Respiratory conditions Flashcards
Pneumonia: Signs and symptoms
Pleuritic chest pain
Fever
Hypoxia
Fatigue
Weakness
Dull percussion (fluid)
crackles
productive cough
COPD: Signs and symptoms
hyperventilation
dyspnoea on exertion
peripheral oedema: pulmonary hypertension causes fluid back in the right ventricle and into systemic circulation.
barrel chest
prolonged expiration
Pneumothorax: pathophysiology
air accumulation in the pleural cavity caused by trauma or spontaneous air entry. air in this space increases pressure and can lead to partial or complete lung collapse.
Pneumonia: pathophysiology
Caused by viral, fungal or bacterial infection. Once in the lungs, pathogens multiply by clonal expansion and infection worsens. Infection in alveolar spaces causes inflammation and migration of lymphocytes. Alveoli fill with fluid and blood which impedes on gas exchange. Pneumonia can be bronchial, lobar or aspiration.
Pneumonia: risk factors
Hospitalisation
ventilator
COPD
age
Smoking
drug misuse
alcoholism
diabetes
flu
obesity
Pneumonia: treatment and management
Antibiotics
O2 therapy if hypoxic
Analgesia for chest pain
encourage hydration
GP/CPT referral if low risk
Transfer if medium/high risk #.
primary pneumonia
results from inhalation or aspiration of a pathogen, such as a bacteria or virus.
secondary pneumonia
results from hematogenous spread of bacteria or a noxious chemical, or from inhalation of foreign matter into the bronchi from the stomach.
COPD: exacerbation
Increased dyspnoea
increased hypoxia
tachypnoea
increased sputum
cough
wheeze
COPD: pathophysiology chronic bronchitis
inflammation of bronchi caused by prolonged inflammation of irritants or infection.
Inflammatory response over long periods of time causes cilia dysfunction, increased goblet cell size and mucus production. this results in increased small airway resistance and V/q imbalance. This diminishes the respiratory drive and so patient hypo ventilates and hypoxia occurs.
COPD: pathophysiology emphysema
caused by a deficiency in alpha-protease inhibitors, recurrent inflammation triggers release of proteolytic enzymes which break down the elastic fibres in the alveoli by hydrolysis of peptide bonds leading to an increase in the size of airspaces in the lungs. This reduces alveolar integrity and lung compliance meaning less expansion in inhalation and air trapping/alveolar collapse on expiration.
COPD: risk factors
Smoking
Alpha-protease deficiency
smoking
age
Socio-economic status
exposure to toxins
COPD: treatment and management
oxygen therapy
coached breathing
position
bronchodilators
salbutamol for exacerbation
diuretics for oedema
corticosteroids for inflammation
Asthma: signs and symptoms
cough
wheezing
chest tightness
difficulty breathing
Asthmaticus: signs and symptoms
marked respiratory distress
marked wheezing/absent breath sounds
pulsus paradoxus (10mmhg decreased stroke volume/BP pulse wave on inhalation.)
Asthma: Pathophysiology
Exposure to allergens triggers production of Ige antibodies with each exposure increasing amount of IgE in bloodstream. Antigens bind 1:2 with IgE and form complexes which bind to mast cells and activate them to release histamine from their granules. Histamine causes bronchoconstriction and mucus production. An asthmatic person already has oversensitive bronchial linings which causes muscular spasm, mucosal oedema and thick secretions.
Asthma: risk factors
gender (male in childhood, female in adulthood)
environmental factors
genetics
obesity
respiratory infection in childhood.
Asthma: mild treatment
Salbutamol, own inhaler, GP pathway
Asthma: moderate treatment
own inhaler, salbutamol, leave with prednisolone
Asthma: severe treatment
O2, salbutamol, ipratropium bromide, steroids
Asthma: life threatening treatment
O2, salbutamol, IM adrenaline, IV magnesium, ipratropium bromide, steroids
ways of classifying pneumonia
type (inhalation/aspiration), origin (bacterial, viral, fungal, protozoal), location (proximal/distal).
ipratropium bromide
acetylcholine antagonist with anti-cholinergic effects including reduction in bronchial contraction and reduction in mucosal secretions allowing for bronchodilation to improve asthma and COPD symptoms
salbutamol
binds to Beta-2-adrenergic receptors to reduce bronchial contraction and stimulate airway relaxation from trachea to bronchioles.
