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High Acuity > Restrictive and Obstructive Pulmonary Disorders > Flashcards

Restrictive and Obstructive Pulmonary Disorders Flashcards

1
Q

Restrictive Pulmonary Disorder

A

Limited Expansion during inhalation

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2
Q

How do restrictive pulmonary disorders compromise oxygenation?

A

Reduced total long capacity, meaning loss of lung volume

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3
Q

Extra pulmonary restrictive pulmonary disorders

A

obesity, flail chest, muscular dystrophy

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4
Q

Intra pulmonary restrictive pulmonary disorders

A

Pneumonia, HF, pneumothorax

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5
Q

Obstructive pulmonary disorders

A

Airflow limitation during exhalation; hard to fully exhale

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6
Q

How do obstructive pulmonary disorders compromise oxygenation?

A

air moves in and out at a reduced rate, leading to air trapping

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7
Q

COPD

A

a collection of lower airway disorders that interfere with airflow and gas exchange

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8
Q

Asthma

A

chronic disease; acute reversible airway obstruction occurs intermittently, reducing airflow

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9
Q

Chronic bronchitis

A

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

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10
Q

Emphysema

A

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)

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11
Q

Cystic Fibrosis

A

autosomal recessive genetic disease that affects many organs, mostly impairing lung and pancreatic function

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12
Q

4 Obstructive Respiratory Diseases

A
  • Emphysema
  • Chronic bronchitis
  • Cystic fibrosis
  • Asthma
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13
Q

Bronchiectasis

A

Destruction and widening of large airways, resulting in mucus hypersecretion and recurrent infections

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14
Q

Clinically, COPD is seen as what 4 things?

A
  1. Progressive, partially reversible airflow obstruction and lung hyperinflation causing cough, sputum, dyspnea
  2. Post-bronchodilator spirometry result of FEV1/FVC < 0.7
  3. Increased frequency and severity of acute exacerbations
  4. Systemic manifestation such as deconditioning and muscle weakness
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15
Q

5 things that happen to the lungs in obstructive disorders:

A
  1. air flows into the lungs and becomes trapped
  2. difficulty exhaling increases expiratory time, not allowing alveoli to empty, trapping CO2 in lungs
  3. airway narrowing
  4. airway obstruction
  5. hyperinflation of lungs and loss of elastic recoil
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16
Q

What causes airway narrowing in obstructive disorders?

A

bronchospasm, bronchoconstriction, edema

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17
Q

What causes airway obstruction in obstructive disorders?

A

pooling of secretion, destruction of bronchioles/alveoli

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18
Q

4 cues seen in obstructive disorders:

A
  1. increased expansion/compliance
  2. decreased expiratory flow
  3. abnormal PFT
  4. chronically abnormal ABG
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19
Q

FEV1

A

the amount of air you can force from your lungs in one second (forced expiratory volume)

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20
Q

FVC

A

total amount of air exhaled during the FEV test

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21
Q

FEV1:FVC PFT result COPD

A
  • Ratio between two values should be 70-80% in normal adults
  • < 70% indicates possibility of COPD
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22
Q

Effect of COPD on FEV

A

decreased

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23
Q

Effect of COPD on TLC

A

normal to increased

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24
Q

Effect of COPD on FRV

A

increased

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25
Q

Effect of COPD on VC

A

decreased

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26
Q

FRV

A

functional residual capacity (FRV): the volume remaining in the lungs after a normal, passive exhalation

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27
Q

VC

A

the maximum amount of air you can forcibly exhale from your lungs after fully inhaling

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28
Q

ABG of COPD patient

A
  • 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)
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29
Q

Which type of COPD is hypercapnia chronically present in?

A

Hypercapnia is often chronically present in advanced emphysema (alveoli) rather than bronchitis (airway)

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30
Q

Asthma can lead to:

A

severe lower airway obstruction

31
Q

Classic symptoms of asthma

A
  • Dyspnea
  • Wheeze
  • Cough
32
Q

2 Types of short acting bronchodilators

A
  1. Short Acting Muscarinic Antagonist/Anti-cholinergic SAMA
  2. Short Acting Beta Antagonist SABA
33
Q

2 types of long acting bronchodilators

A
  1. Long Acting Muscarinic Antagonist/Anti-cholinergic LAMA
  2. Long Acting Beta Antagonist LABA
34
Q

Status Asthmaticus

A

A long-lasting and severe asthma attack that does not respond to standard treatment.

35
Q

5 Major Features of Status Asthmaticus

A
  1. pulsus paradoxus
  2. extremely labored breathing
  3. significant lung hyperinflation
  4. hypoxemic ABG
  5. sudden onset decreased wheezing/breath sounds
36
Q

Atrovent is a _______ and also known as __________

A

SAMA/anticholinergic

Ipratropium Bromide

37
Q

2 SABA examples

A

Salbutamol

Terbutaline

38
Q

Inhaled, oral and IV corticosteroids used in COPD management

A

Inhaled: fluticasone or budesonide

Oral: prednisolone

IV: hydrocortisone

39
Q

4 Key Cues in AECOPD and 4 Others

A

Key:
1. dyspnea
2. sputum
3. increased cough
4. respiratory failure

  • may have fever
  • increased respiratory effort
  • increased weakness/fatigue
  • ABG abnormalities
40
Q

Presentation of respiratory failure

A

Confusion, lethargy, respiratory muscle fatigue, peripheral edema, cyanosis, paradoxical chest wall movement

41
Q

5 Management Points of AECOPD

A
  1. inhaled/nebulized bronchodilators
  2. systemic corticosteroids
  3. antibiotics
  4. oxygen (BiPAP)
  5. smoking cessation
42
Q

What is the backbone to treat AECOPD?

