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Pulm > Restrictive and Obstructive Lung > Flashcards

Restrictive and Obstructive Lung Flashcards

1
Q

VO2

A

Oxygen consumption

Good reflection of O2 demand

(arterial O2 content - venous O2) * cardiac output

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2
Q

OER

A

O2 extraction ratio

VO2/DO2

OER is normally 23% at rest

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3
Q

Manifestations of respiratory disease

A

Impaired oxygenation

Impaired CO2 removal

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4
Q

Hypoxemia

A

Low PaO2 in the blood

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5
Q

Hypoxia

A

Low oxygen in the tissues

Can also occur due to other conditions that can restrict the oxygen supply to tissues

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6
Q

Anoxia

A

Absence of oxygen

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7
Q

Signs/symptoms of impaired oxygenation

A

Cyanosis
Cerebral hypoxia
Cardiac arrhythmia
Pulmonary artery vasoconstriction

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8
Q

Hypercapnia

A

Increased PCO2

Sx/sy...
Increased HR and BP
Dizziness
Headache
Confusion or loss of consciousness
Mm twitching and tremor
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9
Q

Hypocapnia

A

Low PCO2

Sx/sy...
Lightheadedness (Cerebral vasoconstriction, decreased blood flow)
Fatigue
Irritability
Inability to concentrate
Tingling
Impaired consciousness
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10
Q

Pneumotaxic area in pons

A

Sends inhibitory impulses to the inspiratory area

SHORTENS inhalation

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11
Q

Drop in CO2 will…

A

Increase pH

Decrease ventilation

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12
Q

Obstruction

A

Disease of respiratory tract, which produces and obstruction to airFLOW

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13
Q

Restriction

A

Abnormal reduction in pulmonary ventilation often due to diminished lung expansion
Decreased volume of gas moving in and out

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14
Q

COPD

A

Lung diseases that result in air trapping in the lungs

Can affect both mechanical fx and gas exchange

Dx made by pulmonary fx test, symptoms, and hx

Pts usually present c hyperinflation, barrel chest, and increased accessory mm use

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15
Q

COPD Pathogenesis

A

Inflammatory immune response in the lungs usually in response to noxious stimuli

Can also see…
Increased mucus production (impaired clearance)
Inflammation of mucosal lining of bronchi
Mucosal thickening
Bronchospasm (constriction of bronchial walls due to smooth mm spasm)
Decrease in the size of bronchial lumen
HYPERinflated lungs (air gets trapped behind collapsed bronchial walls)

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16
Q

COPD signs

A 
Hypoxemia
Hypercapnia
Increase production of mucous/impaired mucous clearance
Pulmonary HTN
Polycythemia (increased RBCs)
Cor pulmonale (R side heart failure)
Increased resistance to coronary artery
Often see productive cough (also can see ineffective cough)
Decreased expiratory flow rates (FEV1)
Increased residual volume
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17
Q

COPD symptoms

A

Dyspnea on exertion
Chronic cough
Expectoration of mucus
Wheezing

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18
Q

Types of COPD

A 
Bronchitis
Emphysema
Asthma
Bronchiecstasis
Cystic fibrosis
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19
Q

Variability of COPD

A

Primary cause
Location of obstruction
Reversibility

Common co-existing conditions…
Asthmatic bronchitis
Chronic bronchitis with emphysema
Cystic fibrosis with bronchiecstasis

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20
Q

Bronchitis

A

Productive cough on MOST days for 3 mos during 2 consecutive years

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21
Q

Bronchitis sx/sy

A 
Chronic cough
Morning expectoration
Frequent infections
Barrel chest
May be overweight
Cyanotic (blue bloater)
Edema due to heart failure
If it gets worse...
IV fluids
Antibiotics
Bronchodilators
Steroids
O2
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22
Q

