Restrictive and Obstructive Pulmonary Disorders Flashcards
Restrictive Pulmonary Disorder
Limited Expansion during inhalation
How do restrictive pulmonary disorders compromise oxygenation?
Reduced total long capacity, meaning loss of lung volume
Extra pulmonary restrictive pulmonary disorders
obesity, flail chest, muscular dystrophy
Intra pulmonary restrictive pulmonary disorders
Pneumonia, HF, pneumothorax
Obstructive pulmonary disorders
Airflow limitation during exhalation; hard to fully exhale
How do obstructive pulmonary disorders compromise oxygenation?
air moves in and out at a reduced rate, leading to air trapping
COPD
a collection of lower airway disorders that interfere with airflow and gas exchange
Asthma
chronic disease; acute reversible airway obstruction occurs intermittently, reducing airflow
Chronic bronchitis
inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke
Chronic, productive cough for a total duration of 3 months/year for over 2 continuous years
Emphysema
destructive problem of lung elastic tissue that reduces its ability to recoil after stretching; leads to lung hyperinflation
permanent enlargement of acini (airspaces distal to terminal bronchioles)
Cystic Fibrosis
autosomal recessive genetic disease that affects many organs, mostly impairing lung and pancreatic function
4 Obstructive Respiratory Diseases
- Emphysema
- Chronic bronchitis
- Cystic fibrosis
- Asthma
Bronchiectasis
Destruction and widening of large airways, resulting in mucus hypersecretion and recurrent infections
Clinically, COPD is seen as what 4 things?
- Progressive, partially reversible airflow obstruction and lung hyperinflation causing cough, sputum, dyspnea
- Post-bronchodilator spirometry result of FEV1/FVC < 0.7
- Increased frequency and severity of acute exacerbations
- Systemic manifestation such as deconditioning and muscle weakness
5 things that happen to the lungs in obstructive disorders:
- air flows into the lungs and becomes trapped
- difficulty exhaling increases expiratory time, not allowing alveoli to empty, trapping CO2 in lungs
- airway narrowing
- airway obstruction
- hyperinflation of lungs and loss of elastic recoil
What causes airway narrowing in obstructive disorders?
bronchospasm, bronchoconstriction, edema
What causes airway obstruction in obstructive disorders?
pooling of secretion, destruction of bronchioles/alveoli
4 cues seen in obstructive disorders:
- increased expansion/compliance
- decreased expiratory flow
- abnormal PFT
- chronically abnormal ABG
FEV1
the amount of air you can force from your lungs in one second (forced expiratory volume)
FVC
total amount of air exhaled during the FEV test
FEV1:FVC PFT result COPD
- Ratio between two values should be 70-80% in normal adults
- < 70% indicates possibility of COPD
Effect of COPD on FEV
decreased
Effect of COPD on TLC
normal to increased
Effect of COPD on FRV
increased
Effect of COPD on VC
decreased
FRV
functional residual capacity (FRV): the volume remaining in the lungs after a normal, passive exhalation
VC
the maximum amount of air you can forcibly exhale from your lungs after fully inhaling
ABG of COPD patient
- Oxygen decreases (hypoxemia)
- Carbon increases (hypercapnia)
- Chronic respiratory acidosis (high PaCO2) occurs and then results in..
- Metabolic alkalosis as compensation by kidney retention of bicarbonate (high HCO3)
- pH remains low (acidic)
Which type of COPD is hypercapnia chronically present in?
Hypercapnia is often chronically present in advanced emphysema (alveoli) rather than bronchitis (airway)
Asthma can lead to:
severe lower airway obstruction
Classic symptoms of asthma
- Dyspnea
- Wheeze
- Cough
2 Types of short acting bronchodilators
- Short Acting Muscarinic Antagonist/Anti-cholinergic SAMA
- Short Acting Beta Antagonist SABA
2 types of long acting bronchodilators
- Long Acting Muscarinic Antagonist/Anti-cholinergic LAMA
- Long Acting Beta Antagonist LABA
Status Asthmaticus
A long-lasting and severe asthma attack that does not respond to standard treatment.
5 Major Features of Status Asthmaticus
- pulsus paradoxus
- extremely labored breathing
- significant lung hyperinflation
- hypoxemic ABG
- sudden onset decreased wheezing/breath sounds
Atrovent is a _______ and also known as __________
SAMA/anticholinergic
Ipratropium Bromide
2 SABA examples
Salbutamol
Terbutaline
Inhaled, oral and IV corticosteroids used in COPD management
Inhaled: fluticasone or budesonide
Oral: prednisolone
IV: hydrocortisone
4 Key Cues in AECOPD and 4 Others
Key:
1. dyspnea
2. sputum
3. increased cough
4. respiratory failure
- may have fever
- increased respiratory effort
- increased weakness/fatigue
- ABG abnormalities
Presentation of respiratory failure
Confusion, lethargy, respiratory muscle fatigue, peripheral edema, cyanosis, paradoxical chest wall movement
5 Management Points of AECOPD
- inhaled/nebulized bronchodilators
- systemic corticosteroids
- antibiotics
- oxygen (BiPAP)
- smoking cessation
What is the backbone to treat AECOPD?
