Respiratory Conditions Flashcards
define COPD
OBSTRUCTIVE respiratory disease largely caused by smoking
progressive, partially reversible airflow obstruction and abnormal inflammatory response to noxious particles or gases.
includes: emphysema, bronchitis, bronchiectasis (your genetics decide)
COPD pathophysiology
Parenchymal Inflammation and destruction of lung tissue leading to larger air spaces (loss of airways and capillary bed) leads to ↓recoil and stale air trapping (Emphysema)
OR
Airway inflammation & remodeling (small airway thickening, reduction in lumen size), inc.mucous, damage to cilia decreasing bronchial hygiene (Chronic Bronchitis - productive cough for at least 3 months to a year)
leading to ↓ Expiratory flow, hyperventilation hyperinflation (breathing at higher lung vol. of stale air, diaphragm at mechanical disadvantage) & gas exchange abnormalities, ↓diffusing capacity (alveoli destruction)
bronchiectasis - chronic inflammation and purulent, productive cough
COPD S&S
Signs:
- Airflow obstruction - mandatory for diagnosis
- FEV1/FVC <70% for diagnosis
- Increased lung volumes (i.e. breathing at higher lung volumes) - increased RR
- Hypoxemia (Hb oxygen saturation is less than 90%)
- weight loss/anorexia
- cyanosis; clubbing
- decreased breath sounds and adventitious sounds
Sx: Dyspnea (esp. on exertion), chronic cough often productive/hemoptysis, wheeze, frequent exacerbations (viral, bacterial, environmental triggers), tiredness, muscle weakness, deconditioned
(downward spiral of COPD - dyspnea leads to decreased PA which increases deconditioning very quickly)
COPD CXR + ABG’s
shows big lungs with flatter diaphragm ribs horizontal (hyperinflation) barrel chested hyperlucency ABG's: hypoxia; hypercapnea
COPD PT management
- pursed lip breathing
- slow breathing and relaxation technique
- exercise prescription to prevent cardiovascular disease, OP, depression
- also smoking cessation, SOS for SOB, oxygen therapy, surgery*
Define Asthma
OBSTRUCTIVE chronic inflammatory disease of airways, reversible spontaneously or with treatment
- increased reactivity of trachea and bronchi to various stimuli (allergens, exercise, cold etc.) - widespread narrowing due to inflammation, sm. muscle constriction and increased secretions
Asthma S&S
acute (airway lumen narrows, mucous secretion; Status Asthmaticus –> emergency)
Cough (hacking, irritative, nonproductive or productive of clear sputum)
Dyspnea
Wheezing, typically on expiration
Sit upright but hunched over
Coarse breath sounds
Use of accessory muscles
Asthma management
regular use of inhaled corticosteroids (ICS), even when symptoms improve
Exercise induced asthma
Acute, reversible, airflow obstruction 5-15 min after onset of exercise
May be due to inhalation of cold, dry air
Coughing may be the first sx– also dyspnea, chest tightness and wheezing
Keep patient upright, leaning forward, pursed-lip breathing, use inhaler if prescribed
Use of inhaler 10-20 min prior to exercise
Define Cystic Fibrosis
genetic disorder of chloride and sodium transport across the epithelium of the respiratory, digestive and genital tracts
Cystic Fibrosis
scarring and formation of cysts in the affected body organs
Defective ion transport = thick mucous
Chronic bacterial infections and progressive loss of lung function leads to respiratory failure and early death
Cystic Fibrosis S&S
Malnutrition, failure to thrive
Initially the lungs are normal
Recurrent chest infections with wheezing, dyspnea and productive cough
Anorexia, reduced muscle mass
Cystic Fibrosis CXR
Linear opacities
Thickened bronchial walls, increased diameter
Consolidation, atelectasis
Cystic Fribrosis PT Management
Daily airway clearance (v thick secretions)
Exercise
time treatment after bronchodilator
poor posture: thoracic mobility and ext. exercises
Active Cycle of Breathing Technique (ACBT)
FORCED EXPIRATORY TECHNIQUE (FET) – HUFFING
POSITIVE EXPIRATORY PRESSURE (PEP) MASK
INTERSTITIAL LUNG DISEASES
RESTRICTIVE, irreversible
Loss of lung compliance (the ability of alveoli to expand with increasing pressure), small lung volumes
Typically an increase in scarring and connective tissue occurs aka pulmonary fibrosis
Interstitial lung disease S&S
Dyspnea ++ , with rapid, shallow breathing pattern
Dry, often painful cough
Severe oxygen desaturation
Finger clubbing
cannot use Airway clearance techniques
Define Atelectasis/collapse
Collapse of lung due to another pathology recent hx of: -trauma -surgery -obstruction of airway -loss of lung surfactant -compression of the lung -pulmonary edema
Microatelectasis (diffuse distribution of lung units that are perfused but not ventilated)
Segmental/lobar atelectasis (lung segment collapse)
Atelectasis/collapse pathophysiology
breathing at low lung volumes (due to pain, meds, sedation)
fluid in pleural space
due to consolidation (↑ in volume/fluid in lung, sputum, blood, vomit), can cause collapse of lower area
airway narrowing, airway obstruction due to mucus
Atelectasis S&S
- pt may not show signs if small areas affected
- fine inspiratory crackles
- quiet breath sounds if extensive
- possible dyspnea, tachypnea, cyanosis if shunt present
Atelectasis CXR
shifting of lung structures toward collapse
shift of landmarks (fissures, mediastinum, trachea, diaphragm, hilum)
Sometimes an elevation of hemidiaphragm or decrease in spacing between the ribs
Silhouette signs
if collapse decrease in inspiratory volume (note when counting ribs), also no breath sounds
Atelectasis PT management
increase supplemental O2
deep breathing with inspiratory hold
airway clearance:
suctioning if due to ↑ secretions
positioning, mobility, breathing exercises
Active Cycle of Breathing Technique (ACBT)
if due to surgery:
- coordinate treatment with pain meds
- support area with pillow while moving or coughing
Why is secretion clearance important?
