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CardioPulmoaryPT1 > Restrictive (Can't get air IN) Lung Dysfunction: Exam 2 > Flashcards

Restrictive (Can't get air IN) Lung Dysfunction: Exam 2 Flashcards

1
Q

Lobular Consolidation

Think Lobe==Large

Lobes are LARGE

A

Consolidation IN lobes

Lg. amount bc lobes are LRG

*something in lungs that SHOULD NOT be…

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2
Q

Segmental Consolidation

Segments are SMALL

think SMALL amt bc segments are SMALL

A

Small amt of consolidation

INCd attenuation

**More white in chest x-ray instead of black (Air)

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3
Q

Atelectasis

A
  • Inside lungs
  • Collapsed alveoli
  • Cond or status lung is in
  • inability to fully expand alveoli
  • collapsed lung @ alveolar lvl
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4
Q

Pleural Effusions

“fire in the wall”

A

“Water ON lung”

  • Fluid b/w layers of pleura
  • IN lining of lungs
  • ***remember the fire IN the wall analogy!!!
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5
Q

Pulmonary Edema

“fire in the Room”

A

fluid IN lungs

  • remember the “fire in the ROOM” analogy!!
  • Think
    • CHF
    • Infections
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6
Q

Ventilation

AIR in and out of lungs

Alllllll of these things go along w/ Ventilation

A
  • lung compliance
  • elastic recoil
  • surface tension
  • surfactant
  • Inspiratory mm contraction
  • intrapleural pressure
  • diaphragmatic excursion
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7
Q

Ventilation:

Lung compliance

A

allows tissue to stretch aka dispensibility of the lungs

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8
Q

Ventilation:

Elastic Recoil

A

INWARD PULL of lungs back to orig. size

*like when you exhale

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9
Q

Ventilation

Surface Tension

WHY we blow harder into balloon initially

A
  • INWARD pull
  • determinant of lung recoil
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10
Q

Ventilation:

Surfactant

A

Type II Alveolar cells

DECs surface tension

keeps the alveoli from collapsing after exhalation and makes breathing easy.

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11
Q

Ventilation:

Inspiratory muscle contractions create:

A

OUTWARD pull

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12
Q

Ventilation:

Intrapleural Pressure

A

when BELOW ATM pressures==> air comes IN

Normally slightly LESS than ATM pressure

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13
Q

Ventilation:

Diaphragmatic excursion

A
  • Diaphragm descends —> sucks air IN
  • diaphragm ascends –> pushes air OUT

Remember the elevator analogy as you breathe IN thru nose—-goes DOWN

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14
Q

Diffusion of lungs

tollbooths opening for air to get into lungs

*all of these are tools to get O2 to blood*

A
  • Surface area of the capillary membrane
  • Diffusion capacity
    • thick capillary-alveolar memb’s
    • ability of air to diffuse
  • V/Q ratio
    • zones of west
  • LOWER LUNGS
    • ​BEST potential to expand BUT last recruited when one breathes
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15
Q

Perfusion of lungs

think BLOOD

A
  • Gravity dependent
  • Cardiac output
    • CO==HR*SV

**Optimized V/Q is @ MIDZONE in healthy individuals== 0.8

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16
Q

Etiology:

Restrictive Lung Disease

A

Everything smaller, BUT ratios are the SAME

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17
Q

Pathophysiological aspects of Restrictive Disease

Normal vs. Abnormal Alveolus

A

Cant get air IN

alveoli cannot Expand

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18
Q

Actual Restrictive Diseases

We will cover the following Subtopics:

A
  • Idiopathic Pulmonary Fibrosis
  • Cancers
  • MSK
  • NMSK
  • Pulmonary Edema
  • Connective Tissue
  • PNA
  • Traumatic
  • Alteration in Thoracic/Abdominal Pressure Balance
  • Others:
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19
Q

