Respiratory Diseases and Disorders Flashcards
Disorders of Obstruction
- Asthma
- Status asthmaticus
- COPD (chronic bronchitis, Emphysema)
Pulmonary Disorders
- Acute Respiratory failure
- Adult Respiratory distress syndrome
- Aspiration
- Hypo/hyperventilation
Respiratory Tract Infections
- Pneumonia
- Pleurisy
- Pleural Effusion
Pulmonary Vascular Disease
- Pulmonary edema
- Pulmonary embolism
Chronic inflammatory disorder of the lower airways. Obstruction increases resistance to flow
Asthma
2 Types of Asthma
- Intrinsic
- Extrinsic
Not associated with specific antigen-antibody reaction
Intrinsic Asthma
Specific antigen-anitbody reaction (common in children)
Extrinsic Asthma
Common Triggers of Asthma
- External or environmental factors (pollen, dust, feathers, foo, drugs)
- Infections
- Cold air
- Chemical irritants
- Tobacco smoke
- Exercise
- Emotional stress
Progression of Asthma
- Antigen is inhaled to lower airway
- Sensitized IgE antibodies trigger mast-cell degranulation in submucosa
- Mast-cell membrane ruptures releasing
- Histamine
- Leukotrienes
- Prostaglandins
Phase 1 of Asthma
Within minutes of exposure
1. Bronchial smooth muscle contraction (Bronchoconstriction)
2. Fluid leakage from peribronchial capillaries (bronchial edema)
Phase 2 of Asthma
~3-4 hours later cells of the immune system invade respiratory submucosa, resulting in:
1. Sustained bronchiole inflammation
2. Increased mucous production
3. Bronchial edema
Classifications of Asthma Severity
- Mild Intermittent
- Mild persistant
- Moderate persistant
- Severe persistant
Treatment for Asthma
- Correct hypoxia (O2)
- Reverse Bronchoconstriction
- treat inflammation and edema
Severe prolonged attack that cannot be broken by bronchodilators
Status Asthmaticus
Signs and Symptoms of Status Asthamticus
- Similar to asthma, however bronchodilators don’t help
- Greatly diminished breather sounds
- Imminent Respiratory Arrest
- Pulsus paradoxus (systolic drop 10 mmHg or more)
- Pneumothorax may occur due to air trapping and pressures
- Silent chest with PCO2 > 70 mmHg
Treatment for Status Asthmaticus
- Rapid transport is imperative
- Administer high-concentration oxygen
- Anticipate need for intubation and aggressive ventilatory support
- Dehydrated common so IV fluid administration may be required
- Closely monitor the patient’s respiratory status
- Continuous bronchodilator therapy may be ordered
Hypersecretion of mucous and chronic productive cough that continues for at least 3 months/year or 2 consecutive years
Chronic Bronchitis
Blue Bloaters
Chronic Bronchitis
History for Chronic Bronchitis
- Frequent respiratory infections
- Productive cough
Inspection findings for Chronic Bronchitis
- Often Overweight
- Pursed-Lip Breathing
- JVD
- Ankle Edema
Lung sound for Chronic Bronchitis
Rhonchi
Management of Chronic Bronchitis
- Relieve hypoxia (seated semi-fowlers, O2 prn to maintain SpO2> 90%, IV NS TKVO)
- Reverse bronchoconstriction (bronchodilator nebulized)
Destruction of the alveolar walls distal to the terminal bronchioles that causes abnormal enlargement of gas exchange airways and loss of elastic recoil. Decrease in diffusion.
Emphysema
Pink Puffers
Emphysema
History for Emphysema
- Recent weight loss
- Dyspnea with exertion
- Cigarette and tobacco usage common
- Lack of cough except in the AM
Inspection finding for emphysema
- Thin
- Barrel chest
- Pink skin due to extra red cell production (Polycythemia)
- Hypertrophy of accessory muscles
Percussion finding with Emphysema
Hyperresonance
Lung sounds for emphysema
- Wheezes and rhonchi
- Prolonged expiration
Emphysema management
- STOP SMOKING
- Relive hypoxia (semi-fowlers, O2 prn to maintain SpO2 >90%, IV NS TKVO)
- Reverse Bronchocontriction (Anticholinergic inhaled/nebulized, B2-adrenic agonist inhaled/nebulized)
Form of pulmonary edema that is caused by fluid accumulation in the interstitial space within the lungs
ARDS
Precipitating factors of ARDS
- Sepsis
- Aspiration
- Pneumonia
- Pulmonary injury
- Burns/inhalation injury
- Oxygen toxicity
- Drugs
- High altitude
- Hypothermia
- Near-drowning syndrome
- Head injury
- Pulmonary Emboli
- Tumor Destruction
- Pancreatitis
- Invasive procedures
- Bypass, hemodialysis
- Hypoxia, hypotension, or cardiac arrest
Pathophysiology of ARDS
- Disruption of the alveolar-capillary membrane
- Affects interstitial fluid
Treatment of ARDS
- Manage underlying condition
- High-concentration O2 (CPAP, PEEP)
- IV access
- Pulse oximetry, ECG
- RApid transport
- Use of pharmacological agents
Passage of fluid and solid particles into lungs
Aspiration
Signs and Symptoms of Aspiration
- Decreased LOC or CNS causing cough reflex
- abnormal swallowing mechanism
Predisposing Factors for Aspiration
- Substance abuse