A

systemic corticosteroids

43
Q

What is key in prevention of COPD exacerbations?

A

drug regime and an exercise plan

as well as vaccines, smoking cessation and inhalers

44
Q

Describe chronic respiratory insufficiency/failure

A

Acceptable gas exchange through cardiopulmonary compensation

Slow onset, progressive. Ongoing condition, develops gradually and requires long-term treatment

45
Q

In chronic respiratory insufficiency, the body has time to:

A

compensate for gas exchange deficits

46
Q

ABG of chronic respiratory failure

A

Maintain oxygenation & acid/base until late stage

Acid base imbalance

Normal pH and high PaCO2, high HCO3 = compensated respiratory acidosis; normal to low PO2

47
Q

Define pneumonia

A

Acute infection of the pulmonary parenchyma that is associated with:

  1. at least 2 of the following symptoms: fever, chills, new cough, chest pain, SOB
  2. lung sounds consistent with pneumonia (crackles, bronchial)
  3. new opacity on CXR
48
Q

What populations are at greatest risk for pneumonia?

A
  1. COPD/chronic lung disease
  2. elderly
  3. small children
  4. vaccination status
  5. immunocompromised
  6. ventilated patients
  7. hospitalized patients
  8. altered LOC
  9. corticosteroid use
49
Q

CAP

A

community acquired pneumonia
* Has not been hospitalized for at least 14 days

50
Q

Most common causative agents of CAP

A

bacterial = streptococcal pneumoniae

viral= influenza A, B, Covid-19

51
Q

HAP

A

hospital-acquired pneumonia
* Onset/diagnosis >48hrs after hospital admission

52
Q

VAP

A

ventilator-associated pneumonia
* Onset/diagnosis >48hrs after intubation

53
Q

Most common causative agents of VAP

A

MRSA, Streptococcal pneumoniae

54
Q

Aspiration Pneumonia

A

Abnormal entry of secretions into the lower airway due to suppression of gag and cough reflexes

55
Q

Cues seen in pneumonia (14)

A
  • 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
56
Q

What is CURB-65 score and what does it assess?

A

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

57
Q

How do you improve impaired gas exchange in bacterial pneumonia?

A
  1. antibiotics
  2. support O2 needs: supplemental oxygen, bronchodilators, ?mechanical ventilation
  3. support cardiac status: PO/IV fluids
  4. removal of exudate: chest physio, suctioning, DB and C
58
Q

3 Characteristics of Viral Covid Pneumonia

A
  1. diffuse alveolar damage/collapse
  2. long term respiratory effects
  3. huge variation in symptoms (fever, cough, dyspnea)
59
Q

How is COVID transmitted?

A

droplet and aerosol

60
Q

Medications used in COVID management

A
  1. IV fluids
  2. abx - ceftriaxone and azithromycin
  3. antivirals: remdesivir
  4. corticosteroids: dexamethasone
  5. venous thromboprophylaxis
61
Q

Management of COVID besides medications

A
  1. CXR, O2 to maintain > 90, ABG
  2. BW
  3. PCR/antigen test
  4. if pleural effusions or empyema, consider drains
62
Q

What type of oxygenation problem in pneumonia?

A

Fluid accumulation occurs causing a DIFFUSION issues at alveolar capillary membrane

63
Q

Why are bronchodilators used in pneumonia compared to obstructive diseases?

A

mucus/fluid buildup occurring causing narrowing – not constriction like obstructive but can still be beneficial

64
Q

Why is oxygen supplementation given in pneumonia?

A

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

65
Q

Why are IV fluids given in pneumonia?

A

Heart will try to compensate in response. Fluids to assist in maintaining perfusion to body and heart itself.

66
Q

What does removal of exudate help with in pneumonia?

A

Removal allows for better diffusion

67
Q

Empyema

A

Pneumonia Complication
collection of infected pleural fluid; pus. Infected cavity can encroach into lung tissue shrinking size that lung can expand to.

68
Q

Pleural Effusion

A

Pneumonia Complication
collection of fluid in pleural cavity. Localized to certain areas, can occur in various places. Treated with thoracentesis.

69
Q

Atelectasis

A

Pneumonia Complication

caused by blockages in the lungs. Sputum/mucus causes collapse of certain areas.

70
Q

Abscess as pneumonia complication

A

collection of infected material. Can present like effusion but can grow its own chamber/wall (abscess is always walled off)

71
Q

What is seen on CXR on viral pneumonia/covid?

A

ground glass opacities – white specs throughout entire lung fields

72
Q

Corticosteroids used in obstructive disease vs viral pneumonia

A

obstructive: methylprednisolone

covid: dexamethasone

73
Q

Management of Asthma (8 components)

A
  1. oxygen above 94
  2. SABA
  3. SAMA
  4. Corticosteroid
  5. no sedatives
  6. chest x-ray
  7. IV magnesium sulphate
  8. mechanical ventilation
74
Q

Why is magnesium sulphate used in asthma management?

A

muscle relaxant; relax bronchiole muscle/constriction

High Acuity (20 decks)

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