S/S Restrictive Lung Disease

A
  • Tachypnea OR dyspnea
  • Dry, nonproductive cough
  • Cachectic
    • mm wasting/atrophy
  • Hypoxemia
  • DECd breath sounds
  • DECd PFT
  • DECd diffusing capacity
  • R. sided HF or cor pulmonale
  • DEC TLC
  • INCd work breathing
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20
Q

More S/S Restrictive Lung Disease

A

See chart

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21
Q

Changes in Lung Volumes and Capacities

Restrictive vs. Normal vs. Obstructive

A

see chart

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22
Q

PFT

A

see chart

NOTE: SAME but smaller ratios

NOTE: FEV1/FVC for Restrictive will be HIGHER

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23
Q

Tx Measures for Restrictive Diseases

A
  • Supplemental O2
  • Exercise
  • CORTICOSTEROIDS—-control Inflammation!!! (you will see this OFTEN)
  • Smoking cessation
  • avoid exposure to irritating stimulus/noxious stim.
  • Pulm hygiene tech’s ===secretion mgmt
  • diaphragm strenghtening
    • IMT
  • good nutrition
  • cytotoxic drugs
  • lung transplant for IPF
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24
Q

Respiratory Distress Syndrome

Babies

old name== Hyaline Membrane Syndrome

What is it???

A
  • dis. of prematurity OR lack of complete lung maturation
  • lack of surfactant (allows alveoli to open/close) and inadequate surfactant production
  • Diffuse micro-atelectasis
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25
Q

Respiratory Distress Syndrome

Tx

A
  • Mom’s Milk!!!
  • surfactant replacement therapy
  • Extracorpeal membrane oxygenation (ECMO)
    • ​blood O2’d outside of body
  • Corticosteroids to mother BEFORE birth
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26
Q

Normal ventilation

vs.

Ventilators

A

Normally==> Neg. pressure—suction

Ventilators==> Pos. pressure–PUSH air in–barotrauma–this irritates lungs

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27
Q

What do we WANT to see on Chest X-ray for babies??

A

Sail Sign

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28
Q

+ Respiratory Distress Syndrome

*babies

A

see pics

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29
Q

Clinical Manifestation of Respiratory Distress Syndrome

A

See chart

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30
Q

Bronchopulmonary Dysplasia

Dysplasia==altered growth/production

what is it and what is the cycle?

A
  • Chronic respiratory distress syndrome > 1month
  • Cycle:
    • ​Scarring of lung tissue –> fibrosis–> thick alveolar walls–> segmental atelectasis (collapsing of alveoli)
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31
Q

Idiopathic Pulmonary Fibrosis

Idiopathic== do not know where came from

Fibrosis==scar tissue, difficulty O2 diffusion

What is it and Etiology??

A
  • Inflammatory process of alveolar wall
  • Etiology:
    • ​patchy focal lesions scattered, chronic inflamm. changes –> epithelial damage–> scarring –> become fibrotic
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32
Q

Idiopathic Pulmonary Fibrosis

Tx

A
  • Corticosteroids
    • you will see this w/ anything INFLAMMATORY
  • Cytotoxic drugs
  • smoking cessation
  • maint. adequate oxygenation/ventilation
  • good nutrition
    • for EVERY lung disease
      • ​supports extra mm contracts.
        • ​extra breathing tools! ​
    • w/ Restrictive disease, pts are using a LOT of fuel so NEED TO EAT but they do not WANT to eat
  • Tx infection
  • lung transplant
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33
Q

Idiopathic Pulm Fibrosis

Normal lungs vs. Lungs w/ Pulm Fibrosis

A

see pics

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34
Q

Chronic Coal Workers’ Pneumoconiosis

*starts w/ irritant*

A
  • interstitial lung dis. caused by inhalation of coal dust==fibrotic changes in lungs
  • Tx
    • ​cessation of exposure
    • nutrition
    • intervents to ensure adeq. oxygenation/vent.
    • progress. ex.
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35
Q