- Sedation
- Anesthesia
- Seizure disorder
- CVA
- Myasthenia gravis (neuro disorder)
- Guillain-Barr’s syndrome (inflammation of nerves)
History taking for Aspiration
- Sudden onset of choking
- May be fever, dyspnea, wheezing
Aspiration Management
- Prevention
- Standard dyspnea treatment pre-hospitally
- ??PEEP
- ??Antibiotic
Ventilation that exceeds metabolic demands
Hyperventilation Syndrome
Common Causes of Hyperventilation Syndrome
- Anxiety
- Hypoxia
- Pulmonary disease
- Cardiovascular disorders
- Drugs
- Fever
- Infection
- Pain
- Pregnancy
Signs and Symptoms of Hyperventilation Syndrome
- Dyspnea with rapid breathing and high minute volume
- Chest pain
- Circumoral tingling
- Carpopedal spasm
- Other assessment findings will vary, based on the cause of the syndrome
Infection of the lower respiratory tract
Pneumonia
Types of Pneumonia
- Bacterial
- Viral
- Aspiration
- Hospital acquired vs community acquired
- Inhalation of microorganisms
- Infection can spread throughout lungs
- Alveoli may collapse, resulting in ventilation disorder
Bacterial and Viral Pneumonia
History Assessment for Pneumonia
- Generally, appear ill with generalized weakness and malaise
- Recent Hx of fever and chills
- Deep, productive cough (yellow to brownish sputum)
Inspection finding for Pneumonia
Pleuritic chest pain (sharp, tearing pain)
Auscultation finding for Pneumonia
- Inspiratory crackles with decreased air movement in involved segment
- Egophony
Management of Pneumonia
- Adequate ventilation and oxygenation (semi-fowlers, O2 prn to maintain SpO2 > 90%, IV NS TKVO)
- Reverse Bronchospasm prn (symptomatic relief) (B2-adrenergic agonist inhaled/nebulized)
- In-hosptal:
- X-ray/lab confirmation
- Antibiotic therapy (bacterial)
Inflammation of the pleura
Pleurisy
Pleurisy Pathology
Frequently preceded by upper respiratory infection
History finding for Pleurisy
- Chills
- Fever
Inspection finding for Pleurisy
- Pleuritic chest pain (sharp, tearing) on inspiration
- Pain may also be referred to shoulder
Auscultation findings for Pleurisy
Pleural friction rub may be heard over affected area
Pleurisy Management
- Adequate ventilation and oxygenation (semi-fowlers, O2 prn to maintain SpO2 > 90%)
- ECG
- IV NS TKVO
- If unsure of cause of chest pain, treat according to chest pain protocol
Presence of fluid in the pleural space
Pleural Effusion
Sources of fluid in Pleural Effusion
- Blood vessels
- Lymph nodes
- Abscess
- Inflammation of tissue
- CHF
History Findings for Pleural Effusion
- Chills
- Fever
Inspection finding for Pleural Effusion
- Pleuritic chest pain (sharp, tearing pain) on inspiration
- Pain may also be referred to shoulder
Auscultation findings for Pleural Effusion
Pleural friction rub may be heard over affected area
Management of Pleural Effusion
- Adequate ventilation and oxygenation (semi-fowlers, O2 prn to maintain SpO2 > 90%)
- ECG
- IV NS TKVO
- if unsure of cause of chest pain, treat for chest pain protocol
A condition characterized by an abnormal collection of fluid in the lungs
Pulmonary Edema
Assessment for Pulmonary Edema
Diaphoresis, pallor and pitting edema are commonly found
Lungs Sounds for Pulmonary Edema
- Mild to moderate presents with crackles in bases of lungs upon inspiration
- Moderate to Severe produce coarse crackles heard throughout all lungs lobes during both inspiration and expiration
- Tactile fremitus may also be present, palpating abnormal chest wall vibrations as a patient speak
Management of Pulmonary Edema
- High flow O2
- If SpO2 < 85% despite basic O2 therapy, advanced airway management with PEEP may be indicated
- Rapid transport
Occlusion of a portion of the pulmonary vascular bed by an embolus
Pulmonary Embolism
What can cause a Pulmonary Embolism
- Thrombus
- Tissue fragment
- Lipids
- Air embolus
History findings for Pulmonary Embolism
- Sudden onset of dyspnea
- Pleuritic chest pain
- Unproductive cough (rare hemoptysis)
- Recent Hx immobilization (trauma, inactivity)
Inspection findings of Pulmonary Embolism
- Laboured breathing
- Tachypnea, tachycardia
- S&S of right sided failure (JVD, hypotension)
Auscultation of Pulmonary Embolism
- Usually unremarkable
- Occasionally crackles, wheezes may be noted
Assessment findings for Pulmonary Embolism
- Check extremities for S&S of deep vein thrombosis (DVT) (warm, swollen extremity, thick cord palpated along medial thigh, pain on palp or calf extension)
- Extreme S&S include: confusion, cyanosis, hypotension, cardiac arrest, petachiae)
Pulmonary Embolism Management
- Maintain airway
- Support breathing
- IV NS TKVO
- Monitor vitals
- Transport in position of comfort
- Definitive care requires hospitalization and thrombolytic or heparin therapy
- Prepare for cardiac arrest
