Respiratory - Class 2 Flashcards
Defined as the presence of blood in the pleural cavity; can result in the collapse of a lobe or an entire lung, leading to impaired ventilation and oxygenation.
Hemothorax
Defined as the presence of air/gas in the pleural cavity; can result in the collapse of a lobe or an entire lung, leading to impaired ventilation and oxygenation.
Pneumothorax
Chest pain: severe and/or stabbing, radiating to the ipsilateral shoulder and increasing with inspiration (pleuritic-type pain), due to hypoxia.
Pneumothorax
Dyspnea, respiratory distress or respiratory arrest.
Pneumothorax
Tachypnea and tachycardia (mediastinum can shift as a result, which can affect hemodynamic stability).
Signs and Symptoms of
Pneumothorax
Traumatic: blunt trauma or penetrating trauma that disrupts the parietal or visceral pleura eg. gunshot, arrow, stabbing, rib fracture, surgery.
Pathologic: rupture of pleural layers or alveoli eg. tumors, abscess, COPD, CF, TB, and air enters the pleural space via distended/damaged/ruptured alveoli.
Iatrogenic: secondary to diagnostic or therapeutic medical intervention.
Idiopathic: no preceding trauma and no underlying lung pathology - not uncommon in tall, thin, athletic adolescents, and smokers.
Causes of Pneumothorax
Dependent on the degree of collapse of the lung, can range from completely asymptomatic to life-threatening respiratory distress.
Signs and Symptoms of Pneumothorax
An inflammation of the pleural membranes
Pleuritis (Pleurisy)
Can be extremely painful, often unilateral with abrupt onset
May be accompanied by reflex splinting of chest muscles
Pleuritis (Pleurisy)
Pain may be referred to shoulder
Pleuritis (Pleurisy)
Pain worsens when the inflamed pleura is stretched on breathing (deep breathing, coughing), so breath tends to be shallow and may be rapid
Pleuritis (Pleurisy)
May be accompanied by reflex splinting of chest muscles
Pleuritis (Pleurisy)
- chest pain with breathing/moving, exacerbated by coughing or sneezing - pain is usually severe, sharp, and knife-like on inspiration
- tachypnea which may lead to tachycardia
- dry cough
- weakness
- headache
- fever
Symptoms of Pleuritis (Pleurisy)
- treatment is directed to the underlying cause and suppressing the inflammation
- pain medications
- laying on the affected side to limit breathing movement may reduce the stretching of the pleura and therefore the pain, when pleuritis is acute
Treatment for Pleura’s (Pleurisy)
Pain Differentiation vs. Pleuritis
often bi-lateral and located around lower ribs, irritated by coughing?
Musculoskeletal
Pain Differentiation vs. Pleuritis
sub-sternal and dull, “tightening”, made worse by coughing but not deep breathing
Bronchial
Pain Differentiation vs. Pleuritis
substernal discomfort, not affected by respiratory movements
Myocardial
a.k.a. Atelectasis
Dysfunctional Lung Expansion
incomplete expansion of part of a lung, or the entire lung.
Atelectasis
May be caused by airway obstruction, lung compression or lung collapse
Atelectasis
Can result in reduced ventilation and oxygenation of lung tissue (poor perfusion).
Atelectasis
May also interfere with secretion clearance from the lungs, leading to an increased risk of infection.
Atelectasis
acute pneumonia, bronchiectasis, respiratory failure, sepsis, pleural effusion and empyema.
COMPLICATIONS due to Alectasis
a collection or gathering of pus within a naturally existing anatomical cavity e.g.: pleural cavity (as differentiated from an abscess, which is a collection of pus in a newly formed cavity or wound). Or as Eeeen says, “a Boston cream lung”
Empyema
1 of 3 Sources of Atelectasis
When there is an obstruction that blocks an airway between the alveoli and the trachea. Air trapped distal to obstruction is absorbed, leading to airway/lung collapse.