Asbestosis

*macrophages try to eat asbestos===MORE inflammation

asbestos is indestructible

A
  • Diffuse interstitial pulmonary fibrotic disease due to inflammation from asbestos exposure
  • long latency pd. after exposure of 15-20yrs
  • Tx: no cure
    • ​symptomatic support
    • dis. progresses even when exposure ceases
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36
Q

Bronchiolitis Obliterans

Popcorn lung disease

*attacks DISTAL airways—-> terminal bronchioles

A
  • fibrotic lung dis. affects small airways
  • Pediatrics: assoc’d w/ viral infection
  • Adults: assoc’d w/ toxic fume inhalation, viral, bacterial, mycobacterial and connect. tissue dis.
  • Necrosis of resp. epithel
    • ​inner lining lungs
  • Tx:
    • ​Children
      • supportive–> hydration, O2, postural drainage
    • Adults
      • O2, fluid balance, corticosteroids
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37
Q

Atelectasis

What is it and types?

A
  • Incomplete expansion of lung OR loss of volume
  • Types:
    • Primary
    • Obstructive
    • Post-op
    • Compression/Collapse
  • Chest radiograph shows opacification (whiteness) OR collapsed lung and elevated hemidiaphragm
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38
Q

Atelectasis

Prevention:

Tx:

A
  • Deep breathing
  • incentie spirometry
  • coughing
  • early mobility
  • DEC sedation

Tx: chest tube

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39
Q

Mechanisms of Atelectasis

  • Something pushing on lungs —cannot expand
    • ==Atelectasis
  • tracheal deviations
A

See pics

  • Pneumothorax
    • Air
    • collapsed lung
  • Hydrothorax
    • Fluid
    • Compression
  • Tumor
    • Obstruction
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40
Q

Open Pneumothorax

vs.

Tension Pneumothorax

A
  • Open:
    • Air can still get in and out
  • Tension
    • Life-threatening emergency
    • One-way door
    • ​Continue to inhale only bc no way for air out
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41
Q

Pneumonia

PNA

What is it and types

A
  • inflamm process of lung parenchyma (site of gas exchange)
  • Begins as infection in the lower resp. tract
  • 2 types:
    • ​Community acquired
      • CAP
    • Hospital acquired
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42
Q

Pneumonia

Can be ____ and _____

Most common routes?

A

Can be bacteria and virus

  • Most common routes of infection:
    • ​inhalation—breathe something in
    • aspiration–choke–something down wrong tube==infection
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43
Q

Pneumonia

Tx

*we need the underlying patho.

A
  • drug therapy
    • antibiotics if bacterial
  • O2
  • Mech. vent OR noninvasive vent.
  • Postural drainage
  • Airway clearance tech’s
    • must get fluid OUT
44
Q

Bacterial Pneumonias

A
  • Streptococcus pneumoniae
  • Legionella pneumophila
  • Haemophilus influenzae
  • Klebsiella pneumoniae
  • Pseudomonas aeruginosa
  • Staphylococcus aureus:
    • Methicillin-resistant Staphylococcus aureus
      • ​== MRSA ****
45
Q

Viral Pneumonias

A
  • Cytomegalovirus
    • CMV
  • Influenza virus
    • Flu
  • COVID-19
    • ​Corona Virus
46
Q

Fungal Pneumonias

A
  • Pneumocystis carinii
    • PCP

​

47
Q

Adult Respiratory Distress Syndrome

ARDS

**Diffuse—all alveoli filled w/ fluid

2 Characteristics:

A
  • SEVERE hypoxemia
    • acute respiratory failure
  • INCd permeability of alveolar-cap membrane
    • ​MORE permeable to fluid==hypoxia

***O2 Sats DEC!!!***

48
Q

2 Types of Adult Resp Distress Syndrome

A
  • Direct:
    • injury TO lungs
      • ex. ventilator
  • Indirect:
    • outside lungs
    • fluid from something other than lungs
      • ​ex. burn victim—systemic
49
Q

ARDS

Causes:

A
  • trauma
    • lung contusion
  • drowning w/ aspiration
  • aspiration
  • drugs
    • heroin, narcotics, amiodarone
  • inhaled toxins
    • smoke, high O2 conc’s on mech. vents, PNA’s

