Restrictive and Other Pulm. Dysfunction Flashcards
Restrictive DYSFUNCTION (or disorder) - not a disease!!! How do you define it
Disorder in which the lungs can’t fully expand
Lung volumes/capacities are dec.
With restrictive dysfunction it is hard to ___ ___ ___
get air in
Restrictive dysfunction results from what
Diseases
Trauma
Therapeutic interventions
Drugs
With restrictive dysfunction the work of breathing is
increased
What happens with pulmonary compliance with restrictive dysfunction
decreased due to chest wall and/or lung and their decreased ability to expand
What happens to the lung volumes and capacities with restrictive dysfunction
all dec
TV and IRV are the first to dec
How does one compensate for dec volumes and capacities with a restrictive dysfunction
breathe faster - is exhausting and can actually lead to mm wasting
6 classic signs of restrictive dysfunction
Tachypnea Hypoxemia Dec breath sounds Dec lung vol and capacities Dec diffusing capacity Cor pulmonale
What is tachypnea
inc RR
What is Cor pulmonale
R heart failure
in this case due to R heart working so much harder and also is getting some backflow
3 hallmark symptoms with restrictive dysfunction
Dyspnea
Dry non productive cough (typically)
Weight loss and mm wasting
T or F: a patient with a restrictive lung dysfunction will have inc use of accessory mm
TRUE
Disorders of the pleural space
Pleural effusion (includes pleural emphysema)
Pleurisy
Pneumothorax
Define pleural effusion
accumulation of fluid in the pleural space
What systems are invovled with pleural effusion
vascular and/or lymphatic
An underlying pathology exists
What is the fluid called in pleural effusion
Transudate or exudate
Describe transudate - what is it made of
straw color
low protein count
What causes fluid to be transudate (reason)
abnormal hydrostatic pressure
What are some causes of transudate fluid
CHF
Nephrotic syndrome
Cirrhosis
Pericardial disease
Describe exudate - what is it made of
darker
high protein count, cellular debris, WBCs
What causes fluid to be exudate (reason)
change in permeability OR a trauma
What are some causes of exudate fluid
Trauma (Most common) Malignancies Pneumonias Infection Lupus, RA Abdominal abscess
General symptoms for pleural effusion (both transudate and exudate)
Dyspnea
Nonspecific chest discomfort
Pleuritic (sharp) chest pain
General signs for pleural effusion (both transudate and exudate)
as fluid inc, the lung tissue can compress and could potentially collapse
Fluid acts like a space occupying lesion
Pleural effusion - what will you see on x-ray
blunting (opaque) at the costophrenic angle
Pleural effusion - what will happen when you auscultate
you will not hear anything over the fluid
Pleural effusion - what will happen to lung volumes
dec if the effusion is large enough
Pleural effusion - what will the cough be
dry, non productive
Fluid is outside of the lung
Pleural effusion exam findings
Dec chest wall mvmnt
Mediastinum shift if large (to contralateral side)
Might have pleural friction rub
If pt has significant right pleural effusion, the trachea will shift
left
Diagnosing a pleural effusion
Chest radiograph (AP,PA,lateral decubitus) Thoracacentesis
Diagnosing a pleural effusion - AP/PA vs. lateral decubitus
Lateral will allow you to see a pleural effusion in the earlier stages
Diagnosing a pleural effusion - thoracacentesis
have them lean forward and stick a needle in to drain the fluid
Can be treatment or diagnostic
Pleurisy (Pleuritis) - define
inflammation of the pleura
Pleurisy (pleuritis) - which pleura is causing pain
parietal (visceral does NOT sense pain)
What is the parietal pleura innervated by
intercostal nerves
What are the causes of pleurisy (pleuritis)
Infection
Injury
Tumor
Complication of lung or other disease process
Clinical manifestations with pleurisy (pleuritis)
Abrupt onset Unilateral (lower and lateral pleura) Fever and chills Worse with deep breath, cough Pleural rub can be heard Tachypnea
Complications that can happen from pleurisy (pleuritis)
Pleural effusion Significant splinting Dec chest mvmnt Atelectasis Pleural adhesions
Treatment of pleurisy (pleuritis)
Self-limiting if no underlying pathology
Antibiotics and pain meds can be used
Encourage breathing as tolerated
What to be aware of in regards to pleurisy (pleuritis)
referal patterns can occur to the neck, trap, shoulder, or even lumbar
A therapist working with a patient with pleurisy in the acute care setting should
coordinate with other disciplines so that the patient isn’t getting everything at once - they need some uninterrupted bed rest
Define pneumothorax