Obstruction (resorption)
2nd of 3 Sources of Atelectasis
Occurs from any space-occupying lesion of the thorax compressing the lung and forcing air out of the alveoli e.g. tumour.
Compression
3rd of 3 Sources of Atelectasis
Causes of collapse include: pleural effusion, pneumothorax, hemothorax.
Collapse
Atelectasis Neonatorum and Acquired Atelectasis
Two types of Atelectasis
Primary Atelectasis
Atelectasis Neonatorum
TYPE OF Atelectasis that Implies the lung has never been inflated, or has not inflated properly
Atelectasis Neonatorum
TYPE OF Atelectasis that may be complete or partial
Atelectasis Neonatorum
TYPE OF Atelectasis that most often seen in premature or other high risk births
Atelectasis Neonatorum
TYPE OF Atelectasis that may be fatal
Atelectasis Neonatorum
TYPE OF Atelectasis that implies the collapse of all or part of a lung that has previously been inflated
Acquired Atelectasis
TYPE OF Atelectasis that commonly is caused by obstruction or compression
Acquired Atelectasis
- tachypnea
- tachycardia
- dyspnea
- cyanosis
- diminished chest expansion
Clinical Manifestations of Atelectasis
- reducing obstruction or compression
- re-inflation of collapsed lung
- deep breathing and positions that favour increased lung expansion, as appropriate
- oxygen therapy
Treatment of Atelectasis
is a common, chronic, inflammatory disorder of the airway that causes episodes of airway obstruction characterized by recurring symptoms, including respiratory hypersensitivity, that cause inflammation and acute attacks of intermittent obstruction.
Asthma
Chronic inflammation increases airway hyperresponsiveness and results in decreased airflow in susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing. Contraction of the airway and subsequent swelling leads to further obstruction.
Chronic Inflammatory Conditions (Asthma)
Episodes are common at night or in the early morning.
Chronic Inflammatory Conditions (Asthma)
Widespread airflow obstruction is often reversible, either spontaneously or with treatment.
Chronic Inflammatory Conditions (Asthma)
Roughly 7-8% of Canadians are affected (more biological females than males).
Chronic Inflammatory Conditions (Asthma)
There are 2 main types (allergic and non-allergic), and the common factor in both is an exaggerated hyper-responsiveness to a variety of stimuli.
Chronic Inflammatory Conditions (Asthma)
- allergies
- family history of asthma
- exposure to tobacco smoke and environmental pollutions
- hormones – biological females are more likely to develop adult-onset asthma after menopause
- respiratory infections (especially viral)
- premature birth and increased maternal age
- maternal smoking and prenatal exposure to tobacco smoke
Risk Factors of Developing Asthma
- attack lasting for several hours and unresponsive to medical treatment
- this is a medical emergency - call 911
- patient will become fatigued and lethargic, due to respiratory muscle exertion
- patient becomes cyanotic from lack of oxygen
- may lead to respiratory failure and death
Status Asthmaticus
Severe asthma exacerbations that progress rapidly and do not respond to standard acute asthma protocol
Status Asthmaticus
Cases in people over 35 years of age tend to be stress-related, or due to chronic exposure to inhaled pollutants or chemicals (often occupational, or prolonged exposure to smog).
Atopic Asthma (allergy induced asthma)
Allergies are the strongest predisposing factor for asthma.
Atopic Asthma (allergy induced asthma)
Chronic exposure to airway irritants or allergens increases the risk for developing asthma.
Atopic Asthma (allergy induced asthma)
Common Allergens:
seasonal: grass, tree and or weed pollens
perennial: mold, dust mites, animal dander especially cat and dog, cockroaches
Atopic Asthma (allergy induced asthma)
Treatment Considerations
Potential Modifications for treating px’s w/ Asthma
- awareness of cardiovascular health and hypertension
- caution re: allergens and sensitivities – careful with use of essential oils, detergents, disinfectants
- face cradle may feel claustrophobic, re: sensation of respiratory distress
- pillowing and/or prone position may inhibit diaphragm function
