Restrictive Lung diseases Flashcards
what is the chief problem of all restrictive lung diseases?
can’t get air in, but have normal exhale (but of course exhale is small too bc the amount of air u got in in the first place in order to exhale it is small)
how are restrictive lung diseases classified?
reduced lung volumes with normal expiratory flow rates
what is the usual ultimate pathological condition that most ppl with RLDs end up with?
diffuse fibrosis
Restrictive lung dysfunction. (RLD)
side effect of reduced compliance of lungs or of chest wall for a number of different reasons.
is RLD a disease process?
no, its a side effect
what are the values for RLD?
transpulmonary pressure is kept relatively constant due to lack of elasticity, this causes dec. of volume that can get in
inc. in RR to try to help but then that gives up and u are left with dec. RR, dec. FVC, dec. TLC, dec. VC, dec. ERV dec. IRV, dec. FRC (ERV+RV)
what is work of breathing in RLD? what is normal?
greater than or equal to 25%, norm is 5%
might these ppl need o2 during therapy?
yes, maybe up to 1-6L with exercise
what might be reasons for RLD?
pollutants causing injury to lung–>scarring and fibrosis
injury to chest wall: paralysis, torn mm, broken rib, obesity
classic signs of RLD?
Tachypenea (inc. RR) hypoxemia dec. breath sounds- with rales non productive dry, irritating cough (#1 symp. that brings ppl in to doctor) emaciated appearance
what do ppl with RLD usually die from?
cor pulmonale
why do ppl with RLD get cor pulmonale?
hypoxemia and fibrosis of capillaries leads to pulm. HTN and creates inc. pressure for the R ventricle to pump against until it gives out.
ppl with chronic bronchitis have a _______ cough, but ppl with RLD have a ___________ cough!
bronchitis= productive! RLD= non productive
PULMONARY FIBROSIS- types
sarcoidosis lupus IPF scleroderma rheumatic disease
sarcoidosis
granulomatous disease of unknown etiology
what is it that causes granulomas at the site injection if u have sarcoidosis?
kviem antigen
what does fibrosis alveolitis look like on an X ray?
honeycomb, scarring
S&S of sarcoidosis
dry, irritating cough, general weakness, fatigue, weight loss, malaise, fever
tx for sarcoidosis
corticosteroids and immunosuppressive drugs
Lupus
systemic autoimmune disease with varied clinical manifestations
who does lupus affect most often?
women ages 15-45
what lung sounds do ppl with lupus have?
dec. souds, friction rub, rales,
what do ppl with lupus present like?
butterfly rash, cyanotic, may have raynauds
rheumatoid disease
dec. chest wall compliance secondary to systemic and pulmonary rheumatoid disease.
who is affected by rheumatoid disease?
females more than males, 50-60 years old
Scleroderma
an autoimmune disease that affects the endothelial cells of blood vessels and connective tissues causing fibrosis in organs. non-reversible damage.
who is affected by scleroderma?
F >M x5
Idiopathic pulmonary fibrosis (IPF)
chronic lung disease that causes fibrosis of alveoli and capillary network, differentiated only by lack of any causative factor or environmental agent.
chief sign of IPF
slow, progressive dyspnea
Who gets IPF?
Middle aged men>women
life expectancy of someone diagnosed with IPF?
50% live 5 years, R sided heart failure, or lack of O2
values for IPF
dec. TLC, VC, FRC (ERV+RV), inc. venilation-perfusion mismatch
when in doubt, how do u treat all restrictive lung diseases?
immunosuppressors and corticosteroids
4 categories of restrictive environmental lung diseases
infectious agents
organic dusts
inorganic dusts
gases
pneumoconioses
inhalation of inorganic dust- COAL WORKERS
silicosis
inhaling silicas (crystalline silicone dioxide)- mining, grinding, polishing rock, ship building,
asbestos
inhaling silicates- sheet metal, ships, asbestos mines
what sound do u here both with asbestos and coal workers pneumonia?
rales
irritant gasses that are inhaled
ammonia sulfur dioxide chlorine nitrogen dioxide ozone phosgene
what happens when irritant gasses are inhaled?
epithelial injury, hyperemia, edema, mucosal sloughing, coughing, dyspnea, cyanosis-pulmonary fibrosis from significant exposure
restrictive lung diseases caused by spine and chest wall pathology
kyphosis scoliosis kyphoscoleosis (lateral and posterior curvature) lordosis pectus excavatum- scoop chest pectus carinatum- pigeon chest
S&S of restrictive diseases caused by spine and chest wall
dyspnea, frequent pneumonia, respiratory insufficiency, hypoxia, hypercapnia, risk of cardiac failure
restrictive lung diseases caused by the neuromuscular system
myasthenia gravis
guillan barre
ALS
quadriplegia
myasthenia gravis
autoimmune disease,
body destroys its own ACH receptors= not enough ACH= weak mm, including resp. mm
treat with anticholinesterase drugs and steriods
Guillan Barre syndrome
acute inflammatory polyneuritis, idiopathic
demyelination of peripheral nerves, ascending paralysis, need to get to a hospital before it paralyzes your diaphragm, after that scary time (1-3 weeks) (as long as u don’t get pneumonia) you should start to heal up in 2-4 weeks.
ALS
inflammatory or neoplastic disease of the spinal cord
quadriplegia- what level of injury affects the diaphragm?
C3,C4,C5
what level of injury affects the scalenes?
C5-6
what level affects the intercostals?
T1-T11
what level effects the abdominals
T8-T12
what is defined as an acute inflammatory process that affects the gas exchange units of the lungs?
pneumonia!
in pneumonia, what happens in response to inflammation?
fluid and RBCs pour into the alveoli, phagocytes also pour into the infected area to engulf and kill bacteria, then the alveoli undergo “consolidation” and become filled with fulid, looking milky.
what happens if the adjacent lining of the pleural cavity gets involved in pneumonia?
pleural effusion
S&S of pneumonia
malaise, chills, fever, cough, chest pain, dyspnea