***lungs change from air-filled to fluid-filled organ

50
Q

ARDS

Progression:

A
  • Acute phase:
    • resolves completely
  • Acute phase:
    • fibrotic subacute phase
51
Q

ARDS and Refractory Hypoxemia

A
  • No matter amount of O2 pt is on—> will NOT raise O2 lvls bc O2 cannot get thru
52
Q

ARDS

S/S

53
Q

ARDS

Tx

A
  • Treat precipitating cause + underlying trigger
    • ​flu, toxins, etc..
  • Support adeq. gas exchange and tissue oxygenation
    • ​mech. vents
      • forces fluid out thru (+) pressure==opens lungs up
    • ECMO
      • O2 blood outside body
    • Prone positioning
      • ​Tummy Time—improves V/Q matching
  • manage nutritional status and fluid bal.
  • prevent OR treat comps
54
Q

Cancer

Bronchogenic Carcinoma

What is it and Causes?

A
  • Malignant growth of abnorm epithelial cells
    • ​proliferate unchecked
  • Primary Causitive factor is cigarette smoking
    • ​Other causes:
      • ​occupational agents
55
Q

Cancer:

Bronchogenic Carcinoma

Types:

A
  • Small Cell
  • Non-Small Cell:
    • Adenocarcinoma
      • ​non-smokers, females
    • Squamous Cell
      • ​smokers, men
56
Q

Cancer

Bronchogenic Carcinoma

TNM:

A
  • Primary tumor, nodal involvement, metastatic presence
57
Q

Lung Cancers often metastasize to other organs

  • bc lungs are filled w/ everything cancer wants
  • Cx in lungs can go anywhere
  • Iatrogenic fx’s
    • ​can be Cx
58
Q

Cancer

Bronchogenic Carcinoma

TONS S/S

ex’s: pain @ night, pain doesn’t go away w/ anything

A

see chart

just have a relative idea

59
Q

Cancer

Bronchogenic Carcinoma

Risk Factors:

A
  • Environment:
    • smoking
    • 2nd hand smoke
    • occupation, air pollution
  • Nutrition
    • free radicals
  • Genetics
  • Age
  • Pulmonary Lung Dis.
60
Q

Pleural Effusions

remember fire in the WALL example

A
  • accumulation of fluid w/in pleural space/lining
    • ​fire in the WALL
  • disruption in balance of pleural fluid reabsorption
61
Q

Pleural Effusions:

2 types of Fluids/Effusions

A
  • Transudative Effusions– fluid in/out
    • assoc’d w/ hydrostatic pressure in pleural caps
      • ​more CHF
  • Exudative Effusions–comes from inflamm.
    • assoc’d w/ INC in permeability of pleural surfaces
62
Q

Pleural Effusions

Tx

A
  • Target underlying cause
  • Dx thoracocentesis
    • ​see pics

*NOTE: Quicker accumulation of fluid===worse/poorer outcomes

63
Q

Pleural Effusion

Where exactly is the fluid accumulating???

64
Q

Sarcoidosis

You should immediately think…

A

Specific—-GRANULOMAS ===focal points of inflammation

65
Q

Sarcoidosis

A
  • Autoimmune multisystem disease characterized by presence of Granulomas in many organs
  • Affects: YOUNG 20-40 yo and women
  • 90% pts have lung involvement
66
Q

3 Distinct Stages of Sarcoidosis

A
    1. Alveolitis
    1. Formation of well-defined granulomas
    1. Pulmonary Fibrosis
67
Q

Sarcoidosis

Tx

A
  • Corticosteroids
    • remember granulomas are focal pts of inflammation—–corticosteroids for inflamm!!!
68
Q

Vaping-Induced Lung Disease

Electronic Nicotine Delivery Systems

ENDS

what specifically should you remember???

A

Solid vitamin E in lungs!!!

