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Diseases: Davisson > Restrictive Diseases > Flashcards

Restrictive Diseases Flashcards

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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
How to diagnose pneumonitis?
History of exposure to irritant/ radiation Cough: typically dry and persistent Acute onset Possibly respiratory failure
26
What syndrome can pneumonitis lead too?
ARDS
27
How to treat pneumonitis?
Aims to reduce inflammation of lung tissue O2 therapy, bronchodilators, steroids, monitor signs for developing ARDS
28
What is ARDS?
The development of severe lung injury with poor oxygenation and fluid buildup.
29
What is ARDS also known as ?
Stiff lung or non-cardiogenic pulmonary edema
30
What is the most common cause of ARDS?
Sepsis: systemic infection in blood
31
How does ARDS present?
Severe shortness of breath, increased RR and WOB, high HR, low BP Lung sounds: rattling, bubbling, “wet” Productive cough
32
How to diagnose ARDS?
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
What does ARDS show on CXR?
Ground glass
34
How to treat ARDS?
O2 ventilation, meds, fluids, proning, ECMO
35
What is ILD?
The disruption of interstitial tissue of lungs
36
What is ILD also known as?
Pulmonary fibrosis (PF)
37
How does ILD progress ?
The elastic tissue is replaced with more fibrotic tissue. This lead to Interstitial Pulmonary Fibrosis (IPF), Idiopathic Pulmonary Fibrosis , and Sarcoidosis
38
What is Sarcoidosis?
Development of small lumps of inflammatory tissue (sarcoids/ granulomas) in skin, lungs and eyes
39
Can sarcoidosis be restrictive and obstructive? T/F?
True, although rare.
40
Who develops sarcoidosis?
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
How to diagnose ILD?
Older patients history, reduced lung volumes of PFT, dyspnea, dry non productive cough, dry crackles CXR shows classic HONEYCOMBING (means fibrosis developed) Hypoxemia
42
Can you reverse the damage from ILD?
No it is irreparable, progresses rapidly with most patients only living ~5 years after diagnosis WITHOUT treatment
43
How to treat ILD?
O2 therapy, bronchodilators, pulmonary rehab, meds, infection avoidance, and lung transplant
44
What is pulmonary edema?
Accumulation of excessive amounts of fluid in lungs
45
What are the 2 types of Pulmonary edema?
Interstitial and alveolar
46
What is interstitial pulmonary edema?
The excess fluid accumulation in the lung INTERSTINUM
47
What is alveolar pulmonary edema?
The excess of fluid accumulation in the AIR SPACES
48
What’s the two causes of pulmonary edema?
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
Who get cardiogenic pulm. Edema?
Seen with heart failure patients Patients with renal failure or fluid overload
50
Who gets noncardiogenic pulm. Edema?
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
How does pulmonary edema impact the lungs?
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
How is pulmonary edema for both types diagnosed?
Hypoxemia, dyspnea, tachycardia, tachypnea Wet inspiratory crackles, pink frothy secretions (cardiogenic) Diminished, possibly with crackles (noncardiogenic) CXR
53
How does Cardiogenic pulm. Edema look on a CXR?
Butterfly pattern, Kerley B lines, prominent vasculature markings, fluffy infiltrates
54
How is noncardiogenic pulm. Edema shown on an CXR?
Ground glass, reticulonodular, white out
55
How to treat Cardiogenic pulmonary edema?
O2, diuretics, inotropes, non invasive ventilation, control I/Os, hemodynamic monitoring
56
How to treat noncardiogenic pulmonary edema?
Goes through 3 phases: Exudative, proliferative, fibrotic No stopping once it had started, must run it’s course High mortality
57
Pleural effusion is?
Collection of abnormal amounts of fluid between visceral and pleural pleura of lungs
58
What are the types of a pleural effusion? What are the 3 most COMMON?
Transduative, exudative, hemothorax, chylothorax, empyema 3: Transudative, exudative, hemothorax
59
Who gets a pleural effusion?
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
How to diagnose Pleural effusion? What would a CXR show?
* Blunted Costophrenic angles on AP CXR Lateral decubitus CXR to confirm (fluid shifts) Dull percussion over affected area Hypoxemia, lung expansion ineffective
61
Treatment for a pleural effusion if needed?
Thoracentasis: needle aspiration of small amounts of fluid from pleasurable space Thoracostomy: (chest tube)
62
What is a pneumothorax?
Describes free air in the chest. Air is outside of the lung
63
What are the 3 types of a pneumothorax?
Simple pneumothorax, open pneumo, tension pneumo
64
What is a simple pneumothorax
Accumulation of air between visceral and parietal pleura
65
What is an open pneumothorax
Communication between atmosphere and pleural space, external injury
66
What is a tension pneumothorax
Increase size and pressure of thoracic air pocket “one way valve” injury. Immediately life-threatening
67
Who gets a pneumothorax?
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
If image shows development of a tension pneumothorax, what will vitals look like?
Reduced BP, Qt, and SpO2 dramatically
69
How is a pneumothorax diagnosed?
Acute onset, decreased breath sounds and hyperresonance on affected side **Hyperlucency on CXR Dyspnea, pluretic chest pain Asymmetrical chest wall movement Hypoxemia
70
How are pneumothorax treated?
Prehospital: needle decompression Hospital: chest tube insertion

Diseases: Davisson (5 decks)

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