Prevent infection ↑ ventilation ↑ quality of life ↓ WOB Prevent and/or delay use of supplemental O2 ↓ risk of mortality
Post-op Respiratory Conditions
Atelectasis
Aspiration – of gastric contents may lead to bronchospasm, pneumonia, and Acute Respiratory Distress Syndrome
Pulmonary embolism – blood clot from elsewhere travels to lung
Pneumothorax
trauma resulting in puncture to the chest wall
collapse due to air in pleural space
HEMOTHORAX
collapse due to blood
TENSION PNEUMOTHORAX
wound sealed, ↑ pressure in pleural space
Pneumothorax CXR
hyperlucent lung with pleural line with free air between it and chest wall (Air in the pleural space will cause a dark area)
if v.severe, in tension pneumothorax, trachea and heart will be shifted to opposite side
Pneumothorax S&S
- chest pain, SOB
- breath sounds diminished, or absent if severe
- if severe, increased respiratory rate, may be hypoxemic (low blood oxygen)
Define Pneumonia
Acute inflammation of the lungs in which some or all of the alveoli are filled with fluid (consolidation)
complications: can lead to ARDS
- surgery
- chronic lung disease
- immobility/difficulty swallowing, ↑risk of aspiration
- intubation
- being in hospital
Pneumonia S&S
- productive cough purulent and/or bloody
- dyspnea
- pleuritic pain with breathing (gritty feeling)
- O/A: bronchial breath sounds over consolidated areas; possibly coarse crackles and wheezes if secretion retention
- decreased breath sounds over area of pneumonia
- fever, chills
- fatigue
Pneumonia PT management
HOB >30deg airway secretion clearance (if productive): -suctioning -postural drainage -percs and vibes -supported coughing -increase mobility as soon as able
- Active Cycle of Breathing Technique (ACBT)
- ensure pt using O2 if prescribed
Define Bronchiectasis
chronic necrotizing infection of the bronchi and bronchioles leading to abnormal dilation of these airways
Hx of other chronic lung disease such as cystic fibrosis or tuberculosis
Bronchiectasis S&S
Large amounts of purulent sputum
coarse crackles
spirometry - obstruction
Bronchiectasis PT management
airway secretion clearance postural drainage percs and vibes Active Cycle of Breathing Technique (ACBT) Flutter, Acapella Bronchodilators
Define Pleural Effusion
Abnormal accumulation of fluid in the pleural space
transudate fluid - thin, clear, non-infected
exudate fluid- thick, green, infected
Pleural Effusion S&S
pain with deep breathing and cough
dypsnea
pleuritic chest pain with infections
dullness to percussion and absent breathing sounds
if infectious, pleural rub (squeaking or grating sound with breathing) may be present
O/A : decreased or absent sounds
Pleural Effusion CXR
massive effusion may lead to mediastinal shift to the opposite side
Pulmonary Edema
Increased fluid outside of the vessels and in the extravascular spaces in the lungs
- heart failure (most cases): not able to pump blood causing back pressure in lungs
- renal failure
- volume overload
- drug induced
- inhalation of noxious gas, acute respiratory distress syndrome
Pulmonary Edema CXR
enlarged peripheral vascular markings as the main blood vessels become engorged
numerous minute opacities (1-3mm diameter ) accompanied by fluffy shadows (spider web, cotton candy appearance)
CXR
PEIREDMLHBC
Pulmonary Edema S&S
- may start with general feeling of getting ill
- stiff lungs = ↑ work of breathing = dyspnea
- hypoxemia if edema in alveoli resulting in poor gas exchange->dyspnea
- cough productive of frothy, pink-tinged (from blood) sputum if edema moves into alveoli
- ↑ respiratory rate
- Fine inspiratory crackles on auscultation
- severe=may lose consciousness (syncope-prone to passing out)
Pulmonary Edema Management
supplemental oxygen and mechanical ventilation
cardiogenic pulmonary edema must be treated medically
do not use airway clearance techniques
suctioning may be indicated to maintain clear airway in the intubated patient
FiO2
Fraction of inspired oxygen
room air is 21% O2
oxygen enriched air =FiO2>0.21
conversions:
1L of air = 25%
every other L add 3%
ARDS