Emphysema

A

Abnormal, irreversible enlargement of airway distal to terminal bronchioles

Alveolar disease

Destructive change in alveolar wall - can see collapse of airway on exhalation

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23
Q

Centriacinar emphysema

A

Begins in the respiratory bronchioles and spreads peripherally
AKA centrilobular emphysema
Associated c long-standing cigarette smoking
Upper half of the lungs

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24
Q

Panacinar emphysema

A

Destroys the entire alveolus uniformly
Lower half of the lungs
Generally observed in pts c AAT deficiency

In those that smoke, focal panacinar may accompany centriacinar

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25
Q

Paraseptal emphysema

A

AKA distal acinar emphysema

Involves distal airway sxs, alveolar ducts, and alveolar sacs

Process localized around the septae of the lungs or pleura

Airflow frequently preserved; however, apical bullae may lead to spontaneous pneumothorax

Giant bullae occasionally cause severe compression of adjacent lung tissue

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26
Q

Hyper-inflated lungs lead to…

A

Compensatory changes of chest wall

Decreased diaphragmatic excursion

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27
Q

Bullae

A

Emphysemidus spaces that are bigger than 1 cm in size

Decreased/no participation in gas exchange or diffusion

Increased incidence of pneumothorax

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28
Q

Emphysema sx/sy

A 
Barrel chest
Floppy lungs
Flat diaphragm
"Pink puffer"
SOB/DOE
Minimal sputum
Increased subcostal angle, horizontal ribs
Hypertrophied accessory mm***
PLB at rest
Often thin
Clinically (ausc, xray, etc)
PFT
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29
Q

Emphysema tx

A 
Medication
O2
Fluids
Bronchodilators
Surgery (bullectomy, volume reduction)
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30
Q

Asthma

A

Chronic inflammatory disease of the airways

Characterized by REVERSIBLE obstruction to airflow

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31
Q

Asthma attack is a combination of all these

A

Increased mucosal edema
Bronchospasm > bronchoconstriction
Secretions

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32
Q

Extrinsic asthma

A

Begins in childhood

Triggered by allergens

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33
Q

Intrinsic asthma

A 
Begins as adult (usually after age 35)
More severe (non-allergic)
34
Q

Exercise induced asthma

A

Due to loss of water/heat in lower respiratory system

35
Q

Status astmaticus

A

Attack that persists for hours and is unresponsive to medical management

MEDICAL EMERGENCY

36
Q

Bronchiectasis

A

Abnormal permanent dilation of bronchi and bronchioles
Trouble c pulmonary hygiene
Frequent infections

Mucopurulent sputum
Permanent dilation can ulcerate and become fibrotic

37
Q

Bronchiectasis auscultation

A

Crackles
Wheezes
Pleural rub

38
Q

Bronchiectasis treatment

A 
P/PD
Fluids
Abx (as needed)
O2
Other meds
Encourage to drink lots of water to help keep
39
Q

Cystic fibrosis

A

Exocrine gland dysfunction

Respiratory - thick, excessive secretions and poor ciliary fx

GI - pancreatic enzyme deficiency; can digest fat; stress incontinence

Integumentary - increased sweat production

40
Q

Respiratory cystic fibrosis

A 
Obstructions of small airways
...
Develop mucus plugs and destroy cartilagenous support of airways
...
Bronchiecstasis

BRONCHIAL HYGIENE IS KEY

41
Q

CF clinical signs

A 
CXR - flattening of lungs, increased chest expansion
PFT
Ausc
Cough
Accessory mm use
Clubbing
42
Q

CF treatment

A 
Pulmonary care
Management of pancreatic insufficiency
Antibiotics/antifungals
Nutritional supplements
General exercise
43
Q

Bronchopulmonary dysplasia (BPD)

A

One of the most common chronic lung diseases in children (Asthma, CF also)

O2 distress and obstruction within one month of age; abnormal development of lung tissue (scarring/inflammation)

44
Q

Restrictive dysfunction etiology

A

Abnormal reduction in pulmonary ventilation - can’t get air in

Not a disease in and of itself, but arises from other disease states in or out of the pulmonary system