69
Q

Vaping-Induced Lung Disease

Electronic Nicotine Delivery Systems

ENDS

Vit. E Acetate Theory

A
  • Vit. E cuts well w/ nicotine or weed
    • theory is Vit. E converts BACK to solid IN lungs
70
Q

Vaping-Induced Lung Disease

Electronic Nicotine Delivery Systems

ENDS

Pt present/CT

A
  • Pt. Presentation
    • wheezing/dyspnea
  • CT scan shows:
    • acute eosinophilic pneumonia
    • diffuse alveolar damage
    • groud-glass opacity
71
Q

Vaping-Induced Lung Disease

Electronic Nicotine Delivery Systems

ENDS

Patho. Findings

A
  • Giant-cell interstitial PNA
  • Hypersensitivity pneumonitis
  • Diffuse alveolar hemorrhage
72
Q

Pulmonary Edema

Fire in the ROOM

A

Inc in amt of fluid w/in the lung

73
Q

Pulmonary Edema

2 Primary Causes:

A
  • INC pulmonary capillary hydrostatic pressure
    • ​L. sided CHF
    • Cardiogenic pulmonary edema
  • INC in alveolar capillary membrane permeability
    • ​ARDS
    • Pulmonary edema
74
Q

Pulmonary Edema

Tx

A
  • aimed @ DECing cardiac Preload and maint. oxygenation
75
Q

what sounds will you hear w/ pulmonary edema?

A

Crackles

INC voice sounds

LOTS of consolidation

76
Q

S/S Pulmonary Edema

77
Q

Cervical Spinal Cord Injury

C3, C4, C5 keeps

A

Keeps the Diaphragm Alive!!!!!!!

78
Q

NMSK cause of Restrictive Lung Disease

C/S Injury

SCI

A
  • damage to OR interruption of neuro. pathways contained in SC
  • Cervial Injuries:
    • ​lead to expiratory mm paralysis/weakness
    • results in poor cough
    • inspiratory mm paralysis/weakness
    • inability to completely inflate lungs/hypoventilatin
    • prone to atelectasis
      • bc lose mm’s that open up lungs–diaphragm
    • V/Q mismatching
79
Q

C/S SCI

Tx

A
  • strengthen + INC endurance of any remaining ventilatory mm’s
  • active/passive chest wall stretch
  • PNF
  • Clear secretions
80
Q

Cervical SCI and Paradoxical Breathing

A

https://www.youtube.com/watch?v=8TnrNrrEjuE

  • OPP breathing pattern
    • INHALE—stomach IN
    • EXHALE—stomach OUT
81
Q

Diaphragmatic Paralysis

NMSK cause of Restrictive Lung Disease

*lose Phrenic N. C3, C4, C5

A
  • Loss or impairment of motor function of diaphragm due to lesion in the neuro or MSK system
  • Cause commonly injury to phrenic N​
82
Q

Diaphragmatic paralysis leads to diaphragm pulled ______ and ant. ribs pulled_______

THIS RESULTS IN???

A

leads to diaphragm pulled UPWARD and Ant. ribs pulled INWARD

This results in alveolar hypOventilation

83
Q

Diaphragmatic Paralysis

Tx:

A
  • If unilateral involve…
    • ​usually NO Tx
  • B/L involve…
    • ​req’s lvl of mech. vent.
84
Q

Kyphoscoliosis

MSK cause of Restrictive Lung Dis.

A
  • Combo of:
    • excess A/P and Lat. curvature of T-spine
  • skeletal abnorms DEC lung compliance
  • **MOST ventilation occurs in upper lobes
    • ​so now V/Q mismatch
85
Q

Kyphoscoliosis

Over life-time

A
  • Develop Atelectasis and R.side HF
86
Q

Kyphoscoliosis

Sig. spinal curvature must be present before Pulm. sx’s develop

A
  • Angles <70degs
    • no pulmonary dysf.
  • Angles 70-120degs
    • some pulm dysf
  • Angles >120degs
    • SEVERE RLD and resp. failure
87
Q

Kyphoscoliosis

Tx:

