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