systemic corticosteroids
What is key in prevention of COPD exacerbations?
drug regime and an exercise plan
as well as vaccines, smoking cessation and inhalers
Describe chronic respiratory insufficiency/failure
Acceptable gas exchange through cardiopulmonary compensation
Slow onset, progressive. Ongoing condition, develops gradually and requires long-term treatment
In chronic respiratory insufficiency, the body has time to:
compensate for gas exchange deficits
ABG of chronic respiratory failure
Maintain oxygenation & acid/base until late stage
Acid base imbalance
Normal pH and high PaCO2, high HCO3 = compensated respiratory acidosis; normal to low PO2
Define pneumonia
Acute infection of the pulmonary parenchyma that is associated with:
- at least 2 of the following symptoms: fever, chills, new cough, chest pain, SOB
- lung sounds consistent with pneumonia (crackles, bronchial)
- new opacity on CXR
What populations are at greatest risk for pneumonia?
- COPD/chronic lung disease
- elderly
- small children
- vaccination status
- immunocompromised
- ventilated patients
- hospitalized patients
- altered LOC
- corticosteroid use
CAP
community acquired pneumonia
* Has not been hospitalized for at least 14 days
Most common causative agents of CAP
bacterial = streptococcal pneumoniae
viral= influenza A, B, Covid-19
HAP
hospital-acquired pneumonia
* Onset/diagnosis >48hrs after hospital admission
VAP
ventilator-associated pneumonia
* Onset/diagnosis >48hrs after intubation
Most common causative agents of VAP
MRSA, Streptococcal pneumoniae
Aspiration Pneumonia
Abnormal entry of secretions into the lower airway due to suppression of gag and cough reflexes
Cues seen in pneumonia (14)
- Fever and chills OR low temp
- New onset cough or sputum production
- Pleuritic chest pain
- Flu like feelings
- Tachypnea (RR >25)
- Signs of consolidation on CXR
- On auscultation- bronchial wheezes or crackles, decreased air entry
- New onset confusion
- Tachycardia
- Increased WBC
- Positive sputum cultures
- Night sweats
- Muscle aches and pain
- Fatigue
What is CURB-65 score and what does it assess?
estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment
C- confusion
U - urea (BUN > 7)
R - RR > 30
B - BP <90 systolic, >60 diastolic
65 -age
How do you improve impaired gas exchange in bacterial pneumonia?
- antibiotics
- support O2 needs: supplemental oxygen, bronchodilators, ?mechanical ventilation
- support cardiac status: PO/IV fluids
- removal of exudate: chest physio, suctioning, DB and C
3 Characteristics of Viral Covid Pneumonia
- diffuse alveolar damage/collapse
- long term respiratory effects
- huge variation in symptoms (fever, cough, dyspnea)
How is COVID transmitted?
droplet and aerosol
Medications used in COVID management
- IV fluids
- abx - ceftriaxone and azithromycin
- antivirals: remdesivir
- corticosteroids: dexamethasone
- venous thromboprophylaxis
Management of COVID besides medications
- CXR, O2 to maintain > 90, ABG
- BW
- PCR/antigen test
- if pleural effusions or empyema, consider drains
What type of oxygenation problem in pneumonia?
Fluid accumulation occurs causing a DIFFUSION issues at alveolar capillary membrane
Why are bronchodilators used in pneumonia compared to obstructive diseases?
mucus/fluid buildup occurring causing narrowing – not constriction like obstructive but can still be beneficial
Why is oxygen supplementation given in pneumonia?
Oxygen being brought in, trying to increase FiO2 so that although ventilation is okay, increase the amount of oxygen being diffused because that is where the difficulty
Why are IV fluids given in pneumonia?
Heart will try to compensate in response. Fluids to assist in maintaining perfusion to body and heart itself.
What does removal of exudate help with in pneumonia?
Removal allows for better diffusion
Empyema
Pneumonia Complication
collection of infected pleural fluid; pus. Infected cavity can encroach into lung tissue shrinking size that lung can expand to.
Pleural Effusion
Pneumonia Complication
collection of fluid in pleural cavity. Localized to certain areas, can occur in various places. Treated with thoracentesis.
Atelectasis
Pneumonia Complication
caused by blockages in the lungs. Sputum/mucus causes collapse of certain areas.
Abscess as pneumonia complication
collection of infected material. Can present like effusion but can grow its own chamber/wall (abscess is always walled off)
What is seen on CXR on viral pneumonia/covid?
ground glass opacities – white specs throughout entire lung fields
Corticosteroids used in obstructive disease vs viral pneumonia
obstructive: methylprednisolone
covid: dexamethasone
Management of Asthma (8 components)
- oxygen above 94
- SABA
- SAMA
- Corticosteroid
- no sedatives
- chest x-ray
- IV magnesium sulphate
- mechanical ventilation
Why is magnesium sulphate used in asthma management?
muscle relaxant; relax bronchiole muscle/constriction