A
  • Conservative
    • orthotics + exercise
  • Sx
    • Harrington distraction strut bars
  • ​Preventative + Supportive measures for pulm. compromise
88
Q

Pectus Excavatum

MSK cause of RLD

A

*funnel chest

*connective tissue disorder

89
Q

Pectus Excavatum

MSK cause RLD

A
  • Funnel chest:
    • congenital abnorm
  • Sternal depression, DEC A/P diameter
  • If SEVERE…
    • DECd TLC, VC, MVV (max voluntary ventilation)
    • MVV== tot. volume air exhaled during 12s of rapid deep breathing
90
Q

Pectus Carinatum

A
  • Pigeon breast
  • Sternum protrudes ANT
  • ***Assoc’d w/ prolonged childhood asthma***
91
Q

Kyphoscoliosis/Pectus Excavatum

MSK causes RLD

PFT:

A
  • in proportion to deformity….
    • DECd volumes and capacities
  • Diffusions usually normal
92
Q

Kyphoscoliosis/Pectus Excavatum

Chest X-ray

A
  • GROSSLY impaired due to severe spinal/chest deformity
  • Compressed side visible w/ incd vasculature
93
Q

Kyphoscoliosis/Pectus Excavatum

ABG:

94
Q

Kyphoscoliosis/Pectus Excavatum

Auscultation:

A
  • DECd breath sounds over restricted side
    • ​no air going in!

​

95
Q

Kyphoscoliosis/Pectus Excavatum

Cardio:

A
  • Potential for pulm HTN and R.sided HF
96
Q

Scleroderma

Connect. Tissue cause of RLD

What is it?

A
  • Progressive systemic sclerosis
  • Progressive fibrosing disorder causes degen changes in:
    • ​skin
    • sm. blood vessels
    • esophagus
    • intestinal tract
    • lung
    • heart
    • kidney
    • articular structures
97
Q

Scleroderma

In lungs?

A
  • In lung appears as progressive diffuse interstitial fibrosis
98
Q

Scleroderma

Tx:

A
  • No effective drug intervention
  • specific symptoms treated
  • supportive care
99
Q

Pregnancy

A

NOT A DISEASE CONDITION

  • Cannot descend diaphragm efficiently bc baby
  • progesterone INCs RR

see chart

100
Q

Obesity Hypoventilation Syndrome

explain Obesity

A
  • BW > 20% or more over ideal BW
101
Q

Obesity Hypoventilation Syndrome

Affect on Lungs:

A
  • Extra tissue req’s add. O2
  • Excess adipose tissue around chest wall DECs compliance of thorax
  • LESS diaphragmatic excursion
  • LESS chest wall expansion
    • ​shallow breaths
  • Extra adipose rests on lungs:
    • == inad. diaphragm use
      • ​== stresses access. resp. mm’s
102
Q

Pharmaceutical causes of RLD

A
  • more than 350 drugs pot. cause RLD
103
Q

Pharmaceutical causes RLD

Adversely Affect:

A
  • lung parenchyma directly
    • drug induced interstitial lung disease
  • ventilatory pump
  • ventilatory drive
    • suppressed
  • chest wall compliance
104
Q

Pharmaceutical causes RLD

Ex’s

A
  • O2
    • >21%==Drug
  • antibiotics
  • anti-inflamm’s
  • CV drugs
    • Amyoteran
  • Chemotherapeutic
  • poisons
  • anesthetics
  • mm relaxers
  • ilicit drugs
    • vapes/Vit E
    • nicotine/THC
  • radiation to chest

****Remember- Inflamm==scar tissue==RLD

105
Q

Comparing Obstructive (cant get air OUT) vs. Restrictive (cant get air IN)

A
  • Obstructive
    • cannot get air OUT
    • vol’s/ratios DIFFERENT
      • BIG/INC TLC
      • INC RV
  • Restrictive
    • cannot get air IN
    • vol’s REDUCED but ratios/vol’s compared to Normal are the SAME

CardioPulmoaryPT1 (12 decks)

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