accumulation of air within the pleural cavity leading to partial or complete collapse of the affected lung (atelectasis)
What happens to the pleura with a pneumothorax
parietal and visceral pleura become separated
What happens that causes the atelectasis from a pneumothorax
The negative pressure is lost and recoil of the lungs occurs
What are the types of pneumothorax
Spontaneous
Traumatic - open AND tension/closed
Hemothorax
Spontaneous pneumothorax is what
rupture of BLEBs what can happen with a cough or sneeze
Two types of spontaneous pneumothorax
Primary - genetic, males 20-40
Secondary - associated with underlying disease that makes the lung tissue weak
Two types of traumatic pneumothorax
Open
Traumatic/Closed
What is an open traumatic pneumothorax
Air enters the pleural cavity during inspiration and some is able to exist with expiration
Bad, but doesn’t progress as quickly since some air is getting out
What is a closed/tension pneumothorax
air enters the pleural cavity during inspiration but cannot escape so continues to build up with every inhale
What is a hemothorax
accumulation of blood within the pleural space usually due to trauma
Blood can fibrose and lead to fibropneumothorax
Events associated with what condition are considered an acute life threatening situation
Tension pneumothorax
Signs and Symptoms with pneumothorax
Inc RR Dyspnea Pleural pain Dec lung volume Dec lung compliance Impaired gas exchange (less SA for it to occur0
Exam findings with pneumothorax
Jugular vein distention
Dec or absent breath sound over area
Ches wall asymmetry
Mediastinum deviation to contralateral side
Treatment for pneumothorax
Ches tube to release air and alter pressure to return to normal
Parenchymal and pulmonary vasculature disorders
Atelectasis Pneumonitis Pulmonary fibrosis Pneumonia Bronchiolitis obliterans Pulmonary edema Pulmonary embolism
Define atelectasis
restrictive lunge dysfunction in which parts of the lung are unable to aerate - typically alveoli collapse
Atelectasis is considered what -
A condition NOT a disease
Types of atelectasis
Compressive
Obstructive (absorptive)
Post operative
Compressive atelectasis - define
something pressing on the lung tissue that leads to collapse
Obstructive (absorptive) atelectasis - define
Something plugs a bronchial or the airway and everything distal to the plug collapses
This is the most common
Post operative atelectasis - define
from anesthesia or narcotics associated with surgery
Clinical manifestation of large atelectasis includes what
Dec breath sound over area
Dyspnea
Cyanosis if large enough
Inc RR
Primary intervention for preventing atelectasis post op
deep breathing
walking
Pneumonitis define
inflammation of the lungs without the toxemia associated with pneumonia
Often is localized
Pneumonitis is often caused by
environmental exposure to organic material
Pneumonitis signs and symptoms
difficulty breathing accompanied by cough
often complain of fatigue
tx for pneumonitis
encourage rest
avoid the allergen
Sometimes will be given corticosteroid or antibiotic if there is an underlying infection
Pneumonitis can lead to
pulmonary fibrosis
Pulmonary fibrosis - define
inflammatory process involves alveolar wall and progresses to distortion of the lung
components of pulmonary fibrosis
inflammatory process
scarring or fibrotic process
Which component happens first with pulmonary fibrosis
inflammatory process first and then leads to the scarring
Causes of pulmonary fibrosis
Idiopathic
Viral
Genetic
Immune system disorders
Signs of pulmonary fibrosis
Dec TLC, VC, FRC, RV
Hypoxemia
End inspiratory dry rales (adventitious sounds)
Symptoms with pulmonary fibrosis
Cough - non productive Weight loss Fatigue Dyspnea Dec ex tolerance
Tx for pulmonary fibrosis
Corticosteroids and/or cytotoxic drugs
Supportive measures
Lung transplant
Define pneumonia
inflammatory process of the lung
Classifications of pneumonia
By pathogen
By anatomic location
By the cause
Or can be a combination
Risk Factors of pneumonia
1 Lower pt resistance to agents in URT maybe due to smoking, chronic bronchitis, resp infection, sinusitis, poorly controlled DM, malnutrition, existing illness
2 Inactivity/immobility
Diagnosis of pneumonia is based on
clinical presentation
chest radiographs
blood culture
sputum cultures
Bacterial pneumonia - most common cause
Strep
Bacterial pneumonia - signs
Tachypnea
Crackles
Fluid
Symptoms with bacterial pneumonia
High fever Chills Dyspnea Tachypnea Productive cough!
Viral pneumonia - most common cause
adenovirus
Influenza
Viral pneumonia - signs
Insidious onset
Diffuse infiltrates
Hypoxemia
Viral pneumonia - symptoms
low to mod temp Myalgia Dyspnea Tachypnea Nonproductive cough!
