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Diseases: Davisson > Restrictive Diseases > Flashcards

Restrictive Diseases Flashcards

1
Q

Restrictive diseases restrict ____ and cause trouble with _____.

A

lung volume, oxygenation

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2
Q

Are restrictive diseases more likely to cause deadspace issues or shunting issues?

A

Shunting issues

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3
Q

Any extra effort to expand the lungs to accomodate volume increases _____.

A

WOB

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4
Q

What is ATX?

A

Collapsed, empty/ deflated/ de-recruited alveoli

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5
Q

Loss of alveolar inflation is one the the primary causes of what ?

A

Intrapulmonary shunting

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6
Q

ATX can develop from alveolar hypoventilation? Why?

A

Not taking deep enough breaths

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7
Q

Patients most at risk for ATX?

A 
Post-op : abdominal and thoracic
Receiving sedative
Non-ambulatory
Prolonged mechanical ventilation
Patients with restrictive and neuromuscular disease or mucus retention.
Primary ATX
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8
Q

What is primary ATX?

A

Failure to expand lungs at birth

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9
Q

What are the types of ATX?

A

Contraction: conditions that may cause fibrosis and lung tissue collapse

Absorption: conditions that promote degassing to airway obstruction (CF, MG, GB, bronchiectasis.

Compression: conditions that compress the lungs tissue. ( Flail chest, pneumo, pleural disease)

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10
Q

How to diagnose ATX?

A

Can occur by itself, or secondary to other underlying disease.

Unexplained hypoxemia, hypoinflation on CXR, late inspiratory crackles (especially on bases)

Dull percussion note over collapsed tissue, short shallow breaths, increased WOB.

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11
Q

How to treat ATX?

A

It is something that is very problematic once it is established.

Prevention is key: lung expansion therapy, ambulation, pain control, identification of at risk patients and aggressive preventative measures.

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12
Q

What is pneumonia?

A

The result of an infection causing inflammation that leads to capillary leakage into alveoli

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13
Q

What is the fluid from pneumonia that leaks into alveoli?

A

A mix of RBC, leukocytes, and macrophages

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14
Q

Who is at risk for pneumonia ?

A

People with weakened immune systems, artificial airways, impaired secretion clearance, exposures and aspirations.

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15
Q

What CAUSES pneumonia?

A

Viruses, bacteria, fungi, parasites, TB, anaerobic organisms , aspiration or inhalation of irritants.

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16
Q

Risk factors of PNA?

A

Older age, cancer, chronic disease, prolonged bed rest, tracheostomy or ETT, rib fractures, etc.

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17
Q

What are the two acquired PNA?

A

Community and Healthcare

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18
Q

What’s the the 3 types of healthcare acquired PNA?

A

Healthcare associated (HAP), ventilator associated (VAP), and aspiration.

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19
Q

How does PNA affect the lung?

A

Causes irritation and inflammation, eventually causing complete filling, flooding and collapse of alveoli (consolidation)

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20
Q

How is PNA diagnosed?

A

Patients typically present with febrile, tachycardia, dyspneic, and with increased RR

Cough, crackles heard over decreased lung area

CXR useful, but there is a “lag time”

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21
Q

PNA treatment?

A

O2 therapy, bronchodilators, mucolytics, CPT, lung expansion therapy, mechanical vent if necessary.

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22
Q

What is Pneumonitis?

A

The swelling of the air spaces, usually secondary to irritating agent.

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23
Q

Pneumonitis is common after inhalation of what?

A

Gases, chemicals, fumes

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24
Q

Who contracts pneumonitis?

A

Industrial workers, pool cleaners, peoples involved in spills/accidents.

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25
Q

How to diagnose pneumonitis?

A

History of exposure to irritant/ radiation

Cough: typically dry and persistent

Acute onset

Possibly respiratory failure

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26
Q

What syndrome can pneumonitis lead too?

A

ARDS

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27
Q

How to treat pneumonitis?

A

Aims to reduce inflammation of lung tissue

O2 therapy, bronchodilators, steroids, monitor signs for developing ARDS

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28
Q

What is ARDS?

A

The development of severe lung injury with poor oxygenation and fluid buildup.

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29
Q

What is ARDS also known as ?

A

Stiff lung or non-cardiogenic pulmonary edema

30
Q

What is the most common cause of ARDS?

A

Sepsis: systemic infection in blood

31
Q

How does ARDS present?

A

Severe shortness of breath, increased RR and WOB, high HR, low BP

Lung sounds: rattling, bubbling, “wet”

Productive cough

32
Q

How to diagnose ARDS?

A

Signs and sympts, medical history 1 week from event, imaging, ruling out heart failure origin

PaO2/ FiO2 ratio on vent:
200-300 = mild
100-200 = moderate
<100 = severe

33
Q

What does ARDS show on CXR?

A

Ground glass

34
Q

How to treat ARDS?

A

O2 ventilation, meds, fluids, proning, ECMO

35
Q

What is ILD?

A

The disruption of interstitial tissue of lungs

36
Q

What is ILD also known as?

A

Pulmonary fibrosis (PF)

37
Q

How does ILD progress ?

A

The elastic tissue is replaced with more fibrotic tissue. This lead to Interstitial Pulmonary Fibrosis (IPF), Idiopathic Pulmonary Fibrosis , and Sarcoidosis

38
Q

What is Sarcoidosis?

A

Development of small lumps of inflammatory tissue (sarcoids/ granulomas) in skin, lungs and eyes

39
Q

Can sarcoidosis be restrictive and obstructive? T/F?