45
Q

Restrictive dysfunction pathogenesis

A

Compliance (of lung and chest wall)…

Decreased
Stiffer/more difficult to expand
Takes greater pulm pressure to expand the lung to a given volume

Lung volumes and capacities…

Decreased
Most marked decrease in IRV and ERV

Work of breathing…

Pt has to work harder to move air into the lungs

46
Q

Clinical manifestations of restrictive dysfunction

A 
Tachypnea
Hypoxemia
Diminished breath sounds
Possible adventitious breath sounds
Decreased lung volumes
Decreased diffusion capacity
Cor pulmonale (R heart failure)
Dyspnea
Cough (dry, non-productive)
Emaciation
47
Q

Medical management of restrictive dysfunction

A

Supportive…

Supplemental O2
Management of secretions
Nutritional support
Prevention of infection

Corrective…

Treatment specific to injury/dx

48
Q

Pulmonary fibrosis

A

Inflammatory process of alveolar wall
Scarring leads to stiffness (decreased compliance)
May be idiopathic (IPF)
Immune response
Genetic
Occupational hazards (coal dust, asbestosis)

49
Q

Pulmonary fibrosis s/s

A

Shallow/fast breathers

50
Q

Pulmonary fibrosis tx

A

Corticosteroid

51
Q

Pulmonary prognosis

A

5-6 years on average

Cause of death respiratory/heart failure related to pulmonary HTN

52
Q

Pneumonia

A 
Primary pulmonary pathologies in RLD
Inflammatory process of the lung
Begins from a lower respiratory tract infection
10% of all nosocomial infections
CAP
HAP
VAP
Risk factors... medical condition, environmental conditions
Dx... xray
53
Q

Pneumonia s/s

A

Dyspnea
Fever
Increased WBC

54
Q

Pneumonia tx

A

Sputum sample to determine bug

55
Q

Acute Respiratory Distress Syndrome

A

AKA acute lung injury
Sudden respiratory failure due to fluid accumulation in alveoli
Fluid leaking from smallest blood vessels in lungs into the alveoli
Can lead to fibrosis

56
Q

ARDS s/s

A 
SOB
Labored/unusually rapid breathing
Hypotension
Confusion
Extreme fatigue
Cough
Fever
Hypoxia
May not respond to supplemental O2
Xray - diffuse infiltrates (vessels will look normal in size)
57
Q

ARDS treatment

A 
Treat the cause
Maintain the airway
Manage nutrition
Manage fluid balances
Prevent complications
Symptomatic management (pain, infection, etc)
58
Q

Carcinoma

A

80-90% of lung cancers are caused by tobacco
Leading cause of cancer deaths
Small cell vs non-small cell

59
Q

Carcinoma tx

A

Surgery
Radiation
Chemotherapy

60
Q

Pleural effusion s/s

A 
SOB
Pleuritic pain
Dry cough
Non-productive
Poor chest expansion
Pleural run heard during ausc
61
Q

Pleural effusion dx

A

Chest xray or US
V/Q mismatch
Fluid aspiration

62
Q

Pleural effusion tx

A

Thoracocentesis or chest tube

63
Q

Transudative vs exudative fluid

A

Exudative - infectious

64
Q

Sarcoidosis

A

MULTISYSTEM disease with presence of noncaseating epithelioid granulomas

Autoimmune disease that results in fibrosis
Kidneys, heart, CNS, GI system, skin, eyes
Might hear crackles
Clubbing
SOB
Decreased exercise tolerance
Chronic steroids
Proximal steroidal myopathy
Non-productive cough
Chest p! c exercise due to attempt to increase TV

Tx - chemotherapy

65
Q

Bronchiolitis obliterans (BO)

A

BOOP - with Organizing Pneumonia

Fibrotic lung dx of smaller airways with necrosis of the respiratory epithelium
Infants by RSV (respiratory synctial virus)
Adults by toxic fumes or other infections

