax
hyper-resonance
What does the chest x-ray look like for a pneumothorax
hyperlucent lung, medialstinal shift away from the side of the pneumothorax
What does a pneumothorax sound like?
Decreased breath sounds
What is a tension pneumothorax
Can be quickly fatal
Increased pressure on heart can cause it to stop breathing
Need to remove seal of quickly insert a catheter needle
What is a hemothorax?
Collapse of lung due to blood gathering in the pleural space, usually due to trauma
What does a hemothorax sounds like?
Decreased breath sounds
What is flail chest?
Multiple rib fractures with free floating rib section
Results in inefficient ventilation and poor oxygenation
What happens during flail chest upon inhalation and exhalation?
On inspiration:
o Flail segment sucks in: lung, heart, mediastinum shift away, reducing air entry into the unaffected lung
• On expiration:
o Flail segment pushes outward: lung, heart, mediastinum pushed toward flail segment
What is the treatment for flail chest?
Pain control, airway clearance, O2, intubation, ventilation if needed
Is asthma is restrictive or obstructive lung disease?
Obstructive