Acute respiratory failure with severe hypoxemia as a result of a pulmonary or systemic problem Often due to: -major insult to the lung and injury to the alveolar-capillary mb -shock -severe trauma or infection -overwhelming pneumonia -inhaled toxins -near drowning -aspiration
ARDS S&S
- ↑ respiratory rate, shallow breathing
- pulmonary edema
- hypoxemia
- severe dyspnea, cyanosis, accessory muscle use ++
- can involve kidneys, liver, CNS, and cardiovascular systems if not treated
ARDS CXR
bilateral lung ‘white-out’
ARDS PT management
positioning to improve V/Q mismatch - prone (bad lung up)
decreased mobility - bed exercises; gradually increase mobility to patient tolerance
Pneumonia CXR
any of the following can be seen:
- Increased opacity with a fluffy distribution
- Atelectasis and consolidation
- trachea or mediastinal, heart shift towards side of atelectasis and collapse if it occurs
- +silhoutte signs
Common Respiratory problems
1) Expiratory airflow limitations
- decreased lung elastic recoil
- increased airway resistance
- increased airway compressibility
2) Fibrosis/restriction of air entry
3) V/Q mismatch
4) decreased lung host defense/disturbance of the mucociliary escalator
5) atelectasis - collapse of whole or part of the lung
6) consolidation - lung fills with liquid–>lung solid and firm
Pleural effusion PT management
deep breathing (only if chest tube is inserted in pneumothorax), positioning, especially upright positions to facilitate draining, ensure patient is using oxygen if prescribed
Pulmonary Embolus PT management
prevention:
-promoting bed exercises and early
mobilization
-Anti-embolic stockings and sequential compression devices
Once DVT and pulmonary
embolus are suspected, all mobilization is halted until adequate anticoagulation is achieved
CHF S&S
-dyspnea related to pulmonary edema
-orthopnea: dyspnea when lying down flat due to an increase in venous return. Sometimes it is
accompanied by a dry hacking cough, which is relieved by sitting up
O/A: adventitious breath sounds wheezes and moist crackles
frothy sputum
what is angina?
Angina is pain in the chest arising from myocardial ischemia myocardial oxygen supply not meeting demand. It is a common cardiac symptom.
What are some risk factors for lung disease?
- Smoking
- Allergens (pets, dust, mites, pollens, food)
- Occupational exposures (Asbestos, coal mines, pidgeon breeders lung, popcorn worker’s lung)
- Genetic risk factors (i.e CF etc.)
- Biomass fuels (open fires)
- Infection (viral, bacterial, fungal)
- Previous Resp. History
- Extrapulmonary disorders (cardiac disease, autoimmune disorders, metastasis)
What are some signs and symptoms of respiratory disease?
- Dyspnea (disproportionate to level of exertion)
- Cough (productive/nonproductive, persistent/intermittent)
- Wheeze (high pitched, low pitched; inspiratory, expiratory)
- cyanosis (acute or chronic illness)
- finger and toe clubbing (can occur CF, COPD, pulmonary fibrosis)
- decreased O2 saturation (pulmonary system not usually the limiting factor to activity therefore desaturation not normal)
What are the GOLD stages of COPD?
fix this one
Name some obstructive diseases.
Emphysema/chronic bronchitis
Bronchiectasis
Asthma
Cystic Fibrosis
Name some restrictive diseases.
Interstitial lung disease
Idiopathic pulmonary fibrosis
Sarcoidosis
Name some vascular diseases.
Pulmonary edema.
Pulmonary embolism
Pulmonary Hypertension.
Name some restrictive chest wall diseases.
Pleural effusion. Neurmuscular disorders. Obesity Musculoskeletal Fractures Hemo/pneumothorax
Name some infectious/environmental/cancerous disease.
Pneumonia
Lung abscess
lung cancer
asbestos, particulate pollutants.
Name some pharmacological treatments for COPD (in order they would be prescribed).
BRONCHODILATORS (for smooth muscle relaxation)
- Inhaled bronchodilators (short-acting such as ventolin; long acting such as spiriva)
- Oral bronchodilators (such as theodur)
CORTICOSTEROIDS (for reduced airway inflammation)
- Inhaled corticosteroids (such as pulmicort)
- Oral corticosteroids (such as prednisone)