After a bone marrow transplant
Pts present as COPD pts, but more restrictive/mixed in nature
Progressive dyspnea on exertion
Developing cough
Wheezes and crackles, especially with more of an obstructive pattern

Tx - supplemental O2, antivirals, antibiotics, corticosteroids, bronchodilators

66
Q

Atelecstasis

A

Incomplete expansion (or collapse) of lung

Can result from…

Secretion retention
Compression of the lung

S/s

Decreased chest wall movement
Absent or diminished breath sounds
Fast breathing
Fever if related to infection
Increased density in involved area
67
Q

DO2

A

O2 delivery

Arterial oxygen content * cardiac output

68
Q

Pneumothorax

A

PTX
Presence of air in pleural cavity
Signs/symptoms vary based on size and other pulmonary dysfx

S/s…

Severe disease
Pleuritic chest pain
Hyperresonant percussion
Decreased fremitus

69
Q

PTX tx

A
70
Q

Types of pneumothorax (PTX)

A 
Primary - spontaneous
Secondary - COPD underlying disease
Iatrogenic - MD causes it
Traumatic - GSW, stab wound
Tension - when air enters pleural space, but can't escape; can compromise venous return
71
Q

PRIMARY pulm pathologies in RLD

A 
Pulmonary fibrosis
Pneumonia
Acute Respiratory Distress Syndrome (ARDS)
Carcinoma
Pulmonary effusion
Sarcoidosis
Bronchitis Obliterans (BO)
Atelectasis
PTX
72
Q

SECONDARY pulm pathologies in RLD

A 
Pulmonary edema
Pulmonary embolism
Neurological conditions - SCI, ALS, GBS, MG, MD, CVA
Ankylosing spondylitis
Lupus (SLE)
Obesity
Pregnancy
Scoliosis
Trauma
Oxygen toxicity
73
Q

Pulmonary edema

A

Increased fluid in the lung (alveoli), often due to ventricular failure (especially L)
Can be a medical emergency

S/s…

Dyspnea
Fast breathing
Restless/uncomfortable
Crackles (wetter breath sound)
Cyanosis
Clubbing
Ventilator use if severe enough

Tx…

Treat the cause
Diuretics
Vasodilators
Steroids
Supplemental O2
74
Q

Pulmonary embolism

A

10% mortality rate
Blood clot lodges in pulmonary artery (location determines severity)

S/s…

Acute sign of SOB
Sweating
Chest pain
Wheezing possible
Irregular pulse
Light headedness
Could come from DVT (prox worse than distal)

Tx…

Early mobilization for prevention
Meds - anti-coagulation, thrombolytic drug, surgery

75
Q

CVA?

A

Hemidiaphragm

76
Q

Ankylosing spondylitis

A

Spines are getting fused and they are all hunched over

77
Q

Obesity

A

Decreased chest wall compliance and increased O2 demand, higher resting diaphragm, closure of small airways and alveoli at bases

Leads to V/Q mismatch

78
Q

Obesity hypoventilation syndrome

A

Can’t take a deep enough breath bc of how much soft tissue they have

Increased O2 demand

79
Q

O2 toxicity

A

High concentrations can cause interstitial lung disease, alveolar edema, and hemorrhage with atelectasis

Need to keep FiO2

80
Q

TB

A

Restrictive disease
Mycobacterium Tuberculosis
PREVENTION first line of tx (universal precautions, respiratory isolation)

Airborne

Incubation period = 2-12 weeks
PPD + 6-8 weeks

S/s…

Unproductive cough
Fever
Night sweats
Weight loss
Dyspnea
Crackles
Xray abnormal c fluffy shadows, atelectasis, enlarged lymph nodes, cavitations in upper lobes, lung scarring

Tx…

Medication (rifambpin and isoniazid (INH)) for several mos
Respiratory isolation

Pulm (10 decks)

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