A

True, although rare.

40
Q

Who develops sarcoidosis?

A

Industrial workers exposed to dusts: metal, glass, talc, wood, concrete, coal.

Industrial workers exposed to asbestos: miners, mechanics, naval construction

Secondary to meds/ procedures: Aminodarone, Bleomycin, certain immunosuppressants, radiation

41
Q

How to diagnose ILD?

A

Older patients history, reduced lung volumes of PFT, dyspnea, dry non productive cough, dry crackles

CXR shows classic HONEYCOMBING (means fibrosis developed)

Hypoxemia

42
Q

Can you reverse the damage from ILD?

A

No it is irreparable, progresses rapidly with most patients only living ~5 years after diagnosis WITHOUT treatment

43
Q

How to treat ILD?

A

O2 therapy, bronchodilators, pulmonary rehab, meds, infection avoidance, and lung transplant

44
Q

What is pulmonary edema?

A

Accumulation of excessive amounts of fluid in lungs

45
Q

What are the 2 types of Pulmonary edema?

A

Interstitial and alveolar

46
Q

What is interstitial pulmonary edema?

A

The excess fluid accumulation in the lung INTERSTINUM

47
Q

What is alveolar pulmonary edema?

A

The excess of fluid accumulation in the AIR SPACES

48
Q

What’s the two causes of pulmonary edema?

A

Cardiogenic: caused by insufficient function of the left heart.

Noncardiogenic: caused by increased permeability of pulmonary capillaries from either direct or indirect injury to the lungs. Aka ARDS

49
Q

Who get cardiogenic pulm. Edema?

A

Seen with heart failure patients

Patients with renal failure or fluid overload

50
Q

Who gets noncardiogenic pulm. Edema?

A

Usually secondary to massive injury or infection.

Caused by overwhelming immune response and release cytokines and proteases

Injury does not have to direct involve lungs

ARDS

51
Q

How does pulmonary edema impact the lungs?

A

Fluid entering the alveolar space dilutes surfactant

  • increased surface tension
  • decreased compliance

Results in “wet lung” which are difficult to inflate, and do not exchange gas efficiently

52
Q

How is pulmonary edema for both types diagnosed?

A

Hypoxemia, dyspnea, tachycardia, tachypnea

Wet inspiratory crackles, pink frothy secretions (cardiogenic)

Diminished, possibly with crackles (noncardiogenic)

CXR

53
Q

How does Cardiogenic pulm. Edema look on a CXR?

A

Butterfly pattern, Kerley B lines, prominent vasculature markings, fluffy infiltrates

54
Q

How is noncardiogenic pulm. Edema shown on an CXR?

A

Ground glass, reticulonodular, white out

55
Q

How to treat Cardiogenic pulmonary edema?

A

O2, diuretics, inotropes, non invasive ventilation, control I/Os, hemodynamic monitoring

56
Q

How to treat noncardiogenic pulmonary edema?

A

Goes through 3 phases:
Exudative, proliferative, fibrotic

No stopping once it had started, must run it’s course

High mortality

57
Q

Pleural effusion is?

A

Collection of abnormal amounts of fluid between visceral and pleural pleura of lungs

58
Q

What are the types of a pleural effusion?

What are the 3 most COMMON?

A

Transduative, exudative, hemothorax, chylothorax, empyema

3: Transudative, exudative, hemothorax

59
Q

Who gets a pleural effusion?

A

Commonly seen in hospitalized patients and usually required no intervention as they commonly resolve with underlying disease.

Patients @ risk:
Pneumonia, heart failure, chest trauma, thoracic cancers, etc

60
Q

How to diagnose Pleural effusion?

What would a CXR show?

A
  • Blunted Costophrenic angles on AP CXR

Lateral decubitus CXR to confirm (fluid shifts)

Dull percussion over affected area

Hypoxemia, lung expansion ineffective

61
Q

Treatment for a pleural effusion if needed?

A

Thoracentasis: needle aspiration of small amounts of fluid from pleasurable space

Thoracostomy: (chest tube)

62
Q

What is a pneumothorax?

A

Describes free air in the chest. Air is outside of the lung

63
Q

What are the 3 types of a pneumothorax?

A

Simple pneumothorax, open pneumo, tension pneumo

64
Q

What is a simple pneumothorax

A

Accumulation of air between visceral and parietal pleura

65
Q

What is an open pneumothorax

A

Communication between atmosphere and pleural space, external injury

66
Q

What is a tension pneumothorax

A

Increase size and pressure of thoracic air pocket “one way valve” injury. Immediately life-threatening

67
Q

Who gets a pneumothorax?

A

Pneumothoraces: can be spontaneous or result of an injury or disease

Spontaneous: most common in tall thin males, can occur during flight bc of pressure change

Injury/traumatic: penetrating chest wall injury, rib fractures, etc

Disease Related: bullous, emphysema, severe air trapping

68
Q

If image shows development of a tension pneumothorax, what will vitals look like?

A

Reduced BP, Qt, and SpO2 dramatically

69
Q

How is a pneumothorax diagnosed?

A

Acute onset, decreased breath sounds and hyperresonance on affected side

**Hyperlucency on CXR

Dyspnea, pluretic chest pain

Asymmetrical chest wall movement

Hypoxemia

70
Q

How are pneumothorax treated?

A

Prehospital: needle decompression

Hospital: chest tube insertion

Diseases: Davisson (5 decks)

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