Fungal pneumonia - cause
Opportunistic infection (immune system is already weak from something else)
Fungal pneumonia - signs
bilateral diffuse or interstitial alveolar infiltrates
Funal pneumonia - symptoms
Fever Dyspnea Cough Chest pain Malaise Fatigue Weight loss Night sweats
Bronchopneumonia - cause
VIRAL
Lobar pneumonia - cause
BACTERIAL
Aspiration pneumonia - cause
inhale foreign object
Common in those with dysphagia and neuro pop
Symptms with aspiration pneumonia
Dyspnea
Wheezing
Fatigue
Green or bloody sputum
Hypostatic pneumonia - cause
immobility
Community acquired pneumonia - cause
viral but can turn into bacterial
Nosocomial pneumonia (HAP) - cause
opportunistic - after hospital for 48 hours
Bacterial pneumonia - tx
Antibiotics
3 Ps - percussion, position change, postural drainage
Viral pneumonia - tx
Supportive
Anti virals
Fungal pneumonia - tx
corticosteroids
antifungals
Bronchopneumonia - tx
VIRAL!
Lobar pneumonia - tx
BACTERIAL
Antibiotics
3 Ps
Aspiration pneumonia - tx
deep breathing
cough
mobility
Hypostatic pneumonia - tx
depends on if viral or bacterial
Supportive
Community acquired pneumonia - tx
Usually meds, rest fluids, maybe pain med
Nosocornial (HAP) pneumonia - tx
depends on fending organism
Oxygen
Supportive
Chronic aspiration most often causes recurrent bouts of pneumonia in which lobe
Right! - more vertical
Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) - define
Bronchioles and alveoli become inflamed and plugged with connective tissue
BOOP is usually from what
necrosis of respiratory epithelium in bronchioles
Fluid and debris cause alveolar pulmonary edema
Can lead to atelectasis
BOOP - cause
Peds - viral usually Adults - toxic fumes Can be viral or bacterial CT disease Organ transplant Idiopathic
BOOP - signs
Dec or norm lung volumes
Hypoxemia
Rales and wheezing
Tachycardia
Symptoms - BOOP
coughing dyspnea Inc RR Cyanosis Chronic infections
Tx - BOOP
Supportive measures
Peds - postural drainage or suction
Adult - corticosteroids
Tuberculosis - define
Disease caused by mycobacterium tuberculosis
Tuberculosis - includes
two conditions
Latent
Active
Latent TB -
You have the infection and it can present itself later
Active TB -
Active bacteria and is multiplying
TB can impact
LUNGS first and mainly
but also brain, kidneys, spine, hear, liver
TB - process of it
Bacteria replicate in alveoli
Inflammatory response
Fibrosis and calcification
Cavitation and scarring
If you auscultate over TB lung what will you hear
absent or dec
Symptoms of TB
Bad cough for 3 weeks or longer Pain in chest Cough blood or sputum Weakness No appetite Weight loss Chills/fever Sweating at night
Tx of TB
Antibiotics 6-9 months
Prevention
Incubation 2-12 weeks
If untreated TB - what is mortality rate
80% - usually from heart failure
Pulmonary edema - define
Excessive fluid in the interstitial tissue then in the alveoli and alveolar sac
Causes of pulmonary edema
Inc hyprostatic press
Inc alv cap permeability
Lymphatic obstruction
Dec serum and albumin
The increase in pulmonary capillary hydrostatic pressure with pulmonary edema is caused by
Left ventricular failure
Signs of pulmonary edema
Dec lung volume
Pleural effusion is common
Dec breath sounds
Maybe bronchospasm or wheezing
Symptoms of pulmonary edema
Restless, anxiety Labored breathing Cyanotic Tachypnea Productive cough
Tx for pulmonary edema
Prevention!
Dec preload
Maintain oxygenation of tissue
Dec Na intake
Adult Resp. Distress Syndrome (ARDS) known as
Noncardiogenic pulmonary edema, shock lung, acute lung injury
ARDs caused by
lung injury
Trauma, aspiration, drug associated, inhaled toxins, shock…
ARDs mortality rate
HIGH! it is a critical illness
ARDs causes what to happrn
inc in permeability of pulmonary membrane
alveoli become fluid filled
atelectasis occurs
ARDs- signs
dec FRC, VC, TV
Wet crackles, wheezing
Tachycardic and arrhythmias
Dec breath sounds over fluid areas
ARDs - symptoms
Restless, anxious
Dyspnea at rest
Maybe impaired mental status
Cyanotic
Pulmonary emboli - define
blood clot lodged in a pulmonary artery obstructing blood supply to lung parenchyma
Pulmonary emboli - complication of what
venous thrombosis - most often from leg
Common cause of sudden death in hospital is what
pulmonary emboli
Risk factors with pulmonary emboli
Blood stasis - immobility
Enothelial injury
Hypercoaguable states
Obesity, smoking, HTN, infection, previous hx
Signs pulmonary emboli
Dec lung volume
Dec breath sounds
Tachycardia
Symptoms pulmonary emboli
Dyspnea
Pleuritic ches pain
Apprehension
Persistent cough
Tx pulmonary emboli
Prevention
Thrombolytics
Filter in vena cava
Thombectomy/embolectomy
